ANH HUdNG CUA CAC YEU TO KINH TE - XA HOI DEN Strc KHOE CON NGUdl
DAO THI MINH HlTONG*
Tic khda: sue khde, yeu td dnh hudng, thu nhcq?, gido due. thue phdm, tiin bg trong y khoa.
chinh sdeh.
Ngdy nhdn bdi: 30/10/2019. ngdy giri phdn bi^n: 31/10/2019. ngdy duy$t ddng bdi:
16/12/2019.
1. Cdch xae djnh cdc yeu to anh hirffng den sire khoe
SiJrc khde, lau nay van du<?c xem nhu la trinh trang khdng cd b?nh t^t, dau ySu. Tuy nhien, theo djnh nghia cua To chuc Y t^ thg gidi (WHO), khai niem ve sue khde bao hdm y nghla rpng hem - do la "mpt trang thai thoai mai ve the chat, tam thhn va xa hpi chOr khong chi dom thuan la khdng c6 bpnh hay tat" (Constitution ofthe WHO, 2006). TCr mpt phia, sue khde la nguon lyc gia tri giiip cho con ngucri Iam chii ban than, x5 hpi va ddi song kinh te, cho hp su tu do lam viec, hpc tap va tham gia tich cyc vao ho^t dpng gia dinh, ddi song cpng ddng, tu phia khae, siic khde ciia ca nhan va cpng dong chju anh hudng ciia nhieu yeu td khae nhau, trong do cd cac yeu td kinh te - xa hpi.
Cac nghien cuu da chi ra tinh trang siic khde ciia mot ngudi bj anh hudng bdi nhieu yeu to trong dd cd cdc yeu to lien quan den ca nhan, cac yeu to moi trudng va yeu to kinh te - xa hpi (WHO, 2010). Chi tieu cho y te, thu nhap va giao dye co tac dpng ddng ke den sue khde dan s6 (Heijink va cpng su. 2013; Moreno - Serra va Peter Smith, 2015). 6 nhiem moi trudng va 16i song (dSc biet la hiit thuoc va uong rupu) thudng cd tac dyng xdu d6n sue khoe (Shaw, 2005). Mpt sd it cong trinh nghien ciiu da ket hpp cdc bien phdn dnh tinh trang thdt nghiep, danh myc nghe nghiep hoac bat binh ddng thu nh^p trong mdi quan he vdi sue khde vd phat hien thdy muc dp dnh huong ciia cdc bien nay den sue khde la khae nhau (Lin., 2009).
Cdc ySu td sau ddy thucmg dupc xem nhu la cac yeu td sue khde va dupc phan loai:
Yiu td di truyin id yiu td sdn co vd thuang khdng thay doi duac trong mgt thdi gian ngdn. ddng vai trd it nhiiu dnh hudng din tuoi thg. the trgng. ciing nhu vi^c hinh thdnh mgt sd bC'nh lgt, Tuy nhien. chi do dinh dudng vd ldi sdng ed the cdi thien tdc ddng gen di truyin din strc khoe theo hudng tieh cue. l^i vdy. yiu td di truyen chi quyit dinh-din sue khde mgt phdn ndo chir khdng phdi Id tdt cd.
' TS.; Vi?n Nghien CLTU Con ngufri. Vi?n Han lam Khoa hoc .xa hpi Viet Nam.
NghlSn oiu Con ngudi so 6(105) 2019
Ddo Thi Minh Huang
Gioi tinh tao ra str khae biet \i the chit chiic nSng \'a \ ai tro khae nhau giSa dan ong va phti nii. vi thi no tac dpng din siic khoe diroi biiu hi?n djc thu cac djng b?nh t?t hay gjp phai ctia dan ong \a phy nii. Dan ong chju nhieu hon ganh nSng b?nh tat tir cac c a gay nghi&n va rui ro nghi nghiep. Phy nir thirong chiu ganh nSng b?nh t?t do thieu bi?n phap tranh thai, thiiu hut dinh duong trong qua trinh mang thai va b?nh do 6 nhiem trong dun nau (WHO. 2016).
Cac yiu to hanh \ i ca nhan va lii sing nhu chi dp dinh dirong, hojit dpng the lyc, hut thuoc. uing rupu. each dii pho vcri cac cSng thing,... diu 14 nhiing yiu ti anh hirong tieu cue ho^c tich circ toi siic khoe.
Cac yiu ti moi trucmg \\f nhien nhu chat lupng nuac, chit lupng khong khi, tieng on, nhift dp. thien tai. diu co anh huong din siic khoe. Theo thong ke cua WHO. trung binh cii moi nam co tren 9 trieu ca tii vong vi 6 nhiem moi trucmg tren toan the gioi.
Trong do 7 Uifu nguoi bj chit \ i 6 nhiem khong khi, chiim khoang 11% si ca tu vong tren toan ciu'- va 1,8 trieu ca tu vong do cac b?nh ve duong tieu hoa va nhiem ki sinh trimg CO lien quan den 6 nhiem nguon nuoc^.
Thu nhap va tinh trang \i hpi, vipc lam \a dieu ki?n lam viec la nhiing yiu ti quan trpng CO tac dpng true tiep den stic khoe. Hau het cac quan diem cho rang, nhiing nguai CO thu nhap cao va co viec lam on dinh vol moi truong lam vipc tot thuang co sure khde icM hon phan con lai.
Chinh sach va quan li nha nuoc cimg vol tien bp trong kT thuat y te la yiu t i quan trpng tac dpng den stic khoe thong qua vai tro quan li, dieu tiet va kiem sodt he thong y te trong cham soc stic khoe, dieu tri benh tat cho con nguai.
Giao due la yeu to co anh huong nhieu den nhan thirc, hoat dpng sing, vi thi xa hpi, eac quan he gia dinh va quan he xa hpi cua con nguoi trong suit chu trinh vong doi va co tac dpng khong tiho den siic khoe. Trinh dp hpc van thap ciia ca nhan dupc cho ring c6 moi lien quan voi siic khoe yeu kem, cang thang hon trong cupc sing va kem ty tin.
