Braveman Paula, Gruskin Sofia
Department of Family and Community Medicine and Center on Social Disparities in Health, University of California San Francisco, San Francisco, CA, 94143-0900, USA.
Bull World Health Organ. 2003;81(7):539-45. Epub 2003 Sep 3.
Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.
关注贫困与健康问题的人士有时将公平与人权视为抽象概念,几乎没有实际应用价值,而且健康、公平与人权之间的联系也未得到系统研究。审视贫困、公平和人权与健康以及它们彼此之间的关系表明,它们在概念和操作上紧密相连,并且每一项都为卫生机构的工作提供了宝贵且独特的指导。公平和人权视角能够切实推动卫生机构应对贫困与健康问题的努力,而关注贫困对于落实这些承诺至关重要。公平和人权原则都表明,必须为那些遭受边缘化或歧视的人群争取平等的健康机会。卫生机构可以通过以下五种总体方式,在一个包含公平和人权关切的框架内应对贫困与健康问题:(1)将公平和人权视角系统且常规地应用于所有卫生部门行动的做法制度化;(2)加强并扩展除医疗保健之外的公共卫生职能,这些职能为健康创造必要条件;(3)实施公平的医疗保健筹资,这应有助于减少贫困,同时增加穷人获得医疗服务的机会;(4)确保卫生服务有效应对贫困和弱势群体中可预防的健康不良的主要成因;(5)监测、倡导并采取行动,以应对所有影响健康的部门(不仅是卫生部门)政策可能对健康公平和人权产生的影响。