Closing the gap

Blue Ridge Academic Health Group report

Some of the most influential leaders in academic medicine have another consideration to add to health care reform—the social factors that affect health.

A new report by the Blue Ridge Academic Health Group shines a bright light on the impact that social determinants have on the health and well-being of society. These social determinants—as defined by the WHO —include access to health care, poverty, education, and work, leisure, and living conditions. These factors substantially impact the health of people and nations, and they contribute to disparities in health care systems around the world, including the United States.

For example, in Montgomery County, Maryland, an affluent suburb of Washington, D.C., the average life expectancy for whites is 80 years but only 63 years for African Americans. What accounts for this disparity of almost 22% is the substantial, yet less than fully understood contribution of the social determinants of health, according to the Blue Ridge report authors.

While health care reform is an important part of the solution of eliminating disparities, it can’t succeed unless widespread social conditions underlying those disparities are addressed, say the Blue Ridge co-chairs Fred Sanfilippo, Emory executive vice president for health affairs, and Don Detmer, professor of medical education at the University of Virginia.

The report calls for further research to better answer how the social determinants of health impact clinical effectiveness, costs, insurance, regulations, and policies. To see specific recommendations of the Blue Ridge Group, visit

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