摘要：Although researchers acknowledge that health disparities have multiple determinants, most recommendations for reducing inequities focus on a single approach. We suggest integrating 2 approaches for reducing disparities: improving access to primary care and updating and more vigorously enforcing consumer and environmental protection laws. This strategy could reduce the main causes of disparities, such as chronic diseases and injuries; win public and policymaker support; and provide a cost-effective start for achieving equity. Most of the scientific knowledge needed to implement this strategy exists, thus years of additional research would not be needed. Developing targeted regulatory and health care policies to reduce deaths from chronic diseases and injuries would be a major step forward in eliminating health disparities in the United States. MORE THAN 20 YEARS AGO, the US government acknowledged the persistence of socioeconomic and racial/ethnic disparities in health, 1 and more than a decade ago it announced the goal of eliminating these disparities. 2 To date, however, neither the federal government nor any other body has articulated a comprehensive, coordinated, science-driven, and politically feasible agenda for achieving this goal. Although thousands of research studies have documented disparities and hundreds of interventions have worked to reduce some specific disparity affecting a particular population or place, too often the cumulative impact of these efforts has been less than the sum of their parts. We advocate integrating 2 approaches for reducing disparities: improving access to primary health care and strengthening, updating, and more vigorously enforcing consumer and environmental protection laws. This 2-pronged strategy would directly benefit the socioeconomically disadvantaged and racial/ethnic groups who now bear the largest burden of disparities. Combining these 2 approaches and targeting selected health conditions that are driving disparities would create possible synergies that could accelerate the achievement of more equitable health outcomes across populations. Although in our view the evidence suggests that these particular strategies have the potential to reduce a range of disparities, our broader argument is that to promote health equity, public health needs to move beyond a piecemeal approach and toward a systemic analysis that integrates scientific evidence and policy analysis. Our criteria for making these recommendations are their potential for improving the health of the American people and their feasibility of implementation. We hope our analysis encourages others to propose further strategies for applying systems thinking to disparity reduction.
