Russell Cormac
Asset-Based Community Development Institute at DePaul University, Chicago, USA.
Gac Sanit. 2019 Nov-Dec;33(6):579-583. doi: 10.1016/j.gaceta.2018.11.006. Epub 2019 Feb 2.
A proper understanding of health is a social and political challenge, the modern social medicine approach to public health and health approaches more generally tend to minimise this, making the isolated individual the primary unit of health. Ivan Illich, social critic and philosopher, was at the forefront of arguing for a collective health approach and challenging medical hegemony. His theories of institutional counter-productivity, proportionality and his critique of the medical model which he argued was entrenched within an economics of scarcity are as relevant today as they were at their height of popularity, in the 1970s. Applying his analysis to current trends in health approaches I conclude, as did he, that beyond a certain institutional scale or intensity more medicine is making us sicker. Therefore public health requires a dramatic shift away from a focus on individual deficits, lifestyle diseases, behaviour change and health promotion approaches towards genuine community building and significant political investment in the health creation of local communities. Moreover, there is need for more resolute regulation of the marketplace to prevent the health-harming behaviours of industrial and other institutional interests, including public sector and third sector organisations engaged in institutional overreach.
对健康的正确理解是一项社会和政治挑战，现代社会医学对公共卫生及更广泛的健康方法往往将此最小化，使孤立的个体成为健康的主要单位。社会批评家和哲学家伊万·伊里奇站在倡导集体健康方法和挑战医学霸权的前沿。他的制度反生产力、相称性理论，以及他对医学模式的批判（他认为这种模式深深植根于稀缺经济学之中），在今天与它们在20世纪70年代最受欢迎时一样具有现实意义。将他的分析应用于当前健康方法的趋势，我得出的结论与他一样，即超过一定的制度规模或强度，更多的医疗反而让我们病得更重。因此，公共卫生需要从关注个体缺陷、生活方式疾病、行为改变和健康促进方法，大幅转向真正的社区建设以及对当地社区健康创造进行重大政治投资。此外，需要对市场进行更坚决的监管，以防止工业和其他机构利益（包括从事机构越界行为的公共部门和第三部门组织）的有害健康行为。
