Southgate Institute for Health, Society and Equity, Flinders University, Bedford Park, South Australia.
BMC Public Health. 2011 Jan 31;11:67. doi: 10.1186/1471-2458-11-67.
This paper reports on a qualitative study of lay knowledge about health inequalities and solutions to address them. Social determinants of health are responsible for a large proportion of health inequalities (unequal levels of health status) and inequities (unfair access to health services and resources) within and between countries. Despite an expanding evidence base supporting action on social determinants, understanding of the impact of these determinants is not widespread and political will appears to be lacking. A small but growing body of research has explored how ordinary people theorise health inequalities and the implications for taking action. The findings are variable, however, in terms of an emphasis on structure versus individual agency and the relationship between being 'at risk' and acceptance of social/structural explanations.
This paper draws on findings from a qualitative study conducted in Adelaide, South Australia, to examine these questions. The study was an integral part of mixed-methods research on the links between urban location, social capital and health. It comprised 80 in-depth interviews with residents in four locations with contrasting socio-economic status. The respondents were asked about the cause of inequalities and actions that could be taken by governments to address them.
Although generally willing to discuss health inequalities, many study participants tended to explain the latter in terms of individual behaviours and attitudes rather than social/structural conditions. Moreover, those who identified social/structural causes tended to emphasise individualized factors when describing typical pathways to health outcomes. This pattern appeared largely independent of participants' own experience of advantage or disadvantage, and was reinforced in discussion of strategies to address health inequalities.
Despite the explicit emphasis on social/structural issues expressed in the study focus and framing of the research questions, participants did not display a high level of knowledge about the nature and causes of place-based health inequalities. By extending the scope of lay theorizing to include a focus on solutions, this study offers additional insights for public health. Specifically it suggests that a popular constituency for action on the social determinants of health is unlikely to eventuate from the current popular understandings of possible policy levers.
本文报告了一项关于公众对健康不平等及其解决办法的定性研究。健康的社会决定因素是造成国家内部和国家之间健康不平等（健康状况水平不平等）和不公平（获得卫生服务和资源的机会不平等）的主要原因。尽管有越来越多的证据支持针对社会决定因素采取行动，但人们对这些决定因素的影响的理解并不广泛，政治意愿似乎也缺乏。虽然数量不多，但越来越多的研究已经探讨了普通人如何理论化健康不平等及其采取行动的影响。然而，这些研究结果在强调结构与个体能动性之间以及“处于风险之中”与接受社会/结构性解释之间的关系方面存在差异。
本文借鉴了在澳大利亚阿德莱德进行的定性研究的结果，以探讨这些问题。该研究是混合方法研究城市位置、社会资本与健康之间联系的一个组成部分。它包括对四个社会经济地位不同的地点的 80 名居民进行的深入访谈。受访者被问及不平等的原因以及政府可以采取哪些行动来解决这些问题。
尽管大多数研究参与者普遍愿意讨论健康不平等问题，但许多人倾向于用个人行为和态度来解释后者，而不是用社会/结构性条件来解释。此外，那些认为存在社会/结构性原因的人在描述典型的健康结果途径时，往往更强调个体化因素。这种模式似乎在很大程度上独立于参与者自身的优势或劣势经历，并且在讨论解决健康不平等问题的策略时得到了加强。
尽管研究重点和研究问题的框架明确强调社会/结构性问题，但参与者对基于地点的健康不平等的性质和原因并没有很高的了解。通过将公众的理论化范围扩展到关注解决办法，本研究为公共卫生提供了更多的见解。具体来说，它表明，针对健康的社会决定因素采取行动的一个受欢迎的选民群体不太可能从当前对可能的政策杠杆的普遍理解中产生。
