Département de médecine sociale et préventive, Université de Montréal, Canada.
Glob Health Promot. 2013 Jun;20(2):39-52. doi: 10.1177/1757975913486686.
The creation of supportive environments for health is a basic action principle of health promotion, and equity is a core value. A settings approach offers an opportunity to bridge these two, with its focus on the interplay between individual, environmental and social determinants of health.
We conducted a scoping review of the literature on theoretical bases and practical applications of the settings approach. Interventions targeting social inequities in health through action on various settings were analyzed to establish what is done in health equity research and action as it relates to settings.
Four elements emerged as central to an equity-focused settings approach: a focus on social determinants of health, addressing the needs of marginalized groups, effecting change in a setting's structure, and involving stakeholders. Each came with related challenges. To offer potential solutions to these challenges we developed a conceptual framework that integrates theoretical and methodological approaches, along with six core guiding principles, into a 'settings praxis'.
Reducing social inequities in health through the creation of supportive environments requires the application of the settings approach in an innovative way. The proposed conceptual framework can serve as a guide to do so, and help develop, implement and evaluate equity-focused settings-related interventions.
为健康创造支持性环境是健康促进的基本行动原则，公平是其核心价值。环境方法提供了一个将这两者联系起来的机会，其重点是个人、环境和健康社会决定因素之间的相互作用。
我们对环境方法的理论基础和实际应用的文献进行了范围界定审查。通过对各种环境采取行动来针对健康方面的社会不平等进行干预，以确定在与环境相关的健康公平研究和行动中所做的工作。
有四个要素是关注公平的环境方法的核心：关注健康的社会决定因素，满足边缘化群体的需求，改变环境结构，以及让利益相关者参与。每个要素都伴随着相关的挑战。为了解决这些挑战，我们开发了一个概念框架，将理论和方法方法以及六个核心指导原则整合到“环境实践”中。
通过创造支持性环境来减少健康方面的社会不平等，需要以创新的方式应用环境方法。所提出的概念框架可以作为这样做的指南，并有助于制定、实施和评估以公平为重点的环境相关干预措施。
