醫事人員對社會決定因素之認識與因應

Health Professionals' role in Addressing Social Determinants of Health

社會決定因素是健康問題「上游的上游」，對不健康之影響超過健康照護體系、生活型態，造成顯著可預防之醫療支出與健康不平等。世界衛生組織及聯合國永續發展議程皆提出因應政策，以邁向全民均健、不讓任何一人掉隊。為與國際接軌，國民健康署與英國倫敦大學健康公平學院合作，於2016出版「臺灣健康不平等報告」，為亞洲第一本國家級健康不平等報告，從健康狀況分析證實國人健康同樣存在「社會階梯現象」，政策分析列舉過去有效縮小健康不平等的成功案例，並依國際政策架構，提出臺灣未來精進建議。該政策架構與建議，有助於瞭解哪些是因應社會決定因素之正確措施。醫事人員處在健康之下游，透過醫事教育、臨床、機構與社區四大層次之介入，提升醫事人員對社會決定因素之認識，發展公平正義之團隊文化，建立流程與採取行動，成為病人、組織及社區改善社會決定因素之觸媒，並以專業角色對政府與社會進行倡議，有助於逆轉惡性循環，共創醫療與社會的多贏及永續。

Social determinants of health (SDH) is the root cause of all causes. The proportion of attributable deaths to SDH is higher than healthcare system and lifestyles. SDH caused avoidable healthcare cost and health inequalities. World Health Organization and the United Nations have both proposed policies addressing SDH to achieve health for all and to leave no one behind. In response to such global efforts, the Health Promotion Administration has published 'Health Inequalities in Taiwan' in collaboration with University College London, Institute of Health Equity in 2016 as the first national health inequalities report in Asia. Through analysis of health statistics, it showed similar social gradient phenomenon in Taiwan. Based on the conceptual policy framework, it reviewed and identified Taiwan's success practices and provided recommendations for doing better in the future. This framework and its recommendations provide insight on what works in addressing SDH. Health professionals work at the downstream of ill health and play a pivotal role in addressing SDH to reverse the vicious cycle and create win-win co-benefits between healthcare system and the society. This paper provides summary of interventions at health professions education, clinical level, practice level and community level that aimed to raise awareness on SDH, develop a just-based team culture, renovate clinical pathways, and transform health profession into a change agent to improve SDH for patients, organizations and communities and to advocate for governmental policy changes.