Recent trends in U.S. health have been mixed, with improvements among some groups and geographic areas alongside declines among others. Medical sociologists have contributed to the understanding of those disparate trends, although important questions remain. In this article, we review trends since the 1980s in key indicators of U.S. health and weigh evidence from the last decade on their causes. To better understand contemporary trends in health, we propose that commonly used conceptual frameworks, such as social determinants of health, should be strengthened by prominently incorporating commercial, political-economic, and legal determinants. We illustrate how these structural determinants can provide new insights into health trends, using disparate health trajectories across U.S. states as an example. We conclude with suggestions for future research: focusing on structural causes of health trends and inequalities, expanding interdisciplinary perspectives, and integrating methods better equipped to handle the complexity of causal processes driving health trends and inequalities.

美国健康的近期趋势喜忧参半，一些群体和地理区域的改善与其他的下降。尽管仍然存在重要问题，但医学社会学家为理解这些不同的趋势做出了贡献。在本文中，我们回顾了自 1980 年代以来美国健康关键指标的趋势，并权衡了过去十年中有关其原因的证据。为了更好地理解当代健康趋势，我们建议应通过突出纳入商业、政治经济和法律决定因素来加强常用的概念框架，例如健康的社会决定因素。我们以美国各州不同的健康轨迹为例，说明这些结构性决定因素如何为健康趋势提供新的见解。