McKinlay J, Marceau L
New England Research Institutes, Boston, MA, USA.
Lancet. 2000 Aug 26;356(9231):757-61. doi: 10.1016/S0140-6736(00)02641-6.
No one can question the remarkable contribution of US public health to understanding the causes and consequences of illness, disability, and death. However, some commentators question the agenda: the endless pursuit of individual risk factors and the cursory attention to social determinants of disease. We attempt to illustrate some limitations of US public health by focusing on type-2 diabetes (adult-onset non-insulin-dependent diabetes)--an increasingly prevalent but still poorly understood medical condition with devastating complications and implications for quality of life. A more theoretically based multilevel approach to diabetes, outlined for the 21st century, has an almost exclusive downstream curative focus, that ranges from midstream preventive programmes to upstream healthy public policy.
没有人能够质疑美国公共卫生在了解疾病、残疾和死亡的原因及后果方面所做出的卓越贡献。然而，一些评论家对其议程提出了质疑：对个体风险因素的无休止追求以及对疾病社会决定因素的草率关注。我们试图通过关注2型糖尿病（成人发病型非胰岛素依赖型糖尿病）来说明美国公共卫生的一些局限性——这是一种日益普遍但仍了解不足的医学状况，会引发严重的并发症并对生活质量产生影响。为21世纪勾勒的一种更具理论基础的糖尿病多层次方法，几乎完全侧重于下游治疗，范围从中游预防计划到上游健康公共政策。
