搜索结果：International journal of environmental health research

Associations between modifiable exposures and disease seen in observational epidemiology are sometimes confounded and thus misleading, despite our best efforts to improve the design and analysis of studies. Mendelian randomization—the random assortment of genes from parents to offspring that occurs during gamete formation and conception—provides one method for assessing the causal nature of some environmental exposures. The association between a disease and a polymorphism that mimics the biological link between a proposed exposure and disease is not generally susceptible to the reverse causation or confounding that may distort interpretations of conventional observational studies. Several examples where the phenotypic effects of polymorphisms are well documented provide encouraging evidence of the explanatory power of Mendelian randomization and are described. The limitations of the approach include confounding by polymorphisms in linkage disequilibrium with the polymorphism under study, that polymorphisms may have several phenotypic effects associated with disease, the lack of suitable polymorphisms for studying modifiable exposures of interest, and canalization—the buffering of the effects of genetic variation during development. Nevertheless, Mendelian randomization provides new opportunities to test causality and demonstrates how investment in the human genome project may contribute to understanding and preventing the adverse effects on human health of modifiable exposures. Genetic epidemiology—the theme of this issue of the International Journal of Epidemiology—is seen by many to be the only future for epidemiology, perhaps reflecting a growing awareness of the limitations of observational epidemiology1 (Box 1). Genetic epidemiology is concerned with understanding heritable aspects of disease risk, individual susceptibility to disease, and ultimately with contributing to a comprehensive molecular understanding of pathogenesis. The massive investment and expansion of human genetics, if it is to return value for the common good, must be integrated into public health functions. The human genome epidemiology network (HuGE Net—http://www.cdc.gov/genetics/huge.htm) has been established to promote the use of genetic knowledge—in terms of genetic tests and services—for disease prevention and health promotion.2,3 A broad taxonomy of human genome studies of public health relevance has been developed4 (Box 2). In this issue of the IJE, we publish a paper by Miguel Porta,5 who highlights the need for a more rational approach to genetic testing, given the likely low penetrance of many genes associated with cancers,6 likening the role of the genome to a jazz score that is interpreted and developed through experience and context—and is seldom predictable. Such insights may well temper enthusiasm for genetic testing in populations. However, in parallel to the approaches advocated by HuGE, genetic epidemiology can lead to a more robust understanding of environmental determinants of disease (e.g. dietary factors, occupational exposures, and health-related behaviours) relevant to whole populations (and not simply to genetically susceptible sub-populations).7–10 This approach has recently been referred to as ‘Mendelian randomization’.11–15 Here we begin by briefly reviewing reasons for current concerns about aetiological findings generated by conventional observational epidemiology and then we outline the potential contribution (and limitations) of Mendelian randomization. ‘Epidemiology set to get fast-track treatment’ ‘A consortium of leading European research centres and pharmaceutical companies will this week announce a plan to transform epidemiology by combining it with the new techniques of high-throughput biology. They plan to create a new field of study—genomic epidemiology—by using screening technologies derived from the human genome project … We think it is important to expand classical epidemiology and genetic epidemiology to take it to this high-throughput mode, says Esper Boel, vice-president of biotechnology research at Novo Nordisk. We want to use post-genomic technologies to create a new clinical science, to turn functional genomics into real clinical chemistry.’ From: Butler D. Epidemiology set to get fast-track treatment. Nature 2001;414:139. Reprinted with permission. Surveillance Population frequency of gene variants predisposing to specific diseases Population frequency of morbidity and mortality from such diseases Population frequency and effects of environmental factors known to interact with gene variants Economic costs of genetic components of diseases Coverage, access, and uptake of genetic tests and services Aetiology Magnitude of disease risk associated with gene variants in different populations Contribution of gene variants to the overall level of disease in different populations Magnitude of disease risk associated with gene–gene and gene–environment interactions in different populations Health services research Clinical validity and utility of genetic tests in different populations Determinants and impact of using genetic tests and services in different populations Adapted from Khoury MJ, Burke W, Thomson EJ (eds). Genetics and Public Health in the 21st Century. Oxford: Oxford University Press, 2000.

