TY - JOUR
T1 - Addressing population health and health inequalities
T2 - The role of fundamental causes
AU - Cerda, Magdalena
AU - Tracy, Melissa
AU - Ahern, Jennifer
AU - Galea, Sandro
PY - 2014/1/1
Y1 - 2014/1/1
N2 - Objectives. As a case study of the impact of universal versus targeted interventions on population health and health inequalities, we used simulations to examine (1) whether universal or targeted manipulations of collective efficacy better reduced population-level rates and racial/ethnic inequalities in violent victimization; and (2) whether experiments reduced disparities without addressing fundamental causes. Methods. We applied agent-based simulation techniques to the specific example of an intervention on neighborhood collective efficacy to reduce populationlevel rates and racial/ethnic inequalities in violent victimization. The agent population consisted of 4000 individuals aged 18 years and older with sociodemographic characteristics assigned to match distributions of the adult population in New York City according to the 2000 US Census. Results. Universal experiments reduced rates of victimization more than targeted experiments. However, neither experiment reduced inequalities. To reduce inequalities, it was necessary to eliminate racial/ethnic residential segregation. Conclusions. These simulations support the use of universal intervention but suggest that it is not possible to address inequalities in health without first addressing fundamental causes.
AB - Objectives. As a case study of the impact of universal versus targeted interventions on population health and health inequalities, we used simulations to examine (1) whether universal or targeted manipulations of collective efficacy better reduced population-level rates and racial/ethnic inequalities in violent victimization; and (2) whether experiments reduced disparities without addressing fundamental causes. Methods. We applied agent-based simulation techniques to the specific example of an intervention on neighborhood collective efficacy to reduce populationlevel rates and racial/ethnic inequalities in violent victimization. The agent population consisted of 4000 individuals aged 18 years and older with sociodemographic characteristics assigned to match distributions of the adult population in New York City according to the 2000 US Census. Results. Universal experiments reduced rates of victimization more than targeted experiments. However, neither experiment reduced inequalities. To reduce inequalities, it was necessary to eliminate racial/ethnic residential segregation. Conclusions. These simulations support the use of universal intervention but suggest that it is not possible to address inequalities in health without first addressing fundamental causes.
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U2 - 10.2105/AJPH.2014.302055
DO - 10.2105/AJPH.2014.302055
M3 - Article
C2 - 25100428
AN - SCOPUS:84906097778
VL - 104
JO - American Journal of Public Health
JF - American Journal of Public Health
SN - 0090-0036
IS - SUPPL. 4
ER -