Mohs E
Ministry of Health, San José, Costa Rica.
Scand J Soc Med Suppl. 1991;46:14-24.
In Costa Rica, three sequential health paradigms have been identified over the last 50 years. The first began to develop during the 40's and has been called that of the deficiency diseases, since with a diachronic approach it placed excessive emphasis on malnutrition. The second began in 1970 and it is known as that of the infectious diseases, since through a holistic or synchronic approach, it underlined the importance of infections in high rates of morbidity and mortality. The third and last is the paradigm of the chronic diseases, it appeared in the 80's and is presently in process, doing battle with the chronic ailments, life styles, and environment, and it also utilizes a holistic approach. The recognition of these three paradigms has permitted Costa Rica a rapid advance in improving the health of its population, to the point that with a per capita outlay of $130 (US dollars), it has indices similar to those of the industrialized nations. This particular experience could be useful for other less-developed countries that are still applying the paradigm of the deficiency diseases.
在哥斯达黎加,过去50年里已确定了三种相继出现的健康模式。第一种模式始于20世纪40年代,被称为营养缺乏疾病模式,因为从历时性角度来看,它过度强调营养不良问题。第二种模式始于1970年,被称为传染病模式,因为从整体或共时性角度来看,它强调感染在高发病率和高死亡率中的重要性。第三种也是最后一种模式是慢性病模式,它出现在20世纪80年代,目前仍在发展中,致力于应对慢性疾病、生活方式和环境问题,并且同样采用整体方法。对这三种模式的认识使哥斯达黎加在改善其民众健康方面取得了迅速进展,以至于在人均支出130美元(美元)的情况下,其健康指标与工业化国家相似。这一独特经验可能对其他仍在应用营养缺乏疾病模式的欠发达国家有用。