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Place-Based Diminished Returns of Economic Resources in Rural America: A Framework for Understanding Geography-Conditioned Inequality. 美国农村经济资源基于地点的收益递减:一个理解地理条件不平等的框架。
Pub Date : 2025-01-01 Epub Date: 2025-10-01 DOI: 10.31586/jsmhes.2025.6067
Shervin Assari, John Ashley Pallera, Babak Najand, Mojgan Azadi, Hossein Zare

Background: Socioeconomic status (SES) is widely associated with improved health, behavioral, and educational outcomes. However, emerging research suggests that these benefits are not uniformly experienced across populations or contexts. The theory of Marginalization-related Diminished Returns (MDRs) has primarily focused on racial and ethnic disparities, showing that individuals from racially marginalized groups often experience weaker protective effects of SES. There is a lack of evidence on geography-particularly rural residence-as a moderator of SES effects.

Objective: This review explores how place, especially rural contexts in the U.S., shapes the extent to which SES translates into improved outcomes. We extend the MDRs framework to include place-based and geography-based marginalization, arguing that even among non-Hispanic White populations, rural residence can lead to diminished returns on education, income, and other forms of capital.

Content: Drawing on theoretical models such as Fundamental Cause Theory and Bronfenbrenner's Ecological Systems Theory, and synthesizing empirical findings from studies of academic achievement, substance use, and educational aspirations, this review highlights how structural disadvantages in rural areas weaken the effectiveness of individual and family-level resources.

Conclusion: Rural health and educational disparities are not solely due to a lack of resources but may also reflect systemic conditions that erode the value of existing resources. Policy interventions must be place-aware and address the contextual constraints that limit opportunity. Future research should more explicitly test how geography moderates the effects of SES across a range of outcomes and populations.

背景:社会经济地位(SES)与改善的健康、行为和教育结果广泛相关。然而,新兴的研究表明,这些好处并不是在不同的人群或环境中都能得到的。边缘化相关收益递减理论(mdr)主要关注种族和民族差异,表明来自种族边缘化群体的个体往往经历较弱的社会经济地位的保护作用。缺乏证据表明地理位置——尤其是农村居住——是社会经济地位效应的调节因素。目的:本综述探讨了地方,特别是美国的农村环境,如何影响社会经济地位转化为改善结果的程度。我们将mdr框架扩展到包括基于地点和地理的边缘化,认为即使在非西班牙裔白人人口中,农村居住也会导致教育、收入和其他形式的资本回报减少。内容:本文借鉴了基本原因理论和布朗芬布伦纳生态系统理论等理论模型,并综合了学术成就、物质使用和教育愿望研究的实证结果,强调了农村地区的结构性劣势如何削弱了个人和家庭层面资源的有效性。结论:农村卫生和教育差距不仅是由于缺乏资源,而且可能反映了侵蚀现有资源价值的系统性条件。政策干预必须有地方意识,并解决限制机会的背景制约因素。未来的研究应该更明确地测试地理如何在一系列结果和人群中调节社会经济地位的影响。
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引用次数: 0
Education Does Not Equally Increase Financial Well-being for All. 教育并不能平等地提高所有人的经济福利。
Pub Date : 2024-01-01 Epub Date: 2024-11-15 DOI: 10.31586/jsmhes.2024.1113
Shervin Assari, Hossein Zare, Amanda Sonnega

Background: Financial well-being is a key domain of overall well-being, encompassing an individual's ability to meet financial obligations, secure their financial future, and maintain a sense of financial freedom. Education is often viewed as a critical pathway to enhancing financial well-being. However, the returns of education on financial well-being are not uniform across racial, ethnic, and nativity groups. The theory of Minorities' Diminished Returns (MDRs) suggests that the positive effects of education on outcomes such as income and financial security are weaker for marginalized groups, including Black individuals, Latinos, and immigrants.

Objective: This study examines the diminished returns of education on financial well-being among Black, Latino, and immigrant populations in the United States. We aim to investigate how structural inequalities contribute to weaker financial returns on education for these groups compared to their White and native-born counterparts.

Methods: We utilized data from the Understanding America Study (UAS 2014) to conduct a cross-sectional analysis of adult respondents. The study assessed financial well-being outcomes (e.g., income, savings, and financial security) and their association with educational attainment across racial, ethnic, and nativity groups. Regression models were employed to test for interaction effects between education and race/ethnicity/nativity, adjusting for sociodemographic factors such as age, gender, employment, and family structure.

