Räisänen Ulla, Bekkers Marie-Jet, Boddington Paula, Sarangi Srikant, Clarke Angus
Health Communication Research Centre, Cardiff University, Cardiff, Wales, UK.
Med Health Care Philos. 2006;9(3):293-306. doi: 10.1007/s11019-006-9007-5.
The prevention, treatment and management of disease are closely linked to how the causes of a particular disease are explained. For multi-factorial conditions, the causal explanations are inevitably complex and competing models may exist to explain the same condition. Selecting one particular causal explanation over another will carry practical and ethical consequences that are acutely relevant for health policy. In this paper our focus is two-fold; (i) the different models of causal explanation that are put forward within current scientific literature for the high and rising prevalence of the common complex conditions of coronary artery disease (CAD) and type 2 diabetes mellitus (T2D); and (ii) how these explanations are taken up (or not) within national health policy guidelines. We examine the causal explanations for these two conditions through a systematic database search of current scientific literature. By identifying different causal explanations we propose a three-tier taxonomy of the most prominent models of explanations: (i) evolutionary, (ii) lifecourse, and (iii) lifestyle and environment. We elaborate this taxonomy with a micro-level thematic analysis to illustrate how some explanations are semantically and rhetorically foregrounded over others. We then investigate the uptake of the scientific causal explanations in health policy documents with regard to the prevention and management recommendations of current National Service Frameworks for CAD and T2D. Our findings indicate a lack of congruence between the complexity and frequent overlap of causal explanations evident in the scientific literature and the predominant focus on lifestyle recommendations found in the mainstream health policy documents.
疾病的预防、治疗和管理与对特定疾病病因的解释方式密切相关。对于多因素疾病而言，因果解释不可避免地很复杂，而且可能存在相互竞争的模型来解释同一种疾病。选择一种特定的因果解释而非另一种，会带来与卫生政策密切相关的实际和伦理后果。在本文中，我们关注两个方面：（i）当前科学文献中针对冠状动脉疾病（CAD）和2型糖尿病（T2D）等常见复杂疾病的高患病率及不断上升的患病率所提出的不同因果解释模型；（ii）这些解释在国家卫生政策指南中是如何（或未如何）被采纳的。我们通过对当前科学文献进行系统的数据库搜索来研究这两种疾病的因果解释。通过识别不同的因果解释，我们提出了一个三层分类法，列出最突出的解释模型：（i）进化模型，（ii）生命历程模型，以及（iii）生活方式和环境模型。我们通过微观层面的主题分析来详细阐述这个分类法，以说明某些解释在语义和修辞上是如何比其他解释更突出的。然后，我们就当前冠心病和2型糖尿病国家服务框架的预防和管理建议，调查了卫生政策文件中对科学因果解释的采纳情况。我们的研究结果表明，科学文献中明显存在的因果解释的复杂性和频繁重叠，与主流卫生政策文件中主要关注生活方式建议之间缺乏一致性。
