Denier Yvonne
Ethical Perspect. 2005 Mar;12(1):41-66. doi: 10.2143/ep.12.1.583362.
Public-health measures are very effective and efficient means of improving health, yet public health is either neglected by the literature or fraught with unease, mainly due to the combination of the aggregate-distributive tension with the element of compulsion. I argue that this unease can be decreased by 1) a pluralist-holistic view of health, situating the normative value of health in its effect on well-being, incorporating both the objective and subjective source of the value of health; and 2) by a rich concept of reciprocity. This article supports Martha Nussbaum's critique of social-contract thinking for placing too much weight on the scale of normal functioning and productive reciprocity, as well as Sen's distinction between well-being and agency freedom. To reach an adequate understanding of the value and goal of public health within the general setting of health care, a pluralist conception of health, well-being and reciprocity is necessary.
公共卫生措施是改善健康状况非常有效且高效的手段，然而公共卫生要么被文献所忽视，要么充满了不安，这主要是由于总体分配张力与强制因素相结合所致。我认为，这种不安可以通过以下方式减少：一是对健康采取多元整体观，将健康的规范价值定位为其对幸福的影响，纳入健康价值的客观和主观来源；二是通过丰富的互惠概念。本文支持玛莎·努斯鲍姆对社会契约思维的批判，因为这种思维过于强调正常功能和生产性互惠的尺度，同时也支持森对幸福与行动自由的区分。为了在医疗保健的总体背景下充分理解公共卫生的价值和目标，有必要对健康、幸福和互惠采取多元概念。