Results: Our analysis included 8,121 individuals. The mean age of the respondents was 48 years (SD = 16). High education was associated with higher financial well-being (B = 1.284, 95% CI: 1.157, 1.410). The interaction terms between education and immigrant status (B = -0.507, 95% CI: -0.930, -0.084), race (Black) (B = -0.770, 95% CI: -1.208, -0.331), and ethnicity (Hispanic) (B = -0.589, 95% CI: -0.969, -0.210) were all significant, suggesting that immigrant, Black, and Hispanic individuals experience diminished returns on education in terms of financial well-being, relative to US-born non-Hispanic White individuals. The significant negative interactions between education and minority statuses (Black, Hispanic, and immigrant) indicate that while education generally improves financial well-being, the magnitude of this improvement is substantially smaller for these marginalized groups.

Conclusion: Understanding how education translates to financial well-being across different racial, ethnic, and nativity groups is critical for addressing persistent financial disparities.

背景:财务健康是整体健康的一个关键领域,包括个人履行财务义务的能力,确保他们的财务未来,并保持财务自由的感觉。教育通常被视为提高财务状况的重要途径。然而,教育对经济福利的回报在种族、民族和出生群体中并不统一。少数群体收益递减理论(mdr)表明,教育对收入和金融安全等结果的积极影响对边缘化群体(包括黑人、拉美裔和移民)较弱。目的:本研究考察了美国黑人、拉丁裔和移民人口中教育对经济福祉的递减回报。我们的目标是调查与白人和本土出生的同龄人相比,结构性不平等是如何导致这些群体的教育财务回报较低的。方法:我们利用了解美国研究(UAS 2014)的数据对成年受访者进行横断面分析。该研究评估了不同种族、民族和出生群体的财务状况(如收入、储蓄和财务安全)及其与受教育程度的关系。采用回归模型检验教育与种族/民族/出生之间的相互作用效应,并对年龄、性别、就业和家庭结构等社会人口因素进行调整。结果:我们的分析包括8121个人。受访者的平均年龄为48岁(SD = 16)。高等教育与较高的财务状况相关(B = 1.284, 95% CI: 1.157, 1.410)。教育与移民身份(B = -0.507, 95% CI: -0.930, -0.084)、种族(黑人)(B = -0.770, 95% CI: -1.208, -0.331)和种族(西班牙裔)(B = -0.589, 95% CI: -0.969, -0.210)之间的相互作用项均显著,表明移民、黑人和西班牙裔个体在财务福利方面的教育回报相对于美国出生的非西班牙裔白人个体减少。教育与少数族裔地位(黑人、西班牙裔和移民)之间显著的负相互作用表明,虽然教育总体上改善了经济状况,但对这些边缘化群体来说,这种改善的幅度要小得多。结论:了解教育如何转化为不同种族、民族和出生群体的财务状况,对于解决持续存在的财务差异至关重要。
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引用次数: 0
Walking the Divide: A Public Health Journey from Manhattan to Harlem. 漫步鸿沟:从曼哈顿到哈莱姆的公共卫生之旅》。
Pub Date : 2024-01-01 Epub Date: 2024-08-11 DOI: 10.31586/jsmhes.2024.1018
Shervin Assari, Hossein Zare

This paper examines the striking contrasts and inequalities observation by walking from Manhattan to Harlem in New York City, highlighting the significant social and economic differences that have profound implications for public health and social policy. Through this journey, we explore various aspects including racial segregation, the composition of shops, smoking habits, street cleanliness, police presence, unemployment, real estate disparities, and the pervasive sense of insecurity. The transition from a predominantly White Manhattan to a predominantly Black and Hispanic Harlem underscores the historical and systemic inequalities that continue to shape the city's demographic and economic landscape. These disparities, rooted in discriminatory housing policies, economic disparities, and social exclusion, manifest in poorer health outcomes, higher rates of substance use, and limited economic opportunities for minority populations. By addressing these structural issues through targeted policies and sustained interventions, policymakers may work towards reducing health disparities and promoting racial equity. This paper also highlights the concept of Minorities' Diminished Returns (MDRs), where the benefits of education and income are less pronounced for minority individuals compared to their White counterparts, further perpetuating cycles of disadvantage. Comprehensive efforts to dismantle systemic inequities are essential for fostering a more equitable and healthy society.

