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What you should know about RACISM-20 in the U.S.: a fact sheet in the time of COVID-19 关于美国RACISM-20,你应该知道什么:新冠肺炎时期的情况介绍
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-05-20 DOI: 10.1080/09581596.2022.2078180
Ryan J. Petteway
ABSTRACT Drawing from social epidemiology literature on structural racism, and rooted in critical race theory and critical theory related to narrative power, this paper uses satire and humor as commentary on mainstream U.S. public health discourse related to the role of “race” (properly understood, racism) in shaping inequities observed via COVID-19. Taking the form of a “RACISM-20” fact sheet, this paper transposes structural racism and COVID-19. In doing so, it accentuates how individualist, ahistoric, and pathologizing “downstream” frames of health risks/solutions curtail productive dialogue and action to advance racial and health equity. In the spirit of “racial emancipatory humor”, this work represents a potential pedagogical tool to discuss and critique dominant frames of racial(ized) risks, “vulnerability”, and responsibility – both in the context of COVID-19 and within broader discourse of racial health inequities, including as related to racialized police violence. In this capacity, this “fact sheet” serves as an example health promotion product of critical resistance and counternarrative.
摘要本文借鉴关于结构性种族主义的社会流行病学文献,以批判种族理论和与叙事力量相关的批判理论为基础,运用讽刺和幽默对美国主流公共卫生话语进行评论,这些话语涉及“种族”(正确理解为种族主义)在塑造新冠肺炎观察到的不平等中的作用。本文以“RACISM-20”概况介绍的形式,将结构性种族主义与新冠肺炎进行了转换。在这样做的过程中,它强调了个人主义、非历史性和病态化的健康风险/解决方案的“下游”框架如何阻碍了促进种族和健康公平的富有成效的对话和行动。本着“种族解放幽默”的精神,这项工作代表了一种潜在的教学工具,可以在新冠肺炎的背景下,以及在更广泛的种族健康不平等的讨论中,包括与种族化警察暴力有关的讨论和批判种族化风险、“脆弱性”和责任的主导框架。以这种身份,这份“情况说明书”是一个具有批判性抵抗和反叙事的健康促进产品的例子。
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引用次数: 0
Emotions of burden, intensive mothering and COVID-19 vaccine hesitancy 负担情绪、密集育儿和COVID-19疫苗犹豫
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-04-11 DOI: 10.1080/09581596.2022.2061917
Lisa Schuster, L. Gurrieri, Paula Dootson
ABSTRACT Addressing mothers’ vaccine hesitancy, which is a state of indecision rather than refusal, may become critical to public health responses to the COVID-19 pandemic. Extant research separately examines how intensive mothering ideology and emotions interact with childhood vaccine hesitancy; however, little is known about the emotions at the intersection of motherhood and vaccine hesitancy. To address this, we seek to understand the emotions experienced by COVID-19 vaccine hesitant mothers who experience the societal pressures arising from the ideology of intensive mothering. Interviews (n = 30) were conducted with women in Australia who identify as mothers and self-report to have concerns about COVID-19 vaccination of their children. The findings suggest ‘emotions of burden’, specifically fear of being a ‘bad mother’ and anticipated guilt about failing to be a ‘good mother’, are experienced by mothers striving to meet societal expectations of intensive mothering though their vaccination decision. These findings provide a more nuanced understanding of mothers’ experiences in making vaccination decisions for their children and lends further empirical support to critiques of intensive mothering ideology as well as public perceptions of vaccine hesitant mothers. Practically, public health campaigns that avoid intimations of ‘bad mothering’ and acknowledge how emotionally burdensome the COVID-19 vaccination decision can be for vaccine hesitant mothers are indicated.
