Health equity or iniquity?
Health equity or iniquity?
复制标题
健康公平还是不公平？
DOI：
10.1007/s10935-011-0237-9
复制
发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Wendel,MonicaL
中科院分区：
文献类型：
--
作者：
McLeroy,KennethR;Wendel,MonicaL
我们要感谢我们的同事迈克尔·杜波依斯和大卫·布坎南提出了预防的伦理学和经济学方面的重要问题，为这篇社论提供了基础。在Dubois的文章中，他强调了围绕将预防政策纳入私人和公共资助的医疗保险的一些哲学论点。特别是，他叙述了这样一种观点，即个人有义务为社会做出富有成效的贡献，以及社会团结的重要性--这一观点在欧洲的话语中可能比在美国更为突出。作为回应，布坎南利用德国健康保险的例子来说明社会公益和团结之间的紧张关系，指出个人采取积极措施保持健康可能被视为对共同公益的贡献，但预防政策也可能破坏团结，因为不成比例地奖励那些已经健康的人。在这些文章和公共话语中，与健康和医疗保健相关的几个论点都集中在个人责任上;然而，人们往往不清楚个人责任到底意味着什么，以及它如何影响健康和其他结果（Wikler 1987）。例如，有些人认为，个人的生活方式选择和行为与某些疾病和健康结果有关，但这种联系的程度对于预防实践中的许多行为是值得怀疑的。此外，即使行为和健康结果之间存在很强的联系，一些行为也不完全在个人的控制之下，即使是在个人控制之下的行为也可能受到社会和结构因素的强烈影响（Krieger 2008）。正如布坎南所认为的那样，环境可能会限制个人控制下的选择和行为。丹·维克勒（Dan Wikler）（1987）还提出了一个关键问题，即假设个人对自己的健康负有唯一（甚至主要）责任的意识形态基础。他总结道：“关于个人健康责任的辩论......也是关于公众健康责任的程度，这些责任应该放在非人身上，主要是工业和政府。将健康责任归于个人的论点往往是试图免除这些较大的机构分别造成疾病或未能提供护理的责任“（第24页）。可以推测，如果个人对自己的健康负责，那么社会就没有什么义务保证健康服务和个人健康的条件。
We want to thank our colleagues Michael Dubois and David Buchanan for raising important issues in the ethics and economics of prevention that provide the foundation for this editorial. In Dubois’s article, he highlights some of the philosophical arguments surrounding the inclusion of prevention policies in private and publicly-funded health insurance. In particular, he recounts the argument that individuals have an obligation to make a productive contribution to society and the importance of social solidarity—an argument that may be more prominent in European discourse than in the US. In response, Buchanan utilizes the example of German health insurance to illustrate the tension between the social good and solidarity, pointing out that an individual taking active steps to be healthy may be viewed as contributing to the common good but that prevention policies may also undermine solidarity by disproportionately rewarding those who are already advantaged. Several arguments in these articles and in the public discourse related to health and health care focus on individual responsibility; however, it is frequently unclear what individual responsibility really means and how that may affect health and other outcomes (Wikler 1987). For example, some argue that individual lifestyle choices and behavior are linked to certain diseases and health outcomes, but the magnitude of that link is questionable for many behaviors of interest in the practice of prevention. Moreover, even when there is a strong link between a behavior and a health outcome, some behaviors are not entirely under the control of the individual, and even those under individual control may be strongly influenced by social and structural factors (Krieger 2008). As Buchanan argues, context may restrict the choices and behaviors under individual control.Dan Wikler (1987) also raised a key question about the ideological underpinnings of assuming that individuals are solely (or even primarily) responsible for their health. He concluded,‘‘The debate over personal responsibility for health… is also about the degree of responsibility for the health of the public which ought to be placed on non-persons, primarily industry and government. The argument for assigning responsibility for health to the individual is often an attempt to absolve these larger institutions of blame for having caused sickness or for having failed to provide care, respectively’’(p. 24). Presumably, if individuals are responsible for their health, then society may have little obligation to assure health services and the conditions under which individuals
影响因子：
2.1
作者：
Schellhorn, M
通讯作者：
Schellhorn, M