Marmot M, Feeney A
Department of Epidemiology and Public Health, University College London Medical School, UK.
IARC Sci Publ. 1997(138):207-28.
Life expectancy has always differed according to status in society, with a higher mortality among those of lower social status. Although cancer and cardiovascular diseases are more common as causes of death in rich than in poor societies, in industrialized countries the major causes of death are more common in those of lower social status. In this chapter, the magnitude of socioeconomic differences in health is examined using different measures of socioeconomic status, and methodological issues relating to these measures are discussed. Much of the discussion about social inequalities in health has been focused on the health disadvantage of those of lowest socioeconomic status. However, data from the Whitehall studies show that the social gradient in morbidity and mortality exists across employment grades in British civil servants, none of whom is poor by comparison with people in developing countries, suggesting that there are factors that operate across the whole of society. A number of potential explanations are considered here. The magnitude of socioeconomic differences in health varies between societies, and over time within societies. This suggests that identification of factors that influence socioeconomic status and health, and the pathways by which they operate, is an important public health task that could lay the basis for a reduction in inequalities in health.
预期寿命一直因社会地位而异,社会地位较低者的死亡率更高。尽管在富裕社会中,癌症和心血管疾病作为死因比贫穷社会更为常见,但在工业化国家,主要死因在社会地位较低者中更为常见。在本章中,我们使用不同的社会经济地位衡量指标来研究健康方面社会经济差异的程度,并讨论与这些指标相关的方法问题。关于健康方面社会不平等的许多讨论都集中在社会经济地位最低者的健康劣势上。然而,来自白厅研究的数据表明,英国公务员的发病率和死亡率的社会梯度存在于各个就业等级之间,与发展中国家的人相比,他们中没有一个是穷人,这表明存在着在整个社会中起作用的因素。这里考虑了一些可能的解释。健康方面社会经济差异的程度在不同社会之间以及在一个社会内部随时间而变化。这表明,确定影响社会经济地位和健康的因素以及它们发挥作用的途径,是一项重要的公共卫生任务,可为减少健康不平等奠定基础。