Daw Jonathan
AJS. 2015 May;120(6):1595-640. doi: 10.1086/681961.
Why do health disparities persist when their previous mechanisms are eliminated? Fundamental-cause theorists argue that social position primarily improves health through two metamechanisms: better access to health information and technology. I argue that the general, cumulative, and embodied consequences of social stratification can produce another metamechanism: an efficiency-equity trade-off. A case in point is kidney transplantation, where the mechanisms previously thought to link race to outcomes--ability to pay and certain factors in the kidney allocation system--have been greatly reduced, yet large disparities persist. I show that these current disparities are rooted in factors that directly influence posttransplant success, placing efficiency and racial/ethnic equity at cross-purposes.
当先前导致健康差距的机制被消除后，为何这种差距依然存在？根本原因理论学家认为，社会地位主要通过两种元机制改善健康状况：更好地获取健康信息和技术。我认为社会分层的普遍、累积和内在后果能够产生另一种元机制：效率与公平的权衡。一个恰当的例子是肾脏移植，此前被认为将种族与结果联系起来的机制——支付能力和肾脏分配系统中的某些因素——已大幅减少，但巨大的差距仍然存在。我表明，当前的这些差距源于直接影响移植后成功率的因素，使效率与种族/民族公平处于相互矛盾的境地。
