Poureslami Iraj M, MacLean David R, Spiegel Jerry, Yassi Annalee
Iran University of Medical Sciences.
MedGenMed. 2004 Sep 20;6(3):51.
For hundred of years, people in the region encompassed by the Afghanistan-Iran-Pakistan borders (AIP region) have been challenged by conflict and political and civil instability, mass displacement, human rights abuses, drought, and famine. It not surprising that health and quality of life of vulnerable groups in this region are among the worst in the world. In general, women and children, in particular girls, in the AIP region have had especially limited access to healthcare. Women and children have dramatically high rates of communicable and non-communicable disease, morbidity, and mortality and a general low life expectancy that is rapidly declining. In spite of national and international efforts to improve health status of vulnerable populations in this region, the key underlying sociocultural determinants of health and disparities (ie, gender, language, ethnicity, residential status, and socioeconomic status) have not been systematically studied, nor have their relationships to environmental challenges been examined.
We set out to summarize existing information regarding the sociocultural, environmental, and traditional determinants of health disparities among different population groups in the AIP region; identify gaps in research regarding the communities' needs in the region; and highlight factors that must be considered in the design and implementation of future health intervention studies in the region.
We reviewed current health literature, official documents, and other information (eg, reports of UN agencies) related to the social, cultural, and environmental factors that may influence the health outcomes of subpopulations living in the AIP region. We also interviewed individuals who had recently worked in this region.
Overall, the health problems faced by this underdeveloped region can be categorized into those resulting from lack of essential supplies and services and those stemming from the existing cultural practices in the area. The low health status of the people, particularly women and children, in the AIP region is associated with not only poor hygiene and lack of water but also limited knowledge and lack of access to healthcare services. In addition, cultural, political, and socioenvironmental factors play a role, including gender inequality and differences between languages spoken locally in the region and those most often used in written health education materials.
Future intervention programs designed for this region must use culturally sensitive strategies not only to provide health information and health services but also to address the underlying nonmedical determinants of health related to gender inequalities.
数百年来，阿富汗 - 伊朗 - 巴基斯坦边境地区（AIP地区）的人们一直面临冲突、政治和社会动荡、大规模流离失所、侵犯人权、干旱和饥荒等问题。毫不奇怪，该地区弱势群体的健康和生活质量是世界上最差的之一。总体而言，AIP地区的妇女和儿童，尤其是女孩，获得医疗保健的机会特别有限。妇女和儿童的传染病和非传染病发病率及死亡率极高，总体预期寿命较低且正在迅速下降。尽管国家和国际社会努力改善该地区弱势群体的健康状况，但健康和差距的关键潜在社会文化决定因素（即性别、语言、种族、居住身份和社会经济地位）尚未得到系统研究，它们与环境挑战的关系也未得到审视。
我们旨在总结AIP地区不同人群健康差距的社会文化、环境和传统决定因素的现有信息；找出该地区社区需求研究方面的差距；并强调在该地区未来健康干预研究的设计和实施中必须考虑的因素。
我们查阅了当前与可能影响AIP地区亚人群健康结果的社会、文化和环境因素相关的健康文献、官方文件及其他信息（如联合国机构的报告）。我们还采访了近期在该地区工作的人员。
总体而言，这个欠发达地区面临的健康问题可分为因基本物资和服务匮乏导致的问题以及源于该地区现有文化习俗的问题。AIP地区人们，尤其是妇女和儿童的健康状况不佳，不仅与卫生条件差和缺水有关，还与知识有限以及获得医疗服务的机会不足有关。此外，文化、政治和社会环境因素也起作用，包括性别不平等以及该地区当地语言与健康教育书面材料中最常用语言之间的差异。
为该地区设计的未来干预项目必须采用文化敏感策略，不仅要提供健康信息和健康服务，还要解决与性别不平等相关的健康潜在非医学决定因素。
