A model of underlying socioeconomic vulnerability in human populations: evidence from variability in population health and implications for public health
A model of underlying socioeconomic vulnerability in human populations: evidence from variability in population health and implications for public health
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DOI：
10.1016/j.socscimed.2004.11.028
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发表时间：
2005-06-01
影响因子：
5.4
通讯作者：
Karpati, A
中科院分区：
文献类型：
--
作者：
Galea, S;Ahern, J;Karpati, A
从对复杂生物系统的可变性的见解中，我们提出，人类群体的健康反映了潜在脆弱性之间的相互关系（由人口水平的社会和经济因素决定;例如，收入分配）和能力（由人口水平的有益资源决定，例如，社会资本）以及受这些脆弱性和能力影响的人口如何应对间歇性压力源（例如，经济衰退）和保护性事件（例如，一所学校的介绍）。在人口水平上监测这一动态可以通过不仅检查疾病和死亡率，而且检查人口之间或人口内部随时间变化的比率来实现。我们使用1990年至2001年纽约市社区的死亡率数据来检验与人口健康模型一致的两个相关假设：（a）在以社会经济脆弱性为特征的社区之间，死亡率在某个时间点上的变异性更大;以及（B）在以社会经济脆弱性为特征的社区内，死亡率随时间的变化更大。我们发现，以社会和经济脆弱性为特征的社区在特定的死亡率方面表现出很大的差异。显示出最大变异性的死亡率是由可能对社会条件敏感的原因造成的（例如，凶杀率或艾滋病毒/艾滋病率）。人群健康的变异性存在于一个时间点上潜在脆弱性的社区之间以及随着时间的推移脆弱社区内部。这一分析的结果是一致的理论的基本社会经济脆弱性的人口，并建议在人口健康的变化可能是一个重要的考虑因素，在人口健康评估。(c)2004爱思唯尔有限公司保留所有权利。
Drawing from insights into the variability of complex biologic systems we propose that the health of human populations reflects the interrelationship between underlying vulnerabilities (determined by population-level social and economic factors; e.g., income distribution) and capacities (determined by population-level salutary resources, e.g., social capital) and how populations, shaped by these vulnerabilities and capacities, respond to intermittent stressors (e.g., economic downturns) and protective events (e.g., introduction of a school). Monitoring this dynamic at the population-level can be accomplished by examining not only rates of illness and mortality, but vciriability in rates, either between populations or within populations over time. We used mortality data from New York City neighborhoods between 1990 and 2001 to test two related hypotheses consistent with this model of population health: (a) There is greater variability in mortality rates at a point in time between neighborhoods that are characterized by socioeconomic vulnerability; and (b) there is greater variability in mortality rates over time within neighborhoods that are characterized by socioeconomic vulnerability. We found that neighborhoods characterized by social and economic vulnerability displayed substantial variability in particular mortality rates. Mortality rates displaying the greatest variability were from causes that may be sensitive to social conditions (e.g., homicide or HIV/AIDS rates). Variability in population health existed both between neighborhoods with underlying vulnerability at one point in time and within vulnerable neighborhoods over time. The results of this analysis are consistent with a theory of underlying socioeconomic vulnerabilities of human populations and suggest that variability in population health may be an important consideration in population health assessment. (c) 2004 Elsevier Ltd. All rights reserved.