关于健康公平现实选择

健康公平是全人类共同追求的目标,然而由于经济、社会和文化等因素又造成了健康的极大不公平.如何在现有条件下满足人们对健康的需要,实现健康公平,揭示了健康公平的内涵,以及现实中健康不公平的表现形式;同时,提出健康公平的现实选择应从我国的现实国情出发,解决目前健康不公平问题.     

老龄健康公平研究

全球范围的老龄健康不公平现象客观存在,主要体现为发展程度不同的国家医疗资源分配的差异性、老龄人口死亡率的差异性、人均预期寿命的差异性。实现老龄健康公平是保障老龄健康权利的需要,是健康老龄化制度伦理建构的需要,也是全球人口共享健康资源和共同健康发展的现实需要。实现老龄健康公平的社会伦理对策主要包括:促进医疗资源的全球公平配置、构建全球共享的老年医疗保障协同发展机制、推进代际健康机会公平和代内健康结果公平。     

论健康公平

社会地位综合症导致了人与人之间存在着健康等级的差别事实。健康公平要求消除不同的社会群体之间的系统性差异,即由社会经济制度等人为的社会因素造成的健康差别。结果公平和手段公平是健康公平的两种价值诉求,应当以手段公平来促进健康的实质性公平。健康不公平的判断标准是,该健康的差别事态是可避免的、非个人自由选择的且归因于一个责任主体。     

社会分配不公引起的心理误差(摘要)

……社会分配不公会引起人们的心理误差,这就是人们把本来是公平的分配当作不公平来反映。或者把不公平分配的社会现象过度强化而产生的心理误差。……这种心理误差多产生于不同性质的劳动上,就复杂劳动与简单劳动来说,前者的社会报酬应高于后者才是公平的,否则就会产生不公平的心态。现在社会上流传的“摆个小摊,顶个县官”,“造原子弹的不如卖茶鸡蛋的”,正是产生心理误差的现实反映。还有程度高的复杂劳动与程度低的复杂劳动,前者的报酬应高于后者才是公平的,而现实确相反,一个红歌星的出场费高得惊人,只要     

从毕生发展的视角看健康的贫富差距

健康的贫富差距是所有个体从出生到死亡都需要面对的现实, 也是全球所有国家都存在的社会问题。目前已经有相当的理论和实证研究尝试从毕生发展的视角理解健康的贫富差距。在毕生发展研究中, 健康的贫富差距有其独特的概念和测量方式。该领域重要的理论包括累积优(劣)势假设、累积不公平模型和社会阶层文化周期模型。研究者就儿童期、青少年期、成年期和老年期的健康贫富差距开展了大量的实证研究。未来毕生发展研究和实践的可能方向包括早年和当前社会经济地位的交互作用、社会经济地位的稳定特征和情境效应、跨领域实践干预等。毕生发展视角的健康贫富差距研究有助于理解健康贫富差距的发展根源和形成过程, 是促进国民健康和开展健康公平实践工作的理论基础。     

健康公平--概念、影响因素与政策

长期以来健康不平等和不公平一直是卫生改革与发展所关注的重点,并已经成为了国际卫生政策的主要方向.在国家之间健康不平等和不公平也存在不同的理解.发达国家主要集中在产生疾病和导致死亡率差异的社会经济阶层的形成机制,将健康不平等作为疾病病原学的一个函数,关键措施是加强初级卫生保健;在中低收入国家,人们却趋向于通过提供基本的医疗保健服务来解决这一问题.     

论代际公平

公平问题是一个现代社会日益凸现的问题。如果将公平问题放在“代”的语境中加以讨论和审视 ,则可以将公平分为代内公平和代际公平。代内公平实际上就是一般所说的公平。代际公平可分为在场各代之间的公平和在场各代与后代之间的公平。由于对这两种代际公平未加区分 ,因此 ,人们在讨论代际公平问题时往往显得语义含糊。由于在场各代处于现实的关系之中 ,他们之间的公平是具有实践基础的。但是 ,对在场各代与尚未出场的人类后代之间的公平却存在着较大的争议 ,其焦点在于尚未出场的人类后代与在场各代之间的关系并不是现实的。为此 ,对在场各代与人类后代的公平进行权利论证明就是当前一个迫切的理论课题。     

