Systems change for the social determinants of health
Systems change for the social determinants of health
复制标题
DOI：
10.1186/s12889-015-1979-8
复制
发表时间：
2015-07-14
影响因子：
4.5
通讯作者：
Crammond, Brad
中科院分区：
文献类型：
--
作者：
Carey, Gemma;Crammond, Brad
背景资料：健康的社会决定因素的分布不平等现在是一个广泛认识到的问题，被视为需要立即采取重大行动（卫生和社会发展委员会）。在一代人的时间里缩小差距。日内瓦：世卫组织; 2008年; Marmot M.公平社会，健康生活：土拨鼠评论。2010年后英格兰健康不平等战略审查。伦敦; 2010）。尽管早在1980年代就提出了关于健康的社会决定因素的行动建议，但许多国家的不平等现象继续加剧。在本文中，我们提供了一个分析的建议，从主要的社会决定因素的健康报告使用的概念“系统杠杆点”。越来越多的，强大的和有效的行动，健康的社会决定因素的概念化，这是针对政府行动的非健康问题，推动health outcomes.Methods：建议采取行动，从6个主要的国家报告健康的社会决定因素的来源。每个报告的建议都是根据两个框架编码的：约翰斯顿等人最近开发的干预水平框架（ILF）和Meadow开创性的“12个系统干预点”（约翰斯顿LM，Matteson CL，Finegood DT。系统科学与肥胖政策：分析和反思人口水平规划的新框架。美国公共卫生杂志。2014;（0）：e1-e9; Meadows D.在系统中思考。美国：可持续发展研究所; 1999）（N = 166）.结果：我们的分析发现，随着时间的推移，所提出的建议类型发生了几个重大变化，包括向范式转变和远离个体干预的转变。结果从梅多的框架揭示了一些潜在的强大的系统干预点，目前在公共卫生的思考，对健康的社会决定因素的行动利用不足。结论：当通过系统的透镜来看，很明显，干预的力量不是来自它的目标，而是它如何工作，以创造系统内的变化。这意味着，如果针对政府政策的努力是为了改变相对薄弱的杠杆点，那么这些努力的效力就有限。我们的分析提出了进一步（和更微妙的）问题，即对健康的社会决定因素采取什么样的有效行动。
Background: Inequalities in the distribution of the social determinants of health are now a widely recognised problem, seen as requiring immediate and significant action (CSDH. Closing the Gap in a Generation. Geneva: WHO; 2008; Marmot M. Fair Society, Healthy Lives: The Marmot Review. Strategic Review of Health Inequalitites inEngland Post-2010. London; 2010). Despite recommendations for action on the social determinants of health dating back to the 1980s, inequalities in many countries continue to grow. In this paper we provide an analysis of recommendations from major social determinants of health reports using the concept of 'system leverage points'. Increasingly, powerful and effective action on the social determinants of health is conceptualised as that which targets government action on the non-health issues which drive health outcomes.Methods: Recommendations for action from 6 major national reports on the social determinants of health were sourced. Recommendations from each report were coded against two frameworks: Johnston et al's recently developed Intervention Level Framework (ILF) and Meadow's seminal '12 places to intervene in a system' (Johnston LM, Matteson CL, Finegood DT. Systems Science and Obesity Policy: A Novel Framework forAnalyzing and Rethinking Population-Level Planning. American journal of public health. 2014;(0): e1-e9; Meadows D. Thinking in Systems. USA: Sustainability Institute; 1999) (N = 166).Results: Our analysis found several major changes over time to the types of recommendations being made, including a shift towards paradigmatic change and away from individual interventions. Results from Meadow's framework revealed a number of potentially powerful system intervention points that are currently underutilised in public health thinking regarding action on the social determinants of health.Conclusion: When viewed through a systems lens, it is evident that the power of an intervention comes not from where it is targeted, but rather how it works to create change within the system. This means that efforts targeted at government policy can have only limited effectiveness if they are aimed at changing relatively weak leverage points. Our analysis raises further (and more nuanced) questions about what effective action on the social determinants of health looks like.