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Resource links

Academic research centers

Advocacy and opinion

Affordable Care Act

Behavior and individual risk taking

Childhood environment

Community Health Status Indicators (CHSI) online tool

Education & health

Environmental hazards and disparities

Experts

Food environment

Fundamental causes of health disparities

History and background

Implications for medical practice

Journalism

LGBT health

Measuring the problem

Neighborhoods and social networks

Stress and the allostatic load hypothesis

Veterans

Violent injuries & deaths

Academic Research Centers

Journal of Health Care for the Poor and Underserved
Meharry Medical College’s Journal of Health Care for the Poor and Underserved publishes peer-reviewed work related to health care and medically underserved communities. Published by The Johns Hopkins University Press, the quarterly journal regularly covers issues such as access, costs, health promotion and disease prevention, among others. Contact: Virginia Brennan, editor, 615-327-6819 or vbrennan@mmc.edu.

Johns Hopkins Urban Health Institute
Established in 2000, Johns Hopkins University’s Urban Health Institute aims to leverage its academic expertise to benefit East Baltimore, a typically underserved area with high poverty and health issues. While primarily focused on health issues affecting Baltimore, its work on early childhood development, teenagers’ sexual health and other areas can guide your reporting on these topics in other cities, as well as provide some expertise. The institute holds an annual symposium on the Social Determinants of Health each spring.

Center for Mental Health Disparities
This University of Louisville program promotes health and wellness in historically underserved families. Its work is interdisciplinary and collaborative, focusing on research with adults, children, couples, and families across cultures. The Center's research is intended to contribute to understanding mental health disparities in ethnic minority families, leading to the ongoing development of culturally sensitive interventions.

Center for Health Policy and Inequalities Research
Researchers at this Duke University center focus on wide range of interdisciplinary studies of health disparities from population-based data to reviews of health systems and intervention. Recent studies have looked at teen pregnancy initiatives, the impact of child care environments and HIV in the southern United States. Their work, part of the Duke Global Health Institute, focuses on health inequality worldwide.

National Center for Children in Poverty
Part of Columbia University’s Mailman School of Public Health, NCCP covers targets everything from healthy development of infants and toddlers to children’s mental health and the impacts of immigration, early care and families’ wages. Useful data measure risks for young children as well as policy and demographic changes in all 50 U.S. states.

National Institute on Minority Health and Health Disparities
The NIMHD leads scientific research to improve minority health and eliminate health disparities. In that role, it plans, reviews, coordinates, and evaluates all minority health and health disparities research and activities of the National Institutes of Health, supports the training of a diverse research workforce and translates and disseminates research information.

Center on Society and Health at Virginia Commonwealth University
Provides objective, independent analysis on the health effects of social distress, neighborhood environment, education, welfare policy, and other aspects of the social determinants of health.

The MacArthur Research Network on Socioeconomic Status and Health
A collaboration of scholars in medicine, psychology, sociology, and other fields who are trying to figure out how socioeconomic status alters the performance of biological systems to alter disease risk and mortality. The web site links to helpful notebooks, research papers and bibliographies.

Whitehall II Study of British Civil Servants
The first Whitehall study, started in 1967, famously showed that men in the lowest employment grades were much more likely to die prematurely than men in the highest grades. Whitehall II, launched in 1984, is tracking a larger group and includes women.

Symposium on the Social Determinants of Health
Started in 2012 at Johns Hopkins University, “to raise awareness about the impact and importance of the social determinants of health.” The website archives videos and slide presentations by experts on topics such as early life, race and gender, stress, poverty and education.

Advocacy and Opinion

National Rural Health Association (NRHA)

The National Rural Health Association is a national organization for rural health care providers and government agencies that advocates for rural health issues. It offers its own look at how rural health differs than care provided in other areas, including a snapshot with statistics comparing less populated areas to urban centers. It also produces a quarterly magazine  that may offer story ideas or potential contacts.

Healthy People 2020: Lesbian, Gay, Bisexual & Transgender Health

Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress. It has added social determinants of LGBT health as a topic area (see this PDF presentation). Its portal on the topic includes an overview of health disparities in the LGBT community, as well as references, data, Healthy People 2020’s objectives in this area and evidence-based resources.

Who and What Is a “Population”? Historical Debates, Current Controversies, and Implications for Understanding “Population Health” and Rectifying Health Inequities
Nancy Krieger, Milbank Q. (2012)
An eye-opening critique of the ways that medical researchers define and study “populations” and attempt to apply findings in medicine and public health. Epidemiology, for example, routinely uses population data to study disease causation with the understanding that such research cannot predict which individual will get the disease in question, while medical research “remains bent on using just these sorts of data to predict an individual's risk.” Krieger goes on to ask, “what might be the adverse consequences of discounting people that mainstream research already routinely and problematically calls ‘hard-to-reach’ populations? These populations include the disempowered and dispossessed, whose adverse social and physical circumstances mean that their range of exposures almost invariably differ, in both level and type, from those encountered by the effectively ‘easy-to-reach.’”

Overcoming Obstacles to Health in 2013 and Beyond
RWJF Commission to Build a Healthier America (2013)
Poor, middle-class and even wealthy Americans are less healthy than their counterparts in other affluent countries. The authors analyze the existing research to explain why Americans are not as healthy as they could be, and suggest evidence-based solutions.

Healthy People: A 2020 Vision for the Social Determinants Approach
Howard K. Koh, Julie J. Piotrowski, Shiriki Kumanyika, and Jonathan E. Fielding; Health Education & Behavior (2011)
For 30 years, the U.S. government’s “Healthy People” initiative set public health goals with little regard to factors such as poverty and education. Koh, U.S. assistant secretary for health, explains how that started to change in 2010, with the Healthy People 2020 update

Closing the gap in a generation: health equity through action on the social determinants of health
Michael Marmot, Sharon Friel, Ruth Bell, Tanja A. J. Houweling, Sebastian Taylor; WHO Commission on Social Determinants of Health; Lancet (2008)
“Social injustice is killing people on a grand scale, and the reduction of health inequities, between and within countries, is an ethical imperative,” assert the authors, who distill the findings and recommendations of the WHO Commission on Social Determinants of Health.

Reaching for a Healthier Life
John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health (2008)
Makes the case that policies to support healthy living conditions for all citizens are needed, and that the cost of implementing such policies would be offset by subsequent savings through increased productivity and lower health care costs.

