Professionalization and public health: historical legacies, continuing dilemmas.
Professionalization and public health: historical legacies, continuing dilemmas.
复制标题
专业化和公共卫生：历史遗产，持续的困境。
DOI：
10.1097/phh.0b013e3181af0a95
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
P. Starr
中科院分区：
文献类型：
--
作者：
P. Starr
公共卫生的专业化反映了更广泛的体制和政治力量。根据不同国家的历史背景，公共卫生已经发展成为一个医学专业或一个独立的领域，完全在国家或公私混合机构中，与社会运动密切或微弱联系，并与工程，护理，环境科学和军事等领域有不同的关系。在20世纪初的美国，医学专业的兴起和疾病的生物医学模式对公共卫生产生了影响，导致了与英国不同的制度模式。公共卫生在美国出现（1）主要是在医学专业之外，但受生物医学模式的影响;（2）没有医学的专属管辖权和高地位;（3）在医疗保健组织和规划中的作用有限。公共卫生中的医疗保健继续受到相互矛盾的压力和不确定性的影响。医疗保健改革、生物恐怖主义和环境危机可能会扩大其授权和资源获取，但与其他机构的冲突可能会限制公共卫生专业人员行使专属管辖权的能力。
Professionalization in public health reflects wider institutional and political forces. Depending on the historical context in different countries, public health has developed as a medical specialty or as an independent field, entirely within the state or in mixed public-private institutions, closely or weakly tied to social movements, and in varying relations to fields such as engineering, nursing, environmental science, and the military. In early 20th-century America, the rise of the medical profession and the biomedical model of disease had a formative influence on public health, leading to a different institutional pattern from Britain. Public health in the United States emerged (1) largely outside the medical profession, but under the sway of the biomedical model; (2) without medicine's command of an exclusive jurisdiction and high status; and (3) with a limited role in healthcare organization and planning. Professionalism in public health continues to be subjected to contradictory pressures and uncertainties. Healthcare reform, bioterrorism, and environmental crises could expand its mandate and access to resources, but conflicts with other institutions are likely to result in limits on the capacity of public health professionals to assert an exclusive jurisdiction.