群体身份调节最后通牒博弈的公平关注

群际互动是社会互动的一种重要形式, 在人类社会发展中起着重要作用。已有的行为研究表明个体参与群际互动时, 互动对象的群体身份会影响其心理加工和行为决策。但目前关于群体身份如何影响公平加工的动态时间过程尚不清楚。为了研究群体身份对最后通牒任务(Ultimatum Game, UG)中反应者公平关注的影响, 15名健康成人作为反应者与组内和组外提议者进行UG博弈, 提议包括极端不公平、中等不公平或公平提议三种。事件相关电位结果发现, 组外互动时公平提议和中等不公平提议比极端不公平提议诱发更负的AN1, 组内互动时不同提议诱发的AN1无显著差异。来自组内成员的中等和极端不公平提议比公平提议引起更负的内侧额叶负波(MFN), 但来自组外成员的不同提议则没有导致MFN波幅的变化。这些结果表明在群体互动情境下, 互动成员的群体身份能够影响个体的早期注意资源分配和公平关注加工。     

论发展模式的正义之维

正义是评价和选择发展模式的伦理之维。强调发展模式的正义之维,要求发展必须以人的尊严和自由价值为根本,保障发展权利,促进公平发展和共享发展,提升人的生存质量和生命价值。在新时代,随着我国社会主要矛盾的变化,现阶段正是我国发展模式调适的重要时期。应该以正义原则来反思并调适发展模式,抑制现实发展中的不公正不合理现象,才能促进社会公平正义和健康有序发展。     

公平并不存在

“不公平”是牢骚的集结点,比如,你是医院主任医师,看到推销药物者每月赚上万元,会说“脑体收入倒挂,真太不公平了”;你是个体经营者,会抱怨:我的收入与那些处长、厅长相比,“含水量”太高,真不公平。凡事我们总是要求公平,一旦发现现实中并非如此,就会牢骚满腹,甚至勃然大怒。因为你会认为自己在这个社会上吃了亏。 要求公平,仿佛是人情使然,佛教《金刚经》写道:“是法平等,无有高下”,公元前1世纪,小亚细亚奴隶起义,提出建立一个“没有     

论影响卫生资源分配公平性的因素

公平分配卫生资源是促进社会公正的重要方面.观念、体制与政策是影响卫生资源公平分配的重要因素.重医疗、轻预防的观念使宏观卫生资源分配失去公平,而城市尤其是大中城市优先的制度安排、按医疗项目付费方式的弊端、医疗保障体制的不公平等体制与政策因素则使微观卫生资源分配失去公平.从观念因素、体制与政策因素两个方面入手,改进卫生资源分配的公平性,是我国提高全民健康水平、促进社会公正的必由之路.     

Organization justice evaluations, job control, and occupational strain.

To explore how organizational justice evaluations affect the occupational stress process, the authors formulated and tested the following 2 hypotheses: (a) The effect of job control on strain is mediated by justice evaluations, and (b) justice evaluations moderate the effect of job control on occupational strain. The results of structural equation modeling, based on data collected from 688 employees, suggest that job control affects strain through justice evaluations. Thus, the results of this study supported the 1st hypothesis and provided evidence that perceptions of the organization are potential factors contributing to employee health.     

The moderating effect of perceived organizational support on the relationships between organizational justice and objective measures of cardiovascular health

This paper builds on a recent meta-analytic review on the relationships between organizational justice and health. Specifically, we examine the moderating role of perceived organizational support (POS) on the relationships between organizational justice and three objective cardiovascular health measures, namely, heart rate, systolic blood pressure, and diastolic blood pressure, among a population of 290 public construction workers. The interaction between justice and POS was statistically significant using procedural justice, demonstrating that procedural justice is associated with improvements in the three health outcomes only when POS is relatively high. In other words, higher levels of both procedural justice and POS were needed for reduced heart rate and reduced systolic and diastolic blood pressure. However, the interaction between distributive justice and POS did not significantly relate to the health outcomes. This study makes a contribution to the field by focusing the effects of psychosocial workplace variables on measures of cardiovascular health, and demonstrating an important boundary condition of the relationships between procedural justice and cardiovascular risk factors.     

Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms

The organizational justice literature has consistently documented substantial correlations between organizational justice and employee depression. Existing theoretical literature suggests this relationship occurs because perceptions of organizational (in)justice lead to subsequent psychological health problems. Building on recent research on the affective nature of justice perceptions, in the present research we broaden this perspective by arguing there are also theoretical arguments for a reverse effect whereby psychological health problems influence perceptions of organizational justice. To contrast both theoretical perspectives, we test longitudinal lagged effects between organizational justice perceptions (i.e., distributive justice, interactional justice, interpersonal justice, informational justice, and procedural justice) and employee depressive symptoms using structural equation modeling. Analyses of 3 samples from different military contexts (N? = 625, N? = 134, N? = 550) revealed evidence of depressive symptoms leading to subsequent organizational justice perceptions. In contrast, the opposite effects of organizational justice perceptions on depressive symptoms were not significant for any of the justice dimensions. The findings have broad implications for theoretical perspectives on psychological health and organizational justice perceptions.     