Affordable Care Act

IOM Summary: Achieving Health Equity via the Affordable Care Act
This December 2015 report follows an Institute of Medicine workshop on Achieving Health Equity via the Affordable Care Act: Promises, Provisions, and Making Reform a Reality for Diverse Patients. Although it does not offer any consensus of the panel’s opinion, the workshop summary does offer readers takeaways on how the 2010 health care law could help achieve more equity between various groups. The panel’s 26-members weighed issues such as patient-centered medical homes, public policy and safety nets and insurance affordability

Behavior and Individual Risk Taking

UCLA’s psychoneuroimmunology center: The Norman Cousins Center for Psychoneuroimmunology at University of California at Los Angeles (UCLA) focuses on research aimed at the psychosocial and behavioral factors that influence health and disease through psychoneuroimmunological (PNI) pathways. Its work has or is examining “the reciprocal regulation of immune response gene expression and central nervous system (CNS) function”; sleep disturbance and depression risk; the role of social stress; and how behavioral changes could reduce inflammation and curb insomnia and depression; among other topics. Part of UCLA’s Semel Institute for Neuroscience and Human Behavior, it also helps funds related research projects. Contact:  310-825 8281.

Tackling Harmful Alcohol Use: Economics and Public PolicyThe Organisation for Economic Co-operation and Development (OECD) has released this paper on global alcohol consumption and societal costs of alcohol use. It provides a detailed examination of trends and socioeconomic disparities in alcohol consumption.

Socioeconomic Disparities in Health Behaviors 
Fred C. Pampel, Patrick M. Krueger, and Justin T. Denney, Annual Review of Sociology (2010)
An excellent review of evidence for and against nine major pathways by which socioeconomic status shapes health behavior. “These studies recognize that SES disparities in health behavior involve more than freely chosen lifestyles,” the authors asssert. “To the contrary, the explanations reviewed below suggest that unhealthy behaviors result from the vast differences in the social circumstances of low- and high-SES groups.”

Association of socioeconomic position with health behaviors and mortality. The Whitehall II study
Silvia Stringhini, Séverine Sabia, Martin Shipley, Eric Brunner, Hermann Nabi, Mika Kivimaki, and Archana Singh-Manoux; Journal of the American Medical Association (2010)
Follow-up on the Whitehall II study finds that health behaviors account for most of the observed difference in mortality between lower and higher social status populations.

Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: a longitudinal study
N. H. Rod, M. Grønbæk, P. Schnohr, E. Prescott, T. S. Kristensen; Journal of Internal Medicine (2009)
Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking, more likely to become physically inactive, less likely to stop drinking above the sensible drinking limits, and stressed women were more likely to become overweight during follow-up. Men and women with high stress were more likely to use antihypertensive medication, and stressed men were more than two times as likely to develop diabetes during follow-up.

Childhood Environment

Harvard’s Center on the Developing Child
This research and development center at Harvard University focuses on a range of issues that affect childhood development from toxic stress and neglect to resilience and brain architecture.  There are issue briefs on a range of current issues. The center ties its work and findings to possible policy and medical practice recommendations, listing its projects by topic area, and provides a tip sheet on communicating about science. Media contact: press_developingchild@harvard.edu or (617) 496-0429.

Child Welfare Information Gateway
This service of the Department of Health and Human Services’ Children's Bureau offers regular updates of information related to children, families and their well-being. The bureau, part of HHS’ Administration for Children and Families, includes information on a range of issues from adoption and foster care to child abuse. Reporters can subscribe to get regular updates on new data, research and other news by email here.

Annie E. Casey Foundation
The Baltimore-based nonprofit organization focuses on improving the well-being of children and their families. The data-driven group is perhaps most well-known for its annual Kids Count report, which examines the trends in U.S. youth in five areas: overall child well-being, economic well-being, education, health, family and community. The private, independent foundation is funded by an endowment by UPS founder Jim Casey and provides grants to various non-profit organizations for initiatives aimed at improving educational, economic, social and health outcomes. Press contact: Sue Lin Chong, media@aecf.org, @SueLinChong, 410-223-2836

Preventing Bullying Through Science, Policy, and Practice
Rivara and Le Menestrel, editors; National Academies of Sciences, Engineering, and Medicine (2016)
This comprehensive review examines the current state of bullying among children and adolescents. The multidisciplinary committee gathered by the National Academies of Sciences, Engineering, and Medicine  “was charged with critically examining the state of the science on the biological and psychosocial consequences of bullying and on the risk factors and protective factors that, respectively, increase or decrease bullying behavior and its consequences.” Members examined definitions, initiatives, research methods, and current literature in their review, which delved into aggression, violence and cyberbullying as well as bullying prevention.

NCSL: Lead Hazards Project
The National Conference of State Legislatures’ Lead Hazards Project offers a comprehensive look at U.S. states’ efforts to address the hazards of lead. The site includes a searchable list of relevant laws by state as well as related legislation under consideration. Media contact: 202-624-3557.

Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention
This key 2012 report by the Centers for Disease Control and Prevention’s Advisory Committee on Childhood Lead Poisoning Prevention includes specific recommendations for the CDC as well as other federal agencies as well as state and local authorities to take action to prevent lead poisoning. The expert panel’s report also outlines evidence behind the group’s call for lowering the CDC’s blood lead level of concern.

Stress and Child Development
Ross A. Thompson, The Future of Children (Spring 2014)
The kinds of stressful experiences that are endemic to families living in poverty can alter children’s neurobiology in ways that undermine their health, their social competence, and their ability to succeed in school and in life. This massively footnoted review considers the evidence for the most promising types of interventions that can help children growing up in adverse environments.

Early Childhood Investments Substantially Boost Adult Health
Frances Campbell, James Heckman & others; Science (2014)
Early childhood programs are effective at promoting school success, raising earnings in adulthood, and reducing crime. And now there’s good evidence that they produce health benefits that persist into adulthood. Babies born in the 1970s in North Carolina were randomized to receive cognitive and social stimulation interspersed with caregiving and supervised play throughout a full eight-hour day for the first five years. Thirty years later, researchers found that the group that got care was far healthier. Disadvantaged children randomly assigned to treatment have significantly lower prevalence of risk factors for cardiovascular and metabolic diseases in their mid-30s. The evidence was particularly strong for males.

