规范性公平与普遍不平等时代的健康促进。
Health Promotion in an Age of Normative Equity and Rampant Inequality.
机构信息
Canada Research Chair, Globalization and Health Equity, Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
出版信息
Int J Health Policy Manag. 2016 Dec 1;5(12):675-682. doi: 10.15171/ijhpm.2016.95.
The world was different when the Ottawa Charter for Health Promotion was released 30 years ago. Concerns over the environment and what we now call the 'social determinants of health' were prominent in 1986. But the acceleration of ecological crises and economic inequalities since then, in a more complex and multi-polar world, pose dramatically new challenges for those committed to the original vision of the Charter. Can the 2015 Sustainable Development Goals (SDGs), agreed to by all the world's governments, offer a new advocacy and programmatic platform for a renewal of health promotion's founding ethos? Critiqued from both the right and the left for, respectively, their aspirational idealism and lack of political analysis, the SDGs are an imperfect but still compelling normative statement of how much of the world thinks the world should look like. Many of the goals and targets provide signals for what we need to achieve, even if there remains a critical lacuna in articulating how this is to be done. The fundamental flaw in the SDGs is the implicit assumption that the same economic system, and its still-present neoliberal governing rules, that have created or accelerated our present era of rampaging inequality and environmental peril can somehow be harnessed to engineer the reverse. This flaw is not irrevocable, however, if health promoters - practitioners, researchers, advocates - focus their efforts on a few key SDGs that, with some additional critique, form a basic blueprint for a system of national and global regulation of capitalism (or even its transformation) that is desperately needed for social and ecological survival into the 22nd century. Whether or not these efforts succeed is a future unknown; but that the efforts are made is a present urgency.
30 年前发布《渥太华促进健康宪章》时,世界大不相同。1986 年,人们对环境和我们现在所说的“健康的社会决定因素”的担忧非常突出。但自那时以来,在一个更加复杂和多极化的世界中,生态危机和经济不平等的加速发展,给那些致力于宪章最初愿景的人带来了全新的挑战。所有国家政府都同意的 2015 年可持续发展目标(SDGs)能否为促进健康的创始精神提供一个新的宣传和方案平台?可持续发展目标从右翼和左翼受到批判,分别是因为其理想主义和缺乏政治分析,它是世界上大多数人认为世界应该是什么样子的一个不完美但仍然引人注目的规范性陈述。许多目标和指标为我们需要实现的目标提供了信号,即使在阐述如何实现这一目标方面仍存在关键空白。可持续发展目标的根本缺陷是隐含的假设,即同样的经济体系及其仍然存在的新自由主义治理规则,创造或加速了我们当前这个贫富差距日益扩大和环境危险的时代,以某种方式可以被利用来设计相反的结果。然而,如果健康促进者——从业者、研究人员、倡导者——将精力集中在少数几个关键的可持续发展目标上,这些目标在经过一些额外的批判后,就形成了一个对资本主义进行国家和全球监管的基本蓝图(或者甚至是其转型),这对于进入 22 世纪的社会和生态生存来说是迫切需要的,那么这个缺陷并非不可逆转。这些努力是否成功是一个未来的未知数;但现在的紧迫性在于要去努力。