What Do We Know About the Drivers of Health and Equity? A Narrative Review of Graphic Representations

Givens, Marjory L.; Catlin, Bridget B.; Johnson, Sheri P; Pollock, Elizabeth A.; Faust, Victoria; Inzeo, Paula Tran; Kindig, David A.

doi:10.1089/heq.2020.0013

Cited by 13 publications

(16 citation statements)

References 26 publications

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“…While there are over 100 models to guide implementation science research, only a handful explicitly include health equity [20,90,94,[106][107][108][109]. These frameworks are informed by development and use of a larger set of models on health and equity [110].…”

Section: Integrate Equity Into Implementation Modelsmentioning

confidence: 99%

Implementation science should give higher priority to health equity

et al. 2021

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Background There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice—health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity. Main text We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts. Conclusions Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we “leave no one behind” and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.

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Section: Integrate Equity Into Implementation Modelsmentioning

confidence: 99%

Implementation science should give higher priority to health equity

et al. 2021

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“…[22][23][24][25][26][27][28][29][30] In addition, numerous frameworks have collectively advanced efforts to integrate the SDOH literature for use in research and applied work, including the widely cited SDOH framework developed by the World Health Organization Commission on Social Determinants of Health, the National Institute on Minority Health and Health Disparities (NIMHD) research framework, frameworks of health and health equity drivers reviewed by Givens and colleagues, as well as others. [31][32][33][34][35][36] Still, to date, the nuances of SDOH mechanisms described in the literature are too often not reflected in the broad, SDOH domainfocused frameworks that continue to inform health policy, public health, and clinical practice, representing a research-to-practice translation gap and missed opportunity for more effective SDOH mitigation.…”

Section: Resiliencementioning

confidence: 99%

“…The framework serves as a tool to facilitate the translation of scholarly SDOH work into effective health policy, programming, and clinical care, thereby addressing a scarcity of peer-reviewed organizing frameworks of SDOH mechanisms that are explicitly designed to inform practice. 36…”

Section: Moving Toward a Strength-based Paradigm For Addressing Healt...mentioning

confidence: 99%

“…To this end, we propose and apply a practical, heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing the key SDOH mechanisms that represent leverage points—intervention opportunities to maximize potential impact in mitigating a given health inequity. The framework serves as a tool to facilitate the translation of scholarly SDOH work into effective health policy, programming, and clinical care, thereby addressing a scarcity of peer‐reviewed organizing frameworks of SDOH mechanisms that are explicitly designed to inform practice 36 …”

Section: Moving Toward a Strength‐based Paradigm For Addressing Healt...mentioning

confidence: 99%

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Conceptualizing the Mechanisms of Social Determinants of Health: A Heuristic Framework to Inform Future Directions for Mitigation

2023

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A large body of scientific work examines the mechanisms through which social determinants of health (SDOH) shape health inequities. However, the nuances described in the literature are infrequently reflected in the applied frameworks that inform health policy and programming. We synthesize extant SDOH research into a heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing key mechanisms that represent intervention opportunities for mitigating the impact of harmful SDOH. In light of scarce existing SDOH mitigation strategies, the framework addresses an important research‐to‐practice translation gap and missed opportunity for advancing health equity. Context The reduction of health inequities is a broad and interdisciplinary endeavor with implications for policy, research, and practice. Health inequities are most often understood as associated with the social determinants of health (SDOH). However, policy and programmatic frameworks for mitigation often rely on broad SDOH domains, without sufficient attention to the operating mechanisms, and effective SDOH mitigation strategies remain scarce. To expand the cadre of effective SDOH mitigation strategies, a practical, heuristic framework for policymakers, practitioners, and researchers is needed that serves as a roadmap for conceptualizing and targeting the key mechanisms of SDOH influence. Methods We conduct a critical review of the extant conceptual and empirical SDOH literature to identify unifying principles of SDOH mechanisms and to synthesize an integrated framework for conceptualizing such mechanisms. Findings We highlight eight unifying principles of SDOH mechanisms that emerge from landmark SDOH research. Building on these principles, we introduce and apply a conceptual model that synthesizes key SDOH mechanisms into one organizing, heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing the key SDOH mechanisms that represent intervention opportunities to maximize potential impact for mitigating a given health inequity. Conclusions Our synthesis of the extant SDOH research into a heuristic framework addresses a scarcity of peer‐reviewed organizing frameworks of SDOH mechanisms designed to inform practice. The framework represents a practical tool to facilitate the translation of scholarly SDOH work into evidence‐based and targeted policy and programming. Such tools designed to close the research‐to‐practice translation gap for effective SDOH mitigation are sorely needed, given that health inequities in the United States and in many other parts of the world have widened over the past two decades.

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“…1 It is estimated that >70% of health outcomes are attributable to social and environmental factors outside of the medical setting. [2][3][4] In fact, the number deaths attributable to low education, racial segregation, and low social support is comparable to the number of deaths from myocardial infarction, cerebrovascular disease, and lung cancer, respectively. 5 The relationship between SDOHs and health care outcomes is neither simple nor unidirectional.…”

Section: Introductionmentioning

confidence: 99%

Universal social needs assessment in gynecologic oncology: An important step toward more informed and targeted care in the public safety net

Nyakudarika

Holschneider

Sinno

2021

Cancer

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BACKGROUND: Social needs are actionable mediators of social determinants of health. Along with distress, they affect quality of life and survival in patients with cancer. The objectives of this study were to identify the most common social needs and distress in a largely immigrant gynecologic oncology patient population at a public safety-net hospital and to evaluate for specific needs associated with distress and poor outcomes. METHODS: This was a prospective, survey-based cohort study of patients who participated in a performance-improvement initiative offering social needs assessment and distress screening. Patients provided sociodemographic information and completed validated surveys adapted from the Health Leads Social Needs Screening Toolkit, the National Comprehensive Cancer Network Distress Thermometer, and the Emotion Thermometers Tool. Associations between social needs, distress, and treatment outcomes were analyzed. RESULTS: In total, 135 women were included. Of these, 65.2% had at least 1 unmet social need, and 36.3% screened positive for distress. Help reading hospital materials (30.4%) was the most frequently reported need. Social isolation (odds ratio [OR], 3.65; 95% CI, 1.35-9.9; P = .01) and lack of safety at home (OR, 4.90; 95% CI, 2.23-10.62; P = .0001) were associated with distress. Perceived lack of finances for medical care (OR, 5.69; 95% CI, 1.12-28.9; P = .036) and lack of transportation (OR, 20.5; 95% CI, 2.69-156.7; P = .004) were associated with nonadherence-related treatment interruption, whereas positive distress scores were associated with interruption because of comorbidities or treatment-related toxicities (OR, 20.5; 95% CI, 1.5-268.6; P = .02). CONCLUSIONS: Systematically identifying social needs and developing interventions aimed at mitigating them may lead to more actionable health care disparities research and affect treatment outcomes.

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What Do We Know About the Drivers of Health and Equity? A Narrative Review of Graphic Representations

Cited by 13 publications

References 26 publications

Implementation science should give higher priority to health equity

Implementation science should give higher priority to health equity

Conceptualizing the Mechanisms of Social Determinants of Health: A Heuristic Framework to Inform Future Directions for Mitigation

Universal social needs assessment in gynecologic oncology: An important step toward more informed and targeted care in the public safety net

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