Lifetime Socioeconomic Inequalities in Physical and Cognitive Aging
Louise Hurst, Mai Stafford, Rachel Cooper, Rebecca Hardy, Marcus Richards, and Diana Kuh; American Journal of Public Health (2013)
This study demonstrates that in a representative British cohort born in 1946, the legacy of low socioeconomic status during childhood persists at least up to conventional retirement age, affecting both physical and cognitive performance. The authors conclude that “effective strategies will need to affect the social determinants of health in early life to influence inequalities into old age.”

Childhood socioeconomic status and adult health
Sheldon Cohen, Denise Janicki-Deverts, Edith Chen, Karen A. Matthews; Annals of the New York Academy Of Sciences (2010)
There is strong evidence that socioeconomic status during childhood influences health and mortality well into adulthood, but it’s not yet known when childhood experiences matter most, how long they need to last, what behavioral, psychological, or physiological pathways link the childhood socioeconomic status to adult health, and which specific adult health outcomes are vulnerable to childhood exposures.

Community Health Status Indicators (CHSI) 

This website produces public health profiles for all 3,143 counties in the United States. Each profile includes key indicators of health outcomes, which describes the population health status of a county and factors that have the potential to influence health outcomes, such as health care access and quality, health behaviors, social factors, and the physical environment. The online application includes updated peer county groups, health status indicators, a summary comparison page, and U.S. Census tract data and indicators for sub-populations (age groups, sex, and race/ethnicity) to identify potential health disparities. In this version of CHSI, updated in March 2015, all indicators are benchmarked against those of peer counties, the median of all U.S. counties, and Healthy People 2020 targets. 

Education & health

Why Education Matters to Health: Exploring the Causes
Virginia Commonwealth University Center on Society and Health (2014)
The links between education and health are complex and intertwined with income and the “geography of opportunity” where people live. This policy brief explores three connections: 1) How education creates opportunities for better health; 2) How poor health puts educational attainment at risk; and 3) How living conditions – especially beginning in early childhood – affect both health and education. The report is the second of a four-part series sponsored by the Robert Wood Johnson Foundation.

Differences In Life Expectancy Due To Race And Educational Differences Are Widening, And Many May Not Catch Up
S. Jay Olshansky & others, Health Affairs (2012)
From 1990 to 2008, the disparity in life expectancy between the most and least educated increased from 7.7 years to 10.3 years for women, and from 13.4 years to 14.2 years for men. Adults with fewer than 12 years of education now have life expectancies not much better than those of the overall U.S. population in the 1950s. The authors say the message for policy makers is clear: "Implement educational enhancements at young, middle, and older ages for people of all races, to reduce the large gap in health and longevity that persists today.” 

The Increasing Value of Education to Health
Dana Goldman and James P. Smith, Soc Sci Med (2011)
The health benefits associated with additional schooling have risen in recent decades by more than 10 percentage points, as measured by self-reported health status in this national study (limited to non-Hispanic whites). The gap has widened both in the likelihood of developing a chronic disease and in the health outcomes of those who become ill. “We need a better understanding of what the barriers are that make it more difficult for the less educated to invest in their health and benefit equally from the health enhancing improvements,” the authors conclude. “Without waiting for that understanding, we need to find remedies that compensate for deteriorating relative health outcomes of the most disadvantaged.”

Widening Educational Disparities in Premature Death Rates in Twenty Six States in the United States, 1993–2007
Jiemin Ma, Jiaquan Xu, Robert N. Anderson, and Ahmedin Jemal PLoS One (2012)
From 1993 through 2007, relative educational disparities in all-cause mortality continued to increase among working-aged men and women in the U.S., due to larger decreases of mortality rates among the most educated coupled with smaller decreases or even worsening trends in the less educated. For example, all-cause mortality in women with ≤12 years of education increased by 0.9 percent from 1993–2007.

The Gap Gets Bigger: Changes In Mortality And Life Expectancy, By Education, 1981-2000
E. R. Meara; Health Affairs (2008)
Since 1980, life expectancy has changed very little among the less-educated and virtually all gains in life expectancy occurred among highly educated groups.

Giving everyone the health of the educated: an examination of whether social change would save more lives than medical advances
Steven H. Woolf, M.D., M.P.H.; Robert E. Johnson, Ph.D.; Robert L. Phillips Jr., M.D., M.S.P.H.; and Maike Philipsen, Ph.D.; American Journal of Public Health (2007)
Argues that social changes to reduce education disparities would save more lives than would society’s heavy investment in medical advances.

Environmental hazards and disparities

Being overburdened and medically underserved: Assessment of this double disparity for populations in the state of Maryland 
Sacoby Wilson, Hongmei Zhang, Chengsheng Jiang, Kristen Burwell, Rebecca Rehr,  Rianna Murray, Laura Dalemarre and Charles Naney; Environmental Health, 2014
Are minorities and low-income individuals disproportionately affected by land with environmental hazards, such as Toxic Research Inventory (TRI) facilities? The researchers analyzed spatial disparities in the placement of these TRI facilities across the state of Maryland using several socioeconomic and demographic indicators. Using univariate and multivariate regression with Geographic Information Systems (GIS), they  assessed the burden of TRI facilities in four groups of census tracts: Tracts with at least one TRI facility, tracts located under 0.5 km from the nearest TRI facilities, and tracts located between 0.5 km and 1 km from the nearest TRI facilities. “We found that tracts with higher proportions of non-white residents and people living in poverty were more likely to be closer to TRI facilities,” the researchers wrote.  “We found that people of color and low-income groups are differentially burdened by TRI facilities in Maryland.” They also concluded that low-income and low-education individuals were overburdened and medically underserved as well.

Experts

Paula A. Braveman, M.D., M.P.H.
Director of the Center on Social Disparities in Health at the University of California, San Francisco, and a professor of family and community medicine at UCSF.
Email: braveman@fcm.ucsf.edu
Expertise: Measuring, understanding, and addressing socioeconomic and racial/ethnic disparities, particularly in maternal and infant health. During the 1990s she collaborated with World Health Organization staff in Geneva to develop a global initiative on equity in health and health care. She has been the Research Director for a national commission on the social determinants of health in the U.S. supported by the Robert Wood Johnson Foundation.

