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颂扬加文·穆尼的工作:对全球及公共卫生问题的包容与参与。

Celebrating the work of Gavin Mooney: inclusiveness and involvement in global and public health issues.

作者信息

McIntyre Diane

机构信息

Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa.

出版信息

Soc Sci Med. 2014 May;108:262-6. doi: 10.1016/j.socscimed.2014.02.001. Epub 2014 Feb 4.

Abstract

This paper considers Gavin Mooney's contributions to the research literature on inclusiveness in global and public health issues. Much of his contribution in this area stems from engaging with Indigenous people, which cemented his conviction that it is important to recognise the heterogeneity of groups in society, especially in relation to cultural differences. He believed that in order to develop appropriate equitable and efficient health and related policies, the preferences of citizens should be elicited. While this could feed into very specific policy decisions, such as how to allocate available resources within a particular community, more generally, community preferences should determine the core values that underpin a health system. He proposed that these values be documented in a 'constitution' and serve as the basis on which policy-makers and health managers make decisions. Preference elicitation has value in itself, as procedural justice allows for self-determination and contributes to empowerment. Further, engagement by citizens in deliberative processes can overcome polarisation. Health systems themselves, if developed as social institutions, can influence the nature of society and contribute to greater unity. Mooney raised similar concerns about policies arising from mono-cultural global perspectives and argued that, whether at the national or global level, values for health systems should be based on community preferences. He particularly highlighted the unequal distribution of benefits of neoliberal globalisation as the cause of growing health and wealth inequalities globally. There is resonance between Mooney's views on these issues and some of the contributions to the post-2015 development agenda debates. While it is unlikely that we have reached a point where the stranglehold of neo-liberal governments on key global institutions will be broken, the current debates nevertheless present an important window of opportunity to struggle for shifts in the global political economy. Current debates about universal coverage also provide a critical opportunity to move towards health systems that are built on values determined by citizens and are social institutions that build solidarity, redress inequalities and unite fractured societies.

摘要

本文探讨了加文·穆尼对全球和公共卫生问题包容性研究文献的贡献。他在这一领域的诸多贡献源于与原住民的接触,这使他坚信认识社会群体的异质性非常重要,尤其是在文化差异方面。他认为,为了制定恰当、公平且高效的卫生及相关政策,应该了解公民的偏好。虽然这可以为非常具体的政策决策提供依据,比如如何在特定社区内分配可用资源,但更普遍地说,社区偏好应该决定支撑卫生系统的核心价值观。他提议将这些价值观记录在一部“宪法”中,并作为政策制定者和卫生管理人员决策的基础。偏好调查本身具有价值,因为程序正义允许自决并有助于增强权能。此外,公民参与审议过程可以克服两极分化。卫生系统本身,如果发展成为社会机构,可以影响社会的性质并促进更大的团结。穆尼对单一文化全球视角产生的政策也提出了类似的担忧,并认为,无论在国家还是全球层面,卫生系统的价值观都应该基于社区偏好。他特别强调新自由主义全球化利益分配不均是全球卫生和财富不平等加剧的原因。穆尼在这些问题上的观点与2015年后发展议程辩论中的一些观点产生了共鸣。虽然我们不太可能达到打破新自由主义政府对关键全球机构控制的程度,但当前的辩论仍然提供了一个重要的机会窗口,来争取全球政治经济的转变。当前关于全民医保的辩论也提供了一个关键机会,推动建立基于公民确定的价值观的卫生系统,这些系统是建立团结、纠正不平等并团结分裂社会的社会机构。

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