Starfield B
Department of Health Policy and Management, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD 21205-1996, USA.
Int J Health Serv. 2001;31(3):545-66. doi: 10.2190/DGJ8-4MQW-UP9J-LQC1.
Equity in health and health care have become important priorities for the world. If efforts at achieving equity are to have any basis in evidence concerning which strategies are likely to work, a research agenda is necessary. An adequate research agenda requires a knowledge of what the problem is, an understanding of the genesis and correlates of the problem, methods to measure these correlates, and rigorous testing of alternative explanations and interventions. This article presents a working definition of equity in health and health services, a conceptual framework in which to view the various types of influence on health and distribution of health in populations, a summary of evidence on the effects of some of these categories, and a research agenda for guiding efforts to improve knowledge on which to base interventions that enhance the attainment of equity. Because of their relative neglect in the existing literature on equity in health, the special roles of political forces and of primary care as a particularly key element of health services are stressed.
卫生与医疗保健领域的公平性已成为全球重要的优先事项。若要使实现公平的努力基于有关哪些策略可能有效的证据，就需要一个研究议程。一个充分的研究议程需要了解问题是什么，理解问题的成因及相关因素，掌握衡量这些相关因素的方法，并对替代解释和干预措施进行严格测试。本文提出了卫生与卫生服务公平性的实用定义，一个用以审视对人群健康及健康分布的各类影响的概念框架，关于其中一些类别的影响的证据总结，以及一个研究议程，以指导相关工作，增进知识，为旨在促进公平实现的干预措施提供依据。鉴于政治力量以及初级保健作为卫生服务特别关键要素的特殊作用在现有卫生公平性文献中相对被忽视，故予以强调。
