McKinlay J B, Marceau L D
New England Research Institutes, Watertown, MA 02472, USA.
Am J Public Health. 2000 Jan;90(1):25-33. doi: 10.2105/ajph.90.1.25.
The threshold of the new millennium offers an opportunity to celebrate remarkable past achievements and to reflect on promising new directions for the field of public health. Despite historic achievements, much will always remain to be done (this is the intrinsic nature of public health). While every epoch has its own distinct health challenges, those confronting us today are unlike those plaguing public health a century ago. The perspectives and methods developed during the infectious and chronic disease eras have limited utility in the face of newly emerging challenges to public health. In this paper, we take stock of the state of public health in the United States by (1) describing limitations of conventional US public health, (2) identifying different social philosophies and conceptions of health that produce divergent approaches to public health, (3) discussing institutional resistance to change and the subordination of public health to the authority of medicine, (4) urging a move from risk factorology to multilevel explanations that offer different types of intervention, (5) noting the rise of the new "right state" with its laissez-faire attitude and antipathy toward public interventions, (6) arguing for a more ecumenical approach to research methods, and (7) challenging the myth of a value-free public health.
新千年的开端提供了一个契机，让我们能够庆祝过去取得的卓越成就，并思考公共卫生领域充满希望的新方向。尽管取得了历史性成就，但仍有许多工作要做（这是公共卫生的内在本质）。每个时代都有其独特的健康挑战，而我们如今面临的挑战与一个世纪前困扰公共卫生领域的挑战不同。在传染病和慢性病时代所形成的观点和方法，在面对公共卫生领域新出现的挑战时效用有限。在本文中，我们通过以下方式对美国公共卫生状况进行评估：（1）描述美国传统公共卫生的局限性；（2）识别产生不同公共卫生方法的不同社会哲学和健康观念；（3）讨论对变革的制度性抵制以及公共卫生对医学权威的从属地位；（4）敦促从风险因素学转向提供不同类型干预措施的多层次解释；（5）指出秉持自由放任态度且反感公共干预的新“右派国家”的兴起；（6）主张采用更加包容的研究方法；（7）挑战公共卫生无价值取向的神话。
