Department of Ethics, Equity, Trade and Human Rights, World Health Organization, Geneva, Switzerland.
J Epidemiol Community Health. 2011 Aug;65(8):656-60. doi: 10.1136/jech.2009.093914. Epub 2009 Nov 22.
Increasing focus on health inequities has brought renewed attention to two related policy discourses - primary health care and the social determinants of health. Both prioritise health equity and also promote a broad view of health, multisectoral action and the participation of empowered communities. Differences arise in the lens each applies to the health sector, with resultant tensions around their mutual ability to reform health systems and address the social determinants. However, pitting them against each is unproductive. Health services that do not consciously address social determinants exacerbate health inequities. If a revitalised primary health care is to be the key approach to organise society to minimise health inequities, action on social determinants has to be a major constituent strategy. Success in reducing health inequities will require ensuring that the broad focus of primary health care and the social determinants is kept foremost in policy - instead of the common historical experience of efforts being limited to a part of the health sector.
对健康不平等现象的日益关注，使人们重新关注到两个相关的政策论述——初级卫生保健和健康的社会决定因素。这两者都优先考虑健康公平，并促进对健康的广义看法、多部门行动以及赋权社区的参与。每个论述对卫生部门的应用视角存在差异，因此围绕它们相互改革卫生系统和应对社会决定因素的能力存在紧张关系。然而，将它们对立起来是无益的。不有意识地解决社会决定因素的卫生服务会加剧健康不平等。如果要振兴初级卫生保健作为组织社会以最大限度减少健康不平等的主要方法，那么就必须将社会决定因素作为主要组成部分的策略。要想成功减少健康不平等，就需要确保初级卫生保健和健康的社会决定因素的广泛重点在政策中处于首要地位——而不是像常见的历史经验那样，将努力仅限于卫生部门的一部分。
