公共卫生的过去与现在翻译可编辑.docx
- 文档编号:12143787
- 上传时间:2023-04-17
- 格式:DOCX
- 页数:9
- 大小:25KB
公共卫生的过去与现在翻译可编辑.docx
《公共卫生的过去与现在翻译可编辑.docx》由会员分享,可在线阅读,更多相关《公共卫生的过去与现在翻译可编辑.docx(9页珍藏版)》请在冰豆网上搜索。
公共卫生的过去与现在翻译可编辑
外文翻译
原文:
PublicHealthThenandNowTheMedicalCareProgramsoftheFarmSecurityAdministration,1932through1947:
ARehearsalforNationalHealthInsurance?
Introduction
From1935to1947,thefederalgovernmentsponsoredanextensivecivilianmedicalcareprogramundertheaegisoftheUSDepartmentofAgriculture'sFarmSecurityAdministration(FSA).TheFSA'smission—torehabilitatelowincomefarmers,sharecroppers,andmigrantworkers—ledittodevelopacomprehensivemedicalcareprogramdescribedbytheSaturdayEveningPostasa"giganticrehearsalforhealthinsurance."'Attheprogram'speak,morethan650(XH)p Itsdecentralizedapproachpromotedkicalautonomyandgavephysicianssubstantialbutnotabsolutecontrolovertheoperationofthemedicalcareplans.Certainly,philanthropies,unions,physicians,andprivateindustrysponsoredvariousprepaidhealthcareplansthroughoutthisperiodandeveneariier.However,thepublic/privatecharacter,extensiveenrollment,comprehensivecoveragecoverageprovisions,andpreventiveorientationoftheFSAprogramgivesitahistoricalimportthatexceedsthatofeariierorparallelhealthcaredeliveryprograms.Throughoutmostofthisperiod,theAmericanMedicalAssociationvehementlyopposedfederalinvolvementinmedicalcaredelivery.Inspiteofthisopposition,physiciansupportoftheFSAplansatthegrassrootslevelwassubstantialandwasdrivenbyhumanitarianandeconomicconcerns.Whilephysicianssawtheprogramasatemptiraryfederalefforttoprovidemedicalcaretoanindigentgroup,theagencyitselfpursuedabroaderpublichealthagenda.TheFSA'sextensivepublicandpreventivehealtheffortsanditssystematicuseofpublichealthnurses,nutritionists,andUSPublicHealthServicemedicalofficersbeliethepublicpostureassumedbytheagency.Overtime,theFSA'smultifacetedruralhealthprogramsanditseventualalliancewithreformersfavoringnationalhealthinsurancemadephysiciansincreasinglyuncomfortable.Thisdiscomfortcoincidedwithphysicians'improvingincomesandtheeasingoftheeconomicpressuresonthemintheyearsleadinguptoWorldWarII.GrowingcongressionaloppositiontoNewDealsociallegislation,thedivisivedebateovernationalhealthinsurance,andconcertedoppositiontotheFSAbyconseI^'ativefarmgroupsonlyaddedtotheagency'swoes.Insharpcontrast,otherTheauthoriswiththeDepartmentofMedicineandtheDepartmentofCommunityMedicineandHeahhCare,UniversityofConnecticutSchtH)lofMedicine,Farmington.Conn.RequestsforreprintsshouldbesenttoMichaelR.Grey,MD.MPH.SectionofOccupationalandEnvironmentalMedicine.Bldg12.UniversityofConnecticutHealthCenter,Farmington,CT06030.privatelyfundedvoluntarygroupprepaymentplans(e.g..KaiserPermanente,BlueCross,andphysicianservicebureaus)werelessvulnerabletoattackandmadesteadygainsinthepostwarera.Inretrospect,however,therootcauseoftheFSAplans'eventualdemisewasanideologicalconflictbetweenthegovernmentandthemedicalprofession.Forthisreason,thehistoryoftheFSAmedicalcareprogramilluminatestheideological,economic,andhumanitarianmotivationsofAmericanphysiciansinthefaceofhealthcarereformMedicineandHealthinthe1930sAmericanmedicine,likemuchofsocietyinthe1930s,wasintransition.Solopracticeandfee-for-servicestilldominatedmedicalpractice,andruralhospitalswerefewandoftenproprietary.However,thewaninginfluenceofgeneralpractitioners,therisingdominanceofspecialists,andcentralizationofcareinhospitalswerewellunderwaybythattime.*^In1932,theCommitteeontheCostsofMedicalCarepublisheditslandmarkreportMedicalCarefortheAmericanPeople,themostexhaustiveandinfluentialstudyofthestateofAmericanhealthandmedicinethathadeverbeenpublished.Thecommitteefoundthatpoorcommunitiesexperiencedmoresicknessandreceivedlesscarethanmoreaffluentcommunities.Medicalresources,whileplentiful,werenot"distributedaccordingtoneeds,butratheraccordingtotherealorsupposedabilityofpatientstopayforservices.""Thenumerical,income,andgeographicalimbalancebetweengeneralpractitionersandspecialistsledthecommitteetoconcludethatthenationneededfarfewerspecialistsandfarmoregeneralpractitioners.Finally,thecommitteelinkedaccessandcostbarriersascriticalissuesforundersenedpopulations,settingthetoneforvirtuallyallheaithcarereformstothepresentday,'"Anobviousbutoftenneglectedfactisthatthemostnettlesomeproblemsinourhealthcaresystemantedatedchangessuchastheexplosionofmedicaltechnology,theaccelerationofmedicalspecialization,andthedominanceofhospital-basedcareinthewakeofWorldWarII.Thecommittee's1932reportcallingforanintegratedsysteminwhichgenerallstsprovidethemajorityofacuteandpreventiveserviceswasprescient.TheGreatDepressiongreatlyexacerbatedbutdidnotcreatetheproblemshighlightedbytheCommitteeontheCostsofMedicalCare.Unemploymentsoaredtoanunprecedented25%,overwhelmingprivateandlocalreliefagencies.Lackofmoneyforcedmanypeopletogowithoutmedicalservices,andasingleseriousillnesswasenoughtoplungealargeandsteadilyincreasingpercentageofAmericanfamiliesintoprolongeddebt."Ihavetotreatmanyfamilies,"lamentedonephysician,"shuttingmyeyestothefactthatnotoneofmyinstructionscanbecarriedout.""Physicians'netincomeplungedby17%,andmanyruralphysicians'incomesdroppedbelow50%ofbillings.''^Otherhealthcareprofessionalsweresimilarlyaffected.TheGreatDepressiondevastatedruralAmerica.Mechanizationandlandconsolidation,thenation'sworst-everdrought,andbluntlegislativeeffortssuchastheAgriculturalAdjustmentActconspiredtocreatethelargestinternalmigrationinourhistory.Vastnumbersoffamilieslefttheirfarmsburiedindust,loadeduptheirjalopies,andheadedwest(seephotoonnextpage).TheDepartmentofAgricultureestimatedthatbetween1and2millionoftheestimated10.5millionpeopleemployedinagricultureweremigrants.'Thehealthconditionsofruralcitizens,whichhadbeendecliningrelativetothoseofurbanAmericanssincetheturnofthecentury,werealsoadverselyaffected.Ruralareashad80physiciansper1000(K)population,vs171per100(X)0inurbanareas.In1900,nearly50%ofmedicalschoolgraduatespracticedinruralareas;by1931.fewerthan21%didso.! ""InmetrojXJlitanareas,72%ofbirthsoccurredinhospitals,infantmortalitywas34.2per1000livebirths,andimmunizationsaveraged89%.Incontrast,only14%ofruralbabieswereborninhospitals,ruralinfantmortalitywas43.3per1000 livebirths,andonly37%ofruralchildrenwereimmunized.'InNewEnglandtherewere81hospitalbedsper100(XX)population,whileinihemoreruralSouththerewereonly30bedsper100(KX).NinetyfourpercentofallwatersuppliesintheSouth,accordingtothe1940census,wereopen;66%ofSouthernersstillusedprivies,andfewerthan12%hadpotablewaterwithin50feet.Athirdofthenation's3070countieshadnopublichealthunit;virtuallyallwererural."Healthconditionsamongmigrantswereparticularlyabysmal.Outbreaksofinfectiousdiseasessuchastyphoid,dysentery,andtuberculosiscreatedvigilantemovementsthatweresometimesledbylocalhealthdepartments.Wroteonecountyhealthofficer,"Onehastodealwithapeoplewhoseculturalandenvironmentalbackgroundissobadthatforaperiodofmorethan3(M)yearsnoadvanceshavebeenmadeinlivingconditionsamongthem."Racism,xenophobia,andfearofcontagion—powerfulhistoricalthemesinsociety'sresponsetodiseaseepidemics—ledtotheviolentandsystematicdestructionofsquattereampsor"Hoovervilies."Tomanypeople,diseaseanddegradedmortalityseemedequallycontagious."Riwseveitquicklymovedtopromotemassivefederalinterventionduringthefamous"HK)days"ofhispresidenc7.CongresspassedanomnibusreliefmeasurecreatingtheFederalEmergencyReliefAdministration(FERA)inMareh1933.TheFERAchanneleddirectfederalreliefthroughstateemergencyreliefadministrationsandcreatedadivisiondevotedsolelytoruralreliefandrehabilitation.ThehallmarksoftheFERAruralrehabilitationprogram—friendlysupervisionandeasycredit—remainedatthecoreofallsubsequentefforts.TheereationoftheWorksProgressAdministration(WPA)andtheResettlementAdministrationin1935signaledashiftinfederalpolicyawayfromdirectmonetaryrelief.Themorewell-knownWPAconcentratedonmassiveinfrastructureprojectsandurbanworkrelief.TheResettlementAdministrationassumedtheruralrehabilitationprerogativesoftheFERAandoperatedfor2yearsasanindependentcabinet-levelagencyunderbraintrusterandpoliticallightningrodRexfbrdTugwell.In
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 公共卫生 过去 现在 翻译 编辑