公共卫生实践
- 1. Public Health Practice and Improvement Framework – Practices and Essential Services – 公共卫生实践,改善框架 -实践和关键服务-
- 2. *Public Health Infrastructure Goal 公共卫生基础设施目标Every health department better prepared 每一个卫生部门都应该准备好 Every community better protected 每一个社区都受很好的保护What does it take to be fully prepared? 如何才能做好充分的准备？
- 3. *Step One 第一步Develop a Community Health Assessment Plan 制定社区卫生评估计划 Gather Most Important Data 收集重要数据 Interpret the Data 对数据进行分析 Report 撰写报告 brief, 简洁 to the point, 重点突出 clear data 数据明晰 specific recommendations 明确的建议
- 4. *Assessment Essential Services 评价关键服务Monitor health status to identify community health problems 监测卫生现状,确定社区卫生问题 Diagnose and investigate health problems and health hazards in the community 诊断和调查社区的卫生问题和健康危害 Evaluate effectiveness, accessibility, and quality of personal and population-based health services 评价有效性,可获得性,以及个人和人群健康服务的质量
- 5. *Causes of Premature Death in the U.S. 1990 1990年美国过早死亡的原因 Cause原因 % of Total Deaths总死亡 Tobacco烟草 38% Diet/activity patterns饮食/运动模式 28% Alcohol酒精 10% Microbial agents微生物 8% Toxic agents毒物 6% Firearms 枪支 4% Sexual behavior 性行为 2% Motor vehicles 交通事故 2% Illicit drugs 非法毒品 1%Source: McGinnis & Foege, JAMA 1993What would be the leading causes in China? 在中国首要原因是什么?
- 6. *What is Most Important to Monitor? Some possible criteria… 监测的重点是什么？一些可能的标准Contribute most to years of productive life lost? 是否导致生产年的丧失？ Affects other regions and countries? 是否影响其他的区域和国家？ Could be improved greatly with good data 是否可以通过好的数据显著改善健康状况？ 0
- 7. *Top Three Health Problems?___ Aging problems 老龄化 ___ Cancers 癌症 ___ Child abuse /neglect, orphans 虐待儿童 ___ Diabetes 糖尿病 ___ Domestic Violence 家庭暴力 ___ Heart disease/stroke 心脏病/中风 ___ blood pressure高血压 ___ HIV / AIDS 艾滋病 ___ Homicide 他杀___ Infant Death 婴儿死亡 ___ Infectious Diseases 传染病 ___ Mental health problems精神病 ___ Car /Bike injuries 车祸 ___ Rape性暴力 ___ Lung disease 肺病 ___ Sexual Diseases 性病 ___ Suicide 自杀 ___ Other:__其他_____
- 8. *What Would You Like to Achieve By 2010? 到2010年想要达到什么目标不？objectives for change 目标 Develop An Objective (By when, what will be changed, by how much change, for what group?)_____________________________________________ 制定目标（何时、取得何种变化、变化多少、目标人群是哪个？）
- 9. *Leading Health Indicators 主要的健康指标Biological causes of death, illness, injury 导致死亡、疾病、伤害的生物学因素 Behavior and Lifestyle 行为与生活方式 Environment: quality of air, water, food, land 环境因素：空气、水、食物、土地的质量 Immunizations 免疫接种 Access to health care 卫生保健的获得
- 10. *Services Need to Address All Determinants of Public Health 解决公共健康所有决定因素所需要的服务 Broad social, economic, cultural, health, and environmental conditions and policies at the global, national, state, and local levels Living and working conditions Social, family and community networks Individual behavior Innate individual traits: age, sex, race, and biological factors --- The biology of disease Over the life spanabLiving and working conditions may include:工作生活环境包括: Psychosocial factors 社会心理因素 Employment status and occupational factors 就业状况和职业因素 Socioeconomic status (income, education, occupation) 社会经济状况(收入,教育,职业) The natural and builtc environments 自然和人为环境 Public health services 公共卫生服务 Health care services 医疗服务
- 11. *Slide Details: Multiple Determinants of Health 健康的影响因素Biology 生物学 Behavior 行为 Social, Family & Community Networks 社会,家庭和社区网络 Living & Working Conditions 工作生活环境 Employment & occupation, Education, Socioeconomic status, Psychosocial factors 雇佣和职业,教育,社会经济状况,社会心理因素 Natural and built environment 自然和人为环境 Public & health care services 卫生服务 Social, economic, cultural & environmental policies 社会,经济,文化和环境政策
- 12. *Key Components to Monitor Health Status 监测卫生现状的关键指标death certificates if detailed & accurate 死亡登记(详细,准确) immunization registries 免疫接种登记 large population surveys 大人群调查 health interview & exam studies 健康访谈和体检研究 required reporting of key infectious diseases 主要传染性疾病法定报告制度 proxy measures: infant mortality, average lifespan 替代指标:婴儿死亡率,平均寿命 integration across districts, providers, diseases 地区,来源,疾病数据的整合 electronic records: secure, simple, standard variables, updated regularly, well staffed 电子记录:安全,简单,标准变量,经常更新,装备先进
- 13. *Assessment Recommendations 评价建议Develop National Health Information Infrastructure 建立国家卫生信息基础设施 Regularly assess the state of the nation’s public health system and its capacity to provide the essential public health services to every community 常规评价全国公共卫生系统的现状和为社区提供基本公共卫生服务的能力 Evaluate the status of the nation's public health laboratory system performance 评价全国公共卫生实验室系统的运行状况
- 14. *Step Two 第二步Develop a Community Health Improvement Plan 制定社区健康改善计划 National, 国家级 Provincial 省级 Local 地方 Develop Communication Links Between All Partners 在各合作方间建立交流机制0
- 15. *Policy Development 政策发展For problems that affect large population segments 针对影响最大人群的问题 For problems with roots in environment or institutions or businesses 针对环境,体制或商业的根本 Focus more on improving community wide conditions, services and practices. 重点在提高广泛社区的状况,服务和实践 Can be used to create a more comprehensive and linked public health care system. 可以用于创造一个更综合,紧密连接的公共卫生系统
- 16. *Essential Policy Components That Must Be Put in Place for Success 成功的基本要素Enactment 颁布Enforcement 实施Plan for communication between decision makers, and mobilizing support 决策者和支持者之间的交流计划Plan for communication between authorities, and enough resources 当局者和足够资源之间的交流计划Plan for education to increase awareness, and motivation 提高意识和动员水平的教育计划Compliance 执行
- 17. *Important Policy Components 重要的政策要素 Is there a system for identifying and tracking all policies in place? 是否有确认和跟踪政策实施的系统? Is policy compliance monitored and enforced? If not, then there may be no motivation to comply 是否有政策监测系统? Is it clear who has responsibility for each law and how to get them to take action? 每项法律的负责人是否清楚,如何使他们行动起来? Is public informed? 公众是否知情? Does public believe it will be enforced? 公众是否相信政策可行?
- 18. *Policy Recommendations 政策建议Appoint a national commission to develop a framework for state public health law reform. 任命一个全国委员会建立国家公共卫生法律改革的框架 Support bold, large-scale demonstrations to test new approaches to increase the efficiency and effectiveness of health care delivery systems 支持大规模演示,以检验新方法提高卫生服务系统的有效性
- 19. *Assurance Essential Services 基本服务保证Enforce public health laws and policies 加强公共卫生法律和政策 Assure a competent public health and personal health care workforce 保证一支有力的公共卫生和个人医疗服务的队伍 Link people to needed personal health services and assure the provision of health care when otherwise unavailable 将个人和个人所需的健康服务连接起来 Evaluate compliance, service delivery, health outcomes and need for change 评价依从性,服务,健康产出和改善要求
- 20. *Overview of Health Promotion Strategies 健康促进策略回顾Education: change knowledge, attitudes, beliefs, readiness, intentions and behaviors 教育：改变知识、态度、信仰、愿望、目的和行为 Policy: discourage unhealthy practices, improve infrastructure and environment 政策：不鼓励那些不健康的作法，促进基层单位和环境的改善 Environment: make the environment safer to provide healthy conditions 环境：使之更加安全，以提供健康的环境条件
- 21. *Self-Assessment for Selected Health Issue 卫生问题的自我评价 A strong governmental public health infrastructure for leadership and services? 强大的政府公共卫生基础设施 Up-to-date and linked systems for understanding health status and trends? 理解健康状况和趋势的实时监测系统 Clear system of health policies that assure adequate and sustained community health? 确保适当和持续的社区健康的卫生政策系统 Systems in place to protect and enhance the public’s health? 保护和加强公众健康的合适系统
- 22. *Mobilize community partnerships to identify and solve health problems 动员社区,确认和解决卫生问题Governments cannot work alone to tackle big and complex problems 政府不能在解决大的复杂问题上单枪匹马 Poverty, poor food, inadequate wages and lack of physical exercise require community partnerships 贫穷,差的食物,不适当的工资以及缺少体育锻炼方面需要社区配合 Example: sex trade 例如: 性交易
- 23. *The Public Health Workforce: Is it Ready to Provide the Core Functions and Essential Services at ALL Levels? 公共卫生队伍: 能否在各个层次上提供核心功能和关键服务 Is there a well developed plan to provide each service? 是否有提供各种服务的成熟计划? Are there enough people and resources? 是否有足够的人员和资源? Are people sufficiently trained? 人员是否经过充分培训? Is it integrated with other essential services? 是否与其它基本服务相整合? Is there good working relationship between the local, regional and national public health systems? 在地方,地区和全国的公共卫生系统之间是否存在良好的工作关系? Is there good communication with other sectors that affect health such as stores and schools? 与影响健康的其它部门,例如商店和学校,之间是否存在良好的沟通与交流?
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