James R. Dunn, Ph.D.
Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada.
Email: jim.dunn@mcmaster.ca
Expertise: Socio-economic inequalities in health in urban areas. Current research includes studies of the effects of housing redevelopment on adult mental health and healthy child development, the health impacts of neighbourhood-based redevelopment strategies, the effects of subsidized housing on adult mental health and healthy child development and the effects of the built environment on physical activity.

Arvin Garg, M.D., M.P.H.
Department of Pediatrics, Division of General Pediatrics, Boston University School of Medicine, Boston Medical Center
Email: arvin.garg@bmc.org
Media contact: Jenny Eriksen, jenny.eriksen@bmc.org, 617-638-6841.
Expertise: Confronting the social determinants of health as a medical caregiver using the "patient-centered medical home" model of care.

Anthony Iton, M.D., J.D., M.P.H.
Senior vice president of Healthy Communities, The California Endowment
Former director and County Health Officer for the Alameda County Public Health Department.
Media Contact: Jeff Okey, jokey@calendow.org, 213-928-8622.
Expertise: Addressing the root causes of health disparities in ethnic populations and disadvantaged neighborhoods.

Jill Litt, Ph.D.
Associate Professor, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado at Denver
Email: Jill.Litt@ucdenver.edu
Telephone: 303-724-4402
Expertise: How the built environment and social forces interact to shape health and health disparities

Sir Michael Marmot
Professor at University College London
Director of the Institute of Health Equity
Email: m.marmot@ucl.ac.uk
Media contact: Felicity Porritt, senior media adviser, felicity.porritt@googlemail.com, phone: 44-7739419219
Expertise: One of the leading researchers on health inequalities; principal investigator of the famous Whitehall Studies of British civil servants; chaired the Commission on Social Determinants of Health set up by the World Health Organization in 2005; author of Status Syndrome: How your social standing directly affects your health and life expectancy.

Rima Rudd, M.S.P.H., Sc.D.
Department of Social and Behavioral Sciences, Harvard School of Public Health, Harvard University
Email: rrudd@hsph.harvard.edu
Media contact: Todd Datz, 617-432-8413
Expertise: Health literacy, including barriers to health information, health programs, and health care; health disparities

Megan Sandel, M.D., M.P.H.
Associate Professor of Pediatrics at the Boston University Schools of Medicine and Public Health, former pediatric medical director of Boston Healthcare for the Homeless program.
Email: megan.sandel@bmc.org
Expertise: The impact of housing on child health. She’s a co-author of the first national report on housing and child health (the DOC4Kids report), and co-principal investigator with Children’s HealthWatch. She’s worked with the Boston Public Health Commission and Massachusetts Department of Public Health to create links between housing inspection offices and the patient electronic medical record. And she bridges patients-to-policy work as Medical Director for the National Center for Medical-Legal Partnership.

David R. Williams, Ph.D., M.P.H.
Professor at Harvard University/Harvard School of Public Health & Department of African and African American Studies
Email: dwilliam@hsph.harvard.edu
Expertise: Social influences on physical and mental health, including race, racism, socioeconomic status, stress, health behaviors and religious involvement. Williams developed the Everyday Discrimination scale aimed at measuring perceived discrimination in health studies. He has served in various national public health roles, including positions with the Robert Wood Johnson Foundation and the Institute of Medicine, where he helped prepare the report “Unequal Treatment.” He currently directs the National Institutes of Health-funded Lung Cancer Disparities Center at the Harvard School of Public Health.

Cheri Wilson, M.A., M.H.S.
Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
Contact: chwilson@jhsph.edu or 443-287-0305
Expertise: Cheri Wilson is the program director of the Culture-Quality-Collaborative at JHU. Her areas of expertise include: health disparities, minority health, cultural competency and language barriers.

Steven H. Woolf, M.D.
Director of the Center on Human Needs and a professor in the Department of Family Medicine at Virginia Commonwealth University, in Richmond.
Email: swoolf@vcu.edu
Expertise: He was chair of the National Research Council’s Committee on Understanding International Health Differences in High-Income Countries, and a member of the Center for the Advancement of Health’s board of trustees, the Institute of Medicine (IOM) Committee on Public Health Strategies to Improve Health and on the IOM’s Interest Group on Health Disparities.

Food Environment

Food Systems and Public Health Disparities
Roni A. Neff and others, J Hunger Environ Nutr (2009)
The roots of health disparities go deeper than individual choice, nutrition, or price, say the authors of this opinionated review. Disparities in access to healthy food are driven by broad social, economic, and political forces that impact food supply, nutrient quality, and affordability. Environmental and social impacts of food production and processing also contribute to health disparities. “We cannot effectively address food-related health disparities or the ecologic harms of the food system without also working to make access to healthy and more sustainably produced food a right, not a privilege,” the authors conclude.

The art of grocery shopping on a food stamp budget
Kristen Wiiga and Chery Smith, Public Health Nutrition (2009)
The authors interviewed 92 low-income moms about their food shopping and meal planning.  “Key findings suggest that their food choices and grocery shopping behaviour were shaped by not only individual and family preferences, but also their economic and environmental situation. Transportation and store accessibility were major determinants of shopping frequency, and they used various strategies to make their food dollars stretch (e.g. shopping based on prices, in-store specials).”

Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis
Mayuree Rao, Ashkan Afshin, Gitanjali Singh, and Dariush Mozaffarian, BMJ Open (2013)
Healthy eating costs about $1.50 more per day per adult than eating a low-quality diet ($550 more annually per person), according to this meta-analysis by researchers at Brown University and the Harvard School of Public Health. The extra cost represents a 25 percent increase for a household that spends $6 per person on food each day, which is more than many low-income families spend.

Exhaustion Of Food Budgets At Month’s End And Hospital Admissions For Hypoglycemia
Hilary K. Seligman, Ann F. Bolger, David Guzman, Andrea López and Kirsten Bibbins-Domingo; Health Affairs (2014)
What happens every month when food money runs out? A surge in hospitalizations for hypoglycemia, the authors found. In many households, particularly low-income ones, a “pay cycle” develops in which expenditures increase when money becomes available, and they decrease just before the next check is due – the time when household budgets are most likely to be exhausted. The authors looked at how the pay cycle affects hypoglycemia because they expected it to be highly influenced by reduced food access.

