Siddiqi Arjumand, Hertzman Clyde
University of Tennessee, Knoxville, TN, USA.
Soc Sci Med. 2007 Feb;64(3):589-603. doi: 10.1016/j.socscimed.2006.09.034. Epub 2006 Nov 13.
This paper uses a comparative case study of Canada and the USA to argue that, in order to fully understand the associations between population health and the socioeconomic environment we must begin to place importance on the dynamic aspect of these factors--examining them as they evolve over time. In particular, for institutional and policy shifts that often unfold over decades, population health must attend to these big, slow moving processes by adopting a historical perspective to the knowledge base. We compare Canada and the USA on basic health outcomes and a range of determinants of health for which routine data have been collected for all or most of the period between 1950 and the present. During the analysis that follows, we are able to establish that, at the level of society (i) greater economic well being and spending on health care does not yield better health outcomes, that (ii) public provision and income redistribution trump economic success where population health is concerned, and (iii) that the gradual development of public provision represents the buildup of social infrastructure that has long-lasting effects on health status. Our case study shows what can be gleaned from a comparative perspective and a long-term view. The long view allows us to detect the gradual divergence in health status between these two societies and to trace potential institutional causes that would otherwise go unnoticed. The perspective introduced here, and in particular the comparison of Canada and the USA, provides strong support for the use of cross-national comparative work, and a historical perspective on the investigation of societies that successfully support population health.
本文通过对加拿大和美国的比较案例研究认为，为了全面理解人口健康与社会经济环境之间的关联，我们必须开始重视这些因素的动态方面——考察它们如何随时间演变。特别是，对于通常持续数十年的制度和政策转变，人口健康领域必须通过采用历史视角来审视知识库，从而关注这些重大且进展缓慢的进程。我们比较了加拿大和美国在基本健康结果以及一系列健康决定因素方面的情况，这些决定因素在1950年至当前的全部或大部分时间里都有常规数据收集。在接下来的分析中，我们能够确定，在社会层面：（i）更高的经济福祉和医疗保健支出并不会带来更好的健康结果；（ii）在人口健康方面，公共供给和收入再分配比经济成功更为重要；（iii）公共供给的逐步发展代表着社会基础设施的建设，对健康状况具有长期影响。我们的案例研究展示了从比较视角和长期视角可以获得什么。长期视角使我们能够察觉到这两个社会在健康状况上的逐渐差异，并追溯那些否则就会被忽视的潜在制度原因。这里引入的视角，尤其是加拿大和美国的比较，为跨国比较研究的运用以及对成功支持人口健康的社会进行调查的历史视角提供了有力支持。
