为公共卫生事业效力:政治、地方主义与实践认识论
Working for the public health: politics, localism and epistemologies of practice.
作者信息
Phillips Gemma, Green Judith
机构信息
School for Public Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
出版信息
Sociol Health Illn. 2015 May;37(4):491-505. doi: 10.1111/1467-9566.12214. Epub 2015 Feb 13.
The recent move of public health back to English local government has reignited debates about the role of a medicalised public health profession. The explicit policy rationale for the move was that local government is the arena in which the social determinants of health can be addressed, and that public health specialists could provide neutral evidence to support action on these. However, if a discourse of 'evidence-based' policy is in principle (if not practice) relatively unproblematic within the health arena, within the more overtly politicised local government space, rather different policy imperatives come to the fore. Responding to calls for research on evidence in practice, this article draws on ethnographic data of local authorities in the first year of the reorganised public health function. Focusing on alcohol policy, we explore how decisions that affect public health are rationalised and enacted through discourses of localism, empiricism and holism. These frame policy outcomes as inevitably plural and contingent: a framing which sits uneasily with normative discourses of evidence-based policy. We argue that locating public health in local government necessitates a refocusing of how evidence for public health is conceptualised, to incorporate multiple, and political, understandings of health and wellbeing.
近期公共卫生职能回归英国地方政府的举措,再度引发了关于医学化公共卫生专业角色的争论。此举明确的政策依据是,地方政府是能够应对健康的社会决定因素的场所,且公共卫生专家可为针对这些因素采取的行动提供中立证据。然而,如果说“循证”政策话语在卫生领域原则上(即便实际并非如此)相对没有问题,那么在政治化程度更高的地方政府领域,截然不同的政策要务就会凸显出来。为回应开展实践中证据研究的呼声,本文借鉴了公共卫生职能重组第一年地方当局的人种志数据。以酒精政策为重点,我们探讨了影响公共卫生的决策如何通过地方主义、经验主义和整体主义话语得以合理化并实施。这些话语将政策结果框定为不可避免地具有多元性和偶然性:这种框架与循证政策的规范性话语不太相符。我们认为,将公共卫生置于地方政府层面,有必要重新聚焦公共卫生证据的概念化方式,以纳入对健康和福祉的多元且政治性的理解。