Hernández-Aguado Ildefonso, Santaolaya Cesteros María, Campos Esteban Pilar
Departamento de Salud Pública, Historia de Ciencia y Ginecología, Universidad Miguel Hernández, Alicante, España.
Gac Sanit. 2012 Mar;26 Suppl 1:6-13. doi: 10.1016/j.gaceta.2011.09.036. Epub 2012 Feb 8.
The health system is a social determinant of health. Although not the most important determinant of health, the health system's potential contribution to reducing social inequalities in health should not be underestimated. Due to its characteristics, primary health care is well placed to attain equity in health. To make progress in achieving this goal, the main measures to be considered are the removal of barriers to access to services, the provision of care proportionate to need, and engagement in intersectoral work. This article reviews the background and framework for action to tackle social inequalities in health and provides a summary of the primary health care actions that could help to reduce social inequalities in health and are mentioned in the most important national and international documents on health policy. We hope to stimulate debate, promote research in the field and encourage implementation. The proposals are grouped in the following five intervention lines: information systems; participation; training; intersectoral work; and reorientation of health care. Each intervention is ordered according to its targets (population and civil society; primary health team; health center and health area management; and health policy decision-makers).
卫生系统是健康的一个社会决定因素。尽管它并非健康的最重要决定因素,但卫生系统在减少健康方面的社会不平等方面的潜在贡献不应被低估。由于其特性,初级卫生保健在实现健康公平方面具有优势。为在实现这一目标方面取得进展,需要考虑的主要措施包括消除获得服务的障碍、根据需求提供相应的护理以及参与部门间工作。本文回顾了应对健康方面社会不平等的行动背景和框架,并总结了有助于减少健康方面社会不平等的初级卫生保健行动,这些行动在最重要的国家和国际卫生政策文件中均有提及。我们希望引发讨论、推动该领域的研究并鼓励实施。这些提议分为以下五条干预线路:信息系统;参与;培训;部门间工作;以及卫生保健的重新定位。每项干预措施均按照其目标进行排序(人群和民间社会;初级卫生保健团队;卫生中心和卫生区域管理;以及卫生政策决策者)。