心得重點
1.適應能力的定義
Broadly speaking it may be described as the ability or capacity of a system to modify or change its characteristics or behaviour so as to cope better with existing or anticipated external stresses.
從廣義上講，它(適應能力)可以被描述為修改系統、改變其特性或行為的能力，以便能對現有的或預期的外部壓力有更好的應對。
We may view reductions in social vulnerability as arising from the realization of adaptive capacity as adaptation.
我們可能會認為減少社會的脆弱性所產生的適應能力作為適應實現。
The term adaptation is used here to mean adjustments in a system’s behaviour and characteristics that enhance its ability to cope with external stresses.
在這裡適應這個詞用來指調整系統的行為和特性，提高其應對外部壓力的能力。
Given constant levels of hazard over time, adaptation will allow a system to reduce the risk associated with these hazards by reducing its social vulnerability.
由於不斷的危險水平隨著時間的推移，適應將允許系統以降低風險與減少這些危害社會的脆弱性。
2.社會資本與適應能力
由社會資本在這裡我們是指一組網絡，協議和流量的信息。
其核心概念封裝“功能的社會組織，如信任，規範和網絡，可以提高效率的社會，促進協調行動”（普特南等人，1993年，第167頁）。
Social capital provides an explanation for how individuals use their relationships to other actors in societies for their own and for collective good, both in material terms and for wider spiritual and social benefits.
社會資本提供了一個解釋，個人是如何使用他們的個人關係，在社會中的其他演員為自己和集體利益，無論是在物質上和精神上的和更廣泛的社會效益。
4.個人適應力與社會適應力的區別
Although the capacity of individuals to adapt to climate change is a function of their access to resources, the adaptive capacity of societies depends on the ability to act collectively in the face of the threats posed by climate variability and change.
雖然個人適應氣候變化的能力是一個獲取資源的函數，但社會的適應能力是取決於在面對氣候變率和變化所造成的威脅，共同行動的能力。
Thus adaptive capacity, as an element of overall vulnerability of a society, can be illuminated through examining the institutions for resource management and their effectiveness, efficiency and legitimacy.
因此將適應能力當作整體社會脆弱性的一個元素，透過檢視機構資源管理的有效性，效率和合法性來映照此一脆弱性。
Social capital is made up of the networks and relationships between individuals and social groups that facilitate economic well-being and security.
社會資本是由網絡和個人與社會團體之間的關係所組成，以促進經濟福祉和安全。
Many aspects of adaptive capacity are, in effect, latent in the networks and information of those likely to be affected.
實際上，許多方面的適應能力，潛藏在那些可能受到影響的網絡和信息。
This suggests, though has yet to be tested, that some groups within society may be less at risk than modelling studies portray because of this latent ability to cope in times of stress.
儘管尚未得到檢驗，這表明社會中有些群體可能會比模擬研究所描繪風險還少，是因為其有潛在的適應能力，足以應付時代的壓力。
5.
Adaptation does not occur instantaneously; a system requires time to realise its adaptive capacity as adaptation.
適應不會發生瞬間，一個系統需要時間來實現其適應能力作為適應。
Adaptive capacity represents potential rather than actual adaptation.
適應能力代表潛力，而不是實際的適應。
A high level of adaptive capacity therefore only reduces a system’s vulnerability to hazards occurring in the future (allowing the system time to adapt in an anticipatory manner) or to hazards that involve slow change over relatively long periods, to which the system can adapt reactively.
因此一個高層次的適應能力，不僅降低了系統未來發生危害時的脆弱性（允許系統有時間以預期的方式來適應）或是使危害在相對長的時間緩慢的變化，直到到該系統能被動適應。
6.we must ask ourselves whether a system is likely to implement the necessary adaptation measures in the time available to it in order to reduce risk to a subjectively defined acceptable level.
我們必須自問是否給系統充足的時間實施必要的適應措施，以減少風險到一個主觀可接受的水平。
3.4. Adaptive capacity and the adaptation process
適應能力的定義
The above discussion has gone some way towards developing a conceptual framework of vulnerability and risk, based on the distinction between social and biophysical vulnerability, and on the equivalence of biophysical vulnerability and risk.
This distinction helps us to make sense of the apparently contradictory definitions in the IPCC TAR (IPCC, 2001), by associating hazard with climate variation, sensitivity with social
vulnerability, and vulnerability as defined in IPCC Def. 1 with biophysical vulnerability or risk.
However, we have not yet addressed the issue of adaptive capacity, and its relationship to social and biophysical vulnerability.
3.4。適應能力和適應的過程
以上的討論已經某種方式對發展的概念框架的脆弱性和風險的基礎上，區分社會和生物物理脆弱性，並在等效生物物理脆弱性和風險。
這種區別可以幫助我們，使意義上的明顯矛盾的定義在IPCC第三次評估報告（IPCC，2001），通過關聯風險與氣候變化，靈敏度與社會
脆弱性和脆弱性定義為在警監會投籃。 1與生物物理弱點或風險。
然而，我們還沒有解決的問題的適應能力，及其與社會和生物物理脆弱性。
Many definitions of adaptive capacity exist (e.g. IPCC, 2001; Burton et al., 2002; Adger et al., 2003); broadly speaking it may be described as the ability or capacity of a system to modify or change its characteristics or behaviour so as to cope better with existing or anticipated external stresses.
We may view reductions in social vulnerability as arising from the realization of adaptive capacity as adaptation.
The term adaptation is used here to mean adjustments in a system’s behaviour and characteristics that enhance its ability
to cope with external stresses.
Given constant levels of hazard over time, adaptation will allow a system to reduce the risk associated with these hazards by reducing its social vulnerability.
Faced with increased hazard, a system may maintain current levels of risk through such adaptation; reductions in risk in the face of increased hazard will require a greater adaptation effort.
If hazards increase dramatically in frequency or severity, a human system may face greater risk despite reduction in social vulnerability achieved through the implementation of adaptation strategies.
許多定義的適應能力存在（如IPCC，2001;伯頓等人，2002;阿傑等人，2003年）;從廣義上講它可以被描述的能力或能力的系統修改或改變其特性或行為，以便以更好地應對現有的或預期的外部壓力。
我們可能會認為減少脆弱性的社會所產生的適應能力作為實現適應。
這個詞用在這裡適應是指調整系統的行為和特性，提高其能力
要應對外部壓力。
由於不斷的危險水平隨著時間的推移，適應將允許系統以降低風險與減少這些危害社會的脆弱性。
面對增加的危險，系統可能會維持當前水平的風險通過這種適應，減少風險，面對增加的危險，需要更大的適應工作。
如果危險急劇增加的頻率或嚴重程度，人類系統可能面臨更大的風險，儘管減少社會脆弱性實現通過實施適應戰略。
社會的適應能力
Societies have inherent capacities to adapt to climate change.
These capacities are bound up in the ability of societies to act collectively.
Decisions on adaptation are made by individuals, groups within society, organizations and governments on behalf of society.
But all decisions privilege one set of interests over another and create winners and losers.
Examining the social dynamics and outcomes of adaptation moves beyond simply accounting for the economic costs and benefits of adaptation.
One element of this project has been to explore the nature of these society-environment interactions, particularly the role of social institutions and social capital in adaptation processes.
By social capital here we mean a set of networks, agreements, and flows of information.
At its core the concept encapsulates ‘features of social organisation such as trust, norms and networks that can improve the efficiency of society by facilitating co-ordinated actions’ (Putnam et al., 1993, p. 167).
Some social capital may emerge as a result of economic transactions and activities, but many aspects of social capital do not. Social capital provides an explanation for how individuals use their relationships to other actors in societies for their own and for collective good, both in material terms and for wider spiritual and social benefits.
社團具有內在的能力，以適應氣候變化。
這些能力是在一定的社會的能力，以集體行動。
決定適應是由個人，團體在社會，組織和政府代表的社會。
但是，所有的決策權限一組利益，創造了另一個贏家和輸家。
研究社會動態和成果的適應超越了單純的經濟核算成本與收益的調整。
其中一個要素這一項目已探索的性質，這些社會與環境的相互作用，特別是社會機構的作用和社會資本的適應過程。
由社會資本在這裡我們是指一組網絡，協議和流量的信息。
其核心概念封裝“功能的社會組織，如信任，規範和網絡，可以提高效率的社會，促進協調行動”（普特南等人，1993年，第167頁）。
一些社會資本可能出現的結果是經濟交易和活動，但許多方面的社會資本沒有。社會資本提供了一個解釋如何使用他們的個人關係，在社會中的其他演員為自己和集體利益，無論是在物質上和精神上的和更廣泛的社會效益。
國家的適應能力
The nature of the relationships between state and civil society and the relative role of each in adaptation has been explored in a series of conceptual and empirical papers (Adger, 2001, 2003, 2004; Tomkins and Adger 2003).
The conceptual work argues that current frameworks promoted by, for example, the IPCC, fail to point out the key relationship between civil society and government.
Often distinctions are drawn between planned adaptation by governments on behalf of society on the one hand and autonomous adaptation by individuals on the other (summarized in Smit et al., 2001).
But this distinction obfuscates the role of the state in promoting development paths that cause institutional and technological lock-in and indeed often promote unsustainable practices that reduce the ability to adapt in the long run.
該性質的關係國家與民間社會和相對作用的每一個適應已經探索了一系列的概念和經驗的論文（阿傑，2001，2003，2004;湯姆金斯和阿傑2003年）。
工作的概念認為，目前的框架推動下，例如，警監會，未能指出的關鍵關係的民間社會和政府。
通常區分之間繪製計劃由政府代表的適應社會，一方面，自治區適應個人的其他（總結斯密特等人，2001年）。
但這種區別混淆的作用，國家在促進發展的路徑，導致體制和技術鎖定，實際上往往不可持續的做法，促進適應能力降低，長期運行。
Although the capacity of individuals to adapt to climate change is a function of their access to resources, the adaptive capacity of societies depends on the ability to act collectively in the face of the threats posed by climate variability and change.
Thus adaptive capacity, as an element of overall vulnerability of a society, can be illuminated through examining the institutions for resource management and their effectiveness, efficiency and legitimacy.
Social capital is made up of the networks and relationships between individuals and social groups that facilitate economic well-being and security.
Indeed previous research in coastal environments demonstrates that social capital is an important element for coping with climate variability and hazard in the present day.
In the Caribbean, for example, Tompkins and Agder (2003) show that communities find strategies to manage risks through strategic and local networks and interactions.
Many aspects of adaptive capacity are, in effect, latent in the networks and information of those likely to be affected.
This suggests, though has yet to be tested, that some groups within society may be less at risk than modelling studies portray because of this latent ability to cope in times of stress.
雖然個人的能力，以適應氣候變化是一個函數的獲取資源，對社會的適應能力取決於行動的能力，在面對共同的威脅所造成的氣候變率和變化。
因此適應能力，作為一個元素的整體脆弱性的社會，可以照亮研究機構通過對資源的管理和其有效性，效率和合法性。
社會資本是由網絡和個人之間的關係和社會團體，以促進經濟福祉和安全。
事實上，以前的研究表明，在沿海環境中的社會資本是一個重要的元素為應對氣候變率和危險的今天。
在加勒比地區，例如，湯普金斯和Agder的（2003）表明，社區尋找戰略風險管理戰略和地方通過網絡和交互。
許多方面的適應能力，實際上，潛伏在網絡和信息的那些可能受到影響。
這表明，儘管尚未得到檢驗，有些群體在社會中可能會少風險比模擬研究描繪，因為這種潛在能力，以應付時代的壓力。
The direct effect of adaptation is to reduce social vulnerability.
Whether or not this translates into a reduction in biophysical vulnerability or risk will depend on the evolution of hazard.
In the case of anthropogenic greenhouse warming and any associated changes in climate, the only certain way of reducing risk is therefore via a combination of adaptation and mitigation strategies, the purpose of the latter being to reduce hazards.
In the following discussion on adaptive capacity and adaptation, the term vulnerability will therefore be used to refer to social vulnerability, unless otherwise stated.
