School of Nursing & Health Studies, Georgetown University.
J Law Med Ethics. 2010 Fall;38(3):486-9. doi: 10.1111/j.1748-720X.2010.00507.x.
Despite good intentions and decades of discussion addressing the need for transformative changes globally to reduce poverty and improve health equity, little progress has been made. A fundamental shift in framing the current conversation is critical to achieve "health for all," moving away from the traditional approaches that use the more narrowly focused medical model, which is intent on treating and curing disease. A public health framework for action is needed, which recognizes and confronts the complex, and often-times difficult-to-achieve social determinants of health. A restructuring of global health policy development and implementation will be ineffective unless key areas are addressed including primary education and the environment, in addition to economic considerations. A public health framework that embraces a community-based participatory approach would provide a comprehensive platform for identifying critical components that impact health, and for developing effective strategies for change. A participatory approach would encourage dialogue and problem-solving for region-specific issues among those most affected by the broader health and social justice issues, with those who create policy.
尽管有良好的意愿和几十年来一直在讨论需要在全球范围内进行变革性的改变，以减少贫困和改善健康公平，但几乎没有取得任何进展。要实现“全民健康”，就必须从根本上转变当前的讨论框架，摆脱传统的方法，这种方法狭隘地侧重于医疗模式，旨在治疗和治愈疾病。需要采取行动的公共卫生框架，认识和应对复杂的、往往难以实现的健康决定因素。除非解决包括基础教育和环境在内的关键领域，以及经济考虑因素，否则全球卫生政策的制定和实施的结构调整将是无效的。一个公共卫生框架，如果采用以社区为基础的参与式方法，将为确定影响健康的关键因素以及制定有效的变革战略提供一个全面的平台。参与式方法将鼓励那些受更广泛的健康和社会正义问题影响最大的人与制定政策的人之间就具体区域的问题进行对话和解决问题。
