Slater C, Carlton B
University of Texas, Houston.
Am J Prev Med. 1985 Sep-Oct;1(5):25-33.
Health promotion has become an official health policy of this country, and it is being pursued through efforts to change individuals' health-related behavior. This approach is based on the assumption that it is in fact an individual's behavior that most directly determines his or her health status. But how good is the evidence that supports this assumption? Specifically, is the evidence sufficient for this assumption to outweigh the long-standing finding that social and economic conditions have a strong relationship to health status? The major support for the behavior approach derives from the coronary heart disease risk-factor studies and the Alameda County Study. In a series of reports over time, the relationship between individuals' health practices and their health status generally, as well as that between heart disease and cancer specifically, have been established by these studies. These observations, however, have not been confirmed when deliberate efforts have been made to change those practices. The evidence in support of the importance of social and economic conditions to health status has been documented through a long series of studies in this country, which have found a direct relationship between individuals' socioeconomic status and their health status. This relationship, however, has not in this country been tested by intervention. Only a few studies have examined the interrelationship between these two approaches to health promotion, but the evidence to date has failed to suggest that either one is the mediator of the other. We must, therefore, conclude that pursuing a policy of health promotion based on either approach to the exclusion of the other would indeed be short-sighted health policy.
健康促进已成为该国的一项官方卫生政策，并且正在通过努力改变个人与健康相关的行为来加以推行。这种方法基于这样一种假设，即实际上正是个人行为最直接地决定其健康状况。但是，支持这一假设的证据有多可靠呢？具体而言，该证据是否足以使这一假设比社会和经济状况与健康状况有着紧密联系这一长期存在的发现更具说服力呢？对行为方法的主要支持来自冠心病危险因素研究和阿拉米达县研究。随着时间的推移，在一系列报告中，这些研究确立了个人健康行为与其总体健康状况之间的关系，以及特别是心脏病和癌症与健康行为之间的关系。然而，当人们刻意努力去改变这些行为时，这些观察结果并未得到证实。通过该国一系列长期研究记录了支持社会和经济状况对健康状况重要性的证据，这些研究发现个人社会经济地位与其健康状况之间存在直接关系。然而，在该国这种关系尚未通过干预进行检验。只有少数研究考察了这两种健康促进方法之间的相互关系，但迄今为止的证据并未表明其中任何一种方法是另一种方法的中介因素。因此，我们必须得出结论，仅基于其中一种方法而排除另一种方法来推行健康促进政策确实是目光短浅的卫生政策。
