Miller School of Medicine, University of Miami, FL 33101, USA.
Am J Public Health. 2012 Oct;102(10):1848-57. doi: 10.2105/AJPH.2012.300714. Epub 2012 Aug 16.
The United States excels at treating the most complex medical conditions, but our low-ranking health statistics (relative to other countries) do not match our high-end health care spending. One way to understand this paradox is to examine the history of federal children's health programs. In the 1800s, children's health advocates confronted social determinants of health to reduce infant mortality. Over the past 100 years, however, physicians have increasingly focused on individual doctor-patient encounters; public health professionals, meanwhile, have maintained a population health perspective but struggled with the politics of addressing root causes of disease. Political history and historical demography help explain some salient differences with European nations that date to the founding of federal children's health programs in the early 20th century. More recently, federal programs for children with intellectual disability illustrate technical advances in medicine, shifting children's health epidemiology, and the politics of public health policy.
美国擅长治疗最复杂的医疗状况，但我们排名较低的健康统计数据（相对于其他国家）与我们高端的医疗保健支出不匹配。了解这种悖论的一种方法是研究联邦儿童健康计划的历史。在 19 世纪，儿童健康倡导者面对健康的社会决定因素，以降低婴儿死亡率。然而，在过去的 100 年里，医生越来越关注医患之间的个人接触；与此同时，公共卫生专业人员一直保持着对人口健康的看法，但在解决疾病根本原因的政治问题上举步维艰。政治历史和历史人口统计学有助于解释一些与欧洲国家的显著差异，这些差异可以追溯到 20 世纪初联邦儿童健康计划的成立。最近，联邦智障儿童计划说明了医学的技术进步、儿童健康流行病学的转变以及公共卫生政策的政治。
