不平等の傾向を説明する:ブラジルの子どもの健康に関する研究の証拠
C G Victora1, J P Vaughan, F C Barros
1Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Brazil.
Lancet (London, England)
|September 29, 2000
まとめ
子どもの健康上の不平等は,新しい健康プログラムが富裕層に有利になるにつれて,当初は悪化する. 逆の公平性仮説は,これらの格差が時間の経過とともにどのように進化し,貧困層がアクセスを獲得するにつれて最終的に改善することを説明します.
科学分野:
- 公衆衛生は公衆衛生である.
- エピデミオロジー エピデミオロジー
- 健康 公平性 研究 健康 公平性 研究
背景:
- 国際的に懸念されるのは,国内と国間の子どもの健康上の不平等が悪化していることにある.
- 逆の公平性仮説は,時間の経過とともに健康格差の動的変化を理解するための枠組みを提供します.
- 社会経済的な地位は,公衆衛生介入へのアクセスと結果に大きな影響を与えます.
研究 の 目的:
- ブラジルの子供の健康データを用いて"逆の公平性仮説"を検証する.
- 子どもの健康上の不平等の時間的な傾向とその社会経済的地位との関係を分析する.
- 新しい公衆衛生介入が当初,健康格差を悪化させ,または緩和するかどうかを評価する.
主な方法:
- ブラジルの子どもの健康格差を追跡するために3つの疫学データセットを使用しました.
- 罹病率と死亡率の指標の不平等比率のタイムトレンドを分析した.
- 社会経済的なグラデーションに関連した健康状態の改善の比較.
主要な成果:
- 幼児の罹病率と死亡率の不平等比率の観測された時間トレンドは,逆の公平性仮説と一致しています.
- 絶対的な健康上の利益にもかかわらず,不平等が改善される前に悪化した事例を実証した.
- 時間の経過とともに社会経済的な地位に基づく介入の影響の違いを強調した.
結論:
- 逆の公平性仮説は,子供の健康不平等の変動を理解するための有効なモデルを提供します.
- 健康平等の改善は必ずしも線形ではないし,格差が悪化する時期が先行する可能性があります.
- すべての社会経済的集団が公衆衛生の介入に公平なアクセスを確保するために,ターゲットに絞られた戦略が必要である.
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