THE SOCIOCULTURAL ENVIRONMENT

The fields of social epidemiology, psychology, anthropology, sociology, and economics are converging in the development of theories and methodologies, helping us to understand factors underlying health disparities. Levine and his colleagues set the stage for this convergence, especially with the Handbook of Medical Sociology (Freeman and Levine, 1989). Recent reviews by Yen and Syme (1999) and Social Studies in Health and Medicine (Albrecht, Fitzpatrick, and Scrimshaw, 2000) are among many recent analyses dealing with these complex issues. The recent Institute of Medicine report, Promoting Health (2000), advances our understanding of health behavior and health disparities. Some common themes from these sources give directions to the underlying factors contributing to health disparities, as follows:

  • Disparate access to prevention and treatment services;

  • Differences in patterns of use of services;

  • Differences in behaviors in response to illness;

  • Differences in environmental and occupational risks;

  • Differences in health promotion and disease prevention behaviors;

  • Differences in community factors such as stress, societal support, and community cohesion; and

  • Genetic factors that come into play for individuals, but seldom for groups.

The Centers for Disease Control and Prevention Task Force on the Guide to Community Preventative Services developed an organizing logic framework for looking at many of these themes (see Figure 7-1). The Task Force was charged with developing evidence-based guidelines for community public health practice (Truman et al., 2000; Centers for Disease Control and Prevention, 2000b). Other topics in the guide include major risk behaviors such as smoking, sex, drugs, injury, nutrition, and exercise, and some diseases, such as cancer and diabetes. The discussion of the



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