龔鵬程x諾伊豪斯｜公眾參與的公共衛(wèi)生學科

龔鵬程對話海外學者第九十三期：在后現代情境中，被技術統(tǒng)治的人類社會，只有強化交談、重建溝通倫理，才能獲得文化新生的力量。這不是誰的理論，而是每個人都應實踐的活動。龔鵬程先生遊走世界，并曾主持過“世界漢學研究中心”。我們會陸續(xù)推出“龔鵬程對話海外學者”系列文章，請他對話一些學界有意義的靈魂。范圍不局限于漢學，會涉及多種學科。以期深山長谷之水，四面而出。

琳達·諾伊豪斯教授（Professor Linda Neuhauser）

美國加州大學伯克利分校公共衛(wèi)生科學教授，加州大學伯克利分校行動健康研究中心聯(lián)合主審官。

龔鵬程教授：您好。我對您在研究、教學和實踐中都能利用跨學科過程共同設計、共同實施和共同評估研究方法來改善健康，十分好奇。能舉幾個例子嗎？

琳達·諾伊豪斯教授：龔教授，您好。我在加州大學伯克利分校的小組專注于在美國和全球使用高度參與性的方法進行共同設計、共同實施和共同評估。我們首先確定經歷健康問題的人口群體的領導人和成員。然后，我們一起使用多步驟的參與式流程深入了解問題，并共同制定和實施隨著時間推移而不斷完善的解決方案。

一個例子是位于中國常州的常州工人健康項目，旨在使工業(yè)區(qū)的工廠工人受益。

過去許多這樣的項目都失敗了，因為工人和管理人員沒有參與確定問題和解決方案。作為第一步，我們成立了"利益相關者委員會"，其中包括：工廠工人和管理人員、當地的政治家、醫(yī)療機構、研究人員（南京郵電大學和加州大學伯克利分校）、溝通專家和其他人。我們與利益相關者團體一起使用設計思維過程來確定工人問題和解決方案。在工廠里，我們確定了"工人領袖"，他們將其他工人和管理人員聚集在一起，使用參與式設計來探索問題和想法。漸漸地，工人團體和更大的利益相關者團體確定了優(yōu)先問題和干預措施。這些過程產生了三個關鍵的干預措施：在每個工廠中由工人設計的 "健康之家"，一個支持新工人的對等系統(tǒng)，以及由工人設計的包含關鍵健康信息的 "工人健康指南"。工人和其他利益相關者的共同評估將繼續(xù)改善這些成功的干預措施。

My group at the University of California, Berkeley focuses on using highly participatory methods for co-design, co-implementation and co-evaluation in the US and globally. We first identify leaders and members in the population groups that experience a health issue. Then, together, we use multi-step participatory processes understand the problems in depth and co-develop and implement solutions that are refined over time.

An example is the Changzhou Worker Wellness Project in Changzhou, China intended to benefit factory workers in industrial zones. Many such projects have failed in the past because workers and managers were not involved in identifying problems and solutions. As a first step, we set up “stakeholder committees” that included: factory workers and managers, local politicians, health providers, researchers (Nanjing Youdian University and Berkeley), communication experts, and others. We used design thinking processes with stakeholder groups to define worker issues and solutions. In the factories, “worker leaders” were identified who brought together teams of other workers and managers and used participatory design to explore issues and ideas. Gradually, priority issues and interventions were defined by the worker groups and the larger stakeholder group. These processes resulted in 3 key interventions: a worker-designed “wellness house” in each factory, a peer-to-peer system to support new workers, and a worker-designed “worker wellness guide” containing key wellness information. Co-evaluation by the workers and other stakeholders continues to improve these successful interventions.

龔鵬程教授：您對調整工程、建筑和計算機科學以改善大型健康計劃，有什么做法嗎？

琳達·諾伊豪斯教授：在20世紀中期以前，許多公共衛(wèi)生研究和實踐活動都是傳統(tǒng)的專家設計的，打算從工作中受益的人沒有提供足夠的投入，而且往往沒有什么空間來改變干預設計，在最終評估之前，關于項目是否有效的信息也很有限。

這導致了許多失敗的努力。從20世紀中期開始，所謂的"科學革命 "促使了新的科學思維范式。其中之一就是被稱為 "設計科學 "的認識論分支。

設計科學包括與"人類設計的 "物體（建筑、軟件等）以及程序（健康、教育等）有關的理論和方法。設計科學為未來的創(chuàng)造提供指導，而不僅僅是研究 "是什么"。包括建筑學、計算機科學、工程學和其他社會技術科學在內的學科都采用了這種科學基礎。公共衛(wèi)生——這個也是 "面向未來 "的領域——正在迅速采用設計科學的指導。

