title: Addressing population health and health inequalities: the role of fundamental causes.
abstract: OBJECTIVE
  As a case study of the impact of universal versus targeted interventions on population health and health inequalities, we used simulations to examine (1) whether universal or targeted manipulations of collective efficacy better reduced population-level rates and racial/ethnic inequalities in violent victimization; and (2) whether experiments reduced disparities without addressing fundamental causes.
  
  
  METHODS
  We applied agent-based simulation techniques to the specific example of an intervention on neighborhood collective efficacy to reduce population-level rates and racial/ethnic inequalities in violent victimization. The agent population consisted of 4000 individuals aged 18 years and older with sociodemographic characteristics assigned to match distributions of the adult population in New York City according to the 2000 U.S. Census.
  
  
  RESULTS
  Universal experiments reduced rates of victimization more than targeted experiments. However, neither experiment reduced inequalities. To reduce inequalities, it was necessary to eliminate racial/ethnic residential segregation.
  
  
  CONCLUSIONS
  These simulations support the use of universal intervention but suggest that it is not possible to address inequalities in health without first addressing fundamental causes.
authors.affiliation: Magdalena Cerdá, Melissa Tracy, and Sandro Galea are with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Jennifer Ahern is with the Department of Epidemiology, University of California, Berkeley.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cerdá
authors.forename: Melissa
authors.initials: M
authors.lastname: Tracy
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ahern
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
mesh_terms: D000375:Aging; D003198:Computer Simulation; D019548:Crime Victims / Q000523:psychology / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008962:Models, Theoretical; D044469:Racial Groups / Q000523:psychology / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology
references.citation: Am J Public Health. 2007 May;97(5):838-45
references.pmid: 16809593
references.citation: Am J Psychiatry. 1995 Apr;152(4):529-35
references.pmid: 7694900
references.citation: J Epidemiol Community Health. 2013 Feb;67(2):159-65
references.pmid: 22918895
references.citation: Arch Pediatr Adolesc Med. 2005 Aug;159(8):731-9
references.pmid: 16061780
references.citation: Addiction. 1999 May;94(5):751-7
references.pmid: 10563040
references.citation: Public Health Rep. 2001 Sep-Oct;116(5):404-16
references.pmid: 12042604
references.citation: Soc Indic Res. 2010 Jan;95(1):169-180
references.pmid: 19966916
references.citation: J Health Soc Behav. 2001 Jun;42(2):151-65
references.pmid: 11467250
references.citation: Am J Public Health. 2005 Feb;95(2):224-32
references.pmid: 15671454
references.citation: Int J Epidemiol. 2010 Apr;39(2):372-7
references.pmid: 19887510
references.citation: Drug Alcohol Depend. 2009 Oct 1;104 Suppl 1:S6-10
references.pmid: 19477607
references.citation: Milbank Q. 2008 Dec;86(4):557-80
references.pmid: 19120980
references.citation: Arch Gen Psychiatry. 1995 Dec;52(12):1048-60
references.pmid: 7492257
references.citation: Drug Alcohol Depend. 2009 Feb 1;100(1-2):138-45
references.pmid: 19010610
references.citation: Arch Gen Psychiatry. 2004 Aug;61(8):807-16
references.pmid: 15289279
references.citation: J Urban Health. 2014 Feb;91(1):84-95
references.pmid: 23440488
references.citation: Milbank Q. 2008 Dec;86(4):581-600
references.pmid: 19120981
references.citation: Am J Community Psychol. 2003 Dec;32(3-4):245-52
references.pmid: 14703260
references.citation: J Health Soc Behav. 2004 Sep;45(3):265-85
references.pmid: 15595507
references.citation: J Interpers Violence. 2005 Feb;20(2):218-24
references.pmid: 15601795
references.citation: Arch Gen Psychiatry. 1998 Jul;55(7):626-32
references.pmid: 9672053
references.citation: Arch Pediatr Adolesc Med. 2006 Jan;160(1):74-81
references.pmid: 16389215
references.citation: J Urban Health. 2013 Feb;90(1):27-40
references.pmid: 22696175
references.citation: Int J Epidemiol. 2006 Jun;35(3):643-7
references.pmid: 16556642
references.citation: Epidemiology. 2008 Jan;19(1):47-54
references.pmid: 18091003
references.citation: Arch Gen Psychiatry. 2009 Feb;66(2):152-61
references.pmid: 19188537
references.citation: JAMA. 1994 Aug 17;272(7):530-4
references.pmid: 8046807
references.citation: J Consult Clin Psychol. 1992 Jun;60(3):409-18
references.pmid: 1619095
references.citation: Psychol Med. 2011 Jan;41(1):71-83
references.pmid: 20346193
references.citation: Am J Public Health. 2008 Feb;98(2):216-21
references.pmid: 18172133
references.citation: Science. 1997 Aug 15;277(5328):918-24
references.pmid: 9252316
references.citation: Soc Sci Med. 2004 May;58(10):1929-52
references.pmid: 15020009
references.citation: Am J Community Psychol. 2009 Jun;43(3-4):345-59
references.pmid: 19387823
references.citation: J Health Soc Behav. 2008 Dec;49(4):367-84
references.pmid: 19181044
references.citation: Int J Epidemiol. 1985 Mar;14(1):32-8
references.pmid: 3872850
references.citation: J Health Soc Behav. 1995;Spec No:80-94
references.pmid: 7560851
references.citation: Int J Health Serv. 2011;41(1):1-9
references.pmid: 21319717
references.citation: Am J Epidemiol. 2008 May 1;167(9):1041-9
references.pmid: 18310621
references.citation: Trials. 2012 Jul 06;13:105
references.pmid: 22769971
references.citation: J Health Soc Behav. 2010;51 Suppl:S28-40
references.pmid: 20943581
references.citation: Health Aff (Millwood). 2005 Mar-Apr;24(2):325-34
references.pmid: 15757915
references.citation: Child Abuse Negl. 2007 May;31(5):479-502
references.pmid: 17537508
references.citation: J Child Psychol Psychiatry. 1998 Feb;39(2):215-24
references.pmid: 9669234
references.citation: Am J Epidemiol. 2011 Jun 15;173(12):1453-62
references.pmid: 21527512