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Challenges and Successes in Reducing Health Disparities: Workshop Summary
much to be learned about the overall impacts of these approaches, as well as their specific health consequences.
The thesis of this review for the IOM is that the “action” in community approaches to addressing health disparities lies in better understanding, design, and implementation of “hybrid” approaches to community development and health disparities. We define hybrid approaches as those derived from a combination of clinical, community, and other heterogeneous sources such as public health and policy. The best of these approaches have the virtue of empowering and mobilizing community resources and residents, but at the same time implementing systematic, sustainable, and clinically sound approaches to health behavior, screening, prevention and promotion, and treatment. Admittedly, the knowledge base for this assertion is thin; in fact, we believe one of the key frontiers in this field lies in creating an evidence-based approach, yielding results for community development that build off of the knowledge base about both community and health disparities that is more purposeful about evaluation and accomplishes better sharing and translation of information across disciplines and stakeholders.
DISPARITIES IN A COMMUNITY CONTEXT
Although many concepts and constructs of community abound, this paper treats communities as largely geographical or spatial units, though only as the best proxy for capturing a set of social relations and social institutions.3 This means that we are largely concerned with so-called place-based approaches to health disparities and aligned with the literature on neighborhood or area effects on health (Diez Roux, 2001; Sampson, 2003).
A large literature focused on the role of socioeconomic and community factors in health outcomes has grown up in social science, public health, and the field of community organization and development. The backdrop to this literature on community effects is an even larger literature on the socioeconomic determinants of racial and ethnic health disparities. The pathways by which socioeconomic position and resources affect health status are well understood in concept, but more difficult to attribute empirically. Education, for example, provides opportunities for certain occupational pathways, which in turn produce different income streams, occupational exposure to health hazards, wherewithal to engage in positive health behaviors, and access to communities and social networks that are believed to reinforce health behaviors. Perceptions of racial discrimination, for example, have been linked across a large body of studies to
For a complete discussion and review of different concepts of community see Robert Chaskin (1997).