Arcaya Mariana C, Arcaya Alyssa L, Subramanian S V
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University in Boston, MA, USA.
Region 2, United States Environmental Protection Agency, New York, NY, USA.
Glob Health Action. 2015 Jun 24;8:27106. doi: 10.3402/gha.v8.27106. eCollection 2015.
Individuals from different backgrounds, social groups, and countries enjoy different levels of health. This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. We describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behavior, environmental, and selection explanations. Concepts of relative versus absolute; dose-response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. We close by reflecting on what conditions make health inequalities unjust, and to consider the merits of policies that prioritize the elimination of health disparities versus those that focus on raising the overall standard of health in a population.
来自不同背景、社会群体和国家的个人享有不同程度的健康。本文定义并区分了不可避免的健康不平等与不公正且可预防的健康不公平现象。我们描述了通常用于审视健康不平等的维度，包括全球人口层面、国家或州之间以及地理区域内部，按种族/族裔、性别、教育程度、种姓、收入、职业等社会相关分组来进行审视。不同的理论试图解释群体层面的健康差异，包括心理社会、物质匮乏、健康行为、环境和选择等方面的解释。相对与绝对的概念；剂量反应与阈值；构成与背景；地点与空间；健康的生命历程视角；健康的因果途径；有条件的健康影响；以及群体层面与个体差异，对于理解健康不平等至关重要。我们最后思考哪些条件会使健康不平等变得不公正，并考量优先消除健康差距的政策与那些着重提高总体人群健康水平的政策的优劣。
