Towards health equity: the urgent need for upstream intervention studies in gastroenterology and hepatology.
Towards health equity: the urgent need for upstream intervention studies in gastroenterology and hepatology.
复制标题
DOI：
10.1016/s2468-1253(22)00012-7
复制
发表时间：
2022-03
影响因子：
35.7
通讯作者：
Issaka, Rachel B.
中科院分区：
文献类型：
--
作者：
Liu, Joy J.;De Cuir, Nicole;Kia, Leila;Issaka, Rachel B.
健康不平等是实现更广泛的社会公平和公正社会的重大挑战。减少健康不平等的干预措施可以针对健康的下游决定因素，例如个人医疗保健需求，中游决定因素，例如邻里条件，或上游决定因素，例如结构性种族主义和歧视。 1 例如，减少非裔美国人结直肠癌死亡率不平等的干预措施可能包括邮寄关于粪便免疫化学检测的提醒（下游干预）；为患者提供导航、交通或其他直接援助以获取医疗保健服务（中游干预）；或改变重新分配权力、财富和资源的法律，包括健康保险（上游干预）。 2 在美国，美国国立卫生研究院承认结构性种族主义和歧视对健康的影响，并专门资助该领域的科学研究。结构性种族主义和歧视被广泛地描述为基于种族或族裔、性别、性取向、残疾状况、国籍以及其他身体特征或健康状况的歧视。研究发现结构性种族主义和歧视与胃肠道疾病患者的不良预后有关。例如，抵押贷款中的种族偏见（也称为红线）与黑人女性结直肠癌特定生存时间的缩短有关，与居住地区无关。 3 尽管此类研究在美国以外很少见，但在其他国家（包括加拿大和荷兰）也有报道称存在红线，并且在这些环境中黑人女性中出现类似结果也就不足为奇了。 4, 5
Health inequity is a major challenge to achieving broader social equity and a just society. Interventions to reduce health inequity can be directed at downstream determinants of health, such as individual healthcare needs, midstream determinants, such as neighbourhood conditions, or upstream determinants, such as structural racism and discrimination. 1 For example, interventions to reduce inequities in colorectal cancer mortality in African-American people could include mailing reminders about faecal immunochemical tests (downstream intervention); providing patient navigation, transportation, or other direct aid to access health-care services (midstream intervention); or changing laws that redistribute power, wealth, and resources, including health insurance (upstream intervention). 2 In the USA, the National Institutes of Health acknowledge the impact of structural racism and discrimination on health, and have dedicated funding to scientific investigation in this area. Structural racism and discrimination are broadly described as discrimination based on race or ethnicity, gender, sexual orientation, disability status, national origin, and other physical characteristics or health conditions. Research has linked structural racism and discrimination with poor patient outcomes in gastrointestinal diseases. For example, racial bias in mortgage lending, also known as redlining, has been associated with decreased colorectal cancerspecific survival time in Black women, independent of area of residence. 3 Although such research is rareoutside the USA, redlining has been reported in other nations, including Canada and the Netherlands, and similar outcomes among Black women in these settings would be unsurprising. 4, 5