From Mental Health to Juvenile Justice: What Factors Predict This Transition?

We identify youth who are at risk for a critical transition from mental health to juvenile justice. A statewide longitudinal sample of Medicaid-eligible youth (aged 10–17) in the public mental health system (n = 5,455), during approximately one fiscal year (July 1, 1994–August 30, 1995), was used to determine the risk factors for, and timing of, a subsequent juvenile justice detention or commitment during the three subsequent fiscal years (1994–1997). Logistic regression and Cox Proportional Hazards modeling were used. Risk factors for juvenile justice detention or commitment included being: male, black or Hispanic, in junior high school, involuntarily admitted to mental health, having a DSM-IV diagnosis of conduct disorder, alcohol problems, a constellation of risk behavior, and receiving prior mental health services. Factors that accelerate the timing of detention or commitment in the juvenile justice system after a mental health visit included most of the general risk factors except risk behavior and involuntary admission were no longer significant and having a DSM-IV nonalcohol drug use diagnosis, antisocial behavior, and school problems became significant. Our study helps to identify youth who are at risk for multiple system use so that they may be provided appropriate services to prevent multiple system use.     

Sleeping problems and health behaviors as mediators between organizational justice and health.

The aim of this longitudinal cohort study was to investigate whether sleeping problems and health behaviors (smoking, alcohol consumption, and sedentary lifestyle) mediate the association between organizational justice and employee health. Health indicators were minor psychiatric morbidity, as assessed by the General Health Questionnaire (U. Werneke, D. P. Goldberg, I. Yalcin, & B. T. Ustun, 2000), and poor self-rated health status. The results of logistic regression analysis of data for 416 male and 3,357 female hospital employees working during the 1998-2000 period in 10 Finnish hospitals suggest that sleeping problems are one of the underlying factors causing the adverse health effects of low organizational justice at work. No support for a mediating role of health behaviors between low organizational justice and health problems was obtained.     

群体健康与关系“正义”

生命伦理学具有广泛性和综合性,着眼于群体健康是当前生命伦理学发展的趋势。在群体水平的生命伦理学的研究中,有关“正义”的概念是核心的问题。涛慕思·W·博格提出了正义的“关系概念”,借以考察范围广泛的社会制度与健康结果的产生具有什么样的因果关系,进而强调社会制度的制定者和支持者对其产生的健康结果负有责任。通过对此“关系概念”进行分析,以期对中国国内健康领域问题的解决有所启示。     

我国医疗卫生改革中的伦理缺席

“中国的医疗卫生体制改革从总体上说是不成功的”结论的发表在社会上引发了对卫生改革的种种议论,从卫生改革的设计、实施和评估三方面论述了由于政府的缺位和伦理学的缺席,将卫生改革引向功利主义的死胡同,使得卫生改革背离了公正的目标而导致失败。但退回计划经济体制下的办医模式同样没有出路,在今后的深化改革中,必须强调医学目的,贯彻以人为本的指导思想,加大政府的投入,围绕公正目标,建立覆盖全民的医疗保障体制。     

How Do Job Insecurity and Organizational Justice Relate to Depressive Symptoms and Sleep Difficulties: A Multilevel Study on Immediate and Prolonged Effects in Swedish Workers

Drawing on stress and justice literature, we argue that perceptions of job insecurity induce feelings of low procedural justice, which has immediate and prolonged negative effects on health (depressive symptoms, sleep difficulties). Moreover, we explore whether the strength of the job insecurity–justice relationship differs between individuals as a function of their average level of job insecurity over time. Finally, we explore whether the procedural justice–health relationship differs between individuals as a function of variability in justice perceptions over time. We analyzed Swedish panel data from permanent workers over four consecutive waves (with a two-year time lag between waves) using multilevel analysis, separating within- and between-person variance. Results showed that job insecurity associated negatively with procedural justice at the same time point for all waves. Prolonged effects were less stable. We found immediate (but not prolonged) indirect effects of job insecurity on health outcomes via procedural justice. Average levels in job insecurity over time moderated the within-person job insecurity–justice relationship. However, variability in procedural justice over time did not moderate the within-person justice–health relationship. In conclusion, disentangling within- and between-person variability of job insecurity and justice perceptions contributes to the understanding of health effects.     

社会正义是对健康的最好保障

健康是公民的一项基本权利,社会或政府有义务保障公民的这一权利。公民的健康除了由医疗卫生和生理因素决定外,还由诸多社会因素决定。这些健康的社会决定因素所反映的实际上是社会正义问题,因此要保障公民的健康权利,最根本的是要营造一个正义的社会环境,并建立一个正义的社会保障支持系统。