健康危险因素与个体健康间的结构方程模型

目的探索健康危险因素与个体健康间的潜在关系,以及各潜变量对测量指标的影响。方法利用健康风险评估调查问卷调查西安市某三级甲等医院健康体检人群。构建健康危险因素与个体健康间的结构方程模型,解释不同因子间的相互作用及其对总体健康的效应权重。结果健康行为与健康意识之间呈显著正相关。健康行为对躯体健康的直接效用为0.85,健康意识不仅直接作用躯体健康,而且通过对心理健康的影响对躯体健康产生间接效应,总效应达0.78。结论健康行为、健康意识均是可控的健康危险因素,对躯体健康、心理健康产生一定影响。通过改变这些可控因素可以提高人们整体健康水平。     

Health educators' role in promoting health literacy and advocacy for the 21st century

This article discusses the relationship between health literacy and advocacy for health and health education, cites achievement of advocacy as a critical outcome of health education, and identifies health advocacy competencies for both students and health educators. The paper also delineates a role for health education in developing health-literate citizens and in training health educators to advocate for health and health education. The article draws on recent initiatives in comprehensive school health education and coordinated school health programs to identify content and strategies for developing health advocacy skills among elementary, middle, and senior high school students. The article provides a variety of approaches and strategies for developing advocacy skills among preservice and inservice health educators.     

新疆公共卫生服务供给存在的问题和对策

为实现公共卫生服务均等化的目标,分析了新疆公共卫生供给中面临的主要问题是基层医疗卫生经费投入不足,政府对公共卫生机构投入不足,基层卫生资源配置不足,公共卫生人才不足、素质较低,公共卫生服务成本较高,公共卫生服务供给不足。从加大政府对公共卫生的投入、科学设计均等化服务项目、整合卫生资源,加快人才培养等方面提出了建议。     

广西卫生事业发展现状分析

从健康水平、妇幼保健、卫生机构、卫生人力、卫生床位、医疗服务、传染病疫情、卫生经费等多角度分析广西卫生事业发展现状,并与全国平均水平进行比较。结果表明,近年来广西卫生事业发展水平不断提升,居民主要健康指标总体优于全国平均水平;卫生资源总量持续增加;社会资本办医成效显著,民营医院发展迅速;卫生筹资结构在不断优化,个人卫生负担有所减轻。但也面临妇幼保健体系有待完善、卫生人均量不足、基层医疗卫生资源利用不足、医疗费用持续上涨、法定传染病报告发病率上升、社会卫生筹资不足以及农村居民人均医疗保健支出增长过快等问题。因此,广西卫生事业发展综合水平还有待进一步提升。     

我国基层卫生机构服务功能分析

基层卫生机构功能决定着基本卫生服务的供给。本文利用国家第四次卫生服务总调查以及专题调查资料,对城乡基层卫生机构服务开展情况进行了分析。根据经济社会发展水平、基层卫生机构服务能力和城乡居民需要解决的主要健康问题,本研究将基本卫生服务项目按照优先程度分为三个等级。约三分之一的城乡基层卫生机构尚不能提供最应优先开展的基本卫生服务;农村基层卫生机构服务能力与城市基层卫生机构相比更为薄弱,特别是村级卫生机构基本卫生服务能力需要加强;乡镇卫生院和社区卫生服务中心开展最优先项目的比例均不足70%;村卫生室和社区服务站开展最优先项目比例分别为62%和77%。影响基层卫生机构功能的主要因素为人员数量不足、人员能力不够、缺乏运转资金等。需要以基层卫生机构功能建设为核心,创新我国基本医疗卫生保健体系。     

上海市商业健康保险制度研究

通过对国际医疗保健模式的比较和国内社会医疗保险及商业健康保险的分析,并结合高端医疗服务的现状,提出建立适应上海高端人群医疗服务特点的上海商业健康保险新模式。基本医疗服务由社会保险给予支付,高端医疗服务通过分类给付办法,即在社会医疗保险支付基本医疗服务费用基础上,其余费用由商业健康保险给予支付。基本医疗保险与商业健康保险相结合,满足不同层次人群对医疗服务的需求。     

Training health services managers: improving health by more health economics?

In times of rising health expenditures and imminent health problems, efficiency is a crucial element for maintaining and improving health care and, finally, health. One major support measure is the effective management of health services. This paper considers possible improvements of health care by training health services managers in health economics. It surveys the current state of health economics training, presents approaches towards the key issues of health economics, discusses the impact of health economics by two examples, and considers management aspects of health economics training.     

