University of Leeds, Leeds, UK and general practitioner, York Street Practice, Leeds, UK
Clin Med (Lond). 2021 Mar;21(2):147-149. doi: 10.7861/clinmed.2020-0945.
Social determinants of health are responsible for a large proportion of disease which disproportionately affects deprived population groups, resulting in striking disparities in life expectancy and quality of life. Even systems with universal access to healthcare (such as the UK's NHS) can only mitigate some consequences of health inequalities. Instead substantial societal measures are required both to reduce harmful exposures and to improve standards of housing, education, work, nutrition and exercise. The case for such measures is widely accepted among healthcare professionals but, in wider discourse, scepticism has remained about the role of government and society in improving life chances along with the belief that responsibility for health and wellbeing should rest with individuals themselves. The stark inequalities exposed by the coronavirus pandemic could be an opportunity to challenge this thinking. This paper argues that doctors should do more to persuade others of the need to address health inequalities and that to achieve this, it is important to understand the ethical and philosophical perspectives that are sceptical of such measures. An approach to gaining greater support for interventions to address health inequalities is presented along with reflections on effective political advocacy which is consistent with physicians' professional values.
健康的社会决定因素导致了很大一部分疾病，这些疾病不成比例地影响到贫困人群，导致预期寿命和生活质量的显著差异。即使是拥有全民医疗保健（如英国的 NHS）的系统，也只能减轻健康不平等的一些后果。相反，需要采取大量的社会措施，既要减少有害暴露，又要提高住房、教育、工作、营养和锻炼的标准。医疗保健专业人员广泛接受这些措施，但在更广泛的讨论中，人们仍然对政府和社会在改善生活机会方面的作用持怀疑态度，同时也认为健康和幸福的责任应该由个人自己承担。冠状病毒大流行所暴露的明显不平等现象可能是一个挑战这种思维的机会。本文认为，医生应该做更多的工作来说服其他人解决健康不平等问题，为了做到这一点，重要的是要理解对这些措施持怀疑态度的伦理和哲学观点。本文提出了一种方法来争取更多人支持解决健康不平等问题的干预措施，并对与医生的专业价值观一致的有效政治倡导进行了思考。
