Division of Health Policy and Management, School of Public Health, University of California, Berkeley, CA 94720-7360, USA.
Ann N Y Acad Sci. 2010 Feb;1186:24-36. doi: 10.1111/j.1749-6632.2009.05384.x.
This article places socioeconomic gradients in health into a broader international and historical context. The data we present supports the conclusion that current socioeconomic gradients in health within the United States are neither inevitable nor immutable. This literature reveals periods in the United States with substantially smaller gradients, and identifies many examples of other countries whose different social policy choices appear to have led to superior health levels and equity even with fewer aggregate resources. The article also sheds light on the potential importance of various hypothesized mechanisms in driving major shifts in U.S. population health patterns. While it is essential to carefully examine individual mechanisms contributing to health patterns, it is also illuminating to take a more holistic view of the set of factors changing in conjunction with major shifts in population health. In this article, we do so by focusing on the period of the 1980s, during which U.S. life expectancy gains slowed markedly relative to other developed countries, and U.S. health disparities substantially increased. A comparison with Canada suggests that exploring broad social policy differences, such as the weaker social safety net in the United States, may be a promising area for future investigation.
本文将健康领域的社会经济梯度置于更广泛的国际和历史背景下。我们呈现的数据支持这样的结论，即当前美国健康领域的社会经济梯度既不是不可避免的，也不是不可改变的。这一文献揭示了美国历史上存在着社会经济梯度显著较小的时期，并列举了许多其他国家的例子，这些国家的不同社会政策选择似乎导致了更高的健康水平和公平性，即使其总资源较少。本文还揭示了各种假设机制在推动美国人口健康模式重大转变方面的潜在重要性。虽然仔细研究对健康模式有贡献的各个机制至关重要，但从与人口健康重大转变同时发生的一系列因素的整体角度来看待问题也同样具有启发性。在本文中，我们通过关注 20 世纪 80 年代这一时期来做到这一点，在此期间，与其他发达国家相比，美国的预期寿命增长明显放缓，健康差距也大幅扩大。与加拿大的比较表明，探索广泛的社会政策差异，例如美国较弱的社会安全网，可能是未来研究的一个有前途的领域。
