Community Mental Health Journal

, Volume 55, Issue 1, pp 9–23 | Cite as

Modeling Health Disparities and Outcomes in Disenfranchised Populations

  • Emily J. HauensteinEmail author
  • Rachael S. Clark
  • Elizabeth I. Merwin
Original Paper


The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.


Health disparities Health outcomes Intersectionality Mental illness Community characteristics 



Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities under award number R01MD010354. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Research Involving Human Participants and/or Animals

This article does not contain any studies with human participants or animals performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of DelawareNewarkUSA
  2. 2.School of NursingDuke UniversityDurhamUSA

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