Table 3 Summary of recent reviews of priorities for and impacts of interventions addressing health equity and social determinants of health
From: Implementation science should give higher priority to health equity
First author Focus of study | Year of publication | Type of review | Selected findings |
|---|---|---|---|
Paradies [62] Racism as a determinant of health | 2015 | Systematic review (meta-analysis) | • Racism was associated with poorer mental health (r = − .23; 95% confidence interval (CI) = − .24, − .21) • Racism was also associated with poorer general health (r = − .13; 95% CI = − .18, − .09) and poorer physical health (r = − .09; 95% CI = − .12, − .06) • Among physical health outcomes, racism was associated with diabetes (r = − .02; 95% CI = − .09, .04) |
Purnell [63] Gaps and innovative interventions for health equity | 2016 | Narrative review | • Identified persistent disparities for cardiovascular disease and cancer risk by race and urban-rural residence • Culturally tailored, promotora-based interventions improved mammography screening among Latinas • Use of referrals to community resources to address sociocultural barriers was associated with smoking cessation • A stakeholder-engaged, culturally tailored intervention was effective in controlling blood pressure |
Taylor [64] Impacts of investments in social determinants interventions | 2016 | Narrative review | • Housing support interventions showed reduced healthcare costs and improvements in health outcomes (obesity, diabetes, asthma, HIV) • Nutrition support interventions improved health outcomes (protective for low birthweight and preterm delivery, body weight) • Income support interventions consistently demonstrated a positive impact on health outcomes (infant mortality, disability rates, mental health) • Care coordination and community outreach interventions showed decreased healthcare costs |
Asare [65] Social determinants and cancer disparities | 2017 | Narrative review | • Social and economic factors may negatively affect minority patients’ ability to participate in cancer research • Lack of accessible transportation can restrict access to health and cancer care • Exposure to discrimination may lead to mistrust of elements of this society and suspicion of healthcare systems • The social determinants of health framework posits that all social and economic constructs are interrelated |
Bailey [4] Structural racism and health inequities | 2017 | Narrative review | • Most studies on racism and health have focused on interpersonal racial/ethnic discrimination, with comparatively less emphasis on investigating the health effects of structural racism • Structural racism involves interconnected institutions, whose linkages are historically rooted and culturally reinforced Promising approaches include: • Use of a focused external force that acts on multiple sectors at once (e.g., place-based multisector initiatives such as Promise Neighborhoods) • Disruption of leverage points within a sector that might have ripple effects in the system (e.g., reforming drug policy and reducing excessive incarceration) |
Dendup [66] Environmental risk for type 2 diabetes | 2018 | Systematic review | • Walkability, air pollution, food and physical activity environment, and roadways proximity were the most common environmental characteristics studied • Higher levels of walkability and green space were associated with lower risk of type 2 diabetes • Increased levels of noise and air pollution were associated with greater risk |
Suleman [67] Xenophobia and health | 2018 | Scoping review | • Among individuals living with HIV, xenophobia is a barrier to medical service access • Xenophobia is associated with higher rates of mental health outcomes (e.g., depression, chronic anxiety, psychoses) |
Thomson [39] Health policies and inequalities | 2018 | Umbrella review of systematic reviews | • Results were mixed across the public health domains • Some policy interventions were shown to reduce health inequalities (e.g., food subsidy programs, immunizations) • Some policy interventions had no effect • Some interventions appear to increase inequalities (e.g., 20 mph and low emission zones) |
Naik [38] Macroeconomic determinants of health inequalities | 2019 | Review of systematic reviews | • Policies to promote employment and improve working conditions can improve health and reduce gender-based health inequities • Market regulation of tobacco, alcohol, and food was effective at improving health and reducing inequities (rates of smoking, alcohol use, healthy food consumption) • Privatization of utilities and alcohol sectors, income inequality, and economic crises increase health inequities |
Martinez-Cardoso [68] Social determinants of diabetes management | 2020 | Narrative review | • Diabetes management and care is deterred by housing precarity, food insecurity, poverty, uninsurance and underinsurance, and limited support for immigrants in healthcare systems • Interventions to address diabetes require a more upstream approach to mitigate the drivers of diabetes disparities among immigrants |