A Systematic Review of Food Deserts, 1966-2007
The U.S. stands out for its “clear evidence” of disparities in food access by income and race, in this systematic review of 49 studies in 5 countries. “Evidence for the existence of food deserts in other high-income nations is weak,” write authors Julie Beaulac, Elizabeth Kristjansson, & Steven Cummins (Prev Chronic Dis, 2009).

Access to Healthy Food and Why it Matters: A Review of the Research
A review of the research on access to healthy food and its impact on individual and community health, with a bibliography of more than 250 up-to-date scientific papers, books and other references. By Judith Bell, Gabriella Mora, Erin Hagan, Victor Rubin, Allison Karpyn, Policy Link & The Food Trust (2013).

Fundamental causes of health disparities

The Kaiser Family Foundation: Disparities Policy
The Henry J. Kaiser Family Foundation (KFF), a nonpartisan group, offers comprehensive resources on policies related to health disparities. It includes information on utilization by race, health care coverage – including for those who are uninsured or on Medicaid or Medicare, health promotion and other related topics. There are also plenty of visuals, from polls to graphics. For those just starting on the issue, these Five Key Questions and Answers are a good starting point. (KFF is not part of health care provider Kaiser Permanente.)

The Quality of Data on ‘‘Race’’ and ‘‘Ethnicity’’: Implications for Health Researchers, Policy Makers, and Practitioners
Judith B. Kaplan (2014)
Researchers and reporters writing about health disparities may make assumptions about the quality of underlying data on race and ethnicity. It is often taken for granted that these terms are defined universally or consistently, or that the classifications themselves are worthwhile.  In this paper, Judith Kaplan, Center  for Quality Improvement, Centers for Medicare and Medicaid Services, outlines some challenges to the assumption that “race and ethnicity data” is generalizable and of good quality. “These classifications are inherently too imprecise to allow meaningful statements to be made about underlying biological or genetic differences between groups,” Kaplan cautions. “Findings of racial/ethnic differences should be reported with appropriate caveats and interpreted with caution.”

Social Conditions as Fundamental Causes of Disease
Bruce G. Link, Jo Phelan
Journal of Health and Social Behavior (1995)
In this influential 1995 paper, Link and Phelan were among the first to make the case that inequalities in health are unlikely to change unless we take steps to reduce inequalities in income, education, and social status:  “For example, there are powerful social, cultural, and economic factors shaping the diet of poor people in the United States. Consequently, providing information about healthy diet to poor people and exhorting them to follow nutritional guidelines is unlikely to have much impact. Without an understanding of the context that leads to risk, the responsibility for reducing the risk is left with the individual, and nothing is done to alter the more fundamental factors that put people at risk of risks.”

Technological Innovation and Inequality in Health
Sherry Glied & Adriana Lleras-Muney, Demography (2008)
People with more education live longer than those with less education, and this survival advantage of the more-educated increases in the case of diseases with more rapid progress in treatment technology. The findings support the idea that higher levels of education equip people with the knowledge and resources to access new treatments more readily than those with limited education.

Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications
Jo C. Phelan, Bruce G. Link and Parisa Tehranifar, Journal of Health and Social Behavior (2010)
The authors explain the theory of fundamental causes, review the supporting evidence,  consider limits to the theory, and discuss its implications for policy efforts to reduce health inequalities.

History and Background

HealthyPeople.Gov – Determinants of Health: This ongoing federal initiative includes a look at the broad categories impacting people’s health, including policymaking, social factors, health services, individual behavior and biology and genetics. Part of the Department of Health and Human Services project aimed at improving Americans’ health by the year 2020, it offers a basic overview of the social determinants of health as well as additional resources and reports. It also includes a separate section on health disparities

CBPP: A Guide to Statistics on Historical Trends in Income Inequality: The Center on Budget and Policy Priorities offers this useful guide on the historical trends in income inequality. The report analyzes data from both the U.S. Census Bureau and Internal Revenue Service to offer a picture of U.S. incomes since the 1970s.

Covering Health in a Multicultural Society
AHCJ produced this book as a tool for understanding the increasing diversity of the audiences we serve. It is meant to expand reporters’ knowledge of what culture, ethnicity, health and well-being mean to people from a variety of backgrounds.

CDC Health Disparities and Inequalities Report — United States, 2013
This the second CDC report to address a multitude of differences in mortality and disease risk related to behaviors, access to health care, and social determinants of health – the conditions in which people are born, grow, live and work. The topics table lists the issues studied in the report and provides links to current data and information about the ongoing work on health disparities across the agency. Download a PDF of the report or get the 2011 version.

The Biology of Disadvantage: Socioeconomic Status and Health
Edited by Nancy E. Adler and Judith Stewart; Annals of the New York Academy of Sciences (2010)
How does socioeconomic status “get under the skin” to affect health? This volume surveys the current state of knowledge with 13 articles distilling a decade of research by a network of scholars funded by the John D. and Catherine T. MacArthur Foundation.

Social Conditions as Fundamental Causes of Disease
Bruce G. Link, Jo Phelan; Journal of Health and Social Behavior (1995)
In this influential paper, Link and Phelan were among the first to make the case that inequalities in health are unlikely to change unless we take steps to reduce inequalities in income, education, and social status: “For example, there are powerful social, cultural, and economic factors shaping the diet of poor people in the United States. Consequently, providing information about healthy diet to poor people and exhorting them to follow nutritional guidelines is unlikely to have much impact. Without an understanding of the context that leads to risk, the responsibility for reducing the risk is left with the individual, and nothing is done to alter the more fundamental factors that put people at risk of risks.”

Employment grade and coronary heart disease in British civil servants
M. G. Marmot, Geoffrey Rose, M. Shipley, and P. J. S. Hamilton; Journal of Epidemiology and Community Health (1978)
A classic paper, based on the pioneering Whitehall study of British civil servants, showing that heart disease mortality rises with decreasing employment grade – even after taking into account differences in body mass index, blood pressure, blood sugar, smoking and physical activity. “It is to be hoped that from a better understanding of the reasons for social class difference in disease, some means may emerge of protecting groups at such greatly increased risk,” the authors conclude.

The Fall and Rise of US Inequities in Premature Mortality: 1960–2002
Nancy Krieger, David H. Rehkopf,  Jarvis T. Chen, Pamela D. Waterman, Enrico Marcelli, Malinda Kennedy; PLoS Medicine (2008)
Between 1960 and 2002, U.S. infant death rates and premature mortality fell among county populations across income levels, and socioeconomic and racial/ethnic inequities shrank between 1966 and 1980. But since 1980, the relative health inequities have grown wider. Had all persons experienced the same yearly age-specific premature mortality rates as the highest income one-fifth of the white population, between 1960 and 2002, 14 percent of the white premature deaths and 30 percent of the premature deaths among populations of color would not have occurred.

