The Social Determinants of Health and Health Disparities
Paula Braveman
Abstract
Abstract This book not only poses the question, What influences health? but also asks, What influences the influences? It examines current scientific knowledge of how social factors—such as wealth, education, neighborhood characteristics, and racism—and the factors such as power and social values that influence social factors shape health and health disparities. Throughout, readers are challenged to look “upstream” at the root or fundamental causes of good and ill health rather than considering only the more visible “downstream” causes that were set in motion by the more fundamental but often hidden upstream factors. The book reviews the critical mass of knowledge that has accumulated on the social determinants of health, which has documented associations, explored causal pathways and biological mechanisms, and provided a previously unavailable scientific foundation for appreciating the role of social factors in health. The questions are no longer whether social factors influence health and health disparities but, rather, how they do so and how best to intervene. Each of the chapters discusses knowledge of how a given social determinant—income and wealth, education, stress, racism, neighborhoods, housing, work, and behaviors—affects health and health disparities (health differences adversely affecting socially disadvantaged groups of people). Each chapter also discusses the upstream influences on that determinant and potential interventions. Key points and questions for discussion are provided for each chapter to assist instructors of university courses in public health, public policy, and related fields.