Reducing disparities downstream: Prospects and challenges

Peter Franks, Kevin Fiscella

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Addressing upstream or fundamental causes (such as poverty, limited education, and compromised healthcare access) is essential to reduce healthcare disparities. But such approaches are not sufficient, and downstream interventions, addressing the consequences of those fundamental causes within the context of any existing health system, are also necessary. We present a definition of healthcare disparities and two key principles (that healthcare is a social good and disparities in outcomes are a quality problem) that together provide a framework for addressing disparities downstream. Adapting the chronic care model, we examine a hierarchy of three domains for interventions (health system, provider-patient interactions, and clinical decision making) to reduce disparities downstream and discuss challenges to implementing the necessary changes.

Original languageEnglish (US)
Pages (from-to)672-677
Number of pages6
JournalJournal of General Internal Medicine
Issue number5
StatePublished - May 2008


  • Downstream
  • Education
  • Healthcare disparity
  • Poverty
  • Upstream

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)


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