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1、Public Health Practice and Improvement Framework Practices and Essential Services 公共卫生实践公共卫生实践,改善框架改善框架-实践和关键服务实践和关键服务- Public Health Infrastructure Goal公共卫生基础设施目标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 p
2、repared?如何才能做好充分的准备？2Step One第一步第一步1.Develop a Community Health Assessment Plan制定社区卫生评估计划2.Gather Most Important Data收集重要数据3.Interpret the Data对数据进行分析4.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3AssessmentEssential Services评价关键服务评价关键服务1.Monitor health status t
3、o identify community health problems 监测卫生现状,确定社区卫生问题2.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3.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 4Causes of Premature Dea
4、th in the U.S. 19901990年美国过早死亡的原因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 lea
5、ding causes in China?在中国首要原因是什么?5What is Most Important to Monitor?Some possible criteria监测的重点是什么？一些可能的标准监测的重点是什么？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？6Top Three
6、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
7、暴力_ Lung disease 肺病_ Sexual Diseases性病_ Suicide 自杀_ Other:_其他_ 7What Would You Like to Achieve By 2010? 到到2010年想要达到什么目标不？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？）8Leading Health Indicators
8、主要的健康指标主要的健康指标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9Services 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解决公共健康所有决定因
9、素所需要的服务 Over the life spanLiving 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
10、Health care services医疗服务10Slide 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
11、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 11Key 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
12、& 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
13、电子记录:安全,简单,标准变量,经常更新,装备先进12Assessment 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 nations 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Ev
14、aluate the status of the nations public health laboratory system performance评价全国公共卫生实验室系统的运行状况13Step Two第二步第二步1.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2.Develop Communication Links Between All Partners在各合作方间建立交流机制14Policy Development 政策发展For problems that
15、 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.
16、 可以用于创造一个更综合,紧密连接的公共卫生系统15Essential 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 educat
17、ion to increase awareness, and motivation提高意识和动员水平的教育计划Compliance执行16Important 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 c
18、lear 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?17Policy Recommendations 政策建议Appoint a national commission to develop a framework for state public health law reform. 任命一个全
19、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18Assurance 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 h
20、ealth 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19Overview of He
21、alth 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 healt
22、hy conditions 环境：使之更加安全，以提供健康的环境条件20Self-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
23、 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 publics health?保护和加强公众健康的合适系统21Mobilize 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
24、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22The 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
25、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?23
