期刊名称：Proceedings of the National Academy of Sciences
印刷版ISSN：0027-8424
电子版ISSN：1091-6490
出版年度：2017
卷号：114
期号：25
页码：6421-6423
DOI：10.1073/pnas.1706988114
语种：English
出版社：The National Academy of Sciences of the United States of America
摘要：Daoud et al. intentionally restricted their study largely to a period before the Millennium Development Goals were well under way, and before the substantial global infusion of resources to addressing child health in LMICs ( 9 ). Changes have also occurred to the lending mechanisms of multilateral financial institutions, such as the IMF and World Bank ( 17 ). Notwithstanding the identification challenges and issues highlighted in this commentary, these changes also raise the question of the validity of inferences drawn from pre- or early 2000s for current policy discussion and action. Global efforts to reduce the burden of avoidable disease and deprivation in LMICs could still be undermined, even in the presence of more health-sensitive and propoor policies by multilateral financial institutions. Although attempting to quantify the impact of adverse policy contexts on social factors of health is useful to trigger policy deliberations, even well-intentioned studies will suffer from serious shortcomings, such as those related to study design, inadequate evidence of pathways, and heterogeneous findings, underscoring the limits of empirical evidence to forge consensus and action. Under such circumstances, a “freedom” or “value-based” perspective to assessing the rationale for certain policies or interventions might be equally important ( 18 ), especially within the context of social determinants of health that often have considerable intrinsic eminence.
