Health Inequalities Research Group, Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
J Epidemiol Community Health. 2013 Mar;67(3):286-91. doi: 10.1136/jech-2011-200363. Epub 2012 Aug 17.
The last decade has witnessed a surge in interest for policies to tackle health inequalities. Adequate theoretical development of policy models is needed to understand how to design and evaluate equity-oriented health policies. In this paper we review Graham's typology of policies (focused on the worst-off, on the gap, or on the gradient) and propose an adaptation (targeted, universal with additional targeting, redistributive, and proportionate universalism). For each type, potential scenarios of impact on population health and health inequalities are depicted following the idea of Geoffrey Rose's population curves and strategies, policy examples are given and a simulation with survey data is shown. The proposed typology of scenarios of health inequality reduction can serve as an effective tool to interpret the differential impact of interventions and to reflect on how to adequately design or re-orient a policy and which measures to use to evaluate it.
过去十年，人们对解决健康不平等问题的政策产生了浓厚的兴趣。为了理解如何设计和评估面向公平的健康政策，需要充分发展政策模型的理论。在本文中，我们回顾了 Graham 的政策分类（关注最弱势群体、差距或梯度），并提出了一种适应方法（有针对性、普遍加额外针对性、再分配和相称的普遍主义）。对于每一种类型，根据 Geoffrey Rose 的人口曲线和策略的思想，描绘了对人口健康和健康不平等的潜在影响情景，给出了政策实例，并展示了一项基于调查数据的模拟。拟议的健康不平等减少情景分类可作为一种有效工具，用于解释干预措施的差异影响，并思考如何充分设计或重新定位政策，以及使用哪些措施来评估政策。
