Newman Lareen, Baum Fran, Javanparast Sara, O'Rourke Kerryn, Carlon Leanne
Southgate Institute for Health Society & Equity, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
Southgate Institute for Health Society & Equity, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
Health Promot Int. 2015 Sep;30 Suppl 2:ii126-43. doi: 10.1093/heapro/dav054.
Changing settings to be more supportive of health and healthy choices is an optimum way to improve population health and health equity. This article uses the World Health Organisation's (1998) (WHO Health Promotion Glossary. WHO Collaborating Centre for Health Promotion, Department of Public Health and Community Medicine, University of Sydney, NSW) definition of settings approaches to health promotion as those focused on modifying settings' structure and nature. A rapid literature review was undertaken in the period June-August 2014, combining a systematically conducted search of two major databases with targeted searches. The review focused on identifying what works in settings approaches to address the social determinants of health inequities, using Fair Foundations: the VicHealth framework for health equity. This depicts the social determinants of health inequities as three layers of influence, and entry points for action to promote health equity. The evidence review identified work in 12 settings (cities; communities and neighbourhoods; educational; healthcare; online; faith-based; sports; workplaces; prisons; and nightlife, green and temporary settings), and work at the socioeconomic, political and cultural context layer of the Fair Foundations framework (governance, legislation, regulation and policy). It located a relatively small amount of evidence that settings themselves are being changed in ways which address the social determinants of health inequities. Rather, many initiatives focus on individual behaviour change within settings. There is considerable potential for health promotion professionals to focus settings work more upstream and so replace or integrate individual approaches with those addressing daily living conditions and higher level structures, and a significant need for programmes to be evaluated for differential equity impacts and published to provide a more solid evidence base.
改变环境以更支持健康和健康选择是改善人群健康和健康公平性的最佳方式。本文采用世界卫生组织（1998年）（《世界卫生组织健康促进术语汇编》。悉尼新南威尔士大学公共卫生与社区医学系健康促进合作中心）对健康促进环境途径的定义，即那些专注于改变环境结构和性质的途径。2014年6月至8月期间进行了快速文献综述，将对两个主要数据库的系统检索与定向检索相结合。该综述聚焦于确定在环境途径中哪些措施有助于解决健康不平等的社会决定因素，采用了“公平基础：维州健康促进公平框架”。该框架将健康不平等的社会决定因素描述为三层影响，以及促进健康公平的行动切入点。证据综述确定了在12个环境（城市；社区和邻里；教育；医疗保健；网络；基于信仰的；体育；工作场所；监狱；以及夜生活、绿色和临时环境）中的工作，以及在“公平基础”框架的社会经济、政治和文化背景层面（治理、立法、监管和政策）的工作。它发现相对较少的证据表明环境本身正在以解决健康不平等社会决定因素的方式发生改变。相反，许多举措聚焦于环境内的个体行为改变。健康促进专业人员有很大潜力将环境工作更多地聚焦于上游，从而用解决日常生活条件和更高层面结构的方法取代或整合个体方法，并且迫切需要对项目进行评估以了解其对公平性的不同影响，并予以公布以提供更坚实的证据基础。