Trong so cac yeu to ke tren, mpt si yeu to co thi thay dii hoac kiim soat dupc vi dy nhu moi nguoi co the chpn cho minh mpt lii song lanh manh, bao gim chi dp an uing, lao dpng, tap luyen va nghi ngoi. Hay nhu, chinh phii cac nude ban hanh chinh sach va uu tien nguon lyc nang cao kha nang tiep can ciia nguoi dan va cai thien chit lupng cac djch vy ; te. nang cao chat lupng moi miong sing,... Tuy nhien co nhQng yiu ti nhu di
' "How air pollution is destroying our liealtti", (tinps://www.wtio.inl/airpollution/news-and-events/liow.ai poliution-is-deslroying-our-tiealth).ngaytnjycap2l/9/20I9. ' '~
• "Ambicnl air pollution". (tilTps « w w.wtio.inL'gtio'plic^outdoorairjxjiiulion/eiVE), ng4y truy C9p 21 /9/20 j q ' "Ambient air pollution". (tmps:/'ww\^ \^ho inL'gtioptie/outdoorairjjollution/en/E). ngiy tnjy c ^ 21/9/2019
^ NgNSn CM Con ngudf »6t(10S) 2019
Anh hudng cUa ede yeu to..
truyen thi khd de thay ddi, nhung cd the mpt phdn dupc kiem soat vd cai thien nhd bien phap can thiep y te va nang cao the luc ca nhan. Vdy nhiing y^u id ndo thyc su dnh hudng den sue khde con ngudi vd trong dd dau la yeu td quan trpng nhdt, cung nhu y^u td nao cd the la nguy ca gay mat an ninh sue khoe? Day Id tranh ludn khong cd hdi ket vd dudng nhu cac nha khoa hpc di den thda hiep Id yeu td dnh hudng quan trpng, cung nhu y^u td ndo CO the trd thanh nguy ca gay mat an ninh sue khde phu thupc vdo bdi canh phdt triin toan cau va boi cdnh phdt trien kinh te - xd hpi timg qudc gia (Agus Deaton, 2013). Thda hi?p nay c6 cdn cii tu viec md hinh benh tdt cd sy khde biet dang kk giiia cdc qudc gla thu nhdp cao, thu nhap trung binh va thu nhap thap, vd nhu vay, cdc yiu td anh hudng quyit djnh den tinh trang siic khde ngudi dan cung khde nhau. Doi vdi cdc nude cd thu nh^p cao va trung binh thi cdc yeu to siic khde quan trpng nhit dupc cho la co lien quan din cde b?nh mdn tinh nhu b?nh tim mach, ung thu. Trong dd hut thudc la, mpt yiu to trong ph^m trii hanh vi ldi sdng la mpt trong nhung nguy co hang ddu cho cd hai loai b?nh tren chiem 11 % ganh nSng b?nh tat vd 18% ttr vong d cdc nude cd thu nhap cao. Ben c^h dd, su dyng rupu, beo phi va tdng huyet dp cung dang ddn dau nguyen nhdn ciia nhiing ndm cupc song khde manh gidm di, chiem tir 6 - 7%^.
Trong khi do 6 cac nude cd thu nhap trung binh, ben canh rui ro ddi vdi cdc b?nh man tinh ciong gay ra phan lan cdc ca tii vong va ganh ndng benh tat thi nhiing nguy ca nhu quan h? tinh dye khong an todn, dimg nude khdng an todn vd ve sinh mdi trudng khdng tot eiing gdy ra phdn ldn hem gdnh ndng benh tdt so vdi cdc nude cd thu nhdp cao. Trong khi dd, d cdc quoc gia cd thu nhdp thdp, nhiing nii ro nay thuang bao gom vi?c tdng ti 1?
ho$c muc dp nghiem trpng ciia cac b?nh truyen nhiem va suy dinh duang. Tinh trang suy dinh duang, thieu vi chat (sdt, vitamin A va kem) vd cho con bii dudi mirc tdi iru Id nguy co hdng dau vd Id nguyen nhan gdy nen 7% cdc ca tii vong va 10% tong ganh ndng b?nh t^t. Ganh n?ng kit hpp tir nhirng nii ro dinh dudng d cac nude thu nhdp thap gan nhu tucmg duang vdi todn bp gdnh nang benh tat va chdn thucmg ciia cdc quoc gia cd thu nhdp cao*. Cac yiu to sire khoe nguy ca khdng chi khae nhau giQ:a cac qude gia d cdc miic dp phat triin khde nhau, md cdn thay ddi dang ke theo dp tudi. Vi du che dp thyc pham, chat lupng mdi trudng vd khdng gian sdng cd tdc ddng rat ldn den siic khoe tre nhd va tre vi thdnh nien, cd khd ndng dl lai di chung ddi vdi siic khde cho nhirng giai doan phdt trien tilp theo cua diia tre. Ddi vdi ngudi lan, hdu het cdc gdnh nang benh tat bat nguon tir cac chdt gdy nghi?n, quan hp tinh due khdng an todn, thieu bien phap trdnh thai, thieu sdt vd
* BO Y t^ vk cic doi tic. Bdo cdo long quan ngdnh yte, 2014.
' "Cac y£u t6 nguy ca tdi siJc khoe", (https7/ww\v.moh.gov.vn/web/phong-chong-benh-nghe-nghiep/thong-tin- hoai-dong/-/assel_publisher/xjpQsFUZRw4q/content/-cac-yeu-to-nguy-co-toi-suc-khoe?inheritRedirect=falsc), ngiy truy c§p 18/9/2019.
Nghl6n cuu Con ngudi s6 6(105) 2019
Ddo Thj Minh Huang
lam dyng tinh dye xa> ra 6 nhitng ngucri tte tuii. Con ganh n ^ g b?nh t^t tir cae >cu o nguy CO dii voi cac benh m§n tinh nhu benh tim mach va ung thu thucmg xay ra o lua luil lon hem.
2. Cac yeu to kinh Ic - la hpi anh birffng den sire khoe
Cac yiu ti kinh ti - \i hpi qu>it djnh din siic khoe la nhiing dieu kien trong do mpi nguoi dupc sinh ta. Ion len, sing, lam vi?c. gia di va ca h? thing y ti. Nhihig dieu kipil nay dupc hinh thanh boi su phan bi quyin lyc. tiin b?c va cac nguon tai lyc o cac cap dp todn ciu, quic gia va dja phuang (WHO. 2008). Cac yiu ti kinh ti - xa hpi quyet djnh din sire khoe con nguoi la mpt linh vyc duoc quan tam nghien cira dSng ke vi vipc dua ra chinh sach xa hpi hpp li dya tten co so thuc chimg c6 tac dyng rat lon doi viii vipc ca^
thipn sire khoe ctia cac cpng ding dan cu Noi each khae. giai quyit vfin de cac yeu to kinh ti - xa hpi quyit djnh din siic khoe la di cap din vipc lam thi nao di cic chinh sach kinh ti - \i hpi co anh huang tich cue din sire khde va giai quyit "nguyen nhfin cua nhiing nguyen nhfin" bpnh tat.
