Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities . David R. Williams, PhD, MPH Florence & Laura Norman Professor of Public Health Professor of African & African American Studies and of Sociology Harvard University.
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David R. Williams, PhD, MPH
Florence & Laura Norman Professor of Public Health
Professor of African & African American Studies and of Sociology
Olds 2002, Prevention Science
* Recruited from the local community, one month of training to address social and medical needs of persons with hypertension.
Source: Syme et al.
After seven months of follow-up, patients in the outreach group:
Source: Syme et al.
Policies to reduce inequalities in health must also address fundamental non-medical determinants.
Effective Policies to reduce inequalities in health must address fundamental non-medical determinants.
An individual’s chances of getting sick are largely unrelated to the receipt of medical care
Where we live, learn, work, play and worship determine our opportunities and chances for being healthy
Social Policies can make it easier or harder to make healthy choices
Health Policies include policies in all sectors of society that affect opportunities to choose health, including, for example,
Leventhal and Brooks-Gunn, 2003
City-wide de-concentration of public housing
Fauth et al. Social Science and Medicine, 2004
Kehrer and Wolin, 1979
Costello et al. 2003
Huston, et al. Developmental Psychology, 2005
Mexico’s PROGRESA (now Oportunidades) established in 1997
Low income families, randomized at the community, level receive additional cash conditional on children’s school attendance, preventive care visits and participation in health information sessions
Compared to controls, the intervention group had decreased illness rates, child stunting, BMI and improvements in endurance, language development, memory, and height for age
Additional cash is key determinant of program success
Rawlings & Rubin, 2005; Paxson & Shady, 2007; Fernand et al. 2008
Kaplan et al. 2008; Cooper et al. 1981; Almond & Chay, 2006; Almond et al. 2006
Source: Economic Report of the President, 1998
Investments in early childhood programs in the U.S. have been shown to have decisive beneficial effects
High/Scope Educational Research Foundation
Schweinhart & Montie, 2005