Lamarche P A
Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Canada.
Public Health Rep. 1995 Sep-Oct;110(5):556-60; discussion 555, 561.
Health care systems are rapidly shifting attention from providing health care to producing health, profoundly altering how and which services are provided. To free up individual and collective resources for investment in activities with a greater impact on health, less care will be given. This paper posits that the current model--increased health resources make for better health care make for better health status--is too simplistic a system. Structural problems inherent in this model are being observed as the boundaries of the paradigm are pushed. Resources are limited, and health outcomes are no longer being improved despite the application of large percentages of Gross National Product. A new health paradigm is emerging, one with increased focus on health prerequisites such as housing, minimum decent income, food, education, and good social and physical environment.
医疗保健系统正在迅速将注意力从提供医疗服务转向促进健康，这深刻地改变了医疗服务的提供方式和内容。为了释放个人和集体资源，用于投资那些对健康有更大影响的活动，将会减少医疗服务的提供。本文认为，当前的模式——增加健康资源会带来更好的医疗保健，进而带来更好的健康状况——是一个过于简单化的体系。随着这一模式的边界被突破，其内在的结构性问题正在显现。资源是有限的，尽管将很大比例的国民生产总值用于医疗，但健康结果却不再得到改善。一种新的健康模式正在出现，它更加关注健康的先决条件，如住房、最低体面收入、食物、教育以及良好的社会和自然环境。
