Improving health outcomes in diverse and vulnerable populations: building on the experience of the Centers for Medical Treatment Effectiveness in Diverse Populations (MEDTEP).
Improving health outcomes in diverse and vulnerable populations: building on the experience of the Centers for Medical Treatment Effectiveness in Diverse Populations (MEDTEP).
复制标题
改善多样化和弱势人群的健康结果：借鉴多样化人群医疗有效性中心 (MEDTEP) 的经验。
DOI：
10.1080/1355785022000060682
复制
发表时间：
2002
影响因子：
3.1
通讯作者：
Elm,JordanJaskwhich
中科院分区：
文献类型：
--
作者：
Tilley,BarbaraC;Elm,JordanJaskwhich
美国医学研究所(IOM)最近的一份报告1表明，美国健康结果中的种族/民族差异仍然存在(见图12)，并且在根据机会和其他社会经济因素进行调整后仍然存在。该报告还指出，健康差距的部分原因是卫生保健方面的差距。从国际移民组织的报告中可以明显看出，我们需要以不同的方式更深入地思考种族的概念。根据尼肯斯的说法，历史上，美国的种族观念一直建立在特定的生物学和政治背景下。种族和自卑的观念至少在一定程度上是在殖民主义经济制度的背景下形成的。关于种族的现代观念已经改变，由移民养活的人口的多样性也发生了变化。目前的种族概念有五个主要缺陷：(1)种族没有反映当前的遗传和生物学知识；(2)种族受到历史的塑造，但也被历史扭曲；(3)种族/阶级方案非常不精确；(4)“种族”的分类存在很大的差异；(5)按照种族分类的数据可能会使调查人员不去考虑其他必须考虑的重要因素，如社会经济地位。然而，种族在美国的概念是一个不容忽视的强大概念。健康差距并不是美国独有的。世界卫生组织与联合国合作，鼓励各国为土著人民制定健康方案，并促进对医疗保健不平等的研究，以告知各国，以便它们能够采取适当的行动。来自英国、南非和澳大利亚的4个例子说明了对这一倡议的回应。英国卫生部首席医疗官报告说，尽管健康状况总体上有所改善，但社会弱势群体和富裕群体之间的差距仍在扩大。英国政府已将消除健康方面的不平等作为首要任务。5.
A recent report by the US Institute of Medicine (IOM) 1 suggests that racial/ethnic disparities in health outcomes in the USA remain (see Figure 12), and persist after adjustment for access and other socioeconomic factors. The report also suggests that health disparities are partially attributable to disparities in health care. It is obvious from the IOM report that we need to think differently and more deeply about the concept of race. According to Nickens, 3 historically the idea of race in the USA has been based in particular biological and political contexts. The notions of race and inferiority developed at least in part in the context of the economic system of colonialism. Modern ideas about race have changed, as has the diversity of the population which has been fed by immigration.There are five major flaws in the current concept of race:(1) race does not reflect current genetic and biological knowledge;(2) race has been shaped by history but distorted by it as well;(3) the race/class schemes are highly imprecise;(4) wide variability exists within classifications of ‘race’; and (5) thinking in terms of data categorized by race can lull investigators away from thinking about other important factors that must be considered, such as socioeconomic status. However, the concept of race in the USA is a powerful one that cannot be ignored. Health disparities are not unique to the USA. The World Health Organization has collaborated with the UN to encourage countries to develop health programs for indigenous people and promote research on inequalities in health care to inform countries so that they can take appropriate action. 4 Examples from the UK, South Africa, and Australia illustrate responses to this initiative. The Chief Medical Officer of the UK Department of Health reports that despite overall improvements in health the gap between socially disadvantaged and affluent sections of the population has widened. The UK government has made the elimination of inequalities in health a top priority. 5