加快发展农村卫生事业 为建设社会主义新农村作贡献

——建立基本设施齐全、队伍素质较高的农村公共卫生与基本医疗服务体系．使“农村防病治病有个好的网络”。 ——建立以大病统筹为主的新型合作医疗制度和医疗救助制度．使“农民看病就医有个好的保障”。     

构建经济发达地区农村公共卫生服务体系

以台州地区为例,针对经济发达地区农村公共卫生服务体系建设过程中凸现出的问题,从分析公共卫生内涵入手,提出经济发达地区农村公共卫生服务体系建设构想:加大公共卫生服务投入;完善农村公共卫生管理体制;重塑三级预防保健网功能;加强部门协调合作;加强服务人员业务能力培训;加强上级部门对农村公共卫生工作指导;加强健康教育、健康促进工程.     

关于加强公共卫生体系建设的思考

《中共中央关于制定国民经济和社会发展第十一个五年规划的建议》中提出：“加强农村公共卫生和基本医疗服务体系建设，基本建立新型农村合怍医疗制度，加强 人畜共患疾病的防治。”这是非常有见地的。结合金华地区公共卫生现状，提以下观点和同志们商榷。     

强县 建乡 管村——湖南省“十五”农村公共卫生和基本医疗服务体系建设的基本思路

《中共中央关于制定国民经济和社会发展第十一个五年规划的建议》对农村卫生工作提出了明确要求，强调要“加强农村公共卫生和基本医疗服务体系建设”。贯彻落实《建议》，结合湖南实际．今后几年我省农村公共卫生和基本医疗服务体系建设的基本思路是——强县、建乡、管村。     

"十一五"及2020年西部地区农村卫生情景模拟分析

该文分析影响西部地区农村居民健康的主要因素并预测“十一五”及2020年西部地区农村卫生的不同发展情景。为实现理想模式，需要在科学发展观指导下，规范公共财政制度，加大对西部地区农村公共卫生投入，采取内涵式卫生发展模式。     

农村公共卫生服务体系建设的SWOT分析

目的：掌握农村公共卫生服务体系的建设进展，发现和解决存在的问题。方法：采用SWOT分析法，对浙江省农村公共卫生服务体系进行综合评价。结果：浙江省农村公共卫生服务体系的优势为：公共卫生服务体系基本健全，服务内涵和技术水平较高；劣势：农村三级公共卫生服务网的功能仍需完善和加强，且资源配置不尽合理；机遇：政府对农村卫生工作的大力支持，社会经济的快速发展；威胁：疾病防控工作任务严峻，流动人口、人口老龄化等问题日益严重。结论：按照全面推进社会主义新农村建设的有关要求，以“农民健康工程”为载体，建构农村公共卫生服务的新框架，通过创新农村公共卫生筹资机制等，进一步理顺公共卫生宏观管理体制，最终目标是实现人人享有基本的公共卫生服务。     

加强农村公共卫生服务体系建设的探索与思考

体制转换导致农村卫生投入减少，农村公共卫生服务体系被削弱，公共卫生服务工作滞后。农民因病致贫，因病返贫情况严重。如何加强农村公共卫生服务，做好农村防病工作。本文介绍了实行乡、村“一体化”管理，恢复县、乡村三级预防保健网，推行农村公共卫生综合目标管理以及政府“购买”公共卫生服务的做法，以及其显著的社会效果。     

农村公共卫生服务体系绩效评价指标在农村卫生改革中的实践

目的:评价中国农村卫生发展项目(简称"卫十一项目")实施期间,项目地区公共卫生服务体系的绩效。方法:采用项目开发的农村公共卫生服务绩效评价指标体系,连续收集40个项目县2008—2013年的投入、产出指标,进行综合分析与评价。结果:项目地区2008—2013年间公共卫生的投入和产出均逐年提高,分别由项目初期的22.73分和39.05分增加到32.62分和57.60分,增幅达43.15%和47.50%,部分项目省份投入增幅较产出明显。项目地区投入产出比从1.72增加到1.77,年间略有波动。结论:采用公共卫生服务体系绩效考核指标监测项目实施进程,有利于及时发现农村公共卫生服务体系建设中存在的薄弱环节,从而针对性地采取有效措施促进体系的完善。在加大公共卫生投入的时候,如何高效利用资源,提高服务效果依然是亟需解决的问题。     

农村公共卫生服务体系建设存在的问题及对策

农村公共卫生服务体系建设是保障农民身体健康、促进农村经济和社会和谐发展的重要内容。改革开放以来，村卫生室的产权和服务模式发生了根本转变，多数村卫生室不愿意或无能力提供公共卫生服务，致使农村公共卫生服务体系基本处于瘫痪状态，农村公共卫生服务几乎成为“空白”。尽管《中共中央、国务院关于进一步加强农村卫生工作决定》颁布以来，农村卫生工作有了较大改善，但在公共卫生方面仍有很多问题，亟待解决。     

