理解环境与卫生的关联性:以中国为例

新中国成立以来,中国环境与卫生的关联性主要体现在问题关联、认知关联、政策法规关联、机构关联和内外关联5个方面,呈现出日益紧密和日益复杂的发展趋势。环境与卫生治理体系不够健全和高效以及应对环境与健康问题的能力比较薄弱是当前中国环境与卫生治理面临的两大主要挑战。     

中国参与全球环境与卫生治理:机遇、挑战与对策

中国参与全球环境与卫生治理机遇与挑战并存。主要机遇包括:(1)全球环境与卫生治理的走向与中国在此领域的战略部署高度吻合,为其积极参与全球环境与卫生治理提供了强大的内生动力。(2)全球环境与卫生领域的资源为中国提供了有益的参考和借鉴,有利于加快和完善国内环境与卫生领域的治理。(3)全球环境与卫生问题具有公益性质,是中国展现负责任大国形象的重要领域。(4)当前全球环境与卫生治理的相关制度还有待规范和完善,这为中国争取更多的话语权提供了机遇。主要挑战包括:(1)中国国内环境与卫生问题层出不穷,从而使得中国参与全球环境与卫生治理时精力有限,同时也面临较大的国际压力。(2)中国缺乏全球环境与卫生战略。(3)全球"大卫生观"尚未完全建立,有待进一步拓展和完善。(4)智力支撑不足。(5)在中国国际定位方面,中外存在分歧且呈现扩大趋势。为有效参与全球环境与卫生治理,中国应统筹国内和国际两个层面采取一系列应对措施。     

全球环境与卫生的关联性:科学认知的深化

本文基于历史和环境视角分析了全球环境与卫生之间关联性的科学认知的变化。环境问题对人类健康的影响越来越受到国际社会的关注和重视,现有科学研究已充分证明,环境问题与人类健康风险之间存在明显的因果关系,环境问题是导致人类各种疾病的重大因素之一;从全球层面对环境问题的健康影响进行量化研究是当前相关研究的重点、亮点和难点,目前国际上在研究方法和具体结论上都存在许多分歧,但定量研究方兴未艾;如何将现有的科学认知与全球层面的政策制定与实施有机结合起来是摆在全球环境与卫生治理面前的一大课题。     

基于灰色关联度分析法的我国卫生总费用影响因素研究

目的分析2005-2018年我国卫生总费用的影响因素及其关联程度,并提供建议。方法通过灰色关联度分析法构建影响我国卫生总费用的指标体系,并分析卫生总费用与5个维度14个指标之间的关联程度。结果 11个指标均与卫生总费用之间存在强关联性;其余3个指标的关联性较弱。从维度看经济、卫生资源、医疗服务、卫生经费指标与卫生总费用的关联较为密切,而社会、医疗保障指标与卫生总费用的关联较弱,但其影响力不容小觑。结论各影响因素与卫生总费用之间的关联强度,需从控制增速、建立绩效考评体制、提高患者满意度、加强基层卫生服务工作以及完善筹资方案等方面进行改善。     

全球健康的内涵与学科发展

全球化的纵深发展使人群健康状况得到明显改善的同时也带来许多新的健康问题,使世界卫生体系面临巨大挑战。运用全球健康的理念,采取跨国界的合作行动应对全球卫生问题成为各国的共识。本文从全球健康的概念出发,比较了全球健康、国际卫生和公共卫生的异同,指出:强调全球合作和参与主体的多元化、需要运用多学科知识、依靠全球治理来实现是全球健康的特征。我国的全球健康学科与世界相比仍存在着较大差距,应积极推动全球健康学科的发展,培养具有全球视野的专业人才,为我国参与全球卫生治理提供有力支撑。     

卫生资源优先次序分配的政府治理研究——国际研究述评及对我国的启示

卫生资源优先次序分配作为政府有效治理的重要领域,在我国仍缺乏类似层面的综合思考。西方在该领域的研究趋势已从单纯的经济学思考走向了政治经济学、制度约束、卫生筹资的全面分析,并在更宏大的组织和政治情境中,考量政府的治理范围、手段,建构操作性强的优先次序分配框架。在卫生决策实践中,找寻跨学科工具的最佳组合考验着决策者的治理水平。本文梳理政治学、卫生经济学、哲学、法学、循证医学等不同学科对卫生资源优先次序分配的思考。最后明确政府卫生资源治理的层次、治理策略建议,强调卫生决策从＂作为结构的治理＂走向＂作为过程的治理＂的发展规律因应我国所面临的挑战。     