設計科學有各種各樣的方法；所有的方法都是以用戶為中心的，并且是迭代的。一個流行的例子是"設計思維"，這是一種涉及連續(xù)原型的密集用戶設計技術。

這種方法是在斯坦福大學發(fā)展起來的，包括一個快速的、多步驟的過程，在這個過程中，物體或程序的開發(fā)者與用戶密切接觸，去感同身受潛在的問題，"構思"出多個大膽的想法，并對這些想法進行原型化和反復測試，直到滿足用戶的要求。

我和我的同事們在我們的大多數項目中使用設計思維，作為一種與不同的用戶/利益相關者接觸的方式，對問題產生深刻的理解，并提出可以產生重大影響的原創(chuàng)想法。

我們測試原型干預措施，并逐步完善它們。通過一些早期的"失敗"，我們比預先設想的、"專家設計的 "干預措施更有可能取得最終的成功。

Prior to the mid-20th century, many public health research and practice activities were traditionally expert-designed, with insufficient input from the people intended to benefit from the work and often little room to change the intervention design and limited information before the final evaluation about whether the project was effective or not. This resulted in many failed efforts. Beginning in the mid-20th century, the so-called “scientific revolution” prompted new paradigms of scientific thinking. One of these is the epistemological branch called “design sciences.” The design sciences comprise theory and methods relevant to “human-designed” objects (buildings, software, etc.) as well as programs (health, education, etc.). Design sciences provide guidance about creating for the future, rather than just studying “what is.” Disciplines including architecture, computer science, engineering and other socio-technical sciences have adopted this scientific foundation. Public Health—field that is also “future-oriented”—is rapidly adopting design science guidance.

Design science has a wide variety of methods; all are user-centered and iterative. One popular example is “design thinking” a technique of intensive user-design involving successive prototypes. This approach, developed at Stanford University, involves a rapid, multi-step process in which object or program developers engage closely with users to empathize about an underlying issue, “ideate” to come up with multiple, bold ideas, and prototype and test those ideas iteratively until user requirements are met.

My colleagues and I use design thinking in most of our projects as a way to engage with diverse users/stakeholders, generate a deep understanding of problems, and come up with original ideas that can have a major impact. We are testing prototypic interventions and gradually refining them. Withsome early “failures”, we are significantly more likely to achieve a final success than with pre-conceived, “expert-designed” interventions.

龔鵬程教授：可介紹一下您領導的加州大學伯克利分校行動健康研究中心。

琳達·諾伊豪斯教授：多年前，我致力于尋找方法，將跨學科及其共同設計、共同實施和共同評估公共衛(wèi)生行動的過程付諸實踐。

我的方法是在美國加州大學伯克利分校公共衛(wèi)生學院建立了一個中心——行動健康研究中心。我們有一群跨越重要公共衛(wèi)生領域和方法的人：研究人員、臨床醫(yī)生、社會學家、社區(qū)工作者、政策專家和溝通專家。我的所有同事在參與式設計理論和方法方面都有豐富的專業(yè)知識，并且在美國和全球非常多樣化的社區(qū)中都有工作經驗。

對于我們工作的任何問題，我們首先與來自打算從這些活動中受益的社區(qū)的利益相關者建立牢固的關系。我們與社區(qū)代表合作，找出了解問題的最佳方法。這通常包括確定社區(qū)領袖，他們從社區(qū)成員那里收集信息然后向我們提供建議，例如，通過深入訪談、調查、拍攝、觀察、設計思維研討會等。通過合作，我們使用這些方法，從社區(qū)成員的角度來理解問題和解決方案。

我們通常還會成立"利益相關者咨詢委員會"，其中包括重點社區(qū)的領導人和其他成員，以及來自不同學科或部門的相關人士，他們可以加入對話。這些委員會審查社區(qū)內關于問題和干預想法的形成性研究結果，增加他們自己的建議和其他關于確定向前推進的最佳干預措施的意見。然后，我們共同實施并反復共同評估干預措施的進展，逐步進行改進，直到解決方案被接受并達到成功。我們的小組已經在全球許多國家使用參與式方法來解決許多種健康問題，而且取得了非常積極、可持續(xù)的成果。

Many years ago, I committed to finding ways to put transdisciplinarity and its processes to co-design, co-implement and co-evaluate public health actions into practice. My approach has been to set up a center at the School of Public Health at the University of California, Berkeley (USA)—the Health Research for Action Center. We have a group of people that cross important public health areas and methods: researchers, clinicians, sociologists, community practitioners, policy experts and communication experts. All of my colleagues have extensive expertise in participatory design theory and methods and experience working with people in very diverse communities in the US and globally. For any issue we work on, we first establish strong relationships with stakeholders from the communities that are intended to benefit from the activities. We work with community representatives to figure out the best ways to understand the issues. That often includes identifying community leaders to advise us on the best ways to gather information from community members—for example, through in-depth interviews, surveys, videos, observations, design thinking workshops, etc. Working together, we use these approaches to understand issues and solutions from the viewpoints of community members.

