Addressing Population Health and Health Inequalities: The Role of Fundamental Causes
Published Date:Sep 2014
Source:Am J Public Health. 104(0 4):S609-S619.
Pubmed Central ID:PMC4126171
Funding:1K01DA030449/DA/NIDA NIH HHS/United States
DP2 HD080350/HD/NICHD NIH HHS/United States
DP2HD080350/DP/NCCDPHP CDC HHS/United States
K01 DA030449/DA/NIDA NIH HHS/United States
R21 AA021909/AA/NIAAA NIH HHS/United States
R21AA021909/AA/NIAAA NIH HHS/United States
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.
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 US Census.
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.
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.
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