本文探讨了从纽约市曼哈顿区步行到哈莱姆区所观察到的鲜明对比和不平等现象,突出强调了对公共卫生和社会政策具有深远影响的重大社会和经济差异。通过这次旅行,我们探讨了包括种族隔离、商店构成、吸烟习惯、街道清洁度、警力、失业率、房地产差距以及普遍存在的不安全感在内的各个方面。从白人占主导地位的曼哈顿到黑人和西班牙裔占主导地位的哈莱姆区,凸显了历史性和系统性的不平等,这些不平等继续影响着这座城市的人口和经济格局。这些不平等现象植根于歧视性住房政策、经济差距和社会排斥,表现为健康状况较差、药物使用率较高以及少数群体的经济机会有限。通过有针对性的政策和持续的干预措施来解决这些结构性问题,政策制定者可以努力缩小健康差距,促进种族公平。本文还强调了 "少数群体收益递减"(MDRs)的概念,即与白人相比,少数群体个人的教育和收入收益并不明显,这进一步延续了弱势循环。全面努力消除系统性的不平等对于建设一个更加公平和健康的社会至关重要。
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引用次数: 0
Extreme Heat Exposure Is Associated with Higher Socioeconomic Disadvantage and Elevated Youth Delinquency. 极端高温与较高的社会经济劣势和青少年犯罪率升高有关。
Pub Date : 2024-01-01 Epub Date: 2024-08-18 DOI: 10.31586/jsmhes.2024.1044
Shervin Assari, Hossein Zare

Background: Climate change has led to an increase in the frequency and intensity of extreme heat events, a trend expected to continue. This poses significant health risks, particularly for vulnerable populations like children. While previous research has largely concentrated on the physical health impacts of extreme heat, less attention has been given to behavioral outcomes, such as delinquency.

Objectives: This study investigates the association between extreme heat exposure and delinquency among children, utilizing data from the Adolescent Brain Cognitive Development (ABCD) study. It also explores the potential mediating roles of neighborhood socioeconomic status (SES; measured by median home value), puberty, peer deviance, and financial difficulties.

Methods: Data from the national ABCD study were analyzed to assess the relationship between extreme heat exposure (exposure) and delinquency (outcome). Covariates included race/ethnicity, sex, and age. Mediators examined were neighborhood SES, puberty, peer deviance, and financial difficulties. Structural equation modeling (SEM) was employed for data analysis.

Results: Overall, 11,878 children entered our analysis. The analysis revealed a significant association between extreme heat exposure and higher levels of delinquency among children. Children more exposed to extreme heat were more likely to be Black, reside in lower SES neighborhoods, experience greater financial difficulties, and have more advanced puberty status. The group facing the highest heat exposure was also economically disadvantaged.

Conclusions: The findings suggest that children already disadvantaged by socio-economic factors are disproportionately affected by extreme heat, leading to increased delinquency. This highlights the need for targeted interventions to protect these vulnerable populations and address the mediators of extreme heat exposure. Future research should focus on longitudinal studies and evaluate the effectiveness of various mitigation strategies to address these disparities.

背景:气候变化导致极端高温事件的频率和强度增加,预计这一趋势将持续下去。这给人们的健康带来了巨大风险,尤其是对儿童等弱势群体而言。以往的研究主要集中于极端高温对身体健康的影响,而对行为结果(如犯罪)的关注较少:本研究利用青少年大脑认知发展(ABCD)研究的数据,调查极端高温暴露与儿童犯罪之间的关联。研究还探讨了邻里社会经济地位(SES,以房屋价值中位数衡量)、青春期、同伴偏差和经济困难的潜在中介作用:分析了全国性 ABCD 研究的数据,以评估极热暴露(暴露)与犯罪(结果)之间的关系。协变量包括种族/民族、性别和年龄。研究的中介因素包括邻里社会经济地位、青春期、同伴偏差和经济困难。数据分析采用了结构方程模型(SEM):共有 11,878 名儿童参与了分析。分析结果表明,酷热与儿童犯罪率较高之间存在明显联系。更容易受到酷热影响的儿童更有可能是黑人、居住在社会经济地位较低的社区、经济困难更大、青春期更晚。面临最高高温的群体在经济上也处于不利地位:研究结果表明,由于社会经济因素而处于不利地位的儿童受到极端高温的影响尤为严重,从而导致犯罪率上升。这突出表明,有必要采取有针对性的干预措施来保护这些弱势人群,并解决极端高温暴露的媒介问题。未来的研究应侧重于纵向研究,并评估各种缓解策略对解决这些差异的有效性。
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引用次数: 0
Higher Neighborhood Crime Rates Don't Always Predict Early Initiation of Tobacco, Marijuana, and Alcohol. 较高的邻里犯罪率并不总能预测早期吸烟、吸食大麻和酗酒的情况。
Pub Date : 2024-01-01 Epub Date: 2024-08-24 DOI: 10.31586/jsmhes.2024.1049
Shervin Assari, Payam Sheikhattari

