!๘হ࿐ิፇኯLj311:
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ڦႹ——ஃྺକईݥฆᄽႠݴ
݀Ljᆌၠ๘হ࿐ิፇኯӲت༵ฤ൩Ljں
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ԨӲ֑ᆩڦఁࢅרຎڦଙժ փپ๘হ࿐ิፇኯܔඪࢆࡔॆĂଶںĂ
ईں൶ईഄړਆڦࢇ݆ں࿋Ljई࠲ᇀ Չহईݴহ၍ڦࡀۨᆶඪࢆᅪ९ăںฉ ڦႵ၍๖ీช࿄ྜඇٳׯᅃዂڦٷዂ Չহ၍ă
ݐ༵तగၵࠅິईగၵሰฆڦׂ
้Ljժփᅪ࿆ጣ்ᅙྺ๘হ࿐ิፇኯ
ණईླྀ४LjईԲഄ࿄༵तڦཞૌࠅິ
ईׂ߸ࡻăأֶٱࢅࢮྔLjݐጆ૧ׂ
ఁ࠴ᅜٷႀጴజLjᅜ๖൶՚ă
๘হ࿐ิፇኯᅙ֑ൽᅃൎࢇڦᇨݞ ٯแઠࢃํԨӲዐԈࡤڦ႑တăڍLj ᅙӲଙڦݴ݀ඪࢆඓईࡤႺڦԍ ኤăࢅ๑ᆩଙڦሴඪൽਦᇀ܁ኁă๘ হ࿐ิፇኯܔᇀᅺ๑ᆩኄၵଙሰׯڦ฿
փڅሴඪă
ዐ࿔ᅳǖ૰! Ⴙৢ! רᆗ อၯǖࡓჼ! ᆄࣱ
Printed in China WHO Library Cataloguing-in-Publication
Data
Closing the gap in a generation: health equity through action on the social determinants of KHDOWK¿QDOUHSRUWRIWKHFRPPLVVLRQRQVRFLDO determinants of health.
1. Socioeconomic factors. 2. Health care rationing. 3. Health services accessibility. 4.
Patient advocacy. I.Commission on Social Determinants of Health.
ISBN 978 92 4 556370 9 1/0FODVVL¿FDWLRQ:$
Suggested Citation
&6'+ Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
Photos
WHO/Marko Kokic; WHO/Christopher Black; WHO/Chris De Bode 6SHFL¿FSKRWRFUHGLWVFDQEHREWDLQHGIURP:+2
มࣷࠅኟิຶᎸ࠲ڦ࿚༶ăፑᆸጣට்ڦ
