Stafford Mai, Cummins Steven, Ellaway Anne, Sacker Amanda, Wiggins Richard D, Macintyre Sally
UCL Medical School, London, UK.
Soc Sci Med. 2007 Nov;65(9):1882-97. doi: 10.1016/j.socscimed.2007.05.042. Epub 2007 Jul 20.
Many studies document small area inequalities in morbidity and mortality and show associations between area deprivation and health. However, few studies unpack the "black box" of area deprivation to show which specific local social and physical environmental characteristics impact upon health, and might be amenable to modification. We theorised a model of the potential causal pathways to obesity and employed path analysis using a rich data set from national studies in England and Scotland to test the model empirically. Significant associations between obesity and neighbourhood disorder and access to local high street facilities (local shops, financial services and health-related stores found in a typical small UK town) were found. There was a tendency for lower levels of obesity in areas with more swimming pools and supermarkets. In turn, policing levels, physical dereliction and recorded violent crime were associated with neighbourhood disorder. The analysis identifies several factors that are associated with (and are probably determinants of) obesity and which are outside the standard remit of the healthcare sector. They highlight the role that public and private sector organisations have in promoting the nation's health. Public health professionals should seek to work alongside or within these organisations to capitalise on opportunities to improve health.
许多研究记录了发病率和死亡率方面的小区域不平等现象，并表明区域贫困与健康之间存在关联。然而，很少有研究打开区域贫困这个“黑匣子”，以揭示哪些具体的当地社会和自然环境特征会对健康产生影响，以及哪些特征可能易于改变。我们构建了一个肥胖潜在因果路径的模型，并利用来自英格兰和苏格兰全国性研究的丰富数据集进行路径分析，以实证检验该模型。研究发现肥胖与邻里混乱以及使用当地商业街设施（英国典型小镇上的当地商店、金融服务和健康相关商店）之间存在显著关联。在有更多游泳池和超市的地区，肥胖水平往往较低。反过来，治安水平、物质荒废和记录在案的暴力犯罪与邻里混乱相关。该分析确定了几个与肥胖相关（且可能是肥胖的决定因素）的因素，这些因素超出了医疗保健部门的标准职责范围。它们凸显了公共和私营部门组织在促进国民健康方面所起的作用。公共卫生专业人员应寻求与这些组织合作或在这些组织内部开展工作，以利用改善健康的机会。
