Arblaster L, Lambert M, Entwistle V, Forster M, Fullerton D, Sheldon T, Watt I
United Health Commission, South Humberside, UK.
J Health Serv Res Policy. 1996 Apr;1(2):93-103. doi: 10.1177/135581969600100207.
To review the available evidence in order to identify effective interventions which health services alone or in collaboration with other agencies could use to reduce inequalities in health.
A search of the literature was undertaken using a number of databases including Medline (from 1990), Applied Social Science Index and Abstracts (1987-1994), and the System for Information on Grey Literature in Europe (1984-1994), on a large range of key words. Studies were included if they assessed interventions designed to reduce inequalities in health or improve the health of a population group relevant to the review, and could be carried out by a health service alone or in collaboration with other agencies. Only studies evaluating interventions using an experimental design were included. Papers in any language were considered. In addition, systematic reviews of the research on the effectiveness of health promotion and the treatment of conditions where there are significant health inequalities were identified in order to illustrate the potential for reducing inequalities in health.
94 studies were identified which satisfied all the inclusion criteria and 21 reviews were included. A number of interventions have been shown to improve the health of groups who are disadvantaged by socio-economic class, ethnicity or age and, if properly targeted, could be expected to reduce health inequalities. If a health intervention is being used, there should be evidence that it has an impact on health status. Attention should then be given to the way in which the intervention is delivered and the characteristics of a programme to promote implementation. Characteristics of successful interventions specifically aimed at reducing health differentials include: systematic and intensive approaches to delivering effective health care; improvement in access and prompts to encourage the use of services; strategies employing a combination of interventions and those involving a multi-disciplinary approach; ensuring interventions address the expressed or identified needs of the target population; and the involvement of peers in the delivery of interventions. However, these characteristics alone are not sufficient for success, nor are they universally necessary.
Although it is likely that the most significant contributions to reducing health inequalities will be in improving economic and social conditions and the physical environment, there are interventions which health services, either alone or in collaboration with other agencies, can use to reduce inequalities in health.
回顾现有证据，以确定卫生服务机构单独或与其他机构合作可用于减少健康不平等现象的有效干预措施。
使用多个数据库进行文献检索，包括Medline（自1990年起）、《应用社会科学索引与摘要》（1987 - 1994年）以及欧洲灰色文献信息系统（1984 - 1994年），检索词范围广泛。若研究评估了旨在减少健康不平等或改善与本综述相关人群健康状况的干预措施，且可由卫生服务机构单独或与其他机构合作实施，则纳入研究。仅纳入采用实验设计评估干预措施的研究。考虑任何语言的论文。此外，还确定了关于健康促进有效性及存在显著健康不平等状况下疾病治疗的研究系统评价，以说明减少健康不平等的潜力。
确定了94项符合所有纳入标准的研究，并纳入了21篇综述。已证明一些干预措施可改善因社会经济阶层、种族或年龄而处于不利地位群体的健康状况，若目标明确，有望减少健康不平等。若采用健康干预措施，应有证据表明其对健康状况有影响。然后应关注干预措施的实施方式以及促进实施的项目特征。专门旨在减少健康差异的成功干预措施的特征包括：提供有效医疗保健的系统且强化的方法；改善服务可及性并鼓励使用服务的提示；采用多种干预措施组合及多学科方法的策略；确保干预措施满足目标人群明确表达或确定的需求；以及让同龄人参与干预措施的实施。然而，仅这些特征并不足以确保成功，也并非普遍必要。
尽管对减少健康不平等的最大贡献可能在于改善经济和社会条件以及物质环境，但卫生服务机构单独或与其他机构合作可采用一些干预措施来减少健康不平等。
