Sociology Department, Woodrow Wilson School, Princeton University, Princeton, NJ 08544, USA.
J Public Health Manag Pract. 2009 Nov;15(6 Suppl):S26-30. doi: 10.1097/PHH.0b013e3181af0a95.
Professionalization in public health reflects wider institutional and political forces. Depending on the historical context in different countries, public health has developed as a medical specialty or as an independent field, entirely within the state or in mixed public-private institutions, closely or weakly tied to social movements, and in varying relations to fields such as engineering, nursing, environmental science, and the military. In early 20th-century America, the rise of the medical profession and the biomedical model of disease had a formative influence on public health, leading to a different institutional pattern from Britain. Public health in the United States emerged (1) largely outside the medical profession, but under the sway of the biomedical model; (2) without medicine's command of an exclusive jurisdiction and high status; and (3) with a limited role in healthcare organization and planning. Professionalism in public health continues to be subjected to contradictory pressures and uncertainties. Healthcare reform, bioterrorism, and environmental crises could expand its mandate and access to resources, but conflicts with other institutions are likely to result in limits on the capacity of public health professionals to assert an exclusive jurisdiction.
公共卫生的专业化反映了更广泛的制度和政治力量。根据不同国家的历史背景，公共卫生要么发展成为医学专业，要么发展成为一个独立的领域，完全在国家内部或公私混合机构中，与工程、护理、环境科学和军队等领域密切或弱相关，并与这些领域保持不同的关系。在 20 世纪初的美国，医学专业的兴起和疾病的生物医学模式对公共卫生产生了重大影响，导致了与英国不同的制度模式。美国的公共卫生（1）主要是在医学专业之外发展起来的，但受到生物医学模式的影响；（2）没有医学的专属管辖权和高地位；（3）在医疗保健组织和规划方面作用有限。公共卫生的专业化仍然受到矛盾的压力和不确定性的影响。医疗改革、生物恐怖主义和环境危机可能会扩大其任务授权和资源获取，但与其他机构的冲突可能会限制公共卫生专业人员主张专属管辖权的能力。
