Health inequality and governance in Scotland since 2007
Health inequality and governance in Scotland since 2007
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DOI：
10.1016/j.puhe.2013.04.019
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发表时间：
2013-06-01
期刊：
影响因子：
5.2
通讯作者：
Fox, Daniel M.
中科院分区：
文献类型：
--
作者：
Fox, Daniel M.
背景资料：自1999年苏格兰权力下放以来，历届政府都优先考虑减少健康不平等和促进经济增长。2007年当选并于2011年再次当选的苏格兰国民党政府对解决这些优先事项给予了相当大的关注，并拨出了大量资源。本文描述了苏格兰治理的参与者（广义上包括中央政府内外的人）为什么、如何以及迄今为止取得了哪些成果，解决了健康的决定因素，以减少不平等，从而改善人口的健康状况。研究设计：解释性分析。方法：本文的研究应用了解释社会科学的方法来获取和分析已发表和未发表的公共文献;以及与苏格兰国家卫生服务及其地区的部长、官员、工作人员以及其他积极参与苏格兰卫生治理的人员的访谈。苏格兰卫生事务治理的参与者通过以下方式为减少卫生不平等和改善人口健康做出了重要贡献：（1）将解决健康不平等问题的政策与提高医疗保健、公共卫生、社会和住房服务以及教育的效力和效率的政策联系起来;（2）将解决健康决定因素的政策与刺激经济增长的政策联系起来，从而增加就业和收入;（3）接受并应用关于导致健康不平等的人口健康状况缺陷原因的独特综合研究结果。这些研究结果可能有助于修订一些研究人员和政策顾问的假设和建议，他们研究人口健康的决定因素，从而研究健康不平等，以便提出政策建议。人口健康文献的许多撰稿人认为，健康的决定因素具有普遍性，解决这些问题的有效干预措施也可能具有普遍性。然而，本文的研究表明，一个国家的治理参与者，也许是每个国家的治理参与者，在描述健康的决定因素时，考虑到其文化，历史和当前的政治，以便提出减少健康不平等的政策。因此，本文所述的苏格兰经验可能有助于有关卫生政策的对话，这些对话涉及来自许多司法管辖区的治理领导人;二十年来经常发生的对话。(C)2013年，皇家公共卫生学会。由爱思唯尔有限公司出版。保留所有权利。
Background: Since Scottish devolution in 1999, successive governments have accorded priority to reducing health inequality and increasing economic growth. The Scottish Nationalist Party Government elected in 2007 and re-elected in 2011 has accorded considerable attention and allocated substantial resources to addressing these priorities. This article describes why, how and with what results to date the participants in the governance of Scotland, broadly defined to include persons outside as well as within central government, have addressed the determinants of health in order to reduce inequality and, as a result, improve the health status of the population.Study design: Interpretive analysis.Methods: Research for this article applied the methods of interpretive social science to obtain and analyse published and unpublished public documents; secondary sources in relevant disciplines; and interviews with ministers, officials, staff of National Health Service Scotland and its regions, and other persons active in health governance in Scotland.Results: Participants in the governance of health affairs in Scotland are making important contributions to the reduction of health inequality and the improvement of population health by: (1) linking policy to address health inequality with policy to make health care, public health, social and housing services, and education more effective and efficient; (2) linking policy to address the determinants of health with policy to stimulate economic growth and, as a result, increase employment and income; and (3) embracing and applying a unique synthesis of research findings about the causes of deficiencies in population health status that contribute to health inequality.Conclusions: These findings could contribute to revising the assumptions and recommendations of some of the researchers and policy advisers who study the determinants of population health, and thus of health inequality, in order to recommend policy. Many contributors to the literature on population health argue that the determinants of health are universal, and that effective interventions to address them are also likely to be universal. Research for this article suggests, however, that participants in the governance of one country, and perhaps of each country, take account of its culture, history and current politics when they describe the determinants of health in order to propose policy to reduce health inequality. The Scottish experience described in this article could, therefore, contribute to conversations about health policy that involve leaders in governance from numerous jurisdictions; conversations that have been occurring regularly for two decades. (C) 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.