Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Cambridge Institute of Public Health, University of Cambridge, Robinson Way, CB2 0SR, UK.
Soc Sci Med. 2017 Aug;187:20-28. doi: 10.1016/j.socscimed.2017.06.015. Epub 2017 Jun 15.
A growing body of research attests to the impact of welfare regimes on health and health equity. However, the mechanisms that link different kinds of welfare entitlement to health outcomes are less well understood. This study analysed the accounts of 29 older adults in England to delineate how the form of entitlement to welfare and other resources (specifically, whether this was understood as a universal entitlement or as targeted to those in need) impacts on the determinants of health. Mechanisms directly affecting access to material resources (through deterring uptake of benefits) have been well documented, but those that operate through psychosocial and more structural pathways less so, in part because they are more challenging to identify. Entitlement that was understood collectively, or as arising from financial or other contributions to a social body, had positive impacts on wellbeing beyond material gains, including facilitating access to important health determinants: social contact, recognition and integration. Entitlement understood as targeted in terms of individualised concepts of need or vulnerability deterred access to material resources, but also fostered debate about legitimacy, thus contributing to negative impacts on individual wellbeing and the public health through the erosion of social integration. This has important implications for both policy and evaluation. Calls to target welfare benefits at those in most need emphasise direct material pathways to health impact. We suggest a model for considering policy change and evaluation which also takes into account how psychosocial and structural pathways are affected by the nature of entitlement.
越来越多的研究证明了福利制度对健康和健康公平的影响。然而，将不同类型的福利权利与健康结果联系起来的机制还不太清楚。本研究分析了英国 29 名老年人的说法，以阐明福利权利和其他资源（具体来说，是将其理解为普遍权利还是针对有需要的人）的形式如何影响健康决定因素。直接影响获取物质资源的机制（通过阻止福利的获取）已经有充分的记录，但通过心理社会和更结构性途径发挥作用的机制则不然，部分原因是它们更难以识别。从集体角度理解的权利，或者从对社会机构的财务或其他贡献中产生的权利，除了物质收益之外，对幸福感有积极影响，包括促进获得重要的健康决定因素：社会联系、认可和融合。从个体化的需求或脆弱性概念出发理解的有针对性的权利，会阻碍获取物质资源，但也会引发关于合法性的争论，从而通过侵蚀社会融合，对个人幸福感和公共健康产生负面影响。这对政策和评估都有重要意义。呼吁将福利福利针对最需要的人，强调了对健康影响的直接物质途径。我们建议考虑政策变革和评估的模型，同时也要考虑权利的性质如何影响心理社会和结构途径。
