Kelman S
Int J Health Serv. 1975;5(4):625-642. doi: 10.2190/X5H6-TC5W-D36T-K7KY.
In this article it is argued that through the adoption of the appropriate theoretical approach and the derivation of suitable analytical categories, the definition problem in health can be seen as operational, nontrivial, and highly problematic to the determination of health care policy. Specifically, an attempt is made to isolate the social basis of the definition of health. Part one develops that theoretical approach to the problem. First, notions of health are traced paradigmatically, then a historical materialist approach is employed to develop the social basis of an operational, contemporary definition of health. This definition is then compared with other existing definitions, and part one concludes with a discussion of the possibilities of a normative definition. Part two applies the new definition by reinterpreting parts of the history of public health and medicine, and concludes with a discussion of how this definition is highly problematic to the major structural reforms currently under way in the American health care system.
本文认为，通过采用适当的理论方法并推导出合适的分析范畴，健康领域的定义问题可被视为操作性的、重要的，且对医疗保健政策的制定极具问题性。具体而言，本文试图找出健康定义的社会基础。第一部分阐述了针对该问题的理论方法。首先，以范式方式追溯健康观念，然后采用历史唯物主义方法来发展健康操作性当代定义的社会基础。接着将此定义与其他现有定义进行比较，第一部分最后讨论了规范性定义的可能性。第二部分通过重新解读公共卫生与医学史的部分内容来应用新定义，并在结尾讨论了该定义对于美国医疗保健系统当前正在进行的重大结构改革而言是如何极具问题性的。
