Zaboli Rouhollah, Tourani Sogand, Seyedin Seyed Hesam, Oliaie Manesh Alireza
Department of Health Services Management, School of Health, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
Hospital Management Research Centre, Iran University of Medical Sciences, Tehran, IR Iran.
Iran Red Crescent Med J. 2014 Apr;16(4):e12607. doi: 10.5812/ircmj.12607. Epub 2014 Apr 5.
One of the main challenges of healthcare systems of developing countries is health inequality. Health inequality means inequality in individuals' ability and proper functioning, resulting in inequality in social status and living conditions, which thwarts social interventions implemented by the government.
This study aimed to determine and prioritize the social determinants of health inequality in Iran.
This was a mixed method study with two phases of qualitative and quantitative research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect qualitative data along with a multiple attribute decision making method for the quantitative phase of the research in which the TOPSIS technique was employed for prioritization. The qualitative findings were entered into NVivo for analysis, as were the quantitative data entered into MATLAB software.
The results approved the suitability of the conceptual framework of social determinants of health suggested by the WHO (world health organization) for studying social determinants of health inequality; however, this framework general and theoretical rather than a guideline for practice. Thus, in this study, 15 themes and 31 sub-themes were determined as social determinants of social health inequality in Iran. Based on the findings of the quantitative phase of our research, socioeconomic status, living facilities such as housing, and social integrity had the greatest effect on decreasing health inequality.
A major part of the inequality in health distribution is avoidable because they are mostly caused by adjustable factors like economic conditions, educational conditions, employment, living facilities, etc. As in the majority of developing countries the living and health conditions are the same as Iran, the findings of this study may be applicable for other developing countries.
发展中国家医疗保健系统面临的主要挑战之一是健康不平等。健康不平等指的是个体能力和正常功能方面的不平等，进而导致社会地位和生活条件的不平等，这阻碍了政府实施的社会干预措施。
本研究旨在确定伊朗健康不平等的社会决定因素并对其进行优先级排序。
这是一项混合方法研究，包括定性和定量研究两个阶段。研究对象包括处理健康社会决定因素的专家。采用了立意、分层和非随机抽样方法。进行半结构化访谈以收集定性数据，并采用多属性决策方法进行研究的定量阶段，其中运用TOPSIS技术进行优先级排序。定性研究结果录入NVivo进行分析，定量数据录入MATLAB软件进行分析。
结果证实了世界卫生组织（WHO）提出的健康社会决定因素概念框架适用于研究健康不平等的社会决定因素；然而，该框架较为笼统和理论化，而非实践指南。因此，本研究确定了15个主题和31个子主题作为伊朗社会健康不平等的社会决定因素。根据我们研究定量阶段的结果，社会经济地位、住房等生活设施以及社会诚信对减少健康不平等的影响最大。
健康分布不平等的主要部分是可以避免的，因为它们大多由经济状况、教育状况、就业、生活设施等可调节因素引起。由于大多数发展中国家的生活和健康状况与伊朗相同，本研究结果可能适用于其他发展中国家。