Cac dicu kipn vi thu nhap. giao dye. viec lara, thyc phfim, tien bp y ti va chinh sach deu la nhiing yeu ti quan trpng tac dpng khong chi din sire khoe mfi con gay ra bat binh dang vi sire khoe a cap dp ca nhan va cip dp cpng ding, trong do siic khoe kem co lien quan din bit lpi x5 hpi va kinh te. Nhu mpt si tac gia da chi ra su phan phii khong dong diu cac yiu ti xa hpi va kinh ti ctia sue khoe nhu thu nhap, viec lam, giao dye, nha 6 vi moi Uvcmg, tiio ra sy bat binh ding vi siic khoe (Graham H, Kelly MP., 2004). Do d6, cac >iu to quyit djnh sire khoe co lien quan mpt each c6 he thong vtji bat lpi xa hpi va yeu ti ben li (Braveman, 2003). Hon nOra, mpt so nha nghien cim cho rang sy khfic bi^t IcVn vi thu nhap khong chi gay ra sy bat binh ding ve sue khoe, ma con co the gfiy bat lpi cho sire khoe dan si (Kate E. Pieken, Richard G. Wilkinson, 2015).
2.1. Anh hudng eda yeu to thu nhgp den sue khde
Khi xem xet vi yiu to anh huang den sue khoe, cac tac gia thucmg tap trung xem x6t moi quan he gitra thu nhap va tuoi thp. Xu the chung - cung nhu cac ngoai le ve moi quan h? nay da dupc nhfi dan so hoc Samuel Preston dua ra. Trong nghien ciru vao nam 1975
"The changing relation between mortality and level of economic developmen", ong phat hi?n ring tuoi thp vfi thu nhap c6 tuong quan thuan. Theo ong va cac nha nghien ciru sau do nhu Angus Deaton, nhtmg ngucri co miic song vat chfit o mirc thfip tihu hau het ngucri dan 6 chfiu Phi tieu Sahara - cung thuong la nhimg ngucri co sire khoe khong tot va ganh nang bpnh tat cao. Tuoi thp thap hem va ti le hi vong cua tte em a day cao hem hai lan so vai cac nuoc phat Uien. Can phai nhan manh ring, cac nghien cim nay khong chi ra mii quan he tu>in tinh giiia thu nh^p va sire khoe, nghla la khong khing djnh ring cir thu nhap cao thi
Nghiin cliu Con ngitM stf Sflos; 201s
Anh hudng cua cdc yeu to..
ngudi dan sS cd sue khde tot han, hay ngheo ddi gdy ra hien tupng thudng dupe gpi la "cac cdn b?nh eiia ngudi ngheo". Nhimg quan he tren Id khdng the phii nhan vi thu nhap cd vai trd quan trpng vdi sue khde d nhOtig moc phat trien kinh t l - x a hpi nhdt dinh. Cy thi, theo cdc tdc gid, thu nh|ip ddng vai trd rat quan trpng d nhimg nai md viec cai thien siic khde doi hdi phdi cd nhieu dinh dudng hem, can cd nuoc saeh va dilu kien ve sinh, y tl tdt hem, nhu d cdc nude thu nhdp thap va thu nhap trung binh thdp, nai ganh nang benh tat tap tnmg vdo b?nh truyen nhiem va suy dinh duong. 0 nhihig nude nay, gia tang siic khde, d^c biet la tudi thp. chiiu eao, gidm ti lp tir vong d tre em vd tdng tudi thp trung binh phdi din tir vipc kiem sodt benh tat thdng qua cdc bien phap y te edng cpng va tiem chung va chiing ti 1?
thu^n vdi gia tdng thu nhgp, ngudn lyc dau tu cho he thdng y te, lucmg thyc vd vp sinh mdi trudng. 6 mpt thai cyc khde, khi tudi thp trung binh, hay chieu cao tiim ndng dd dgt mure eao nhu d Nhgt Bdn, hay d MT vd mpt sd nude phat trien khde, thi vipc tilp tyc gia tdng nd s5 trd nen khd khdn, ngay ed khi thu nhdp cd tang len. Ciing d cdc nude phdt triin ndy, khi gdnh n§ng bpnh tdt tap trung vdo cdc benh khdng truyen nhiem nhu tim mach, huyet dp thi khi dd moi tuang quan thu nhgp vd tinh trang siic khde, trong dd cd tudi thp vd chieu cao cdng ft thdy r6 hon (Samuel Preston, 1975; Angus Deaton, 2013). Vd ciing tir day da xuit hi^n mpt s6 nh^n djnh cho rdng khong cd mdi quan he giua thu nhap va tudi thp d cac nude gidu tren thi gidi (Richard Wilkinson, 1994; Kate E. Pickett, Richard G. Wilkinson, 2015).
Ndi vl moi quan hp phi tuyen tinh giua thu nhgp va tinh trang siic khde, ben canh vipc quan hp nay phy thupc vdo miic dp phdt trien kinh te - xa hpi ciia mpt qudc gia, cac tdc gid cdn nhan manh den nguyen nhan khde nhu chien tranh vd dieh benh da dan den vipc mpt so nude cd ket qud ve siic khde khdng tuang thieh vdi muc thu nhgp ciia hp. Vi dy bpnh djch HIV/AIDS d mpt s6 nuoc chau Phi da lay di todn bd hay hdu het nhimg tien bp dgt dupc trong tuoi thp tir ehien tranh The gidi ldn thii hai. Viec phan tich cdc trudng hpfp d$e trung md d dd kit qua siic khde tdi han trong tucmg quan vdi thu nhap vi dy nhu Nga vd MT hodc kit qud ve siic khde tdt han miie ki vpng tuomg iing vdi thu nhgp, vi dy nhu Nepal, Vipt Nam, Trung Qudc, Chile vd Nhdt Ban, cho phep ede tdc gid kit ludn rdng cd nhiing each de ddm bao siic klide tdt vd an ninh siic khde d miic thu nhdp thdp vd ed nhQng chinh sdch bdt hpp li dan din vipc tieu khoan tien ldn khong hieu qud (Samuel Preston, 1975; Angus Deaton, 2013).
