健康公平性概述

健康公平性在国际上得到广泛关注,各国把消除健康不公平作为卫生改革与发展的主要目标。本文就健康公平性的内涵进行梳理,为我国健康公平性内涵和测量研究提供参考。     

A new approach to health promotion in Ontario

Ontario is attempting a radical change in the way it approacheshealth and health policy. Aninte, sectoral Premier's Councilon Health Strategy was formed in late 1987, comprising CabinetMinisters and representatives of the community. Council's workhas been much influenced by the Health for All Movement. Healthgoals have been officially adopted by the province, and somehave been converted to objectives and targets. The Council haspublished policy documents on health services, devolution ofservices to the local level, and healthy public policy. Somemomentum was lost during a change in government in 1990 andthe Council has now been replaced by a new Council with a broadermandate. There appears to be a good chance that the Council'swork will significantly affect the new government's policy.     

Cancer Screening Practices Among Amish and Non‐Amish Adults Living in Ohio Appalachia

Purpose: The Amish, a unique community living in Ohio Appalachia, have lower cancer incidence rates than non‐Amish living in Ohio Appalachia. The purpose of this study was to examine cancer screening rates among Amish compared to non‐Amish adults living in Ohio Appalachia and a national sample of adults of the same race and ethnicity in an effort to explain cancer patterns. Methods: Face‐to‐face interviews focusing on perception of risk, cancer screening behaviors, and screening barriers were conducted among Amish (n = 134) and non‐Amish (n = 154) adults living in Ohio Appalachia. Cancer screening rates were calculated and then compared to a national sample of adults. Findings: More Ohio Appalachia non‐Amish males (35.9% vs 14.5%; P= .022) and females (33.3% vs 12.5%; P= .008) reported that they would probably develop cancer in the future compared to Amish males and females. Amish adults had significantly lower prostate (13.5% vs 63.1% vs 44.6%; P < .001), colorectal (males: 10.3% vs 40.0% vs 37.2%, females: 8.6% vs 31.6% vs 42.9%; P < .001), cervical (48.0% vs 84.0% vs 80.0%; P < .001), and female breast (24.8% vs 53.7% vs 56.9%; P < .05) cancer screening rates compared to Ohio Appalachia non‐Amish participants and a national sample of adults, respectively. Barriers to cancer screening were similar among the 2 Ohio groups; however, Amish males reported that prostate cancer screening was not necessary more often than did Ohio Appalachia non‐Amish males (78.6% vs 16.7%; P= .003). Conclusions: Lower rates of cancer screening were documented among the Amish and may be a contributing factor to the reduced cancer incidence rates reported among this population.     

The future of public health nutrition: a critical policy analysis of Eat Well Australia

Objective: To better understand how public health nutrition has been represented during the past decade in Australia this paper critically analyses Eat Well Australia: An Agenda for Action for Public Health Nutrition 2000 – 2010 and its accompanying National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan. Method: The paper uses an interpretive approach, drawing on Bacchi's method of problem representation, to examine the strategies being offered within the policy. It uses this framework to uncover how public health nutrition has been represented and examines if the representation provided considers all aspects of the issue. The paper also considers how contextual factors affected policy development through examination of publicly available documents. Results: The problem is represented as being both an individual one and one due to social, structural and economic circumstances. There is a large focus on collaboration, research and capacity building. The context of the policy's development has affected the solutions contained within. Conclusion: The policy's proposed actions reflect the policy‐making environment in which it was conceived. A manifestation of this was unclear division of roles and responsibilities, lack of dedicated resources and inadequate focus on the social determinants of health. Implications: As the policy's timeframe is drawing to its end, critical reflection on how the problem of nutrition has been represented over the previous decade provides greater insight and awareness to direct future public health nutrition work.     

Twenty years since Ottawa and Epp: researchers' reflections on challenges, gains and future prospects for reducing health inequities in Canada

November 2006 marked the 20-year anniversary of the Ottawa Charterfor Health Promotion and Canada's Epp Report. Encapsulatingthe tenets of health promotion (HP), these publications articulateda vision for reducing health inequities, and described a policyframework for achieving this vision, respectively. These documentsalso triggered the launch of the population health (PH) field,focused on elucidating the empirical relationships between socioeconomicgradients and population health inequities. Over two decades,a rich HP/PH theoretical and evidentiary base on socioeconomicgradients in health has established. Yet, despite valuable contributionsfrom Canadian researchers, insufficient headway has been madein this country to achieve the Charter's vision. There are numerous challenges to reducing population healthinequities in Canada. Informational challenges include complexityof HP/PH evidence, and inadequate knowledge translation beyondtraditional targets. Institutional challenges include the relativeimmunity of the healthcare sector to funding reductions, andthe organization of policy responsibilities into silos. Concernsfrom non-healthcare sectors of ‘health imperialism’,and inter-governmental tensions are interest-related challenges,while ideological challenges include lack of media discourseon health inequities and a strong neo-liberal political climate. Gains have been made in Canada towards reducing health inequities.The HP/PH discourses are firmly entrenched in academic and policyspheres across the country, while several inter-sectoral policyinitiatives are currently underway. HP/PH researchers couldbe more proactive in the knowledge-translation sphere by engagingother researchers outside of medicine and health, non-healthcarepolicy-makers, and the general public, vis-à-vis themedia, on the health inequities knowledge base. Ultimately,significant and sustained progress will only be made if researchersand other champions recognize the inherently political aspectof their work and understand how to overcome ideologically drivenresistance.     