Background: The initiation of substance use during adolescence is a significant public health concern with long-term implications. Structural and environmental factors, such as community-level crime statistics related to drug offenses, are often assumed to influence the likelihood of substance use among youth. However, the relationship between these environmental crime indicators and early substance use initiation in adolescents is not well understood.

Objective: This study aims to examine the association between environmental drug-related crime statistics-derived from Uniform Crime Reports, including drug abuse violations, drug sales, marijuana sales, drug possession, and driving under the influence (DUI)-and the use of tobacco, marijuana, and alcohol among adolescents aged 9-16 in the United States.

Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study, which follows a cohort of adolescents from ages 9-10 to 16, were analyzed. 11,878 participants entered our analysis. The primary environmental measures included total drug abuse violations, drug sale offenses, marijuana sale offenses, drug possession offenses, and DUI reports. Substance use outcomes of interest were the frequency and prevalence of tobacco, marijuana, and alcohol use across the observed age range.

Results: Contrary to expectations, higher levels of drug-related crime in a community were not associated with increased use of tobacco, marijuana, or alcohol among adolescents. In fact, the study found a significant inverse relationship between the total number of drug-related crimes and tobacco use, suggesting lower tobacco use in areas with higher reported drug abuse violations, drug sales, marijuana sales, drug possession, and DUI incidents. No significant associations were observed between these crime indicators and the use of marijuana or alcohol.

Conclusions: These findings challenge the prevailing assumption that higher environmental drug-related crime statistics necessarily predict greater substance use among adolescents. The observed inverse relationship between drug-related crime and tobacco use warrants further investigation to understand the underlying mechanisms and to inform targeted intervention strategies. Future research should explore the complex interplay between structural environmental factors and youth substance use to better inform public health policies.

