Leicester School of Allied Health Sciences, De Montfort University, Leicester, England, UK.
Department of Health Sciences, University of York, York, England, UK.
BMC Public Health. 2019 Jul 24;19(1):997. doi: 10.1186/s12889-019-7334-8.
The term evidence based medicine was introduced in the early 1990s in clinical medicine to educate clinicians about how to assess the 'credibility' of research to ensure best treatments for their patients. The evidence based medicine paradigm has become more diffuse in times of austerity and randomised controlled designs are being used to address complex issues in public health and disability research. This research is not addressing inequalities in terms of disability nor how people can live well with disabilities.
We argue that there are four ways that public health research needs to change if it wants to address inequalities linked to disability: 1) rethinking theoretical connections between public health and disability; 2) building ethics and equity into interventions through a human rights approach; 3) ensuring ethical inclusion through intersectionality; and 4) evaluating policy and other social impacts to ensure they capture diversity. We argue that these are key issues to building a social determinants of flourishing.
We need to understand how disability might have an accumulative impact across the life course, as well as how to ensure equity for people living with disabilities. This means conceptualising a social determinants of flourishing where we evaluate how exactly randomised controlled trials and public health interventions, not only lead to greater equality but also ensure rights to health and wellbeing.
循证医学一词于 20 世纪 90 年代初在临床医学中提出，旨在教育临床医生如何评估研究的“可信度”，以确保为患者提供最佳治疗。在紧缩时期，循证医学范式变得更加普及，随机对照设计被用于解决公共卫生和残疾研究中的复杂问题。然而，这项研究并没有解决残疾方面的不平等问题，也没有探讨人们如何在残疾的情况下过上美好生活。
我们认为，如果公共卫生研究想要解决与残疾相关的不平等问题，需要进行以下四个方面的变革：1）重新思考公共卫生和残疾之间的理论联系；2）通过人权方法将伦理和公平纳入干预措施；3）通过交叉性确保伦理包容性；4）评估政策和其他社会影响，以确保其捕捉多样性。我们认为，这些是构建繁荣的社会决定因素的关键问题。
我们需要了解残疾如何在整个生命周期中产生累积影响，以及如何确保残疾人生存的公平性。这意味着要将繁荣的社会决定因素概念化，评估随机对照试验和公共卫生干预措施如何不仅导致更大的平等，而且还确保健康和福祉的权利。
