Hertzman Clyde, Siddiqi Arjumand
Healthc Policy. 2008 Nov;4(2):16-24.
Fifty years ago, Canadian and US life expectancies were roughly equal. Now, however, Canadians are, on average, healthier than Americans. To discover the reasons behind this trend, the authors compared Canada and the United States on a range of determinants of health based on data from 1950 to the present. Their analysis yielded three conclusions: (1) greater economic well-being and spending on healthcare did not yield better health outcomes; (2) public provision and income redistribution trump economic success where population health is concerned; and (3) the gradual development of public provision represents the build-up of social infrastructure that has long-lasting effects on health status. The authors contend that in the context of thinking about population health, the historical, dynamic approach casts a clearer light on trends than does the cross-sectional approach.
五十年前，加拿大和美国的预期寿命大致相当。然而现在，加拿大人的总体健康状况优于美国人。为了探寻这一趋势背后的原因，作者基于1950年至今的数据，在一系列健康决定因素方面对加拿大和美国进行了比较。他们的分析得出了三个结论：（1）更高的经济福祉和医疗保健支出并未带来更好的健康结果；（2）在人口健康方面，公共供给和收入再分配比经济成就更为重要；（3）公共供给的逐步发展代表着社会基础设施的建设，这对健康状况具有长期影响。作者认为，在思考人口健康问题时，历史动态方法比横断面方法能更清晰地揭示趋势。