ิऄݛ๕Ăᮎ࣒दթڦీႠतࡗራຶྨڦޅ၃ă
்ܔ๘হᅃၵں൶ྭంࢅॳጒڦჄ߀
ศߌႌ࿏Ljཞ้ᅨܔᆶၵں൶ժ߀࠵ߌڟኒă ᅃၵࡔॆႎิᆊڦᇨంٳ 91 ܠLjܸሞᆶ ၵࡔॆชփڟ 56 ăन๑ሞཞᅃࡔॆLjփཞڦม
ࣷں࿋ሞٷײ܈ฉᄺࣷڞዂට்ڦॳጒփ ᅃᄣăሞᅃࡔኮాࢅࡔᇑࡔኮक़Ljਨփᆌ٪ሞኄ
ٷڦă
ኄၵԨՆ௨ڦॳփࠅೝ၄ၡᇑට்ڦׯ
ĂิऄĂ߾ፕĂ࣍ৣत၄ᆶڦᅅଐ܈ݴփ ਸڦăܸට்ิᇀຯĂፂᇀຯڦ࣍ৣᆼศአዎĂ มࣷࢅঢ়षᅺ໎ᆖၚă
ܹཡጠׯժၛݿܠ֒ڦิऄLj࣏
ࣷิऄԙ֚Ljมࣷࢅঢ়षአ֧ഐጣਦۨႠڦᆖၚă
ࡔࢅ൬ࡔႴᄲਦڦ࿐ิ࿚༶Ⴀዊනᅮ൵ৎă
ᅜߵට்ॳײ܈Ăมࣷ߳֫ڦॳݴքࠅೝ
ᇑޏतփଆॳሰׯփ૧ᅺ໎ڥڟتڦײ܈Ljઠ ೠ६ᇧมࣷईೖઓมࣷڦ݀ቛ൧ă
Ԩ ጣ ม ࣷ ࠅ ኟ หLj ๘ হ ࿐ ิ ፇ ኯDŽXIPDž ᇀ 3116 ย૬କॳڦมࣷਦۨᅺ໎྿ᇵࣷLjᅜ
णኤLjֱᅜ֑ൽࢆዖႜۯٝॳࠅೝLj ժླྀۯ݀ഐඇ൰ॳࠅೝሏۯă
ໜጣ྿ᇵࣷ߾ፕڦਸቛLj๑ڥැ߅ࡔॆࢅऐࠓ ׯྺࢇፕअӵăኄၵࡔॆࢅࢇፕअӵထྭཚࡗ۩
ඇมࣷڦአ֧ࢅࡀࣄLjኍܔॳڦมࣷਦۨᅺ໎֑
ൽႜۯLj౮૰ٝॳࠅೝă்ኄׇඇ൰ሏۯ ڦံބă
྿ᇵࣷࢬᇛ XIP ࢅ߳ࡔአުኸڞॳڦมࣷ
ਦۨᅺ໎ଶᇘڦඇ൰ႜۯLj౮૰ํ၄ॳࠅೝă߳
ࡔአުĂ௷क़ཷ༹ĂXIP तഄඇ൰Ⴀፇኯ၄ሞ ՂႷཚ૰ࢇፕLj֑ൽႜۯ߀๘হ߳ࡔට௷ڦิऄă ሞᅃپට้क़ํ၄ॳࠅೝႜڦLjᄺኟඓ ڦLj၄ሞՂႷ૬नྺኮႜۯഐઠă
Ԓߢ߁ᄲ
ڼᅃևݴ! ඇ൰ॳࠅೝ֧ڦԝৠ
ڼ 2 ቤ! ᅃ߲ඇ൰ႎᅱײĊĊॳڦมࣷਦۨᅺ໎྿ᇵࣷ
ڼ 3 ቤ! ඇ൰ॳࠅೝĊĊႜۯႴᄲ ڼ 4 ቤ! ᇱᅺࢅӸ݆
ڼܾևݴ! ኤĂႜۯĂႜۯኁ ڼ 5 ቤ! ኤࢅႜۯڦԨዊ
ኤࣹጺ
྿ᇵࣷڦ߁ॐ ಒኤ
྿ᇵࣷڦႜۯࢅॺᅱڦ࠲॰ଶᇘ ߴփཞ֖ᇑኁڦॺᅱ
ॽॺᅱዃᇀ༬ۨԝৠዐ
ڼෙևݴ! ߀නิऄ࣍ৣ
ڼ 6 ቤ! ഐۅࠅೝ
ྺظሰ߸ेࠅೝڦഐۅܸ֑ൽڦႜۯ ገՎ࠵
ํ७ዐڦܹཡራਸ݀ጹࢇ߅ᇨٯแ ঞᇣݔྷ
ঞᇣቱҹ
ཡঞᇣ
ڼ 7 ቤ! ॳൽਦᇀ࿐ิ࣍ৣ
ॺ૬ଆႠิऄ࣍ৣڦႜۯ
֖ᇑႠ࠶
߀ਃዿཉॲ
ࡀࣄࢅยऺٝॳႜྺࢅҾඇ
ཱིں๑ᆩ
౫٩ڦิऺ
౫٩एإยแࢅޜခ ౫٩ၠڦദᅎ ጲ࣍ৣ
ڼ 8 ቤ! ࠅೝ৽ᄽᇑ༹௬߾ፕ ظሰࠅೝ৽ᄽࢅ༹௬߾ፕ
ኧႠڦࡔा࣍ৣ
ेഽ߾ටሞࡔॆአ֧ۨዐڦ݀ჾ
Ҿඇ༹ܸ௬ڦ߾ፕՔጚ փ࿘ۨڦ߾ፕ
ణ!
