Raphael Dennis, Bryant Toba
School of Health Policy and Management, Atkinson Faculty of Liberal and Professional Studies, York University, Toronto, Ont., Canada M3J 1P3.
Health Policy. 2006 Aug 22;78(1):39-55. doi: 10.1016/j.healthpol.2005.09.002. Epub 2005 Oct 11.
Despite the expanding literature on the importance role public policy plays in influencing the broader determinants of the public's health, profound differences exist among jurisdictions in the attention placed by the State - as represented by public health authorities and agencies - upon such activities. In this paper we examine the dominant public health models of Canada, USA, UK, and Sweden. The Canadian and USA public health communities are focused upon individualized approaches to risk management. In contrast, the UK and Swedish public health scenes are more oriented toward broader approaches to health determinants. We argue that the extent to which governments, public health agencies and public health workers concern themselves with public policy approaches to address broader determinants of health depends upon the particular model of health adhered to within each jurisdiction. And whether a health model is adopted depends upon the ideological and political context within which a nation is situated. Canada represents a situation where concerted effort to influence governmental policy directions by the public health community could reap significant benefits.
尽管关于公共政策在影响公众健康的更广泛决定因素方面所起的重要作用的文献不断增加，但在不同司法管辖区，以公共卫生当局和机构为代表的国家对这类活动的关注程度存在着巨大差异。在本文中，我们研究了加拿大、美国、英国和瑞典占主导地位的公共卫生模式。加拿大和美国的公共卫生界专注于风险管理的个性化方法。相比之下，英国和瑞典的公共卫生领域更倾向于针对健康决定因素的更广泛方法。我们认为，政府、公共卫生机构和公共卫生工作者关注公共政策方法以解决健康更广泛决定因素的程度，取决于每个司法管辖区所遵循的特定健康模式。而是否采用一种健康模式则取决于一个国家所处的意识形态和政治背景。加拿大的情况表明，公共卫生界齐心协力影响政府政策方向可能会带来巨大益处。
