Integrating a social determinants of health approach into public health practice: A five-year perspective of actions implemented by CDC's national center for HIV/AIDS, viral hepatitis, STD, and TB prevention

摘要

In the United States, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), viral hepatitis, sexually transmitted disease (STD), and tuberculosis (TB) infections are among the most prevalent and most commonly reported conditions-with STDs alone accounting for more than 19 million new infections per year and direct costs in excess of $15 billion. Their nonrandom distribution in the population is characterized by increasing disease concentration among the poor, those with poor access to curative services, populations with a high prevalence of risky or stigmatized behaviors, or the socially marginalized. Strong vertical programs that provide highly specialized technical approaches to disease control have been the mainstay of the domestic efforts during the past four decades, with a focus on scaling up screening, diagnosis, treatment, and partner notification efforts. However, our evolved understanding of the complex and overlapping (syndemic) nature of these conditions and their close interrelationship with social and structural determinants has necessitated the adoption of new approaches to enhance traditional disease control efforts.