Crawford R
Int J Health Serv. 1977;7(4):663-80. doi: 10.2190/YU77-T7B1-EN9X-G0PN.
This article describes the emergence of an ideology which blames the individual for her or his illness and proposes that, instead of relying on costly and inefficient medical services, the individual should take more responsibility for her or his health. At-risk behavior is seen as the problem and changing life-style, through education and/or economic sanctions, as the solution. The emergence of the ideology is explained by the contradictions arising from the threat of high medical costs, popular expectations of medicine along with political pressures for protection or extension of entitlements, and the politicization of environmental and occupational health issues. These contradictions produce a crisis which is at once economic, political and ideological, and which requires responses to destabilizing conditions in each of these spheres. These ideological initiatives, on the one hand, serve to reorder expectations and to justify the retrenchment from rights and entitlements for access to medical services, and, on the other, attempt to divert attention from the social causation of disease in the commercial and industrial sectors.
本文描述了一种意识形态的出现，这种意识形态将个人的疾病归咎于其自身，并提议个人不应依赖昂贵且低效的医疗服务，而应更多地为自己的健康负责。高危行为被视为问题所在，而通过教育和/或经济制裁来改变生活方式则被视为解决办法。这种意识形态的出现是由以下矛盾所解释的：高昂医疗成本的威胁、公众对医学的期望、政治上对保护或扩大权益的压力，以及环境与职业健康问题的政治化。这些矛盾引发了一场危机，这场危机同时涉及经济、政治和意识形态领域，并且需要在这些领域应对不稳定状况。这些意识形态举措一方面有助于重新调整期望，并为减少获取医疗服务的权利和权益提供正当理由，另一方面试图转移人们对商业和工业部门中疾病社会成因的关注。