我国乡镇卫生院公共卫生管理功能定位思考

通过分析目前我国农村乡镇卫生院公共卫生管理的现状，探讨农村乡镇卫生院公共卫生功能，提出我国农村公共卫生管理范畴定位。从而明确乡镇卫生院公共卫生管理范畴，促进农村卫生三级网络的建设和完善，更好的发挥乡镇卫生院在农村卫生工作中的作用，推动农村公共卫生事业的健康发展，促进农村居民的健康。     

Beginn der Routinephase Gesundheitsberichterstattung des Bundes

The federal German health reporting system, financed by the Federal Ministry of Health, is monitoring the status of health, health behaviour, risk factors, health care utilisation, costs and resources of the health care system on the national level. The health reports offer action-oriented information on health related topics and provide a scientific basis for health policy decisions. This paper gives an overview on upcoming topics of the health report and briefly describes how the health reporting system is organised by the Robert Koch-Institute. Beside the health monitoring on national level the federal health reporting system co-operates with other health reporting systems on sub- and international level.     

21世纪卫生系统改革对卫生经济学发展的影响

该文介绍了发达国家和发展中国家在卫生改革中遇到的问题。前者有：组建医院间“战略联盟”,管理保健市场发展,卫生服务效率、公平性和可及性等。后者有：减少政府的作用,改变公共部门的组织及管理,增加卫生资金的来源及数量。这些问题引起卫生经济学界关注。第二次国际卫生经济学会会议将讨论以下专题：信息不对称及卫生保健组织间关系、卫生保健的选择,卫生及卫生服务的需求,健康及卫生服务的分布,卫生保健的经济学评价,卫生保健市场分析,健康保险,管理保健,卫生服务的产出等18个主题。     

病例组合方法及应用探讨

为了保证卫生资源分配的有效性和公平性,我国社会医疗保险制度中有必要引入病例组合(Casemix)的管理模式,病例组合是迄今为止国际上较为理想的卫生资源管理及疾病组合模式,病例组合的实施还能够帮助卫生管理机构建立医疗服务质量的评判标准及医疗机构和个人医疗服务质量与效率的比较标准,从而促进医疗服务质量与效率以及我国公共卫生管理水平的全面提高。     

National health care reform and the 103rd Congress: the activities and influence of public health advocates.

OBJECTIVES: This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress. METHODS: Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed. RESULTS: The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates. CONCLUSIONS: The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress.     

Levels of health development: a new tool for comparative research and policy formulation

Levels of health development are formed by mathematically clustering countries using six health status indicators: crude birth, crude death, infant mortality and child death rates, and male and female life expectancy. Stratifying two international samples of 128 and 163 countries into levels of health development--groups with similar health status profiles--improves the results of regression analyses used to identify economic, political, social, educational, health and other health determinants. For this reason, health development levels are a systematic framework for delineation of health determinants. Earlier large scale statistical studies have been limited in their success in part because they did not partition their data sets prior to analysis, or used inappropriate criteria that blurred rather than heightened developmental differences in underlying social systems. These developmental differences regulate the way in which health status inputs are converted into health status outputs, defining the relative importance of health determinants at various developmental levels. At lowest health development levels (countries with poorer health status), the under-development of economic, health and educational infrastructures creates a vacuum which allows international intervention (aid, investment, export/import activities) to play a dominant role in health status determination. At middle health development levels, health and educational infrastructures are better developed, but still secondary in importance as health status determinants to basic economic infrastructure. Demographic problems are particularly apparent at these levels. At higher health development levels, education, women's status, and political structure are especially important health status determinants. This research has facilitated the identification of health status determinants for use in health policy analysis. Recommendations for future research include use of findings in health policymaking by individual countries and by comparative researchers, and development of appropriate health systems models for each level of health development.     

An analysis of health levels and various indicators of urban environments for Healthy Cities projects

STUDY OBJECTIVES: (1) To identify and to categorise the various city indicators that are related to health levels; (2) to demonstrate the extent of the influence on health of these categorised health determinants; and (3) to demonstrate both the interactive associations among the health determinants and the magnitude of influence of each health determinant on the people's health. DESIGN: By using city statistics of study areas, the health index and health determinant indices were formulated. The extent of influence of health determinants on the health index was examined by regression analysis; the interrelations between the health determinants and the health index were examined by correlation analysis. SETTING: All the administrative units in Japan with populations more than 100 000 were selected as study areas to analyse the relation of health and health determinants. MAIN RESULTS: The nine health determinant indices used-healthcare resources, preventive health activities, environmental quality, housing, urban clutter, local economy, employment, income, and education-explained 51.6% of the variances of the health index as a whole in the cities studies. The health determinant indices showed interrelations with each other, in addition to individual health determinant indices having a high correlation with the health level index of the population. CONCLUSIONS: Both individually and collectively the health determinants are closely related to the health status of a population and individual determinants interact with each other. Simultaneous analysis of the interrelations among health determinants and health status would contribute to widen integration oriented perspective in policy interventions based on collaboration between different sectors of society.     