Cdc cdng trinh nghien ciiu khae ciing da chi ra rang chi tieu cho y te vd thu nhap thudng c6 tde dpng mgnh hon din viec giam ti Ie tii vong ddi vdi nhirng benh H cd the phdng trdnh dupc va giam ti 10 tii vong tre sa sinh hem la lam tang tudi thg ciia ddn so (Heijink vd cpng sy, 2013). Cac yeu td dpng eiing ddng vai trd quan trpng, vi du, suy thoai kinh te tam thdi dd cho thdy nhieu dnh hudng khae nhau din kit qud sue khde, lam xau di siie khde tam thdn
Hgt\tin ciAt Con ngtM sd6(10S) 2019
Dao Thj Minh Huon^
nhung ciing cd khd ndng lam giam ti le tir vong chung do tai nan giao thdng \ a o nhu-m mdi trudng giam (Kees \'an Gool va Mark Pearson, 2014).
2.2. Anh hir&ng eda yeu to nghe nghi&p den sire khde
Mdi trudng lao dpng vd tinh chat cdng \ iec ciing Id mpt yiu to quan trpng anh hucmg din siic khde. Sdng \ a ldm vipc uong mdi trudng khdng hpp vp sinh. khdng an todn hoge d nhiem cung lam tdng ngu; co bj bpnh hodc tir vong (Deguen vd Zmirou-Navier, 2010).
Anh hudng nay thi hipn thii nhdt d tai nan nghi nghipp, ma cd t h i dan din tii vong ho$c gdy thucmg tich d cac miic dp khde nhau. Tmh trgng that nghipp vd dilu kien ldm vipe kdm thudng anh hudng xdu din siic khde tam thdn. mpt so nghe nhdt djnh cd nguy co b) chdn thuang n^ng han. Sd lieu thdng ke ciia WHO eho thdy cd khodng han 350.000 edng nhan tii vong moi nSm do tai nan Iao dpng. 6 nam gidi trong dp tuoi tir 15 - 59, 8% tong ganh ndng thuang tich khong chu y la do chdn thucmg vipc lam tai cdc nude thu nh§p cao, 18% d cdc nude cd thu nhgp thdp vd trung binh^. Ben canh tai nan nghe nghipp, 6 nhiem khong khi, d nhiem tilng dn. d nhiem nude vd tiep xiic hda chat trong cdng viec la nguyen nhdn gdy tir vong vd gdy bpnh mdn tinh. It nhat cd 150 tdc nhdn hda hpc vd sinh hpc trong Iao dpng cd the gay ra bpnh img thu, mde dii b?nh ung thu nghe nghiep ed the ngdn ngira dupc thdng qua logi bd, thay the cac vgt lipu an todn, quy trinh vd hp thong thdng gid. Tren the gidi, 8% ung thu phdi Id ude tinh phd bien nhdt eua ung thu nghe nghi?p. Phoi nhiem nghe nghi?p vdi cdc hat khong khi dupc uoc tinh gay ra 12% cdc ca tir vong do b?nh phdi tdc nghen man tinh. Ngoai ra, udc tinh cd khodng 29.000 trudng hpp tir vong la do bui phdi silic. ho di iing do silie, amidng vd liep xiic vdi bui than. Tieng on qua miic la mpt trong nhimg nii ro nghe nghi?p phd biin nhdt, ddc bipt ddi vdi khai thde khodng sdn, sdn xuat vd edng nhan xdy dung 6 cac nude dang phdt triin. Anh hudng nghiem trpng nhat ciia nd la khiem thinh. Hdu hit cac tilp xiic cd t h i duac gidm thieu bdng bipn phap kT thuat d l gidm tieng dn. Khoang 16% ngudi ldn mdt thinh luc tren toan the gidi Id do tiep xuc vdi tieng dn nghi nghiep'.
2.3. Anh hudng eda yeu to thtrc phdm din sue khde
Quan diem danh gia cao vai trd thuc phdm, eu thi id dinh dudng trong ddm bdo siic khde va khd ndng chdng lgi bpnh tat dupc dua ra vd phat trien trong nhilu nam bdi nha kinh te hpc dgt giai Nobel, Robert Fogel vd cac cpng sy. Theo cdc tac gid, dinh dudng la mpt yiu td quan upng uong viec gidm nguy co b?nh tat va gidm ti le hi vong sdm. Ca ehl
* Global Health Obscrvalon.' (GHO) data.
""Cic \i\i xii ngu> CO loi sire khoe". (https:/^*-rt-w.moh.gov.vn/web/phong-chong-benh-nghe-nghiep/thonB ti hoal-<k)ng/Vasselj)ublisher/xjpOsFUZRw4<V''conient/<ac-yeu-to-i]guyK:o-ioi-suc-khoe?mheritRedire^
ngfty tiuN c?p 18^/2019. ^ ' • g HgN*n c(Ju Con ngiM si 6(105) ZQn
Anh hudng cua cdc yeu td...
ndy dupc gidi thich nhu sau: tre em tieu thu tfaieu chat dgm vd ndng lupng, dan din ca thi thieu hyt vitamin va khodng ehdt, lam giam hipu qud qua trinh trao ddi chdt vd khd ndng hap thy cdc chdt dinh duong can thiet cho co the. Tinh trang thiiu edn va khdng dii chieu cao do suy dinh duang ldm tre de mac ede benh nhiem trimg. Ddi vdi tre nhd, sQ^ m?
khdng ddy dii ve lupng vd ddm bdo ve chdt cung Id nguy co gia tang b?nh tgt vd tir vong do thieu dinh dudng va khdng cd siic de khang. Thieu dinh duang va nhiing rui ro khde thudng cimg tdn tgi, tucmg tde ldn nhau vd ddng gdp vdo kit qud mde benh (Robert Fogel vd cdc cpng sy, 1997). Thieu dinh duang la nguyen nhdn ldn nhdt dan din ede ea tu vong vd Id gdnh ndng benh tat d tre em dudi 5 tudi, ddc biet trong dp tudi tir 6 thdng din 2 ndm.
