Catley-Carlson M
Department of National Health and Welfare, Ottawa, Ontario, Canada.
Acad Med. 1992 Jul;67(7):419-24. doi: 10.1097/00001888-199207000-00001.
The author explains why global problems, both known and unknown and unpredictable, are going to affect the health sector in the next few decades even more than they do today. Five examples are given of global health-related dilemmas that must be faced: (1) the worldwide aging of the population and the changing morbidity trends and physician supply needs this creates; (2) rising worldwide poverty, which has a direct relation to health status and has some new causes in this century; (3) ethical dilemmas, such as those resulting from new reproductive and life-prolonging technologies; (4) the need for adequate and affordable health care systems (the Canadian system is described and several misconceptions about it are clarified); and (5) the need to allocate scarce resources to meet practically infinite health care demands. The author concludes by listing some of the important actions that must be taken if we are to deal effectively with the dilemmas fostered by global problems: (1) people must be taught that their health status is the result of many factors in addition to their health care (e.g., socioeconomic status, lifestyle, the environment); (2) medical education must be refocused to prepare physicians to deal with global challenges; (3) there must be greater international cooperation (e.g., working together to share research and implement strategies to control AIDS); (4) countries must invest in worldwide efforts, such as family planning and primary education; and (5) international partnerships must be created to develop worldwide strategies, such as a global drug strategy.
作者解释了为何全球问题，无论是已知的、未知的还是不可预测的，在未来几十年对卫生部门的影响将比现在更大。文中给出了五个必须面对的与全球卫生相关的困境例子：（1）全球人口老龄化以及由此产生的发病率变化趋势和医生供应需求；（2）全球范围内贫困加剧，这与健康状况直接相关且在本世纪有一些新的成因；（3）伦理困境，比如新的生殖技术和延长生命技术所引发的困境；（4）需要建立充足且可负担得起的医疗保健系统（文中描述了加拿大的系统并澄清了一些关于它的误解）；（5）需要分配稀缺资源以满足几乎无穷无尽的医疗保健需求。作者最后列出了一些若要有效应对全球问题所引发的困境必须采取的重要行动：（1）必须让人们明白，他们的健康状况是除医疗保健之外诸多因素的结果（例如社会经济地位、生活方式、环境）；（2）医学教育必须重新定位，以使医生能够应对全球挑战；（3）必须加强国际合作（例如共同开展研究并实施控制艾滋病的策略）；（4）各国必须投资于全球范围内的努力，如计划生育和初等教育；（5）必须建立国际伙伴关系以制定全球战略，如全球药物战略。
