什么是卫生公平? 这个想法是如何产生的?为什么它很重要

Lea en español

It's an idea as old as modern medicine and as new as the latest medical research. 无论你如何看待健康公平，对话都涉及矛盾.

但 at its core are fundamental questions about illness and health, 目睹了这一话题从学术辩论的边缘走向21世纪医疗保健主流的专家们如是说.

The term can be abstract, but the facts are not. 最富有的1%的美国人的预期寿命比最贫穷的1%的人至少高出10年. Where a person lives can predict their likelihood of developing heart disease, 高血压, 糖尿病和其他疾病.

卫生公平旨在解决这一问题. "Health equity means that we achieve health that is as equal as possible, 在我们能解决的问题范围内,”医生说。. Sandro 最低潮, dean of the School of Public Health at Boston University.

因为卫生公平的解释与不平等和正义等术语重叠, 隐喻会派上用场.

最低潮, who has been studying health equity issues for a quarter century, uses this one: If one person is taller than another, 这种不平等是无法解决的. 然而, if medicine is being kept on a high shelf that only tall people can reach, 解决方案涉及到公平.

"Health equity is about fixing health gaps that are fixable," 他说. “往往, 卫生不平等反映了一种不公正, in that we have not paid enough attention to what can be fixed."

用更具体的术语来说, 最低潮说，一个人的胆固醇水平比另一个人高可能有很多原因. 但 "if your cholesterol is lower than mine because you have access to broccoli, 我能吃到的只有薯片, 问题变成了, “这是为什么??'"

在一个经常被争论和传播的插图中, equity is likened to people attempting to watch a baseball game over a fence; a short person will need a boost that a taller one doesn't.

但是这些“吸引人的、引人注目的简短定义留下了很多空白需要填补。. Paula Braveman, 加州大学健康公平中心的创始主任, 旧金山.

Braveman, a professor emeritus of family community medicine, has said that if you asked 100 experts for a definition of health equity, you might get 100 substantively different replies. 如果你在她研究这个主题的三十年中不同的沙巴足球体育平台问她一个定义, 你可能会得到不同的答案."

These days, her preferred definition comes from a 罗伯特·伍德·约翰逊基金会报道 “健康公平意味着每个人都有公平公正的机会尽可能保持健康. This requires removing obstacles to health such as poverty, 歧视, 以及它们的后果, including powerlessness and lack of access to good jobs with fair pay, 优质教育和住房, 安全的环境, 还有医疗保健."

Such factors are called social determinants of health, another academic term that came of age alongside health equity.

It's also why discussions of health equity often include a history lesson. 这里仅举一个例子，说明近一个世纪前的沙巴体育平台点击进入如何影响当今的健康, 20世纪30年代, 银行的种族歧视限制了美国黑人的居住地以及他们能否获得抵押贷款. 直到今天, 他们被限制居住的社区不成比例地暴露在污染中, 获得健康食物的机会较少，主要心血管疾病和心力衰竭的几率较高.

最低潮 offers another metaphor about such problems. 他说，想象一只在碗里的金鱼. “说它运动，绕着鱼缸游泳，吃健康的食物，有一个好的金鱼医生. 但 it won't be healthy at all unless you change its water."

The term "health equity" first shows up in medical research in 1966, and ideas around health equity were championed by Dr. 马丁·路德·金. 在那十年里.

但是最低潮说，关于社会公正和健康的概念至少可以追溯到19世纪中期, 当时德国科学家鲁道夫·维尔绍, 微生物学的先驱, 他将斑疹伤寒的流行与社会状况联系起来，并表示解决办法不是增加医生或医院，而是提高工资和普及教育等社会变革.

加利亚说，这使得卫生公平成为一个古老的想法，但在过去的25年里，它又出现了复苏. “我认为，人们认识到卫生保健应该公平、均匀地分配，这影响了人们对卫生保健的兴趣重新抬头."

Braveman first heard the term in the early 1990s, when she was doing work for the World Health Organization. 在美国.S., 她说, academic interest initially focused on racial gaps in health care. "There was quite an active movement focused on health disparities, and that crowd took up the health equity banner right away, because it was something positive" for people to work toward, 她说.

Research interest soared in the 1990s and early 2000s, statistics show. Braveman said that was partly because "the seeds had been sown,这个想法的时机已经成熟.

全球政治也起了作用. Before the collapse of the Soviet Union in the early '90s, "one had to walk on eggshells to talk about these issues,布拉曼说. It took the retreat of global communism for public health experts in the U.S. to feel at ease even using the term social justice.

“那时候你真的做不到，”她说. “你可以试着绕开它，或者用一些非常具体的例子来暗示它, 但你不能说“社会正义”.'"

在接下来的二十年里, Braveman写过, 卫生公平的重要性和塑造卫生的社会力量“从默默无闻和耻辱变成了光明和受人尊敬”."

2020年，新冠肺炎疫情将公平问题带入公众视野. Death rates from the coronavirus showed huge gaps along racial and ethnic lines, 这个国家面临着某人的工作, home and even internet access could be matters of life and death.

“我确实认为COVID具有催化作用，”加利亚说.

现在, 他说, “有一代公共卫生科学家和从业人员将卫生公平视为他们工作的核心."

Braveman谨慎地希望，这一代人将能够在他们已经发展起来的势头的基础上继续发展. 在未来几十年里, “我希望我们可能会缓慢但稳步地朝着更大的卫生公平的方向前进."

但, 她说, 如果人们不普遍认识到“没有公平就没有卫生公平”，就不会取得进展." The public must be willing to act on matters of "poverty, 照顾孩子, 住房歧视, quality education – all those social determinants of health."

这使得医疗公平成为一个政治问题. 对她来说，这意味着医疗公平的未来将由沙巴体育平台点击进入决定.

最低潮 agrees that health equity can't be divorced from politics. 但这并不意味着它必须是分裂的, 他说, "because I don't think that people of good conscience, 无论党派如何, actually think that health gaps are a good thing, 或凭良心的."

他以一种乐观的态度展望未来，这种乐观的态度来自于接受矛盾.

在过去的25年里, 他说, "I think there's been enormous recognition of the importance of health inequity.尽管美国黑人和白人之间的差异“大得令人无法接受”,“已经取得了进展.

例如，在2000年至2019年期间， 死亡率 心血管疾病的发病率下降, and the gap between Black and white adults narrowed, 根据2022年发表在美国心脏协会期刊《沙巴体育平台点击进入》上的一项研究. 联邦数据显示在1900年, the life expectancy gap between Black and white Americans was more than 14 years. 到2021年，这一差距缩小到5.5年.

So it can be simultaneously true that "the world is a terrible place, 世界需要变得更好——但世界比以往任何时候都要好得多,加利亚说. “这三件事都是真的."