Nathan Chomilo (
Health Aff (Millwood). 2023 Mar;42(3):392-394. doi: 10.1377/hlthaff.2022.01689.
Capitalism and health are not synonymous. Numerous health care advances and innovations have stemmed from the financial incentives that a capitalistic society fosters, but individuals and communities achieving optimal health is not always tied to a financial gain. The impact of capitalism-derived financial tools such as social bonds to address social drivers of health (SDH) therefore needs to be carefully scrutinized, not only for the potential benefits but also for the potential unintended consequences. Ensuring that as much of the social investment as possible is directed by communities experiencing gaps in health and opportunity will be crucial. Ultimately, failure to find ways to share both the health and financial benefits of SDH bonds or other market-derived interventions risks perpetuating underlying wealth inequities between communities and deepening the structural issues that cause SDH disparities in the first place.
资本主义与健康并非同义词。众多医疗保健方面的进步和创新源于资本主义社会所培育的经济激励,但个人和社区实现最佳健康状况并不总是与经济收益挂钩。因此,需要仔细审查源自资本主义的金融工具(如社会债券)对健康社会决定因素的影响,不仅要考虑其潜在收益,还要考虑其潜在的意外后果。确保尽可能多的社会投资由健康和机会存在差距的社区来引导将是至关重要的。最终,如果无法找到共享健康和社会决定因素债券或其他市场干预措施的经济利益的方法,就有可能使社区之间的基本财富不平等永久化,并加深造成健康社会决定因素差异的结构性问题。