BACKGROUND: One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred? DISCUSSION: We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by an assessment of the likely barriers and facilitators. Although our evidence on the likely effectiveness of different strategies to overcome specific barriers remains incomplete, there is a range of informative systematic reviews of interventions aimed at healthcare professionals and consumers (i.e., patients, family members, and informal carers) and of factors important to research use by policy makers. SUMMARY: There is a substantial (if incomplete) evidence base to guide choice of knowledge translation activities targeting healthcare professionals and consumers. The evidence base on the effects of different knowledge translation approaches targeting healthcare policy makers and senior managers is much weaker but there are a profusion of innovative approaches that warrant further evaluation.

BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations. METHODS: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. FINDINGS: In 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. INTERPRETATION: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. FUNDING: Bill & Melinda Gates Foundation.

Heavy metals are well-known environmental pollutants due to their toxicity, persistence in the environment, and bioaccumulative nature. Their natural sources include weathering of metal-bearing rocks and volcanic eruptions, while anthropogenic sources include mining and various industrial and agricultural activities. Mining and industrial processing for extraction of mineral resources and their subsequent applications for industrial, agricultural, and economic development has led to an increase in the mobilization of these elements in the environment and disturbance of their biogeochemical cycles. Contamination of aquatic and terrestrial ecosystems with toxic heavy metals is an environmental problem of public health concern. Being persistent pollutants, heavy metals accumulate in the environment and consequently contaminate the food chains. Accumulation of potentially toxic heavy metals in biota causes a potential health threat to their consumers including humans. This article comprehensively reviews the different aspects of heavy metals as hazardous materials with special focus on their environmental persistence, toxicity for living organisms, and bioaccumulative potential. The bioaccumulation of these elements and its implications for human health are discussed with a special coverage on fish, rice, and tobacco. The article will serve as a valuable educational resource for both undergraduate and graduate students and for researchers in environmental sciences. Environmentally relevant most hazardous heavy metals and metalloids include Cr, Ni, Cu, Zn, Cd, Pb, Hg, and As. The trophic transfer of these elements in aquatic and terrestrial food chains/webs has important implications for wildlife and human health. It is very important to assess and monitor the concentrations of potentially toxic heavy metals and metalloids in different environmental segments and in the resident biota. A comprehensive study of the environmental chemistry and ecotoxicology of hazardous heavy metals and metalloids shows that steps should be taken to minimize the impact of these elements on human health and the environment.

International Journal of Pharmaceutical Sciences and Research (IJPSR) is an official publication of Society of Pharmaceutical Sciences & Research. It is an open access online and print International Journal published monthly. Website: www.ijpsr.com Projected Impact Factor (2012): 2.44, ICV 2012: 5.50, 2011: 5.07, 2010: 4.57 DOI: 10.13040/IJPSR.0975-8232 SJ Impact Factor (2012): 3.226 Global Impact Factor (2013): 0.533, (2012): 0.452 Indexing - EMBASE- Elsevier's

BACKGROUND: Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. METHODS: A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. RESULTS: The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. CONCLUSIONS: Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.

Mental health is fundamental to health, according to Mental Health: A Report of the Surgeon General, the first Surgeon General’s report ever to focus exclusively on mental health. That report of two years ago urged Americans to view mental health as paramount to personal well-being, family relationships, and successful contributions to society. It documented the disabling nature of mental illnesses, showcased the strong science base behind effective treatments, and recommended that people seek help for mental health problems or disorders. The first mental health report also acknowledged that all Americans do not share equally in the hope for recovery from mental illnesses. This is especially true of members of racial and ethnic minority groups. That awareness galvanized me to ask for a supplemental report on the nature and extent of disparities in mental health care for racial and ethnic minorities and on promising directions for the elimination of these disparities. This Supplement documents that the science base on racial and ethnic minority mental health is inadequate; the best available research, however, indicates that these groups have less access to and avail-ability of care, and tend to receive poorer quality mental health services. These disparities leave minority communities with a greater disability burden from unmet mental health needs. A hallmark of this Supplement is its emphasis on the role that cultural factors play in mental health. The cultures from which people hail affect all aspects of mental health and illness, including the types of stresses they confront, whether they seek help, what types of help they seek, what symptoms and concerns they bring to clinical attention, and what types of coping styles and social supports they possess. Likewise, the cultures of clinicians and service systems influence the nature of mental health services.