Where the text refers to reductions in vulnerability as a result of adaptation, this should be interpreted as social vulnerability, and by extension to biophysical vulnerability only under conditions of constant hazard.
直接效果是減少的適應社會的脆弱性。
這是否轉換成生物物理脆弱性或減少風險將取決於演變的危險。
在案件的人為溫室變暖和任何關聯的氣候變化，只有一定的方式降低風險，因此通過組合適應和減緩戰略，後者的目的是減少危害。
在下面的討論適應能力和適應，長期脆弱性將因此被用來指社會脆弱性，除非另有說明。
如果文本是指減少脆弱性，結果適應，這應該被理解為社會的脆弱性，並由此延伸到生物物理弱點只有在不斷的危險條件。
In IPCC Def. 1, biophysical vulnerability is a function of adaptive capacity, which is viewed as distinct from sensitivity, which we may view in turn as being broadly to social vulnerability.
Given the broad equivalence of biophysical vulnerability and risk (Section 3), IPCC Def. 1 suggests that if a system has a high
capacity to adapt, it is less “at risk”.
However, the adaptation process and the nature of the relationship between the vulnerability and adaptive capacity of a system will be
mediated by the nature of the hazard(s) faced by the system.
Three broad categories of hazard may be identified:
Category 1:
Discrete recurrent hazards, as in the case of transient phenomena such as storms, droughts and extreme rainfall events.
Category 2: Continuous hazards, for example increases in mean temperatures or decreases in mean rainfall occurring over many years or decades (such as anthropogenic greenhouse warming or desiccation such as that experienced in the Sahel over the final decades of the 20th century (Hulme, 1996; Adger and Brooks, 2003).
Category 3:
Discrete singular hazards, for example shifts in climatic regimes associated with changes in ocean circulation; the palaeoclimatic record provides many examples of abrupt climate change events associated with the onset of new climatic conditions that prevailed for centuries or millennia (Roberts, 1998; Cullen et al., 2000; Adger and Brooks, 2003).
在警監會投籃。1，生物物理脆弱性是一個函數的適應能力，這被認為是有別於敏感性，我們可以查看之交被廣泛地社會脆弱性。
鑑於廣大等價生物物理脆弱性和風險（第3），警監會防守。 1表明，如果一個系統具有較高的
適應能力，它是那麼“危險”。
但是，適應的過程和性質之間的關係脆弱性和適應能力的系統將
介導的性質危害（S）所面臨的系統。
三大類別的危險可能會發現：
第一類：
離散經常性的危害，如遇短暫現象，如暴風雨，乾旱和極端降雨事件。
第2類：連續的危害，例如增加或減少，平均氣溫的平均降雨量發生在許多年或數十年（如人為的溫室變暖或乾燥等，有經驗的薩赫勒地區在最後幾十年的20世紀（休姆，1996年;阿傑和Brooks，2003）。
第3類：
離散奇異的危害，例如在氣候變化制度與海洋環流的變化;的古氣候記錄提供了許多例子，氣候突變事件的發生與氣候條件的新的流行百年或幾千年（羅伯茨，1998年;庫倫等，2000年，阿傑和Brooks，2003）。
Adaptation does not occur instantaneously; a system requires time to realise its adaptive capacity as adaptation.
Adaptive capacity represents potential rather than actual adaptation.
A high level of adaptive capacity therefore only reduces a system’s vulnerability to hazards occurring in the future (allowing the system time to adapt in an anticipatory manner) or to hazards that involve slow change over relatively long periods, to which the system can adapt reactively.
In other words, adaptive capacity is a determinant of vulnerability to Category 2 hazards and anticipated future Category 1 and 3 hazards.
The damage to a system resulting from a discrete hazard event such as a storm or flood occurring tomorrow would not be a function of the system’s ability to pursue future adaptation strategies – it is existing adaptations resulting from the past realization of adaptive capacity that determine current levels of vulnerability.
The likelihood of a system adapting responsively to (as opposed to coping with) a sudden short-lived event such as a hurricane is negligible.
適應不會發生瞬間，一個系統需要時間來實現其適應能力作為適應。
適應能力代表潛力，而不是實際的適應。
一個高層次的適應能力，因此不僅降低了系統的脆弱性危害發生的未來（允許系統時間來適應在預期的方式）或危害，包括緩慢變化在相對長的時間，到該系統能適應被動。
換句話說，適應能力是決定因素的脆弱性2類危險和預計未來的1類和第3的危害。
的損害，導致系統從離散危險事件，如風暴或洪水發生的明天會不會是一個功能的系統的能力，追求未來的適應戰略 - 這是現有的適應產生由過去實現的適應能力，確定目前的水平脆弱性。
一個系統的可能性，以適應 responsively（而不是應付）突然短暫的事件，如颶風是微不足道的。
However, a system’s vulnerability to more gradual, longer-term change will be a function of it’s ability to adapt incrementally and responsively, and its vulnerability to discrete hazards occurring in the future will be a function of its ability to anticipate and pre-empt those hazards via appropriate planned adaptation strategies.
The rate at which risk (or biophysical vulnerability) associated with a particular type of hazard is reduced (or increased) will depend on the timescales associated with the implementation of adaptation measures (i.e. the realisation of adaptive capacity as adaptation) and also on the timescales associated with the evolution or occurrence of the hazard in question (in the case of global-scale anthropogenic climate change the latter will be influenced by global development pathways and the extent to which mitigation is pursued).
In other words, we must ask ourselves whether a system is likely to implement the necessary adaptation measures in the time available to it in order to reduce risk to a subjectively defined acceptable level.
但是，一個系統的脆弱性更加漸進的，長期的變化將是一個函數它的適應能力逐步和responsively，其脆弱性離散危害發生的未來將是一個函數它能夠預測和先發製人的通過適當的危害計劃的適應戰略。
的速率風險（或生物物理漏洞）與特定類型的危險降低（或增加），將取決於相關的時間尺度與實施適應措施（即實現適應能力作為調整），並在時間尺度與進化或發生危險的問題（的情況下，全球規模的人為氣候變化，後者將受到全球發展途徑和在何種程度上緩解是追求）。
換句話說，我們必須自問系統是否可能實施必要的適應措施，提供給它的時間，以減少風險的一個主觀確定可接受的水平。
For example, global mean sea level is expected to rise by a maximum of around 45 cm by 2050 (Sear et al., 2001).
While many countries are currently vulnerable to a 45 cm sea
level rise (assuming no further adaptation were to occur over the next half-century), for this particular threat we are concerned with future vulnerability, perhaps assessed in terms of the ability to cope with a given annual or decadal rise in sea levels up until the
middle of the twenty first century.
The risk posed to a country or coastal zone by sea level rise will depend on the rate at which it occurs, the system or region’s existing vulnerability, and the rate at which the system can adapt (c.f. IPCC Def. 1).
Existing (social) vulnerability is important as it constitutes the “baseline” from which any reduction of vulnerability to “acceptable” levels via adaptation must take place.
Risk assessments for sea level rise typically examine the risk associated with a given increase in sea level assuming current levels of social vulnerability, perhaps modulated by changes in population density (Nicholls et al., 1999; Parry et al., 2001).
A comprehensive assessment of risk would examine the likelihood of a specific rate of sea level rise over a given period (hazard), and the potential or likely evolution of a system’s vulnerability to that rise based on current vulnerability and the potential or likely amount of adaptation over that period.
例如，全球平均海平面預計將上升，最高的約 45厘米，2050（灼燒等，2001）。
雖然許多國家目前正在容易受到45厘米海
海平面上升（假設沒有進一步適應了發生在未來半世紀），這個特定的威脅，我們所關心的是未來的脆弱性，也許在評估方面的能力，以應付某一年度或年代際海平面上升，直到的
中間的二十一世紀。
風險構成一個國家或地區由沿海海平面上升將取決於它的速度時，系統或地區現有的脆弱性，以及速率系統可以適應（比照IPCC定義 1）。
現有的（社會）的脆弱性非常重要，因為它構成了“基準”，任何減少脆弱性“可接受”水平通過調整必須進行。
風險評估研究海平面上升的風險通常與一個給定的海平面上升假設目前水平的社會脆弱性，可能通過改變調製的人口密度（Nicholls等人，1999年，帕里等人，2001年）。
全面評估風險會研究的可能性特定率海平面上升對一定時期內（危險），以及潛在的或可能演化系統的脆弱性的上升基於當前的脆弱性和潛在的或可能的數量適應在此期間。
2011年7月16日 星期六
Uncertainty in adaptive capacity心得
Abstract
The capacity to adapt is a critical element of the process of adaptation: it is the vector of resources that represent the asset base from which adaptation actions can be made.
Adaptive capacity can in theory be identified and measured at various scales, from the individual to the nation.
The assessment of uncertainty within such measures comes from the contested knowledge domain and theories surrounding the nature of the determinants of adaptive capacity and the human action of adaptation.
While generic adaptive capacity at the national level, for example, is often postulated as being dependent on health, governance and political rights, and literacy, and economic well-being, the determinants of these variables at national levels are not widely understood.
We outline the nature of this uncertainty for the major elements of adaptive capacity and illustrate these issues with the example
of a social vulnerability index for countries in Africa.
To cite this article:W.N. Adger, K. Vincent, C. R. Geoscience 337 (2005).
2004 Académie des sciences. Published by Elsevier SAS. All rights reserved.
摘要
適應能力是一個關鍵因素適應的過程：它是向量的資源，代表了資產的基地，可適應行動。
適應能力在理論上可以識別和衡量尺度不同，從個人到國家。
在評估這些措施的不確定性來自有爭議的知識領域和理論周圍的性質的決定因素的適應能力和適應人的行動。
雖然一般的適應能力在國家一級，例如，通常被假定為依賴於健康，治理和政治權利，掃盲和經濟福祉的決定因素，這些變量在國家水平沒有得到廣泛的理解。
我們勾勒出大自然的這種不確定性為主要內容的適應能力，並說明這些問題的例子
一個社會的脆弱性指數的國家在非洲。
舉這篇文章：W.N.阿傑，K.文森特，C. R.地球科學337（2005年）。
2004年琪DES科學。由Elsevier出版SAS。保留所有權利。
Yet evidence from traditional societies demonstrates that the capacity to adapt in many senses depends more on experience, knowledge and dependency on weather-sensitive resources.
然而，證據表明，從傳統的社會適應能力在許多意義上取決於更多的經驗，知識和依賴於天氣敏感的資源。
In this area of research, then, it is apparent that uncertainty in the science of adaptation stems more from contested underlying theories of behaviour, politics, and risk than of data and observation.
Hence adaptive capacity is a scale-dependent concept and adaptation itself can best be conceptualized as a characteristic
of an adapting system [45].
The challenge for emerging insights into adaptation is how to characterize this adaptive capacity in a meaningful sense and to find generic determinants of adaptive capacity at various scales to build predictive models of its evolution into the future.
在這方面的研究，那麼，很明顯，在科學不確定性的適應莖多從有爭議的行為的基本理論，政治和風險比數據和觀察。
因此，適應能力是一個規模相關的概念和適應自己才能最好地概念化為特徵的適應系統 [45]。
新興的見解的挑戰是如何將適應這一特點適應能力在真正意義上的一般決定因素，並找到了在不同尺度的適應能力，以建立預測模型，其演變到未來。
Adaptive capacity is a vector of resources and assets that represent the asset base from which adaptation actions and investments can be made.
Within the IPCC Third Assessment Report, it is recognized that this capacity may be latent and be important only when sectors or systems are exposed to the actual or expected climate stimuli [49].
Vulnerability to climate change is therefore made up of a number of components including exposure to impacts, sensitivity, and the capacity to adapt.
Adaptive capacity is, therefore, a component of vulnerability [34,48].
Adaptive capacity has diverse elements encompassing the capacity to modify exposure to risks associated with climate change, absorb and recover from losses stemming from climate impacts, and exploit new opportunities that arise in the process of adaptation.
