Brown Lawrence D
Mailman School of Public Health, Columbia University, New York, NY USA.
Public Health Rev. 2010;32:155-173. doi: 10.1007/BF03391596. Epub 2010 Jun 7.
Public health is politically paradoxical because its core conceptual components - the exercise of public authority and the promotion of population health - stand in practical tension that belies their theoretical promise. Across Western nations, public policymakers stand accused of failing properly to honor and support the crucial contributions that public health makes to the improvement of health outcomes and of overinvesting in acute medical care services, the need for which timely interventions in prevention and health promotion might have averted. The dramatic budgetary discrepancies in Western nations between the massive funds devoted to medical care and the minuscule sums allotted to public health are often taken as evidence that in such matters, political leaders are irrational (or perhaps uninformed, or captured by big-moneyed medical interests) and that good public policy would have epidemiologists and other public health experts running, or at least orchestrating, the show. This paper explores the sources of this tension between population health and political power within the concept of public health and seeks to show why these strains prove to be so durable, indeed irresolvable. The argument and evidence draw largely on the United States, but the supposition - yway, the hope - is that the analysis will also throw light on the politics of public health in other nations.
公共卫生在政治上自相矛盾，因为其核心概念要素——公共权力的行使与人群健康的促进——在实际中存在着矛盾，这与它们在理论上的前景不符。在西方国家，公共政策制定者被指责未能恰当地尊重和支持公共卫生对改善健康结果所做出的关键贡献，且过度投资于急性医疗服务，而对预防和健康促进的及时干预或许本可避免对这类服务的需求。西方国家在医疗护理投入的巨额资金与分配给公共卫生的微量资金之间存在巨大的预算差异，这常被视为证据，表明在这类问题上，政治领导人是不理性的（或者可能是信息不足，或者被有钱的医疗利益集团俘获），而良好的公共政策应该让流行病学家和其他公共卫生专家来掌控局面，或者至少进行统筹安排。本文探讨了公共卫生概念中人群健康与政治权力之间这种矛盾的根源，并试图说明为何这些矛盾如此持久，甚至无法解决。论点和证据主要基于美国，但推测——无论如何，希望是——该分析也能为其他国家的公共卫生政治提供启示。
