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南非健康状况的社会医学指标

Socio-medical indicators of health in South Africa.

作者信息

Jinabhai C C, Coovadia H M, Abdool-Karim S S

出版信息

Int J Health Serv. 1986;16(1):163-76. doi: 10.2190/JTNM-2D1H-8TK8-63DV.

Abstract

Socio-medical indicators developed by WHO for monitoring progress towards Health-for-All have been adapted to reveal, clearly and objectively, the devastating impact of state planning based on an outmoded immoral and unscientific philosophy of race superiority in South Africa on the health of the disenfranchised majority within the context of social and economic discrimination; Health policy indicators confirm that the government is committed to three options (Bantustans, A New Constitution, and A Health Services Facilities Plan) all of which are inconsistent with the attainment of Health-for-All; Social and economic indicators reveal gross disparities between African, Coloured, Indian, and White living and working conditions; Provision of health care indicators show the overwhelming dominance of high technology curative medical care consuming about 97 percent of the health budget with only minor shifts towards community-based comprehensive care; and Health status indicators illustrate the close nexus between privilege, dispossession and disease with Whites falling prey to health problems related to affluence and lifestyle, while Africans, Coloureds, and Indians suffer from disease due to poverty. All four categories of the indicator system reveal discrepancies which exist between Black and White, rich and poor, urban and rural. To achieve the social goal of Health-for-All requires a greater measure of political commitment from the state. We conclude that it is debatable whether a system which maintains race discrimination and exploitation can in fact be adapted to provide Health-for-All.

摘要

世界卫生组织制定的用于监测全民健康进展情况的社会医学指标,已被调整以清晰、客观地揭示,在社会和经济歧视的背景下,南非基于过时的、不道德且不科学的种族优越哲学进行的国家规划,对被剥夺权利的多数群体健康造成的毁灭性影响;卫生政策指标证实,政府致力于三种方案(班图斯坦、新宪法和卫生服务设施计划),而所有这些方案都与实现全民健康不一致;社会和经济指标揭示了非洲人、有色人种、印度人和白人在生活和工作条件方面的巨大差距;医疗保健提供指标显示,高科技治疗性医疗占据绝对主导地位,消耗了约97%的卫生预算,仅有少量转向基于社区的综合保健;健康状况指标表明特权、剥夺与疾病之间存在紧密联系,白人易患与富裕和生活方式相关的健康问题,而非洲人、有色人种和印度人则因贫困患病。指标体系的所有四个类别都揭示了黑人和白人、富人和穷人、城市和农村之间存在的差异。要实现全民健康这一社会目标,国家需要做出更大程度的政治承诺。我们的结论是,一个维持种族歧视和剥削的体系是否真的能够适应以实现全民健康,这是值得商榷的。

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