Department of Family and Community Medicine, University of California San Francisco, San Francisco, California 94118-0943, USA.
Am J Prev Med. 2011 Jan;40(1 Suppl 1):S58-66. doi: 10.1016/j.amepre.2010.09.026.
The Robert Wood Johnson Foundation Commission to Build a Healthier America was charged to identify strategies beyond medical care to address health disparities in the U.S. related to social and economic disadvantage. Based on insights gained while providing scientific support for the commission's efforts, this paper presents an overview of major issues that arise when assessing evidence to inform policies and programs to address the social determinants of health. While many of the insights are not new, they have not been widely assimilated within medicine and public health. They have particular relevance now, given growing awareness of the important health influences of social factors. The discussion presented here is intended to highlight key considerations for researchers who study social determinants of health and policymakers whose decisions are shaped by research findings. Policies should be based on the best available knowledge, derived from diverse sources and methods. An array of tools and guidelines is now available to guide the assessment of evidence on the social determinants of health, building on--and going beyond--principles first articulated in the "Evidence-Based Medicine" movement. The central thesis of the current paper is that the standards for evidence to guide social policies must be equally rigorous but also more comprehensive than those traditionally used to inform clinical interventions, because social policies must deal with upstream factors that affect health through complex causal pathways over potentially long time periods.
罗伯特伍德约翰逊基金会建设更健康美国委员会受委托确定超越医疗保健的战略，以解决美国与社会经济劣势相关的健康差异问题。本文件根据为委员会工作提供科学支持时获得的见解，概述了在评估证据以制定政策和方案来解决健康的社会决定因素时出现的主要问题。虽然许多见解并不新鲜，但它们尚未在医学和公共卫生领域得到广泛吸收。鉴于人们越来越意识到社会因素对健康的重要影响，这些见解具有特别的现实意义。本文的讨论旨在强调研究健康的社会决定因素的研究人员和受研究结果影响的政策制定者需要考虑的关键问题。政策应该基于最佳的现有知识，这些知识来自不同的来源和方法。现在有一系列工具和准则可用于指导对健康的社会决定因素的证据评估，这些准则建立在（并超越）最初在“循证医学”运动中阐述的原则之上。本文的中心论点是，指导社会政策的证据标准必须同样严格，但也必须比传统上用于为临床干预提供信息的标准更全面，因为社会政策必须处理通过复杂的因果途径在潜在的长时间段内影响健康的上游因素。