Context: Rehabilitation Medicine is dedicated to optimise patients function and health in the most comprehensive manner. ICF, the latest International Classification by World Health Organization (WHO) is a conceptual framework for the assessment of functioning, disability and health. The purpose of this paper is to describe the applications of ICF in Rehabilitation Medicine practice in the Medical Rehabilitation Unit, University of Malaya Medical Centre (UMMC), Kuala Lumpur. Issues: ICFconsists of body function, structure, activity, participation and environmental factor. ICF categories are exhaustive, but are not practical to be used entirely and not applicable in clinical practice on theirown. How is ICF used from the clinical perspective' It has to be dapted to make it usable. In Rehabilitation Medicine settings, the following are ways ICF is applied in clinical practice: research in terms of validating the use of available ICF Core Sets and development of new ICF Core Set; clinical practice based on the ICF-based sheet; and educational tools. Conclusion: The practice of Rehabilitation Medicine is in line and compatible with the concept of ICF and can serve as a new important language that can improve the practice of Rehabilitation Medicine. It can be a universal language in functioning, disability and health and can improve understanding in addressing issues on disability within the medical community, improve multi professionals' communication among patients, healthcare providers and stakeholders.

The International Journal of Plant, Animal and Environmental Sciences  [IJPAES] is a peer reviewed multi-disciplinary an online international journal to promote all fields of Anatomy, Agronomy, Ecology, Biodiversity, Pathology, Entomology, Forest biology Economic Botany, Morphology, Cell and Tissue Culture, Genetics, Phytochemistry, Paleobotany, Horticulture, Cell biology, Molecular Biology, EcoPhysiology, Conservation Biology, Reproductive Biology, Taxonomy, Palaeontology, Anthropology, Biochemistry, Biotechnology, Microbiology, Proteomics, Genomics, Immunology, Pathology, Mammalogy, Nemotalogy, Helminthology, Paracytology, Virology, Mycology, Bacteriology, Animal Breeding, Behavior reproduction, Husbandry, Meat Science, Cloning, Nutrition, Health and Welfare, Environmental Sciences, Environmental chemistry, Environmental Biology, Ecology, Geosciences, Abatement technology, Environmental Physics, Aquatic Environment, Polloution, Environmental health study, Natural resources, Toxicology, Environment, Climate change, Remote sensing Human Biology, Stem Cells, Evolutionary Biology, Endocrinology, Endangered Plants, Immunopathology and Hydrology. IJPAES welcomes research articles, review articles, short communications from Scientists, Biologists and Research scholars involved in Plant, Animal and Environmental Sciences and all other related areas from all over the world to publish high quality and refereed papers.

T his article describes the L ife C ourse H ealth Development (LCHD) framework, which was created to explain how health trajectories develop over an individual's lifetime and how this knowledge can guide new approaches to policy and research. Using recent research from the fields of public health, medicine, human development, and social sciences, the LCHD framework shows that Health is a consequence of multiple determinants operating in nested genetic, biological, behavioral, social, and economic contexts that change as a person develops. Health development is an adaptive process composed of multiple transactions between these contexts and the biobehavioral regulatory systems that define human functions. Different health trajectories are the product of cumulative risk and protective factors and other influences that are programmed into biobehavioral regulatory systems during critical and sensitive periods. The timing and sequence of biological, psychological, cultural, and historical events and experiences influence the health and development of both individuals and populations. The life course health development (LCHD) framework organizes research from several fields into a conceptual approach explaining how individual and population health develops and how developmental trajectories are determined by interactions between biological and environmental factors during the lifetime. This approach thus provides a construct for interpreting how people's experiences in the early years of life influence later health conditions and functional status. By focusing on the relationship between experiences and the biology of development, the LCHD framework offers a better understanding of how diseases occur. By suggesting new strategies for health measurement, service delivery, and research, as well as for improving health outcomes, this framework also supports health care‐purchasing strategies to develop health throughout life and to build human health capital.

The environment and contested notions of sustainability are increasingly topics of public interest, political debate, and legislation across the world. Environmental education journals now publish research from a wide variety of methodological traditions that show linkages between the environment, health, development, and education. The growth in scholarship makes this an opportune time to review and synthesize the knowledge base of the environmental education (EE) field. The purpose of this 51-chapter handbook is not only to illuminate the most important concepts, findings and theories that have been developed by EE research, but also to critically examine the historical progression of the field, its current debates and controversies, what is still missing from the EE research agenda, and where that agenda might be headed. Published for the American Educational Research Association (AERA).

