Rowe Rachel, Stephenson Niamh
School of Public Health and Community Medicine, The University of New South Wales, Australia.
Sociol Health Illn. 2016 Nov;38(8):1203-1216. doi: 10.1111/1467-9566.12450. Epub 2016 Jul 17.
Where modern public health developed techniques to calculate probability, potentiality, risk and uncertainty, contemporary finance introduces instruments that redeploy these. This article traces possibilities for interrogating the connection between health and financialisation as it is arising in one particular example - the health impact bond. It locates the development of this very recent financial innovation in an account of public health's role within governance strategies over the 20th century to the present. We examine how social impact bonds for chronic disease prevention programmes bring two previously distinct ways of thinking about and addressing risk into the same domain. Exploring the derivative-type properties of health impact bonds elucidates the financial processes of exchange, hedging, bundling and leveraging. As tools for speculation, the functions of health impact bonds can be delinked from any particular outcome for participants in health interventions. How public health techniques for knowing and acting on risks to population health will contest, rework or be subsumed within finance's speculative response to risk, is to be seen.
现代公共卫生领域开发了计算概率、可能性、风险和不确定性的技术，而当代金融则引入了重新配置这些因素的工具。本文通过一个具体例子——健康影响债券，探寻审视健康与金融化之间联系的可能性。文章将这一最新金融创新的发展置于对20世纪至今公共卫生在治理策略中所起作用的阐述之中。我们研究了用于慢性病预防项目的社会影响债券如何将两种此前截然不同的思考和应对风险的方式带入同一领域。探究健康影响债券的衍生类属性，阐明了交换、套期保值、捆绑和杠杆化等金融过程。作为投机工具，健康影响债券的功能可以与健康干预参与者的任何特定结果脱钩。公共卫生领域了解和应对人群健康风险的技术将如何与金融对风险的投机性反应进行抗争、重塑或被其吸纳，还有待观察。