Vi dy, tre nhd vd phy nG trong thai gian thai ki do thirc dn thiiu chdt dam de dan den thiiu mdu do thieu sdt. iTdc ti'nh cd khodng 41% phy nu: mang thai vd 27% tre em mdm non tren todn the gidi hi thieu mau do thieu sdt. Thiiu mdu, thiiu sdt Iam gidm tri thdng minh; nd cfing cd the dan din chdm phdt trien vd khuyet tat. Khodng 18% tii vong m? d cdc nude thu nhgp thap vd trung binh - gan 120.000 ngudi chet la do thiiu sdt. 40% tdng so gdnh ndng toan cau do thieu sdt xdy ra d khu vyc ehau A, khu vue Ddng Nam A vd cdc khu vyc chau Phi^.
Mdi quan hp thyc phdm vd sire khde khdng chi gidi han trong quan hp giOa vi$c dupc eung cap ddy dii thye phdm ve Iupng, ddm bdo ve chat vd tang tudi thp, thdng qua gidm ti lp chet sdm md ede nhd khoa hpc cdn ehi ra mdi quan he hai chieu theo hinh xodn oc giua ehe d$ dinh dudng vd miic thu nhdp eua mpt ngudi trong tuong lai thdng qua c^u trung gian Id tinh trang sire khde vd tri tup cua hp. De khdng dinh mdi quan he ndy, cde tde gid gidi thieh rang, dinh duang tdt han cho phep ca the to ldn han vd khde manh hem, nhd dd giiip ndng suat lao dpng tdng theo vd tao ra su hop lyc tich cue va hd trp lan nhau glQa tdng thu nhgp vd cdi thien siie khde. Khi ca the eua tre thieu chat dinh duong cdn thiet de phat triin, ndo bp khd phat triin din mirc tiim nang. Do dd, nhiing tre sinh trudng trong gia dinh day dii kinh te hon cd ca hpi phat trien ndo bd hon, cd nhieu kha ndng Id nhihig ngudi thdng minh han vd dilu ndy edng thiic ddy tdng trudng kinh te va day nhanh vdng xodn dc di len. Nhung ngudi cao to hon sdng lau hon vd tre em an dii ehdt hon it cd khd ndng tir vong hon vd cd khd ndng ehong lai benh tdt tdt hon (Robert Fogel vd cdc cpng sy, 1997).
M^c dil khdng dinh thiic dn nhilu hon vd tdt hon hay dinh duong tdt hon Id mgt yeu td cd ve hpp li lam giam ti lp tu vong d cdc nude ngheo trong thdi gian gan day, ede tdc gid
' "CSc y i u t6 nguy co tdi sOrc khoe", (https:/Avww.nioh.gov.vn/web/phong-chong-benh-nghe-nghiep/thong-tin- hoat-<iong/-/asset_publisher/xjpQsFUZRw4q/content/-cac-yeu-to-nguy-co-toi-suc-khoe?inheritRedirect=false), ngiy truy c$p 18/9/2019.
Nghiin cAi Con ngutH si6(10S) 2019 9
Ddo Thj Minh Huang
ciing quan ngai va canh bao xu huong vi kha nfing du thira dan den bio phi v4 mOl so b^nh khfic d nhimg nguai fin qua nhiiu chir khong phai fin qufi it ho^c fin lo»i thuc fin khong c6 chfit lupng va khong dam bao an tofin thyc phfim (Robert Fogel, 1994; Robert W. Fogel vfi Dora L. Costa. 1997). Bao cao diiu tien v i ganh n ^ g benh t?t truyen qua thyc phfim tren toan cfiu do WHO cong bd cho thfiy ginh nfing b?nh t | t cfic b«nh truyen qua thyc phfim cung tuong duong ganh nfing ciia ba b?nh chinh (HlV/AlDS. lao phoi va sot ret) (Havelaar et al.. 2015). Tir mpt danh sfich dai cac m i i nguy tiem tang truySn qua thuc phfim. sau do duac gifim \ u i n g vi cfic li do kh6 kiim chumg, nghien cilu cuoi cimg cua nhom nghien cihi djch te hoc v i benh djch thyc phfim - FERG cua WHO dua ra 3^1 mil nguy gay benh qua thuc phfim, bao g i m 11 mil nguy gay b$nh tieu chfiy (1 mot nguy Ifi vi riit, 7 mii nguy Ifi vi khufin va 3 mii nguy Ifi dong vat nguyen sinh), 7 moi nguy gay benh truyin nhiem xam Ifin (1 m i i nguy Ifi vi rut, 5 m i i nguy Ifi vi khuan vfi 1 moi nguy Ifi dpng vat nguyen sinh), 10 m i i nguy Ifi giun san va 3 moi nguy hoa hge. Ket hop vdi nhau hofic rieng re. 31 mii nguy hiim tofin cfiu dfi gfiy ra khoang 600 (chfic chfin khoang 95% trong khofing tir 420 - 960 tti?u ca benh truyin qua thuc phfim vfi 420.000 ca (chic chin khoang 95% trong khofing tir 310.000 - 600.000) ca tu vong trong nfim 2010 (WHO. 2015). Cfic benh do thuc phfim khong an tofin vfi ngp dpc thyc pham dang thu hilt nhiiu sy chii y o Viet Nam do co nhiiu thong tin va ket qua diiu tra v i nguy c a thyc phfim khong an tofin trong chuii thyc phfim tir trang trai den ban fin. MSc dii dil li$u ve b?nh do thyc phfim khong co sin o cap quic gia, nhimg cfic chuyen gia dong i rfing ti 1?
mic b?nh thyc phfim co thi tuong ty cr Viet Nam so vcri cfic q u i c gia khae trong khu vuc.
Diiu nfiy ngy y ring b?nh thyc phfim co the chiu trfich nhi?m cho khofing 7% gfinh nfing b^nh truyen nhiem. Sir dyng h? thong xep hang ciia WHO ve cfic benh quan trpng, benh thyc pham co 16 s6 xep thu 29 a Vi?t Nam. Tire la b?nh thyc phfim it quan trong hon dpt qyy, chan thuong hofic benh lao nhung quan trpng han benh sai, b?nh bach cfiu hofic b?nh tim, tfing huyet ap. Nhu vay, benh thyc pham co the vfi nen dupc coi la mpt van de sire khoe cpng dong quan trpng a Viet Nam, nhung mfit khae, khong nfim trong so cfic uu tien hang dau (Havelaar AH, et all, 2015).