適應能力是一個向量的資源和資產，代表資產的基地，適應行動和投資可。
在IPCC第三次評估報告，人們已經認識到這種能力可能是潛在的，只有在重要行業或系統暴露在實際或預期的氣候刺激[49]。
氣候變化的脆弱性，因此由一個數量的元件，包括暴露的影響，靈敏度和適應能力。
適應能力，因此，一個組件的脆弱性[34,48]。
適應能力有不同的要素包括能力修改暴露風險與氣候變化，吸收和恢復的損失所引起的氣候影響，並利用新的機會，在這個過程中出現的適應。
Adaptation decisions taken by individuals (e.g., to use insurance, relocation away from threats, or changing technologies) and taking place within an institutional context can act to facilitate or constrain adaptation.
It is clear that individuals and societies will adapt and have been adapting to climate change over the course of human history – climate is part of the wider geographical and historical landscape of human habitation.
Thus individuals and societies are vulnerable to climate risks and other factors and this vulnerability can act as a driver for adaptive resource management.
There are various geographic scales and social agents involved in adaptation.
Some adaptation by individuals is undertaken in response to climate threats, often triggered by individual extreme events [46].
Other adaptation is undertaken by governments on behalf of society, sometimes in anticipation of change but again, often in response to individual events.
Government policies and individual adaptations are not independent of each other – they are embedded in governance
processes that reflect the relationship between individuals, their capabilities and social capital, and the government.
A previously hypothesised distinction between planned and autonomous adaptation [49] fails to account for the nested nature of decision-making – each individual adaptation action is constrained by antecedent development and regulatory decisions.
Indeed all adaptation decisions and policies have socially differentiated impacts and equity implications.
This emerging set of insights into how adaptation occurs is likely to be planned for the future, and on the nature of the capacity to adapt (see [6] for a review), pose significant challenges for the description and incorporation of uncertainty into its assessment.
適應由個人作出的決定（例如，使用保險，搬遷遠離威脅，或改變技術）和發生在一個體制環境可以採取行動，促進或制約的適應。
很顯然，個人和社會將適應，並已適應氣候變化對人類歷史的過程 - 氣候是部分更廣泛的地域和歷史景觀的人類居住。
因此，個人和社會都容易受到氣候風險和其他因素，此漏洞可以作為驅動的自適應資源管理。
有各種各樣的地理範圍和社會代理人參與了適應。
一些適應個人是開展應對氣候威脅，往往引發的個人極端事件[46]。
其他適應工作，由政府代表社會，有時在預期的改變，但再次，往往因應個別事件。
政府政策和個人的修改是不是相互獨立 - 它們嵌入在治理
過程，反映了個人之間的關係，他們的能力和社會資本，和政府。
一個先前hypothesised區分計劃和自主適應 [49]沒有考慮嵌套性決策 - 每個人的適應行動受制於先前的發展和監管的決定。
事實上，所有的決定和政策，適應社會不同的影響和公平的影響。
這種新興的集洞察如何適應發生很可能是對未來的計劃，並在自然的適應能力（見 [6]的評論），構成重大挑戰的描述和將其納入評估的不確定性。
6W.N. Adger, N. Brooks, G. Bentham, M. Agnew, S. Eriksen,
New indicators of vulnerability and adaptive capacity, Technical
Report 7, Tyndall Centre for Climate Change Research,
University of East Anglia, Norwich, UK, 2004.
The capacity to adapt is a critical element of the process of adaptation: it is the vector of resources that represent the asset base from which adaptation actions can be made.
Adaptive capacity can in theory be identified and measured at various scales, from the individual to the nation.
The assessment of uncertainty within such measures comes from the contested knowledge domain and theories surrounding the nature of the determinants of adaptive capacity and the human action of adaptation.
While generic adaptive capacity at the national level, for example, is often postulated as being dependent on health, governance and political rights, and literacy, and economic well-being, the determinants of these variables at national levels are not widely understood.
We outline the nature of this uncertainty for the major elements of adaptive capacity and illustrate these issues with the example
of a social vulnerability index for countries in Africa.
To cite this article:W.N. Adger, K. Vincent, C. R. Geoscience 337 (2005).
2004 Académie des sciences. Published by Elsevier SAS. All rights reserved.
摘要
適應能力是一個關鍵因素適應的過程：它是向量的資源，代表了資產的基地，可適應行動。
適應能力在理論上可以識別和衡量尺度不同，從個人到國家。
在評估這些措施的不確定性來自有爭議的知識領域和理論周圍的性質的決定因素的適應能力和適應人的行動。
雖然一般的適應能力在國家一級，例如，通常被假定為依賴於健康，治理和政治權利，掃盲和經濟福祉的決定因素，這些變量在國家水平沒有得到廣泛的理解。
我們勾勒出大自然的這種不確定性為主要內容的適應能力，並說明這些問題的例子
一個社會的脆弱性指數的國家在非洲。
舉這篇文章：W.N.阿傑，K.文森特，C. R.地球科學337（2005年）。
2004年琪DES科學。由Elsevier出版SAS。保留所有權利。
Yet evidence from traditional societies demonstrates that the capacity to adapt in many senses depends more on experience, knowledge and dependency on weather-sensitive resources.
然而，證據表明，從傳統的社會適應能力在許多意義上取決於更多的經驗，知識和依賴於天氣敏感的資源。
In this area of research, then, it is apparent that uncertainty in the science of adaptation stems more from contested underlying theories of behaviour, politics, and risk than of data and observation.
Hence adaptive capacity is a scale-dependent concept and adaptation itself can best be conceptualized as a characteristic
of an adapting system [45].
The challenge for emerging insights into adaptation is how to characterize this adaptive capacity in a meaningful sense and to find generic determinants of adaptive capacity at various scales to build predictive models of its evolution into the future.
在這方面的研究，那麼，很明顯，在科學不確定性的適應莖多從有爭議的行為的基本理論，政治和風險比數據和觀察。
因此，適應能力是一個規模相關的概念和適應自己才能最好地概念化為特徵的適應系統 [45]。
新興的見解的挑戰是如何將適應這一特點適應能力在真正意義上的一般決定因素，並找到了在不同尺度的適應能力，以建立預測模型，其演變到未來。
Adaptive capacity is a vector of resources and assets that represent the asset base from which adaptation actions and investments can be made.
Within the IPCC Third Assessment Report, it is recognized that this capacity may be latent and be important only when sectors or systems are exposed to the actual or expected climate stimuli [49].
Vulnerability to climate change is therefore made up of a number of components including exposure to impacts, sensitivity, and the capacity to adapt.
Adaptive capacity is, therefore, a component of vulnerability [34,48].
Adaptive capacity has diverse elements encompassing the capacity to modify exposure to risks associated with climate change, absorb and recover from losses stemming from climate impacts, and exploit new opportunities that arise in the process of adaptation.
適應能力是一個向量的資源和資產，代表資產的基地，適應行動和投資可。
在IPCC第三次評估報告，人們已經認識到這種能力可能是潛在的，只有在重要行業或系統暴露在實際或預期的氣候刺激[49]。
氣候變化的脆弱性，因此由一個數量的元件，包括暴露的影響，靈敏度和適應能力。
適應能力，因此，一個組件的脆弱性[34,48]。
適應能力有不同的要素包括能力修改暴露風險與氣候變化，吸收和恢復的損失所引起的氣候影響，並利用新的機會，在這個過程中出現的適應。
Adaptation decisions taken by individuals (e.g., to use insurance, relocation away from threats, or changing technologies) and taking place within an institutional context can act to facilitate or constrain adaptation.
It is clear that individuals and societies will adapt and have been adapting to climate change over the course of human history – climate is part of the wider geographical and historical landscape of human habitation.
Thus individuals and societies are vulnerable to climate risks and other factors and this vulnerability can act as a driver for adaptive resource management.
There are various geographic scales and social agents involved in adaptation.
Some adaptation by individuals is undertaken in response to climate threats, often triggered by individual extreme events [46].
Other adaptation is undertaken by governments on behalf of society, sometimes in anticipation of change but again, often in response to individual events.
Government policies and individual adaptations are not independent of each other – they are embedded in governance
processes that reflect the relationship between individuals, their capabilities and social capital, and the government.
A previously hypothesised distinction between planned and autonomous adaptation [49] fails to account for the nested nature of decision-making – each individual adaptation action is constrained by antecedent development and regulatory decisions.
Indeed all adaptation decisions and policies have socially differentiated impacts and equity implications.
This emerging set of insights into how adaptation occurs is likely to be planned for the future, and on the nature of the capacity to adapt (see [6] for a review), pose significant challenges for the description and incorporation of uncertainty into its assessment.
適應由個人作出的決定（例如，使用保險，搬遷遠離威脅，或改變技術）和發生在一個體制環境可以採取行動，促進或制約的適應。
很顯然，個人和社會將適應，並已適應氣候變化對人類歷史的過程 - 氣候是部分更廣泛的地域和歷史景觀的人類居住。
因此，個人和社會都容易受到氣候風險和其他因素，此漏洞可以作為驅動的自適應資源管理。
有各種各樣的地理範圍和社會代理人參與了適應。
一些適應個人是開展應對氣候威脅，往往引發的個人極端事件[46]。
其他適應工作，由政府代表社會，有時在預期的改變，但再次，往往因應個別事件。
政府政策和個人的修改是不是相互獨立 - 它們嵌入在治理
過程，反映了個人之間的關係，他們的能力和社會資本，和政府。
一個先前hypothesised區分計劃和自主適應 [49]沒有考慮嵌套性決策 - 每個人的適應行動受制於先前的發展和監管的決定。
事實上，所有的決定和政策，適應社會不同的影響和公平的影響。
這種新興的集洞察如何適應發生很可能是對未來的計劃，並在自然的適應能力（見 [6]的評論），構成重大挑戰的描述和將其納入評估的不確定性。
6W.N. Adger, N. Brooks, G. Bentham, M. Agnew, S. Eriksen,
New indicators of vulnerability and adaptive capacity, Technical
Report 7, Tyndall Centre for Climate Change Research,
University of East Anglia, Norwich, UK, 2004.
Adaptation of an instrument to measure health literacy of older people心得
閱讀心得
In this study, health literacy is conceived as the extent to which people are able to seek, understand and share health information, with a view to health maintenance and promotion across the lifetime in different contexts(11). In this health literacy perspective, people are not passive health information receivers, but serve as their protagonists in all social interaction spheres(9,11).
"在這項研究中，健康素養是被定義為在不同環境下個體整個生命週期能夠尋求、了解和分享健康信息以期健康維護和促進的程度（11）。在這種健康素養的角度看，人不是被動的信息接收者的健康，但作為他們的主角在所有社會交往領域（9,11）。"
此處所定義的健康素養，與健康適應能力有著相同的意函，
健康素養一詞有時被用作同義詞的健康教育。這是兩個不同但相關的概念雖然。在更廣泛的概念，涉及健康教育的策略用來使人們做出決定對他們的健康，健康知識為一體的結果（11）。因此，健康教育，因此，健康素養幫助人們做出決定對他們的生活（12）。
不同的參考框架，對健康素養已提出。其中，功能性，互動性和批判性的方法脫穎而出。在功能的方法，健康素養是指掌握信息的健康風險和健康服務的使用。互動式的方法包括個人技能，允許擴大人民和社區的能力獨立行事。關鍵健康素養是指人們和社區的能力，涉及評估的信息為基礎的行動對社會和經濟的健康決定因素和機會，以促進政治和組織的變化（3）。
ABSTRACT
OBJECTIVE: To describe the process of adaptation of an instrument that analyzes the health literacy of older people.
METHODS: The adaptation consisted of steps to determine conceptual equivalence of items, operationally and semantically.
RESULTS: The stages of conceptual and item equivalence showed that the items and concepts of this Canadian instrument was suitable for use in Brazil. The steps of initial translation, back translation, expert committee review and pre-test performed during evaluation of semantic equivalence have resulted in alterations to some items and rewording of some questions. Regarding operational equivalence, the interview was appropriate to local realities.
CONCLUSION: The steps of transcultural adaptation, generally adopted for validation of measurement tools, were used and allowed researchers to adequately conduct this research study.
