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J Public Health Policy. 2000;21(4):394-427.

Health inequities in the United States: prospects and solutions.

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Department of Public Health Sciences, University of Toronto, McMurrich Building, Toronto, Ontario, M5S IA8, Canada.


An overview of the role that social determinants of health play in influencing health is provided. Emphasis is on the impact of economic inequality in creating health inequities among Americans. Economic inequality is seen as impacting health in three ways: increasing economic inequality weakens population health by creating poverty; weakening communal social structures that support health such as social and health services; and decreasing social cohesion and civil commitment. Documentation is provided of the growing degree of economic inequality in the USA and complicating issues of racial segregation are considered. Specific recommendations for addressing economic inequality, from USA, British, and Canadian sources, are presented. These recommendations indicate the need to move from epidemiologic research to public health action, from demonstrating the major impact of economic inequality on community health to the development and implementation of specific policies and programs to reverse the continuing increase in economic inequality.

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