THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, UK.
Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, UK.
J Public Health (Oxf). 2018 Dec 1;40(4):764-775. doi: 10.1093/pubmed/fdy045.
A strong focus on individual choice and behaviour informs interventions designed to reduce health inequalities in the UK. We review evidence for wider mechanisms from a range of disciplines, demonstrate that they are not yet impacting on programmes, and argue for their systematic inclusion in policy and research.
We identified potential mechanisms relevant to health inequalities and their amelioration from different disciplines and analysed six policy documents published between 1976 and 2010 using Bacchi's 'What's the problem represented to be?' framework for policy analysis.
We found substantial evidence of supra-individualistic and relational mechanisms relevant to health inequalities from sociology, history, biology, neuroscience, philosophy and psychology. Policy documents sometimes expressed these mechanisms in policy rhetoric but rarely in policy recommendations, which continue to focus on individual behaviour.
Current evidence points to the potential of systematically applying broader thinking about causal mechanisms, beyond individual choice and responsibility, to the design, implementation and evaluation of policies to reduce health inequalities. We provide a set of questions designed to enable critique of policy discussions and programmes to ensure that these wider mechanisms are considered.
英国十分重视个人选择和行为，这为旨在减少健康不平等的干预措施提供了信息。我们从多个学科中回顾了更广泛机制的证据，证明它们尚未对方案产生影响，并主张将其系统地纳入政策和研究。
我们从不同学科中确定了与健康不平等及其缓解相关的潜在机制，并使用 Bacchi 的“政策分析的‘问题代表什么？’框架”分析了 1976 年至 2010 年间发布的六份政策文件。
我们从社会学、历史学、生物学、神经科学、哲学和心理学中发现了大量与健康不平等相关的超个体主义和关系机制的证据。政策文件有时会在政策言论中表达这些机制，但很少在政策建议中表达，这些建议仍继续侧重于个人行为。
现有证据表明，有必要系统地应用关于因果机制的更广泛思维，超越个人选择和责任，以设计、实施和评估减少健康不平等的政策。我们提供了一系列问题，旨在使对政策讨论和方案的批评能够确保考虑这些更广泛的机制。
