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J Health Care Poor Underserved. 2009;20(4 Suppl):1-12. doi: 10.1353/hpu.0.0228.

Addressing the social determinants of children's health: a cliff analogy.

Author information

1
Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. cdj9@cdc.gov

Abstract

This paper presents a "Cliff Analogy" illustrating three dimensions of health intervention to help people who are falling off of the cliff of good health: providing health services, addressing the social determinants of health, and addressing the social determinants of equity. In the terms of the analogy, health services include an ambulance at the bottom of the cliff, a net or trampoline halfway down, and a fence at the top of the cliff. Addressing the social determinants of health involves the deliberate movement of the population away from the edge of the cliff. Addressing the social determinants of equity acknowledges that the cliff is three-dimensional and involves interventions on the structures, policies, practices, norms, and values that differentially distribute resources and risks along the cliff face. The authors affirm that we need to address both the social determinants of health, including poverty, and the social determinants of equity, including racism, if we are to improve health outcomes and eliminate health disparities.

PMID:
20168027
DOI:
10.1353/hpu.0.0228
[Indexed for MEDLINE]

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