Rediscovering the social determinants of health
David Mechanic; Health Affairs (2000)
This opinionated review of studies on social determinants of health provides helpful historical background, including how the field began with the work of 19th Century sociologists such as Emile Durkheim and benefitted from a surge of renewed interest starting in the late 1990s.

Q&A with Len Syme, public health pioneer
S. Leonard Syme, who began studying the social determinants of health in the 1950s, talks about the history of the field and where it is heading. He is an emeritus professor at the UC Berkeley School of Public Health and Co-Director of the Health Research for Action Center. Sample quote: “A major flaw in our field is our focus on diseases. We’re really talking about psychosocial risk factors and compromised immune functioning, and while these don’t cause one disease, they increase the risk of all diseases. Once you pick a disease, you’ve lost the power of the approach. But where would you send a grant to study discrimination diseases? Or hopelessness diseases?”

Health Policy Brief: Health Gaps
Health and longevity are driven by factors such as race, gender, educational attainment, and ZIP code “that should not make a difference,” Catherine Dower observes in this health policy brief produced by Health Affairs through a grant from the Robert Wood Johnson Foundation. Dower provides a concise backgrounder on health disparities, a rundown of the policy implications, an informed look at what the future holds, and links to more in-depth research. 

Implications for Medical Practice

Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2
If standardized social and behavioral data can be incorporated into patient electronic health records (EHRs), those data can provide crucial information about factors that influence health and the effectiveness of treatment. With this goal in mind, a committee was convened to conduct a two-phase study - first to identify social and behavioral domains that most strongly determine health, and then to evaluate the measures of those domains that can be used in EHRs.

Rethinking the Social History
Heidi L. Behforouz, Paul K. Drain, and Joseph J. Rhatigan, N Engl J Med (2014)
Doctors don’t pay enough attention to their patients’ ability to pay for medications, access to transportation, available time, and competing priorities. Physicians cannot afford to ignore these social factors in assessments and treatment plans “if we hope to improve outcomes, reduce costs, and improve patient satisfaction,” the authors assert. “Patients know clinicians cannot alleviate their poverty, but empathy and concern shown by a clinician who explicitly addresses it constitute powerful medicine.”

Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment
Deborah Bachrach, Helen Pfister, Kier Wallis, and Mindy Lipson, Manatt Health Solutions. The Commonwealth Fund (2014)
The Affordable Care Act and other changes in the health care landscape are leading medical providers to more directly confront the social determinants of health. New payment models, for example, will increasingly hold providers financially accountable for patient health and the costs of treatment. “These models—including capitated, global, and bundled payments, shared savings arrangements, and penalties for hospital readmissions—give providers economic incentives to incorporate social interventions into their approach to care,” the authors say.

Medical schools neglect social determinants of health

We know a lot about the ways in which inequality destroys health. Why aren't we doing more to fix it? Jonathan Metz, Ph.D., explains that training in biology alone leaves doctors unprepared for understanding how social circumstances shape people's health. Metz, a psychiatrist who happens to have master’s in poetry and doctorate in American studies, directs Vanderbilt University’s Center for Medicine, Health, and Society. You can read further in an unusually lucid sociology paper he co-authored with Helena Hansen of New York University.

Addressing the Social Determinants of Health Within the Patient-Centered Medical Home: Lessons From Pediatrics

Arvin Garg, M.D., M.P.H.; Brian Jack, M.D.; Barry Zuckerman, M.D.; Journal of the American Medical Association (2013)
A pediatrician asserts that medical practices that adopt the patient-centered medical home model are more capable of addressing the social determinants of health.

The Social Determinants of Health and Pandemic H1N1 2009 Influenza Severity
Elizabeth C. Lowcock, Laura C. Rosella, Julie Foisy, Allison McGeer and Natasha Crowcroft; American Journal of Public Health (2012)
Clinical risk factors for severe pandemic H1N1 2009 illness explain only a small portion of the associations observed between socioeconomic status and hospitalization. This suggests that the means by which the social determinants of health affect pandemic H1N1 2009 outcomes extend beyond influencing these recognized risk factors. The authors conclude that “a social determinants approach to promoting public health is an essential component of pandemic planning” and preventing flu-related hospitalizations and deaths.

Journalism

Diversity Style Guide
From the Center for Integration and Improvement of Journalism at San Francisco State University; this guide includes hundreds of terms related to race/ethnicity, disability, immigration, sexuality and gender identity, drugs and alcohol, and geography. amalgamates information from more than 20 different style guides, journalism organizations and resources.

Living Lonely
Lois M. Collins examines the health effects of loneliness on the elderly in this three-part series for the Deseret News. Collins was supported by a 2013 National Health Journalism Fellowship.

The Wealth Paradox
The Globe and Mail’s impressive series of articles, videos and info-graphics explores how Canada’s increasing wealth gap is reshaping society and putting future generations at a disadvantage. Health reporter André Picard’s piece, Wealth begets health: Why universal medical care only goes so far, digs into the health impact of income inequality despite Canada’s longstanding provision of medical care to all.

In Hidalgo County, too much of too little
Told in a riveting narrative style, The Washington Post explores how inequality and a “food-stamp diet” is wrecking the health of many people in Texas’s Rio Grande Valley. Exemplary also for its use of photography, video and data graphics.

Shortened Lives
A deeply reported, four-part series on the gap in health and life expectancies between rich and poor neighborhoods by Bay Area News Group reporters Suzanne Bohan and Sandy Kleffman, with statistical analysis and mapping by epidemiologist Matt Beyers of the Alameda County Public Health Department. Read about how they reported the series.

Unnatural Causes – Is inequality making us sick?
A seven-part video documentary series exploring conditions contributing to racial and socioeconomic inequalities in health, broadcast by PBS in 2008.

LGBT health

Healthy People 2020: Lesbian, Gay, Bisexual, and Transgender Health
The U.S. government’s Healthy People 2020 (HP2020) project includes a new section on lesbian, gay, bisexual and transgender health. The project includes an overview of LGBT health issues and statistics as well as links to other resources and related U.S. government initiatives. It also provides an update of HP2020’s goal to collect health data on LGBT populations. 