Keywords: Validation study; Health education; Health of the elderly
摘要
目的：描述過程適應的儀器，分析了老年人的健康素養。
方法：適應包括步驟，以確定項目的等價概念，運作和語義。
結果：該階段的概念和項目等價表明，項目和概念本儀器是加拿大適合使用在巴西。這些步驟的初始翻譯，回譯，專家委員會的審查和預評估測試執行過程中的語義等價的改變導致了一些項目和措詞的一些問題。關於操作等價，採訪了適合當地實際情況。
結論：該步驟的跨文化適應，普遍採用的測量工具進行驗證，並允許研究人員使用了充分進行這項研究。
關鍵詞：驗證研究;健康教育，健康老人
INTRODUCTION
Health literacy is a relatively new concept in health promotion and has not been investigated yet in Brazil. In the international context, health literacy has been studied in different developed countries, including Canada, Israel, Australia and the United States(1-4), and also more specifically involving elderly people(5-7).
Population aging is a global phenomenon that does not happen similarly in different countries. In developed countries, the elderly population gradually increased, when its citizens had already reached other basic aspects of life. In developing countries, on the other hand, the demographic transition occurred fast and progressively, in a context of social and economic inequalities(8). Thus, it should be highlighted that some population groups can be considered marginalized in terms of health literacy, such as elderly people and people with low education and income levels(9). In Brazil, the challenge is greater in comparison with other countries. Despite the increased life expectancy, most elderly people live in unfavorable conditions, with low socioeconomic, high education and high prevalence levels of chronic illnesses(8,10). The phenomenon affects and generates new demands for health services, entailing the need to (re)organize care models to attend to this population group's health needs.
Health literacy of elderly people is the research problem in one of the projects that is part of the baseline research "Healthy aging in the South of Brazil: facing challenges and developing opportunities for health professionals and elderly people". The aim is to face the challenges of elderly people's access and care in primary health care services and to develop opportunities for health professionals, in order to prepare them to enhance active aging. This is a partnership between the School of Nursing at Universidade Federal do Rio Grande do Sul and the IAPI Health Center in Porto Alegre, Rio Grande do Sul, Brazil.
In this study, health literacy is conceived as the extent to which people are able to seek, understand and share health information, with a view to health maintenance and promotion across the lifetime in different contexts(11). In this health literacy perspective, people are not passive health information receivers, but serve as their protagonists in all social interaction spheres(9,11).
The term health literacy is sometimes used as a synonym of health education. These are two distinct but related concepts though. In a broader conception, health education involves the strategies used to empower people to make decisions about their health, with health literacy as one of the results(11). Thus, health education and, consequently, health literacy help people to make decisions about their lives(12).
Different reference frameworks on health literacy have been proposed. Among these, the functional, interactive and critical approaches stand out. In the functional approach, health literacy refers to the mastery of information on health risks and health service use. The interactive approach involves personal skills that permit broadening people and communities' capacity to act independently. Critical health literacy refers to people and communities' empowerment and involves the assessment of information-based actions on social and economic determinants of health and opportunities to promote political and organizational changes(3).
The study of health literacy rests on a research by Canadian researchers and uses an instrument with open and closed questions that analyzes, based on a recently experienced health/disease situation, how elderly people seek, understand and share health information to make decisions about their health and their life(11).
As this instrument was elaborated in another language, with a view to its effective use in a different context, the researchers decided to accomplish a cross-cultural adaptation process, so as to go beyond a literal translation of words and phrases, covering the target population's different contexts and lifestyles(13). This study used the conceptual, item, semantic and operational equivalence phases(14-15).
The use of a health literacy assessment instrument in Brazil can offer support for care planning to the elderly population, as it is important to identify aspects of its health literacy, so that professionals are apt to enhance health education for this population group, according to its characteristics. For nursing, obtaining this kind of instrument aims to contribute to the elaboration and development of health education actions that involve elderly people.
The goal of this paper is to describe the cross-cultural adaptation process of the health literacy instrument, which analyzes health literacy among elderly people.
引言
健康素養是一個比較新的概念，健康促進，並沒有被查處但在巴西。在國際背景下，健康素養進行了研究，在不同的發達國家，包括加拿大，以色列，澳大利亞和美國（1-4），也比較具體，涉及老人（5-7）。
人口老齡化是一個全球性現象，不會發生類似在不同的國家。在發達國家，老年人口逐漸增加，當其公民已經達成的其他方面的基本生活。在發展中國家，另一方面，人口結構發生快速轉變，並逐步在上下文的社會和經濟不平等（8）。因此，應該強調指出，某些群體可以被視為邊緣化的健康素養方面，如老人和人民的教育和收入水平低（9）。在巴西，更大的挑戰是與其他國家比較。儘管預期壽命延長，大多數老年人生活在不利的條件下，低社會經濟，高學歷，高層次的慢性疾病患病率（8,10）。這種現象影響，並產生了新的要求對醫療服務，帶來的需要（重新）組織醫護模式，以照顧到這一群體的健康需求。
健康素養的老人是研究問題，其中一個項目是部分基線研究“健康的老齡化在南巴西：面臨的挑戰和發展機遇的衛生專業人員和老人”。其目的是要面對的挑戰老人的訪問和護理初級衛生保健服務，並為衛生專業人員開發的機遇，以培養他們積極加強老化。這是一種夥伴關係的護理學院在聯邦大學做南里奧格蘭德州和IAPI健康中心在阿雷格里港，南里奧格蘭德州，巴西。
在這項研究中，健康素養是設想為在何種程度上人們能夠尋求，了解和分享健康信息，以期健康維護和促進整個生命週期在不同環境下（11）。在這種健康素養的角度看，人不是被動的信息接收者的健康，但作為他們的主角在所有社會交往領域（9,11）。
健康素養一詞有時被用作同義詞的健康教育。這是兩個不同但相關的概念雖然。在更廣泛的概念，涉及健康教育的策略用來使人們做出決定對他們的健康，健康知識為一體的結果（11）。因此，健康教育，因此，健康素養幫助人們做出決定對他們的生活（12）。
不同的參考框架，對健康素養已提出。其中，功能性，互動性和批判性的方法脫穎而出。在功能的方法，健康素養是指掌握信息的健康風險和健康服務的使用。互動式的方法包括個人技能，允許擴大人民和社區的能力獨立行事。關鍵健康素養是指人們和社區的能力，涉及評估的信息為基礎的行動對社會和經濟的健康決定因素和機會，以促進政治和組織的變化（3）。
這項研究的健康素養建立在一個由加拿大研究人員的研究和使用的工具與開放式和封閉式的問題，分析的基礎上，最近經歷健康/疾病的情況下，如何尋求老人，理解和分享健康信息作出決策對自己的健康和他們的生活（11）。
由於本儀器在闡述了另一種語言，以期有效使用在不同的背景下，研究人員決定實現一個跨文化適應的過程，這樣才能超越字面翻譯的單詞和詞組，覆蓋目標人群的不同背景和生活方式（13）。本研究使用的概念，項目，語義和操作等價階段（14-15）。
一個健康的使用掃盲評估儀器在巴西可以提供支持照顧老年人口計劃，因為它是重要的，以確定其健康方面的知識，使專業人士很容易加強健康教育這一群體，根據其特徵。對於護理，取得這種儀器的目的是促進制定和發展的健康教育行動涉及的老人。
本文的目的是描述跨文化適應過程中的健康素養儀器，分析健康素養的老人。
In this study, health literacy is conceived as the extent to which people are able to seek, understand and share health information, with a view to health maintenance and promotion across the lifetime in different contexts(11). In this health literacy perspective, people are not passive health information receivers, but serve as their protagonists in all social interaction spheres(9,11).
"在這項研究中，健康素養是被定義為在不同環境下個體整個生命週期能夠尋求、了解和分享健康信息以期健康維護和促進的程度（11）。在這種健康素養的角度看，人不是被動的信息接收者的健康，但作為他們的主角在所有社會交往領域（9,11）。"
此處所定義的健康素養，與健康適應能力有著相同的意函，
健康素養一詞有時被用作同義詞的健康教育。這是兩個不同但相關的概念雖然。在更廣泛的概念，涉及健康教育的策略用來使人們做出決定對他們的健康，健康知識為一體的結果（11）。因此，健康教育，因此，健康素養幫助人們做出決定對他們的生活（12）。
不同的參考框架，對健康素養已提出。其中，功能性，互動性和批判性的方法脫穎而出。在功能的方法，健康素養是指掌握信息的健康風險和健康服務的使用。互動式的方法包括個人技能，允許擴大人民和社區的能力獨立行事。關鍵健康素養是指人們和社區的能力，涉及評估的信息為基礎的行動對社會和經濟的健康決定因素和機會，以促進政治和組織的變化（3）。
ABSTRACT
OBJECTIVE: To describe the process of adaptation of an instrument that analyzes the health literacy of older people.
METHODS: The adaptation consisted of steps to determine conceptual equivalence of items, operationally and semantically.
RESULTS: The stages of conceptual and item equivalence showed that the items and concepts of this Canadian instrument was suitable for use in Brazil. The steps of initial translation, back translation, expert committee review and pre-test performed during evaluation of semantic equivalence have resulted in alterations to some items and rewording of some questions. Regarding operational equivalence, the interview was appropriate to local realities.
CONCLUSION: The steps of transcultural adaptation, generally adopted for validation of measurement tools, were used and allowed researchers to adequately conduct this research study.
Keywords: Validation study; Health education; Health of the elderly
摘要
目的：描述過程適應的儀器，分析了老年人的健康素養。
方法：適應包括步驟，以確定項目的等價概念，運作和語義。
結果：該階段的概念和項目等價表明，項目和概念本儀器是加拿大適合使用在巴西。這些步驟的初始翻譯，回譯，專家委員會的審查和預評估測試執行過程中的語義等價的改變導致了一些項目和措詞的一些問題。關於操作等價，採訪了適合當地實際情況。
結論：該步驟的跨文化適應，普遍採用的測量工具進行驗證，並允許研究人員使用了充分進行這項研究。
關鍵詞：驗證研究;健康教育，健康老人
INTRODUCTION
Health literacy is a relatively new concept in health promotion and has not been investigated yet in Brazil. In the international context, health literacy has been studied in different developed countries, including Canada, Israel, Australia and the United States(1-4), and also more specifically involving elderly people(5-7).
Population aging is a global phenomenon that does not happen similarly in different countries. In developed countries, the elderly population gradually increased, when its citizens had already reached other basic aspects of life. In developing countries, on the other hand, the demographic transition occurred fast and progressively, in a context of social and economic inequalities(8). Thus, it should be highlighted that some population groups can be considered marginalized in terms of health literacy, such as elderly people and people with low education and income levels(9). In Brazil, the challenge is greater in comparison with other countries. Despite the increased life expectancy, most elderly people live in unfavorable conditions, with low socioeconomic, high education and high prevalence levels of chronic illnesses(8,10). The phenomenon affects and generates new demands for health services, entailing the need to (re)organize care models to attend to this population group's health needs.
Health literacy of elderly people is the research problem in one of the projects that is part of the baseline research "Healthy aging in the South of Brazil: facing challenges and developing opportunities for health professionals and elderly people". The aim is to face the challenges of elderly people's access and care in primary health care services and to develop opportunities for health professionals, in order to prepare them to enhance active aging. This is a partnership between the School of Nursing at Universidade Federal do Rio Grande do Sul and the IAPI Health Center in Porto Alegre, Rio Grande do Sul, Brazil.
In this study, health literacy is conceived as the extent to which people are able to seek, understand and share health information, with a view to health maintenance and promotion across the lifetime in different contexts(11). In this health literacy perspective, people are not passive health information receivers, but serve as their protagonists in all social interaction spheres(9,11).
The term health literacy is sometimes used as a synonym of health education. These are two distinct but related concepts though. In a broader conception, health education involves the strategies used to empower people to make decisions about their health, with health literacy as one of the results(11). Thus, health education and, consequently, health literacy help people to make decisions about their lives(12).