加强农村公共卫生服务体系建设的探索与思考

近年来，随着我国经济的快速发展，我国对于农村的公共卫生服务体系的建设加大了投入力度，同时落实了相关的医疗改革政策，我国农村的公共卫生服务体系得到了前所未有的发展。但是，由于我国农村的公共卫生服务体系建设起步较晚，农村的经济发展也相对落后，所以在农村的公共卫生服务体系中仍然存在着很多的问题亟待解决，比如农村公共医疗卫生资源的配置不均衡，公共卫生工作人员的缺乏，公共卫生系统的功能不齐全等问题，困扰着我国农村的公共卫生服务体系的发展。本文通过对相关问题的深入研究，提出了与之对应的解决对策，希望能够提高农村的公共卫生服务体系的整体水平，为农村的生产力提供保障，促进农村经济发展。     

四川省少数民族地区农村卫生系统反应性分析

目的探讨四川省少数民族地区农村卫生系统反应性,为制定民族地区农村卫生发展政策和策略,提高民族地区卫生系统绩效提供依据。方法对四川省少数民族地区农村卫生系统两周就诊以及住院服务反应性进行分析。结果四川省少数民族地区农村卫生系统反应性低于汉族地区农村(P<0.05),卫生系统反应性与广大人民群众普遍合理的期望有一定距离。结论在全面建设小康社会的进程中,应统筹民族地区与汉族地区卫生事业的发展,增加对少数民族地区农村医疗卫生事业的财政投入,提高现有卫生资源的利用效率,强调卫生服务反应性,满足多层次、多样化的医疗服务需求,实现四川医疗卫生事业的可持续和谐发展。     

Racial/ethnic disparities in the use of mental health services in poverty areas

OBJECTIVES: This study examined racial/ethnic disparities in mental health service access and use at different poverty levels. METHODS: We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas. RESULTS: Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas. CONCLUSIONS: Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services.     

Person and place: the compounding effects of race/ethnicity and rurality on health

Rural racial/ethnic minorities constitute a forgotten population. The limited research addressing rural Black, Hispanic, and American Indian/Alaska Native populations suggests that disparities in health and in health care access found among rural racial/ethnic minority populations are generally more severe than those among urban racial/ethnic minorities. We suggest that disparities must be understood as both collective and contextual phenomena. Rural racial/ethnic minority disparities in part stem from the aggregation of disadvantaged individuals in rural areas. Disparities also emerge from a context of limited educational and economic opportunity. Linking public health planning to the education and economic development sectors will reduce racial/ethnic minority disparities while increasing overall well-being in rural communities.     

Differences in health insurance and health service utilization among Asian Americans: method for using the NHIS to identify unique patterns between ethnic groups

The purpose of this study is to outline a method to identify the characteristics of socioeconomic variables in determining the differences in health insurance coverage and health services utilization patterns for different ethnic groups, using the behavioural model of health service utilization. A sample drawn from Asian American adult respondents to the 1992, 1993, and 1994 National Health Interview Surveys (NHIS) in the USA formed the data set. The results showed Asian Americans as not being homogeneous. There were distinctly different demographic and socioeconomic characteristics between six Asian American ethnic groups that affect health insurance coverage and health service utilization. The study method is useful for constructing health policy and services to address the general public need without adversely affecting smaller minority groups. Secondary analysis of well-constructed national data sets such as the specific Asian ethnic groups in NHIS, offers a rich method for predicting the differential impact of specific health policies on various ethnic groups.     

Public policy analysis of Indiana's minority health initiatives

Similar to national health trends in the US, racial/ethnic minorities in the state of Indiana continue to experience disparities in poor health status from preventable health conditions. To address this problem, people from minority communities across the state mobilized a broad base of individuals and organizations to facilitate the successful legislative enactment of a statewide minority health initiative. A case study of the initiative is presented for public policy analysis. The theoretical framework for the study is Etzioni's Societal Guidance Theory. The findings show that minority health advocates were able to impact favorably on public policy formulation and funding of the initiative by increasing knowledge about minority health status among grass‐roots people, generating public consensus for public policy intervention, setting mutual goals via a 5‐year strategic minority health plan, creating organizational structures to implement the plan and utilizing power to push the initiative through the legislative process. The weaknesses of the initiative efforts include a limited infrastructure development of minority health coalitions, restricted effective use of the legislative process and varying degrees of linkages among other advocacy groups. Improvements in these areas are discussed and recommendations are made for the implementation phase of the initiative.     

The contextual model of HRQoL: A paradigm for expanding the HRQoL framework

Cancer is the second leading cause of death in most US populations. Unfortunately, ethnic minority status is associated with increased later stage at diagnosis, greater incidence for many cancer sites, differential treatments, greater mortality and morbidity. The government and public health focus on health disparities, evident in several documents including Healthy People 2010, Unequal Treatment and the Nations Investment in Cancer Research, are spurring interest in research with ethnic minority populations. Research investigating the health-related quality of life (HRQoL) among ethnic minority cancer survivors is new and growing. However, there is a dearth of research that addresses theoretical frameworks in cross cultural research. In conducting research with diverse populations, appropriate theoretical grounding that is responsive to cultural and socioecological contexts must be considered. This paper will discuss the contextual model of HRQoL, a comprehensive framework developed to expand the traditional HRQoL framework to facilitate culturally and socioecologically responsive research. This model may provide a more comprehensive theoretical framework to investigate certain areas of health disparities and risk factors for poor outcomes in HRQoL research with cancer survivors.     

