Department of Family Medicine at Virginia Commonwealth University, Richmond, VA, USA.
Health Aff (Millwood). 2011 Oct;30(10):1852-9. doi: 10.1377/hlthaff.2011.0685.
Health disparities by racial or ethnic group or by income or education are only partly explained by disparities in medical care. Inadequate education and living conditions-ranging from low income to the unhealthy characteristics of neighborhoods and communities-can harm health through complex pathways. Meaningful progress in narrowing health disparities is unlikely without addressing these root causes. Policies on education, child care, jobs, community and economic revitalization, housing, transportation, and land use bear on these root causes and have implications for health and medical spending. A shortsighted political focus on reducing spending in these areas could actually increase medical costs by magnifying disease burden and widening health disparities.
健康差异不仅可以通过医疗保健方面的差异来解释，还可以通过种族或民族群体、收入或教育等方面来解释。教育和生活条件不足——从低收入到社区和社区的不健康特征——可以通过复杂的途径损害健康。如果不解决这些根本原因，缩小健康差距的工作就不可能取得有意义的进展。关于教育、儿童保育、工作、社区和经济振兴、住房、交通和土地使用的政策都与这些根本原因有关，并对健康和医疗支出有影响。政治上短视地关注减少这些领域的支出，实际上可能会通过放大疾病负担和扩大健康差距来增加医疗成本。
