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1、第十一章 疾病的预防策略和疾病监测,温州医学院预防医学系 王怡,第一节 疾病的预防策略,预防和控制疾病应讲究策略和措施： 策略是根据具体情况而制定的指导全局的工作方针。 措施是开展工作的具体手段。 策略和措施的关系： 策略的落实要靠一个个具体措施的实现；而具体措施的实施离不开宏观策略的指导。否则政策落空或者事倍功半，收效甚微。 如全球消灭天花,一、在宏观水平制订预防策略,什么是疾病防制策略： 是在对一个国家或地区疾病防制的当前形势和既往工作进行客观分析与评价的基础上，找出疾病防制工作中存在的主要困难和障碍，确定疾病防制中的优先领域及其近、中、远期步骤和方法。 对疾病防制策略的要求： 切实可行、
2、有效 适应形势变化和发展，即时修订,为什么要修订疾病防制策略？,1、社会发展、疾病谱改变和科学技术进步。 2、医学模式已由生物医学模式发展为现代生物-心理-社会医学模式。 3、社会、经济和文化背景的不同广泛地影响着个体的生物行为和社会行为。 4、生物和社会行为往往是疾病传播和流行的决定因素，因此，社会、经济和文化背景既影响个体对疾病的易感性，也决定着疾病流行的特点和发展趋势。,举例,艾滋病的流行主要是由行为因素造成的，但不同的国家和地区社会、经济和文化情况不同，艾滋病的流行情况千差万别。所以要针对不同情况制订适合不同国家和地区的艾滋病防治策略。 因此，对一种疾病流行的预防与控制必须结合当地的流
3、行背景与流行特点制定相应的策略。现代医学模式的确立为制定疾病的防制策略提供了最佳的思维方式和决策模式。,收集疾病的流行病学资料（分布特点和自然史资料），利用“社区诊断” 确定危害最大的疾病和健康问题及其影响因素。 在确定防病重点时，综合考虑特效的防治方法和当地政府的支持程度（政策的支持、资源的承受能为和全社会的参与程度等）。,制定预防策略的步骤？,我国,始终把预防为主放在首位 基本指导思想 “以农村为重点，预防为主，中西医并重，依靠科技与教育，动员全社会参与，为人民健康服务，为社会主义现代化建设服务” 以农村为重点是卫生工作的特点,二、全球卫生策略和初级卫生保健,(一)、全球卫生策略 全球卫生
4、策略的概念是指世界卫生组织和各国政府2000年以前及以后年代的一项永久性目标。 即1977年世界卫生大会通过了全球卫生策略 “2000年人人享有卫生保健” (health for all by the year2000，HFA),“Health for all by the year 2000”,at least 5% of gross national product should be spent on health; at least 90% of children should have a weight for age that corresponds to the referenc
5、e values; safe water should be available in the home or within 15 minutes walking distance, and adequate sanitary facilities should be available in the home or immediate vicinity; people should have access to trained personnel for attending pregnancy and childbirth; and child care should be availabl
6、e up to at least one year of age.,“Health for all by the year 2000”,全球卫生策略确切的含义：,人们在工作和生活场所都能保持健康； 人们将运用更有效的办法去预防疾病，减轻疾病或伤残带来的痛苦，并且通过更好的途径进入成年、老年，最后安乐地死去； 在全体社会成员中均匀地分配一切卫生资源； 所有个人和家庭，通过自身充分地参与，将享受到初级卫生保健； 人们将懂得自己有力量摆脱可以避免的疾病，赢得健康，并且明白疾病不是不可避免的。,（二）、初级卫生保健（PHC）,1978年 国际初级卫生保健会议 阿拉木图宣言 是实现人人享有卫生保健的基本
7、措施和基本途径,Declaration of Alma-Ata,An International Conference on Primary Health Care was held from 6-12 September 1978 in Alma-Ata, capital of the Kazahhistan. 134 governments and 67 UN organizations, specialized agencies and non-governmental organizations in official relation with WHO and UNICEF atte
8、nded. Declaration of Alma-Ata.,初级卫生保健的概念,初级卫生保健(primary health care，PHC)是应用切实可行、学术可靠又受社会欢迎的方法和技术，并通过社区的个人和家庭积极参与而达到普及，其费用也是社区和国家依靠自力更生原则精神能够负担的一种基本的卫生保健形式。,What is Primary Health Care (PHC)?,PHC is essential health care made universally accessible to individuals and families in the community by mean
9、s acceptable to them, through their full participation and at a cost that the community and country can afford.,初级卫生保健任务的内容：,1、健康教育和健康促进：通过健康教育促使人们自觉地采纳有益于健康的行为和生活方式，消除或减轻影响健康的危险因素，促进健康和提高生活质量。 2、疾病预防和保健服务：采取积极有效的措施，预防各种疾病的发生、发展和流行。,3、基本治疗：以一级医院为中心，面向社会，通过设点、开设家庭病床、巡诊、转诊相结合，为社区提供及早有效的医疗服务。 4、康复：通过设立
10、家庭病床或社区康复点，对丧失正常功能或残疾者，采取医学和社会综合措施，促使康复。,Case study: the Gambia,In the Gambia, in west Africa, a study by the United Kingdom Medical Research Council of 40 villages beginning in 1981 over a 15-year period compared infant and child mortality between villages with and without primary health care (PHC)
11、.,A routine primary health care activities at Thmor Bang Health Center, Koh Kong Province, Cambodia.,Case study:,Extra services to the PHC villages included a paid Community Health Nurse for about every five villages, as well as a Village Health Worker and a trained Traditional Birth Attendant. Mate
12、rnal and child health services with a vaccination program were accessible to residents in both PHC and non-PHC villages. There were marked improvements in infant and child (5 years) mortality in both PHC and non-PHC villages.,After the establishment of PHC in 1983, infant mortality in the PHC villag
13、es dropped from 134/1000 in 19821983 to 69/1000 in 19921994, and from 155/1000 to 91/1000 in the non-PHC villages over the same period. The change in death rates for children aged 14 years between the two groups was not as marked.,Case study:,Case study:,Supervision of the PHC system weakened after
14、1994, and infant mortality rates in the PHC villages rose to 89/1000 in 19941996.The rates in non-PHC villages fell to 78/1000 for the same period. Mortality rates rose significantly when PHC services were weakened.,History of Chinas primary health service system,1949 to 1980: 80% of urban residents
15、 covered by work units; 90% of rural residents were covered by cooperative health plans. 1985 to 2002: The health system was turned over to the market and became dependent on fee-for-service.,Current Policy of Chinas Primary Health Service System,2003 to now: Rural: The New Rural Health Cooperative
16、began. 80% of farmers are covered now. Urban: Community Health System was started in 2006 in major cities and all cities should have the system in place by 2010.,Urban community health services steadily improved,By the end of 2006, over 23,000 community health centers had been in place nationwide, an increase of 5,528 over 2005; 24 provinces nationwide have specified the average financial input per person in community-based public health services.,第二节 传染病的预防措施,一、传染病
