Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
Boston University School of Public Health, Boston, Massachusetts, USA.
BMJ Glob Health. 2022 Jun;7(6). doi: 10.1136/bmjgh-2022-008858.
Despite growing scholarship on the social determinants of health (SDoH), wider action remains in its early stages. Broad public understanding of SDoH can help catalyse such action. This paper aimed to document public perception of what matters for health from countries with broad geographic, cultural, linguistic, population composition, language and income level variation.
We conducted an online survey in Brazil, China, Germany, Egypt, India, Indonesia, Nigeria and the USA to assess rankings of what respondents thought matters for health and what they perceived decision makers think matters for health. We analysed the percentages of each determinant rated as the most important for good health using two metrics: the top selection and a composite of the top three selections. We used two-tailed χ test for significance testing between groups.
Of 8753 respondents, 56.2% (95% CI 55.1% to 57.2%) ranked healthcare as the most important determinant of good health using the composite metric. This ranking was consistent across countries except in China where it appeared second. While genetics was cited as the most important determinant by 22.3% (95% CI 21.5% to 23.2%) of the overall sample with comparable rates in most countries, the percentage increased to 33.3% (95% CI 30.5% to 36.3%) in Germany and 35.9% (95% CI 33.0% to 38.8%) in the USA. Politics was the determinant with the greatest absolute difference (18.5%, 95% CI 17.3% to 19.6%) between what respondents considered matters for health versus what they perceived decision makers think matters for health.
The majority of people consider healthcare the most important determinant of health, well above other social determinants. This highlights the need for more investment in communication efforts around the importance of SDoH.
尽管关于健康的社会决定因素（SDoH）的研究不断增加，但广泛的行动仍处于早期阶段。公众对 SDoH 的广泛理解可以帮助推动这种行动。本文旨在记录来自地理、文化、语言、人口构成、语言和收入水平差异广泛的国家的公众对健康相关因素的看法。
我们在中国、巴西、德国、埃及、印度、印度尼西亚、尼日利亚和美国进行了一项在线调查，以评估受访者认为对健康重要的因素的排名，以及他们认为决策者对健康重要的因素的排名。我们使用两种指标分析了对良好健康最重要的每个决定因素的百分比：最高选择和前三个选择的组合。我们使用双侧 χ 检验比较组间的显著性。
在 8753 名受访者中，56.2%（95%置信区间 55.1%至 57.2%）使用综合指标将医疗保健评为对良好健康最重要的决定因素。这种排名在各国之间是一致的，除了中国，中国的排名似乎是第二。尽管遗传学被 22.3%（95%置信区间 21.5%至 23.2%）的总体样本列为最重要的决定因素，且在大多数国家的比例相当，但在德国这一比例上升至 33.3%（95%置信区间 30.5%至 36.3%），在美国则上升至 35.9%（95%置信区间 33.0%至 38.8%）。政治是受访者认为对健康有影响的因素与他们认为决策者认为对健康有影响的因素之间差异最大的决定因素（18.5%，95%置信区间 17.3%至 19.6%）。
大多数人认为医疗保健是健康最重要的决定因素，远高于其他社会决定因素。这凸显了在 SDoH 的重要性方面需要加强沟通工作的投资。
