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. 2020 Feb 6;20(2):5.
doi: 10.1007/s11882-020-0899-6.

Structural and Social Determinants of Health in Asthma in Developed Economies: a Scoping Review of Literature Published Between 2014 and 2019

Kathryn Sullivan  1 , Neeta Thakur  2
Affiliations

Structural and Social Determinants of Health in Asthma in Developed Economies: a Scoping Review of Literature Published Between 2014 and 2019

Kathryn Sullivan et al. Curr Allergy Asthma Rep. .

Abstract

Purpose of review: Using the WHO Conceptual Framework for Action on the Social Determinants of Health, this review provides a discussion of recent epidemiologic, mechanistic, and intervention studies of structural and social determinants of health and asthma outcomes covering the period from 2014 to 2019.

Recent findings: A majority of studies and interventions to date focus on the intermediary determinants of health (e.g., housing), which as the name suggests, exist between the patient and the upstream structural determinants of health (e.g., housing policy). Race/ethnicity remains a profound social driver of asthma disparities with cumulative risk from many overlapping determinants. A growing number of studies on asthma are beginning to elucidate the underlying mechanisms that connect social determinants to human disease. Several effective interventions have been developed, though a need for large-scale policy research and innovation remains. Strong evidence supports the key role of the structural determinants, which generate social stratification and inequity, in the development and progression of asthma; yet, interventions in this realm are challenging to develop and therefore infrequent. Proximal, intermediary determinants have provided a natural starting point for interventions, though structural interventions have the most potential for major impact on asthma outcomes. Further research to investigate the interactive effect of multiple determinants, as well as intervention studies, specifically those that are cross-sector and propose innovative strategies to target structural determinants, are needed to address asthma morbidities, and more importantly, close the asthma disparity gap.

Keywords: Asthma; Community violence; Discrimination; Ethnicity; Food insecurity; Greenspace; Health disparities; Housing; Neighborhood; Nutrition; Policy; Psychosocial stress; Race; Racism; Social determinants of health; Socioeconomic status; Structural determinants of health.

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Conflict of interest statement

Dr. Thakur reports grants from NHLBI during the conduct of the study. Dr. Sullivan declares no conflicts of interest relevant to this manuscript.

Figures

Fig. 1
Fig. 1
The level at which structural and social determinants affect asthma and contribute to poor asthma outcomes. Adapted from the WHO’s Conceptual Framework for the Social Determinants of Health [15]
See this image and copyright information in PMC

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