How Should We Improve Neighborhood Health? Evaluating Evidence from a Social Determinant Perspective

• Published in: Current epidemiology reports Vol. 3; no. 1; pp. 106 - 112
• Main Authors: Oakes, J. Michael, Fuchs, Erika L., Tate, Allan D., Galos, Dylan L., Biyoow, Ifrah M.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-03-2016
• Subjects: Epidemiology; Medicine; Medicine & Public Health; Section Editor; Social Epidemiology (JM Oakes; Topical Collection on Social Epidemiology; RCT; Social epidemiology; Public health; Community; Health disparities
• ISSN: 2196-2995; 2196-2995
• DOI: 10.1007/s40471-016-0072-x

Background
A great deal of public health research and activism has focused on improving the health of persons residing in specific and/or disadvantaged neighborhoods. There is growing consensus that in order to have an impact, interventions must address the social determinants of health, which include access to health care, education, economic stability, neighborhood and built environment, and social context. Yet, there is some question about the best strategy for actually improving a neighborhood’s health.
Objectives
This paper discusses existing experimental evidence for the effects, or lack thereof, of social interventions on the average health of neighborhoods.
Research Design
We conducted a targeted literature review of published research using PubMed, Social Science Index, and Google Scholar databases. We summarize and synthesize key evaluation research, focusing on experimental studies and those doing comparative analyses of alternative interventions in the USA.
Findings
Despite the publication of thousands of papers addressing the social determinants of health, there is very little experimental and/or rigorous comparative research to guide researchers, policymakers, philanthropists, or other stakeholders on optimal strategies to improve health in communities. Comparative analysis, performed to determine what an alternative intervention or policy would have accomplished, and opportunity costs and unintended consequences are rarely considered.
Conclusions
If scholars and activists truly believe that improvements must address the social determinants of health, it is time for a more concerted effort to determine what works, when and where, and what the opportunity costs relative to plausible alternatives are. While usually expensive, occasionally ethically challenged, and occasionally infeasible, (cluster randomized) experiments remain critical to understanding what works and where. Social epidemiologists must be better positioned to offer guidance in this regard.