Measuring the Problem

Rural Health Information Hub
The federal government’s Rural Health Information Hub serves as an information portal on rural health and related services. Funded by the Federal Office of Rural Health Policy to be a national clearinghouse on rural health issues, the site offers on online library, state-by-state information and other data. It also hosts a special section on the social determinants of health.

CDC Health Disparities and Inequalities Report — United States, 2013
This the second CDC report to address a multitude of differences in mortality and disease risk related to behaviors, access to health care, and social determinants of health – the conditions in which people are born, grow, live and work. The topics table lists the issues studied in the report and provides links to data and information about the ongoing work on health disparities across the agency. Download a PDF of the report or get the 2011 version.

Overcoming Obstacles to Health in 2013 and Beyond
RWJF Commission to Build a Healthier America. (2013)
Poor, middle-class and even wealthy Americans are less healthy than their counterparts in other affluent countries. The authors analyze the existing research to explain why Americans are not as healthy as they could be, and suggests evidence-based solutions.

Estimated deaths attributable to social factors in the United States
Sandro Galea, M.D., Dr.P.H.; Melissa Tracy, M.P.H.; Katherine J. Hoggatt, Ph.D.; Charles DiMaggio, Ph.D.; and Adam Karpati, M.D., M.P.H.; American Journal of Public Health (2011)
About 245,000 deaths in the United States in 2000 were attributable to low education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality and 39,000 to area-level poverty.

The Gap Gets Bigger: Changes In Mortality And Life Expectancy, By Education, 1981-2000
E. R. Meara; Health Affairs (2008)
Since 1980, life expectancy has changed very little among the less-educated and virtually all gains in life expectancy occurred among highly educated groups.

Life and death from unnatural causes: health and social inequity in Alameda County
Alameda County Department of Health, Oakland, Calif. (2008)
Documents the health disparities in Alameda County by neighborhood, income level, and race/ethnicity; examines the links between these disparities and existing economic and social inequities; and suggests policies to reduce inequalities.

The Fall and Rise of US Inequities in Premature Mortality: 1960–2002
Nancy Krieger, David H. Rehkopf,  Jarvis T. Chen, Pamela D. Waterman, Enrico Marcelli, Malinda Kennedy; PLoS Medicine (2008)
Between 1960 and 2002, U.S. infant death rates and premature mortality fell among county populations across income levels, and socioeconomic and racial/ethnic inequities shrank between 1966 and 1980. But since 1980, the relative health inequities have grown wider. Had all persons experienced the same yearly age-specific premature mortality rates as the highest income one-fifth of the white population, between 1960 and 2002, 14 percent of the white premature deaths and 30 percent of the premature deaths among populations of color would not have occurred.

Falling behind: life expectancy in US counties from 2000 to 2007 in an international context
Sandeep Kulkarni, Alison Levin-Rector, Majid Ezzati and Christopher Murray, Population Health Metrics (2011)
A revealing county-level analysis of health inequalities in the U.S. The authors’ maps show the parts of the U.S. where life expectancy lags behind the best performing nations by about 50 years, i.e., it’s equivalent to life expectancies during the 1960s in other wealthy countries. “The extent of geographic inequality is substantially larger in the US than in the UK, Canada, or Japan. Equally concerning is that between 2000 and 2007, more than 85% of American counties have fallen further behind the international life expectancy frontier…”

Healthy People 2020: Lesbian, Gay, Bisexual, and Transgender Health
The U.S. government’s Healthy People 2020 (HP2020) project includes a new section on lesbian, gay, bisexual and transgender health. The project includes an overview of LGBT health issues and statistics as well as links to other resources and related U.S. government initiatives. It also provides an update of HP2020’s goal to collect health data on LGBT populations. 

Neighborhoods and Social Networks

Income Inequality: It’s Also Bad for Your Health
This New York Times map offers a striking look at the impact of living in communities with high income inequality on life expectancy compared to living in areas with less of an income gap.

Place and health: why conditions where we live, learn, work, and play matter
Summary of a round table discussion among experts in the fields of housing and neighborhoods, violence prevention, and the growing use of health impact assessments to determine the health implications of community development and other programs and policies, convened by the Robert Wood Johnson Foundation in 2011.

Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review
K. E. Pickett, M. Pearl; Journal of Epidemiology & Community Health (2001)
Informative critique of studies on the influence of the health impact of neighborhood residence.

City Maps
Maps highlighting the stark differences in life expectancy for babies born in adjacent neighborhoods in five representative cities, part of the Robert Wood Johnson Foundation’s Commission to Build a Healthier America.

Stress and the allostatic load hypothesis

NAS Trauma Systems report (2016)
This report by the National Academies of Sciences, Engineering, and Medicine looks at the nation’s health care system in caring for trauma patients – both U.S. service members as well as civilians –  across the continuum of care from initial injury and hospitalization to  rehabilitation and other care. The report, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths,” looks closely at the experience of those who served in the wars in Afghanistan and Iraq. But the Institutes of Medicine panel calls for a joint military-civilian national trauma care system to improve care nationwide. The U.S. Defense Department, the U.S. Department of Homeland Security, the American College of Emergency Physicians and the American College of Surgeons, among others, sponsored the report.

“Weathering” and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States
Arline T. Geronimus, Margaret Hicken, Danya Keene, and John Bound, Am J Public Health (2006).
The authors compared African-Americans and whites on measure called “allostatic load,” which is supposed to reflect how well or poorly the cardiovascular, metabolic, nervous, hormonal and immune systems are functioning. The study found that blacks scored worse than whites at all ages, and the racial differences persisted after adjustment for poverty. In fact, nonpoor blacks scored worse than poor whites.

Socio-economic differentials in peripheral biology: Cumulative allostatic load
Teresa Seeman, Elissa Epel, Tara Gruenewald, Arun Karlamangla and Bruce S. McEwen, Annals of the New York Academy of Sciences (2010).
Allostatic load theory attempts to explain how psychological and social experiences “get under the skin” and give rise to disease. The basic idea is that repeated stressful experiences can build up over time, gradually wearing down the body’s regulatory systems, opening the door to the onset and progression of many different diseases. The authors present a helpful review of the evidence behind the theory, and how it might contribute to the development of more evidence-based programs and policies to reduce current social inequalities.  

