What can the NHS do to prevent and reduce health inequalities?
What can the NHS do to prevent and reduce health inequalities?
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NHS 可以采取哪些措施来预防和减少健康不平等？
DOI：
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
G. Watt
中科院分区：
文献类型：
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作者：
G. Watt
来自 Deep End 的全科医生的一组新论文设想了 NHS 应如何解决逆向护理法，减少个体患者健康不平等的后果，并缩小预期寿命的社会差异。1
健康不平等的主要原因在于卫生服务之外，这就是为什么预防健康不平等的政策必须从儿童时期开始解决更广泛的健康社会决定因素。然而，仅仅关注预防未来健康不平等是不够的。还有必要减少现有的健康不平等现象，并防止其扩大。实际上，这些方法是互补的（框 1）。
#### 专栏 1. 一个家庭的预防和治疗
大卫已经 14 个月大了。他 18 岁的妈妈莎拉自从 4 年前哥哥上吊自杀以来，一直患有焦虑症。她开始上大学，但不久后怀孕了就离开了。莎拉与她的母亲相处得不好，她指责母亲自从她哥哥去世后就酗酒并且“总是大喊大叫”。她妈妈说她“精神不正常”，是个“十几岁的孩子”。莎拉非常依赖她自己的玛格丽特奶奶。她今年 50 岁，患有中度慢性阻塞性肺病（肺气肿），并且继续吸烟。玛格丽特最近出现了几次胸部感染，她正在努力应对莎拉经常奇怪的行为，以及她是主要照顾者的一个活泼的幼儿。
对于大卫来说，接下来的两年，当他学会走路、说话和互动时，将对他的余生产生巨大的影响。早年的干预措施（例如育儿课程）可能很重要，但仅靠这些干预措施无法改变他的生活机会。他需要支持的邻居、良好的托儿所和足够的家庭收入，还需要最佳的慢性阻塞性肺病护士审查、反应灵敏的酒精和心理健康服务、与社会工作者的良好沟通、持久的……
A new set of papers from GPs at the Deep End imagines how the NHS should address the inverse care law, reduce the consequences of inequalities in health for individual patients, and narrow social differences in life expectancy.1
The principal causes of inequalities in health lie outside the health service, which is why policies to prevent health inequalities must address the wider social determinants of health, starting in childhood. However, it is insufficient to focus on the prevention of future inequalities in health. It is also necessary to reduce existing inequalities in health, and to prevent them getting wider. In practice, these approaches are complementary (Box 1).
#### Box 1. Prevention and treatment in one family
David is 14 months old. His 18-year-old mum Sarah has had anxiety problems since her older brother hanged himself 4 years ago. She started college but left when she became pregnant shortly afterwards. Sarah does not get on well with her mother, whom she accuses of drinking and ‘always shouting’ since her brother died. Her mum says she is ‘mental’ and a ‘teenage brat’. Sarah relies heavily on her own gran Margaret. Aged 50 years, she has moderately severe COPD (emphysema) and continues to smoke. Margaret has had several chest infections recently and is struggling to cope with Sarah’s often strange behaviour and with a lively toddler for whom she is the main care giver.
For David the next 2 years, as he learns to walk, talk, and interact, will have a huge effect on the rest of his life. Early years interventions such as parenting classes may be important, but on their own will fail to change his life opportunities. He will need supportive neighbours, a good nursery, and adequate family income, but also optimal COPD nurse reviews, responsive alcohol and mental health services, good communication with social workers, persistent …