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March 29, 2021

Moving Upstream: The Importance of Examining Policies to Address Health Disparities

Author Affiliations
  • 1Department of Medicine and Center for Vulnerable Populations, University of California, San Francisco
  • 2Department of Family & Community Medicine and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
JAMA Pediatr. 2021;175(6):563-564. doi:10.1001/jamapediatrics.2020.6985

Through decades of research on strategies to best support behavior change, it has become clear that systems- and policy-level interventions can have just as great an influence as individual-level interventions. This fact is particularly true on a population level and especially for situations in which individual behavior change is constrained by structural factors. However, rigorous evaluation of these systems- and policy-level interventions are less frequently found in the health and public health literature. Partly, this limited examination is related to the fact that interventions designed to change systems and policies occur far upstream. It may be challenging to examine in a single study all the links that create a chain from a policy change to a systems change to an individual behavior change and, finally, to an improved health outcome.

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