全球卫生背景下的中国卫生检疫与跨国传染病控制

目的探讨中国卫生检疫在全球卫生治理背景下的发展策略。方法分析传染病在中国和全球间的互动和影响,以及全球卫生治理的必要性,从全球视野和体系建设、健康促进、卫生公平等方面探讨卫生检疫的未来发展趋势。结果中国加入全球化进程导致传染病风险具有全球化特征,全球卫生治理是适应全球传染病控制的有效进路。中国卫生检疫在跨国传染病防控中起到了重要作用。结论中国卫生检疫应从全球理念出发进行战略和机制调整,加大多部门、多组织参与的平台建设,促进全球监测和控制体系建设步伐,同时充分利用健康促进和公平促进更好的发挥传染病防控职能,以在未来的全球卫生中更好的发挥自己的作用。     

全球卫生治理面临的挑战及其应对策略

人人享有健康是一项基本人权。全球卫生治理的使命就是要在全世界范围内促进“人人享有健康”。目前,全球卫生治理面临诸多重大挑战,如治理主体众多但目标不一致导致领导权威难以确立,以国家为中心的国际体制使跨国集体行动的达成存在一定困难,各国对公共卫生事项设置的优先顺序存在分歧,全球卫生资金投入不足且分配不均,全球卫生治理严重缺乏国际协调,全球卫生治理基本框架尚未完全形成等。为了应对挑战,建议深化全球卫生改革,提高全球卫生治理的能力与效率;国际社会与各国政府必须审思与重构自身卫生法律与政策,把重点放在促进卫生公平而非提高经济竞争力上;各国政府必须重点关注民生和民权,重视非卫生领域政策与卫生政策的协调,从根本上改善健康的决定因素;增加全球卫生治理的透明度、建立新型问责制,增强世界卫生组织的权威性;在全球层面构建全球卫生治理基本框架,增强全球卫生治理的有序性。     

我国卫生领域信任缺失问题研究

我国卫生领域信任缺失是个值得关注的问题。在分析我国卫生领域信任缺失分别在人际领域、组织机构领域、卫生系统领域表现的基础上,从制度层面、社会层面和个体层面探讨了卫生领域信任缺失的因素,由此提出完善我国卫生制度、加强卫生职能部门的政策能力、治理卫生行业腐败、加强医务人员道德教育的建议,从制度、社会环境和个人道德修养3个方面共同构建卫生领域的社会信任。     

全球卫生治理机制及中国参与的建议

随着全球化的纵深发展,全球卫生逐渐取代国际卫生,成为学界关注热点.全球卫生领域存在诸多亟需解决的问题,而这些问题的解决需要良好的全球卫生治理,实现全球卫生治理的五大功能,即达成价值观念的共识、制定相应的规则、实现治理的多元化、动员和分配资金、提供领导和协调等.针对全球卫生领域的不同趋势,建议确立以世界卫生组织为中心的全球卫生治理体系、在世界卫生组织框架内实现治理的多元化以及加强全球卫生立法等.中国作为新兴经济力量,在全球卫生治理中占有重要地位,应更为活跃地参与全球卫生治理.首先,建议中国制定国家层面的全球卫生战略;其次,积极参与全球行动网络和治理平台;最后,培养全球卫生研究和实践人才.     

Future-proofing global health: Governance of priorities

The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of ‘global’ health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholders of the global health community; understanding the relationship between health and behaviour; and the role of governance and regulation in supporting global health.     

Globalisation and global health governance: Implications for public health

Abstract Globalisation is a defining economic and social trend of the past several decades. Globalisation affects health directly and indirectly and creates economic and health disparities within and across countries. The political response to address these disparities, exemplified by the Millennium Development Goals, has put pressure on the global community to redress massive inequities in health and other determinants of human capability across countries. This, in turn, has accelerated a transformation in the architecture of global health governance. The entrance of new actors, such as private foundations and multi-stakeholder initiatives, contributed to a doubling of funds for global health between 2000 and 2010. Today the governance of public health is in flux, with diminished leadership from multilateral institutions, such as the WHO, and poor coherence in policy and programming that undermines the potential for sustainable health gains. These trends pose new challenges and opportunities for global public health, which is centrally concerned with identifying and addressing threats to the health of vulnerable populations worldwide.     

Wastewater irrigation and environmental health: implications for water governance and public policy

