Halfon Neal, Russ Shirley A, Kahn Robert S
UCLA Center for Healthier Children, Families and Communities.
Department of Pediatrics, Geffen School of Medicine, University of California.
Curr Opin Pediatr. 2022 Feb 1;34(1):33-38. doi: 10.1097/MOP.0000000000001087.
Established social gradients across a wide range of child health issues including obesity, anxiety, infectious diseases, injuries, prematurity and low birth weight suggest that much illness is avoidable and there is an imperative to intervene in this whole of society issue. This review examines recent advances in understanding of the pathways to health and health inequalities and their application to interventions to improve health equity.
Children's health develops over the life course in ways that are profoundly influenced by their entire developmental ecosystem including individual, family, community and system-level factors. Interventions to address child health inequalities must include action on the structural determinants of health, a greater focus on family and community health development, and attention to the acquisition of developmental capabilities. Nascent dynamic population health initiatives that address whole developmental ecosystems such as All Children Thrive, Better Start Bradford and Generation V, hold real promise for achieving child health equity.
Pathways to health inequalities are driven by social and structural determinants of health. Interventions to address inequalities need to be driven less by older biomedical models, and more by prevailing ecological and complex systems models incorporating a life course health development approach.
在包括肥胖、焦虑、传染病、伤害、早产和低出生体重等广泛的儿童健康问题中，既定的社会梯度表明许多疾病是可以避免的，因此迫切需要干预这一全社会问题。本综述探讨了在理解健康途径和健康不平等方面的最新进展，以及它们在改善健康公平性干预措施中的应用。
儿童健康在其整个生命历程中的发展方式受到其整个发展生态系统的深刻影响，包括个体、家庭、社区和系统层面的因素。解决儿童健康不平等问题的干预措施必须包括针对健康的结构性决定因素采取行动，更加关注家庭和社区健康发展，并注重发展能力的培养。新兴的动态人群健康倡议，如“让每个孩子茁壮成长”、“布拉德福德更好开端”和“第五代计划”，旨在解决整个发展生态系统问题，有望实现儿童健康公平。
健康不平等的途径是由健康的社会和结构决定因素驱动的。解决不平等问题的干预措施应减少受旧的生物医学模式驱动，更多地受当前的生态和复杂系统模式驱动，这些模式采用生命历程健康发展方法。