解决母亲的疫苗犹豫(一种优柔寡断而非拒绝的状态)可能对应对COVID-19大流行的公共卫生措施至关重要。现有的研究分别考察了强烈的母亲意识形态和情绪如何与儿童疫苗犹豫相互作用;然而,人们对母亲身份和疫苗犹豫之间的情绪知之甚少。为了解决这个问题,我们试图了解COVID-19疫苗犹豫的母亲所经历的情绪,她们经历了密集育儿意识形态带来的社会压力。对澳大利亚的女性进行了访谈(n = 30),她们认为自己是母亲,并自我报告对子女的COVID-19疫苗接种感到担忧。研究结果表明,“负担情绪”,特别是害怕成为一个“坏母亲”和对未能成为一个“好母亲”的预期内疚,是那些通过接种疫苗决定努力满足社会对强化母亲的期望的母亲所经历的。这些发现提供了对母亲为子女做出疫苗接种决定的经验的更细致的理解,并为对密集的母亲意识形态的批评以及公众对疫苗犹豫不决的母亲的看法提供了进一步的经验支持。实际上,公共卫生运动避免暗示“不良母亲”,并承认COVID-19疫苗接种决定对疫苗犹豫不决的母亲来说是多么沉重的情感负担。
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引用次数: 4
The work of waste during COVID-19: logics of public, environmental, and occupational health COVID-19期间的废物处理工作:公共、环境和职业卫生的逻辑
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-03-14 DOI: 10.1080/09581596.2022.2048632
E. Garnett, Angeliki Balayannis, S. Hinchliffe, T. Davies, T. Gladding, Phillip Nicholson
ABSTRACT Waste has become a pivotal public health and environmental problem during the COVID-19 pandemic. In this interdisciplinary review, we move beyond the ‘coronalitter’ and ‘coronawaste’ discourses, which have come to dominate public imaginaries of waste, to consider less-visible dimensions of waste infrastructures and systems . We demonstrate how waste is coming to matter in new ways that offer opportunities for reconfiguring health research. By examining the literature addressing the impacts of COVID-19 on the geographies of waste, we shed light on how waste is being problematised and researched through logics of public, environmental, and occupational health. We argue that these logics structure understandings and practice, whilst drawing attention to the overlaps and limits that allow links across disciplinary silos and problem domains to be forged. Developing a multi-logics approach, the paper outlines a research agenda for approaching waste as a critical public health problem at a time of intersecting health crises.
在2019冠状病毒病大流行期间,废物已成为一个关键的公共卫生和环境问题。在这篇跨学科的评论中,我们超越了“冠状垃圾”和“冠状废物”的话语,这些话语已经主导了公众对废物的想象,考虑到废物基础设施和系统的不太明显的方面。我们展示了废物如何以新的方式变得重要,为重新配置健康研究提供了机会。通过查阅有关2019冠状病毒病对废物地域影响的文献,我们了解了如何通过公共、环境和职业健康的逻辑对废物进行问题和研究。我们认为,这些逻辑结构的理解和实践,同时提请注意重叠和限制,允许跨学科竖井和问题领域的链接被锻造。该文件制定了一种多重逻辑方法,概述了在交叉的卫生危机时期将废物作为一个关键公共卫生问题来处理的研究议程。
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引用次数: 3
Inequities in maternal stressful life events between Indigenous and non-Indigenous women – evidence from a prospective cohort study in New Zealand 土著和非土著妇女在产妇压力生活事件中的不平等——来自新西兰一项前瞻性队列研究的证据
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-03-11 DOI: 10.1080/09581596.2022.2050184
S. Paine, Rhiannon Walker, Arier C. Lee, T. Signal
ABSTRACT Experiences of major, stressful life events (SLE) prior to and during pregnancy, and in early childhood, are associated with a range of adverse outcomes that disproportionately impact Indigenous women and their families. However, little is known about Indigenous women's experiences of SLE . The aim of this study was to investigate: (1) inequities in the prevalence and patterning of SLE between Indigenous and non-Indigenous mothers over time, and; (2) associations between maternal SLE and ethnicity, age, socioeconomic deprivation and time. Data were from the Moe Kura prospective cohort study of 418 Indigenous Māori and 768 non-Māori women in New Zealand. Questionnaires were completed at 35–37 weeks gestation, 12-weeks postpartum, and when their child was 3–4 years of age. The prevalence of five SLE domains was estimated by ethnicity. Generalised linear mixed effects models examined associations between SLE domains and ethnicity, age, socioeconomic deprivation, and time. The prevalence of SLE was greater for Māori than non-Māori at each time point. The probability of reporting SLE increased as neighbourhood deprivation worsened. The probability of reporting SLE reduced with older age, although changes in the estimates were greater for non-Māori than Māori women. Findings show that Indigenous women experience persistent and significant inequities in SLE. Younger maternal age and greater socioeconomic deprivation explain some but not all of the inequities observed. Policies and interventions to address how colonialism and racism structure experiences of SLE for Indigenous women, including via socioeconomic deprivation, are required.
