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對貧窮與健康的感知及兩者之間的惡性循環：一個香港醫療服務主要持份者的質性研究
背景
貧窮與健康息息相關。現時有關貧窮與健康之間的惡性循環的研究主要集中於發展中國家，惟當中聯繫貧窮與健康的機制未必能全盤應用於亞洲發達地區。這項研究旨在探索香港醫療服務主要持份者對貧窮與健康之間的惡性循環驅動機制和因素的看法。
方法
我們透過焦點小組訪談社會工作者（n = 8），慢性病患者（n = 8），老年人（n = 6），基層醫療醫生（n = 7）及非正式照顧者（n = 10），仔細轉錄並閱讀所得意見，然後基於社會建構主義作主題分析以識別及整合關鍵主題。
結果
在這高度發達但貧富懸殊的亞洲城市中，貧窮與健康之間的惡性循環依然持續。權力和機會不平等造成物質和社會制約，進而令影響健康的社會決定因素分佈得更不均。在雙軌醫療系統下，醫療服務使用亦因社會階梯高低而有所不同。隨著健康狀況惡化，醫療、社福及勞工干預政策的不協調和不足進一步加劇患者的經濟困難。除此以外，基於受訪者對貧窮本質的認知及其在公共政策中的操作以及不同持份者對疾病概念的理解，此研究還討論了驅動惡性循環的政策因素。
結論
儘管經濟繁榮，貧窮與健康之間的惡性循環仍然是香港現正面臨的巨大挑戰。為了打破循環，潛在政策方向包括採納按比例的普世主義，推動社會融合和加強醫社協作。
Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong
BACKGROUND:
Poverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong.
METHODS:
Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism.
RESULTS:
In this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders.
CONCLUSIONS:
The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.
Link: https://rdcu.be/b1s6o
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