NHS Health Scotland, Elphinstone House, 65 West Regent Street, Glasgow G2 2AF.
Perspect Public Health. 2010 Jan;130(1):34-40. doi: 10.1177/1757913909354149.
The fact that health and disease are products of a complex interaction of factors has long been recognized in public health circles. More recently, the term 'ecological public health' has been used to characterize an era underpinned by the paradigm that, when it comes to health and well-being, 'everything matters'. The challenge for policy makers is one of navigating this complexity to deliver better health and greater equality in health. Recent work in Scotland has been concerned to develop a strategic approach to environment and health. This seeks to embrace complexity within that agenda and recognize a more subtle relationship between health and place but remain practical and relevant to a more traditional hazard-focused environmental health approach. The Good Places, Better Health initiative is underpinned by a new problem-framing approach using a conceptual model developed for that purpose. This requires consideration of a wider social, behavioural etc, context. The approach is also used to configure the core systems of the strategy which gather relevant intelligence, subject it to a process of evaluation and direct its outputs to a broad policy constituency extending beyond health and environment. This paper highlights that an approach, conceived and developed to deliver better health and greater equality in health through action on physical environment, also speaks to a wider public health agenda. Specifically it offers a way to help bridge a gap between paradigm and policy in public health. The author considers that with development, a systems-based approach with close attention to problem-framing/situational modelling may prove useful in orchestrating what is a necessarily complex policy response to mitigate and adapt to climate change.
健康和疾病是多种因素复杂相互作用的产物，这一事实在公共卫生领域早已得到认可。最近，“生态公共卫生”一词被用来描述一个时代，其理念是，在健康和福祉方面，“一切都很重要”。政策制定者面临的挑战是在这种复杂性中进行导航，以实现更好的健康和更大的健康公平。最近苏格兰的工作一直致力于制定环境与健康的战略方法。这旨在该议程中包含复杂性，并认识到健康与地点之间更为微妙的关系，但仍保持与更传统的以危害为重点的环境卫生方法的实用性和相关性。“好地方，更健康”倡议是基于一种新的问题框架方法，该方法使用为此目的开发的概念模型。这需要考虑更广泛的社会、行为等方面。该方法还用于配置策略的核心系统，这些系统收集相关情报，对其进行评估，并将其输出引导到广泛的政策群体，这些群体不仅限于健康和环境。本文强调，一种旨在通过对自然环境采取行动来改善健康和更大的健康公平的方法，也涉及更广泛的公共卫生议程。具体来说，它提供了一种帮助弥合公共卫生范式和政策之间差距的方法。作者认为，随着发展，一种基于系统的方法，并密切关注问题框架/情境建模，可能有助于协调应对气候变化所需的复杂政策反应，以减轻和适应气候变化。
