Stretton Health Equity, School of Social Sciences, The University of Adelaide, Adelaide, South Australia, Australia
Stretton Health Equity, School of Social Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
BMJ Glob Health. 2024 Oct 23;9(Suppl 1):e015694. doi: 10.1136/bmjgh-2024-015694.
Progress in addressing systematic health inequities, both between and within countries, has been slow. However, there are examples of actions taken on social determinants of health and policy changes aimed at shaping the underlying sociopolitical context that drives these inequities.Using case study methodology, this article identifies five countries (Ethiopia, Jordan, Spain, Sri Lanka and Vietnam) that made progress on health equity during 2011-2021 and three countries (Afghanistan, Nigeria and the USA) that had not made the same gains. The case studies revealed social, cultural and political conditions that appeared to be prerequisites for enhancing health equity.Data related to population health outcomes, human development, poverty, universal healthcare, gender equity, sociocultural narratives, political stability and leadership, governance, peace, democracy, willingness to collaborate, social protection and the Sustainable Development Goals were interrogated revealing four key factors that help advance health equity. These were (1) action directed at structural determinants of health inequities, for example, sociopolitical conditions that determine the distribution of resources and opportunities based on gender, race, ethnicity and geographical location; (2) leadership and good governance, for example, the degree of freedom, and the absence of violence and terrorism; (3) a health equity lens for policy development, for example, facilitating the uptake of a health equity agenda through cross-sector policies and (4) taking action to level the social gradient in health through a combination of universal and targeted approaches.Reducing health inequities is a complex and challenging task. The countries in this study do not reveal guaranteed recipes for progressing health equity; however, the efforts should be recognised, as well as lessons learnt from countries struggling to make progress.
在解决国家间和国家内的系统性健康不公平问题方面，进展一直缓慢。然而，已经有一些针对健康决定因素采取行动和进行政策改革的例子，旨在塑造推动这些不公平的基本社会政治背景。本文使用案例研究方法，确定了五个在 2011-2021 年间在健康公平方面取得进展的国家（埃塞俄比亚、约旦、西班牙、斯里兰卡和越南）和三个没有取得同样进展的国家（阿富汗、尼日利亚和美国）。案例研究揭示了似乎是增强健康公平的先决条件的社会、文化和政治条件。与人口健康结果、人类发展、贫困、全民医疗保健、性别平等、社会文化叙述、政治稳定和领导力、治理、和平、民主、合作意愿、社会保护和可持续发展目标相关的数据被审查，揭示了有助于推进健康公平的四个关键因素。这些因素包括：（1）针对健康不公平的结构性决定因素采取行动，例如，决定资源和机会分配的基于性别、种族、族裔和地理位置的社会政治条件；（2）领导力和良好治理，例如，自由程度，以及没有暴力和恐怖主义；（3）为政策制定制定健康公平视角，例如，通过跨部门政策促进健康公平议程的采纳；（4）通过综合普遍和有针对性的方法采取行动，缩小健康方面的社会梯度。减少健康不公平是一项复杂而具有挑战性的任务。本研究中的国家并没有揭示出推进健康公平的保证方法；然而，应该承认这些努力，并从那些努力取得进展的国家中吸取经验教训。
