Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada.
Can J Public Health. 2019 Jun;110(3):279-284. doi: 10.17269/s41997-019-00198-0. Epub 2019 Mar 7.
A focus on populations, and a corresponding population-level approach to intervention, is a foundation of public health and is one reason why public health matters today. Yet, there are indications that this foundation is being challenged. In some policy and practice domains, and alongside growing concern about the social determinants of health and health equity, there has been a shift from a population-level or universal approach to intervention, to a targeted approach focusing on those experiencing social or economic vulnerability. More than 30 years ago, Geoffrey Rose articulated strengths and limitations of population-level and high-risk approaches to prevention. In light of a strong analogy between "high risk" and "targeted" approaches, it seems timely, in a forum on why public health matters today, to revisit Rose's points. Focusing on points of overlap between strengths and limitations of the two approaches as described in public health (population-level; high-risk) and social policy (universal; targeted), I illustrate strengths of a population-level approach from the point of view of health equity. Although different circumstances call for different intervention approaches, recent discourse about the weakening of public health suggests that there is value in discussing foundations of the field, such as the population-level approach, that we as a community may wish to defend.
关注人群，并采取相应的人群干预措施，是公共卫生的基础，也是公共卫生今天如此重要的原因之一。然而，有迹象表明，这一基础正受到挑战。在一些政策和实践领域，以及对健康和健康公平的社会决定因素日益关注的同时，干预措施已从人群层面或普遍方法转向针对那些面临社会或经济脆弱性的目标方法。三十多年前，杰弗里·罗斯（Geoffrey Rose）阐述了人群层面和高危方法在预防方面的优势和局限性。鉴于“高危”和“靶向”方法之间存在很强的类比，在一个关于为什么公共卫生今天如此重要的论坛上，重新审视罗斯的观点似乎是及时的。我从健康公平的角度出发，重点关注公共卫生（人群层面；高危）和社会政策（普遍；靶向）中描述的两种方法的优势和局限性的重叠点，从社会政策的角度说明了人群方法的优势。尽管不同的情况需要不同的干预方法，但最近关于公共卫生削弱的讨论表明，讨论该领域的基础（如人群层面方法）是有价值的，我们作为一个社区可能希望捍卫这些基础。
