Mercado Carla I, Bullard Kai McKeever, Bolduc Michele L F, Andrews Courtni Alexis, Freggens Zoe R F, Liggett Grace, Banks Desmond, Johnson Shanice Battle, Penman-Aguilar Ana, Njai Rashid
Office of Minority Health, Office of Health Equity, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Public Health Rep. 2024 Oct 11:333549241283586. doi: 10.1177/00333549241283586.
Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age that influence health outcomes, and structural and systemic drivers of health (SSD) are the social, cultural, political, and economic contexts that create and shape SDOH. With the integration of constructs from previous examples, we propose an SSD model that broadens the contextual effect of these driving forces or factors rooted in the Centers for Disease Control and Prevention's SDOH framework. Our SSD model (1) presents systems and structures as multidimensional, (2) considers 10 dimensions as discrete and intersectional, and (3) acknowledges health-related effects over time at different life stages and across generations. We also present an application of this SSD model to the housing domain and describe how SSD affect SDOH through multiple mechanisms that may lead to unequal resources, opportunities, and consequences contributing to a disproportionate burden of disease, illness, and death in the US population. Our enhanced SDOH framework offers an innovative and promising model for multidimensional, collaborative public health approaches toward achieving health equity and eliminating health disparities.
健康的社会决定因素（SDOH）是指人们出生、成长、生活、工作和衰老的环境，这些环境会影响健康结果；而健康的结构和系统驱动因素（SSD）是创造和塑造SDOH的社会、文化、政治和经济背景。通过整合先前例子中的概念，我们提出了一个SSD模型，该模型拓宽了这些植根于疾病控制与预防中心SDOH框架的驱动力或因素的背景效应。我们的SSD模型（1）将系统和结构呈现为多维的，（2）将10个维度视为离散且相互交叉的，（3）承认在不同生命阶段和几代人之间随着时间推移产生的与健康相关的影响。我们还展示了这个SSD模型在住房领域的应用，并描述了SSD如何通过多种机制影响SDOH，这些机制可能导致资源、机会和后果不平等，从而造成美国人口中疾病、病患和死亡的不成比例负担。我们改进后的SDOH框架为实现健康公平和消除健康差距的多维、协作性公共卫生方法提供了一个创新且有前景的模型。