在怀孕前、怀孕期间和儿童早期经历重大、紧张的生活事件(SLE)与一系列不良后果相关,这些不良后果对土著妇女及其家庭的影响不成比例。然而,对土著妇女SLE的经历了解甚少。本研究的目的是调查:(1)随着时间的推移,土着母亲和非土着母亲之间SLE患病率和模式的不平等;(2)母亲SLE与种族、年龄、社会经济剥夺和时间的关系。数据来自新西兰418名土著Māori和768名non-Māori妇女的Moe Kura前瞻性队列研究。问卷分别在怀孕35-37周、产后12周和孩子3-4岁时完成。按种族估计5个SLE域的患病率。广义线性混合效应模型检验了SLE域与种族、年龄、社会经济剥夺和时间之间的关系。在每个时间点,Māori的SLE患病率都高于non-Māori。报告SLE的可能性随着邻里剥夺的恶化而增加。报告SLE的可能性随着年龄的增长而降低,尽管non-Māori比Māori女性的估计变化更大。研究结果表明,土著妇女在SLE中经历了持续和显著的不平等。更年轻的母亲年龄和更严重的社会经济剥夺解释了部分(但不是全部)观察到的不平等现象。需要制定政策和干预措施,以解决殖民主义和种族主义如何结构土著妇女的SLE经历,包括通过社会经济剥夺。
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引用次数: 0
Challenging times: disconnects between patient and professional temporalities in chronic condition management 充满挑战的时代:慢性病管理中患者和专业人员暂时性之间的脱节
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-03-02 DOI: 10.1080/09581596.2022.2046705
Sophie A. Lewis, K. Willis, Marika Franklin, L. Smith
ABSTRACT Chronic health conditions represent a key challenge for contemporary public healthcare. Current policy promotes self-management support to reduce demands on health services and improve patients’ health and wellbeing. Though there is emerging recognition that self-management is achieved in collaboration between health professionals and patients, how chronicity is managed in interaction remains relatively underexplored in research. In this paper we report on research examining how people are supported to self-manage their conditions through their healthcare encounters. We draw on observational data from consultations between people with multiple chronic health conditions and their healthcare professionals, and semi-structured interviews with both patients and professionals about these consultations. We illuminate points of disconnect between patients and health professionals and demonstrate how these disconnects unfold in self-management support interactions. We argue that self-management is temporally and socially situated, incorporating past, present and (anticipated) future experiences. However, there is a disjuncture between the temporal logics of self-management enacted by health professionals and the subjective temporalities of people’s lived experience of chronicity. Health professionals focus on patients progressing toward optimistic futures but give less attention to the complexities of patient life histories that render self-management more difficult. For self-management support to be effective, we argue that health professionals need to consider the complexities of people’s life histories and how these shape imagined futures. Policy guidelines, we argue, should attend to how relations between patients and professionals shape self-management support, and the historical and social factors that shape experiences of living with chronic conditions.
摘要慢性健康状况是当代公共医疗面临的一大挑战。目前的政策促进自我管理支持,以减少对医疗服务的需求,改善患者的健康和福祉。尽管人们越来越认识到,自我管理是通过卫生专业人员和患者之间的合作实现的,但如何在互动中管理慢性病在研究中仍相对未得到充分探索。在这篇论文中,我们报道了一项研究,该研究考察了人们如何通过医疗遭遇来支持他们自我管理自己的病情。我们利用了来自患有多种慢性疾病的人和他们的医疗保健专业人员之间的咨询的观察性数据,以及对患者和专业人员关于这些咨询的半结构化访谈。我们阐明了患者和卫生专业人员之间的脱节点,并展示了这些脱节是如何在自我管理支持互动中展开的。我们认为,自我管理是暂时的和社会的,包括过去、现在和(预期的)未来的经历。然而,卫生专业人员制定的自我管理的时间逻辑与人们长期生活经历的主观时间性之间存在脱节。卫生专业人员关注的是患者朝着乐观的未来发展,但较少关注患者生活史的复杂性,这使得自我管理更加困难。为了使自我管理支持有效,我们认为卫生专业人员需要考虑人们生活史的复杂性,以及这些历史如何塑造想象中的未来。我们认为,政策指南应该关注患者和专业人员之间的关系如何影响自我管理支持,以及影响慢性病患者生活体验的历史和社会因素。
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引用次数: 3
Understanding compliance as multi-faceted: values and practices during the COVID-19 pandemic in Austria 将合规理解为多方面的:奥地利新冠肺炎大流行期间的价值观和实践
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-02-11 DOI: 10.1080/09581596.2022.2039379
Wanda Spahl, M. Pot, K. Paul