߀߾ፕ࣍ৣ
ڼ 9 ቤ! ዕิมࣷԍࢺ
ํ၄ඇ௷มࣷԍࢺڦႜۯ ዕิڦඇ௷มࣷԍࢺ܈
มࣷԍቱ༹ဣڦԍቱ૰܈
ణՔ
ॽมࣷԍࢺဣཥླྀ࠽ޮ߃ݔྷኮྔڦට்
ڼ : ቤ! ඇ௷ᅅଐԍॳ
ํ၄ඇ௷࿐ิԍॳڦႜۯ ඇ௷एԨ࿐ิԍॳ
؛प࿐ิԍॳĊĊม֖ࣷᇑࢅม൶ޯ
ᇨݞࢅॳٝ
ሏᆩۨၠ࿐ิԍॳઠॺ૬ඇ௷ޮ߃
࿐ิԍॳබጨĊĊࢅԍ၃ ӻዺ࿐ิ߾ፕኁ
ڼ຺ևݴ! ت૰Ăূബࢅጨᇸݴದփࠅ၄ၡ ڼ 21 ቤ! ሞᆶአ֧Ăဣཥࢅࡀࣄዐ༹၄ॳࠅೝ
ॺ૬ॳࠅೝڦᅃዂୟ০ ॳࠅೝፕྺมࣷօڦኸՔ
አ֧ᅃዂႠĊĊኧॳࠅೝڦᆶၳऐ
አުአ֧ܔॳࠅೝڦᆖၚ
࿐ิଶᇘాڦႜۯ ऐࠓॺย
࿐ิଶᇘڦĐ٣ࣅवđፕᆩ ڼ 22 ቤ! ࠅೝؕጨ
ओटႜۯLjٝࠅೝؕጨ
ે
ඇ൰ࣅ๘হڦ
࿐ิ݀ቛᇲዺDŽEBIDž
ᆩॳڦมࣷਦۨᅺ໎ॐઠኸڞᇲዺ ቐခ३௨
࿄ઠቐခሴඪ
ࢇݴದ ڼ 23 ቤ! ׇڦኰሴ
ׇሴඪ၎࠲ऄۯ
ेഽঢ়षཉሀܔॳࠅೝᆖၚڦೠࠚ ཉሀڦଳऄႠ
ሴඪڦຳᆶևோ
ڼ 24 ቤ! ଇႠೝڪ
߀ॳฉڦႠ՚փೝڪڦႜۯ ૬݆
Ⴀ՚ዷୁࣅ
ॽঢ়षࠋ၅భࡔॆቭࢽ ঞᇣࢅಢჟ
ঢ়ष֖ᇑ
Ⴀࢅิኳॳᇑ૧
ڼ 25 ቤ! ༵ߛአዎں࿋ĊĊԈઔႠᇑ݀ჾ
ਸቛႜۯLjਦࣆᇕࢅথభ܈ዐڦփࠅೝ
አዎޯ૬݆ĊĊ૧ࢅऐࠓ ਦ֧ࡗײዐڦࠅೝ֖ᇑ ጲူܸฉLjٝॳࠅೝ
ڼ 26 ቤ! ඇ൰ଆࡻዎ
ዂ૰ᇀඇ൰ଆࡻዎ
ॳࠅೝĊĊඇ൰ణՔ ܠՉၹۙ
ഥ݀ቛణՔDŽNEHDž ኧඇ൰ॳዎ
ڼևݴ! ኪ๎Ă֪॔ࢅरీǖႜۯڦኧዹ ڼ 27 ቤ! ॳڦมࣷਦۨᅺ໎ǖ֪॔Ăჺ৯ࢅಢჟ
֑ൽႜۯLj༵ߛ֪॔Ăჺ৯ࢅ߅ᇨڦీ૰
ิکऻဣཥ
ࡔॆॳࠅೝႠ༹֪॔ဣ ॳࠅೝႠඇ൰֪॔ဣཥ કٷኪ๎एإ
ॳڦมࣷਦۨᅺ໎ڦಢჟࢅঞᇣ
ڼୃևݴ! ݀ഐᅃ߲ඇ൰ሏۯ
ڼ 28 ቤ! גሁॳڦมࣷਦۨᅺ໎྿ᇵࣷڦჄႜۯ
Ⴤႜۯڦएإ ᅃၜ࿄ྜׯڦᅱײ ॳࠅೝڦణڦࢅణՔ
ཚၠॳࠅೝڦײԘĊĊዐ܌ׯࡕ
B! ඇևॺᅱڦࣹጺ
྿ᇵ०
֖࿔၅
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Ăࢅ
ᆅ
ዂ! ႇ
ኄݻԒߢᆯ XIP ॳڦมࣷਦۨᅺ໎྿
ᇵࣷ݀ഐĂፇኯࢅኸڞڦăԒߢڦጉႀཷܓׯᇵ ᆶ Njdibfm!NbsnpuĂTibspo!GsjfmĂSvui!CfmmĂ Ubokb! BK! Ipvxfmjoh ࢅ Tfcbtujbo! Ubzmps ڪă
ُྔLj྿ᇵࣷڦׯᇵĂኪ๎ྪஏĂࡔॆअӵĂࠅ
௷ ม ࣷ ፇ ኯLj ᅜ त ࿋ ᇀ න ా ྑ ڦ XIP ڦ ཞ ๚
்LjۼܔԨԒߢڦጉႀᆶࠋ၅Ljሞُᅃժߌႇă ཞ ้ ᆮ ഄ ᄲ ܔ Spo! MbcpoufĂEpo! NbuiftpoĂ Ifsobo! TtboepwbmDŽ྿ᇵࣷ༬՚ࠥ࿚Džࢅ Ebwje!
