Forward: A Tale of Two Cities
Forward: A Tale of Two Cities
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前进：两个城市的故事
作者：
R. Lavizzo;W. Richardson;R. K. Ross;J. Rowe
二十世纪在改善美国人的健康和为他们服务的医疗保健系统方面取得了非凡的成就。美国人的平均预期寿命公民的年龄从本世纪初的四十九岁提高到本世纪末的近八十岁。 1915 年至 1977 年间，美国婴儿死亡率下降了 90% 以上。由于免疫接种的广泛普及和卫生设施的改善，许多传染病要么被根除，要么大大减少。本世纪后半叶，影响健康和医疗保健系统的公共政策干预措施以及社区行动也带来了同样重要的健康改善，包括烟草使用的明显减少以及安全带和自行车头盔的使用增加。尽管美国公共卫生和医疗成就的故事确实是一个了不起的故事，但它也包括两个城市的隐喻故事。尽管公共卫生和医疗进步已被证明对许多人有益，但证据也表明，有色人种美国人不太可能从这些非凡成就中获益。尽管种族/族裔背景与社会经济地位之间存在相关性，但仅靠贫困并不能解释少数族裔与白人之间在健康和医疗保健方面存在的一些差距。
The twentieth century ended with an extraordinary record of achievement in improving the health of Americans and the health care system that serves them. The average life expectancy of aU.S. citizen improved from forty-nine years at the start of the century to nearly eighty years at its close. The U.S. infant mortality rate fell by more than 90 percent between 1915 and 1977. Many communicable diseaseswere either eradicated or greatly reduced because of the widespread availability of immunizations and improvements in sanitation. The latter half of the century witnessed equally important health improvements arising from public policy interventions that affected both health and health care systems, and from community action, including a demonstrated reduction in tobacco use and an increase in the use of seat belts and bicycle helmets. But while the story of public health and medical achievement in the United States is truly a remarkable one, it also includes a metaphorical tale of two cities. Although public health and medical progress have proved beneficial for many, the evidence also indicates that Americans of color are less likely to reap the benefits of these remarkable achievements. And although there are demonstrated correlations between racial/ethnic background and socioeconomic status, poverty alone cannot explain some of the gaps in health and health care that exist between minorities and the white population.