Published online February 16, 2009
PEDIATRICS Vol. 123 Supplement March 2009, pp. S174-S184 (doi:10.1542/peds.2008-2233H)
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SUPPLEMENT ARTICLE


Social Determinants: Taking the Social Context of Asthma Seriously

David R. Williams, PhD, MPHa,b,c, Michelle Sternthal, PhDd and Rosalind J. Wright, MD, MPHd,e

a Department of Society, Human Development, and Health, School of Public Health, and Departments of
b African and African American Studies
c Sociology, Harvard University, Cambridge, Massachusetts
d Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
e Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

Although asthma has emerged as a major contributor to disease and disability among US children, the burden of this disease is unevenly distributed within the population. This article provides a brief overview of social-status variables that predict variations in asthma risks and social exposures, such as stress and violence, that are emerging as important risk factors. The central focus of the article is on the distal social variables that have given rise to unhealthy residential environments in which the risk factors for asthma and other diseases are clustered. Effective initiatives for the prevention and treatment of childhood asthma need to address these nonmedical determinants of the prevalence of asthma.

Key Words: childhood asthma prevalence • low-income population • poverty • race • risk factors

Abbreviations: ICS—inhaled corticosteroid • SES—socioeconomic status

Accepted Nov 4, 2008.


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