The U.S. health care sector is highly interconnected with industrial activities that emit much of the nation's pollution to air, water, and soils. We estimate emissions directly and indirectly attributable to the health care sector, and potential harmful effects on public health. Negative environmental and public health outcomes were estimated through economic input-output life cycle assessment (EIOLCA) modeling using National Health Expenditures (NHE) for the decade 2003-2013 and compared to national totals. In 2013, the health care sector was also responsible for significant fractions of national air pollution emissions and impacts, including acid rain (12%), greenhouse gas emissions (10%), smog formation (10%) criteria air pollutants (9%), stratospheric ozone depletion (1%), and carcinogenic and non-carcinogenic air toxics (1-2%). The largest contributors to impacts are discussed from both the supply side (EIOLCA economic sectors) and demand side (NHE categories), as are trends over the study period. Health damages from these pollutants are estimated at 470,000 DALYs lost from pollution-related disease, or 405,000 DALYs when adjusted for recent shifts in power generation sector emissions. These indirect health burdens are commensurate with the 44,000-98,000 people who die in hospitals each year in the U.S. as a result of preventable medical errors, but are currently not attributed to our health system. Concerted efforts to improve environmental performance of health care could reduce expenditures directly through waste reduction and energy savings, and indirectly through reducing pollution burden on public health, and ought to be included in efforts to improve health care quality and safety.

During the past two decades, the public health community's attention has been drawn increasingly to the social determinants of health (SDH)-the factors apart from medical care that can be influenced by social policies and shape health in powerful ways. We use "medical care" rather than "health care" to refer to clinical services, to avoid potential confusion between "health" and "health care." The World Health Organization's Commission on the Social Determinants of Health has defined SDH as "the conditions in which people are born, grow, live, work and age" and "the fundamental drivers of these conditions." The term "social determinants" often evokes factors such as health-related features of neighborhoods (e.g., walkability, recreational areas, and accessibility of healthful foods), which can influence health-related behaviors. Evidence has accumulated, however, pointing to socioeconomic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes. This article broadly reviews some of the knowledge accumulated to date that highlights the importance of social-and particularly socioeconomic-factors in shaping health, and plausible pathways and biological mechanisms that may explain their effects. We also discuss challenges to advancing this knowledge and how they might be overcome.

This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH-CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio-demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12-month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer-assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper-and-pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD-10 and DSM-IV criteria. Elaborate CD-ROM-based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection.

The industrial agriculture system consumes fossil fuel, water, and topsoil at unsustainable rates. It contributes to numerous forms of environmental degradation, including air and water pollution, soil depletion, diminishing biodiversity, and fish die-offs. Meat production contributes disproportionately to these problems, in part because feeding grain to livestock to produce meat--instead of feeding it directly to humans--involves a large energy loss, making animal agriculture more resource intensive than other forms of food production. The proliferation of factory-style animal agriculture creates environmental and public health concerns, including pollution from the high concentration of animal wastes and the extensive use of antibiotics, which may compromise their effectiveness in medical use. At the consumption end, animal fat is implicated in many of the chronic degenerative diseases that afflict industrial and newly industrializing societies, particularly cardiovascular disease and some cancers. In terms of human health, both affluent and poor countries could benefit from policies that more equitably distribute high-protein foods. The pesticides used heavily in industrial agriculture are associated with elevated cancer risks for workers and consumers and are coming under greater scrutiny for their links to endocrine disruption and reproductive dysfunction. In this article we outline the environmental and human health problems associated with current food production practices and discuss how these systems could be made more sustainable.

Research is defined by the Australian Research Council as "the creation of new knowledge and/or the use of existing knowledge in a new and creative way so as to generate new concepts, methodologies, inventions and understandings." Research is thus the foundation for knowledge. It produces evidence and informs actions that can provide wider benefit to a society. The knowledge that researchers cultivate from a piece of research can be adopted for social and health programs that can improve the health and well-being of the individuals, their communities, and the societies in which they live. As we have witnessed, in all corners of the globe, research has become an endeavor that most of us in the health and social sciences cannot avoid.

This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas.