Freeman P, Robbins A
John W. McCormack Institute of Public Affairs, University of Massachusetts, Boston 02125-3393.
J Public Health Policy. 1994 Autumn;15(3):261-82.
Universal access to medical services will not address all important health needs. Impending health care reform, guided by public health strategies, could achieve many previously unattainable health goals. However, such a public health role seems unlikely. Public health reaches beyond the current popular notion of prevention focused on individual lifestyle, yet attention to public health authority has waned. The history of immunization, a personal health service effective only within a public health strategy, illustrates the dilemma. Britain required 40 years of National Health Service before it invoked a public health strategy to assure effective immunization. Reformed health care must perform certain functions systematically that in the past were optional for medical practitioners or left to health departments by default. Reformers must rebuild public health authority in states, to assure that medical services we will pay for under health care reform accomplish functions critical to the health of the public.
普及医疗服务并不能满足所有重要的健康需求。在公共卫生战略的指导下即将进行的医疗改革，可能会实现许多以前无法实现的健康目标。然而，这样的公共卫生角色似乎不太可能实现。公共卫生的范畴超出了当前流行的、专注于个人生活方式的预防观念，但对公共卫生权威的关注却有所减弱。免疫接种的历史就说明了这一困境，免疫接种作为一项个人健康服务，只有在公共卫生战略中才会有效。英国在实施了40年的国民医疗服务体系后，才采用公共卫生战略来确保有效的免疫接种。改革后的医疗保健必须系统地履行某些过去对医生来说是可选择的或默认留给卫生部门的职能。改革者必须重建各州的公共卫生权威，以确保我们在医疗改革下支付费用的医疗服务能够履行对公众健康至关重要的职能。
