Navarro López V, Benach de Rovira J
Escuela Nacional de Sanidad, Ministerio de Sanidad y Consumo, España.
Rev Esp Salud Publica. 1996 Sep-Dec;70(5-6):505-636.
In 1993 the Ministry of Health of the Spanish Government appointed a Scientific Commission to analyze social inequalities in health in Spain, as well as to make recommendations for improving Spanish health, through the practical implementation of public policies to reduce existing inequalities. The present report is the result of the work carried out by the said Commission. It has the following aims: first, to present a general introduction to the topic of social inequalities in health; second, to offer a global vision of the topic in Spain based upon the editing of available information: finally, to encourage the need for an in-depth analysis of the study and the reduction in social inequalities in health in the scientific and social fields, offering illustrative examples. The first chapter points out the importance of the topic, and Spain is located in the international historical and geographical context. The second chapter presents the most important concepts regarding the definition and measurement of health and inequality. The third and fourth chapters review various international and national studies of particular importance, and the Spanish case includes the current limitations to research. The fifth chapter presents two original investigations on the four perspectives of social inequalities in health in Spain: death rate, noticeable health, conducts related to health and the use and access to health services. Chapter six comments on some examples of policies aimed at reducing inequalities in health. Finally, the seventh chapter summarises the main conclusions of the report and makes some recommendations both for the improvement of current information systems as well as for obtaining the main conclusions for the health policies. Amongst the report's main conclusions the following may be pointed out: 1) an ecological study on the social inequalities in the death rate of small areas between 1990-1992 has revealed the existence of inequalities at a small area level. Autonomous Communities and regions. Inequality is confirmed between North-Northwestern Spain (with a high level) and South-Southwestern Spain (with a low level). Likewise, a positive relationship may be observed between various social indicators and the death rate; 2) the analysis of health surveys for 1987 and 1993 according to social class has revealed the existence of inequalities in health. Thus, in most of the health variables studied regarding the state of health-the conducts related to health or health services-the most disadvantaged social classes present greater health problems; 3) the political social and health experiences carried out in the Basque Country and Barcelona respectively, aimed at improving living standards, social welfare and the health of the most vulnerable sectors of the population have been positive and should be expanded and studied in depth; 4) the study and decrease of social inequalities in health by putting into practice social and health public policies should be a main objective of all political and social forces.
1993年，西班牙政府卫生部任命了一个科学委员会，以分析西班牙健康方面的社会不平等现象，并通过切实实施公共政策来减少现有不平等现象，从而为改善西班牙人的健康状况提出建议。本报告是上述委员会开展工作的成果。其目标如下：第一，对健康方面的社会不平等这一主题进行总体介绍；第二，基于现有信息的编辑，对西班牙的这一主题提供全面的视角；最后，鼓励在科学和社会领域深入分析该研究以及减少健康方面的社会不平等现象，并给出实例说明。第一章指出了该主题的重要性，并将西班牙置于国际历史和地理背景之中。第二章介绍了关于健康和不平等的定义及衡量的最重要概念。第三章和第四章回顾了各类具有特别重要意义的国际和国内研究，西班牙的情况包括当前研究的局限性。第五章从西班牙健康方面社会不平等的四个视角——死亡率、明显的健康状况、与健康相关的行为以及医疗服务的使用和可及性——呈现了两项原创性调查。第六章对旨在减少健康不平等现象的一些政策实例进行了评论。最后，第七章总结了报告的主要结论，并就改进当前信息系统以及得出健康政策的主要结论提出了一些建议。在报告的主要结论中，可以指出以下几点：1）一项关于1990 - 1992年小区域死亡率社会不平等的生态研究揭示了小区域层面存在不平等现象，涉及自治区和地区。西班牙西北部与西南部之间（前者水平高，后者水平低）的不平等得到证实。同样，可以观察到各种社会指标与死亡率之间存在正相关关系；2）根据社会阶层对1987年和1993年健康调查的分析揭示了健康方面存在不平等现象。因此，在研究的大多数与健康状况、与健康相关的行为或医疗服务有关的健康变量中，最弱势的社会阶层存在更严重的健康问题；3）分别在巴斯克地区和巴塞罗那开展的旨在提高生活水平、社会福利以及最弱势群体健康状况的政治、社会和健康方面的实践取得了积极成果，应加以推广并深入研究；4）通过实施社会和健康公共政策来研究和减少健康方面的社会不平等现象，应成为所有政治和社会力量的主要目标。
