In the US there are substantial disparities in health along multiple dimensions: race, ethnicity, nativity, gender, socioeconomic status, and place. This is despite the fact that the US spends more on healthcare than any other nation. The landmark 2003 Institute of Medicine Report "Unequal Treatment" documented inequalities in health care (e.g., access to high quality preventive services, state-of-the-art medical care) along these dimensions. However, it is estimated that only 15% of the variation in health outcomes is due to factors directly related to healthcare: that is, the majority of the variation is due to factors that are outside the healthcare system, and the most prominent among these are social in nature. How social factors influence the emergence and persistence of health disparities - and how the tools of public health can be used to reduce them - is addressed by multiple lines of research at CSEPH.
Social determinants of health broadly refers to any non-healthcare factor that is related to health outcomes. These generally include factors related to education, housing, employment and work characteristics, neighborhood characteristics. Understanding how social factors influence health outcomes requires considering health not just from an interdisciplinary perspective, but from an interprofessional one, in which stakeholders from diverse sectors like education, housing and urban development, criminal justice, faith and community-based organizations, and economic policy have a place at the table. CSEPH faculty and trainees are actively engaged in these types of discussions.
CSEPH faculty are leading several research projects aimed at understanding the social determinants of health and health disparities over the life course. Understanding the processes by which these social factors operate can help identify potential points of intervention for reducing health inequalities. Many of these projects are undertaken in partnership with colleagues at the Institute for Social Research (ISR), the Institute for Healthcare Policy and Innovation (IHPI), and in the departments of Health Behavior and Health Education in the School of Public Health. Some of this work is also undertaken with community partners, who help to translate research into real-world settings.
These research activities address a range of questions including: How does stress, and the ways our bodies respond to stress, influence racial and socioeconomic disparities in diabetes risk? How do communication patterns influence doctor-patient trust in racially-discordant healthcare interactions? What are the mechanisms (e.g., social, biological, psychological, behavioral) that contribute to disparities in health, and how do those change over the life course? How do social and environmental factors influence disparities in disability and functional impairment over time? What factors contribute to ethnic disparities in psychological, social and physical functioning after surviving a stroke?