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      Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews

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          There is increasing pressure to tackle the wider social determinants of health through the implementation of appropriate interventions. However, turning these demands for better evidence about interventions around the social determinants of health into action requires identifying what we already know and highlighting areas for further development.


          Systematic review methodology was used to identify systematic reviews (from 2000 to 2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education, and transport.


          Thirty systematic reviews were identified. Generally, the effects of interventions on health inequalities were unclear. However, there is suggestive systematic review evidence that certain categories of intervention may impact positively on inequalities or on the health of specific disadvantaged groups, particularly interventions in the fields of housing and the work environment.


          Intervention studies that address inequalities in health are a priority area for future public health research.

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          Most cited references 36

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          Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials.

          To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group. Systematic review and meta-analyses. Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews. Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education. 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01; 2.7). Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.
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            A typology of actions to tackle social inequalities in health.

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              Reviews of evidence regarding interventions to reduce alcohol-impaired driving.

              Alcohol-related motor vehicle crashes are a major public health problem, resulting in 15,786 deaths and more than 300,000 injuries in 1999. This report presents the results of systematic reviews of the effectiveness and economic efficiency of selected population-based interventions to reduce alcohol-impaired driving. The Guide to Community Preventive Services's methods for systematic reviews were used to evaluate the effectiveness of five interventions to decrease alcohol-impaired driving, using changes in alcohol-related crashes as the primary outcome measure. Strong evidence was found for the effectiveness of .08 blood alcohol concentration laws, minimum legal drinking age laws, and sobriety checkpoints. Sufficient evidence was found for the effectiveness of lower blood alcohol concentration laws for young and inexperienced drivers and of intervention training programs for servers of alcoholic beverages. Additional information is provided about the applicability, other effects, and barriers to implementation of these interventions. These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement. They can help decision makers identify and implement effective interventions that fit within an overall strategy to prevent impaired driving.

                Author and article information

                [1 ]Department of Geography, Durham University, Durham, UK
                [2 ]MRC Social and Public Health Sciences Unit, Glasgow, UK
                [3 ]Centre for Reviews and Dissemination, University of York, York, UK
                [4 ]Division of Public Health, University of Liverpool, Liverpool, UK
                [5 ]Public and Environment Health Research Unit, London School of Hygiene and Tropical Medicine, London, UK
                Author notes
                Correspondence to Clare Bambra, Department of Geography, Wolfson Research Institute, Durham University Queen's Campus, Stockton on Tees TS17 6BH, UK; clare.bambra@
                J Epidemiol Community Health
                Journal of Epidemiology and Community Health
                BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                26 March 2010
                April 2010
                26 March 2010
                : 64
                : 4
                : 284-291
                © 2010, Published by the BMJ Publishing Group Limited For permission to use, (where not already granted under a licence) please go to

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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