Targeting Health Disparities: A Model Linking Upstream Determinants to Downstream Interventions


Charles Mininger, Dana Sohmer, Martha McClintock, Olufunmilago Olopade, Sarah Gehlert, Tina Sacks


African American women, breast cancer, breast cancer screening, Caucasian women, CIHDR, community partnerships, environmental influences on health, health disparities, health policy, social environment, social indicators, social isolation, University of Chicago's Center for Interdisciplinary Health Disparities Research, upstream policy approaches


Health Affairs

Year Published:


Policy Summary

The evidence of disparities in health outcomes for Caucasian vs. African American breast cancer survival is stunning and widening each year. In 1975 almost 40 more deaths (out of 100,000) occured amongst African American breast cancer cases than in Caucasian breast cancer cases. This gap is widening and reached 44 deaths of African American breast cancer patients in 2004. This paper’s research brings up the importance of considering the social and environmental influences on health outcomes when creating policies and programs to reduce health disparities. The authors argue that policymakers should only determine the effectiveness of a program if that program’s individually focused activities consider the wider, upstream social and environmental determinants (socioeconomoic status, discrimination). The Univeristy of Chicago’s Center for Interdisciplinary Health Disparities Research (CIHDR) model is a model that incorporates upstream social and environmental determinants in program implementation. Upstream methods that could have significant downstream positive benefits include: 1) decreasing social isolation, 2) early detection/better cancer screening for African Americans, 3) including social indicators with clinical information, and 4) strengthening community partnerships. The authors state that social and environmental upstream determinants have significant influence on an individual’s cancer risk and survival, which should be considered in policy and programmatic planning and decisions.

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