Different reference frameworks on health literacy have been proposed. Among these, the functional, interactive and critical approaches stand out. In the functional approach, health literacy refers to the mastery of information on health risks and health service use. The interactive approach involves personal skills that permit broadening people and communities' capacity to act independently. Critical health literacy refers to people and communities' empowerment and involves the assessment of information-based actions on social and economic determinants of health and opportunities to promote political and organizational changes(3).
The study of health literacy rests on a research by Canadian researchers and uses an instrument with open and closed questions that analyzes, based on a recently experienced health/disease situation, how elderly people seek, understand and share health information to make decisions about their health and their life(11).
As this instrument was elaborated in another language, with a view to its effective use in a different context, the researchers decided to accomplish a cross-cultural adaptation process, so as to go beyond a literal translation of words and phrases, covering the target population's different contexts and lifestyles(13). This study used the conceptual, item, semantic and operational equivalence phases(14-15).
The use of a health literacy assessment instrument in Brazil can offer support for care planning to the elderly population, as it is important to identify aspects of its health literacy, so that professionals are apt to enhance health education for this population group, according to its characteristics. For nursing, obtaining this kind of instrument aims to contribute to the elaboration and development of health education actions that involve elderly people.
The goal of this paper is to describe the cross-cultural adaptation process of the health literacy instrument, which analyzes health literacy among elderly people.
引言
健康素養是一個比較新的概念，健康促進，並沒有被查處但在巴西。在國際背景下，健康素養進行了研究，在不同的發達國家，包括加拿大，以色列，澳大利亞和美國（1-4），也比較具體，涉及老人（5-7）。
人口老齡化是一個全球性現象，不會發生類似在不同的國家。在發達國家，老年人口逐漸增加，當其公民已經達成的其他方面的基本生活。在發展中國家，另一方面，人口結構發生快速轉變，並逐步在上下文的社會和經濟不平等（8）。因此，應該強調指出，某些群體可以被視為邊緣化的健康素養方面，如老人和人民的教育和收入水平低（9）。在巴西，更大的挑戰是與其他國家比較。儘管預期壽命延長，大多數老年人生活在不利的條件下，低社會經濟，高學歷，高層次的慢性疾病患病率（8,10）。這種現象影響，並產生了新的要求對醫療服務，帶來的需要（重新）組織醫護模式，以照顧到這一群體的健康需求。
健康素養的老人是研究問題，其中一個項目是部分基線研究“健康的老齡化在南巴西：面臨的挑戰和發展機遇的衛生專業人員和老人”。其目的是要面對的挑戰老人的訪問和護理初級衛生保健服務，並為衛生專業人員開發的機遇，以培養他們積極加強老化。這是一種夥伴關係的護理學院在聯邦大學做南里奧格蘭德州和IAPI健康中心在阿雷格里港，南里奧格蘭德州，巴西。
在這項研究中，健康素養是設想為在何種程度上人們能夠尋求，了解和分享健康信息，以期健康維護和促進整個生命週期在不同環境下（11）。在這種健康素養的角度看，人不是被動的信息接收者的健康，但作為他們的主角在所有社會交往領域（9,11）。
健康素養一詞有時被用作同義詞的健康教育。這是兩個不同但相關的概念雖然。在更廣泛的概念，涉及健康教育的策略用來使人們做出決定對他們的健康，健康知識為一體的結果（11）。因此，健康教育，因此，健康素養幫助人們做出決定對他們的生活（12）。
不同的參考框架，對健康素養已提出。其中，功能性，互動性和批判性的方法脫穎而出。在功能的方法，健康素養是指掌握信息的健康風險和健康服務的使用。互動式的方法包括個人技能，允許擴大人民和社區的能力獨立行事。關鍵健康素養是指人們和社區的能力，涉及評估的信息為基礎的行動對社會和經濟的健康決定因素和機會，以促進政治和組織的變化（3）。
這項研究的健康素養建立在一個由加拿大研究人員的研究和使用的工具與開放式和封閉式的問題，分析的基礎上，最近經歷健康/疾病的情況下，如何尋求老人，理解和分享健康信息作出決策對自己的健康和他們的生活（11）。
由於本儀器在闡述了另一種語言，以期有效使用在不同的背景下，研究人員決定實現一個跨文化適應的過程，這樣才能超越字面翻譯的單詞和詞組，覆蓋目標人群的不同背景和生活方式（13）。本研究使用的概念，項目，語義和操作等價階段（14-15）。
一個健康的使用掃盲評估儀器在巴西可以提供支持照顧老年人口計劃，因為它是重要的，以確定其健康方面的知識，使專業人士很容易加強健康教育這一群體，根據其特徵。對於護理，取得這種儀器的目的是促進制定和發展的健康教育行動涉及的老人。
本文的目的是描述跨文化適應過程中的健康素養儀器，分析健康素養的老人。
2011年7月11日 星期一
On adaptation, life-extension possibilities and the demand for health 心得
On adaptation, life-extension possibilities and the demand for health
是由Smoking, health, risk, and perception一文所提"Our framework is inspired by Gjerde et al. (2001), which presents a formal model of health adaptation based on Grossman (1972a).
心得要點
1."適應過程是被用來形容，人有能力應付或適應惡性變化的健康"，也可以解釋成健康適應能力。
2.格羅斯曼模式中適應是一個重要的概念，其對健康的投資行為將受適應的影響，即某行為適應良好，即有好的健康效果，即表示這行為是有良好的健康適應。
3.主要的論點為適應與健康的相關因素：1.與意外2.與疾病及慢性並有關，但隨著年齡的增加而健康的變化也是重要的
4.故適應是一個以健康為目標的過程，這個過程是有認知的、情感的，是改造的活動、對此活動的價值感受，而方法上有技能的增加、活動的調整、目標的調整、降低期望、提高淡泊和改變觀念等
5.提出健康會因年齡愈高健康愈壞的證據，但研究發現愈老的人雖然健康情形不如年輕人，但確自認為自己是健康的，也就是在自我健康認知上與實際會有落差，這表示老的人是注重健康心態，作者推論是老的人更習慣及更多時間來適應其身體上不健康的情形。
6.作者提出以上適應與老化關係的文獻，來支持要發展一個健康適應的測量來建立理論與量化分析以解釋個人的行為。
7.論文結論：適應對健康的兩個需求
1.適應會隨時間減少對健康投資的意願，也就是說愈適應，就不會去對健康進行投資。
2.同樣的適應覺知，引起對健康計畫的投入
但是適應並不是延長壽命而引起健康投資的主要因素，即其效果不高，它是與健康投資、消費的路徑相同，即對高價醫藥照顧、以較多時間觀注健康有較高的效果。
就此篇的想法是其運用複雜的模式來描述適應與健康及年齡的關係，此模式帶給我目前論文的啟發
文章重點
Yet another type of internal reference points is adaptation theory.
The concept of adaptation originates from biology where it is used to describe adjustments to the conditions under which species must live in order to survive.
Adaptation processes are also discussed in economic literature on preference formation (see Ng and Wang 1993; Rabin, 1998; Frank, 1989) as well as in studies on health status evaluation where they are used to describe the ability individuals have to cope or adapt to malign changes in health.
The theory postulates that humans are sensitive to context, frame, or the current situation rather than absolute characteristics, only.
In this perspective, adaptation suggests mechanisms different from those applied in traditional approaches on health demand such as the pioneering works of Grossman (1972a,b) and subsequent extensions (see, e.g., Muurinen, 1982; Wagstaff, 1986; Ehrlich and Chuma, 1990; Ried, 1998; Eisenring, 1999; Jacobson, 2000).
Consequently, it would be of interest to investigate whether adaptation processes have implications for the results arrived in Grossman types of models, especially since some of their implications are contradicted by available evidence.
然而，另一種類型的內部參考點是適應理論。這個概念源自生物學適應它被用來描述調整的條件下，物種必須住在為了生存。
適應過程還討論了在經濟文獻上的偏好形成（見吳和王1993年，拉賓，1998年弗蘭克，1989年）以及在健康狀況評價的研究，他們被用來形容人有能力應付或適應惡性變化的健康。
該理論認為，人類是敏感的背景，框架，或者當前的形勢，而不是絕對的特點，只。
從這個角度來看，不同的適應機制，從這些建議適用於傳統的方法對健康的需求，如開拓工程格羅斯曼（1972a，b）和隨後的擴展（例如，見 Muurinen，1982;瓦格斯塔夫，1986;埃利希和楚瑪，1990年;里德，1998年; Eisenring，1999;雅各布森，2000）。
因此，這將是利益，以調查是否適應過程所產生的影響的結果抵達格羅斯曼類型的模型，特別是因為他們的一些
含義是相矛盾的證據。
因此可了解
1."適應過程是被用來形容，人有能力應付或適應惡性變化的健康"，也可以解釋成健康適應能力。
2.Grossman (1972a,b)是有名健康適應模式提出者
Grossman, M. (1972a): On the Concept of Health Capital and the Demand for Health,
Journal of Political Economy, 80: 223-255.
Grossman, M. (1972b): The Demand for Health: A theoretical and empirical
investigation, National Bureau of Economic Research, Occasional Paper 119,
Columbia University Press, New York.
對Grossman模式的說明與其原模式建構的原因
In the Grossman model, health is considered a capital stock that increases due to investment (buying health services, medical goods, or spending time on healthy activities), and decreases in response to an advancing age.
According to this model, there are three reasons why individuals demand health.
First, health is a consumption commodity in the way that it directly enters the individual utility function.
Good health implies higher utility than bad health for a given consumption level.
The second reason to demand health is based on health as an investment commodity.
Health determines the total amount of time available for market and non-market activities, e.g., bad health gives more sick days than good health.
Available time increases in health, which again represents a monetary value.
This may be thought of as a return to investment in health.
The third reason follows from health determining the length of life.
A good health condition may give a longer lifetime.
Of the three reasons to demand health, adaptation will be important only for health as consumption good, i.e., how much the utility will be affected from changes in the objective health state.
在格羅斯曼的模式，被認為是健康資本存量的增加，因為投資（購買醫療服務，醫療用品，或花費時間對健康的活動），並減少響應一個年齡的老化。
根據這個模型，有三個原因，個人需求的健康。
首先，健康是消費商品的方式，直接進入個人的效用函數。
良好的健康意味著更高的效用比一個給定的不良健康消費水平。
第二個理由是基於需求的健康保健作為投資商品。
健康決定了總金額的時間可用於市場和非市場活動，如不良的健康提供了更多的病假比身體健康。
可用時間增加在健康，這又是一個貨幣價值。
這可能被認為是回歸到投資的健康。
第三個原因如下決定長度從健康的生活。
良好的健康狀況可能會更長的壽命。
在這三個方面的原因，要求健康，適應將是重要的消費只為健康良好，即有多大的效用將受到影響，從變化的客觀健康狀況。
格羅斯曼模式中適應是一個重要的概念，其對健康的投資行為將受適應的影響，即某行為有好的健康效果，即表示這行為是有良好的健康適應。
We do not know any other studies that formalise adaptation processes.
In this paper, therefore, an effort is made to integrate adaptation to ageing in a formal model framework.
This means that instead of studying rapid changes in health due sickness or accidents, we concentrate on the natural decline in health, as one grows older, i.e., how we adapt to becoming old.
In order to keep the analysis tractable we restrict ourselves to the pure consumption model of Grossman (1972a,b).
The model is extended in yet another direction, by leaving the common assumption of a fixed lifetime or an endogenous lifetime being determined by the stock of health capital reaching a minimum level (see, e.g., Wolfe, 1985, Ehrlich and Chuma, 1990, Ried, 1998, Eisenring, 1999 and Jacobson, 2000).
Rather we prefer to introduce uncertainty into the model by modelling a probability of life-termination decreasing in the stock of health capital (i.e., the random date of death is conditioned upon objective health status).
This allows us to split the demand for health in two parts, as a consumption commodity and as a mean to extend life.
Only the first part is affected by adaptation.
