作者:Adam D. Reich; Helena B. Hansen; Bruce G. Link
出处:Journal of Bioethical Inquiry Pty Ltd. 2016
Fundamentals Intervations:How Clinicians Can Address the Fundamental Causes of Disease
基础干预：临床医生如何解决疾病的根本原因
Abstract:In order to enhance the “structural competency” of medicine----the capability of clinicians to address social and institutional determinants of their patientsrsquo; health----physicians need a theoreticals lens to see how social conditions influence health and how they might address them.We consider one such theoretical lens,fundamentals cause theory,and propose how it might contribute to a more structurally competent medical profession.We first describe fundamental cause theory and hou it makes the social causes of disease and health visible.We then outline the sorts of fundamental intervations that physicians might make in order to address the fundamental causes.
摘要：为提高医学“结构能力”----临床医师解决患者健康状况的社会和制度决定因素的能力----医师需要理论透镜来了解社会条件如何影响健康和如何 我们会考虑一个这样的理论透视，基础原理理论，并提出如何有助于更具结构性的医学专业。我们首先描述根本原因理论，并且使疾病和健康的社会原因变得可见。我们 然后概述了医生为了解决根本原因而可能采取的各种基本的干预措施。
In order to enhance the structural competency of medicine----the capability of clinicians to address social and institutional determinants of their patients health---physicians need a theoretical lens to see how social conditions influence health and how they might address them.We consider one such thoretical lens,fundamental cause theory,and propose how it might contribute to a more structurally competent medical profession.
为了提高医学的结构能力----临床医生解决患者健康的社会和制度决定因素的能力---医生需要一个理论透镜，看看社会条件如何影响健康，以及如何解决这些问题。 考虑一个这样的古代镜头，根本原因理论，并提出如何有助于更结构化的医疗行业。
Given patientsrsquo; unequal access to care and unequal resources for navigating the clinical encounter,foudamental cause theory predicts that clinical pratice may---under certain conditions---actually exacerbate health inequalities.Thus fundamental cause theory highlights the importance of “structural competency”:that clicians understand and act on social and institutional determinants of health,rather than limiting themselves to individual-leval patients intervations.Structural competency is an approch that calls on practitioners annd clinical training programs to foster social and institutional intervation by making the structural causes of health inequalities more visible----that is,identifying and articulating fundamental causes when describing patient cases-----and to pursue structural change by joining or initiating projects that target fundamental causes.At the same time,fundamental cause theory reveals leverage points for improving health equity ,by pointing clinicians to upstream causes of inequlity that may yield the greastest impact on population health.
鉴于患者获得不平等的护理资源和不平等的资源用于临床相遇导航原理理论预测，在某些情况下，临床治疗可能会加剧健康不平等。因此，基本原因理论突出了“结构能力”的重要性， ：医务人员了解并采取行动对健康的社会和制度决定因素，而不是限制自己对个人患者的影响。结构能力是一个要求，从业人员通过临床培训计划来促进社会和机构的干预，使结构性原因健康不平等更加明显 - 即在描述患者病例时确定和阐明根本原因 - 并通过加入或启动针对基本原因的项目来追求结构性变革。同时，根本原因理论揭示了杠杆通过指点临床医生来提高卫生公平性令人不安的原因可能会对人口健康产生最大的影响。
Here we first descibe fundamental cause theory and how it helps to make visible the social cause of disease and health visible.To construct a response to “foundamental causes” we propose “fundamental intervations” in which clinicians can play a key role.We review preliminary research in support of such intervations and indicate the types of actions and indicate the types of actions physicians might take to support them.
在这里，我们首先描述根本原因理论，以及如何有助于使疾病和健康的社会事业变得明显可见。为了构建对“基本原因”的回应，我们提出临床医师可以发挥关键作用的“根本性干预”。 研究支持这种记录，并指出行动类型，并指出医师可能采取的行动类型来支持他们。
Fundamental Cause Theory
Fundamental cause theory makes sense of the fact that an inverse association between socioeconomic status and mortality has been remarkably persistent across places and times.The association is reexpressed even in the face of enormous hostrical changes in the risk factors and diseases afflictinghumans.For example,there was a strong association between SES and mortality in Rhode Island in 1865; people of greater means (“taxpayers”) were much less likely to die than people of less means (“non-taxpayers”).The main causes of death at that time were cholera ,tuberculosis,and small pox,and the main SES-related risk factors were contaminated water,substandard housing condition,and poor sanitation.These risk factors are no longer prominent,given the development of modern sanitation systems,improved housing cconditons,and cleaner water systems.Morever,vaccines and new medications ensure that people no longer die of cholera,tuberculosis and small pox in Rhode Island.Nevertheless,as a robust set of findings tells us,the association between SES and mortality remains strong in the current era.
根本原因理论
基本原因理论说明了社区经济地位与死亡率之间的逆向联系在不同地点和时间上显着持续的事实。即使面对危及生命的危险因素和疾病的巨大变化，协会也被重新表达。例如，那里是1865年罗德岛SES与死亡率之间的强烈关联;更大的手段（“纳税人”）的人比“手段”（“非纳税人”）的死亡人数要少得多，当时的主要死因是霍乱，肺结核和小痘，主要的SES-相关的风险因素是污水，不合标准的住房条件和卫生条件差。鉴于现代卫生系统的发展，改善住房条件和清洁水系统，这些风险因素不再突出。更重要的是，疫苗和新药确保人们罗德岛长期死于霍乱，肺结核和小痘。然而，随着一系列的研究结果告诉我们，当前时代SES与死亡率之间的联系仍然很强。
Fundamental cause theory also predicts that the introduction of new health technologies, in the absence of intervation to address social inequalities,leads to larger health inequalities,given that social stratification drives unequal access to these technologies.Examples of new technologies to which unequal access has meant increasing health disparties include life-saving cancer screenings,medications that lower cholesterol,new regiments for diabetes care,and antidepressants that reduce suicide risk.Thus,clinicians who strive to improve health through the introduction of technologies without attending to their social and instituional settings may end up exacerbating,rathe
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