Muntaner C, Lynch J
School of Medicine, West Virginia University, Morgantown 20506-9190, USA.
Int J Health Serv. 1999;29(1):59-81. doi: 10.2190/G8QW-TT09-67PL-QTNC.
Wilkinson's "income inequality and social cohesion" model has emerged as a leading research program in social epidemiology. Public health scholars and activists working toward the elimination of social inequalities in health can find several appealing features in Wilkinson's research. In particular, it provides a sociological alternative to former models that emphasize poverty, health behaviors, or the cultural aspects of social relations as determinants of population health. Wilkinson's model calls for social explanations, avoids the subjectivist legacy of U.S. functionalist sociology that is evident in "status" approaches to understanding social inequalities in health, and calls for broad policies of income redistribution. Nevertheless, Wilkinson's research program has characteristics that limit its explanatory power and its ability to inform social policies directed toward reducing social inequalities in health. The model ignores class relations, an approach that might help explain how income inequalities are generated and account for both relative and absolute deprivation. Furthermore, Wilkinson's model implies that social cohesion rather than political change is the major determinant of population health. Historical evidence suggests that class formation could determine both reductions in social inequalities and increases in social cohesion. Drawing on recent examples, the authors argue that an emphasis on social cohesion can be used to render communities responsible for their mortality and morbidity rates: a community-level version of "blaming the victim." Such use of social cohesion is related to current policy initiatives in the United States and Britain under the New Democrat and New Labor governments.
威尔金森的“收入不平等与社会凝聚力”模型已成为社会流行病学领域一项重要的研究项目。致力于消除健康方面社会不平等现象的公共卫生学者和活动家，能在威尔金森的研究中发现几个颇具吸引力的特点。特别是，它为以往那些将贫困、健康行为或社会关系的文化层面视为人口健康决定因素的模型提供了一种社会学替代方案。威尔金森的模型要求从社会角度进行解释，避免了美国功能主义社会学中那种在理解健康方面社会不平等的“地位”方法中明显存在的主观主义传统，并呼吁实施广泛的收入再分配政策。然而，威尔金森的研究项目存在一些特点，限制了其解释力以及为旨在减少健康方面社会不平等的社会政策提供信息的能力。该模型忽视了阶级关系，而这种方法或许有助于解释收入不平等是如何产生的，并能说明相对剥夺和绝对剥夺的情况。此外，威尔金森的模型意味着社会凝聚力而非政治变革是人口健康的主要决定因素。历史证据表明，阶级形成既能决定社会不平等的减少，也能决定社会凝聚力的增强。作者援引近期的例子指出，强调社会凝聚力可能会让社区为其死亡率和发病率负责：这是一种社区层面的“指责受害者”。这种对社会凝聚力的运用与美国和英国新民主党及新工党政府当下的政策举措有关。