ABSTRACT In some countries, far-reaching ‘lockdown’ measures to contain the spread of coronavirus were implemented early in 2020. In Austria, these early measures were met with a high degree of compliance among the country’s population. In this paper, we draw upon qualitative interviews, and ask how people made sense of the restrictions imposed during the first lockdown in April 2020 and what shaped their compliance. Empirical research has so far tried to explain compliance by means of people’s disposition and motivations as well as demographic and social characteristics. Instead of focussing on who is compliant, we aim to understand how people practice compliance. We do this by approaching compliance through the concepts of values and practice. First, our findings indicate that people assess whether measures are suitable and legitimate in relation to the values of science, the law, and morality. Second, people assign additional personal value to compliance by stressing its positive implications on their own lives. By adopting a nuanced perspective on compliance as inextricably linked to peoples’ values and practices, our paper critically contributes to the political and scholarly discussion of pandemic public health measures. Understanding compliance through the lens of values shows how people make sense of the measures in the context of their everyday lives, helping us to move away from a binary understanding of (non-)compliance that has become morally charged.
摘要在一些国家,2020年初实施了影响深远的“封锁”措施,以遏制冠状病毒的传播。在奥地利,这些早期措施在该国民众中得到了高度遵守。在这篇论文中,我们利用定性采访,询问人们如何理解2020年4月第一次封锁期间实施的限制,以及是什么影响了他们的遵守。到目前为止,实证研究试图通过人们的性格和动机以及人口和社会特征来解释依从性。我们的目标不是关注谁是合规的,而是了解人们是如何实践合规的。我们通过价值观和实践的概念来实现合规。首先,我们的研究结果表明,人们评估与科学、法律和道德价值观相关的措施是否合适和合法。其次,人们通过强调顺从对自己生活的积极影响,赋予顺从额外的个人价值。通过对合规性与人们的价值观和实践密不可分采取微妙的观点,我们的论文对流行病公共卫生措施的政治和学术讨论做出了重要贡献。从价值观的角度理解合规性,表明人们如何在日常生活中理解这些措施,帮助我们摆脱对(不)合规性的二元理解,这种理解在道德上已经变得充满了负担。
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引用次数: 7
The quest for health and the unhealthy ‘others’. A critical case study of Syrian women newcomers’ meeting with health promotion and civic integration discourses upon arrival in Denmark 对健康和不健康的“他人”的追求。对叙利亚妇女新移民抵达丹麦后与促进健康和公民融合的谈话进行的重要案例研究
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-02-08 DOI: 10.1080/09581596.2021.1937525
S. Agergaard, A. B. Jakobsen, L. Mortensen, K. Ryom
ABSTRACT Increasingly restrictive immigration policies and political attention to newcomers’ civic integration currently intersect with the individualisation of the responsibility for health care and health promotion in Western societies. We aim to examine how such policies shape women newcomers’ perceptions of health and experiences of civic health promoting activities in the first years after granted asylum and temporary residence permit in Denmark. Drawing on conceptualisations of healthism as a super-value for the individual in Western societies, we analyse 29–50 year old Syrian women newcomers’ experiences of meeting an all-encompassing and individualised concept of health that is promoted by various societal institutions in Denmark (including schools and leisure sites). While the women describe their everyday lives in Syria as unconsciously healthy, in the receiving context, they came to appear as consciously unhealthy. Further through individual and focus group interviews, the women characterise white Danish women as a healthy and active group, while describing themselves as the ‘unhealthy others’. The Syrian women take on feelings of blame and individual responsibility for promoting their health, despite also describing a number of structural barriers for their healthy and active living. However, the Syrian women newcomers also deliver an implicit critique of the individual quest for health in Western societies and showcase more collective approaches to health care.