Racial and Ethnic Patterns of Allostatic Load Among Adult Women in the United States: Findings from the National Health and Nutrition Examination Survey 1999–2004
Laura Chyu and Dawn M. Upchurch, J Womens Health (2011).
Allostatic load is an indicator of biological aging, and it reveals a pronounced racial disparity. In this nationally representative study, black women 40–49 years old had allostatic load scores 1.14 times higher than white women 50–59 years old. Meanwhile, Mexican women not born in the United States had lower allostatic load scores than those born in the United States. “The persistent black/white disparity in AL across all age groups observed in this study suggests that black women are already at a significant health disadvantage in early adulthood, and this pattern persists over the life course, with particularly pronounced black/white disparities by midlife,” the authors said.

Sociodemographic Correlates of Allostatic Load Among a National Sample of Adolescents: Findings From the National Health and Nutrition Examination Survey, 1999–2008
Bethany K. Wexler Rainisch and Dawn M. Upchurch, Journal of Adolescent Health (2013).
Using data from 8,000 teenagers, the authors found that by adolescence you can already see racial and socioeconomic inequalities in allostatic load, a measure of biological wear-and-tear (based on a combination of blood pressure, body mass index, blood sugar, and other biomarkers).  Average allostatic load was higher for blacks than whites or Mexican-Americans, and was higher among adolescents of lower socioeconomic status.

Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk: The Whitehall II Prospective Cohort Study
Silvia Stringhini, G. David Batty, Pascal Bovet, Martin J. Shipley, Michael G. Marmot, et al.; PLoS Med (2013).
Cumulative exposure to low socioeconomic status over the lifecourse and a downward trajectory from high SES in childhood to low SES in adulthood were associated with an increased risk of developing type 2 diabetes over the study period. Inflammatory processes, measured repeatedly through biomarkers in the blood, explained as much as one third of this association.

Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease
Bruce S. McEwen and Peter J. Gianaros; Annals of the New York Academy Of Sciences (2010)
A review of research on chronic stress and how it can lead to a long-term dysregulation of vital systems and make people more vulnerable to a spectrum of illnesses.

Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: a longitudinal study
N. H. Rod, M. Grønbæk, P. Schnohr, E. Prescott, T. S. Kristensen; Journal of Internal Medicine (2009)
Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking, more likely to become physically inactive, less likely to stop drinking above the sensible drinking limits, and stressed women were more likely to become overweight during follow-up. Men and women with high stress were more likely to use antihypertensive medication, and stressed men were more than two times as likely to develop diabetes during follow-up.

Veterans

National Veteran Health Equity Report – A government project by the Veterans Administration, this report by the VA’s Office of Health Equity gives basic information on the social determinants of health for veterans receiving care under the Veterans Health Administration, including information by race/ethnicity, gender, age and geography. It also includes data on mental health status.

Violent injuries & deaths

NAS Trauma Systems report (2016)
This report by the National Academies of Sciences, Engineering, and Medicine looks at the nation’s health care system in caring for trauma patients – both U.S. service members as well as civilians –  across the continuum of care from initial injury and hospitalization to  rehabilitation and other care. The report, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths,” looks closely at the experience of those who served in the wars in Afghanistan and Iraq. But the Institutes of Medicine panel calls for a joint military-civilian national trauma care system to improve care nationwide. The U.S. Defense Department, the U.S. Department of Homeland Security, the American College of Emergency Physicians and the American College of Surgeons, among others, sponsored the report.

Neighborhoods and Violent Crime: A Multilevel Study of Collective Efficacy
Robert J. Sampson, Stephen W. Raudenbush, and Felton Earls, Science (1997)
The willingness of neighbors to band together for the common good – their collective efficacy – is tightly linked to levels of neighborhood violence, this influential paper revealed. The authors surveyed about 8,800 Chicago residents, and developed a measure of collective efficacy to compare neighborhoods. The lack of collective efficacy may largely explain why people living in poor neighborhoods are more likely to be victims of violent crime. Based on the findings of this study and others that followed, a number of cities have begun testing ways to mobilize collective efficacy as a way to reduce violent crime.

Prevention of injury and violence in the USA
Tamara M. Haegerich and others, The Lancet (2014)
Injuries and violence kill more young people in the U.S. than any other cause of death. The burden of these deaths varies enormously by race, ethnicity and social class, and this paper provides recent numbers. Deaths by homicide, for instance, are more than eight times more prevalent among blacks than among whites, and homicide deaths are three times more common among American Indians and Alaskan Natives than among whites between the ages of 1 to 30 years old. The authors explain how socioeconomic factors contribute to the unequal burden of violent death.

Years off Your Life? The Effects of Homicide on Life Expectancy by Neighborhood and Race/Ethnicity in Los Angeles County
Matthew Redelings & others, J Urban Health (2010)
Homicide takes two full years off the expected life span of men who are African American in Los Angeles County, and in some low-income sections of LA, homicide subtracts nearly five years from the expected life span of black men. The authors analyzed life expectancy in years and expected life years lost due to homicide during the years 2001–2006.

A Population-Based Analysis of Neighborhood Socioeconomic Status and Injury Admission Rates and In-Hospital Mortality
Ben L. Zarzaur and others, J Am Coll Surg (2010)
The risk of violent injury (and other injuries) rose with each step of decreasing neighborhood socioeconomic status in this ten-year study of hospitalizations in Memphis, Tenn., and surrounding Shelby County.  

Vacant Properties and Violence in Neighborhoods
Charles C. Branas & others, ISRN Public Health (2013)
The so-called Broken Windows theory has led to initiatives that try to reduce violence by restoring deteriorating neighborhoods and sealing or removing vacant buildings. Researchers in Philadelphia found a significant association between the risk of violent assault and the presence of abandoned buildings and vacant lots, even after controlling for demographic and socioeconomic characteristics of the neighborhoods. Vacant properties also had the strongest effect size, prevailing in over almost a dozen well-known indicators of disadvantage.

Urban–Rural Shifts in Intentional Firearm Death: Different Causes, Same Results
Charles C. Branas and others, Am J Public Health (2004)
Firearm death is as pervasive a public health problem in rural counties as it is in urban counties in the United States, the authors found. The rate of firearm suicide in the most rural communities closely resembled that of firearm homicide in the largest cities.