Framing action to reduce health inequalities: what is argued for through use of the 'upstream-downstream' metaphor?
Framing action to reduce health inequalities: what is argued for through use of the 'upstream-downstream' metaphor?
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DOI：
10.1093/pubmed/fdab157
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发表时间：
2022-08-25
影响因子：
4.4
通讯作者：
McMahon, Naoimh E.
中科院分区：
文献类型：
--
作者：
McMahon, Naoimh E.
公共卫生洞察力难以与将健康不平等视为个人行为问题的主导思想竞争。因此，有必要批判性地反思和质疑制定和传达关键见解的不同战略的有效性。以“上游-下游”的比喻为例，这篇文献回顾为必要的第一步做了贡献，通过询问它的使用到底是为了什么而进行的。使用迭代搜索策略来确定可能有助于审查问题的同行评议文章。语篇分析框架提供了24篇文章的数据提取和综合。文章随后被归类，反映了所识别的隐喻的不同用法。所有作者都使用这个比喻来促进对健康不平等的特殊因果理解，导致一些人建议政策和方案，另一些人则专注于实施过程。这个看似简单的比喻已经超越了区分“上游”和“下游”的决定因素，而是传达了一个雄心勃勃的政治参与的变革议程。这个比喻并不是没有批评者，鉴于它的使用中所包含的论点的复杂性，需要努力确定它是否能够并确实像预期的那样引起更广泛的受众的共鸣。
Public health insights struggle to compete with dominant ideas which frame health inequalities as a problem of individual behaviour. There is consequently a need to critically reflect upon and question the effectiveness of different strategies for framing and communicating key insights. Taking the example of the ‘upstream–downstream’ metaphor, this literature review contributes to a necessary first step by asking what exactly is being argued for through its use. An iterative search strategy was used to identify peer-reviewed articles which could contribute to the review question. A discourse analysis framework informed data extraction and synthesis of 24 articles. Articles were subsequently categorized into groups which reflected the different uses of the metaphor identified. All authors used the metaphor to promote a particular causal understanding of health inequalities, leading some to recommend policies and programmes, and others to focus on implementation processes. This seemingly simple metaphor has evolved beyond differentiating ‘upstream’ from ‘downstream’ determinants, to communicate an ambitious politically engaged agenda for change. The metaphor is not without its critics and in light of the complexity of the arguments encapsulated in its use, work is needed to establish if it can, and does, resonate as intended with wider audiences.
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