背景:青少年时期开始使用药物是一个具有长期影响的重大公共卫生问题。结构和环境因素(如与毒品犯罪有关的社区犯罪统计数据)通常被认为会影响青少年使用药物的可能性。然而,人们对这些环境犯罪指标与青少年过早开始使用药物之间的关系还不甚了解:本研究旨在调查美国 9-16 岁青少年中与毒品相关的环境犯罪统计数据(包括药物滥用违法行为、毒品销售、大麻销售、持有毒品和酒驾等)与烟草、大麻和酒精使用之间的关系:我们对青少年大脑认知发展(ABCD)研究的数据进行了分析,该研究对 9-10 岁至 16 岁的青少年进行了跟踪调查。共有 11,878 名参与者参与了分析。主要的环境测量指标包括药物滥用违规行为总数、药物销售违规行为、大麻销售违规行为、持有毒品违规行为和酒驾报告。我们感兴趣的物质使用结果是在观察到的年龄范围内烟草、大麻和酒精使用的频率和流行率:结果:与预期相反,社区中与毒品有关的犯罪率越高,青少年使用烟草、大麻或酒精的比例就越高。事实上,研究发现与毒品有关的犯罪总数与烟草使用量之间存在显著的反比关系,这表明在举报违反药物滥用规定、销售毒品、销售大麻、持有毒品和酒驾事件较多的地区,烟草使用量较低。在这些犯罪指标与大麻或酒精的使用之间没有观察到明显的关联:这些研究结果对普遍认为环境中与毒品有关的犯罪统计数据越高,青少年使用毒品的比例就越高这一假设提出了质疑。观察到的毒品相关犯罪与烟草使用之间的反向关系值得进一步研究,以了解其背后的机制,并为有针对性的干预策略提供依据。未来的研究应探索结构性环境因素与青少年药物使用之间复杂的相互作用,以便更好地为公共卫生政策提供信息。
{"title":"Higher Neighborhood Crime Rates Don't Always Predict Early Initiation of Tobacco, Marijuana, and Alcohol.","authors":"Shervin Assari, Payam Sheikhattari","doi":"10.31586/jsmhes.2024.1049","DOIUrl":"10.31586/jsmhes.2024.1049","url":null,"abstract":"<p><strong>Background: </strong>The initiation of substance use during adolescence is a significant public health concern with long-term implications. Structural and environmental factors, such as community-level crime statistics related to drug offenses, are often assumed to influence the likelihood of substance use among youth. However, the relationship between these environmental crime indicators and early substance use initiation in adolescents is not well understood.</p><p><strong>Objective: </strong>This study aims to examine the association between environmental drug-related crime statistics-derived from Uniform Crime Reports, including drug abuse violations, drug sales, marijuana sales, drug possession, and driving under the influence (DUI)-and the use of tobacco, marijuana, and alcohol among adolescents aged 9-16 in the United States.</p><p><strong>Methods: </strong>Data from the Adolescent Brain Cognitive Development (ABCD) study, which follows a cohort of adolescents from ages 9-10 to 16, were analyzed. 11,878 participants entered our analysis. The primary environmental measures included total drug abuse violations, drug sale offenses, marijuana sale offenses, drug possession offenses, and DUI reports. Substance use outcomes of interest were the frequency and prevalence of tobacco, marijuana, and alcohol use across the observed age range.</p><p><strong>Results: </strong>Contrary to expectations, higher levels of drug-related crime in a community were not associated with increased use of tobacco, marijuana, or alcohol among adolescents. In fact, the study found a significant inverse relationship between the total number of drug-related crimes and tobacco use, suggesting lower tobacco use in areas with higher reported drug abuse violations, drug sales, marijuana sales, drug possession, and DUI incidents. No significant associations were observed between these crime indicators and the use of marijuana or alcohol.</p><p><strong>Conclusions: </strong>These findings challenge the prevailing assumption that higher environmental drug-related crime statistics necessarily predict greater substance use among adolescents. The observed inverse relationship between drug-related crime and tobacco use warrants further investigation to understand the underlying mechanisms and to inform targeted intervention strategies. Future research should explore the complex interplay between structural environmental factors and youth substance use to better inform public health policies.</p>","PeriodicalId":520011,"journal":{"name":"Journal of social mathematical & human engineering sciences","volume":"3 1","pages":"29-37"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quantitative Intersectionality Scoring System (QISS): Opportunities for Enhancing Predictive Modeling, Comparative Analysis, Health Needs Assessment, and Policy Evaluation. 定量交叉性评分系统(QISS):加强预测建模、比较分析、健康需求评估和政策评估的机会。
Pub Date : 2024-01-01 Epub Date: 2024-10-19 DOI: 10.31586/jsmhes.2024.1066
Shervin Assari, Hossein Zare

Intersectionality has significantly enhanced our understanding of how overlapping social identities-such as race, ethnicity, gender, sex, class, and sexual orientation-interact to shape individual experiences. However, despite its theoretical importance, much of the existing literature has relied on qualitative approaches to define and study intersectionality, limiting its application in predictive modeling, comparative analysis, and policy development. This paper introduces the concept of Quantitative Intersectionality Scoring System (QISS), a novel approach that assigns numerical scores to intersecting identities, thereby enabling a more systematic and data-driven analysis of intersectional effects. We argue that QISS can substantially enhance the utility and predictive validity of quantitative models by capturing the complexities of multiple, overlapping social determinants. By presenting concrete examples, such as the varying impacts of socioeconomic mobility on life expectancy among different intersectional groups, we demonstrate how QISS can yield more precise and reliable forecasts. Such a shift would allow policymakers and service providers to dynamically assess economic and health needs, as well as the uncertainties around them, as individuals move through different social and economic contexts. QISS-based models could be more responsive to the complexities of intersecting identities, allowing for a more quantified and nuanced evaluation of policy interventions. We conclude by discussing the challenges of implementing QISS and emphasizing the need for further research to validate these quantifications using robust quantitative methods. Ultimately, adopting QISS has the potential to improve the accuracy of predictive models and the effectiveness of policies aimed at promoting social justice and health equity.

