Susser M
Am J Public Health. 1993 Mar;83(3):418-26. doi: 10.2105/ajph.83.3.418.
The modern idea of health as a human right is examined, as it evolved from the 18th century, in terms of its origins, its essential content, and 20th-century attempts at implementation. Equity for social groups is seen as a guiding principle. Two attempts at implementation, in Britain and in Cuba, are examined for their effects on equity in health service and in health states. The British National Health Service achieved equity between social classes in services but failed to achieve it in health states (as measured by mortality). Deficiencies in commitment to public health services, it is argued, contributed largely to this failure. The Cuban experiment appears to have moved beyond equity solely in services and toward equity in health states. This success reflects an overall Cuban commitment to the public health. Two important elements of that commitment are, first, continuous evaluation with flexible response and, second, community involvement.
本文考察了现代将健康视为人权的理念，该理念自18世纪演变而来，涉及它的起源、基本内容以及20世纪的实施尝试。社会群体公平被视为一项指导原则。本文考察了英国和古巴的两次实施尝试，分析它们对卫生服务公平和健康状况公平的影响。英国国民医疗服务体系在服务方面实现了社会阶层间的公平，但在健康状况（以死亡率衡量）方面未能实现公平。有人认为，对公共卫生服务投入不足在很大程度上导致了这一失败。古巴的试验似乎不仅在服务方面实现了公平，还朝着健康状况公平迈进。这一成功反映了古巴对公共卫生的全面投入。这种投入的两个重要因素，一是持续评估并灵活应对，二是社区参与。
