Towards health equity: the urgent need for upstream intervention studies in gastroenterology and hepatology (The Lancet GI & Hepatology)

Health inequity is a major challenge to achieving broader social equity and a just society. Interventions to reduce health inequity can be directed at downstream determinants of health, such as individual health-care needs, midstream determinants, such as neighbourhood conditions, or upstream determinants, such as structural racism and discrimination. For example, interventions to reduce inequities in colorectal cancer mortality in African-American people could include mailing reminders about faecal immunochemical tests (downstream intervention); providing patient navigation, transportation, or other direct aid to access health-care services (midstream intervention); or changing laws that redistribute power, wealth, and resources, including health insurance (upstream intervention).