從台灣城鄉嬰幼兒死亡率差異探討社會不公平問題

The Probe into Social Injustice through Rural-urban Difference in Infant and Child Mortality in Taiwan

孫樹根(Jun-Sean Liu) ； 劉俊賢(Shou-Ghen Sun)

《農業推廣學報》 21期 (2006/07) Pp. 33-58

https://doi.org/10.29788/RAES.200607.0002

摘要

本研究以嬰、幼兒死亡率做為觀察指標，城鄉間嬰幼兒死亡率差異是健康不平等的表現，而導致健康不平等的因素正構成了城鄉社會不公平的諸多面向。
本研究城鄉界定採用人口密度和農業㆟口比做為城鄉區分指標，將台灣各鄉鎮市區劃分為農業鄉村、非農業鄉村和非鄉村地區等三種城、鄉地區類型。地方影響健康的分析架構主要區分為組成因素和背景因素兩大類。在解釋嬰幼兒死亡率差異的組成因素包括了教育年數、低教育人口比、每人所得，至於背景因素方面則包括了醫療資源、自來水建設等。
1997-2003七年變遷研究發現城鄉嬰、幼兒死亡率差異並沒有減少，醫療資源的城鄉差異逐漸加大，執業醫師人力在台灣農業鄉村仍然嚴重缺乏。教育年數、低教育人口比、每人所得、醫療資源、基礎建設在解釋台灣全鄉鎮以及不同城鄉類型的嬰幼兒死亡率上先後呈現顯著相關，其中又以自來水建設為最重要的解釋變項。農業鄉村、非農業鄉村、非鄉村地區依序來看猶如一動態發展歷程，鄉村地區在社會經濟、醫療資源、民生建設發展上相對處於落後，台灣城鄉之間尚存在著教育不平等、所得不平等、醫療資源不平等、基礎建設不平等之社會問題。
健康不平等之議題強調針對資源最匱乏的地區施以援助不僅符合倫理原則，在心理、生理、社會的總體效益評估下亦絕對符合經濟原則，另外追求社會公平不只是人道主義的價值信念，亦是提昇國人整體健康水準的途徑。

關鍵字

城 ； 鄉之社會不公平 ； 健康不平等 ； 嬰幼兒死亡率 ； 醫療資源 ； 自來水建設 ； 經濟 ； 倫理

並列摘要

This study adopts infant and child Mortality as observe indicator. The difference in this indicator is appearance of health-inequity. Factors result in health-inequity point out various dimensions of social injustice. We combine population density and agricultural population ratio as multiple-basis to define rural and urban areas. Classify Taiwan towns as ”Agricultural rural”, ”Nonagricultural rural” and ”non-rural” three category areas. The analysis of place effects on health divided into ”compositional factors” and ”contextual factors”. Compositional factors effect on infant and child mortality in this study include years of education, low-educated population ratio and individual income. Contextual factors means medical resource and piped-water infrastructure.
In 1997-2003, infant and child mortality differentials between rural/urban was unmoved, medical resource gap increased. Medical manpower shortage in rural areas remained. Explainable variables as educated years, low-educated population ratio, individual income, medical resource and piped-water infrastructure played different role in rural/urban areas, above all, piped-water is most important variable in this study. Agricultural rural, non-agricultural rural and non-rural just as three level of development. Socioeconomic situation, medical resource and infrastructure in rural areas were insufficient. Rural- urban equity of education, income, medical resource and infrastructure is performance of social injustice.
The research of health inequity address that supply to the most deficient place not only follow moral principle, but accompanied with economical principle by consider psychological, physical and social benefit. Particularly, pursue social equity is more than human sympathy, also straight to promote whole body healthy.

並列關鍵字

Rural-urban ； Social injustice ； Health inequity ； Infant and child mortality ； Medical resource ； Piped water ； Moral ； Economical