Kunitz Stephen J
University of Rochester Medical Center, Box 644, 601 Elmwood Ave, Rochester, NY 14642, USA.
Am J Public Health. 2004 Nov;94(11):1894-904. doi: 10.2105/ajph.94.11.1894.
The creation of nation-states in Europe has generally been assumed to be intrinsic to modernization and to be irreversible. The disintegration of Czechoslovakia, the Soviet Union, and Yugoslavia demonstrates that the process is not irreversible. I argue that in the case of Yugoslavia, (1) disintegration was caused by the interaction between domestic policies with regard to nationalities and integration into the global economy and (2) the impact of the disintegration of the federation on health care and public health systems has been profound. Improving and converging measures of mortality before the collapse gave way to increasing disparities afterward. The lesson is that processes of individual and social modernization do not result in improvements in health and well-being that are necessarily irreversible or shared equally.
欧洲民族国家的形成通常被认为是现代化的内在组成部分且不可逆转。捷克斯洛伐克、苏联和南斯拉夫的解体表明这一进程并非不可逆转。我认为,以南斯拉夫为例,(1)解体是由国内民族政策与融入全球经济之间的相互作用导致的;(2)联邦解体对医疗保健和公共卫生系统产生了深远影响。崩溃前死亡率衡量指标的改善和趋同之后被日益扩大的差距所取代。教训是,个人和社会现代化进程不一定会带来必然不可逆转或平等共享的健康和福祉改善。