title: Targeting health disparities: a model linking upstream determinants to downstream interventions.
abstract: Certain social/environmental factors put some groups at extraordinary risk for adverse health outcomes, creating health disparities. We present a downward causal model, originating at the population level and ending at disease, with psychological and behavioral responses linking the two. This approach identifies how specific social environments "get under the skin" to cause disease, illustrated with the disparity in mortality from aggressive premenopausal breast cancer suffered by black women. Broadening our lens to consider the entire chain of causal factors, spanning multiple levels and interacting across the life span, heightens our ability to craft specific interventions to address group differences in health.
authors.affiliation: School of Social Services Administration, University of Chicago, IL, USA. sgehlert@uchicago.edu
authors.forename: Sarah
authors.initials: S
authors.lastname: Gehlert
authors.forename: Dana
authors.initials: D
authors.lastname: Sohmer
authors.forename: Tina
authors.initials: T
authors.lastname: Sacks
authors.forename: Charles
authors.initials: C
authors.lastname: Mininger
authors.forename: Martha
authors.initials: M
authors.lastname: McClintock
authors.forename: Olufunmilayo
authors.initials: O
authors.lastname: Olopade
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality; D002641:Chicago / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D011203:Poverty; D017697:Premenopause; D012307:Risk Factors; D012931:Social Environment; D012934:Social Isolation / Q000523:psychology