Part III summary: What is the role of the social environment in understanding inequalities in health?
Part III summary: What is the role of the social environment in understanding inequalities in health?
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DOI：
10.1111/j.1749-6632.1999.tb08109.x
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发表时间：
1999-01-01
期刊：
影响因子：
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通讯作者：
Kaplan, GA
中科院分区：
文献类型：
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作者：
Kaplan, GA
社会环境与个人和人群的健康密不可分，这一点在很久以前就得到了承认，早在19世纪中期，英国、法国和德国就开始了类似的活动，导致了公共卫生运动的开始。[1]尽管早期城市社会学家做出了重要贡献，[2][3]但在接下来的世纪半里，社会环境的讨论往往集中在物质生活条件上，如住房、卫生、水质等。在世纪的最后四分之一，社会环境的讨论扩大了与约翰·卡塞尔的论文“社会环境对宿主抵抗的贡献”是这一变化的一个哨兵标志。[4]在这篇论文中，Cassel呼吁将健康状况较差与县的社会组织混乱、社会不稳定和人口普查区的贫困程度、家庭能力水平、文化适应、生活压力和社会支持不足联系起来的证据。最近的论文表明，人们生活的地区的特点、5社会联系的模式、6社会和经济政策、7工作的组织、8以及社会环境的其他方面与健康状况的重要差异有关。研讨会这一部分的论文表明，这种兴趣的爆发是活跃的，令人兴奋的，但社会环境是什么？我们可以相对容易地定义物理环境，而社会环境的定义是难以捉摸的。虽然给出一个精确的定义并不重要，但通过观察图1或其他类似的表述，我们可以从图9-12中大致了解到，当我们广泛地谈论社会环境时，所涉及的地形的规模。因此，我们可以认为，社会和经济政策为发展与保健、教育、公共安全、地方和区域发展以及工作条件有关的特定机构和监管制度奠定了基础。重要的是要记住，这些社会和经济政策植根于历史和地理之中，包含着与歧视和文化有关的逆流。邻里和社区的性质，物质和新物质的生活条件，以及个人和群体之间的社会关系模式，这些过程促进或阻碍了个人风险因素的发展，包括行为和心理社会因素，这些因素可能会反馈到上游决定因素。因此，为了了解个人和群体的日常经验，
That the social environment is inextricably involved in the health of individuals and populations was recognized long ago, extending back beyond the parallel activities in England, France, and Germany during the mid-1800s that led to the beginnings of the public health movement. 1 Despite the important contributions of early urban sociologists, 2, 3 for the next century and a half the discussion of the social environment tended to focus on material living conditions such as housing, sanitation, water quality, and so forth. During the last quarter of a century, the discussion of the social environment broadened with John Cassel’s paper “The Contribution of the Social Environment to Host Resistance” being a sentinel marker of this change. 4 In this paper, Cassel called upon evidence that linked poorer health to social disorganization of counties, social instability and poverty level of census tracts, levels of family competence, acculturation, and life stress and poor social support. More recent papers have shown that characteristics of the areas in which people live, 5 patterns of social connections, 6 social and economic policies, 7 organization of work, 8 and other aspects of the social environment are associated with important variations in health status. The papers presented in this part of the symposium show that this explosion of interest is alive, well, and exciting.But what is the social environment? We can relatively easily define the physical environment, whereas a definition of the social environment is elusive. While it may actually not be important to come up with an exact definition, inspection of FIGURE 1, or other similar representations, 9–12 gives some idea of the magnitude of the terrain that is involved when we speak broadly of the social environment. Thus, we can think of social and economic policies setting the context for the development of particular institutions and regulatory systems related to health care, education, public safety, local and regional development, and working conditions. It is important to remember that these social and economic policies are embedded in history and geography and contain cross-currents related to discrimination and culture. The nature of neighborhoods and communities, living conditions, both material and neomaterial, and patterns of social relationships between individuals and groups set in place processes that facilitate or impede the development of individual risk factors, both behavioral and psychosocial, that may feed back on upstream determinants. Thus, in order to understand the day-to-day experience of individuals and groups and