Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
Scand J Public Health. 2022 Nov;50(7):908-913. doi: 10.1177/14034948211022428. Epub 2021 Jun 19.
There are significant inequalities in health by socio-economic status, race/ethnicity, gender, neighbourhood deprivation and other axes of social inequality. Reducing these health inequalities and improving health equity is arguably the 'holy grail' of public health. This article engages with this quest by presenting and analysing historical examples of when sizeable population-level reductions in health inequalities have been achieved. Five global examples are presented ranging from the 1950s to the 2000s: the Nordic social democratic welfare states from the 1950s to the 1970s; the Civil Rights Acts and War on Poverty in 1960s USA; democratisation in Brazil in the 1980s; German reunification in the 1990s; and the English health inequalities strategy in the 2000s. Welfare state expansion, improved health care access, and enhanced political incorporation are identified as three commonly held 'levellers' whereby health inequalities can be reduced - at scale. The article concludes by arguing that 'levelling up' population health through reducing health inequalities requires the long-term enactment of macro-level policies that aggressively target the social determinants of health.
健康状况在社会经济地位、种族/民族、性别、社区贫困程度和其他社会不平等方面存在显著差异。减少这些健康不平等，提高健康公平性，可以说是公共卫生的“圣杯”。本文通过展示和分析过去实现大规模人口健康不平等减少的历史实例，探讨了这一目标。本文提出了五个全球实例，时间范围从 20 世纪 50 年代到 21 世纪：20 世纪 50 年代至 70 年代的北欧社会民主福利国家；20 世纪 60 年代美国的《民权法案》和《向贫困宣战》；20 世纪 80 年代巴西的民主化；20 世纪 90 年代德国统一；以及 21 世纪的英国健康不平等战略。本文认为，福利国家扩张、改善医疗保健获取途径和增强政治包容性是减少健康不平等的三个常见“平等化”因素，可以大规模地实现这一目标。文章最后指出，通过减少健康不平等来提高人口健康水平，需要长期制定积极针对健康决定因素的宏观政策。
