Social Welfare Management Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Soc Sci Med. 2012 Aug;75(3):531-7. doi: 10.1016/j.socscimed.2012.04.003. Epub 2012 Apr 26.
Information about urban health is often based on averages, while to better understand health status in urban areas, inequality should also be included. In this paper, we applied an achievement index approach in order to surmount this defect and to examine mental health status in Iran's capital, Tehran. The data we required for this study were taken from the Urban Health Equity Assessment and Response Tool (Urban HEART) survey which was conducted in Tehran in 2007, covering people aged 15 and above. The concentration index, which is a commonly used measure of socioeconomic inequalities in health, was extended to enable the combination of inequality and averages and the formation of a mental health achievement index. Values from the standard concentration indices showed that mental disorders are concentrated disproportionately among the poor in Tehran. An extension of the standard concentration indices revealed that, in most of Tehran's districts, the mental health of populations in the poorest quintile is much worse than that of other groups. In addition, when we computed the achievement index and ranked districts according to this index, the ranking was different from the ranking by averages. These findings imply that mental health varies significantly across the economic groups of the population in Tehran and that efficiency-oriented strategies which target average level of mental health alone are not sufficient to improve mental health of all people especially mental health of the poor. Equity-oriented strategies which target the mental health inequalities should be considered as well.
城市健康信息通常基于平均值，而要更好地了解城市地区的健康状况，还应包括不平等情况。在本文中，我们应用了成就指数方法来克服这一缺陷，并研究伊朗首都德黑兰的心理健康状况。我们这项研究所需的数据来自于 2007 年在德黑兰进行的城市健康公平评估和应对工具（Urban HEART）调查，涵盖了 15 岁及以上的人群。集中指数是衡量健康方面社会经济不平等的常用指标，我们将其进行了扩展，以实现不平等和平均值的结合，并形成心理健康成就指数。标准集中指数的值表明，在德黑兰，精神障碍在贫困人口中不成比例地集中。对标准集中指数的扩展表明，在德黑兰的大多数区，最贫困五分之一人口的心理健康状况比其他群体差得多。此外，当我们计算成就指数并根据该指数对地区进行排名时，排名与平均值排名不同。这些发现表明，德黑兰人口的不同经济群体的心理健康状况存在显著差异，仅针对平均心理健康水平的以效率为导向的策略不足以改善所有人的心理健康状况，尤其是贫困人口的心理健康状况。应考虑以公平为导向的策略，以解决心理健康不平等问题。
