Fernández González Loreto
Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile.
Rev Med Chil. 2017 Dec;145(12):1605-1609. doi: 10.4067/s0034-98872017001201605.
Cervical cancer is the fourth most common neoplasm in women worldwide and its incidence is associated with profound social inequities. In Chile, it is the second cause of death in women of reproductive age. The Chilean clinical guideline identifies the vaccine against Human Papillomavirus (HPV) as the main preventive measure. Since 2014, the Ministry of Health has implemented free immunization against HPV for girls and female adolescents. This article critically analyzes this public policy from the viewpoint of health equity, using as framework the Social Determinants of Health Model. Specifically, we address the structural determinants of income and gender, which act as material and social barriers for achieving immunization, affecting protection against cervical cancer. These barriers correspond to the high cost of the vaccine, and social attitudes/cultural beliefs towards sexual behavior in Latin America and Chile that affect the acceptability of vaccination. The Social Determinants of Health Model constitutes a useful tool for identifying health inequities and understanding public policy from an equity viewpoint that complements the biomedical and epidemiological understanding of disease. In this topic, the initiative aims to strengthen the idea of health as a human right and health promotion as an essential function of public health policy.
宫颈癌是全球女性中第四大常见肿瘤，其发病率与严重的社会不平等现象相关。在智利，它是育龄女性的第二大死因。智利临床指南将人乳头瘤病毒（HPV）疫苗确定为主要预防措施。自2014年以来，智利卫生部已为女童和少女实施了HPV免费免疫接种。本文以健康的社会决定因素模型为框架，从健康公平的角度对这一公共政策进行批判性分析。具体而言，我们探讨了收入和性别等结构性决定因素，这些因素成为实现免疫接种的物质和社会障碍，影响了对宫颈癌的预防。这些障碍包括疫苗成本高昂，以及拉丁美洲和智利对性行为的社会态度/文化观念影响了疫苗接种的可接受性。健康的社会决定因素模型是识别健康不平等现象并从公平角度理解公共政策的有用工具，它补充了对疾病的生物医学和流行病学理解。在这个主题中，该倡议旨在强化健康是一项人权以及健康促进是公共卫生政策一项基本功能的理念。
