6: No. 3, July 2009
A Health Disparities
Perspective on Obesity Research
|Family Income, % of Federal Poverty Level
||% of Children (95% Confidence
Figure 1. Prevalence (95% confidence interval) of
obesity among children (2-19 years, age adjusted), according to family income as a percentage of the federal poverty level;
the federal poverty level during 2004 was $18,850 for a family of 4 (7). Data source: National Health
and Nutrition Examination Survey, 1999-2004.
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The policy context is the outermost shell of the model.
The next layer is the social context. At the top, as a part of the society
stratum, an intervention can be made here by influencing social
stratification. Social stratification influences social position by race and
class in the individual stratum. This results in differential exposure to
health hazards, and
an intervention can be made here by decreasing harmful exposures (or
increasing health-promoting exposures). Social position by race and class
not only leads to differential exposure but also to differential
vulnerability to the adverse health effects of exposure. Interventions can
be made here to decrease vulnerability (or increase resilience).
Exposure of a vulnerable person leads to disease or injury. Social position
by race and class also results in differential
consequences of disease or injury. Interventions can be made here by preventing unequal
consequences. The differential social consequences of ill health result in further social stratification (linked back to the top of
Figure 2. How health disparities are produced and reproduced across a lifetime and generations, and possible points to intervene. Adapted from Finn Diderichsen, Karolinska Institute, Stockholm;
reprinted with permission.
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