常民參與對醫療知識與衛生政策的貢獻－職業病認定與補償之爭議的歷史分析

本文論證在公共衛生的範疇中，「常民參與」對醫療科學知識及衛生政策的貢獻，特別以台灣工人運動對職業病議題的參與經驗為例，說明職業病的社會建構特性。職業病問題有其特殊社會意涵，西方歷史經驗指出，工人以「社會參與模式」同時對疾病知識的建構與相關政策進行改革：除了疾病的發現之外，在認定和補償的爭議中，工人對生物醫學知識為典範的「科學／專家主義」模式提出質疑和挑戰，進而主張常民流行病學的觀點，且透過集體的行動督促補償制度的逐步改善。透過檢視三個頗具代表性的工人集體爭取職業病補償案例，本文呈現社會參與模式在台灣的幾個特性：包括常民發現、集體行動的產生、職業病認定的爭議、制度的改革。最後，本文強調常民流行病學與工人運動，在職業病的知識發展和相關衛生政策改革上，扮演不可或缺的角色。

關鍵字

醫療知識的社會建構；社會參與模式；常民流行病學；工人運動；職業病認定與補償

並列摘要

This paper demonstrates the contributions of 'lay participation' to the knowledge of medical science and health policy. By taking the example of workers' movement on the issues of occupational disease in Taiwan, this paper illustrates the social construction of occupation diseases. The specific social implication of occupation disease, as it has been discovered in' social participatory model' in western history, is that workers participated the construction of knowledge and simultaneously reformed the relevant policy. Apart from the discovery of a occupational disease, workers questioned and challenged the 'scientific expert only model' which takes biomedical knowledge as a paradigm, in their dispute over recognition and compensation. Instead, they contended the perspective of lay epidemiology, and urged to reform the compensation system through collective actions. By examining three significant cases of collective worker's compensation claims for occupational disease, this paper exhibits some characters of the social participatory model in Taiwan, including: lay discovery, collective action, dispute over disease recognition, and the policy reform. Finally, this paper emphasizes the indispensable role of lay epidemiology and workers' movement in the knowledge development of occupation disease and the reform of relevant health policy.

並列關鍵字

social construction of medical knowledge ； social participatory model ； lay epidemiology ； worker's movement ； recognition ； compensation of occupational disease