Department of Social and Preventive Medicine, IRSPUM, Université de Montréal.
Sociol Health Illn. 2014 Feb;36(2):199-212. doi: 10.1111/1467-9566.12126. Epub 2013 Dec 23.
While empirical evidence continues to show that people living in low socio-economic status neighbourhoods are less likely to engage in health-enhancing behaviour, our understanding of why this is so remains less than clear. We suggest that two changes could take place to move from description to understanding in this field; (i) a move away from the established concept of individual health behaviour to a contextualised understanding of health practices; and (ii) a switch from focusing on health inequalities in outcomes to health inequities in conditions. We apply Pierre Bourdieu's theory on capital interaction but find it insufficient with regard to the role of agency for structural change. We therefore introduce Amartya Sen's capability approach as a useful link between capital interaction theory and action to reduce social inequities in health-related practices. Sen's capability theory also elucidates the importance of discussing unequal chances in terms of inequity, rather than inequality, in order to underscore the moral nature of inequalities. We draw on the discussion in social geography on environmental injustice, which also underscores the moral nature of the spatial distribution of opportunities. The article ends by applying this approach to the 'Interdisciplinary study of inequalities in smoking' framework.
虽然经验证据不断表明，生活在社会经济地位较低社区的人们不太可能采取增进健康的行为，但我们对其原因的理解仍不够清楚。我们提出，要想在这一领域从描述走向理解，可以进行两项改变；（i）从既定的个人健康行为概念转变为对健康实践的背景化理解；（ii）从关注结果层面的健康不平等转变为关注条件层面的健康不公平。我们应用了皮埃尔·布迪厄（Pierre Bourdieu）的资本互动理论，但发现其对于机构在结构变革中的作用的解释不够充分。因此，我们引入了阿玛蒂亚·森（Amartya Sen）的能力方法，作为资本互动理论与减少与健康相关的实践中的社会不公平的行动之间的有用联系。森的能力理论还阐明了根据不公平（而非不平等）来讨论机会不均等的重要性，以突出不平等的道德性质。我们借鉴了社会地理学中关于环境不公平的讨论，该讨论也强调了机会分配的空间分布的道德性质。本文最后将这一方法应用于“吸烟不平等的跨学科研究”框架。
