Social conditions as fundamental causes of disease.
Social conditions as fundamental causes of disease.
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DOI：
10.13016/eooy-l4ik
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发表时间：
1995
影响因子：
5
通讯作者：
Bruce G. Link;J. Phelan
中科院分区：
文献类型：
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作者：
Bruce G. Link;J. Phelan
过去几十年来，流行病学研究在确定重大疾病的风险因素方面取得了巨大成功。然而，大多数研究都将注意力集中在相对接近疾病原因的风险因素上，例如饮食，胆固醇水平，运动等。我们质疑这种强调个人为基础的风险因素，并认为，如果卫生改革是在未来的时间有其最大的影响，必须更加重视基本的社会条件。这种说法有两个原因。首先，我们认为，如果我们要制定有效的干预措施，改善国家的健康，基于个人的风险因素必须通过检查什么使人们处于风险之中。其次，我们认为，社会经济地位和社会支持等社会因素可能是疾病的“根本原因”，因为它们体现了获得重要资源的机会，通过多种机制影响多种疾病的结果，因此即使干预机制发生变化，也会保持与疾病的关联。如果不认真注意这些可能性，我们就有可能实施无效的基于个人的干预战略，并失去采取基础广泛的社会干预措施的机会，而这些干预措施可以为我们的公民带来巨大的健康利益。
Over the last several decades, epidemiological studies have been enormously successful in identifying risk factors for major diseases. However, most of this research has focused attention on risk factors that are relatively proximal causes of disease such as diet, cholesterol level, exercise and the like. We question the emphasis on such individually-based risk factors and argue that greater attention must be paid to basic social conditions if health reform is to have its maximum effect in the time ahead. There are two reasons for this claim. First we argue that individually-based risk factors must be contextualized, by examining what puts people at risk of risks, if we are to craft effective interventions and improve the nation's health. Second, we argue that social factors such as socioeconomic status and social support are likely "fundamental causes" of disease that, because they embody access to important resources, affect multiple disease outcomes through multiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change. Without careful attention to these possibilities, we run the risk of imposing individually-based intervention strategies that are ineffective and of missing opportunities to adopt broad-based societal interventions that could produce substantial health benefits for our citizens.