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Public Health Reports Social Determinants of Health

By Dr. Kevin Fenton and Dr. Hazel Dean

June 14, 2010

This article was cross-posted from the AIDS.gov blog. Dr. Kevin Fenton is Director and Dr. Hazel Dean is Deputy Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (Cross-posted from Health Protection, Perspectives blog, June 7, 2010.)

On June 7, Public Health Reports released a special issue that focuses on Social Determinants of Health in the Prevention and Control of HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infections and Tuberculosis. This groundbreaking supplement brings to the forefront the broad impact social influences, standings, and characteristics can have on the health of each and every person.

We are honored to have worked on this supplement as guest co-editors, reaffirming our commitment to better understand the influence of social determinants on health and to integrate these elements into our work to prevent HIV/AIDS, viral hepatitis, sexually transmitted infections (STIs) and tuberculosis (TB). By integrating a social-determinants-of-health (SDH) framework within the context of our prevention efforts, we will be better able to address the overall health risks of those we serve and improve health outcomes.

Individual risk behaviors do not occur in a vacuum. It is clear that the circumstances in which people grow, live, work, socialize and form relationships influence their individual-level determinants of health, including high-risk behaviors -- unsafe sex and injection drug use. But we also know that patterns and distribution of our focus diseases in a population are influenced by a dynamic interplay among the number of infections in a population, the availability and effectiveness of prevention efforts, and myriad social and structural factors.

This special supplement of Public Health Reports presents research and commentary on the interplay and integration of SDH in prevention efforts. Comprehensive approaches are needed to meet the needs of overall community and societal characteristics. Some of these characteristics are addressed in this issue, such as the effects of incarceration; the differences in HIV transmission among foreign- and native-born persons; income and/or social status, including registered and non-registered female sex workers; stigma; and education; among other areas.

Former CDC Directors Drs. David Satcher and William Foege both provide insightful commentary regarding elevating the profile of SDH (Dr. Satcher) and pursuing this "last mile" in prevention through SDH (Dr. Foege). Also, a selection of studies in this issue focuses on income and social status and examines how economic insecurity and poverty affect the risk of HIV infection. As well, the role of stigma, education level, race, gender are played out in the health arena; and we know that combined, confounding, and complicating factors all contribute to disease risk, poorer health outcomes, and earlier disability and death.

This Public Health Reports' supplement is an important step in our response to persistent and widening health inequities. As we continue to integrate and collaborate in our efforts to address the social and structural barriers to health, we want to help ensure awareness and willingness across the spectrum of public health to address SDH in prevention programs, services, research, and policy interventions. Together, we can achieve innovative, impactful results that improve and save lives.

Please take time to read this report and the pertinent and useful articles included and join us in this movement to expand, integrate, and broaden our focus and our work. We look forward to your comments to this blog entry and in your public health actions.

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