健康教育对初级卫生保健工作的积极影响——随州市初级卫生保健工作调查报告

湖北省随州市于 1 990年成立初级卫生保健委员会 ,制定概略规划 ,正式启动了初保工作。1 992年通过初评 ,1 995年进行了中期自查。与此同时 ,随州市洪山镇始为市健康教育试点 ,继之为全市健康教育示范乡镇 ,几年来扎扎实实地开展了健康教育 ,这促使干群健康意识提高 ,对该镇初保工作也产生了积极影响。该镇已提前实现了初保规划目标。为了解健康教育在初保工作中的作用和影响 ,笔者于1 999年完成了本调查研究。材料与方法1 文献复习　复习下列文件资料。《随州市初级卫生保健概略规划》、《随州市初级卫生保健中期审评自查情况汇报》、《随…     

城市初级卫生保健管理模式构想

城市初级卫生保健管理模式构想彭国强，梁盛民，孙飞（湖北省武汉市卫生局４３０００１）１初保组织管理体系１．１市、区分别成立初级卫生保健委员会，委员会由政府主要领导任主任，计划、财政、教育、环保、劳动、卫生等部门负责人为成员，并设立办公室，常年办公，制定...     

初级卫生保健与农村居民健康促进

农村的初级卫生保健(PrimaryHealthCare,简称PHC)是农村居民应该人人享有的,与农村经济社会发展相适应的基本卫生保健服务。实施农村初级卫生保健是我国社会经济发展总体目标的组成部分,是各级政府的重要职责。经过努力,我国农村已基本实现了1990-2000年初级卫生保健阶段目标。然而,由于各地经济发展的不平衡,各地群众享受的初级卫生保健服务水平高低不一,保健项目的开展也各有差异。理论上,初级卫生保健从受益来说是每个人都能享受的,从需要来说是必不可少的,是一种最能体现社会平等权利的卫生保健措施;因此各地初保工作发展的不平衡同…     

健康教育推动小池镇实现人人享有初级卫生保健

为了探讨在农村社区开展健康教育的组织形式、活动内容、策略和方法,并评估这些策略和方法所产生的效果,福建省自１９９５年开始在龙岩市新罗区小池镇开展以实现人人享有初级卫生保健为目标的社区健康促进和教育课题研究,实践结果使健康教育成为政府牵头、多部门参与的社会工程,并在推动农村环境卫生改造、农民卫生知识提高、卫生行为养成、常见病防治、提供安全水等,旨在提高农民生活质量的工作中发挥基础和先导作用,具有普遍推广意义。     

实施初级卫生保健 提高人民健康水平

我市的“初保”上作,自1989年实施规划以来,坚持“政府领导、部门负责、卫生牵头、群众参与”的原则,以健康教育为先导,抓住农村工作的重点和难点,扎扎实实地工作,为提高人民健康水平,为实现“小康”目标和发展经济做出了贡献,取得了可喜的成果。     

农村卫生工作与初级卫生保健

一、我国农村卫生工作的基本经验在过去的几十年中,中国农村卫生工作的成就是以较少的卫生消费成功地提供了医疗、预防、保健的服务,达到了人民卫生状况的改善和健康水平的提高,大大地超过了经济的发展水平。这一成就,得到了世界的公认。具体的健康水平指标已进入国际的先进行列。解放前与1989年对比,死亡率由25‰下降到6.5‰,婴儿死亡率由200‰下降到21.7‰(部分县),平均寿命从35岁上升到68.9岁(1985)。我国的农村卫生工作,为什么能取得如此重大的成绩呢?这是一个非常需要研究清楚的问题,以便吸取成功的经验,寻找农村卫生工作的客观规律,为指导今后工作做参考。下面谈一些我们对基本经验的看法。     

我国农村实施初级卫生保健的战略与措施

我国有11亿人口，8亿人居住在农村地区，为实现人人享有卫生保健的全球目标，我国始终把在全体农村居民中实施初级卫生保健作为基本的策略和途径。卫生部从中国农村的实际出发，参照世界卫生组织的全球性指标，组织制定了我国农村实现2000年人人享有卫生保健的规划目标，并提出了分层次、分地区、分阶段全面地实施初级卫生保健的构想。本文在此基础上，介绍了我国农村实施初级卫生保健的战略与具体措施。     

论初级卫生保健发展战略

中国曾经是国际初级卫生保健的典范,各国都把＂人人享有初级卫生保健＂作为人人享有健康权的底线,健全初级卫生保健,保障健康公平底线是政府的公共职能,农村是初级卫生保健的重点,社区卫生服务是初级卫生保健的载体。     

城市初级卫生保健的健康教育实践

通过对城市居民的面对面健康教育及问卷测试的资料分析，研讨了各类居民对不同的卫生知识的掌握情况、卫生知识的来源及需求，探索了城市初级卫生保健工作中开展深入的健康教育的新手段，提出了存在的问题和建议。     

