Towards a common definition of global health.
Towards a common definition of global health.
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DOI：
10.1016/s0140-6736(09)60332-9
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发表时间：
2009-06-06
期刊：
影响因子：
168.9
通讯作者：
Wasserheit, Judith N.
中科院分区：
文献类型：
--
作者：
Koplan, Jeffrey P.;Bond, T. Christopher;Merson, Michael H.;Reddy, K. Srinath;Henry Rodriguez, Mario;Sewankambo, Nelson K.;Wasserheit, Judith N.
全球健康是时尚。它引起了媒体、学生和教师的极大兴趣，推动了多个学术项目的建立或重组，作为外交政策的重要组成部分得到了政府的支持，1并已成为主要的慈善目标。全球卫生源自公共卫生和国际卫生，而公共卫生和国际卫生又源自卫生学和热带医学。然而，尽管经常提到全球卫生，但很少对其下定义。如果是这样，定义会有很大的不同，而且往往只不过是对公共卫生共同定义的重新措辞，或者是对国际卫生进行政治上正确的更新。那么，全球健康应该如何定义呢？全球健康可以被认为是一个概念（全球健康的现状），一个目标（一个健康的人的世界，全球健康的条件），或者是学术，研究和实践的组合（有许多问题，问题，技能和能力）。对一个普遍使用和接受的定义的需要超出了语义学的范围。如果没有一个既定的定义，一个诸如全球健康这样的速记术语可能会掩盖医生、研究人员、资助者、媒体和公众之间在哲学、战略和行动优先权方面的重要差异。也许最重要的是，如果我们不明确界定全球卫生的含义，我们就不可能就我们努力实现的目标、我们必须采取的办法、所需的技能以及我们应该如何使用资源达成一致。在本观点中，我们提出了全球健康定义背后的推理，这是由多学科和国际同事组成的小组所商定的。现代意义上的公共卫生出现在世纪中期的几个国家（英国、欧洲大陆和美国），这既是社会改革运动的一部分，也是生物学和医学知识（特别是传染病的病因和管理）增长的一部分。[2]法尔、查德威克、菲尔肖、科赫、巴斯德和沙塔克帮助建立了基于四个因素的学科：（1）基于数据和证据（生命统计、监测和疫情调查、实验室科学）的决策;（2）关注人群而不是个人;（3）社会正义和公平的目标;（4）强调预防而不是治疗护理。所有这些要素都包含在大多数公共卫生定义中。最经得起时间考验的公共卫生定义是温斯洛在近90年前提出的：
Global health is fashionable. It provokes a great deal of media, student, and faculty interest, has driven the establishment or restructuring of several academic programmes, is supported by governments as a crucial component of foreign policy, 1 and has become a major philanthropic target. Global health is derived from public health and international health, which, in turn, evolved from hygiene and tropical medicine. However, although frequently referenced, global health is rarely defined. When it is, the definition varies greatly and is often little more than a rephrasing of a common definition of public health or a politically correct updating of international health. Therefore, how should global health be defined? Global health can be thought of as a notion (the current state of global health), an objective (a world of healthy people, a condition of global health), or a mix of scholarship, research, and practice (with many questions, issues, skills, and competencies). The need for a commonly used and accepted definition extends beyond semantics. Without an established definition, a shorthand term such as global health might obscure important differences in philosophy, strategies, and priorities for action between physicians, researchers, funders, the media, and the general public. Perhaps most importantly, if we do not clearly define what we mean by global health, we cannot possibly reach agreement about what we are trying to achieve, the approaches we must take, the skills that are needed, and the ways that we should use resources. In this Viewpoint, we present the reasoning behind the definition of global health, as agreed by a panel of multidisciplinary and international colleagues. Public health in the modern sense emerged in the mid-19th century in several countries (England, continental Europe, and the USA) as part of both social reform movements and the growth of biological and medical knowledge (especially causation and management of infectious disease). 2Farr, Chadwick, Virchow, Koch, Pasteur, and Shattuck helped to establish the discipline on the basis of four factors:(1) decision making based on data and evidence (vital statistics, surveillance and outbreak investigations, laboratory science);(2) a focus on populations rather than individuals;(3) a goal of social justice and equity; and (4) an emphasis on prevention rather than curative care. All these elements are embedded in most definitions of public health. The definition of public health that has perhaps best stood the test of time is that suggested by Winslow almost 90 years ago: 3