Morgan Antony, Ziglio Erio
Karolinska Institute, Stockholm, Sweden.
Promot Educ. 2007;Suppl 2:17-22. doi: 10.1177/10253823070140020701x.
Historically, approaches to the promotion of population health have been based on a deficit model. That is, they tend to focus on identifying the problems and needs of populations that require professional resources and high levels of dependence on hospital and welfare services. These deficit models are important and necessary to identify levels of needs and priorities. But they need to be complemented by some other perspectives as they have some drawbacks. Deficit models tend to define communities and individuals in negative terms, disregarding what is positive and works well in particular populations. In contrast 'assets' models tend to accentuate positive capability to identify problems and activate solutions. They focus on promoting salutogenic resources that promote the self esteem and coping abilities of individuals and communities, eventually leading to less dependency on professional services. Much of the evidence available to policy makers to inform decisions about the most effective approaches to promoting health and to tackling health inequities is based on a deficit model and this may disproportionately lead to policies and practices which disempower the populations and communities who are supposed to benefit from them. An assets approach to health and development embraces a 'salutogenic' notion of health creation and in doing so encourages the full participation of local communities in the health development process. The asset model presented here aims to revitalise how policy makers, researchers and practitioners think and act to promote a more resourceful approach to tackling health inequities. The model outlines a systematic approach to asset based public health which can provide scientific evidence and best practice on how to maximise the stock of key assets necessary for promoting health. Redressing the balance between the assets and deficit models for evidence based public health could help us to unlock some of the existing barriers to effective action on health inequities. This re-balancing would help in better understanding the factors that influence health and what can be done about them. It would promote a positive and inclusive approach to action.
从历史上看,促进人群健康的方法一直基于一种缺陷模型。也就是说,它们往往侧重于识别需要专业资源以及高度依赖医院和福利服务的人群的问题和需求。这些缺陷模型对于确定需求水平和优先事项很重要且必要。但由于存在一些缺点,它们需要辅以其他一些观点。缺陷模型往往以负面的方式定义社区和个人,而忽视了特定人群中积极且行之有效的方面。相比之下,“资产”模型倾向于强调识别问题和激活解决方案的积极能力。它们专注于促进有助于提升个人和社区自尊及应对能力的健康促进资源,最终减少对专业服务的依赖。政策制定者在做出关于促进健康和解决健康不平等问题的最有效方法的决策时所依据的许多证据都基于缺陷模型,这可能会不成比例地导致一些政策和做法削弱那些本应从中受益的人群和社区的权能。一种基于资产的健康与发展方法包含了一种关于健康创造的“健康促进”理念,这样做鼓励当地社区充分参与健康发展过程。这里提出的资产模型旨在重振政策制定者、研究人员和从业者思考及行动的方式,以推动采取更具资源性的方法来解决健康不平等问题。该模型概述了一种基于资产的公共卫生系统方法,可为如何最大化促进健康所需的关键资产存量提供科学证据和最佳实践。纠正基于证据的公共卫生中资产模型与缺陷模型之间的平衡,有助于我们消除一些阻碍有效应对健康不平等问题的现有障碍。这种重新平衡将有助于更好地理解影响健康的因素以及针对这些因素可以采取的措施。它将促进一种积极且包容的行动方式。