Jones Camara Phyllis, Jones Clara Yvonne, Perry Geraldine S, Barclay Gillian, Jones Camille Arnel
Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
J Health Care Poor Underserved. 2009;20(4 Suppl):1-12. doi: 10.1353/hpu.0.0228.
This paper presents a "Cliff Analogy" illustrating three dimensions of health intervention to help people who are falling off of the cliff of good health: providing health services, addressing the social determinants of health, and addressing the social determinants of equity. In the terms of the analogy, health services include an ambulance at the bottom of the cliff, a net or trampoline halfway down, and a fence at the top of the cliff. Addressing the social determinants of health involves the deliberate movement of the population away from the edge of the cliff. Addressing the social determinants of equity acknowledges that the cliff is three-dimensional and involves interventions on the structures, policies, practices, norms, and values that differentially distribute resources and risks along the cliff face. The authors affirm that we need to address both the social determinants of health, including poverty, and the social determinants of equity, including racism, if we are to improve health outcomes and eliminate health disparities.
本文提出了一个“悬崖类比”，阐述了健康干预的三个维度，以帮助那些正从健康的悬崖上坠落的人们：提供健康服务、解决健康的社会决定因素以及解决公平的社会决定因素。用这个类比的说法，健康服务包括悬崖底部的救护车、半途中的网或蹦床以及悬崖顶部的围栏。解决健康的社会决定因素涉及有意识地让人群远离悬崖边缘。解决公平的社会决定因素则认识到悬崖是三维的，涉及对那些在悬崖表面差异化分配资源和风险的结构、政策、实践、规范和价值观进行干预。作者们断言，如果我们要改善健康结果并消除健康差距，就需要同时解决包括贫困在内的健康的社会决定因素以及包括种族主义在内的公平的社会决定因素。
