Beckfield Jason, Olafsdottir Sigrun
Harvard University.
Boston University.
Am Behav Sci. 2013;57(8):1014-1039. doi: 10.1177/0002764213487343. Epub 2013 Jun 26.
The existence of social inequalities in health is well established. One strand of research focuses on inequalities in health within a single country. A separate and newer strand of research focuses on the relationship between inequality and average population health across countries. Despite the theorization of (presumably variable) social conditions as "fundamental causes" of disease and health, the cross-national literature has focused on average, aggregate population health as the central outcome. Controversies currently surround macro-structural determinants of overall population health such as income inequality. We advance and redirect these debates by conceptualizing inequalities in health as cross-national variables that are sensitive to social conditions. Using data from 48 World Values Survey countries, representing 74% of the world's population, we examine cross-national variation in inequalities in health. The results reveal substantial variation in health inequalities according to income, education, sex, and migrant status. While higher socioeconomic position is associated with better self-rated health around the globe, the size of the association varies across institutional context, and across dimensions of stratification. There is some evidence that education and income are more strongly associated with self-rated health than sex or migrant status.
健康方面社会不平等的存在已得到充分证实。一类研究聚焦于单个国家内部的健康不平等。另一类单独且更新的研究则关注国家间不平等与总体人口健康之间的关系。尽管将（可能可变的）社会状况理论化为疾病和健康的“根本原因”，但跨国文献一直将总体人口的平均健康作为核心结果。目前，诸如收入不平等之类的总体人口健康的宏观结构决定因素存在争议。我们通过将健康不平等概念化为对社会状况敏感的跨国变量，推进并重新引导了这些辩论。利用来自48个世界价值观调查国家的数据（占世界人口的74%），我们研究了健康不平等的跨国差异。结果显示，根据收入、教育程度、性别和移民身份，健康不平等存在显著差异。虽然在全球范围内，较高的社会经济地位与较好的自评健康状况相关，但这种关联的程度因制度背景和分层维度而异。有证据表明，教育和收入与自评健康的关联比性别或移民身份更为紧密。