摘要限制性移民政策和对新移民公民融合的政治关注,目前与西方社会医疗保健和健康促进责任的个性化相交叉。我们的目的是研究这些政策如何影响新移民妇女在丹麦获得庇护和临时居留许可后的头几年对健康的看法和公民健康促进活动的经历。根据西方社会中健康主义作为个人超价值观的概念,我们分析了29-50岁的叙利亚新女性在满足丹麦各种社会机构(包括学校和休闲场所)倡导的包罗万象的个性化健康概念方面的经历。虽然这些女性将她们在叙利亚的日常生活描述为无意识的健康,但在接受采访的背景下,她们开始显得有意识的不健康。通过个人和焦点小组访谈,这些女性将丹麦白人女性描述为一个健康活跃的群体,同时将自己描述为“不健康的他人”。叙利亚妇女在促进健康方面承担着责任和个人责任,尽管她们也描述了健康和积极生活的一些结构性障碍。然而,叙利亚新女性也含蓄地批评了西方社会对健康的个人追求,并展示了更多的集体医疗方法。
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引用次数: 0
Viewing young men’s online wagering through a social practice lens: implications for gambling harm prevention strategies 从社会实践的角度看年轻人的网上赌博:对赌博危害预防策略的影响
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-02-07 DOI: 10.1080/09581596.2022.2031888
Christian Nyemcsok, H. Pitt, P. Kremer, Sa Thomas
ABSTRACT Online wagering has expanded significantly in recent decades and has emerged as a serious public health issue. Research investigating online wagering has predominantly used quantitative methods to explore the determinants that influence young men’s engagement with these products, with fewer qualitative insights. Social practice theory offers a framework in which to qualitatively analyse how online wagering practices are shaped, modified, and evolve. This study explored the online wagering practices of sixteen, 18–24 year old, young men, in Victoria, Australia. In-depth, qualitative interviews explored the contexts and motivations in their early and current wagering practices and the influence of social and structural conditions. Data were interpreted using a reflexive approach to thematic analysis. The data were theoretically conceptualised through a social practice lens, focusing on materials, meanings, and competencies. Materials included social networks and spaces, and wagering infrastructure and marketing. Meanings encompassed peer belongingness and bonding. Perceived competencies included an exaggerated confidence that influenced the type of gambling chosen and perceived spending strategies to achieve financial gain. Importantly, these three elements intersected to form a bundle of wagering practices. Interrupting the interconnection of these bundles may form the basis of public health intervention. Public health research must also continue to monitor how online wagering practices evolve and change in response to a range of interacting determinants and move away from a focus on the individual.
摘要近几十年来,在线博彩业务大幅扩张,已成为一个严重的公共卫生问题。调查在线博彩的研究主要使用定量方法来探索影响年轻男性参与这些产品的决定因素,而定性见解较少。社会实践理论为定性分析在线博彩实践是如何形成、修改和发展的提供了一个框架。这项研究探讨了澳大利亚维多利亚州16、18-24岁年轻男性的在线博彩实践。定性访谈深入探讨了他们早期和当前赌博实践的背景和动机,以及社会和结构条件的影响。对数据进行解释时采用了反身分析的方法。这些数据是通过社会实践的视角从理论上概念化的,侧重于材料、意义和能力。材料包括社交网络和空间,以及博彩基础设施和营销。含义包括同伴归属和联系。感知能力包括夸大的信心,这种信心会影响所选择的赌博类型和感知的实现财务收益的支出策略。重要的是,这三个要素相交形成了一系列的下注实践。中断这些捆绑包的互连可能构成公共卫生干预的基础。公共卫生研究还必须继续监测在线博彩实践是如何演变和变化的,以应对一系列相互作用的决定因素,并摆脱对个人的关注。
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引用次数: 4
Chronicity in/and cancer: a qualitative interview study of health professionals, patients, and family carers 癌症的慢性病:对卫生专业人员、患者和家庭护理人员的定性访谈研究
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-02-07 DOI: 10.1080/09581596.2022.2035319
E. Kirby, Katherine Kenny, A. Broom, Z. Lwin
ABSTRACT The landscape of cancer is changing, with earlier detection and the emergence of new treatment options signalling the potential reconfiguration of cancer (for some) as a chronic condition. Cancer is increasingly experienced in terms of chronicity, incorporating both ongoing episodes of acute treatment alongside the long-term management of disease, symptoms, and side effects. This emphasis refocuses attention toward living-with, as well as beyond, cancer. Yet, how cancer chronicity is understood and experienced by both patients and healthcare professionals remains underexplored. While sociological scholarship has critically analysed how chronic illness has been positioned as a problem of/for the person and/or the healthcare system, less attention has been paid to instances like cancer, where chronicity might be viewed as reflective of forms of success (e.g. through the deferral of mortality even in the absence of ‘cure’). In this paper we draw on qualitative interview data from a large study of cancer survivorship including patients, their family carers and health professionals, across two Australian hospitals. We critically analyse the dimensions of chronicity in the cancer sphere, understanding cancer-as-chronicity as producing a particular form of subjectivity, shaped by the everyday management and experience of treatment, impairment, symptoms, and side-effects. We posit that constructions of cancer as chronic, and associated imperatives linked to longevity, commitment, and resilience, are placing new demands on patients, family carers, and professionals alike.