Public health management: Time for a new start?

One of the themes of health care reform Is a renewed focus onhealth rather than health care. The role of the purchaser isdirected towards health gain rather than merely the maintenanceof health care services. This goal can only be achieved if publichealth specialists and health services managers work togetherand share skills. There is a need for public health physicians,non-clinical public health specialists and health service managersto find an intellectual focus for joint working since theirrespective skills are complementary. Whereas public health haslooked outwards towards the health needs of the population,health care management has focused inwards on the organizationof health services. The concept of public health managementoffers a unifying focus. It centres on the mobilization of society'sresources, including those of the health service sector, toimprove the health of populations through whatever means ismost appropriate. Public health has suffered from a tensionbetween knowledge and action. Public health management seeksto resolve this tension. The paper explores the concept of publichealth management, analyses the skills required for its successfulpractice and considers the training programmes required to developpublic health managers. The authors call on European organizationsto champion the concept of public health management.     

青少年健康素养评价工具研究现状及展望

健康素养与突发公共卫生事件的应对密切相关，研究以评价工具为切入点，重点综述了青少年健康素养评价工具、突发公共卫生事件视域下青少年健康素养评价工具研究现状。建议在突发公共卫生事件视域下加强青少年健康素养评价工具的开发，加强健康教育和提升健康素养，有利于青少年更好地应对突发性公共卫生事件，维护身心健康。     

The geographies of digital health – Digital therapeutic landscapes and mobilities

Digital technologies have long impacted the field of health, causing fundamental changes for the geographies of the production, movement, and consumption of health. Despite this, there is limited health geography engagement with digital health, and an understanding of how digital health affects the spatialities of health remains underdeveloped. Here, using autoethnography, I reflect on personal encounters with digital health in the UK to initiate analytical attention into the geographies of digital health. I demonstrate that digital health technologies are interconnected and increasingly structure access to health, impacting the equality of health; and that digital health disrupts existing, and creates new, therapeutic landscapes and mobilities.     

Toward a lexicon of population health

Despite its undeniable currency in research and policy circles, there remains considerable confusion about what 'population health' is. We propose a lexicon for population health in the hope of clarifying issues and advancing this important research emphasis and policy agenda. It distinguishes population health in its literal meaning from a population health perspective, population health research, a population health framework, and a population health approach to policy. Population health is more than just thinking in aggregate terms or about identifying vulnerable or at-risk subpopulations. A population health perspective is fundamentally concerned with the social nature of health influences. The social structures that shape health experiences transcend the characteristics or actions of any one individual, providing population health with analytic advantages over individualistic-oriented approaches to health and to health policy.     

The Great Lakes Center's health hazard evaluation program: promoting community environmental health through partnerships between academic and public health departments

The Great Lakes Center of Excellence in Environmental Health (GLCEEH), an innovative capacity-building component of the University of Illinois, performs health hazard evaluations in collaboration with the Illinois Department of Public Health and local health departments. GLCEEH has provided state and local health departments with faculty, industrial-hygiene expertise, and research expertise to help them investigate a variety of environmental health issues. This article describes health hazard evaluations performed with support from the National Center for Environmental Health, lessons learned, and recommendations for successful collaboration between academic and public health departments. From the academic perspective, health hazard evaluations are beneficial because they provide faculty and students with the opportunity to engage in public health practice and encounter new issues that advance the science of environmental health through research. From the perspective of a public health department, health hazard evaluations are beneficial because they address priority environmental health concerns and build the capacity of department personnel to conduct health hazard evaluations with internal resources. A collaborative health hazard evaluation program increases public health capacity by developing new approaches to environmental health problems and by sharing limited resources.     

论我国卫生保健服务的公平性

卫生保健服务公平性是指无论社会成员的社会地位、收入等因素如何,都应该以需求为导向获得卫生保健服务。通过卫生保健服务公平性评价体系,分析目前在我国卫生保健服务的公平性方面存在着卫生保障覆盖面小、卫生资源配置不平衡及卫生服务费用分担不合理等问题。要改变这一状况,就应该从增加卫生资源的投入、优化卫生资源配置结构、健全和完善医疗保障制度方面着手,推进卫生保健服务的公平,使每一个社会成员都能得到基本的、公平的卫生保健服务,最终实现人人享有卫生保健的目标。