我們不知道任何其他的研究，正式適應過程。
在本文中，因此，努力向整合是適應老齡化的一個正式的模型框架。
這意味著，而不是學習的快速變化，因疾病或意外事故的健康，我們專注於自然下降，健康為一體的長大，也就是說，我們如何適應成為歷史。
為了保持我們的分析聽話限制自己的純消費型的格羅斯曼（1972a，b）項。
該模型是在另一個方向擴展，留的共同假設一個固定的壽命或內源性的壽命是由股票的健康資本達到最低水平（見，例如，沃爾夫，1985年，艾氏和楚瑪，1990年，里德1998年，Eisenring，1999年和Jacobson，2000）。
相反，我們寧願不確定性引入到模型建模概率生命的終止減少在股市的健康資本（即隨機死亡日期的條件是客觀的健康狀況）。
這使我們分裂的需求健康兩部分，作為消費商品，並作為平均延長壽命。
只有第一部分是受適應。
文獻探討
In the literature, adaptation processes are mainly discussed
i) in the context of abrupt and unexpected changes in health conditions and
ii) for individuals with handicaps and chronic illnesses.
However, adaptation may also be relevant in the context of a
gradually declining health due to an advancing age.
The fact that health deteriorates with age is common knowledge and most likely people realise that their future evaluations of health will be conditioned on age itself.
In this perspective it seems adequate to integrate adaptation in a health planning perspective.
在文獻中，主要討論適應過程
i）在背景下突然和意外的變化，健康狀況和
ii）為個人與殘疾和慢性疾病。
然而，適應可能也有關係的背景下一個
健康逐漸下降，由於一個前進的時代。
事實上，隨著年齡的健康惡化是常識和最可能的人認識到他們今後評估的健康會受到自身條件的年齡。
在健康計畫的觀點來看，人是缺乏整體合性的適應。
主要的論點為市適應與健康的相關因素：1.與意外2.與疾病及慢性並有關，但隨著年齡的增加而健康的變化也是重要的
According to Heyink (1993, p. 1332), adaptation may be defined as “an intrapsychic process in which past, present, and future situations are circumstances given such cognitive and emotional meaning that an acceptable level of well-being is achieved”.
Mentzel et al., (1999) perceive adaptation as the alteration of activities, desires, goals, and values in response to changes in health states and suggest six different factors all considered to be potential elements of adaptation.
These are; skill enhancement, activity adjustment, substantive goal adjustment, lowered expectations, heightened stoicism and altered conception of health.
The same study distinguishes adaptation processes both from initial shocks related to health state changes and the increased knowledge that arises from experiencing adverse health conditions.
據 Heyink（1993年版，第1332），適應可以被定義為“內心的過程，過去，現在和未來的情況是這樣的情況下給予的認知和情感的意思是可以接受的水平的福祉，是實現”。
Mentzel等人（1999）認為適應與改造的活動，願望，目標和價值觀為響應健康狀態的變化，並提出六種不同的因素都被認為是潛在要素適應。
這些，提高技能，活動的調整，實質性的目標調整，降低期望值，提高淡泊和改變觀念的健康。
同樣的研究區別適應過程都從最初的衝擊與健康狀態的變化和增加的知識，來自經歷的不良健康狀況。
故適應是一個以健康為目標的過程，這個過程是有認知的、情感的，是改造的活動、對此活動的價值感受，而方法上有技能的增加、活動的調整、目標的調整、降低期望、提高淡泊和改變觀念等
There is some empirical evidence supporting adaptation processes when health deteriorates naturally over time.
In health surveys for Norway conducted by Statistics Norway, see SSB (1999), elderly people in general consider their health as good, even if many of them reported serious or less serious illnesses or worries.
For people above age 80, 20 per cent reported bad health.
This is a bit surprising as 27 per cent of the respondents above age 80 reported that they had an illness that strongly affected their everyday life.
SSB suggests that the reason may be that health expectations are reduced when one live as long as 80 years or more.
Cassilleth et al., (1984) found, in a study examining 758 patients, that older people seem to develop more effective skills with which to manage stressful life events.
”There may be a biological, evolutionary advantage for older patients, enabling them to adapt to illnesses that are epidemiologically associated with advancing years” (p. 509).
Van Maanen (1988) reports studies among self-defined healthy American born elderly and ill-healthy British born older persons.
The results indicate that many dimensions other than the absence of disease and illnesses determine the perception of health.
The older the person, the more emphasis was placed on health as a state of mind, even in situations of a gradually falling body.
Groot (2000) found elderly people to report better health than younger people.
One reason may be that elderly people may be more adaptive
than younger people: “Older people may have become more accustomed and have had more time to adapt to their health impairments” (p. 413).
有一些經驗證據支持適應過程時健康惡化，自然隨著時間的推移。
在挪威進行的健康調查由挪威統計局，看到國家統計局（1999），老年人普遍認為自己的健康良好，即使其中許多報導嚴重或不太嚴重的疾病或憂慮。
對於 80歲以上的人，20％報告不良健康。
這有點令人驚訝的27％以上的受訪者報告說，他們 80歲有一個疾病，嚴重影響他們的日常生活。
國家統計局認為，其原因可能是健康的期望是當一個人生活減少只要80年或更長時間。
Cassilleth等人（1984）發現，在一項研究中758例檢查，即老年人似乎更有效的技能開發可用於處理壓力的生活事件。
“有可能是生物進化優勢，為老年患者，使他們能夠適應疾病是
流行病學與推進年“（第509頁）。
凡Maanen（1988）的研究報告中自定義的健康美國出生的老人和病人健康的英國出生的老年人。
結果表明，許多方面比其他沒有疾病和病症確定感知的健康。
老一輩的人，更強調的是作為一種對健康的心態，即使在一個逐漸下降的情況下身體。格魯特（2000）發現老人的報告比年輕人更健康。
其中一個原因可能是老年人可能更適應
比年輕人：“老年人可能變得更習慣和有更多的時間來適應他們的健康障礙”（第413頁）。
提出適應會因年齡愈高健康愈壞的證據，但研究發現愈老的人雖然健康情形不如年輕人，但確自認為自己是健康的，也就是在自我健康認知上與實際會有落差，這表示老的人是注重健康心態，作者推論是老的人更習慣及更多時間來適應其身體上不健康的情形。
Findings from studies on adaptation have also triggered a debate on whom to ask about the utility of health states (patients, health personnel, or the general public) and whether patients, if asked, should report ex-ante or ex-post utilities.
E.g., Adang (1997) found that that people who have been through successful transplants assess their pre-transplant quality of life lower relative to assessments made before the transplants took place.
Also, Sackett and Torrance (1978) found that patients rated the value of an impaired state of health more highly than the general public, suggesting that people with deteriorating health adapt to their health condition over time.
從研究結果的適應也引發了一場辯論，誰詢問有關公用事業的健康狀態（患者，醫務人員，還是普通公眾），以及是否患者，若問，應報告事前或事後工具。
例如，阿當（1997年）發現，人們誰已通過評估其成功移植移植前的生活質量相對較低，以評估之前發生的移植。
此外，Sackett和托倫斯（1978）發現，患者的額定價值受損的健康狀況更加高度比一般市民，提示人們適應與健康惡化的健康狀況隨著時間的推移。
This evidence suggests that people may adapt to a lower health level over time.
One implication is that even if one believes that the adaptive behaviour should not be taken into account in health policies such as allocating scarce resources, adaptation may be important in explaining behaviour, such as the demand for medical care.
We, therefore, include an adaptive health measure in a theoretical and numerical analysis explaining individual behaviour.
這些證據表明，人們可能適應較低的健康水平隨著時間的推移。
一個含義是，即使有人認為，適應行為不應該考慮到衛生政策，如分配稀缺資源，適應可能是重要的解釋行為，如對醫療的需求。
因此，我們有一個自適應的衛生措施在理論和數值分析，解釋個人的行為。
作者提出以上適應與老化關係的文獻，來支持要發展一個健康適應的測量來建立理論與量化分析以解釋個人的行為。
3. THE MODEL
In this section we present a theoretical model, which is based on the pure consumption model of Grossman but modified in two respects.
First, adaptation processes are introduced, and second, we apply a probabilistic approach to life termination (uncertain lifetime).
3。的模型
在本節中我們提出了一個理論模型，它是基於純粹的消費模式的格羅斯曼但修改在兩個方面。
首先，適應過程介紹，第二，我們應用概率的方法來結束生命（不確定的壽命）。
.....
4. NUMERICAL RESULTS
There are several difficulties in characterising optimal paths and conducting comparative dynamics in a continuous time model with four stock variables (see also paragraph 4.3 below).
For this reason we apply a numerical version of the model to explore the impacts of adaptation on health stock and medical care.
The model specification and parameter values are given in Appendix 1.
Some important assumptions are, however;
(i) an additive utility function in consumption and health, and
(ii) a Weibull distribution to characterize the hazard rate function.
The calibration of the benchmark scenario with no adaptation (GMEN, Grossman Model ENdogenous hazard) was conducted in order to reach realistic age profiles for the health variables, consumption, as well as for the contingent probabilities for the
occurrence of death.
Health stock and consumption paths are calibrated to reach their
maximal values at young ages (30) and the mid-phase of life (50), respectively.
The first is an assumption, while the second is based on empirical evidence from the US and the UK (Attanasio and Banks, 1998), see also footnote.
To reach a realistic development in the contingent probabilities for the occurrence of death, we calibrated the model to reproduce a realistic expected length of life estimate for an individual
living in an industrialised country; see, e.g., SSB (2000).
4。數值結果
有幾個困難的最佳路徑和特徵進行比較動態的連續時間模型有四個股票變量（見上文第4.3段）。
為此，我們應用數字版的模型，探討了對健康影響的適應股票和醫療。
該模型的規範和參數值列於附錄 1。
一些重要的假設，然而;
（一）添加劑的效用函數消費和健康，
（二）Weibull分佈來刻畫風險率函數。
校準的基準情景，沒有適應（GMEN，格羅斯曼模型內源性危害）進行，以達到逼真的年齡分佈為變量的健康，消費，以及隊伍的概率為
發生死亡。
健康股市和消費路徑校準達到其
最大的價值在年輕的年齡（30歲）和中期階段的生活（50），分別。
首先是一個假設，而第二個是基於經驗證據來自美國和英國（Attanasio和銀行，1998年），也見腳註。
為了達到逼真的發展，在隊伍的發生概率為死亡，我們校準模型再現一個現實的預期壽命估計長度為個人
生活在工業化國家，看到的，例如，國家統計局（2000年）。
.....
5. CONCLUSIONS
Our analysis links adaptation to ageing in the pure consumption model of Grossman with stochastic life-termination.
We show that adaptation has two effects on health demand.
First, the awareness of adaptation makes health investments less attractive,thus yielding a lower optimal health stock over time.
Second, the same awareness gives an incentive for the individual to smoothen planned health stock paths.
The effects of adaptation may, however, not be very high, as a main incentive for demanding health seems to be to prolong life.
Furthermore, it follows that adaptation has effects on health, health investments, and consumption paths being similar to the effects that follow from a higher price on medical care and a higher time preference rate.
However, the smoothening effect observed when analysing adaptation is absent for the same two variables, but show up for a shift in the health depreciation rate.
There is a discussion in the literature of the proper way of doing comparative dynamics in models with many stock variables.
We have, therefore, conducted the analysis on a numerical model, and we show that the effects that arise for the joint development in health and health investments when undertaking comparative dynamics are not changing across models ignoring adaptation and those that do not.
As this analysis concentrates on the effect of adaptation on ageing, i.e., a continuous fall in health, several other interesting problems connected to adaptation is connected to abrupt changes in health.
Also, adaptation as formulated in this work, may not capture all aspects of the phenomena as described in the literature.
There is a lack of formal analyses on adaptation, and future work may provide additional insight.
