Winkelstein W, French F E
Calif Med. 1970 Nov;113(5):7-12.
The weight of evidence does not support the hypothesis that the health status of the population is largely dependent on the quality and quantity of its medical services. Evidence to test this hypothesis is presented in a conceptual model of the relationship between health and disease and their care systems, suggesting that medical care is largely unrelated to the health status of the population. Examples of disease trends and distribution are presented to support the thesis that ecology is the primary determinant of the health status of the populationData from selected epidemiological studies point to poverty and air pollution as key factors in determining the pattern of mortality in the urban eco-system.
证据的权重并不支持这样一种假设，即人口的健康状况在很大程度上取决于其医疗服务的质量和数量。检验这一假设的证据体现在一个关于健康与疾病及其护理系统之间关系的概念模型中，这表明医疗护理在很大程度上与人口的健康状况无关。文中给出了疾病趋势和分布的例子，以支持生态是人口健康状况的主要决定因素这一论点。来自部分流行病学研究的数据指出，贫困和空气污染是决定城市生态系统中死亡模式的关键因素。
