SAĞLIKTA EŞİTSİZLİKLER VE SOSYO-EKONOMİK YAKLAŞIMLAR

Öz

Sağlıkta sosyoekonomik eşitsizlikler, toplumda belirli grupların daha az sağlıklı olmasına neden olmakta ve bu grupların daha sık hastalanıp, daha erken yaşta ölmesine yol açmaktadır. Bu durum, kişinin en temel hakkı olan yaşam hakkının sağlanması ilkesine aykırıdır. Bu eşitsizliklerin iyi açıklanması, en aza indirgenmesi ya da en iyi ifadeyle ortadan kaldırılması ise ülkelerin sağlık sistemlerinin etkin yönetilmesinde birincil amacı oluşturmaktadır. Bu nedenle sağlık alanında ortaya çıkan eşitsizliklerin anlaşılması için ortaya konulan yaklaşımların irdelenmesi önemlidir. Bu derleme çalışmada, sağlık eşitsizliklerine yol açan sosyoekonomik nedenler ve bunları açıklamada kullanılan hipotezlere yer verilmektedir. Eşitsizliklerin ele alınmasında, Grossman modeli, doğrudan gelir ve gelir dağılımı hipotezi, sağlık hizmet erişimi hipotezi, allostatik yük hipotezi ve tutumlu fenotip hipotezi açıklanmış ve sağlık düzeyindeki eşitsizlikleri açıklayan teorik yaklaşımlar çok yönlü olarak ele alınmıştır. Ayrıca, eşitsizlikleri azaltmak için atılabilecek adımlara ilişkin politikalar sunulmaktadır.

Anahtar Kelimeler

• Sağlıkta Eşitsizlik
• Sosyoekonomik Faktörler
• Grosmann Modeli
• Sağlık Politikası

Etik Beyan

Etik beyana gerek duyulmamıştır. Makale derleme makaledir.

HEALTH INEQUALITIES AND SOCIOECONOMIC PERSPECTIVES

Öz

In health, socioeconomic inequalities cause certain groups in society to be less healthy, leading them to get sick more frequently and die at a younger age. This situation is contrary to the principle of ensuring the fundamental right to life. Explaining, minimizing, or ideally eliminating these inequalities is the primary goal in the effective management of a country's healthcare system. There are many reasons for the inequalities in the field of health. For this reason, it is crucial to examine the approaches put forward to understand the inequalities that arise in the health. This review study discusses socioeconomic factors that lead to health inequalities and the hypotheses used to explain them. In addressing these inequalities, the Grossman model, the direct income and income distribution hypothesis, the healthcare access hypothesis, the allostatic load hypothesis, and the thrifty phenotype hypothesis are explained, and theoretical approaches explaining health disparities are considered from various angles. Additionally, policies aimed at reducing inequalities are discussed.

Anahtar Kelimeler

• health inequality
• socioeconomic factors
• Grossman model
• health policy.

Kaynakça

1. Baeten, R., Spasova, S., Vanhercke, B., & Coster, S. (2018). Inequalities in access to healthcare: a study of national policies 2018. European Commission.
2. Bartley, M. (2017). Health inequality: an introduction to concepts, theories and methods. T Polity Press, second edition, ISBN-13: 978-0-7456-9112-.
3. Bobo, J. K., & Husten, C. (2000). Sociocultural influences on smoking and drinking. Alcohol Research & Health, 24(4), 225.
4. Braveman, P. (2006). Health disparities and health equity: concepts and measurement. Annu. Rev. Public Health, 27, 167-194.
5. Braveman, P., Arkin, E., Orleans, T., Proctor, D., Acker, J., & Plough, A. (2018). What is health equity?. Behavioral science & policy, 4(1), 1-14.
6. Brosschot J. F., Pieper S., Thayer J. F. (2005). Expanding stress theory: Prolonged activation and perseverative cognition. Psychoneuroendocrinology, 30, 1043–1049.
7. Calkins, K., & Devaskar, S. U. (2011). Fetal origins of adult disease. Current problems in pediatric and adolescent health care, 41(6), 158-176.
8. Corna, L. M. (2013). A life course perspective on socioeconomic inequalities in health: A critical review of conceptual frameworks. Advances in life course research, 18(2), 150-159.

