Amri Michelle, Enright Theresa, O'Campo Patricia, Di Ruggiero Erica, Siddiqi Arjumand, Bump Jesse B
The W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
Department of Political Science, University of Toronto, 100 St George Street, Toronto, ON, M5S 3G3, Canada.
BMC Glob Public Health. 2024 Dec 4;2(1):81. doi: 10.1186/s44263-024-00106-w.
Scholarly critiques have demonstrated that the World Health Organization (WHO) approaches the concept of health equity inconsistently. For example, inconsistencies center around measuring health inequity across individuals versus groups; in approaches and goals sought in striving for health equity; and whether considerations around health equity prioritize socioeconomic status or also consider other social determinants of health. However, the significance of these contrasting approaches has yet to be assessed empirically.
This study employs critical discourse analysis to assess the WHO's approaches to health equity in select health promotion, social determinants of health, and urban health texts from 2008 to 2016.
We find that the WHO: (i) usually measures health equity by comparing groups; (ii) explicitly specifies three approaches to health equity (although we identified additional implicit approaches in our analysis of WHO discourses); and (iii) considers health equity inconsistently both in terms of socioeconomic status and other social determinants of health, but socioeconomic status was given substantially more attention than other individual social determinants of health.
There is misalignment with the WHO's stated approaches to tackle health inequity and its discourses around health equity. This incongruence increases the likelihood of pursuing short-term solutions and not sustainably addressing the root causes of health inequity. Critical discourse analysis' focus on power allows for understanding why 'radical' approaches are not explicitly expressed to ensure that governments will be agreeable to addressing health inequity.
学术批评表明，世界卫生组织（WHO）在处理健康公平概念时存在不一致性。例如，不一致性集中在跨个体与群体衡量健康不平等；在追求健康公平所采用的方法和目标方面；以及围绕健康公平的考量是优先考虑社会经济地位还是也考虑健康的其他社会决定因素。然而，这些不同方法的重要性尚未得到实证评估。
本研究采用批判性话语分析来评估WHO在2008年至2016年期间关于健康促进、健康的社会决定因素以及城市健康的选定文本中对健康公平的处理方式。
我们发现WHO：（i）通常通过比较群体来衡量健康公平；（ii）明确规定了三种实现健康公平的方法（尽管我们在对WHO话语的分析中发现了其他隐含方法）；（iii）在社会经济地位和健康的其他社会决定因素方面对健康公平的考量不一致，但社会经济地位比健康的其他个体社会决定因素得到了更多关注。
WHO在解决健康不平等问题的既定方法与其围绕健康公平的话语之间存在不一致。这种不一致增加了追求短期解决方案而无法可持续地解决健康不平等根源的可能性。批判性话语分析对权力的关注有助于理解为什么没有明确表达“激进”方法，以确保政府会同意解决健康不平等问题。
