Ladders, pyramids and champagne: the iconography of health inequities
Ladders, pyramids and champagne: the iconography of health inequities
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DOI：
10.1136/jech.2008.079061
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发表时间：
2008-12-01
影响因子：
6.3
通讯作者：
Krieger, N.
中科院分区：
文献类型：
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作者：
Krieger, N.
概念模型对于理论化、描述和解释健康不公平的人口分布至关重要。这是因为视觉概念模型，如地图，可以同时组织和激发想法和观察。视觉模型既有意象又有隐喻，不仅能说明科学理论所规定的关键结构和因果关系，而且还为整合和评估迅速出现的发现以及指导新的研究提供了重要工具。因此，考虑和对比公共卫生、政策和流行文献中出现的不同图像集是有指导意义的，这些图像集涉及（1）社会分层，（2）人口健康的决定因素;（3）健康不公平的决定因素。争论的焦点是不同类型的图像如何阐明或模糊需要改变以改善人口健康和减少健康不公平的相关因果过程，特别令人关切的是，当（a）模型不准确地描述人口和资源的分布和（B）人口健康的决定因素模型，而不是健康不公平的决定因素模型，被用于讨论健康方面的社会不平等。虽然也许可以提出一个务实的论点，在以政策为导向的文件中使用政治争议较小的图像，但我认为，公众的健康将更好地服务于一个图像符号学，一个清晰而明确地描绘权力和资源倾斜分布的社会事实，并描绘产生和维持这些分布的社会过程及其在人口水平上的体现，健康、疾病和福祉的分布。
Conceptual models are crucial for theorising, depicting and explaining population distributions of health inequities. This is because a visual conceptual model, like a map, can simultaneously organise and spur ideas and observations. Incorporating both imagery and metaphor, visual models not only illustrate key constructs and causal relationships specified by scientific theories but also provide an important tool for integrating and evaluating rapidly emerging findings and for guiding new research.It therefore is instructive to consider and contrast different sets of images appearing in the public health, policy and popular literature pertaining to (1) social stratification, (2) determinants of population health and (3) determinants of health inequities. At issue is how different types of images illuminate, or obscure, the relevant causal processes that need to be altered to improve population health and reduce health inequities.Of particular concern are conceptual confusions created when (a) models inaccurately depict the distribution of population and resources and (b) models of determinants of population health, rather than of determinants of health inequities, are used in discussions about social inequalities in health. Although perhaps a pragmatic argument can be made for use of less politically controversial imagery in policy-oriented documents, I would argue that the public's health will be better served by an iconoclastic iconography, one that clearly and unequivocally delineates the social facts of skewed distributions of power and resources and depicts the societal processes that generate and maintain these distributions and their embodiment in population levels and distributions of health, disease and well-being.