Forcadell-Díez Lluís, Juárez Martínez Olga, Abiétar Daniel G, López María José, Sánchez-Martínez Francesca, Perez Gloria
Agència de Salut Pública de Barcelona, Barcelona, Spain; Associate Professor, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
Agència de Salut Pública de Barcelona, Barcelona, Spain.
J Sch Health. 2023 Jun;93(6):521-532. doi: 10.1111/josh.13318. Epub 2023 Mar 14.
Interpersonal relationships undoubtedly have a bidirectional connection with the health of individuals and communities. Relational models based on equity contribute to well-being, while asymmetrical relationships based on hierarchies and differences of power negatively impact mental, physical, and social health.
A conceptual framework for understanding the determinants of interpersonal relational models was developed.
Structural determinants were identified as the combined action of systems of oppression, the socio-historical context that normalizes violence, and social stratification and segregation, consequences which included inequitable access to power, resources, and opportunities. Intermediate determinants include individual, psychosocial, behavioral, and community aspects. Structural and intermediate determinants impact health and health inequalities through multiple relational patterns that are simultaneously established and sustained by individuals and communities. The health impact of inequitable relational patterns includes: Reduced self-esteem; anxiety, stress, and depression; acceptance of violence; physical and sexual harm; suicide; and murder.
This conceptual framework allows for the modification of relational models by influencing structural and intermediate determinants. Six areas of intervention have been identified: educative policies, school governance, physical and symbolic space, school curriculum, school-community relations, and socio-educative interventions to promote healthy and equitable relationships. Healthy and equitable relationships are associated with improved subjective well-being, health status and protection from violence. Socio-educational interventions that consider the elements of this conceptual framework may be effective in promoting healthy and equitable relational models.
人际关系无疑与个人和社区的健康存在双向联系。基于公平的关系模式有助于增进福祉，而基于等级制度和权力差异的不对称关系则会对心理、身体和社会健康产生负面影响。
构建了一个用于理解人际关系模式决定因素的概念框架。
结构性决定因素被确定为压迫制度、使暴力常态化的社会历史背景以及社会分层和隔离的共同作用，其后果包括获取权力、资源和机会的不公平。中间决定因素包括个人、心理社会、行为和社区等方面。结构性和中间决定因素通过个人和社区同时建立和维持的多种关系模式影响健康和健康不平等。不公平关系模式对健康的影响包括：自尊降低；焦虑、压力和抑郁；对暴力的接受；身体和性伤害；自杀；以及谋杀。
这一概念框架允许通过影响结构性和中间决定因素来改变关系模式。已确定六个干预领域：教育政策、学校治理、物理和象征空间、学校课程、学校与社区关系以及促进健康和公平关系的社会教育干预。健康和公平的关系与主观幸福感的提升、健康状况的改善以及免受暴力侵害相关。考虑这一概念框架要素的社会教育干预可能有效地促进健康和公平的关系模式。