摘要癌症的形势正在发生变化,早期检测和新治疗方案的出现表明癌症(对某些人来说)可能会重新构成一种慢性疾病。癌症在慢性方面的经验越来越多,既包括持续的急性治疗,也包括对疾病、症状和副作用的长期管理。这一重点将注意力重新集中在与癌症共存以及超越癌症。然而,患者和医疗保健专业人员对癌症慢性病的理解和体验仍有待进一步探索。虽然社会学学术界对慢性病如何被定位为个人和/或医疗系统的一个问题进行了批判性分析,但对癌症等情况的关注较少,在这些情况下,慢性病可能被视为成功形式的反映(例如,即使在没有“治愈”的情况下,也可以推迟死亡率)。在这篇论文中,我们利用了一项关于癌症生存率的大型研究的定性访谈数据,包括澳大利亚两家医院的患者、他们的家庭护理人员和卫生专业人员。我们批判性地分析了癌症领域的慢性性维度,将癌症作为一种偶然性理解为产生一种特殊形式的主体性,由日常管理和治疗经验、损伤、症状和副作用形成。我们认为,癌症作为慢性疾病的构建,以及与寿命、承诺和恢复力相关的必要性,正在对患者、家庭护理人员和专业人员提出新的要求。
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引用次数: 1
Falling down the rabbit hole? Methodological, conceptual and policy issues in current health inequalities research 掉进兔子洞?当前健康不平等研究中的方法、概念和政策问题
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-02-07 DOI: 10.1080/09581596.2022.2036701
M. Kelly-Irving, W. P. Ball, C. Bambra, C. Delpierre, R. Dundas, J. Lynch, G. McCartney, Katherine Smith
ABSTRACT Persistent health inequalities pose a challenge to researchers and policymakers. Decades of research have illuminated mechanisms that underlie health inequalities, now we must move beyond these observations to enable policies that can reduce them. In this paper, we highlight tensions in the field of health inequalities research regarding the relationship between social determinants and health outcomes, and the effectiveness of welfare policies. We draw on recent evidence to analyse and discuss these areas of debate and provide insight into the evidence on causality, welfare systems and policies aiming to address the social determinants of health inequalities. First, we examine the evidence that inequalities in the social determinants of health are causally related to health inequalities. Second, we discuss whether more egalitarian social policies provide a solution to redressing health inequalities. In conclusion, we suggest that current debates around causal understandings risk sending the field down ‘rabbit holes’ that distract from solution. We argue that, if we combine epidemiological evidence with the broader canon of social science evidence, the case for causal inference is sufficiently strong to suggest we now need to focus on effectively supporting and promoting research-informed policy responses to health inequalities.
摘要持续的健康不平等对研究人员和政策制定者构成了挑战。几十年的研究揭示了健康不平等背后的机制,现在我们必须超越这些观察,制定能够减少这些不平等的政策。在这篇论文中,我们强调了健康不平等研究领域在社会决定因素与健康结果之间的关系以及福利政策的有效性方面的紧张关系。我们利用最近的证据来分析和讨论这些辩论领域,并深入了解因果关系、福利制度和旨在解决健康不平等的社会决定因素的政策方面的证据。首先,我们研究了健康的社会决定因素中的不平等与健康不平等有因果关系的证据。其次,我们讨论了更加平等的社会政策是否能解决健康不平等问题。总之,我们认为,目前围绕因果理解的辩论有可能将领域推向“兔子洞”,从而分散解决方案的注意力。我们认为,如果我们将流行病学证据与更广泛的社会科学证据相结合,因果推断的理由就足够充分,表明我们现在需要专注于有效支持和促进对健康不平等的基于研究的政策反应。
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引用次数: 11
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