Repullo Labrador José Ramón
Instituto de Salud Carlos III, Madrid, España.
Gac Sanit. 2009 Jul-Aug;23(4):342-7. doi: 10.1016/j.gaceta.2008.09.003. Epub 2009 Feb 28.
Behavior is a major determinant of health, but changes in individual conduct are difficult, and health promotion lacks effectiveness. State intervention in the last century, rooted in the modernist movement, went far beyond dealing with externalities and built the framework of the welfare state. The crisis of the welfare state and post modernity after the 1970s led to a weakness of ideologies and values, narcissistic individualism, and lack of trust in institutions, all of which hampered the ability of society's perspective to influence individual behavior. A review of health economics (especially merit goods) and public health (ethics and values of health promotion and prevention) may be useful to understand certain dilemmas in the balance between public intervention and individual autonomy. Given that many unhealthy decisions come from biased or irrational individual preferences, a promising new field in public health interventions is being developed, known as <
行为是健康的主要决定因素,但个人行为的改变困难重重,健康促进成效不佳。上世纪源于现代主义运动的国家干预,远远超出了处理外部性的范畴,构建了福利国家的框架。20世纪70年代后的福利国家危机和后现代性导致了意识形态和价值观的式微、自恋的个人主义以及对机构的不信任,所有这些都阻碍了社会视角影响个人行为的能力。回顾健康经济学(尤其是有益品)和公共卫生(健康促进与预防的伦理和价值观),可能有助于理解公共干预与个人自主之间平衡中的某些困境。鉴于许多不健康的决策源于有偏差或非理性的个人偏好,公共卫生干预领域正在发展一个有前景的新领域,称为“非对称家长主义”,或者更恰当地说,是“有益品的非对称政策”,它允许社会有选择地影响那些决策偏差导致自我伤害行为的个人,而不限制明智自主的个人的自主性(即使他们的偏好可能与社会推荐的偏好不一致)。