健康的社會決定因子 - 跨國公司的角色探討

Abstract

探討社會因子在健康與健康落差的相關研究已經有段歷史。惟，學界對於跨國企業在此議題上應有的責任與貢獻，仍知之甚少。導因於個人(社區)社經地位與國家社經發展程度上的落差，造成個人及群體在多種健康指標當中，存在著普遍的、嚴重的、持續的，且日益嚴峻的現象。此影響的範疇涵蓋醫療層面之疾病發生率、死亡率、以及平均餘命等；社會層面上，則是健康與衛生政策制定者及人權與公平正義倡議者關注的對象。此外，在新自由主義浪潮席捲之下，尤其在發展中國家，弱勢者更加不易維護自身健康的困境，與日遽增；同時，要求富可敵國的跨國企業，在此議題上善盡良好企業公民的角色與責任的呼籲，也日益高漲。 由於社會因子對健康落差的影響，會因時、因地有所不同。作者好奇 - 台灣是否亦然？可惜的是，台灣學界至今對此仍少觸及，跨國公司的資料更是付之闕如。本論文的目的在於：利用作者跨領域的優勢，探究這個多因子、複雜的、且多面向的問題，並補足現有實證的缺口。研究課題與方法如下：一、同時針對健康的社會因子相關理論，以及彌平健康落差的倡議與作為，進行文獻回顧，期能建立具備理論基礎的分析架構。二、從量化的角度，採用全人口的資料庫來檢驗此時此刻的台灣是否真實存在著健康落差。三、運用質性研究的方法，檢驗此分析架構在實務應用上的參考價值。獲致成果包括：一、作者整理六個攸關的重要理論，以及六個彌平健康落差的實作法則，建構個案分析的初步架構；二、作者以量化研究方式獲得社經地位影響健康狀態的台灣實證支持。三、以駐在中國大陸的跨國企業生產基地實際發生的個案處理之質性研究，驗證前述之理論及實作法則的重要性與實用性。 本研究的限制包括：由於相關研究的結果將會因時、因地、以及理論依據、指標與應變項的選擇而有所差異，造成量化結果延伸性的限制；分析架構的應用則是得到初步的驗證，進一步的琢磨，猶待後續的努力。本文最大貢獻是：在這個跨領域的社會醫學或社會流行病學門的議題上，深化其與為國際企業管理的理論與實務上的連結，擴大一個新的研究分枝，並提供被遺漏的台灣經驗。

It has been a long time to explore the significance of social determinants of health (SDOH), still the academia knew little about to what extent multinational enterprises (MNEs) should contribute to this issue. There exist differences of various health outcomes in individual and population level, which are critical, pervasive, persistent and worsening. From a medical aspect, the scope of impacts includes rate of disease incidence, mortality, life expectancy, etc. On the other hand, the health inequities are key issue for scholars of medical sociology and social epidemiology, decision makers of health policy, and advocates of social justice and human right. In addition, as neoliberal globalization has become the dominant ideology resulting underinvestment in national infrastructures, which may further jeopardize the disadvantaged to assess diminishing social welfare resources. The appeals of mega-MNEs that are wealthier than most of the nations to contribute more in population health have become more and more urgent and pressing than ever. As the health inequalities of socioeconomic statuses are contingent on time and space, the author is curious about the relationship of socioeconomic status and health outcomes in Taiwan? Unfortunately, there are few evidences from local researchers, not to mention those involving the role of MNEs. The purpose to this study is to exploit author’s interdisciplinary advantage to explore this multi-factorial, multi-level and multi-dimensional topic, hopefully it can provide the missing part of Taiwan evidence. The research questions and methods are as follows: (1) to construct an analytic skeleton through literature review on SDOH theories, global initiatives and national coping strategies; (2) to utilize two population based data-bases to examine whether there exist social differentials in health outcome in Taiwan; (3) to examine the value of aforementioned analytical framework in a true case happened on a Taiwan-based MNE through qualitative approach to define the role of MNEs in (population) health promotion. The results include: (1) the author has constructed a primary analytical framework with six relevant theories on SDOH and six guiding principles to mitigate health inequities through a comprehensive review of literature; (2) the findings of our quantitative study support extant evidences; (3) the case study also shows the significance and practicability of our framework in explaining the measures and strategic considerations in crisis management. As research findings vary due to differences in time and space, the theoretical bases, selection of measuring indexes and outcome indicators, it will limit the generalizability of this study. The analytic framework has passed its clinical test, however, more efforts are needed for further refinement. The main contributions of this study are ‘advancing the connection of theories and practice of international business with this cross-border social medical research field, providing Taiwan evidence to complete the missing link of global researches on SDOH, and creating a novel research field for researchers of International Business.’