Woolhandler S, Himmelstein D U, Silber R, Bader M, Harnly M, Jones A A
Int J Health Serv. 1985;15(1):1-22. doi: 10.2190/90P3-LEFF-WNU0-GLY6.
We analyzed deaths of blacks and whites in Alameda County, California where previous studies have documented consistent racial inequalities in health services. We classified each death during 1978 as due to preventable and manageable conditions or as "non-preventable" according to lists compiled by the Working Group on Preventable and Manageable Diseases chaired by Dr. David Rutstein. The total death rate for blacks 0-65 years of age exceeded that of whites by 58 percent (p less than .01). Rates of death due to preventable and manageable conditions for persons aged 0-65 years were 77 percent higher for blacks than for whites (p less than .01). More than one-third of the excess total death rate of blacks relative to whites could be explained by the excess of potentially preventable deaths. Our findings suggest that inequalities in health services reinforce broader social inequalities and are in part responsible for disparities in health status. Improvements in the health and longevity of blacks and other oppressed groups might be achieved by improved access to existing medical, public health, and other preventive measures.
我们分析了加利福尼亚州阿拉米达县黑人和白人的死亡情况，此前的研究已记录了医疗服务方面持续存在的种族不平等现象。根据由大卫·鲁茨坦博士主持的可预防和可管理疾病工作组编制的清单，我们将1978年期间的每一例死亡归类为因可预防和可管理疾病导致，或归类为“不可预防”。0至65岁黑人的总死亡率比白人高出58%（p值小于0.01）。0至65岁人群中，因可预防和可管理疾病导致的死亡率，黑人比白人高77%（p值小于0.01）。黑人相对于白人的总死亡率过高，其中超过三分之一可归因于潜在可预防死亡人数过多。我们的研究结果表明，医疗服务的不平等加剧了更广泛的社会不平等，部分导致了健康状况的差异。改善黑人和其他受压迫群体的健康和寿命，或许可以通过增加获得现有医疗、公共卫生及其他预防措施的机会来实现。
