【作者】 侯泽蓉；

【导师】 冯占春；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2007， 硕士

【摘要】 目的:通过理论分析界定了公共卫生的内涵,即公共卫生的基本性质特征,并以此为基础,结合全面小康社会建设的要求和农村居民的健康需要,采用专家咨询法界定了全面小康社会建设时期农村公共卫生的外延,包括农村公共卫生基本功能和基本服务项目。方法:本研究运用卫生事业管理学、福利经济学、卫生统计学等的理论和方法,通过理论分析和专家咨询界定了全面小康社会建设背景下的农村公共卫生内涵与外延。主要方法包括:⑴文献研究法;⑵专家咨询法;⑶卫生统计学方法:主要应用描述性统计分析和卡方检验对专家咨询的结果进行分析。结果:⑴公共卫生就是组织社会共同努力,通过采取改善人类生存环境和卫生条件、预防控制疾病的发生和传播、促进健康行为和文明生活方式、对突发公共卫生事件做出反应、保证卫生服务的可及性和服务质量等综合性措施,达到预防疾病、促进健康和效益的目的。⑵公共卫生的基本特征有:公共性、社会性、社会公正性、社会价值决定性、动态性、科学性、艺术性、丰富的政治内涵、预防第一。⑶全面小康社会建设背景下农村公共卫生主要应履行基本公共卫生功能并提供基本公共卫生服务,包括:针对群体健康的措施或功能;个体预防服务;有公共卫生意义的个体疾病治疗。⑷全面小康社会建设背景下农村公共卫生应履行如下9项基本功能:预防控制传染病和其他疾病流行;对疾病暴发流行和突发公共卫生事件作出应急反应处理;执行相关法律和规章,保护健康、保障安全;多部门协作,组织动员社会资源与社会参与;县、乡、村防保网建设完善;公共卫生成本测算与筹资;监控所在区域卫生状况,确定人群需要优先解决的公共卫生问题;保护生活环境,促进安全用水等;开展健康教育、促进和鼓励健康行为。⑸全面小康社会建设背景下农村公共卫生应提供如下30项基本服务:五苗七病计划免疫;急性传染病的疫情监测和管理;结核病防治;其他重要的免疫接种服务,如流脑、乙脑、甲肝;性病、艾滋病的控制;孕产妇系统管理;儿童系统管理;安全饮用水保障;麻疹的防治;学校卫生等。⑹全面小康社会建设背景下农村公共卫生县、乡、村不同层次体系承担的公共卫生基本服务项目范围有所不同。县级公共卫生体系应承担“五苗七病计划免疫”等28项公共卫生基本服务项目,乡级公共卫生体系应承担“五苗七病计划免疫”等24项公共卫生基本服务项目,村级应承担“卫生厕所改造”等11项公共卫生基本服务项目。结论:⑴公共卫生外延的界定除了对传统公共卫生的继承外,还需要反映新公共卫生的内容与特点;⑵基本公共卫生服务项目要反映疾病谱的变化,根据疾病谱变化适时调整;⑶基本公共卫生服务项目要反映新医学模式的特点与要求;⑷基本公共卫生服务项目对农村弱势群体的关注能够增加国民健康福利总量;⑸逐步落实非临床性预防和部分临床性预防服务是农村公共卫生工作的主要任务与发展选择策略;⑹在全面建设小康社会阶段,传染病防治仍将是农村公共卫生工作的重要内容之一;⑺加强农村公共卫生县、乡、村体系建设,保障服务能力;⑻合理划分各级政府公共卫生财政责任,根据公共卫生基本功能、基本服务项目范围及成本测算结果落实公共卫生筹资。更多还原

【Abstract】 Objective Define the connotation of public health through theoretical analysis, which is the natural characteristics of public health. Combining the demands of a comprehensive well-off society construction and the health needs of rural residents, define the extension of rural public health by applying Delphi on the basic of the connotation,including essential functions and essential services of rural public health.Methods Through theoretical analysis and professional consulting, define the connotation and extension of rural public health on the background of the comprehensive well-off society construction by applying the theories and methods of health management, benefit economics , biostatistics and so on. The main methods include literature study, Delphi and biostatistics, such as descriptive statistics and chi-square test for the results of professional consultation.ResultsFirstly, the definition of public health is that public health is to organize the whole society to work together through a variety of comprehensive measures in order to prevent diseases, promotion health and benefits.These benefits organized aim at ensuring every citizen’s basic right to health protection. That”diseases prevention, health and benefits promotion”is the purpose of public health. That“organizing the whole society work together”has pointed out the nature of public health, Indicating of the governments’limited responsibility and the importance of organizing social forces to participate comprehensively.“Benefits”shows that public health is a kind of public undertaking full of high welfare and emphasizes public health’s mission.“Comprehensive”emphasizes the science and artistry property of public health, and shows that public health is the integration of science, technology and the concept.”A variety of comprehensive measures”shows the scope of public health, such as Improving living environment and health conditions, prevention and control of diseases, health performance and life style promotion, response to public health emergency incidents and so on.Secondly, public health has some natural characteristics as follows: public character, social justice character, rich political connotation, social character, social value decision character, scientific character, comprehensive character, art character,prevention first and dynamic expansibility.Thirdly, on the background of a comprehensive well-off society construction,the rural public health should perform essential functions and provide essential services for rural residents, including measures and functions aim at population health, preventive services for the personal and disease treatment with public health purpose.Fourthly, on the background of the comprehensive well-off society construction, the rural public health should perform nine items of essential functions, including prevention and control the epidemic of communicable diseases and other diseases, emergency response and handling to the outbreak of diseases and emergency public health incidents, carrying out the related laws and rules, protecting the health and ensuring the safety, multi-department collaboration and encouraging the community participation, construction and perfect of the prevention and care net at the level of the county, township and village, cost calculation and financing of public health, monitoring the health status of regions, confirming and resolving the priority public health problems of population, protection the living environment and promoting the safe using of water ,carrying out health education, promotion and encouraging health performance.Fifthly, on the background of the comprehensive well-off society construction, the rural public health should provide 30 items of essential services as follows: immunization for seven special diseases, monitoring and management of the acute communicable diseases, prevention and treatment for TB, other important immunization services, control and health education of AIDS, system management of the pregnant women, system management of children, ensuring of safe water using and so on.Sixthly, on the background of the comprehensive well-off society construction, the rural public health systems at different level need provide different essential services. The rural public health system at the level of county should provide 28 items of essential services such as immunization for seven kinds of special communicable diseases. The rural public health system at the level of township should provide 24 items of essential services such as immunization for seven kinds of special communicable diseases. The rural public health system at the level of village should provide 11 items of essential services such as health toilets rebuilt.Conclusion Firstly, the results defined not only need to represent the traditional public health, but also need to reflect the content and characteristics of the new public health. Secondly, those essential public health service items should reflect the change of main diseases existed. Thirdly, those essential public health service items should reflect the characteristics and demands of the new medicine pattern. Fourthly, that the essential public health service items have paid much attention to the weak groups in rural can increase the total health benefits of people. Fifthly, that implementing non-clinical prevention services and part of clinical prevention services step by step is the main task and optional development strategy of rural public health. Sixthly, during the comprehensive well-off society construction period, the prevention of communicable diseases is still the key point of rural public health. Seventhly, strengthen the construction of rural public health system and ensure the service ability. Eighthly, divide the public health financial responsibility of government in different grades reasonably, and make the public health financing put into effect according to the scope of essential public health functions, essential public health service items and results of cost calculation.更多还原