بررسی وضعیت نابرابری و بی عدالتی در شاخص های سلامت و تعیین کننده های اجتماعی آن در ایران

محورهای موضوعی : فصلنامه علمی برنامه ریزی منطقه ای

محمد رضا رضوانی ¹ , سیامک طهماسبی ² , بهرام هاجری ³

1 - استاد، گروه جغرافیای انسانی، دانشکده جغرافیا، دانشگاه تهران، تهران، ایران.
2 - دانشجوی کارشناسی ارشد سنجش از دور و سیستم اطلاعات جغرافیایی، گروه سنجش از دور و سیستم اطلاعات جغرافیایی، مرکز مطالعات سنجش از دور و GIS، دانشکده علوم زمین، دانشگاه شهید بهشتی، ایران.
3 - دانشجوی دکتری، گروه جغرافیای انسانی، دانشکده جغرافیا، دانشگاه تهران، تهران، ایران.

تاریخ دریافت : 1399/02/09 تاریخ پذیرش : 1400/01/30 تاریخ انتشار : 1401/10/01

کلید واژه: "تحلیل فضایی", "نابرابری سلامت", " تعیین‌کننده‌های اجتماعی سلامت", " نابرابری فضایی", " استان‌های ایران",

چکیده مقاله :

سلامتی از مؤلفه‌های حیاتی بهزیستی انسان‌ها است. عدالت در سلامت از اولویت‌های سیاستی دولت‌ها به شمار می‌رود. اغلب نواحی کشور با مشکل ارتقاء سطح سلامت مواجه‌اند که این امر مانع بزرگ بر سرراه توسعه پایدار نواحی مذکور به شمارمی رود. شناخت و تحلیل نابرابری‌های فضایی سلامت و تعیین کننده‌های آن در مقیاس‌های مختلف(ملی، ناحیه‌ای، محلی) گامی مؤثری در امر سیاست‌گذاری‌ها به شمار می‌رود. هدف اصلی این پژوهش، تحلیل فضایی نابرابری در وضعیت سلامت و تعیین‌کننده‌های اجتماعی آن در استان‌های ایران می‌باشد. شاخص‌های مناسب از طریق مرور ادبیات و نظر متخصصین انتخاب شد. داده‌های موردنیاز برای سال 1395 از طریق سالنامه‌های آماری مرکز آمار ایران و دانشگاه‌های علوم پزشکی جمع‌آوری شد. برای سنجش الگوی فضایی و خوشه‌بندی فضایی به ترتیب از آماره‌های موران سراسری و گیتس- ارد جی استفاده شد. همچنین، برای سنجش روابط بین وضعیت سلامت و متغیرهای مستقل پژوهش از آماره موران دو متغیره استفاده شد. یافته‌های پژوهش نشان می‌دهد که وضعیت سلامت و تعیین‌کننده‌های آن در میان استان‌ها به‌طور نابرابری توزیع شده است. آماره موران سراسری نشان داد که شاخص های وضعیت سلامت به صورت خوشه ای توزیع شده اند. در وضعیت سلامت استان‌های مرزی و به‌خصوص شرق و جنوب شرق کشور در وضعیت نامطلوبی قرار دارند. استان‌های تهران، البرز، کردستان و اردبیل مقادیر بالا را به دست آوردند به عبارتی می‌توان گفت در وضعیت مناسبی قرار دارند در مقابل، استان‌های خراسان شمالی، خوزستان، خراسان جنوبی و سیستان و بلوچستان کم‌ترین امتیاز را به دست آوردند که می‌توان گفت در وضعیت نامناسبی قرار دارند. وضعیت سلامت و متغیرهای مستقل پژوهش یعنی نیروی انسانی 0.142(p<0.001)، کالبدی/ فیزیکی 0.147(p<0.001)، بهداشت و کیفیت محیط 0.135(p<0.001) و وضعیت اقتصادی- اجتماعی 0.222(p=0.000) رابطه مثبت و معناداری را با وضعیت سلامت در استان ها نشان می‌دهد. بااین‌حال، این روابط در میان استان‌ها تغییر می‌کند و همه استان‌ها از یک الگوی مشابه پیروی نمی‌کنند. میزان تأثیرگذاری متغیرهای مستقل پژوهش در میان استان‌ها تغییر می‌کند که در استان‌های جنوب شرقی و شمال غربی کشور بیشتر است.

چکیده انگلیسی:

Health is a vital component of human well-being. Health justice is one of the political priorities of governments. Most region of the Iran are facing the problem of improving the level of health, which is a major obstacle to sustainable development in these regions. Recognizing and analyzing spatial health inequalities and their determinants at different scales (national, regional, local) is an effective step in policy making. The main purpose of this study is to analyze the spatial inequality in health status and its social determinants in the provinces of Iran. The required data collected through statistical yearbooks of Iran Statistics Center and medical universities. To measure the spatial pattern and spatial clustering, the global Moran’s I and Getis-Ord G statistics are used. Also, the two-variable Moran statistic was used to measure the relationship between health status and independent research variables. Findings show that health status and its determinants are distributed unequally among the provinces. In the health stats, the border provinces, especially in the east and southeast of the country are in an unfavorable situation. The provinces of Tehran, Alborz, Kurdistan and Ardabil achieved the highest values. In other words, they can be said to be in a good position. In contrast, the provinces of North Khorasan, Khuzestan, South Khorasan and Sistan and Baluchestan had the lowest scores, which they had poor condition. Health status and independent variables of the study showed significantly positive relationship with health status in the provinces. Highest coefficient values for health prediction status respectively are socio-economic status 0.222 (p = 0.000) physical 0.147 (p <0.001), human resources 0.142 (p <0.001) and environmental quality 0.135 (p <0.001). However, these relations are changing among the provinces, and not all provinces follow the same pattern. The influencing factors of research varies among provinces, which is higher in the southeastern and northwestern provinces of the country.

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