Xppexbse ڪ๖ႇᅪă
࿋ ᇀ ܘ ٷ ბ ڦ ྿ ᇵ ࣷ ກ ت ሴ ට Tibspo! GsjfmLjׯᇵԈઔ Svui! CfmmĂJbo! GpsefĂ Ubokb! BK! IpvxfmjohĂGfmjdjuz! QpssjuuĂFmbjof!
Sfjofsutfo ࢅ Tfcbtujbo! Ubzmps ڪă ࿋ ᇀ ๘ হ ࿐
ิፇኯڦ྿ᇵࣷກتሴටሶ Kfbofuuf! Wfhb DŽ3115.3118Dž ࢅ Ojdl! EsbhfsDŽ3119Džă ሞ ྿ ᇵ
ࣷڦؕԢࢅ߾ፕቛዐഐڟ࠲॰ፕᆩڦ๘হ࿐ิ
ፇ ኯ ߾ ፕ ට ᇵ Ԉ ઔ Fsjl! CmbtĂDisjt! CspxoĂ Ijmbsz! CspxoĂBmfd! JsxjoĂSfof! Mpfxfotpo DŽ ࠥ ࿚ DžĂSjdibse! QpfĂHbcsjfmmf! SpttĂSjuv!
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Tqfzcspfdl ࢅ Njdifm!Uijfsfo ڪă
๘ হ ࿐ ิ ፇ ኯ ሞ ዮ ܠ ݛ ௬ ۼ ܔ ྿ ᇵ ࣷ ڦ ߾ ፕߴᇎକटٷӻዺăሞُLj்ᄲܔ๘হ࿐ิፇ ኯമጺ߅๚ዓᇚձ๗ࢅ၄ඪጺ߅๚רމኆձ ๗ ๖ ዔ ႐ ߌ ႇă ྿ ᇵ ࣷ ࣏ ᄲ ߌ ႇ ዺ ጺ ߅ ๚ Ujn! Fwbot ձ๗ܔ்߾ፕڦኧLjᅜत߳ں൶ ጺ ߅ ๚ Nbsd! Ebo{poĂIvttfjo! Bcefm.Sb{{bl!
BM! Hf{bjszĂObub! NfobcefĂTijhfsv! PnjĂ Tbnmff! QmjbocbohdibohĂNjsub! Sptft! Qfsjbmhp
ࢅ MvΜt! Hpnft! Tbncp ڪă ཞ ้Lj ߳ ں ൶ Ӹ ๚ تڦ၎࠲ටᇵᄺओटದࢇ்ڦ߾ፕLj்ဇ
൶ Ӹ ๚ ت ڦ Bokbob! Civtibo ࢅ Tpf! Ozvou.VLj
౹ዞ൶Ӹ๚تڦ Disjt! CspxoLjெዞں൶Ӹ๚ت ڦ Mvj{! Hbmwbp ࢅ Nbsdp! BdlfsnboLj ۫ ళ ჱ ں
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Nbxbzb ࢅ Disjt! NxjljtbLj ᅜ त ۫ ں ዐ ࡛ ں ൶ Ӹ ๚ ت ڦ Tbnffo! TjeejrjĂTvtboof! Xbuut ࢅ Npibnnfe! BttbjăُྔLj࣏ᆶߌႇ๘হ࿐ิፇ ኯጂ߳ࡔپܔ்ڦኧLjԈઔ Nffob! Dbcsbm!
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NpsfopĂBnjof! LfcfĂKbdpc! Lvnbsftbo ࢅ Fsjp