London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom.
Soc Sci Med. 2010 Jan;70(1):80-8. doi: 10.1016/j.socscimed.2009.09.032. Epub 2009 Oct 21.
Issues around health equity in conflict-affected fragile states have received very little analysis to date. This paper examines the main factors that threaten health equity, the populations that are most vulnerable and potential strategies to improve health equity. The methods employed are a review of the published and grey literature, key informant interviews and an analysis of data on social determinants of health indicators. A new conceptual framework was developed outlining types of inequity, factors that influence equity and possible strategies to strengthen equity. Factors that affect equity include displacement, gender and financial barriers. Strategies to strengthen health equity include strengthening pro-equity policy and planning functions; building provider capacity to provide health services; and reducing access and participation barriers for excluded groups. In conclusion, conflict is a key social determinant of health. More data is needed to determine how conflict affects within-country and between-country equity, and better evaluated strategies are needed to reduce inequity.
目前，有关受冲突影响的脆弱国家中健康公平问题的分析研究还很少。本文探讨了威胁健康公平的主要因素、最脆弱的人群以及改善健康公平的潜在策略。采用的方法包括对已发表和灰色文献的审查、关键知情人访谈以及对社会决定因素健康指标数据的分析。本文提出了一个新的概念框架，概述了不平等的类型、影响公平的因素以及加强公平的可能策略。影响公平的因素包括流离失所、性别和财政障碍。加强健康公平的策略包括加强有利于公平的政策和规划职能；建设提供者提供卫生服务的能力；减少被排斥群体的准入和参与障碍。总之，冲突是健康的一个重要社会决定因素。需要更多的数据来确定冲突如何影响国内和国家间的公平，还需要更好的评估策略来减少不平等。
