Health inequalities and welfare state regimes: theoretical insights on a public health 'puzzle'
Health inequalities and welfare state regimes: theoretical insights on a public health 'puzzle'
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DOI：
10.1136/jech.2011.136333
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发表时间：
2011-09-01
影响因子：
6.3
通讯作者：
Bambra, Clare
中科院分区：
文献类型：
--
作者：
Bambra, Clare
福利国家是健康的重要决定因素。比较社会流行病学几乎无一例外地得出结论，斯堪的纳维亚国家提供的相对慷慨和普遍的福利增进了人口健康。然而，大多数关于健康方面的社会经济不平等的国际研究都提出了一些公共卫生“难题”，因为斯堪的纳维亚福利国家并不像通常预期的那样存在最小的健康不平等。本文通过借鉴现有的健康不平等理论——人工制品、选择、文化行为、唯物主义、社会心理和生命历程——来概述和质疑这个难题，从而产生一些理论见解。它讨论了这些理论在跨国研究方面的局限性；它质疑当代比较卫生不平等研究的重点和规范范式；它考虑了比较社会流行病学的未来。
Welfare states are important determinants of health. Comparative social epidemiology has almost invariably concluded that population health is enhanced by the relatively generous and universal welfare provision of the Scandinavian countries. However, most international studies of socioeconomic inequalities in health have thrown up something of a public health 'puzzle' as the Scandinavian welfare states do not, as would generally be expected, have the smallest health inequalities. This essay outlines and interrogates this puzzle by drawing upon existing theories of health inequalities-artefact, selection, cultural-behavioural, materialist, psychosocial and life course-to generate some theoretical insights. It discusses the limits of these theories in respect to cross-national research; it questions the focus and normative paradigm underpinning contemporary comparative health inequalities research; and it considers the future of comparative social epidemiology.