Department of Health Policy and Management, Johns Hopkins University, USA.
Annu Rev Public Health. 2012 Apr;33:89-106. doi: 10.1146/annurev-publhealth-031811-124528. Epub 2012 Jan 3.
Health disparities, also known as health inequities, are systematic and potentially remediable differences in one or more aspects of health across population groups defined socially, economically, demographically, or geographically. This topic has been the subject of research stretching back at least decades. Reports and studies have delved into how inequities develop in different societies and, with particular regard to health services, in access to and financing of health systems. In this review, we consider empirical studies from the United States and elsewhere, and we focus on how one aspect of health systems, clinical care, contributes to maintaining systematic differences in health across population groups characterized by social disadvantage. We consider inequities in clinical care and the policies that influence them. We develop a framework for considering the structural and behavioral components of clinical care and review the existing literature for evidence that is likely to be generalizable across health systems over time. Starting with the assumption that health services, as one aspect of social services, ought to enhance equity in health care, we conclude with a discussion of threats to that role and what might be done about them.
健康差异，也称为健康不公平，是指在社会、经济、人口统计学或地理上定义的人群中，健康的一个或多个方面存在系统的和潜在可纠正的差异。这个话题已经成为研究的主题，至少可以追溯到几十年前。报告和研究深入探讨了不平等现象是如何在不同社会中产生的，特别是在卫生服务方面，探讨了卫生系统的获取和融资方面的不平等现象。在这篇综述中，我们考虑了来自美国和其他地方的实证研究，并关注卫生系统的一个方面，即临床护理，如何有助于维持社会劣势人群中健康的系统差异。我们考虑临床护理中的不平等现象以及影响这些不平等现象的政策。我们制定了一个考虑临床护理的结构和行为组成部分的框架，并回顾了现有文献，以寻找可能随着时间的推移在卫生系统中具有普遍性的证据。从卫生服务作为社会服务的一个方面应该增强医疗保健公平性的假设出发，我们最后讨论了对这一角色的威胁以及可以采取的措施。
