Salti Nisreen, Abdulrahim Sawsan
Department of Economics, American University of Beirut, Beirut, Lebanon.
Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh 1107, 2020 Beirut, Lebanon.
SSM Popul Health. 2016 May 4;2:317-326. doi: 10.1016/j.ssmph.2016.03.008. eCollection 2016 Dec.
Relative deprivation (RD) has been advanced as a theory to explain the relationship between income inequality and health in high-income countries. In this study, we tested the theory in a low-income protracted refugee setting in a middle-income country.
Using data from the 2010 Socioeconomic Survey of Palestine Refugees in Lebanon, we examined the relationship between RD and health among a representative sample of Palestinian refugee women (=1047). Data were gathered utilizing a household questionnaire with information on socio-demographics and an individual-level questionnaire with information on the health of each respondent. We examined self-rated health (SRH) as the main health measure but also checked the sensitivity of our results using self-reported chronic conditions. We used two measures for absolute SES: total household monthly expenditures on non-food goods and services and total household monthly expenditures on non-health goods and services. With refugee camp as a reference group, we measured a household's RD as a household's rank of absolute SES within the reference group, multiplied by the distance between its absolute SES and the average absolute SES of all households ranked above it. We investigated the robustness of the RD-SRH relationship using these two alternative measures of absolute SES.
Our findings show that, controlling for absolute SES and other possible confounders, women report significantly poorer health when they live in households with a higher score on our RD measure (because of either lower relative rank or lower relative SES compared to households better off in the reference group which we take to be the refugee camp). While RD is always significant as a determinant of SRH under a variety of specifications, absolute SES is not consistently significant. These findings persist when we use self-reported chronic conditions as our measure of health instead of SRH, suggesting that the relationship between health and RD may be operating through a psychosocial mechanism.
Our findings underscore the importance of examining RD under conditions of poverty and in diverse socio-cultural contexts. They also highlight that public health approaches should be concerned with reducing social inequalities in low-income settings in addition to alleviating poverty.
相对剥夺理论已被提出，用于解释高收入国家中收入不平等与健康之间的关系。在本研究中，我们在一个中等收入国家的低收入长期难民环境中对该理论进行了检验。
利用2010年黎巴嫩巴勒斯坦难民社会经济调查的数据，我们在1047名具有代表性的巴勒斯坦难民妇女样本中研究了相对剥夺与健康之间的关系。数据收集采用了一份包含社会人口统计学信息的家庭问卷和一份包含每位受访者健康信息的个人层面问卷。我们将自评健康（SRH）作为主要的健康指标，但也使用自我报告的慢性病情况来检验结果的敏感性。我们使用两种绝对社会经济地位（SES）的衡量指标：家庭每月非食品商品和服务的总支出以及家庭每月非健康商品和服务的总支出。以难民营为参照组，我们将家庭的相对剥夺衡量为该家庭在参照组内绝对SES的排名，乘以其绝对SES与排在其之上的所有家庭的平均绝对SES之间的差距。我们使用这两种绝对SES的替代衡量指标来研究相对剥夺与自评健康关系的稳健性。
我们的研究结果表明，在控制绝对SES和其他可能的混杂因素后，当妇女生活在相对剥夺得分较高的家庭中时（由于与参照组中较富裕家庭相比相对排名较低或相对SES较低，我们将参照组设定为难民营），她们报告的健康状况明显较差。虽然在各种设定下，相对剥夺作为自评健康的决定因素始终具有显著性，但绝对SES并非始终具有显著性。当我们使用自我报告的慢性病情况而非自评健康作为健康衡量指标时，这些结果依然成立，这表明健康与相对剥夺之间的关系可能是通过心理社会机制起作用的。
我们的研究结果强调了在贫困条件下和不同社会文化背景中研究相对剥夺的重要性。它们还突出表明，公共卫生方法除了减轻贫困外，还应关注减少低收入环境中的社会不平等。
