Centre for Food Policy, City University London, UK.
Public Health. 2015 Oct;129(10):1369-82. doi: 10.1016/j.puhe.2015.07.042. Epub 2015 Oct 1.
The paper considers the long-term trajectory of public health and whether a 'Golden Era' in Public Health might be coming to an end. While successful elements of the 20th century policy approach need still to be applied in the developing world, two significant flaws are now apparent within its core thinking. It assumes that continuing economic growth will generate sufficient wealth to pay for the public health infrastructure and improvement needed in the 21st century when, in reality, externalised costs are spiralling. Secondly, there is evidence of growing mismatch between ecosystems and human progress. While 20th century development has undeniably improved public health, it has also undermined the capacity to maintain life on a sustainable basis and has generated other more negative health consequences. For these and other reasons a rethink about the role, purpose and direction of public health is needed. While health has to be at the heart of any viable notion of progress the dominant policy path offers new versions of the 'health follows wealth' position. The paper posits ecological public health as a radical project to reshape the conditions of existence. Both of these broad paths require different functions and purposes from their institutions, professions and politicians. The paper suggests that eco-systems pressures, including climate change, are already adding to pressure for a change of course.
本文探讨了公共卫生的长期发展轨迹，以及公共卫生的“黄金时代”是否即将结束。虽然 20 世纪政策方法的成功要素仍需在发展中国家应用，但在其核心思想中现在已经明显存在两个重大缺陷。它假设持续的经济增长将产生足够的财富，为 21 世纪所需的公共卫生基础设施和改善提供资金，而实际上，外部成本正在螺旋式上升。其次，生态系统和人类进步之间的不匹配越来越明显。虽然 20 世纪的发展无疑改善了公共卫生，但它也破坏了可持续维持生命的能力，并产生了其他更负面的健康后果。出于这些和其他原因，需要重新思考公共卫生的作用、目的和方向。虽然健康必须是任何可行的进步概念的核心，但主导的政策路径提供了“健康跟随财富”立场的新版本。本文将生态公共卫生视为重塑生存条件的激进项目。这两个广泛的路径都需要其机构、专业人员和政治家发挥不同的职能和目的。本文认为，生态系统压力，包括气候变化，已经在加大改变方向的压力。
