Refugee Studies Centre, Department of International Development, University of Oxford, 3 Mansfield Road, OX1 9TB Oxford, UK.
Soc Sci Med. 2013 Apr;82:43-50. doi: 10.1016/j.socscimed.2013.01.003. Epub 2013 Jan 16.
Global inequalities in health have long been associated with disparities between rich and poor nations. The middle-income countries of the Levant (Lebanon, Syria and Jordan) have developed models of health care delivery that mirror the often complex make-up of their states. In Lebanon, which is characterized by political clientelism and sectarian structures, access to health care is more contingent on ethnicity and religious affiliation than on poverty. This case study of the Bedouin of the Middle Bekaa Valley of Lebanon is based on interviews with policymakers, health care providers and the Bedouin as part of a study funded by the European Commission between 2006 and 2010. The study explores the importance of considering social discrimination and political exclusion in understanding compromised health care. Three decades after the Declaration of Alma Ata (1978), which declared that an acceptable level of health care for all should be attained by the year 2000, the Bedouin community of Lebanon remains largely invisible to the government and, thus, invisible to national health care policy and practice. They experience significant social discrimination from health practitioners and policymakers alike. Their unfair treatment under the health system is generally disassociated from issues of wealth or poverty; it is manifested in issues of access and use, discrimination, and resistance and agency. Overcoming their political exclusion and recognizing the social discrimination they face are steps that can be taken to protect and promote equal access to basic reproductive and child health care. This case study of the Bedouin in Lebanon is also relevant to the health needs of other marginalized populations in remote and rural areas.
全球健康不平等长期以来一直与富国和穷国之间的差距有关。中东地区的中等收入国家（黎巴嫩、叙利亚和约旦）制定了医疗保健提供模式，反映了其国家结构的复杂性。在黎巴嫩，政治分赃和宗派结构决定了医疗保健的可及性更多地取决于种族和宗教信仰，而不是贫困。本案例研究以黎巴嫩贝卡谷地中部的贝都因人为例，研究对象为政策制定者、医疗保健提供者和贝都因人。该案例研究是在 2006 年至 2010 年期间由欧盟委员会资助进行的，研究探索了在理解医疗保健质量受损时考虑社会歧视和政治排斥的重要性。《阿拉木图宣言》（1978 年）宣布，到 2000 年，所有人都应享有可接受的卫生保健水平，三十年后，黎巴嫩的贝都因社区在很大程度上仍然不为政府所关注，因此也不为国家卫生保健政策和实践所关注。他们受到卫生从业人员和政策制定者的严重社会歧视。他们在卫生系统中受到不公平待遇，通常与财富或贫困无关，而是表现在获得和使用、歧视以及抵制和代理方面。克服政治排斥，认识到他们面临的社会歧视，是保护和促进基本生殖和儿童保健平等机会的步骤。本案例研究也与偏远和农村地区其他边缘人群的健康需求有关。
