Vallgårda S
Department of Health Services Research, Institute of Public Health, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark.
Eur J Public Health. 2001 Dec;11(4):386-92. doi: 10.1093/eurpub/11.4.386.
Public health strategies reflect governments' wish to make people's lives longer and healthier. This can either be achieved by influencing the frames of people's lives and activities or the way they behave, i.e. to try to 'conduct their conduct'. In this paper the motivations for and methods of four national public health strategies are analysed. They are the English, the Norwegian, the Danish and the Swedish. Four questions are addressed: i) how is the governing activities aimed at improving the health of the population justified; ii) which issues are defined as problems; iii) which causes of the problems are identified; and iv) which governing techniques are suggested to solve the problems. The English and Danish programmes focus on mortality while the others give high priority to non-lethal diseases and conditions. The Danish programme mainly aims at making people conduct themselves in a more healthy way, i.e. change their behaviour, often guided by health professionals. The Norwegian paper has empowerment as its central strategy. The strategy is based on the assumption that if people get more power over their own lives they will become more healthy and behave in a more healthy way. The Swedish emphasis is on changing people's living conditions and much less is said about the role of the individual. The English programme launches a national contract where individuals and authorities should work both to change people's behaviour and their living conditions. All strategies deal with the increasing social inequality in health, the English and Swedish strategies more than the others. There does not seem to be a specific Nordic model in this field of welfare state politics.
公共卫生战略反映了政府希望人们活得更长久、更健康的愿望。这可以通过影响人们生活和活动的框架或他们的行为方式来实现，即试图“引导他们的行为”。本文分析了四项国家公共卫生战略的动机和方法。它们分别是英国、挪威、丹麦和瑞典的战略。文中探讨了四个问题：（i）旨在改善民众健康的治理活动如何得到正当性证明；（ii）哪些问题被界定为问题；（iii）确定了问题的哪些成因；以及（iv）建议采用哪些治理技术来解决这些问题。英国和丹麦的方案侧重于死亡率，而其他方案则高度重视非致命性疾病和状况。丹麦的方案主要旨在使人们以更健康的方式行事，即改变他们的行为，这通常由健康专业人员指导。挪威的方案以赋权作为其核心战略。该战略基于这样一种假设，即如果人们对自己的生活有更多掌控权，他们就会变得更健康，并以更健康的方式行事。瑞典的重点是改变人们的生活条件，而对个人的作用提及较少。英国的方案推出了一项国家契约，个人和当局应共同努力改变人们的行为及其生活条件。所有战略都应对健康方面日益加剧的社会不平等问题，英国和瑞典的战略比其他战略应对得更多。在福利国家政治的这一领域，似乎不存在特定的北欧模式。
