Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Faculté de Santé et Développement Communautaires, Université Libre des Pays des Grands Lacs (ULPGL), Goma, Democratic Republic of the Congo.
PLoS One. 2022 Mar 14;17(3):e0265038. doi: 10.1371/journal.pone.0265038. eCollection 2022.
Conflict can be a primary driver of health inequalities, but its impact on the distribution of social determinants of health is not very well documented. Also, there is limited evidence on the most suitable approaches aiming at addressing health inequalities in post-conflict settings. Thus, we undertook a systematic review of the literature concerning the current knowledge and knowledge gaps about structural determinants of health inequalities and assessed the effects of approaches aimed at addressing health inequalities in post-conflict settings. We performed a systematic search in bibliographic databases such as Web of Science, PubMed, and PsycINFO for relevant publications, as well as institutional websites that are relevant to this topic. The search was initiated in March 2018 and ultimately updated in December 2020. No time or geographical restrictions were applied. The quality of each study included in this review was independently assessed using criteria developed by CASP to assess all study types. Sixty-two articles were deemed eligible for analysis. The key findings were captured by the most vulnerable population groups, including the civilian population, women, children, internally displaced persons (IDPs), and people with symptoms of mental illness. A considerable range of approaches has been used to address health inequalities in post-conflict settings. These approaches include those used to address structural determinants of health inequalities which are accountable for the association between poverty, education, and health inequalities, the association between human rights and health inequalities, and the association between health inequalities and healthcare utilization patterns. However, these approaches may not be the most applicable in this environment. Given the multifactorial characteristics of health inequalities, it is important to work with the beneficiaries in developing a multi-sector approach and a strategy targeting long-term impacts by decision-makers at various levels. When addressing health inequalities in post-conflict settings, it may be best to combine approaches at different stages of the recovery process.
冲突可能是健康不平等的主要驱动因素，但它对健康不平等的社会决定因素分布的影响并没有得到很好的记录。此外，在针对冲突后环境中健康不平等的最适合方法方面，证据也很有限。因此，我们对有关健康不平等的结构决定因素的现有知识和知识差距进行了系统审查，并评估了旨在解决冲突后环境中健康不平等的方法的效果。我们在 Web of Science、PubMed 和 PsycINFO 等文献数据库中进行了系统搜索，以查找相关出版物，以及与该主题相关的机构网站。搜索于 2018 年 3 月启动，并最终于 2020 年 12 月更新。未对时间或地理范围施加任何限制。使用 CASP 制定的标准评估所有研究类型，对纳入本综述的每项研究的质量进行了独立评估。有 62 篇文章被认为适合进行分析。最脆弱的人群群体包括平民、妇女、儿童、国内流离失所者 (IDP) 和有精神疾病症状的人，这些群体的关键发现被捕获。已经使用了相当多的方法来解决冲突后环境中的健康不平等问题。这些方法包括用于解决健康不平等的结构决定因素的方法，这些方法解释了贫困、教育和健康不平等之间的关系、人权与健康不平等之间的关系以及健康不平等与卫生保健利用模式之间的关系。然而，在这种环境下，这些方法可能并不适用。鉴于健康不平等的多因素特征，重要的是与受益者合作制定多部门方法和针对各级决策者的长期影响的战略。在解决冲突后环境中的健康不平等问题时，最好在恢复过程的不同阶段结合使用各种方法。
