Meharry Medical College Ringgold Standard Institution, Institute of Global Health Equity.
Milbank Q. 2023 Apr;101(S1):224-241. doi: 10.1111/1468-0009.12603.
Policy Points Despite increased spending and consuming more health care services than any other country in the world, the United States global health rankings experience continued decline, including worsening performance in life expectancy and mortality owing to lack of investment in and strategies on the upstream determinants of health. These determinants of health are found in our access to adequate, affordable, and nutritious food options; safe housing, blue and green spaces; reliable and safe transportation; education and literacy; opportunities for economic stability; and sanitation, among other important factors and all share a common root driver in the political determinants of health. Health systems are increasingly investing in programs and exerting influence over policies to address these upstream determinants of health, including population health management, however these programs will continue to be hindered without addressing the political determinants through government, voting, and policy. Although these investments are laudable, it is important to understand what gives rise to the social determinants of health and-more importantly-why have they disproportionately and detrimentally affected historically marginalized communities and vulnerable populations for so long? Deeply entrenched and pervasive throughout society, the political determinants of health are the fundamental instigators of these unjust and inequitable outcomes.
政策要点 尽管美国在卫生保健服务方面的支出和消费比世界上任何其他国家都多,但美国的全球卫生排名仍持续下降,包括由于缺乏对健康上游决定因素的投资和战略,导致预期寿命和死亡率恶化。这些健康决定因素存在于我们获得充足、负担得起和营养丰富的食物选择、安全的住房、蓝色和绿色空间、可靠和安全的交通、教育和识字、经济稳定的机会以及卫生等重要因素中,所有这些因素都与健康的政治决定因素有着共同的根源。卫生系统越来越多地投资于项目,并对政策施加影响,以解决这些健康的上游决定因素,包括人口健康管理,然而,如果不通过政府、投票和政策来解决政治决定因素,这些项目将继续受到阻碍。尽管这些投资值得称赞,但重要的是要了解是什么导致了社会决定因素的出现,更重要的是,为什么这些因素长期以来一直不成比例地、有害地影响到历史上处于边缘地位的社区和弱势群体?这些健康的政治决定因素深深地植根于整个社会,是造成这些不公正和不平等结果的根本原因。