Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
J Public Health (Oxf). 2010 Mar;32(1):2-7. doi: 10.1093/pubmed/fdp122.
This paper argues that concepts, methodologies and practices within public health need further development if they are to be sufficient to allow us to develop, undertake and evaluate interventions in the twenty-first century. The public health profession, and the disciplines that contribute to it, maintains the historical focus upon detailed micro analysis (individual and health sector) and not broader macro analysis (societal and system). This brief paper suggests why this is and outlines three challenges it poses: specifying and evaluating outcomes; specifying and understanding complex causal pathways in social interventions and the development of multisector evaluation, to meet information demands from multiple stakeholders. While there is general agreement that public health evaluation needs development, this paper argues that the focus needs to be more upon a broader evaluative space than is currently practiced. There is a need to move beyond primary and secondary health-related effects upon individuals, and focus more on evaluation of the wider range and distribution of direct and indirect effects upon individuals, communities and populations. That is, those involved in public health evaluation need to step back and first consider the wood before focusing in on specific trees.
本文认为，如果公共卫生领域的概念、方法和实践要想足以使我们能够在 21 世纪开展、进行和评估干预措施，就需要进一步发展。公共卫生专业及其为之做出贡献的学科，仍然侧重于历史上的微观分析（个人和卫生部门），而不是更广泛的宏观分析（社会和系统）。本文简要探讨了这种情况的原因，并概述了它带来的三个挑战：具体说明和评估结果；具体说明和理解社会干预措施中的复杂因果关系，并开展多部门评估，以满足来自多个利益攸关方的信息需求。虽然人们普遍认为公共卫生评估需要发展，但本文认为，重点需要放在更广泛的评估空间上，而不是目前的实践。需要超越对个人的初级和二级与健康相关的影响，更加关注对个人、社区和人群的更广泛的直接和间接影响的评估。也就是说，参与公共卫生评估的人员需要退后一步，首先考虑整体情况，然后再专注于具体的问题。
