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Review
.2012 Apr:33:41-58.
doi: 10.1146/annurev-publhealth-031811-124534. Epub 2012 Jan 3.

Conceptual approaches to the study of health disparities

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Review

Conceptual approaches to the study of health disparities

Ana V Diez Roux. Annu Rev Public Health.2012 Apr.

Abstract

Scientific and policy interest in health disparities, defined as systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups, has increased markedly over the past few decades. Like other research, research in health disparities is strongly influenced by the underlying conceptual model of the hypothetical causes of disparities. Conceptual models are important and a major source of debate because multiple types of factors and processes may be involved in generating disparities, because different disciplines emphasize different types of factors, and because the conceptual model often drives what is studied, how results are interpreted, and which interventions are identified as most promising. This article reviews common conceptual approaches to health disparities including the genetic model, the fundamental cause model, the pathways model, and the interaction model. Strengths and limitations of the approaches are highlighted. The article concludes by outlining key elements and implications of an integrative systems-based conceptual model.

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Figure 1
Figure 1
Essential elements of selected conceptual approaches to health disparities. A single-headed arrow from X to Y indicates that X is a cause of Y (e.g., social, environmental, and cultural factors are causally related to health (a), or that X causes increased exposure to Y (e.g., genetic factors cause exposures to certain environments (d ). A double-headed arrow indicates that both factors are associated (for example, genes and environments can become associated if persons of certain ancestry are more likely to live in certain areas as a result of institutional discrimination (a,d ). A line intersecting a one-headed arrow (in the form of a T) indicates that the factor modifies the relation between X and Y.
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