2.4. Anh hudng cua yeu lo tien bp trong y khoa den sire khde
Tim hieu nguyen nhan ciia viec chuyen djch tuoi thp theo thai gian vfi theo mirc thu nhap. Samuel Preston phat hien ring co mot vfii yeu to mang tinh he thong ma khong phai Ifi thu nhap. ciing la nguyen nhfin lha\ doi tuoi thp. Theo ong, tham chi k i cfi khi khong c6 tha\ doi gi uong thu nh^p thi tuoi thp con ngucri cung tfing theo thcri gian tren pham vi toan thi gitiri, t^i cfic nuoc thu nhap thap vfi cfi nude thu nhap cao. Ong gifii thich nguyen nhfin
- NffWAj cOu Con ngudi t^Sflos; 20J9
Anh hudng ciia cde yiu td...
tdng len dd la do tiln bd khoa hpc vd kien thiic y te, hay it nhdt la viee ngay cdng dp dyng nhilu hem tren thyc t l cdc tri thiic khoa hpc vd y te sdn cd (Samuel Preston, 1975). Vi?c san xudt ra cde loai vdc xin tiem ehiing dd eiiu hdng trieu mang sdng d tdt cd cde nude, d^c bi?t ta d ede nude cdn kem phdt trien. Viee nghien ciiru vd sdn xudt cdc loai thude, thyc hanh cac bi?n phap can thiep y khoa tien tien da keo dai tudi thp ciia con ngudi, ciing nhu giam nhp gdnh ndng bpnh tdt vd di chiing bpnh tat cho ngudi benh.
Miic thu nhgp, trinh dp y te duong nhien la ciing cd dnh hudng d i n tinh trang siic khde, nhung dau Id yeu td quyet djnh dan den siie khde tdt hon hay kem di lai ludn Id ehu d l tranh lugn giiia cac nha khoa hpc. Ngudi sang lap ngdnh y hpc xd hdi, Thomas Mckeown dd dua ra mpt logt cac dir li?u eho thdy ti le hi vong ciia rdt nhilu benh tgt dd gidm tir trudc khi phuong phap dieu tri hieu qud ra ddi vd van tiep tyc gidm vdi cimg miic sau khi eae phuang phdp nay xuat hi$n. Chi ra dieu ndy tde gia ham y rdng, ngudn gdc ciia nhung cdi thi?n ve siic khde, nhu ti le tii vong gidm khdng phai do tien bp y khoa quyet dinh ma Id ede tien bp ve kinh te - xd hpi, dde biet Id dinh dudng va dieu kien sdng tdt hem (Thomas Mekeovm, 1980). Ong la mpt trong nhimg ngudi dau tien nhdn thdy rdng vipc chi tap trung vdo nhihig nd lue chuyen mdn trong y te eiing khdng giup ieh gi nhieu trong vipc gia tdng sue khde cpng ddng ma la viec cdi thien tinh trang ngheo ddi, thieu thdn,* mat vp sinh, nhimg nguyen nhdn eo bdn ciia sire khde kem. Chinh vi vgy, nhirng ngudi theo quan diem nay cho rdng vipc tdt len ctia eac dieu kien vdt ehdt quan trpng han nhieu so vdi tien bd y khoa. Ngupc Iai vdi quan diem nay, Rieharrd A. Easterlin, nha kinh te hpe khdng dinh miic dp quan trpng han cua tien bp y khoa so vdi tdng thu nhap trong viec ddm bao siic khde bdng each ehi ra rdng, niu ddi chiiu v l thdi gian thi thda diim bat dau phdt triin kinh tl vdi thin diem cd nhimg cdi thien v l siic khde khdng triing khdp (Richard A. Easteriin, 1999).
Cung theo quan diim nay, mot s6 nghien ciiu tiep theo chi ra rang nguyen nhan ehinh cho vipe gidm ti If tir vong d tre em vd tdng tudi thp trung binh ben eanh viec dam bdo dinh duang cdn phdi kiim sodt benh tdt thdng qua cdc bien phap y te cdng cpng vd can thiep y khoa. Ban ddu dd Id edi thien dilu kien sdng, cy thi la dilu kien ve sinh va cung cap nude sgch (phy thudc nhilu vdo khd ndng tdi chinh ciia cap chinh quyen trung uong va dia phuong) va sau dd Id dya vdo khoa hpe y tl, dae biet la li thuyet ve mam benh, co ehe truyin nhiim va tiln bp v l edng nghe y khoa. Cdc bien phdp nay bao gdm tiem ehung thudng ki chdng Iai benh truyin nhiim va dp dyng cdc quy tdc tdt ve siie khde ca nhdn vd cpng ddng dua tren li thuyit v l mdm benh. Va tilp theo la dp dyng tien bd ve cdng nghe y tl vd tiln bp trong nganh dupe ddi vdi ean thiep v l sue khde tai cac nude phat trien, noi ma ganh ndng benh tgt Id bpnh khdng lay truyin chii khdng phai benh truyen nhiem trong dieu
NghlSn ctiu Con nguH s6 6(10S) 2019
Ddu Thj Mmh Huong
ki?n V? sinh kem va h? tfing > t i khong dfi\ du. Diji di?n cho quan diem nfiy. nha N khiu hpc Samuel Preston uoc tinh ring chua den mpt phan tu miic gia tfing tuoi thp tnmg binh giiia nhimg nfim 1930 vfi nhimg nfim 1960 14 nhft gia tfing muc sing trong nu*;, c n Uu phan lan la nho kiim sofit vecter truyen b^nh, cfic loai thuic moi va tiem chung. Preston dfi phfit hi?n va kit luan ring vi?c giam ti 1? tir vong o chau Au vfi Bic MI trong giM ^ ° 9 "
tir nfim 1850 - 1950 chu yiu nho vao cupc chinh phyc djch bpnh bing each thuc moi de gifil quyit vfin d i sire khoe. voi tfing truong kinh t i dong mpt vai tro quan trpng nhung thu yeu (Samuel Preston, 1975).
Quan diim ciia cfic tfie gifi theo cfic tnrcmg phai khae nhau nay, sau khi diroc cap nhat theo hoan cfinh th&i hi?n dai van dong vai tro quan trpng trong cac cupc tranh luan ve vai tt* then chit dii vdi site khoe cua nhimg sang kiin trong y t i va dieu trj hay ciia yeu to tfing miong kinh ti. Cfic tfie gia sau nfiy dfi co nhiing ghi nhfin khae nhau ve dong g6p ciia tiin bp y hpc va thu nhjp doi vtji vi?c cfii thifn tmh tt?ng siic khoe vfi khong phai cac y kien luon dong thuyin.