Grasping at straws: a recent history of health promotion in Canada

Despite Canada's reputation as a leader in the development of health promotion concepts, implementation of these concepts in the service of health has always been far from stellar. Much of this has to do with Canada's liberal political economy and the recent further ascendance of neo-liberal approaches to public policymaking. These developments have combined with longstanding biomedical and epidemiological traditions in health policy to inhibit health promotion approaches that incorporate the principles and themes of the Ottawa Charter. Additionally, the emergence in Canada of population health as a competing–and displacing–discourse to health policy has further eroded health promotion's profile and presence. There is increasing interest in the social determinants of health concept, yet government spending, media attention, and health sector activities lavished on ‘lifestyle’ approaches to health promotion and the emergence of the ‘obesity epidemic’ as a focus of public, media, and health sector attention serves to further reinforce this dreary picture.     

National opportunities for health promotion: the Canadian experience

Health promotion is a fundamental strategy to address the majorissues which confront health systems in developed and developingcountries alike. Chief amongst these issues are unhealthy environments,health inequities and non-communicable diseases. The infrastructuresfor health promotion include mechan isms for development andimplementation of health policy; policies and programs supportiveof community involvement in health promotion programs; reorientationof the health care system towards prevention; and research.Consensus building among key stakeholders from the public andprivate sectors is at the core of the policy development process.A New Perspective for the Health of Canadians (1974) and theWHO Ottawa Charter for Health Promotion (1987) have guided healthpromotion policy and program development at both the nationaland provincial levels, in Canada, a number of initiatives haveplaced into pra ctice the policy frameworks, among them: HealthyCommunities, the Canadian Heart Health initiative, integrationofpreven lion into clinical practice, and structures to supportresearch in health promotion.     

The role of the nurse in health promotion

This paper describes and discusses issues concerned with therole of the nurse in health promotion work. It represents thefirst phase of a research project designed to explore this role,and presents the evolving philosophical framework for the study.The study is taking place currently in the United Kingdom andhas been made possible by the (first) award of a Post DoctoralNursing Research Fellowship to the project director. Against the backdrop of the World Health Organization's ‘Healthfor All by the year 2000’ (WHO HFA 2000) movement therehave been repeated calls for nurses to be the leaders in healthpromotion. Policy makers and educators have responded to thesecalls by claiming a central role for nursing and putting healthpromotion high on policy and training agendas. Very little attention,however, has been devoted to exploring the legitimacy and developmentof this role in nursing. Generally, nurses seem enthusiasticabout health promotion, and sure that they have a role to play.What is less certain is what this role is. The study seeks toclarify this by exploring policy, behaviour, and attitudes.Policy provides the framework for practice, and operates ata number of levels. In this early paper we review the literatureto explore policy and practice from international to grassrootslevels. We also make some initial observation derived from ourpilot work.     

Prevalence estimates of health risk behaviors of immigrant latino men who have sex with men

Purpose: Little is known about the health status of rural immigrant Latino men who have sex with men (MSM). These MSM comprise a subpopulation that tends to remain “hidden” from both researchers and practitioners. This study was designed to estimate the prevalence of tobacco, alcohol, and drug use, and sexual risk behaviors of Latino MSM living in rural North Carolina. Methods: A community‐based participatory research (CBPR) partnership used respondent‐driven sampling (RDS) to identify, recruit, and enroll Latino MSM to participate in an interviewer‐administered behavioral assessment. RDS‐weighted prevalence of risk behaviors was estimated using the RDS Analysis Tool. Data collection occurred in 2008. Results: A total of 190 Latino MSM was reached; the average age was 25.5 years and nearly 80% reported being from Mexico. Prevalence estimates of smoking everyday and past 30‐day heavy episodic drinking were 6.5% and 35.0%, respectively. Prevalence estimates of past 12‐month marijuana and cocaine use were 56.0% and 27.1%, respectively. Past 3‐month prevalence estimates of sex with at least one woman, multiple male partners, and inconsistent condom use were 21.2%, 88.9%, and 54.1%, respectively. Conclusions: Respondents had low rates of tobacco use and club drug use, and high rates of sexual risk behaviors. Although this study represents an initial step in documenting the health risk behaviors of immigrant Latino MSM who are part of a new trend in Latino immigration to the southeastern United States, a need exists for further research, including longitudinal studies to understand the trajectory of risk behavior among immigrant Latino MSM.