We also typically set up “stakeholder advisory committees” that include leaders and other members of the focal communities and relevant people from different disciplines or sectors who can join the conversation. These committees review the results of formative research in the communities about issues and intervention ideas, add their own suggestions and other advice about figuring out the best interventions to move forward. Then, we all co-implement and iteratively co-evaluate the intervention progress to gradually make refinements until the solution is acceptable and shows success. Our group has used participatory approaches to address many kinds of health issues in many countries globally—with very positive, sustainable results.

龔鵬程教授：這幾年的大疫情，對公共衛(wèi)生或社區(qū)衛(wèi)生科學有什么樣的沖擊？中國，若不管政策面的爭議，傳統(tǒng)中醫(yī)中藥，大量進入公共衛(wèi)生和社區(qū)衛(wèi)生醫(yī)療體系，曾引起您們的關注嗎？

琳達·諾伊豪斯教授：新冠疫情無疑對公共衛(wèi)生和社區(qū)衛(wèi)生科學工作的所有方面產生了巨大的影響。一個影響是，公共衛(wèi)生已經進入了各地的視線。

過去，人們經常會問："什么是公共衛(wèi)生？"或"你們公共衛(wèi)生人員究竟是做什么的？現在，至少人們知道了公共衛(wèi)生在一些領域的作用，如了解疫情的流行病學、幫助開發(fā)疫苗的傳染病和病毒學、了解公眾看法的行為科學以及促進人們自我保護的方法。

至少在美國，人們更加關注公共衛(wèi)生資金的嚴重不足，以及分散的、人員不足的公共衛(wèi)生組織如何在緊急情況增加時努力提供急需的幫助。

在社區(qū)衛(wèi)生科學方面，許多研究和實踐方面的資源被轉用于關注疫情。這是另一個跡象，表明公共衛(wèi)生資源已經捉襟見肘，無法照顧到緊急情況和繼續(xù)正常工作。由于這個原因，許多公共衛(wèi)生服務和研究活動不得不停止或嚴重縮減。這也對支持人們所需的許多其他公共衛(wèi)生服務產生了負面影響，如婦幼保健計劃、衛(wèi)生政策倡議、公共衛(wèi)生教育計劃和許多其他項目。此外，許多非疫情的公共衛(wèi)生研究活動也無法按計劃推進。雖然現在疫情得到了很好的控制，但要等到研究和項目恢復到疫情前的水平還需要一段時間。

除了幫助公眾更好地了解本領域在國內和全球的工作，以及迅速推進有關疫情控制的知識外，還有其他積極的成果。

一個是了解到遠程工作可以非常有效，例如，世界各地的人們可以進行虛擬會議并完成很多工作。許多公共衛(wèi)生和醫(yī)療服務現在使用遠程保健方法，這可以節(jié)省時間、金錢和其他資源。這些領域在疫情期間取得了很大的進展，并不斷取得積極成果。

The Covid-19 pandemic has certainly had a tremendous impact on all facets of public health and community health science work. One impact has been that public health has moved into the limelight everywhere. In the past, people would often ask: “What is public health?” or “What do you public health people actually do? Now, at least people know about public health’s role in areas such as epidemiology to understand pandemics, infectious disease and virology to help develop vaccines, behavioural sciences to understand public perception and foster ways for people to protect themselves. In the USA, at least, there has been a lot more attention to the serious underfunding of public health and how fragmented, understaffed public health organizations struggled to roll out much needed help as the emergency increased.

In terms of community health sciences, many of these resources in research and practice were pivoted to focus on the pandemic. This was yet another sign that public health resources were stretched too thin to take care of the emergencyand continue normal work. For this reason, many public health services and research activities had to be stopped or severely cut back. This, too, had a negative impact on supporting people with the many other public health services they need, such as maternal and child health programs, health policy initiatives, public health education programs, and many others. In addition, many non-pandemic public health research activities could not advance as planned. Although the pandemic is now much better managed, it will take a while until research and programs are back to pre-pandemic levels.

In addition to helping the public better understand what the field does nationally and globally, and rapidly advancing knowledge about pandemic control, there have been other positive outcomes. One is the understanding that remote work can be very effective—for example, people worldwide can meet virtually and get a lot done. Many public health and medical services now use telehealth approaches, which save time, money and other resources. These areas have greatly advanced during the pandemic with continuing positive outcomes.

龔鵬程，1956年生于臺北，臺灣師范大學博士，當代著名學者和思想家。著作已出版一百五十多本。

辦有大學、出版社、雜志社、書院等，并規(guī)劃城市建設、主題園區(qū)等多處。講學于世界各地。并在北京、上海、杭州、臺北、巴黎、日本、澳門等地舉辦過書法展?，F為中國孔子博物館名譽館長、美國龔鵬程基金會主席。