Tengland Per-Anders
Health and Society, Malmö University, 205 06, Malmö, Sweden.
Med Health Care Philos. 2006;9(2):155-67. doi: 10.1007/s11019-005-5642-5.
Health-related quality of life is the ultimate general goal for medicine, health care and public health, including health promotion and health education. The other important general goal is health-related welfare. The aim of the paper is to explain what this means and what the consequences of these assumptions are for health work. This involves defining the central terms "health", "quality of life" and "welfare" and showing what their conceptual relations are. Health-related quality of life has two central meanings: health-related well-being, which constitutes quality of life, and health as ability, which contributes causally to quality of life. Four meanings of health-related welfare are put forward: general well-being, health as ability, other inner properties of the individual, and external factors. States and processes covered by these categories contribute causally to health-related quality of life. Finally, using these distinctions, some more specific goals for medicine and health care, on the one hand, and for public health and health promotion, on the other, are outlined. In the former fields work is primarily directed towards changing the health-related quality of life of the individual through direct measures, "manipulating" the individual, whereas public health work and health promotion primarily use indirect measures and further health through various sorts of health-related welfare changes, e.g. through changing the environment.
与健康相关的生活质量是医学、医疗保健和公共卫生（包括健康促进和健康教育）的最终总体目标。另一个重要的总体目标是与健康相关的福利。本文的目的是解释这意味着什么，以及这些假设对卫生工作有何影响。这涉及定义核心术语“健康”、“生活质量”和“福利”，并展示它们的概念关系。与健康相关的生活质量有两个核心含义：构成生活质量的与健康相关的幸福，以及对生活质量有因果贡献的作为能力的健康。提出了与健康相关的福利的四种含义：总体幸福、作为能力的健康、个体的其他内在属性以及外部因素。这些类别所涵盖的状态和过程对与健康相关的生活质量有因果贡献。最后，利用这些区分，一方面概述了医学和医疗保健的一些更具体的目标，另一方面概述了公共卫生和健康促进的一些更具体的目标。在前述领域，工作主要旨在通过直接措施改变个体与健康相关的生活质量，即“操控”个体，而公共卫生工作和健康促进主要使用间接措施，并通过各种与健康相关的福利变化来促进健康，例如通过改变环境。