四川省民族地区乡村两级卫生人力资源配置及需求预测研究

目的 了解四川省民族地区乡村两级卫生人力资源配置现状并进行需求预测,为进一步优化民族地区及其他边远落后地区的乡村卫生人力资源配置提供决策依据。方法 运用卫生资源集聚度（HRAD）评价乡村卫生人员配置公平性;使用卫生资源密度指数（HRDI）测算乡村卫生人员按地理和人口分布的需求量和缺乏量。结果 全省民族地区乡镇卫生院专科及以下学历的卫技人员占92.40%,初级及以下职称占93.46%,40岁及以上的乡村医生和卫生员占69.15%;乡镇卫生院卫技人员、执业（助理）医师、注册护士及乡村医生和卫生员的HRAD值分别为0.28、0.23、0.26和0.31,通过HRDI计算的缺乏比例分别是81.18%、118.82%、96.97%和63.06%。结论 民族地区乡村两级卫生人员结构不合理、人员素质整体偏低,按地理面积配置公平性差,按人口和地理综合配置的需求量大。应进一步优化乡村两级卫生人员结构和配置公平性,壮大和稳定乡村两级卫生人才队伍。     

柳州市少数民族地区村级卫生组织现状及对策分析

目的 了解柳州市少数民族地区村卫生室人员结构现状,加强村级医疗卫生机构能力建设,促进各民族共同繁荣.方法 乡镇卫生院人员将调查数据录入“广西乡镇卫生院信息录入系统”并分析.结果 少数民族地区村卫生室347个,乡村卫生服务一体化管理比例较高,但业务用房面积达标率明显低于非少数民族县,村卫生人员604人,医学中专及以上学历占24.34％,取得国家执业（助理）医师资格者占3.54％.结论 柳州市少数民族地区村卫生室卫生人员执业（助理）医师转化率低、年龄老化严重且后继乏人,成为少数民族地区提高群众医疗卫生水平的瓶颈.     

Exploring the health visiting service from the view of South Asian clients in England: a grounded theory study

The fact that health inequalities disproportionately affect the minority ethnic population is not new and projections are that the minority ethnic population will continue to increase. The importance of early intervention and the key role that health visitors can play in attempting to reduce health inequalities is well documented as is the requirement for health providers to establish culturally sensitive services. To date, much of the research has focused on the perspectives of healthcare professionals caring for minority ethnic clients in hospital‐based settings and little is known about the perspectives of minority ethnic clients regarding the health visiting service (HVS). The aim of this study was to explore the perspectives of South Asians regarding their experiences with the HVS. The study was conducted in a small town in the South of England between March and June 2013. A qualitative study using a grounded theory approach was used to capture the perspectives of this group regarding their interactions with the HVS. The sample consisted of 15 participants and data were collected through audio‐recorded semi‐structured interviews and analysed using constant comparative approach. Three key categories were identified: ‘understanding the health visitor's role’, ‘sensitivity of services’ and ‘the significance of family’. While clients valued one‐to‐one support from health visitors, there was some evidence of poor communication and ethnocentric tendencies within the service. It was found that South Asian clients distinguish between health and parenting advice, being more likely to accept health advice from their health visitor and more likely to accept parenting advice from their family. The findings, although limited in their generalisability, offer important insights into how South Asians perceive the service and will equip health visitors with a better understanding of how best to improve the experience of South Asian clients accessing the health visiting.     

The buffering effects of ethnic density on experienced racism and health

Studies in the United Kingdom (UK) show a consistent inequality between the health of ethnic minorities and that of white people. This is exacerbated by the over-representation of ethnic minorities in deprived areas, which have been associated with poorer infant and child health, chronic disease, and high mortality rates. Ethnic density, defined as the proportion of ethnic minority residents in an area, is generally thought of in relation to the negative impacts of area effects on health. However, it can be considered in terms of social networks and supportive communities, possibly mitigating the detrimental impact of racism on the health of ethnic minority people. This study investigated the ethnic density effect and hypothesised that ethnic minority people who live in areas of high ethnic density would report decreased experienced racism and better health outcomes compared to their counterparts living in areas of low ethnic density. Multiple logistic regressions were conducted using data from the Fourth National Survey of Ethnic Minorities and the 1991 UK Census. Results showed a negative association between ethnic density and psychotic symptomatology, but no evidence of an association between ethnic density and general self-rated health. Findings confirm that the experience of racism is lower in places of higher ethnic density and indicate a tendency for a weaker association between racism and health as ethnic density increases.