Haggerty Jeannie, Chin Marshall H, Katz Alan, Young Kue, Foley Jonathan, Groulx Antoine, Pérez-Stable Eliseo J, Turnbull Jeff, DeVoe Jennifer E, Uchendo Uche
From the Department of Family Medicine, McGill University, Montreal, Canada (JH); Richard Parrillo Family Professor of Healthcare Ethics, Section of General Internal Medicine, University of Chicago, Chicago, IL (MHC); Manitoba Centre for Health Policy & Professor, Departments of Community Health Sciences and Family Medicine, University of Manitoba, Winnipeg, Canada (AK); School of Public Health, University of Alberta, Edmonton, Canada (KY); Westcott Partners, LLC, Silver Spring, MD (JF); Health Services and University Medicine, Ministère de la Santé et des Services Sociaux, Quebec, Canada (AG); National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (EJP-S); The Ottawa Hospital, Ottawa, Canada (JT); Department of Family Medicine, Oregon Health & Science University, Portland, OR (JED); United States Department of Veterans Affairs, Washingtone D.C. (UU).
J Am Board Fam Med. 2018 May-Jun;31(3):479-483. doi: 10.3122/jabfm.2018.03.170299.
Health inequities persist in Canada and the United States. Both countries show differential health status and health care quality by social characteristics, making zip or postal code a greater predictor of health than genetics. Many social determinants of health overlap in the same individuals or communities, exacerbating their vulnerability. Many of the contributing factors and problems are structural and evade simple solutions.
In March 2017 a binational Canada-US symposium was held in Washington DC involving 150 primary care thought leaders, including clinicians, researchers, patients, and policy makers to address transformation in integrated primary care. This commentary summarizes the session's principal insights and solutions of the session tackling health inequities at policy and delivery levels.
The solution lies in intervening proactively to reduce disparities-developing risk-adjustment measures that integrate social factors; increasing the socioeconomic, racial, and ethnic diversity of health providers; teaching cultural humility; supporting community-oriented primary care; and integrating equity considerations into health system funding. We propose moving from retrospective analysis to proactive measures; from equality to equity; from needs-based to strength-based approaches; and from an individual to a population focus.
加拿大和美国的健康不平等现象持续存在。两国都根据社会特征呈现出不同的健康状况和医疗质量，使得邮政编码比基因更能预测健康状况。许多健康的社会决定因素在同一个人或社区中相互重叠，加剧了他们的脆弱性。许多促成因素和问题是结构性的，难以找到简单的解决办法。
2017年3月，在华盛顿特区举行了一次加美双边研讨会，有150名初级保健领域的思想领袖参加，包括临床医生、研究人员、患者和政策制定者，以探讨综合初级保健的转型。本评论总结了该会议在政策和服务层面解决健康不平等问题的主要见解和解决方案。
解决方案在于积极干预以减少差距——制定整合社会因素的风险调整措施；增加医疗服务提供者的社会经济、种族和民族多样性；传授文化谦逊；支持以社区为导向的初级保健；并将公平考虑纳入卫生系统资金。我们建议从回顾性分析转向积极措施；从平等转向公平；从基于需求的方法转向基于优势的方法；从关注个体转向关注人群。
