Labonté R
Community Health Development, Toronto, Canada.
Aust J Public Health. 1993 Mar;17(1):4-12. doi: 10.1111/j.1753-6405.1993.tb00096.x.
Public health practice is in a transitory state, expanding considerably beyond medical and behavioural models of health and disease to encompass physical and social environmental health determinants. A new public health practice is emerging, apparent in initiatives like the international healthy cities/communities projects. This new public health practice must integrate the challenge of sustainable development, as defined by the 1987 World Commission on Environment and Development. The holosphere framework locates health as its central metaphor, and defines six interacting environmental spheres: a viable natural environment, a sustainable economic environment, a sufficient economy, an equitable social environment, a convivial community, and a livable built environment. There are five functional roles for local government: policy, legislation, education, partnerships and advocacy. Representative actions from each of the six environmental spheres of the holosphere framework are identified and discussed, using the five functional roles of local government. There is a need for new intersectoral forums to act upon the knowledge generated by integrative models such as the holosphere. Canadian Round Tables on Environment and Economy are encouraging examples of such intersectoralism.
公共卫生实践正处于过渡状态，其范围已大幅扩展，超越了健康与疾病的医学和行为模式，涵盖了物理和社会环境健康决定因素。一种新的公共卫生实践正在兴起，在国际健康城市/社区项目等倡议中显而易见。这种新的公共卫生实践必须融入1987年世界环境与发展委员会所定义的可持续发展挑战。全领域框架将健康定位为其核心隐喻，并定义了六个相互作用的环境领域：一个可行的自然环境、一个可持续的经济环境、一个充足的经济、一个公平的社会环境、一个和谐的社区和一个宜居的建成环境。地方政府有五个职能角色：政策制定、立法、教育、伙伴关系和倡导。利用地方政府的五个职能角色，确定并讨论了全领域框架六个环境领域中每个领域的代表性行动。需要新的跨部门论坛来根据全领域等综合模式产生的知识采取行动。加拿大环境与经济圆桌会议就是这种跨部门合作的积极范例。
