In the United States, awareness is increasing that medical care alone cannot
adequately improve health overall or reduce health disparities without
also addressing where and how people live. Acritical mass of relevant
knowledge has accumulated, documenting associations, exploring pathways
and biological mechanisms, and providing a previously unavailable
scientific foundation for appreciating the role of social factors in health.
We review current knowledge about health effects of social (including
economic) factors, knowledge gaps, and research priorities, focusing
on upstream social determinants—including economic resources, education,
and racial discrimination—that fundamentally shape the downstream
determinants , such as behaviors, targeted by most interventions.
Research priorities include measuring social factors better, monitoring
social factors and health relative to policies, examining health effects
of social factors across lifetimes and generations, incrementally elucidating
pathways through knowledge linkage, testing multidimensional
interventions, and addressing political will as a key barrier to translating
knowledge into action