Climate change is a large-scale and emerging environmental risk. It challenges environmental health and the sustainability of global development. Wastewater irrigation can make a sterling contribution to reducing water demand, recycling nutrients, improving soil health and cutting the amount of pollutants discharged into the waterways. However, the resource must be carefully managed to protect the environment and public health. Actions promoting wastewater reuse are every where, yet the frameworks for the protection of human health and the environment are lacking in most developing countries. Global change drivers including climate change, population growth, urbanization, income growth, improvements in living standard, industrialization, and energy intensive lifestyle will all heighten water management challenges. Slowing productivity growth, falling investment in irrigation, loss of biodiversity, risks to public health, environmental health issues such as soil salinity, land degradation, land cover change and water quality issues add an additional layer of complexity. Against this backdrop, the potential for wastewater irrigation and its benefits and risks are examined. These include crop productivity, aquaculture, soil health, groundwater quality, environmental health, public health, infrastructure constraints, social concerns and risks, property values, social equity, and poverty reduction. It is argued that, wastewater reuse and nutrient capture can contribute towards climate change adaptation and mitigation. Benefits such as avoided freshwater pumping and energy savings, fertilizer savings, phosphorous capture and prevention of mineral fertilizer extraction from mines can reduce carbon footprint and earn carbon credits. Wastewater reuse in agriculture reduces the water footprint of food production on the environment; it also entails activities such as higher crop yields and changes in cropping patterns, which also reduce carbon footprint. However, there is a need to better integrate water reuse into core water governance frameworks in order to effectively address the challenges and harness the potential of this vital resource for environmental health protection. The paper also presents a blueprint for future water governance and public policies for the protection of environmental health.     

社区卫生服务管理体制面临的挑战分析——基于六城区的抽样调查

目的：分析我国社区卫生服务管理体制面临的挑战。方法：运用焦点组访谈和个人深入访谈的方法收集六城区有关社区卫生服务管理体制的资料,并运用归纳总结的方法对定性资料进行分析。结果：区级政府作为举办主体理顺社区卫生服务管理体制存在困难;各级政府的事权与财力不相适应;卫生部门与其他部门的跨部门合作机制有待加强;社管中心成立的必要性与功能定位仍然悬而未决;如何管理社会资本举办的社区卫生机构有待进一步探索;缺乏居民参与管理的有效途径。建议：理顺政府相关部门之间的关系,促进财力与事权相匹配;建立有效的跨部门合作机制;制定和完善鼓励社会资本发展社区卫生的相关政策;进一步探索成立社管中心的可行性与必要性;探索和完善居民参与管理的有效途径。     

Rights, Knowledge, and Governance for Improved Health Equity in Urban Settings

All three of the interacting aspects of daily urban life (physical environment, social conditions, and the added pressure of climate change) that affect health inequities are nested within the concept of urban governance, which has the task of understanding and managing the interactions among these different factors so that all three can be improved together and coherently. Governance is defined as: "the process of collective decision making and processes by which decisions are implemented or not implemented": it is concerned with the distribution, exercise, and consequences of power. Although there appears to be general agreement that the quality of governance is important for development, much less agreement appears to exist on what the concept really implies and how it should be used. Our review of the literature confirmed significant variation in meaning as well as in the practice of urban governance arrangements. The review found that the linkage between governance practices and health equity is under-researched and/or has been neglected. Reconnecting the fields of urban planning, social sciences, and public health are essential "not only for improving local governance, but also for understanding and addressing global political change" for enhanced urban health equity. Social mobilization, empowering governance, and improved knowledge for sustainable and equitable development in urban settings is urgently needed. A set of strategic research questions are suggested.     

中国全球健康相关非政府组织的发展策略浅析

国际非政府组织在全球健康治理中发挥了重要作用,也是各国发挥国际影响力的重要渠道,但中国非政府组织目前参与全球健康治理甚少。本文旨在分析中国非政府组织发展的社会政策环境、健康类非政府组织的发展现状并借鉴国外新兴的全球健康相关非政府组织的经验,为中国扶持非政府组织参与全球健康治理提供策略建议。本文发现,中国参与全球健康治理有较好国际机遇;国内社会组织发展环境趋势向好,但具有依附行政体系、政策定向发展等特点。因为专业性、公共服务属性以及与公共治理相关性小,非政府组织参与全球健康可以得到政府的全力支持。健康类非政府组织数量较少、基础较差、参与国际合作少。不同类型健康类社会组织各有长短,国际经验提示新兴机构主要依靠政府力量扶持非政府组织参与全球健康。建议我国政府采取"重点扶持,整体改善"的策略,制定中国全球健康发展战略,以政府附属与社会精英创办的大型非营利机构为重点扶持对象,引导和资助健康类非营利机构走向国际舞台。     

Influence and opportunity: reflections on the U.S. role in global public health

Today's global health crisis illustrates many of the transnational governance challenges the United States faces today. In the arena of global health, the United States can create a new role for itself by moving beyond a national-interest paradigm and strengthening its "soft power" position in health. Health in recent administrations has moved beyond being "just" a humanitarian issue to being one with major economic and security interests. Despite U.S. unilateralism, new approaches to global health governance are being developed by other actors, who have influenced the U.S. agenda and made important contributions. Yet a larger leader is still needed, especially in identifying and following a sound legal and regulatory global health governance system; bringing political legitimacy; and setting priorities. Responsible political action is needed to develop a new mindset and lay the groundwork for better global health in the future.