Glasgow Centre for Population Health, Glasgow, UK.
School of Social and Political Sciences, University of Glasgow, Glasgow, UK.
Eur J Public Health. 2023 Dec 9;33(6):974-980. doi: 10.1093/eurpub/ckad174.
Explaining why some populations are healthier than others is a core task of epidemiology. Socioeconomic position (SEP), encompassing a broad range of exposures relating to economic circumstances, social class and deprivation, is an important explanation, but lacks a comprehensive framework for understanding the range of relevant exposures it encompasses.
We reviewed existing literature on experiential accounts of poverty through database searching and the identification of relevant material by experts. We mapped relevant concepts into a complex systems diagram. We developed this diagram through a process of consultation with academic experts and experts with direct experience of poverty. Finally, we categorized concepts on the basis of whether they have previously been measured, their importance to the causal flow of the diagram, and their importance to those consulted, creating a list of priorities for future measurement.
There are a great many aspects of SEP which are not frequently measured or used in epidemiological research and, for some of these, work is needed to better conceptualize and develop measures. Potentially important missing aspects include stigma, social class processes, access to education, sense of lost potential, neighbourhoods, fairness and justice, emotional labour, masking poverty, being (in)visible, costs, and experiences of power.
Analyses seeking to understand the extent to which SEP exposures explain differences in the health of populations are likely to benefit from a comprehensive understanding of the range and inter-relationships between different aspects of SEP. More research to better conceptualize and measure these aspects is now needed.
解释为什么某些人群比其他人群更健康是流行病学的核心任务。社会经济地位（SEP）涵盖了与经济环境、社会阶层和贫困相关的广泛暴露因素，是一个重要的解释因素，但缺乏一个全面的框架来理解其涵盖的一系列相关暴露因素。
我们通过数据库搜索和专家识别相关材料，回顾了关于贫困经验的现有文献。我们将相关概念映射到一个复杂系统图中。我们通过与学术专家和有贫困直接经验的专家进行咨询的过程来开发这个图表。最后，我们根据概念是否已经被测量、对图表因果关系的重要性以及对咨询者的重要性，对概念进行分类，确定未来测量的优先事项。
有很多社会经济地位方面的因素在流行病学研究中没有被经常测量或使用，对于其中一些因素，需要进行更多的工作来更好地概念化和开发测量方法。潜在重要的缺失方面包括污名、社会阶层过程、获得教育的机会、失去潜力的感觉、邻里环境、公平和正义、情感劳动、掩饰贫困、可见与不可见、成本以及权力体验。
分析寻求理解社会经济地位暴露因素在多大程度上解释了人群健康差异的研究，可能会受益于对社会经济地位的不同方面的范围和相互关系的全面理解。现在需要进行更多的研究，以更好地概念化和衡量这些方面。
