Why the Scots die younger: Synthesizing the evidence
Why the Scots die younger: Synthesizing the evidence
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DOI：
10.1016/j.puhe.2012.03.007
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发表时间：
2012-06-01
期刊：
影响因子：
5.2
通讯作者：
Batty, G. D.
中科院分区：
文献类型：
--
作者：
McCartney, G.;Collins, C.;Batty, G. D.
目的：为了确定在苏格兰相对于其他欧洲国家较高的死亡率的解释，并综合那些最好的证据支持到一个整体的解释framework.Study设计：审查和辩证synthesization.Methods：候选人的假设，确定了文献综述和一系列的研究传播活动的基础上。每一个假设进行了描述，并严格评价与布拉德福德-希尔标准的因果关系，在观察流行病学。一个更令人信服的假说的综合，然后试图使用一个广泛的'辩证' approach.Results：17个假说被确定，包括：人工解释（剥夺、迁移）;“下游解释”（遗传学、健康行为、个人价值观）;“中游”解释（滥用药物;无边界和疏远文化;家庭、性别关系和养育差异;社会资本较低;宗派主义;社会流动性有限的文化;卫生服务的供应或需求;贫困集中）;以及“上游”解释（气候、不平等、去工业化、政治攻击）。几乎没有证据可以确定为什么1950年至1980年期间苏格兰和其他欧洲国家的死亡率会出现差异，但目前最合理的解释与特定的工业、就业、住房和文化模式有关。自1980年以来，死亡率的上升是由不利的健康行为造成的，这些行为似乎很可能与冲突、不公正和丧失权力的气氛加剧有关。这是最好的解释，从政治攻击假说，这表明，从1979年起在英国实施的新自由主义政策不成比例地影响了苏格兰population.Conclusions：1950年和1980年之间的高苏格兰死亡率的原因尚不清楚，但可能与特定的工业，就业，住房和文化模式。从1980年起，死亡率较高很可能是由于1980年代政治环境的变化以及随之而来的绝望和社区分裂所造成的综合影响。这可能与其他国家（如美国）的健康改善步履蹒跚有关。(C)2012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。
Objective: To identify explanations for the higher mortality in Scotland relative to other European countries, and to synthesize those best supported by evidence into an overall explanatory framework.Study design: Review and dialectical synthesis.Methods: Candidate hypotheses were identified based on a literature review and a series of research dissemination events. Each hypothesis was described and critically evaluated in relation to the Bradford-Hill criteria for causation in observational epidemiology. A synthesis of the more convincing hypotheses was then attempted using a broadly 'dialectical' approach.Results: Seventeen hypotheses were identified including: artefactual explanations (deprivation, migration); 'downstream explanations' (genetics, health behaviours, individual values); 'midstream' explanations (substance misuse; culture of boundlessness and alienation; family, gender relations and parenting differences; lower social capital; sectarianism; culture of limited social mobility; health service supply or demand; deprivation concentration); and 'upstream' explanations (climate, inequalities, de-industrialization, political attack). There is little evidence available to determine why mortality rates diverged between Scotland and other European countries between 1950 and 1980, but the most plausible explanations at present link to particular industrial, employment, housing and cultural patterns. From 1980 onwards, the higher mortality has been driven by unfavourable health behaviours, and it seems quite likely that these are linked to an intensifying climate of conflict, injustice and disempowerment. This is best explained by developing a synthesis beginning from the political attack hypothesis, which suggests that the neoliberal policies implemented from 1979 onwards across the UK disproportionately affected the Scottish population.Conclusions: The reasons for the high Scottish mortality between 1950 and 1980 are unclear, but may be linked to particular industrial, employment, housing and cultural patterns. From 1980 onwards, the higher mortality is most likely to be accounted for by a synthesis which begins from the changed political context of the 1980s, and the consequent hopelessness and community disruption experienced. This may have relevance to faltering health improvement in other countries, such as the USA. (C) 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.