2,S. Anh hudng eda Irinh dg gido due den site khde
Mil quan he hpc vfin vfi tinh trang sire khoe Ifi mii quan h$ gifin tiip, dupc David Cutle, Angus Dealton vfi Adriana Lleras - Muney ehi ra thdng qua nhan djnh ring mpt phan cua vi?c phong chong vfi diiu hi b?nh lien quan din tinh chii dpng ciia cfi nhan duy tti th6i quen fin uing tit, tip luy?n, nghi ngoi diiu dp va djnh ki den bac sT de thfim kham siic khoe - mpt th6i quen t i t b6i nhimg nguoi co hpc thtic cao hon, kha gia hem va von khoe mgnh hon. Cfic tfie gifi danh gifi gifio due nhu yiu to tfie dpng den sue khde thong qua phan tich tiin bp ve gifio dye cua phy nG ngay nay so vol truoc kia vfi finh hucmg cua giao dye den cfich ma hp chfim soc sire khoe cho gia dinh vfi dac bi?t la dua tte ciia minh. Ro rang ring, phu nir ngay nay co nhieu co hpi hpc hanh hon, nhieu each tiep can vfi chpn lpc thong tin hon, chinh vi vay cfich hp chfim soc bira fin, giac ngit vfi huong dan thoi quen, hanh vi cho cfic thanh vien ttong gia dinh cung khfic hon (David Cutle, Angus Dealton vfi Adriana Lleras - Mimey, 2005). Dong quan diem nfiy, Mackenbach vfi cpng sir cho rfing nguoi co hpc thtrc hon thucmg eiing co thu nhap kha hon, co the nhfin dupc thong tin tot hon v i cfic ho?tt dpng tim kiem siic khoe (Mackenbach vfi cpng sy, 2008). Theo cfic tfie gia, ngay ca khi phy nii chi c6 mpt it so nfim den truang thi ciing c6 th§ la ngu6i m? co chi dan v i sire kh6e tot hon vfi an tofin hem so voi cfic ba me khfic. De chiing minh cho li^n diim nfiy, cfic tfie gia vien dan kit qufi nghien cim tir An Dp va cic nucrc khae v i kha nfing sing s6t cao hon va phfit trien tot ciia nhimg dua tre sinh ra ttong gia dinh mfi m? c6 hpc vin cao hon so v6i nhiing diia tre trong gia dinh m? co hpc vfin thap hon.
Ngniinctki(UuingtAil»6 9(105)2019
Anh hudng cita cdc yeu to...
Kit qua nghien eiiu cdn eho thdy phy nvt nhdn dupc gido due thudng ed it con han vd cd the ddnh nhieu cdng siie vd thdi gian han eho moi diia tre. Viec sinh con it hem eung tdt cho cde ba me, ldm gidm nguy eo siic khde Hen quan den mang thai vd sinh con vd cho phy nif nhieu co hpi hon trong cupc sdng cua ehinh hp. Mdt ludn diim hit siie quan trpng dd dupc dua ra vd cdn gdy tranh luap dd Id tiln bd trong giao due ed le la nguyen nhdn quan trpng nhat giiip mpi ngudi cd sire khde tdt han d cde nude cd thu nhap thdp hipn nay (Angus Deaton, 2013).
2.6. Anh hudng cua yeu to chinh sdch vd qudn linhd nude din y«t khde Khi ban din cac yiu td quan trpng trong viee phdng chdng vd kiim sodt benh tdt vd eao hon Id dam bao an ninh siic khde thi khdng the khdng nhdc din vai trd ciia Nhd nude vd chinh saeh ban hdnh. Chinh vi dong vai trd quan trpng nen viec cung cap djch vu chdm soc siic khde khu vyc cdng mpt each cong bdng vd dieu tiet hpp li dieh vu chdm soc siic khde khu vyc tu nhdn la chire nang khd khdn nhat vd gdy tranh cdi nhilu nhdt ciia ede chinh phii. Angus Deaton khi nghien eiha vai trd nhd nude trong viee eung cdp djch vy chdm sde siic khde va mdi trudng y te cdng cpng cho rdng vdn de khdng chi ndm d cho chi bao nhieu ngan sach cho y te ma can phai tap trung vdo nhihig gi can dupc thuc hipn, lp trinh thye hipn vd ai thyc hien (Angus Deaton, 2013). Theo dng, de kiem soat mpt sd logi b?nh edn kiem sodt benh dieh tdt hem, ngudn nude tdt hon vd ve sinh mdi trudng tdt - ddc trung y te edng cpng, thdng qua y ehi vd hanh dpng ciia ehinh quyen trung uong hoac dia phuang. Trong khi dd de kiem sodt mot sd logi benh khde can ddu tu vdo nang cao tien bp y khoa bao gdm ca nhdn Iyc va may mdc. Viec nay can den sy van dpng va ddng thudn ve mdt chinh tri trong cde cap chinh quyen de dua ra cdc chinh sdch ngdn han, dai han hpfp li vd khdng the ehi phu thudc vdo thj trudng.
Ciing khdng dinh vai trd qudn tri nha nude va chinh sdch ddi vdi siic khde, Simon Szreter eho rdng bdt eii khi ndo sire khde phy thudc vdo cdc hdnh dpng tap the (dii Id thong qua ede edng trinh edng cpng, viee eung cap dich vu eham soc siic khde, hodc gido dye) thi ehinh sdeh vd qudn tri nhd nude ludn ddng vai tro quan trpng. Vi dy, viec giam sdt cde ed nhdn vd doanh nghiep trong viec xu li nude thai va sir dyng ngudn nude, cdc nhan td cd tde ddng din mdi trudng vd strc khde, thudng rat khd khan va hay bi chdng ddi, viec ndy ddi hdi ndng luc cua nha nude va bp may hanh ehinh cung nhu lugt phdp (Simon Szreter, 1988).
