The Social Determinants of Health: It's Time to Consider the Causes of the Causes
The Social Determinants of Health: It's Time to Consider the Causes of the Causes
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DOI：
10.1177/00333549141291s206
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发表时间：
2014-01-01
影响因子：
3.3
通讯作者：
Gottlieb, Laura
中科院分区：
文献类型：
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作者：
Braveman, Paula;Gottlieb, Laura
在过去二十年中，公共卫生界的注意力越来越多地吸引到健康的社会决定因素（SDH）——医疗保健以外的因素，这些因素可以受到社会政策的影响，并以强有力的方式塑造健康。我们使用“医疗护理”而不是“卫生保健”来指代临床服务，以避免“健康”和“卫生保健”之间的潜在混淆。世界卫生组织健康问题社会决定因素委员会将SDH定义为“人们出生、成长、生活、工作和衰老的条件”以及“这些条件的基本驱动因素”。“社会决定因素”一词通常会引起诸如社区健康相关特征（例如，可步行性、休闲区域和健康食品的可及性）等因素，这些因素会影响与健康相关的行为。然而，越来越多的证据表明，收入、财富和教育等社会经济因素是各种健康结果的根本原因。本文广泛回顾了迄今为止积累的一些知识，这些知识强调了社会因素，特别是社会经济因素在塑造健康方面的重要性，以及可能解释其影响的合理途径和生物机制。我们还讨论了推进这一知识的挑战以及如何克服这些挑战。
During the past two decades, the public health community's attention has been drawn increasingly to the social determinants of health (SDH)-the factors apart from medical care that can be influenced by social policies and shape health in powerful ways. We use "medical care" rather than "health care" to refer to clinical services, to avoid potential confusion between "health" and "health care." The World Health Organization's Commission on the Social Determinants of Health has defined SDH as "the conditions in which people are born, grow, live, work and age" and "the fundamental drivers of these conditions." The term "social determinants" often evokes factors such as health-related features of neighborhoods (e.g., walkability, recreational areas, and accessibility of healthful foods), which can influence health-related behaviors. Evidence has accumulated, however, pointing to socioeconomic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes. This article broadly reviews some of the knowledge accumulated to date that highlights the importance of social-and particularly socioeconomic-factors in shaping health, and plausible pathways and biological mechanisms that may explain their effects. We also discuss challenges to advancing this knowledge and how they might be overcome.