Graham H, Power C
Institute for Health Research, Lancaster University, Lancaster, UK.
Child Care Health Dev. 2004 Nov;30(6):671-8. doi: 10.1111/j.1365-2214.2004.00457.x.
Tackling health inequalities is moving up the policy agenda of richer societies like the UK, with governments looking for evidence to guide policy review and development. Observational studies of how childhood disadvantage compromises health in adulthood are an important part of the evidence base, but are largely inaccessible to the policy community. We develop a framework which captures the findings of these studies. Our framework highlights how disadvantage in childhood adversely affects both socio-economic circumstances and health in adulthood through a set of interlocking processes. Key among these are children's developmental health (their physical, cognitive and emotional development) and health behaviours, together with the associated educational and social trajectories. In breaking down the link between childhood disadvantage and adult health into its constituent elements, the framework provides a basis for understanding where and how policies can make a difference. The paper argues that the process of policy review and development needs to include both new programmes and the mainstream policies in which they are embedded.
解决健康不平等问题正被提上英国等富裕社会的政策议程，政府在寻找证据以指导政策审查和制定。关于童年时期的不利因素如何损害成年期健康的观察性研究是证据基础的重要组成部分，但政策界基本上无法获取这些研究。我们开发了一个框架来总结这些研究的结果。我们的框架强调了童年时期的不利因素如何通过一系列相互关联的过程对成年期的社会经济状况和健康产生不利影响。其中关键的是儿童的发育健康（他们的身体、认知和情感发展）以及健康行为，还有相关的教育和社会轨迹。该框架将童年时期的不利因素与成年期健康之间的联系分解为其组成要素，为理解政策可以在何处以及如何发挥作用提供了基础。本文认为，政策审查和制定过程需要包括新的项目以及包含这些项目的主流政策。
