A health disparities perspective on obesity research
Paula Braveman, MD, MPH,
Prev Chronic Dis 2009;6(3). Volume 6: No. 3, July 2009
Available at: http://www.cdc.gov/pcd/issues/2009/jul/09_0012.htm
“…..Obesity is a major risk factor for chronic disease and can decrease longevity, quality of life, and economic productivity. Compelling ethical, human rights, and practical reasons exist for addressing social disparities in obesity, which requires systematically applying a disparities perspective to obesity research and relevant policy.
A disparities perspective guides us to consider multiple dimensions and levels of social advantage and disadvantage and how those advantages and disadvantages produce disparities in obesity and its consequences….”
“…….A disparities lens has much to contribute to health research in general and to obesity research in particular. Focusing on disparities can guide us to examine multiple dimensions and levels of advantage or disadvantage, relative and absolute deprivation, discrimination, and social exclusion. This perspective leads us to consider conditions in both social and physical environments at the individual/household/family and the community levels that can create opportunities and resources or obstacles to health. Our attention is drawn to exposure to advantage and disadvantage over time and to determinants of vulnerability to exposure effects.
We are reminded of an array of sources of advantage and disadvantage, including cumulative stress related to material poverty and the psychosocial stressors that often accompany it. Such a research framework encourages us to consider social factors that seem distal to obesity but could be highly relevant to experiences and behaviors that result in biological processes underlying obesity and its adverse clinical and social sequellae. A disparities perspective encourages us not to rely entirely on simple categorizations of social advantage or disadvantage, such as low income or educational level, but to examine the actual distributions of the relevant factors and how they relate to the health indicator of interest…..”
“……A disparities perspective leads us to ask the questions: What causes, exacerbates, or ameliorates racial or ethnic or socioeconomic differences in obesity during a person’s lifetime and across generations? Where and how can the pathways to obesity disparities be interrupted most effectively and efficiently? Do interventions that decrease obesity prevalence at the population level also reduce obesity disparities across social groups, and vice versa? What are the differential consequences of obesity, in health and social terms, for people in different social groups?
To answer these questions we must study social factors rather than attempt to control for them. High-quality disparities research looks for the root causes of social disparities in health to inform efforts to intervene. In contrast, prevailing approaches often take poverty, near-poverty, and institutionalized racial bias as givens and focus primarily on how to buffer the health-damaging effects. A disparities lens can make practical contributions to obesity research, even regarding questions whose central focus is not disparities….”
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