Implications of socio-economic differentials in mortality for the health system.
Implications of socio-economic differentials in mortality for the health system.
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社会经济差异对卫生系统死亡率的影响。
DOI：
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发表时间：
1980
期刊：
影响因子：
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通讯作者：
A. Antonovsky
中科院分区：
文献类型：
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作者：
A. Antonovsky
这一讨论的前提是，需要一个系统和持续的监测系统来收集关于社会指标“社会经济死亡率差异”的数据。注意5种特殊类型的数据：长期趋势；阶级差异和年龄；线性与二分法；交叉变量；向下流动和生物选择。对以下两个基本问题进行了审查，并以限定的“是”回答：1)医疗保健系统与死亡率差异有任何相关性；2)医疗保健系统是否有任何程度的有意义的自主性，脱离整个社会制度。从医学教育的价值内容、卫生保健系统的组织、对健康的重视和对社区的关注等方面对这一分析的政策影响进行了审查。控制和权力的概念被分析为社会经济差异的关键。强调不同的“压力源”暴露在所谓的“连贯感”上是不被接受的--这是一种在普遍阻力资源水平较高的背景下，在下层阶级中出现或未能出现的一种全球取向。从根本上说，问题在于，下层社会阶层存在的狭隘、紧急、无能为力和不可预测的特征，阻止了下层社会阶层和群体能够应对压力来源。卫生保健系统可以加强下层阶级的凝聚感的方法包括：在每个社会中建立正式的监测系统；谨慎地假设技术进步、环境控制和健康教育的后果是平等的；以及需要确定下层阶级中的高危群体。
The premise of this discussion is that a systematic and continuous monitoring system is required to assemble data on the social indicator "socio-economic differences in mortality." Attention is directed to 5 particular types of data: secular trends; class differentials and age; linearity versus dichotomy; cross-cutting variables; and downward mobility and biological selection. The following 2 basic questions are examined and answered with a qualified "yes:" 1) does the health care system have any relevance to mortality differentials; and 2) can a health care system have any degree of meaninful autonomy from the overall social system. The policy implications of this analysis are reviewed in terms of the value content of medical education, the organization of the health care system, the emphasis on health, and the focus on the community. The concepts of control and power are analyzed as the key to socioeconomic differentials. Emphasis on differential exposures to "stressors" is rejected for what is termed "a sense of coherence" -- a global orientation which emerges, or fails to emerge among the lower classes, against the background of a high level of generalized resistance resources. Essentially the problem is that the constricted, emergency, powerless, and unpredictable character of lower social class existence prevents individuals of lower class and groups from being able to cope with stressors. Ways that the health care system can strengthen the sense of coherence of the lower classes include the following: a formal monitoring system in each society; caution in assuming that technological advances, environmental control, and health education are egalitarian in their consequences; and the need to identify high-risk groups within the lower classes.