摘要
不同阶层的健康差距问题是全球各国家面临的重要社会问题.我国自改革开放以来,居民的健康状况,随着社会经济的发展,从整体上有了举世瞩目的提高.然而,从不同群体层面来看,随着经济发展,不同阶层的健康差距越来越明显.为了实现消除在不同阶层的健康差距的目标上取得进展,我们需要深入地了解造成该差距的主要因素.基于此,结合社会学、心理学和生理学等理论与研究证据,在阐明社会阶层与健康之间梯度关系和因果方向的基础上,本文着重从远端的社区、家庭环境因素(社区暴力、社会资本、养育方式、家庭冲突),中端的个体心理和行为因素(敌意、健康行为)和近端的生物因素(免疫细胞数量、分子信号通路活性、适应负荷)来系统地梳理和评述社会阶层影响健康的内在机制.未来研究应加强社会阶层与健康关系的理论整合与构建,在"社会-心理-生理"的框架下,从远端、中端和近端层次展开多层面、多学科的交叉整合实证研究,以更深入地揭示社会阶层影响健康的核心机制,为提出更有效的干预方案打下坚实基础.
Health disparities between different classes are important social problems faced by all countries in the world. China is no exception. Since the reform and opening up of China, the health status of residents has improved rapidly with the development of society and the economy. However, the health gap between different social classes has grown at the same time. In order to achieve the goal of eliminating health disparities, we need to have a thorough understanding of the main factors that cause health disparities among different social classes. Therefore, this paper focuses on the mechanisms that may explain the relationship between social class and health. A comprehensive mechanistic analysis should include macro-social factors, such as community and family environment, as well as individual psychological and biological factors. That is, there are multi-level paths by which social class affects health. Firstly, the community provides a context in which various social risks are experienced by the residents. Community violence can significantly affect the health of members of the community, and a series of studies indicates that it is a social mechanism that leads to social class disparities in health. In addition to community violence, conflicts between family members are also an important cause of the health gap between different classes. Meanwhile, factors such as the social capital of the community and the parenting style of the family have also been proved to play a mediating role in the effects of social class on all-cause mortality and cardiovascular mortality. Secondly, the community and family environment eventually affect individuals’ psychological characteristics and behavior, which in turn affect health. Lots of studies indicate that individual psychological characteristics, such as anxiety, depression, pessimism, and hostility, play a mediating role between social class and health. Poor health behaviors have also been shown to be the mechanisms underlying the relationship between lower class and higher morbidity and mortality. Thirdly, the most direct factors affecting health are biological factors, or pathophysiological factors of disease. Asthma has been used as an example to demonstrate the influence of social class on number of immune cells and the level of activity of molecular signaling pathways that regulate cytokine production. Based on the toxic pressure model, another group of researchers have suggested that the HPA system is over-activated by toxic stress, which distorts the normal balance of steady-state components, resulting in too much or too little cortisol, adrenaline, cytokines, metabolic hormones or neurotransmitters, which in turn leads to disease. In sum, we reviewed the "social-psychologicalphysiological" mechanisms of health disparities among social classes. We focused on the multi-level paths to illustrate the relationship between social class and health, which include community and family environmental factors(community violence, social capital, family conflict, and parenting style) as well as individual psychological and behavioral factors(hostility and health behavior) and biological factors(cells, molecular, and HPA). Future studies should strengthen theory integration and construction concerning the relation between social class and health, carrying out multi-faceted and multi-disciplinary empirical research at the distal, middle and proximal levels within a "social-psychological-physical" framework so as to reveal more deeply the core mechanisms underlying the influence of social class on health and lay a solid foundation for proposing more effective intervention programs.
作者
胡小勇
杨沈龙
钟琪
喻丰
陈红
Xiaoyong Hu;Shenlong Yang;Qi Zhong;Feng Yu;Hong Chen(Faculty of Psychology,Southwest University,Key Laboratory of Cognition and Personality (SWU),Ministry of Education,Chongqing 400715, China;Institute of Social Psychology,School of Humanities and Social Sciences,Xi 'an Jiaotong University,Xi'an 710049,China)
出处
《科学通报》
EI
CAS
CSCD
北大核心
2019年第2期194-205,共12页
Chinese Science Bulletin
基金
国家自然科学基金(71601083)
中国博士后科学基金(2018M631054
2017M623138)
重庆市基础科学与前沿技术研究专项(cstc2017jcyjAX0436)
重庆市社会科学规划博士项目(2016BS107)
重庆市博士后科研项目(Xm2017160)
中央高校基本科研业务费专项(SWU1609031)资助
关键词
社会阶层
健康
社会环境
心理特征
生理过程
social class
physical health
social environment
psychological characteristics
physiological processes
