دانلود کتاب بهداشت عمومی ضروری – تئوری و عمل

Health professionals have long lived with the ambiguities of their portrayal in literature and the media: on the one hand as compassionate modern miracleworkers, on the other as self-interested charlatans. The implications of McKeown and Illich’s work were largely ignored by clinicians. However, powerful counterarguments have been mounted in their defence. Attempts have been made to estimate the actual contribution of medical care to life extension or quality of life. Estimating the increased life expectancy attributable to the treatment of a particular condition involves a three-step procedure: _ calculating increases in life expectancy resulting from a decline in disease-specific death rates; _ estimating increases in life expectancy when therapy is provided under optimal conditions (using the results of clinical trials, using life tables); and _ estimating how much of the decline in death rates can be attributed to medical care provided in routine practice. Twenty years ago, Bunker credited 5 of the 30-year increase in life expectancy since 1900, and half the 7 years of increase since 1950, to clinical services (preventive as well as therapeutic). In other words, compared with the large improvements in life expectancy gained from advancing public health, the contribution of medical care was relatively small, but is now a more significant determinant of life expectancy. The continuing inequalities in health point to further potential for improvement. There are thus three main approaches to improving the health of the population as a whole and national policy must take into account their strengths and limitations. _ Increasing investment in medical care may make the most predictable contribution to reducing death and suffering, but its impact is limited. _ The benefits of health promotion and changing lifestyles are less predictable. _ Redistribution of wealth and resources addresses determinants of glaring health inequalities, but is of still more uncertain benefit.