Conceptualizing Health Disparities: Panel Reflections

Abstract

Overall, the excellent set of articles in this supplement to Pediatrics 1–5 defines the critical issues for exploring the life-course perspective on child health disparities and identifies many of the important relationships between social stratification, race/ethnicity, environment, biology, and “time,” that is, over the life course. The purpose of this commentary is to call attention to some of the outstanding challenges (to both science and policy) of adopting this life-course perspective that are raised by the authors. Specifically, we will focus briefly on (1) attributable risk, (2) the gradient effect, (3) biological processes, and (4) policy implications. There is a consensus among these authors that the events of early life have a strong relationship to health across the life span. Whether the independent variable is race/racism, social class, immigrant status, or some other dimension of social inequality, there seems to be an impact of these social parameters on health disparities throughout the life course. The relationships that have been documented, however, are associations between … Address correspondence to Bernard Guyer, MD, MPH, 615 N. Wolfe St., Room E4146, Baltimore, MD 21205. E-mail: bguyer{at}jhsph.edu