Syme S L
School of Public Health, University of California, Berkeley 94720-7360, USA.
Milbank Q. 1998;76(3):493-505, 306-7. doi: 10.1111/1468-0009.00100.
It is now well established that inequalities in income lead to high morbidity and mortality rates. Certain explanations for this phenomenon are explored: (1) Instead of income inequalities causing disease, the inequalities are determined by powerful cultural forces. (2) The rich get richer and the poor get poorer. (2) Wealthier people can buy the means to protect their health. (4) Poorer people suffer not from poverty, but from relative deprivation. (5) Those with the weakest genes drift into the lower income groups. It is difficult to develop interventions directed to these possibilities. The concept of "control and destiny" is a possible explanation for the relation between inequalities and disease; unlike the other explanations, this idea is amenable to intervention.
现在已经充分证实，收入不平等会导致高发病率和死亡率。本文探讨了对这一现象的某些解释：（1）不是收入不平等导致疾病，而是不平等由强大的文化力量决定。（2）富者愈富，穷者愈穷。（3）较富裕的人能够购买保护其健康的手段。（4）较贫穷的人遭受的不是贫困，而是相对剥夺。（5）基因最脆弱的人流入低收入群体。针对这些可能性制定干预措施很困难。“控制与命运”的概念可能解释了不平等与疾病之间的关系；与其他解释不同，这一观点适合进行干预。