Mpt so nghien cuu khae (Katherine Baicker vd Amitabh Chandra, 2004) chi ra rdng viec budng ldng quan li, gidm sat cac djch vy y te tir phia cdc co quan cdng quyen cd khd nang dan den hien tupng cac dich vy y tl khdng du chat lupng dupc cung cap ra thi trudng, hay cung cap vdi miic gid khdng hap li, hay ed yeu cdu xet nghiem vd dieu tri khdng can thiet tir phia ca sd y tl vd bde sT dilu tri ddi vdi ngudi benh nham true lpi ca nhdn. Thudng thi
Nghiin cOu Con ngudf s£6(105) 2019 13
Ddo Thj Minh Huang
nhihig khodn chi phi them ndy mang lai rat it ho§c hdu nhu khdng mang lgi lpi ich ndo \ a trong mdl sd trudng hop cdn ed the ga> hai eho benh nhan. Nen. neu cd co che kiem soat tdt thi chi phi eham soc y tl ed the dupc gidm ddng ke md khong ldm tdn hgi den sue khde. Nhihig danh ddi Ipi ich nay giiia mpt ben la nhiing ngudi, td chiic cung edp djch vy y tl \a mpt ben la nen y te minh bach, hieu qua vd siie khde ngudi dan phdi dupc thye hien thdng qua cac chuang trinh nghj sy bang mpt sd hinh thue tranh luan ddn chu, nhung dd la mpt qud trinh khd khan gay tranh cai vd thudng dupc cung cap thdng tin sai Ipch (Angus Deaton, 2013).
Ket luan
1. Cdc yiu to kinh tl - xa hpi ndo Id yeu td quan trpng anh hudng din siic khde cua con ngudi phy thupc vdo trinh dp phdt trien kinh te - xa hpi cita qude gia va dp tudi cua ed nhdn.
Ddi vdi cdc nude phat trien cd mirc thu nhdp cao, yeu td Idi sdng ca nhan vd yeu to tien bp trong khoa hpc y te Id yeu td quan trpng dnh hudng den siic khde, trong khi dd ddi vdi cdc nude dang phdt trien ndm d nhdm thu nhdp trung binh thi yeu td ehinh sdeh vd qudn li nhd nude ddi vdi hp thdng y te ciing nhu yeu td ldi sdng Id yeu td quan trpng trong vipc kiim soat gdnh n ^ g b?nh tat. Ddi vdi ede nude chdm phat trien d nhom thu nhgp thap thi yiu td nghe nghiep vd thu nhdp ed dnh hudng quan trpng din siic khde.
Thye phdm la yiu td quan trpng hang ddu quyit dinh siic khde eiia tre em trong nhihig nam dau ddi va tiep tyc dnh hudng den sy phdt triin cua tre em d cac liia tuoi sau dd.
M§c dil thyc pham cd the bao vp eon ngudi trudc mpt sd benh, nhung nd khdng phdi Id edeh phdng bpnh phd qudt nen vdn de chdm sde sire khde eho tre em cung rdt quan trpng va dieu ndy phu thupe nhieu vao kiln thiic va trinh dp hpe vdn eiia ngudi me. Thye pham khdng an toan tgo ra 31 mdi nguy gdy benh qua thyc phdm, gay ra nhilu trieu ca benh do thyc pham. trong sd do gdn mia Uieu ea tu vong moi nam. Trong khi yiu td nghi nghipp ciing nhu trinh dp gido dye cd quyet dinh quan trpng din sue khde eiia tuoi trudng thdnh thi tien bp y khoa. cung nhu kha nang tilp can dich vu y tl cd ehdt lupng lai dnh hudng ldn den siic khde cua ngudi cao tudi.
2. Ben cgnh khdng dinh ve tdm quan trpng cua chinh sdeh ndi chung vd chinh sdch y tl ndi rieng lien quan den an ninh sire khde, cdn nhan manh rdng, mdc dii quan h? mirc sdng cd lien quan den thu nhdp va sire khde khdng phai Id tuyin tinh, nhung tang trudng kinh te mang lgi thu nhap tdt han cho ede gia dinh, giup hp cd khd nang cao han trong tilp cdn djch vu y to cd chdt luong. tiep can ngudn thuc pham du vl sd lupng vd dam bao v| chit lupng se giup eho \ ipc edi thi?n thi trang sire khde ciia ede thanh vien gia dinh. Cy thi cd du thu nhdp eho phep mpi ngudi mua hdng hda vd djch vu thiit yiu dl duy tri ho§c cai
] 4 NgNin ciu Con nfloW s66(105) 2oia
Anh hudng eiia cdc yeu td...
thi?n stic khde, chdng hgn nhu thyc phdm dinh duang va noi d. Ben eanh dd, vi^c Idm vd thu nhgp cung dnh hudng den van de siie khde theo each khae niia, dd Id, khi vipc ldm dn djnh vdi thu nhdp tucmg ddi ed tde dyng han ehe nhiing cang thang khdng dang cd v l vdn de ddi sdng va tao difiu kien de ed nhdn cham sde ban thdn va sire khde. CJ cdp dp cpng dong. vipe tdng ngudn thu giiip cho cac chinh quyen trung ucmg \ a dia phuang trong vipc ndng cap ngudn cap nude, vp sinh moi trudng vd phdng chong dieh benh.
3. Cac yeu td xd hpi mang tinh quyet dinh ddi vdi sue khde thudng lien kit chdt eh6 vdi nhau. Mpt ngudi dupe gido due tdt hon thi thudng ciing ed thu nhgp tdt hem, sdng trong moi trudng ldnh manh hon, it co khd ndng hiit thudc han va ed ca hpi tilp can din thyc phdm an todn hon. Mpt qudc gia co thu nhdp trung binh eao hon, cung ed mpt nen y tl hipn dai hon va cd ngudn thye phdm chpn lya hon vd mirc song lien quan din miie thu nh^p cd y nghTa quan trpng vdi siie khde nhung khdng phdi Id quan hp tuyin tinh.
Tai lifu tham khao
1. Angus Deaton. 2013. The Great Escape: Health, Wealth, and the Origin of Inequality.
Princeton University Press.
2. Braveman PA. 2003. "Monitoring equity in health and health care: A conceptual framework".
Journal of Health Population Nutritioii,2li3), pp 181 -92.
3. Constitution of the World Health Organization. Geneva. 2006. (www.who.int/govemance/
eb/who_ constitiition_en.pdf, accessed 30 May 2010).
4. David Cutle, Angus Dealton va Adriana Lleras - Muney. 2005. "The Detemiinants of Mortality".
Journal of Economic Perspectives, American Economic Associalion, vol. 20(3).
5. Deguen and ZmirouNavier. 2010. "Social inequalities resulting from health risks related to ambient air quality-A European reviev/'. The European Journal of Public Health, 20(1):27- 35 Febmaiy 2010, (https://www.researchgate.net/publicaticn/410408 79).
6. Gabriele Doblhammer va James Vauple. 2001, "Lifespan depends on month of birth".
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