5。結論
我們的分析鏈接適應老齡化的純消費型的格羅斯曼與隨機生命的終止。
我們證明了適應有兩個作用對健康的需求。
首先，讓健康的認識適應投資的吸引力，從而產生了較低的最佳健康狀態的股票隨著時間的推移。
其次，同樣的認識提供了一種激勵對個人健康計劃，以理順股票路徑。
適應可能的影響，但是，不會很高，作為一個主要誘因似乎是苛刻的健康，延長壽命。
此外，它遵循，適應了對健康的影響，健康投資和消費路徑是類似的效果，請從一個更高的價格在醫療保健和較高的時間偏好率。
然而，平滑的效果進行分析時，發現不存在適應了相同的兩個變量，但出現了轉變，在健康的折舊率。
有一個討論的文學的正確方法做比較動力學模型中的許多股票的變量。
我們有，所以，進行了分析數值模型，我們表明，效果出現的聯合
發展健康和衛生事業的投資時，是不會改變的比較動力學模型忽略了在適應和那些沒有。
由於這種分析集中在適應老齡化的影響，即持續下降的健康，其他一些有趣的問題，以適應連接連接到突然的變化狀況。
此外，作為制定適應這項工作，可能無法捕獲所有方面的現象在文獻中所述。
有一個正式的分析，缺乏適應和未來的工作可能提供額外的洞察力。
論文結論：適應對健康的兩個需求
1.適應會隨時間減少對健康投資的意願，也就是說愈適應，就不會去對健康進行投資。
2.同樣的適應覺知，引起對健康計畫的投入
但是適應並不是延長壽命而引起健康投資的主要因素，即其效果不高，它是與健康投資、消費的路徑相同，即對高價醫藥照顧、以較多時間觀注健康有較高的效果。
是由Smoking, health, risk, and perception一文所提"Our framework is inspired by Gjerde et al. (2001), which presents a formal model of health adaptation based on Grossman (1972a).
心得要點
1."適應過程是被用來形容，人有能力應付或適應惡性變化的健康"，也可以解釋成健康適應能力。
2.格羅斯曼模式中適應是一個重要的概念，其對健康的投資行為將受適應的影響，即某行為適應良好，即有好的健康效果，即表示這行為是有良好的健康適應。
3.主要的論點為適應與健康的相關因素：1.與意外2.與疾病及慢性並有關，但隨著年齡的增加而健康的變化也是重要的
4.故適應是一個以健康為目標的過程，這個過程是有認知的、情感的，是改造的活動、對此活動的價值感受，而方法上有技能的增加、活動的調整、目標的調整、降低期望、提高淡泊和改變觀念等
5.提出健康會因年齡愈高健康愈壞的證據，但研究發現愈老的人雖然健康情形不如年輕人，但確自認為自己是健康的，也就是在自我健康認知上與實際會有落差，這表示老的人是注重健康心態，作者推論是老的人更習慣及更多時間來適應其身體上不健康的情形。
6.作者提出以上適應與老化關係的文獻，來支持要發展一個健康適應的測量來建立理論與量化分析以解釋個人的行為。
7.論文結論：適應對健康的兩個需求
1.適應會隨時間減少對健康投資的意願，也就是說愈適應，就不會去對健康進行投資。
2.同樣的適應覺知，引起對健康計畫的投入
但是適應並不是延長壽命而引起健康投資的主要因素，即其效果不高，它是與健康投資、消費的路徑相同，即對高價醫藥照顧、以較多時間觀注健康有較高的效果。
就此篇的想法是其運用複雜的模式來描述適應與健康及年齡的關係，此模式帶給我目前論文的啟發
文章重點
Yet another type of internal reference points is adaptation theory.
The concept of adaptation originates from biology where it is used to describe adjustments to the conditions under which species must live in order to survive.
Adaptation processes are also discussed in economic literature on preference formation (see Ng and Wang 1993; Rabin, 1998; Frank, 1989) as well as in studies on health status evaluation where they are used to describe the ability individuals have to cope or adapt to malign changes in health.
The theory postulates that humans are sensitive to context, frame, or the current situation rather than absolute characteristics, only.
In this perspective, adaptation suggests mechanisms different from those applied in traditional approaches on health demand such as the pioneering works of Grossman (1972a,b) and subsequent extensions (see, e.g., Muurinen, 1982; Wagstaff, 1986; Ehrlich and Chuma, 1990; Ried, 1998; Eisenring, 1999; Jacobson, 2000).
Consequently, it would be of interest to investigate whether adaptation processes have implications for the results arrived in Grossman types of models, especially since some of their implications are contradicted by available evidence.
然而，另一種類型的內部參考點是適應理論。這個概念源自生物學適應它被用來描述調整的條件下，物種必須住在為了生存。
適應過程還討論了在經濟文獻上的偏好形成（見吳和王1993年，拉賓，1998年弗蘭克，1989年）以及在健康狀況評價的研究，他們被用來形容人有能力應付或適應惡性變化的健康。
該理論認為，人類是敏感的背景，框架，或者當前的形勢，而不是絕對的特點，只。
從這個角度來看，不同的適應機制，從這些建議適用於傳統的方法對健康的需求，如開拓工程格羅斯曼（1972a，b）和隨後的擴展（例如，見 Muurinen，1982;瓦格斯塔夫，1986;埃利希和楚瑪，1990年;里德，1998年; Eisenring，1999;雅各布森，2000）。
因此，這將是利益，以調查是否適應過程所產生的影響的結果抵達格羅斯曼類型的模型，特別是因為他們的一些
含義是相矛盾的證據。
因此可了解
1."適應過程是被用來形容，人有能力應付或適應惡性變化的健康"，也可以解釋成健康適應能力。
2.Grossman (1972a,b)是有名健康適應模式提出者
Grossman, M. (1972a): On the Concept of Health Capital and the Demand for Health,
Journal of Political Economy, 80: 223-255.
Grossman, M. (1972b): The Demand for Health: A theoretical and empirical
investigation, National Bureau of Economic Research, Occasional Paper 119,
Columbia University Press, New York.
對Grossman模式的說明與其原模式建構的原因
In the Grossman model, health is considered a capital stock that increases due to investment (buying health services, medical goods, or spending time on healthy activities), and decreases in response to an advancing age.
According to this model, there are three reasons why individuals demand health.
First, health is a consumption commodity in the way that it directly enters the individual utility function.
Good health implies higher utility than bad health for a given consumption level.
The second reason to demand health is based on health as an investment commodity.
Health determines the total amount of time available for market and non-market activities, e.g., bad health gives more sick days than good health.
Available time increases in health, which again represents a monetary value.
This may be thought of as a return to investment in health.
The third reason follows from health determining the length of life.
A good health condition may give a longer lifetime.
Of the three reasons to demand health, adaptation will be important only for health as consumption good, i.e., how much the utility will be affected from changes in the objective health state.
在格羅斯曼的模式，被認為是健康資本存量的增加，因為投資（購買醫療服務，醫療用品，或花費時間對健康的活動），並減少響應一個年齡的老化。
根據這個模型，有三個原因，個人需求的健康。
首先，健康是消費商品的方式，直接進入個人的效用函數。
良好的健康意味著更高的效用比一個給定的不良健康消費水平。
第二個理由是基於需求的健康保健作為投資商品。
健康決定了總金額的時間可用於市場和非市場活動，如不良的健康提供了更多的病假比身體健康。
可用時間增加在健康，這又是一個貨幣價值。
這可能被認為是回歸到投資的健康。
第三個原因如下決定長度從健康的生活。
良好的健康狀況可能會更長的壽命。
在這三個方面的原因，要求健康，適應將是重要的消費只為健康良好，即有多大的效用將受到影響，從變化的客觀健康狀況。
格羅斯曼模式中適應是一個重要的概念，其對健康的投資行為將受適應的影響，即某行為有好的健康效果，即表示這行為是有良好的健康適應。
We do not know any other studies that formalise adaptation processes.
In this paper, therefore, an effort is made to integrate adaptation to ageing in a formal model framework.
This means that instead of studying rapid changes in health due sickness or accidents, we concentrate on the natural decline in health, as one grows older, i.e., how we adapt to becoming old.
In order to keep the analysis tractable we restrict ourselves to the pure consumption model of Grossman (1972a,b).
The model is extended in yet another direction, by leaving the common assumption of a fixed lifetime or an endogenous lifetime being determined by the stock of health capital reaching a minimum level (see, e.g., Wolfe, 1985, Ehrlich and Chuma, 1990, Ried, 1998, Eisenring, 1999 and Jacobson, 2000).
Rather we prefer to introduce uncertainty into the model by modelling a probability of life-termination decreasing in the stock of health capital (i.e., the random date of death is conditioned upon objective health status).
This allows us to split the demand for health in two parts, as a consumption commodity and as a mean to extend life.
Only the first part is affected by adaptation.
我們不知道任何其他的研究，正式適應過程。
在本文中，因此，努力向整合是適應老齡化的一個正式的模型框架。
這意味著，而不是學習的快速變化，因疾病或意外事故的健康，我們專注於自然下降，健康為一體的長大，也就是說，我們如何適應成為歷史。
為了保持我們的分析聽話限制自己的純消費型的格羅斯曼（1972a，b）項。
該模型是在另一個方向擴展，留的共同假設一個固定的壽命或內源性的壽命是由股票的健康資本達到最低水平（見，例如，沃爾夫，1985年，艾氏和楚瑪，1990年，里德1998年，Eisenring，1999年和Jacobson，2000）。
相反，我們寧願不確定性引入到模型建模概率生命的終止減少在股市的健康資本（即隨機死亡日期的條件是客觀的健康狀況）。
這使我們分裂的需求健康兩部分，作為消費商品，並作為平均延長壽命。
只有第一部分是受適應。
文獻探討
In the literature, adaptation processes are mainly discussed
i) in the context of abrupt and unexpected changes in health conditions and
ii) for individuals with handicaps and chronic illnesses.
However, adaptation may also be relevant in the context of a
gradually declining health due to an advancing age.
The fact that health deteriorates with age is common knowledge and most likely people realise that their future evaluations of health will be conditioned on age itself.
In this perspective it seems adequate to integrate adaptation in a health planning perspective.
在文獻中，主要討論適應過程
i）在背景下突然和意外的變化，健康狀況和
ii）為個人與殘疾和慢性疾病。
然而，適應可能也有關係的背景下一個
健康逐漸下降，由於一個前進的時代。
事實上，隨著年齡的健康惡化是常識和最可能的人認識到他們今後評估的健康會受到自身條件的年齡。
在健康計畫的觀點來看，人是缺乏整體合性的適應。
主要的論點為市適應與健康的相關因素：1.與意外2.與疾病及慢性並有關，但隨著年齡的增加而健康的變化也是重要的
According to Heyink (1993, p. 1332), adaptation may be defined as “an intrapsychic process in which past, present, and future situations are circumstances given such cognitive and emotional meaning that an acceptable level of well-being is achieved”.
Mentzel et al., (1999) perceive adaptation as the alteration of activities, desires, goals, and values in response to changes in health states and suggest six different factors all considered to be potential elements of adaptation.
These are; skill enhancement, activity adjustment, substantive goal adjustment, lowered expectations, heightened stoicism and altered conception of health.
The same study distinguishes adaptation processes both from initial shocks related to health state changes and the increased knowledge that arises from experiencing adverse health conditions.
據 Heyink（1993年版，第1332），適應可以被定義為“內心的過程，過去，現在和未來的情況是這樣的情況下給予的認知和情感的意思是可以接受的水平的福祉，是實現”。
Mentzel等人（1999）認為適應與改造的活動，願望，目標和價值觀為響應健康狀態的變化，並提出六種不同的因素都被認為是潛在要素適應。
這些，提高技能，活動的調整，實質性的目標調整，降低期望值，提高淡泊和改變觀念的健康。
同樣的研究區別適應過程都從最初的衝擊與健康狀態的變化和增加的知識，來自經歷的不良健康狀況。
故適應是一個以健康為目標的過程，這個過程是有認知的、情感的，是改造的活動、對此活動的價值感受，而方法上有技能的增加、活動的調整、目標的調整、降低期望、提高淡泊和改變觀念等
There is some empirical evidence supporting adaptation processes when health deteriorates naturally over time.