9. Galama, T. J., & Van Kippersluis, H. (2013). Health inequalities through the lens of health-capital theory: issues, solutions, and future directions. In Health and inequality, 263-284.
10. Grossman M (1972b). On the Concept of Health Capital and the Demand for Health. The Journal of Political Economy, 80(2), 223–255.
11. Grossman, M. (1972a) The Demand for Health-A theoretical and Empirical Investigation. New York: National Bureau of Economic Research.
12. Gruer, L., Hart, C. L., Gordon, D. S., & Watt, G. C. (2009). Effect of tobacco smoking on survival of men and women by social position: a 28-year cohort study. Bmj, 338.
13. Hales, C. N., & Barker, D. J. (2001). The thrifty phenotype hypothesis: Type 2 diabetes. British medical bulletin, 60(1), 5-20.
14. Mackenbach J. P. (2012). The persistence of health inequalities in modern welfare states: The explanation of a paradox. Social Science & Medicine, 75, 761–769.
15. Mackenbach JP, Kunst AE, Cavelaars AEJM, Groenhof F, Geurts JJM, et al. (2007) Socioeconomic inequalities in morbidity and mortality in western Europe. Lancet, 349:1655–1659.
16. Mackenbach JP, Stirbu I, Roskam AJR, Schaap MM, Menvielle G, Lein-salu M, et al. (2008). Socioeconomic inequalities in health in 22 European countries. New England Journal Medicine, 358, 2468–8.
17. Manavgat, G. (2023). Sağlık ekonomisi ve sağlık finansmanı, Gazi Kitabevi, ISBN: 978-625-36-51-657.
18. McCartney, G., Collins, C., & Mackenzie, M. (2013). What (or who) causes health inequalities: theories, evidence and implications?. Health Policy, 113(3), 221-227.
19. McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York academy of sciences, 840(1), 33-44.
20. Orach, D. C. G. (2009). Health equity: challenges in low-income countries. African health sciences, 9(2), 49-51.
21. Uphoff, E. P., Pickett, K. E., Cabieses, B., Small, N., & Wright, J. (2013). A systematic review of the relationships between social capital and socioeconomic inequalities in health: a contribution to understanding the psychosocial pathway of health inequalities. International journal for equity in health, 12, 1-12.
22. Pickett, Kate E., and Richard G. Wilkinson (2015). "Income inequality and health: a causal review." Social science & medicine 128: 316-326.
23. Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6), 1019-1028.
24. Ray, D., & Linden, M. (2018). Health, inequality and income: a global study using simultaneous model. Journal of Economic Structures, 7(1), 1-28.
25. Reutter, L., & Kushner, K.E. (2010). Health equity through action on the social determinants of health: taking up the challenge in nursing. Nursing Inquiry, 17(3), 269-280.
26. Segerstrom S. C., Miller G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130, 601–630.
27. Smith, G. D., Hart, C., Watt, G., Hole, D., & Hawthorne, V. (1998). Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study. Journal of Epidemiology & Community Health, 52(6), 399-405.
28. Stöger, R. (2008). The thrifty epigenotype: an acquired and heritable predisposition for obesity and diabetes? Bioessays, 30(2), 156-166.
29. Stringhini, S., Dugravot, A., Shipley, M., Goldberg, M., Zins, M., Kivimäki, M., ... & Singh-Manoux, A. (2011). Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS medicine, 8(2), e1000419.
30. Tekingündüz, S., Kurtuldu, A., & Işık Erer, T. (2016). Sağlık hizmetlerinde eşitsizlik ve etik. Aksaray Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi,8 (4),32-4.
31. Timmermans, S., & Kaufman, R. (2020). Technologies and health inequities. Annual Review of Sociology, 46, 583-602.
32. Wilkinson, R. G., & Pickett, K. E. (2006). Income inequality and population health: a review and explanation of the evidence. Social science & medicine, 62(7), 1768-1784.
33. World Health Organization (WHO) (2008) Final Report of the Commission on Social Determinants of Health. Geneva: Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health.
34. World Health Organization (WHO) (2013). The economics of social determinants of health and health inequalities: a resource book (Vol. 3700). World Health Organization.
35. World Health Organization (WHO) (2015). Health in 2015: from MDGs, millennium development goals to SDGs, sustainable development goals. World Health Organization.