Milbank Memorial Fund, New York, NY, USA.
Public Health. 2013 Jun;127(6):503-13. doi: 10.1016/j.puhe.2013.04.019. Epub 2013 May 30.
Since Scottish devolution in 1999, successive governments have accorded priority to reducing health inequality and increasing economic growth. The Scottish Nationalist Party Government elected in 2007 and re-elected in 2011 has accorded considerable attention and allocated substantial resources to addressing these priorities. This article describes why, how and with what results to date the participants in the governance of Scotland, broadly defined to include persons outside as well as within central government, have addressed the determinants of health in order to reduce inequality and, as a result, improve the health status of the population.
Interpretive analysis.
Research for this article applied the methods of interpretive social science to obtain and analyse published and unpublished public documents; secondary sources in relevant disciplines; and interviews with ministers, officials, staff of National Health Service Scotland and its regions, and other persons active in health governance in Scotland.
Participants in the governance of health affairs in Scotland are making important contributions to the reduction of health inequality and the improvement of population health by: (1) linking policy to address health inequality with policy to make health care, public health, social and housing services, and education more effective and efficient; (2) linking policy to address the determinants of health with policy to stimulate economic growth and, as a result, increase employment and income; and (3) embracing and applying a unique synthesis of research findings about the causes of deficiencies in population health status that contribute to health inequality.
These findings could contribute to revising the assumptions and recommendations of some of the researchers and policy advisers who study the determinants of population health, and thus of health inequality, in order to recommend policy. Many contributors to the literature on population health argue that the determinants of health are universal, and that effective interventions to address them are also likely to be universal. Research for this article suggests, however, that participants in the governance of one country, and perhaps of each country, take account of its culture, history and current politics when they describe the determinants of health in order to propose policy to reduce health inequality. The Scottish experience described in this article could, therefore, contribute to conversations about health policy that involve leaders in governance from numerous jurisdictions; conversations that have been occurring regularly for two decades.
自 1999 年苏格兰权力下放以来，历届政府都优先考虑减少健康不平等和促进经济增长。2007 年当选并于 2011 年再次当选的苏格兰民族党政府对解决这些优先事项给予了相当大的关注，并投入了大量资源。本文描述了苏格兰治理的参与者（广义上定义为包括中央政府内外的人员）如何以及迄今为止取得了哪些成果，来应对健康决定因素，以减少不平等，并因此改善人口健康状况。
解释性分析。
本文的研究方法应用了解释性社会科学方法，以获取和分析已发表和未发表的公共文件；相关学科的二手资料；以及对苏格兰国家卫生服务及其地区的部长、官员、工作人员和其他积极参与苏格兰卫生治理的人员的访谈。
苏格兰卫生事务治理的参与者通过以下方式为减少健康不平等和改善人口健康做出了重要贡献：（1）将解决健康不平等问题的政策与使医疗保健、公共卫生、社会和住房服务以及教育更有效和高效的政策联系起来；（2）将解决健康决定因素的政策与刺激经济增长的政策联系起来，从而增加就业和收入；（3）接受并应用关于导致人口健康状况缺陷的原因的独特综合研究结果，这些缺陷导致健康不平等。
这些发现可能有助于修订一些研究人口健康决定因素的研究人员和政策顾问的假设和建议，从而推荐政策。许多关于人口健康的文献的贡献者认为健康决定因素是普遍存在的，解决这些问题的有效干预措施也可能是普遍存在的。然而，本文的研究表明，一个国家（也许是每个国家）的治理参与者在描述健康决定因素以提出减少健康不平等的政策时，需要考虑到其文化、历史和当前政治。因此，本文描述的苏格兰经验可以为涉及众多司法管辖区治理领导人的关于卫生政策的对话做出贡献；这些对话已经持续了二十年。