In health surveys for Norway conducted by Statistics Norway, see SSB (1999), elderly people in general consider their health as good, even if many of them reported serious or less serious illnesses or worries.
For people above age 80, 20 per cent reported bad health.
This is a bit surprising as 27 per cent of the respondents above age 80 reported that they had an illness that strongly affected their everyday life.
SSB suggests that the reason may be that health expectations are reduced when one live as long as 80 years or more.
Cassilleth et al., (1984) found, in a study examining 758 patients, that older people seem to develop more effective skills with which to manage stressful life events.
”There may be a biological, evolutionary advantage for older patients, enabling them to adapt to illnesses that are epidemiologically associated with advancing years” (p. 509).
Van Maanen (1988) reports studies among self-defined healthy American born elderly and ill-healthy British born older persons.
The results indicate that many dimensions other than the absence of disease and illnesses determine the perception of health.
The older the person, the more emphasis was placed on health as a state of mind, even in situations of a gradually falling body.
Groot (2000) found elderly people to report better health than younger people.
One reason may be that elderly people may be more adaptive
than younger people: “Older people may have become more accustomed and have had more time to adapt to their health impairments” (p. 413).
有一些經驗證據支持適應過程時健康惡化，自然隨著時間的推移。
在挪威進行的健康調查由挪威統計局，看到國家統計局（1999），老年人普遍認為自己的健康良好，即使其中許多報導嚴重或不太嚴重的疾病或憂慮。
對於 80歲以上的人，20％報告不良健康。
這有點令人驚訝的27％以上的受訪者報告說，他們 80歲有一個疾病，嚴重影響他們的日常生活。
國家統計局認為，其原因可能是健康的期望是當一個人生活減少只要80年或更長時間。
Cassilleth等人（1984）發現，在一項研究中758例檢查，即老年人似乎更有效的技能開發可用於處理壓力的生活事件。
“有可能是生物進化優勢，為老年患者，使他們能夠適應疾病是
流行病學與推進年“（第509頁）。
凡Maanen（1988）的研究報告中自定義的健康美國出生的老人和病人健康的英國出生的老年人。
結果表明，許多方面比其他沒有疾病和病症確定感知的健康。
老一輩的人，更強調的是作為一種對健康的心態，即使在一個逐漸下降的情況下身體。格魯特（2000）發現老人的報告比年輕人更健康。
其中一個原因可能是老年人可能更適應
比年輕人：“老年人可能變得更習慣和有更多的時間來適應他們的健康障礙”（第413頁）。
提出適應會因年齡愈高健康愈壞的證據，但研究發現愈老的人雖然健康情形不如年輕人，但確自認為自己是健康的，也就是在自我健康認知上與實際會有落差，這表示老的人是注重健康心態，作者推論是老的人更習慣及更多時間來適應其身體上不健康的情形。
Findings from studies on adaptation have also triggered a debate on whom to ask about the utility of health states (patients, health personnel, or the general public) and whether patients, if asked, should report ex-ante or ex-post utilities.
E.g., Adang (1997) found that that people who have been through successful transplants assess their pre-transplant quality of life lower relative to assessments made before the transplants took place.
Also, Sackett and Torrance (1978) found that patients rated the value of an impaired state of health more highly than the general public, suggesting that people with deteriorating health adapt to their health condition over time.
從研究結果的適應也引發了一場辯論，誰詢問有關公用事業的健康狀態（患者，醫務人員，還是普通公眾），以及是否患者，若問，應報告事前或事後工具。
例如，阿當（1997年）發現，人們誰已通過評估其成功移植移植前的生活質量相對較低，以評估之前發生的移植。
此外，Sackett和托倫斯（1978）發現，患者的額定價值受損的健康狀況更加高度比一般市民，提示人們適應與健康惡化的健康狀況隨著時間的推移。
This evidence suggests that people may adapt to a lower health level over time.
One implication is that even if one believes that the adaptive behaviour should not be taken into account in health policies such as allocating scarce resources, adaptation may be important in explaining behaviour, such as the demand for medical care.
We, therefore, include an adaptive health measure in a theoretical and numerical analysis explaining individual behaviour.
這些證據表明，人們可能適應較低的健康水平隨著時間的推移。
一個含義是，即使有人認為，適應行為不應該考慮到衛生政策，如分配稀缺資源，適應可能是重要的解釋行為，如對醫療的需求。
因此，我們有一個自適應的衛生措施在理論和數值分析，解釋個人的行為。
作者提出以上適應與老化關係的文獻，來支持要發展一個健康適應的測量來建立理論與量化分析以解釋個人的行為。
3. THE MODEL
In this section we present a theoretical model, which is based on the pure consumption model of Grossman but modified in two respects.
First, adaptation processes are introduced, and second, we apply a probabilistic approach to life termination (uncertain lifetime).
3。的模型
在本節中我們提出了一個理論模型，它是基於純粹的消費模式的格羅斯曼但修改在兩個方面。
首先，適應過程介紹，第二，我們應用概率的方法來結束生命（不確定的壽命）。
.....
4. NUMERICAL RESULTS
There are several difficulties in characterising optimal paths and conducting comparative dynamics in a continuous time model with four stock variables (see also paragraph 4.3 below).
For this reason we apply a numerical version of the model to explore the impacts of adaptation on health stock and medical care.
The model specification and parameter values are given in Appendix 1.
Some important assumptions are, however;
(i) an additive utility function in consumption and health, and
(ii) a Weibull distribution to characterize the hazard rate function.
The calibration of the benchmark scenario with no adaptation (GMEN, Grossman Model ENdogenous hazard) was conducted in order to reach realistic age profiles for the health variables, consumption, as well as for the contingent probabilities for the
occurrence of death.
Health stock and consumption paths are calibrated to reach their
maximal values at young ages (30) and the mid-phase of life (50), respectively.
The first is an assumption, while the second is based on empirical evidence from the US and the UK (Attanasio and Banks, 1998), see also footnote.
To reach a realistic development in the contingent probabilities for the occurrence of death, we calibrated the model to reproduce a realistic expected length of life estimate for an individual
living in an industrialised country; see, e.g., SSB (2000).
4。數值結果
有幾個困難的最佳路徑和特徵進行比較動態的連續時間模型有四個股票變量（見上文第4.3段）。
為此，我們應用數字版的模型，探討了對健康影響的適應股票和醫療。
該模型的規範和參數值列於附錄 1。
一些重要的假設，然而;
（一）添加劑的效用函數消費和健康，
（二）Weibull分佈來刻畫風險率函數。
校準的基準情景，沒有適應（GMEN，格羅斯曼模型內源性危害）進行，以達到逼真的年齡分佈為變量的健康，消費，以及隊伍的概率為
發生死亡。
健康股市和消費路徑校準達到其
最大的價值在年輕的年齡（30歲）和中期階段的生活（50），分別。
首先是一個假設，而第二個是基於經驗證據來自美國和英國（Attanasio和銀行，1998年），也見腳註。
為了達到逼真的發展，在隊伍的發生概率為死亡，我們校準模型再現一個現實的預期壽命估計長度為個人
生活在工業化國家，看到的，例如，國家統計局（2000年）。
.....
5. CONCLUSIONS
Our analysis links adaptation to ageing in the pure consumption model of Grossman with stochastic life-termination.
We show that adaptation has two effects on health demand.
First, the awareness of adaptation makes health investments less attractive,thus yielding a lower optimal health stock over time.
Second, the same awareness gives an incentive for the individual to smoothen planned health stock paths.
The effects of adaptation may, however, not be very high, as a main incentive for demanding health seems to be to prolong life.
Furthermore, it follows that adaptation has effects on health, health investments, and consumption paths being similar to the effects that follow from a higher price on medical care and a higher time preference rate.
However, the smoothening effect observed when analysing adaptation is absent for the same two variables, but show up for a shift in the health depreciation rate.
There is a discussion in the literature of the proper way of doing comparative dynamics in models with many stock variables.
We have, therefore, conducted the analysis on a numerical model, and we show that the effects that arise for the joint development in health and health investments when undertaking comparative dynamics are not changing across models ignoring adaptation and those that do not.
As this analysis concentrates on the effect of adaptation on ageing, i.e., a continuous fall in health, several other interesting problems connected to adaptation is connected to abrupt changes in health.
Also, adaptation as formulated in this work, may not capture all aspects of the phenomena as described in the literature.
There is a lack of formal analyses on adaptation, and future work may provide additional insight.
5。結論
我們的分析鏈接適應老齡化的純消費型的格羅斯曼與隨機生命的終止。
我們證明了適應有兩個作用對健康的需求。
首先，讓健康的認識適應投資的吸引力，從而產生了較低的最佳健康狀態的股票隨著時間的推移。
其次，同樣的認識提供了一種激勵對個人健康計劃，以理順股票路徑。
適應可能的影響，但是，不會很高，作為一個主要誘因似乎是苛刻的健康，延長壽命。
此外，它遵循，適應了對健康的影響，健康投資和消費路徑是類似的效果，請從一個更高的價格在醫療保健和較高的時間偏好率。
然而，平滑的效果進行分析時，發現不存在適應了相同的兩個變量，但出現了轉變，在健康的折舊率。
有一個討論的文學的正確方法做比較動力學模型中的許多股票的變量。
我們有，所以，進行了分析數值模型，我們表明，效果出現的聯合
發展健康和衛生事業的投資時，是不會改變的比較動力學模型忽略了在適應和那些沒有。
由於這種分析集中在適應老齡化的影響，即持續下降的健康，其他一些有趣的問題，以適應連接連接到突然的變化狀況。
此外，作為制定適應這項工作，可能無法捕獲所有方面的現象在文獻中所述。
有一個正式的分析，缺乏適應和未來的工作可能提供額外的洞察力。
論文結論：適應對健康的兩個需求
1.適應會隨時間減少對健康投資的意願，也就是說愈適應，就不會去對健康進行投資。
2.同樣的適應覺知，引起對健康計畫的投入
但是適應並不是延長壽命而引起健康投資的主要因素，即其效果不高，它是與健康投資、消費的路徑相同，即對高價醫藥照顧、以較多時間觀注健康有較高的效果。
健康適應模式
A model of health adaptation incorporating multiple individual and environmental variables has been developed by Pender(1982; 1987)and includes polar constructs of health promotion and health protection. The domain of health protection includes individual behavior directed toward the regulation and maintenance of homeostasis and structural integrity. Health promotion is the actualization of inherent and acquired individual potential. Both health-protecting and health-promoting behaviors include physical, social, and self-care components.
Assumptions guiding Pender’s model include concepts of personal choice and self-directed behavior. The assumption of personal suggests that change, self-actualization, or the capacity for change exists if the individual so chooses. A second assumption supposes that individual behavior is purposeful and movtivated toward a goal. Purpose can only exist if choices are available and the individual is capable of making a choice. In a revision of this model, Pender has added a component of environmental modification that includes assessment and sociopolitical change. Enviromental modification is considered along with personal change strategies for illness prevention and health promotion.
Annual Review of Nursing Research, Volume 19, 2001
查閱pender健康促進書的p26中顯示adaptative model是Smith,J, (1983) the idea of health: Implications for the nursing profession提出
adaptive model:Family patterns of interaction with the physical and social enviroment, charaterized by flexible, effective adaptition or ability to change and grow.
Assumptions guiding Pender’s model include concepts of personal choice and self-directed behavior. The assumption of personal suggests that change, self-actualization, or the capacity for change exists if the individual so chooses. A second assumption supposes that individual behavior is purposeful and movtivated toward a goal. Purpose can only exist if choices are available and the individual is capable of making a choice. In a revision of this model, Pender has added a component of environmental modification that includes assessment and sociopolitical change. Enviromental modification is considered along with personal change strategies for illness prevention and health promotion.
Annual Review of Nursing Research, Volume 19, 2001
查閱pender健康促進書的p26中顯示adaptative model是Smith,J, (1983) the idea of health: Implications for the nursing profession提出
adaptive model:Family patterns of interaction with the physical and social enviroment, charaterized by flexible, effective adaptition or ability to change and grow.
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