A Shift in Approach to Addressing Public Health Inequities and the Effect of Societal Structural and Systemic Drivers on Social Determinants of Health.

IF 3 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Public Health Reports Pub Date : 2024-10-11 DOI:10.1177/00333549241283586

Carla I Mercado, Kai McKeever Bullard, Michele L F Bolduc, Courtni Alexis Andrews, Zoe R F Freggens, Grace Liggett, Desmond Banks, Shanice Battle Johnson, Ana Penman-Aguilar, Rashid Njai

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Abstract

Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age that influence health outcomes, and structural and systemic drivers of health (SSD) are the social, cultural, political, and economic contexts that create and shape SDOH. With the integration of constructs from previous examples, we propose an SSD model that broadens the contextual effect of these driving forces or factors rooted in the Centers for Disease Control and Prevention's SDOH framework. Our SSD model (1) presents systems and structures as multidimensional, (2) considers 10 dimensions as discrete and intersectional, and (3) acknowledges health-related effects over time at different life stages and across generations. We also present an application of this SSD model to the housing domain and describe how SSD affect SDOH through multiple mechanisms that may lead to unequal resources, opportunities, and consequences contributing to a disproportionate burden of disease, illness, and death in the US population. Our enhanced SDOH framework offers an innovative and promising model for multidimensional, collaborative public health approaches toward achieving health equity and eliminating health disparities.

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转变应对公共卫生不平等问题的方法，以及社会结构和系统驱动因素对健康的社会决定因素的影响。

健康的社会决定因素（SDOH）是指人们出生、成长、生活、工作和衰老时所处的影响健康结果的环境，而健康的结构性和系统性驱动因素（SSD）是指创造和形成 SDOH 的社会、文化、政治和经济环境。通过整合前述实例中的建构，我们提出了一个 SSD 模型，该模型以美国疾病控制和预防中心的 SDOH 框架为基础，扩大了这些驱动力或因素的环境效应。我们的 SSD 模型(1) 将系统和结构视为多维的，(2) 将 10 个维度视为离散和交叉的，(3) 承认在不同的生命阶段和不同的世代，健康相关的影响随着时间的推移而变化。我们还介绍了这一 SSD 模型在住房领域的应用，并描述了 SSD 如何通过多种机制影响 SDOH，从而可能导致资源、机会和后果的不平等，造成美国人口不成比例的疾病、患病和死亡负担。我们的增强型 SDOH 框架为多维度、协作性的公共卫生方法提供了一个创新且前景广阔的模型，以实现健康公平并消除健康差异。

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来源期刊

Public Health Reports 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.00

自引率

6.10%

发文量

164

审稿时长

6-12 weeks

期刊介绍： Public Health Reports is the official journal of the Office of the U.S. Surgeon General and the U.S. Public Health Service and has been published since 1878. It is published bimonthly, plus supplement issues, through an official agreement with the Association of Schools and Programs of Public Health. The journal is peer-reviewed and publishes original research and commentaries in the areas of public health practice and methodology, original research, public health law, and public health schools and teaching. Issues contain regular commentaries by the U.S. Surgeon General and executives of the U.S. Department of Health and Human Services and the Office of the Assistant Secretary of Health. The journal focuses upon such topics as tobacco control, teenage violence, occupational disease and injury, immunization, drug policy, lead screening, health disparities, and many other key and emerging public health issues. In addition to the six regular issues, PHR produces supplemental issues approximately 2-5 times per year which focus on specific topics that are of particular interest to our readership. The journal''s contributors are on the front line of public health and they present their work in a readable and accessible format.