Journal of Mazandaran University of Medical Sciences
مجله دانشگاه علوم پزشکی مازندران
J Mazandaran Univ Med Sci
Medical Sciences
http://jmums.mazums.ac.ir
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2018
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شاخص ها و علل نابرابری های بهداشت محیط (EHIs)
Indicators and Causes of Environmental Health Inequalities
بهداشت محیط زیست
Environmental Health
مروری
Review
<span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">نابرابری</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های بهداشت محیطی (</span></span></span></span><span style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">EHIs</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">) به تفاوت</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های کلی شرایط بهداشت محیط اشاره می</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">کند. هدف از این پژوهش، معرفی شاخص</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های </span></span></span></span><span style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">EHI</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"> و توصیه</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های کلی برای بهبود سلامت محیط زیست و کاهش نابرابری</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های است. این تحقیق شامل بررسی گزارشات </span></span></span></span><span style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">WHO</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"> در مناطق مختلف است که شاخص </span></span></span></span><span style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">EHI</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"> را در 14 گروه معرفی کرده است و به سه گروه اصلی شامل نابرابری</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های مرتبط با آسیب</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">پذیری، زیست محیطی و مسکن تقسیم</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">بندی می</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">کند. نابرابریهای مرتبط با آسیب دیدگی شامل آسیب</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های مرتبط با کار، تلفات مرگبار جاده</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">ای، مسمومیت</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های مرگبار و سقوط می</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">باشد. هم</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">چنین طبقه</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">بندی زیست محیطی دارای چهار شاخص شامل قرار گرفتن در معرض سر و صدا، عدم دسترسی به مناطق سرسبز و تفریحی، قرار گرفتن در معرض دود دست دوم در درون منزل و محل کار می</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">شود. در این میان نابرابری</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های مرتبط با مسکن خود شامل شش شاخص تامین آب نامناسب، فقدان توالت فلاشینگ دار، فقدان حمام یا دوش، ازدحام، منازل نمناک و مرطوب است. مطالعات نشان می</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">دهد </span></span></span></span><span style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">EHI</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"> ها در تمامی کشورها وجود داشته و اغلب قشر فقیر را تحت تاثیر قرار می</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">دهد. میزان این نابرابری</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های متغیر بوده و از عواملی چون متغیرهای اقتصادی اجتماعی و جمعیت</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">شناسی تاثیر پذیر است. در این میان نابرابری</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های زیست محیطی مستثنی نبوده و ارتباط مستقیم با میزان درآمد، تحصیلات، اشتغال، سن و جنس، نژاد، قومیت، مکان و زمان خاص دارد. علاوه بر این تفاوت در معرض خطر قرار گرفتن افراد در برابر نابرابری</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">های محیط زیستی با توجه به تفاوت جمعیت شناختی و اجتماعی افراد متفاوت است. لذا لزوم طراحی مطالعه</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">ای برای ارزیابی اولیه </span></span></span></span><span style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">EHI</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"> در ایران دیده می</span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;"></span></span></span></span><span dir="RTL" style="letter-spacing:-.1pt;"><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:12.0pt;">شود.</span></span></span></span>
Environmental health inequalities (EHIs) refer to general differences in environmental health conditions. This research aimed at introducing the EHI indicators and providing general recommendations that could improve environmental health and reduce the inequalities observed<span dir="RTL">.</span>This research is the review of WHO reports in various regions. A set of 14 EHI indicators was developed and categorized into three inequality dimensions, including housing-related inequalities, group injury-related inequalities, and environment-related inequalities. The environment-related inequalities include four indicators such as lack of access to green/recreational areas, and noise exposure and second-hand smoke exposure at home or work<span dir="RTL">.</span> The housing-related inequalities include six indicators such as inadequate water supply, lack of a flush toilet, lack of a bath or shower, overcrowding, dampness in home, and inability to keep the home adequately warm. According to literature, EHIs exist in all countries, and most often affect disadvantaged population groups. The magnitude of inequalities and the distribution of inequalities varies between countries and also depend on the socioeconomic or demographic variables. The socioeconomic and demographic inequalities in exposure to environmental hazards exist everywhere and could be associated with factors that may affect the risk of being exposed such as income, education, employment, age, sex, race/ethnicity, and specific locations or settings. In addition to these differences in exposure, environmental health inequalities are also caused by social or demographic differences in vulnerability towards certain risks. Finally, further studies are recommended for initial assessment of EHIs in Iran.<br>
نابرابریهای بهداشت محیطی, نابرابری, عدالت زیست محیطی
Environmental Health Inequalities, inequality, procedural justice
218
229
http://jmums.mazums.ac.ir/browse.php?a_code=A-10-8891-1&slc_lang=fa&sid=1
Mohammad Ali
Zazouli
محمد علی
ززولی