发展城乡基层卫生事业是实施基本卫生保健制度的基础

当前城乡基层卫生事业存在卫生资源不足且城乡差距明显、基本医疗得不到保障舍近求远使看病难导致看病贵、公共卫生服务缺失使危害居民健康因素的隐患增大等主要问题，提出发展城乡基层卫生事业是实施基本卫生保健制度基础的观点，提出把巩固完善城乡基层卫生体系和提高卫生服务能力作为基础工程、把增加卫生投入和实行公共卫生服务政府埋单作为保障工程、把改造不良生活卫生环境和倡导健康生活方式作为配套工程等三个发展城乡基层卫生事业和实施国家基本卫生保健制度的政策建议。     

Can health promotion and primary health care achieve Health for All without a return to their more radical agenda?

Primary health care (PHC) and health promotion (HP), codifiedin the Alma Ata Declaration of 1978 and the Ottawa Charter of1986, and aiming to achieve Health for All by the year 2000(HFA 2000), are strikingly similar in their conception and evolution.Originally conceived as global strategies to reduce inequitiesin health between and within nations and emphasising intersectoraland community action, both have tended to be reduced to a morelimited and technical approach to selected diseases within nations. In the implementation of these strategies, four trends threateningthe achievement of HFA 2000 are analysed. Managerialism, manifestingin a goals and targets approach to health promotion has cometo dominate and constrict its implementation in Australia andother industrialised countries, detracting from social and environmentalimperatives and community action in addressing these. The increasingdominance of market economics and the promotion of economicgrowth at all costs is reinforcing inequities in health experienceglobally and within countries. Individualism, the philosophicalaccompaniment of market economics, has reinforced a behaviouraland lifestyle focus and undermined a collective approach toHP and PHC. Environmental degradation, a growing global threatto public health and ultimately amenable only to global economicrestructuring has been perilously ignored in the managerialistimplementation of HFA. The elements of an agenda for action are identified with somesuggested broader goals. A return to the original more radicalphilosophy underpinning the strategies of PHC and HP, it isargued, is fundamental to the achievement of HFA, even if thisis no longer possible by the year 2000.     

中国农村基本卫生保健工作发展与思考

目的：了解我国农村地区基本卫生保健工作的现状,以及在新世纪第一个十年中取得的成绩和存在的问题,为进一步推进农村基本卫生保健工作提出有针对性的政策建议。方法：按照分层抽样的方法,在全国选择400个县级行政单位,收集当地农村基本卫生保健工作的相关数据。结果与发现：（1）农村基本卫生保健工作得到政府重视,但财政保障仍不足;（2）乡村两级医疗卫生服务体系建设仍需不断完善;（3）基本公共卫生服务在医改政策推动下进展明显,后续要加大力度推进;（4）新型农村合作医疗制度不断完善;（5）基本药物制度实施使基层医疗卫生机构面临发展困境。     

Contribution of primary care to health systems and health

Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.     

The Indigenous primary health care and policy research network: Guiding innovation within primary health care with Indigenous peoples in Alberta

In 2015, the Truth and Reconciliation Commission of Canada released its Final Report with 94 Calls to Action, several of which called upon the health care sector to reform based on the principles of reconciliation. In the province of Alberta, Canada, numerous initiatives have arisen to address the health legacy Calls to Action, yet there is no formal mechanism to connect them all. As such, these initiatives have resulted in limited improvements overall. Recognizing the need for clear leadership, responsibility, and dedicated funding, stakeholders from across Alberta were convened in the Spring of 2019 for two full-day roundtable meetings to provide direction for a proposed Canadian Institutes of Health Research Network Environment for Indigenous Health Research that focused on primary health care and policy research. The findings from these roundtable meetings were synthesized and integrated into the foundational principles of the Indigenous Primary Health Care and Policy Research (IPHCPR) Network. The IPHCPR Network has envisioned a renewed and transformed primary health care system to achieve Indigenous health equity, aligned with principles and health legacy Calls to Action advocated by the Truth and Reconciliation Commission of Canada.     

