Jerrett M, Eyles J, Cole D
Department of Geography, San Diego State University, CA 92182-4493, USA.
Soc Sci Med. 1998 Jul;47(1):33-49. doi: 10.1016/s0277-9536(98)00008-2.
This paper contributes to debates on the broad determinants of health and on the policy shift from curative to preventive and protective interventions. It addresses empirically the relative importance of influences on health with a multiple regression analysis of ecologic data from the 49 counties of Ontario. One model achieved high predictive power (that is, Adj R2 > 75%, p < 0.0001). Educational levels were a strong predictor of population health, showing a consistent inverse relationship with premature mortality ratios for both sexes and it was the strongest predictor for females. A low income variable supplied the strongest prediction for male mortality. This variable displayed a positive association with male mortality. Municipal expenditures on environmental protection exerted a negative effect on male mortality. These findings raise questions about the current directions of health policy in Ontario where the provincial government has reduced funding to social and environmental programs, while promising to maintain health care funding.
本文有助于就健康的广泛决定因素以及从治疗性干预转向预防性和保护性干预的政策转变展开辩论。它通过对安大略省49个县的生态数据进行多元回归分析，实证研究了影响健康的各种因素的相对重要性。其中一个模型具有很高的预测能力（即调整后的R²>75%，p<0.0001）。教育水平是人口健康的有力预测指标，对男女过早死亡率均呈现出持续的负相关关系，且对女性来说是最强的预测指标。低收入变量对男性死亡率的预测能力最强。该变量与男性死亡率呈正相关。市政环境保护支出对男性死亡率有负面影响。这些发现对安大略省当前的健康政策方向提出了质疑，该省政府在承诺维持医疗保健资金的同时，却削减了对社会和环境项目的资金投入。
