文章基本信息

标题：Sectoral Job Training as an Intervention to Improve Health Equity
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作者：Emma K. Tsui
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：Suppl 1
页码：S88-S94
DOI：10.2105/AJPH.2009.181826
语种：English
出版社：American Public Health Association
摘要：A growing literature on the social determinants of health strongly suggests the value of examining social policy interventions for their potential links to health equity. I investigate how sectoral job training, an intervention favored by the Obama administration, might be conceptualized as an intervention to improve health equity. Sectoral job training programs ideally train workers, who are typically low income, for upwardly mobile job opportunities within specific industries. I first explore the relationships between resource redistribution and health equity. Next, I discuss how sectoral job training theoretically redistributes resources and the ways in which these resources might translate into improved health. Finally, I make recommendations for strengthening the link between sectoral job training and improved health equity. From its earliest days, the practice of public health has been animated by its link with economic production and the compelling nature of the stepwise relationship between socioeconomic position and health, now called the social gradient in health.¹ Research in social epidemiology indicates that it is not only absolute income or wealth that matters in shaping health; various forms of inequality are also correlated with poor health and diminished health equity.² Responding to these studies, public health researchers and practitioners have long wondered with James Colgrove, who wrote in the Journal in 2002, Are public health ends better served by targeted interventions or by broad-based efforts to redistribute the social, political, and economic resources that determine the health of populations?³ Although most researchers within public health would agree that both approaches are necessary, the vast majority of intervention research in public health focuses on targeted health interventions rather than on the social, political, and economic conditions that put people at “risk of risks”⁴ and the redistributive policies that might alter these conditions. These latter “social determinants of health” have reached new levels of prominence with the publication of the World Health Organization's 2008 report on health equity and the social determinants of health. In the report's introduction, the authors wrote, [The] unequal distribution of health-damaging experiences is not in any sense a “natural” phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics. Together, the structural determinants and conditions of daily life constitute the social determinants of health and are responsible for a major part of health inequities between and within countries.⁵ Such a statement, along with the detailed recommendations made by the authors, strongly suggests the value of examining social policy interventions, especially those that affect daily life and redistribute resources, for their potential links to health equity. In this article, I examine the ways in which one type of social policy intervention—sectoral job training—might be conceptualized as an intervention to improve health equity. Sectoral job training programs ideally train workers, who are typically low income, for upwardly mobile job opportunities within specific industries. I first explore how resource redistribution can be defined in relation to improving equity in health. I next discuss how sectoral job training theoretically redistributes resources and the pathways through which such resource redistribution might translate into improved health. Finally, I make recommendations for strengthening the link between sectoral job training and improved health and health equity.