Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, South Africa.
Int J Health Serv. 2013;43(4):745-59. doi: 10.2190/HS.43.4.i.
There is a growing interest in health policy in the social determinants of health. This has increased the demand for a paradigm shift within the discipline of health economics from health care economics to health economics. While the former involves what is essentially a medical model that emphasizes the maximization of individual health outcomes and considers the social organization of the health system as merely instrumental, the latter emphasizes that health and its distribution result from political, social, economic, and cultural structures. The discipline of health economics needs to refocus its energy on the social determinants of health but, in doing so, must dig deeper into the reasons for structurally embedded inequalities that give rise to inequalities in health outcomes. Especially is this the case in Africa and other low- and middle-income regions. This article seeks to provide empirical evidence from sub-Saharan Africa, including Ghana and Nigeria, on why such inequalities exist, arguing that these are in large part a product of hangovers from historically entrenched institutions. It argues that there is a need for research in health economics to embrace the social determinants of health, especially inequality, and to move away from its current mono-cultural focus.
人们对健康政策中健康决定因素的兴趣日益浓厚。这增加了在卫生经济学学科内从卫生保健经济学向健康经济学范式转变的需求。前者主要涉及强调最大化个人健康结果的医疗模式，并将卫生系统的社会组织仅仅视为工具，而后者则强调健康及其分布是由政治、社会、经济和文化结构决定的。卫生经济学学科需要将精力重新集中在健康的决定因素上，但在这样做的过程中，必须更深入地研究导致健康结果不平等的结构性不平等的原因。在非洲和其他中低收入地区尤其如此。本文试图从撒哈拉以南非洲（包括加纳和尼日利亚）提供实证证据，说明为什么会存在这种不平等，认为这些不平等在很大程度上是历史上根深蒂固的制度遗留下来的。本文认为，健康经济学研究需要接受健康的决定因素，特别是不平等，并摆脱当前的单一文化焦点。