交叉性极大地增强了我们对重叠的社会身份--如种族、民族、性别、性、阶级和性取向--如何相互作用形成个人经历的理解。然而,尽管交叉性具有重要的理论意义,但现有文献大多依赖定性方法来定义和研究交叉性,从而限制了其在预测建模、比较分析和政策制定中的应用。本文介绍了 "交叉性定量评分系统"(QISS)的概念,这是一种新颖的方法,可为交叉身份分配数字分数,从而对交叉效应进行更系统、更数据化的分析。我们认为,QISS 能够捕捉多重、重叠的社会决定因素的复杂性,从而大大提高定量模型的实用性和预测有效性。通过列举具体实例,如社会经济流动性对不同交叉群体预期寿命的不同影响,我们展示了 QISS 如何产生更精确、更可靠的预测。这种转变将使政策制定者和服务提供者能够随着个人在不同社会和经济环境中的流动,动态评估经济和健康需求,以及围绕这些需求的不确定性。基于 QISS 的模型可以更好地应对身份交叉的复杂性,从而对政策干预措施进行更加量化和细致的评估。最后,我们讨论了实施 QISS 所面临的挑战,并强调需要进一步开展研究,使用可靠的定量方法验证这些量化结果。最终,采用 QISS 有可能提高预测模型的准确性以及旨在促进社会正义和健康公平的政策的有效性。
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引用次数: 0
Paradoxical Effects of Income and Income Inequality on Racial Health Disparities. 收入和收入不平等对种族健康差异的矛盾影响。
Pub Date : 2024-01-01 Epub Date: 2024-07-27 DOI: 10.31586/jsmhes.2024.998
Shervin Assari, Hossein Zare

The intersection of race and place in shaping health disparities presents complex dynamics, as evidenced by studies in cities like Detroit, Baltimore, and Philadelphia, where predominantly Black and economically disadvantaged populations experience high overall rates of health problems. Surprisingly, these cities do not exhibit the most pronounced racial disparities. In contrast, areas with a higher percentage of White residents, indicative of greater income inequality, show stark differences in health outcomes between Black and White populations. This disparity underscores how conditions diverge more sharply between Black and White individuals in wealthier urban areas. This phenomenon suggests a complex and sometimes counterintuitive relationship among race, place, income, and income inequality in shaping racial health disparities. These dynamics have significant policy implications. Addressing health disparities requires nuanced strategies that recognize the multiplicative effects of race and income inequality on health outcomes. Policies focusing on areas with a high disease burden, such as Detroit, Philadelphia, and Baltimore can effectively mitigate disparities both locally and more broadly. Conversely, interventions targeting regions with lower disease prevalence, but higher racial disparities must be approached carefully to avoid exacerbating inequalities. In conclusion, understanding and addressing the complex drivers of health disparities demand comprehensive approaches that acknowledge the intertwined influences of race, income, and place. By prioritizing interventions that address economic disparities alongside health initiatives, policymakers can foster more equitable health outcomes across diverse communities.

在底特律、巴尔的摩和费城等城市,以黑人和经济弱势人群为主的总体健康问题发生率很高。令人惊讶的是,这些城市并没有表现出最明显的种族差异。与此相反,白人居民比例较高的地区(表明收入更加不平等),黑人和白人之间的健康结果却存在明显差异。这种差异突出表明,在较富裕的城市地区,黑人和白人的健康状况差异更大。这一现象表明,在形成种族健康差异的过程中,种族、地方、收入和收入不平等之间存在着复杂的、有时甚至是反直觉的关系。这些动态变化具有重要的政策影响。解决健康差距问题需要采取细致入微的策略,认识到种族和收入不平等对健康结果的倍增效应。以底特律、费城和巴尔的摩等疾病负担较重的地区为重点的政策,可以有效缓解当地和更广泛范围内的差距。相反,针对疾病发病率较低但种族差异较大的地区的干预措施必须谨慎对待,以避免加剧不平等。总之,要了解和解决健康差距的复杂驱动因素,就必须采取全面的方法,承认种族、收入和地区的交织影响。通过优先采取干预措施,在解决经济差距的同时解决健康问题,政策制定者可以在不同社区促进更公平的健康结果。
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引用次数: 0
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