Social determinants of health are the causes of discrepancies in pediatric health outcomes. Upstream determinants, or causes, typically include complex societal issues, such as racism and poverty. Midstream determinants are typically the result of upstream determinants but are potentially more modifiable social risks for poor health outcomes (eg, housing instability, food insecurity, educational attainment, incarceration, and exposure to violence). Addressing midstream social risks to improve outcomes—for example, improving social cohesion (eg, building social support networks) among community members—has been associated with improved physical health and psychological well-being.

中文翻译：

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儿童哮喘的社会干预和医疗保健利用

健康的社会决定因素是导致儿科健康结果差异的原因。上游决定因素或原因通常包括复杂的社会问题，例如种族主义和贫困。中游决定因素通常是上游决定因素的结果，但对于不良健康结果（例如，住房不稳定、粮食不安全、教育程度、监禁和遭受暴力），可能是更容易改变的社会风险。解决中游社会风险以改善结果——例如，提高社区成员之间的社会凝聚力（例如，建立社会支持网络）——与改善身体健康和心理健康有关。