论欧盟国家卫生制度设计的团结安排及变化趋势

团结思想是欧洲卫生公平和卫生政策的重要基础,但正不断受到个人责任、自由主义、私营化改革等新理念冲击,在部分欧洲国家甚至存在因资源匮乏而加大个人自付弱化团结的危险。但团结仍然是欧洲卫生体制安排最具标志的价值观之一,并继续成为欧洲政府对卫生安排的政治承诺和问责的道德基础。在从大政府走向大社会这一全球医改浪潮中,欧洲多国政府通过加强精细化监管来进一步实现卫生系统团结。     

Demand and supply for psychological help in general practice in different European countries: access to primary mental health care in six European countries

BACKGROUND: The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. This may influence patients' expectations and requests for help and GPs' performance. In this paper the effects of working in different health care systems on demand and supply for psychological help were examined. METHODS: Data were collected in six European countries with different health care system characteristics (Belgium, Germany, The Netherlands, Spain, Switzerland and the UK). For 15 consecutive contacts with 190 GPs in the six countries, each patient completed questionnaires concerning reason for visit and expectations (before) and evaluation (after consultation). General practitioners completed registration forms on each consultation, indicating familiarity with the patient and diagnosis. General practitioners completed a general questionnaire about their personal and professional characteristics as well. RESULTS: Practices in different countries differed considerably in the proportion of psychological reasons for the visit by the patient and psychological diagnoses by the GP. Agreement between patients' self-rated problems and GPs' diagnoses also varied. Patients in different countries evaluated their GPs' psychological performance differently as well, but evaluation was not correlated with agreement between request for help and diagosis. In gatekeeping countries, patients had more psycho-social requests, GPs made more psychological diagnoses and agreement between both was relatively high. Evaluation, however, was more positive in non-gatekeeping countries. Individual characteristics of doctors and patients explained only a relatively small part of variance. CONCLUSIONS: Health care system characteristics do affect GPs' performance in psycho-social care.     

The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998

OBJECTIVE: To assess the contribution of primary care systems to a variety of health outcomes in 18 wealthy Organization for Economic Cooperation and Development (OECD) countries over three decades. DATA SOURCES/STUDY SETTING: Data were primarily derived from OECD Health Data 2001 and from published literature. The unit of analysis is each of 18 wealthy OECD countries from 1970 to 1998 (total n = 504). STUDY DESIGN: Pooled, cross-sectional, time-series analysis of secondary data using fixed effects regression. DATA COLLECTION/EXTRACTION METHODS: Secondary analysis of public-use datasets. Primary care system characteristics were assessed using a common set of indicators derived from secondary datasets, published literature, technical documents, and consultation with in-country experts. PRINCIPAL FINDINGS: The strength of a country's primary care system was negatively associated with (a) all-cause mortality, (b) all-cause premature mortality, and (c) cause-specific premature mortality from asthma and bronchitis, emphysema and pneumonia, cardiovascular disease, and heart disease (p<0.05 in fixed effects, multivariate regression analyses). This relationship was significant, albeit reduced in magnitude, even while controlling for macro-level (GDP per capita, total physicians per one thousand population, percent of elderly) and micro-level (average number of ambulatory care visits, per capita income, alcohol and tobacco consumption) determinants of population health. CONCLUSIONS: (1) Strong primary care system and practice characteristics such as geographic regulation, longitudinality, coordination, and community orientation were associated with improved population health. (2) Despite health reform efforts, few OECD countries have improved essential features of their primary care systems as assessed by the scale used here. (3) The proposed scale can also be used to monitor health reform efforts intended to improve primary care.     

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

It has been 30 years since the Declaration of Alma Ata. During that time, primary care has been the central strategy for expanding health services in many low- and middle-income countries. The recent global calls to redouble support for primary care highlighted it as a pathway to reaching the health Millennium Development Goals. In this systematic review we described and assessed the contributions of major primary care initiatives implemented in low- and middle-income countries in the past 30 years to a broad range of health system goals. The scope of the programs reviewed was substantial, with several interventions implemented on a national scale. We found that the majority of primary care programs had multiple components from health service delivery to financing reform to building community demand for health care. Although given this integration and the variable quality of the available research it was difficult to attribute effects to the primary care component alone, we found that primary care-focused health initiatives in low- and middle-income countries have improved access to health care, including among the poor, at reasonably low cost. There is also evidence that primary care programs have reduced child mortality and, in some cases, wealth-based disparities in mortality. Lastly, primary care has proven to be an effective platform for health system strengthening in several countries. Future research should focus on understanding how to optimize the delivery of primary care to improve health and achieve other health system objectives (e.g., responsiveness, efficiency) and to what extent models of care can be exported to different settings.     

Health care reform in six Central European countries

This study gives an overview of the health care reform in six Central European countries after the transition from a central planning system to a regulated market economy. We focused on cost containment policies for drugs, especially the requirements for submitting health economic data in the pricing and/or reimbursement processes. The literature review was supplemented with a survey with decision makers at national health authorities in each country. The study covered Croatia, Czech Republic, Hungary, Poland, Slovakia, and Slovenia. All countries had in common that health economic information was used in reimbursement rather than in pricing processes. Differences between the six countries were mainly variations in the relative importance of health economic data and the presence of explicit requirements and guidelines. Published health economic guidelines exist in two countries and one of the six countries applies a mandatory submission system for a selected range of new drugs. In most of the Central European countries it is more typical that authorities issue a brief list of required data for reimbursement submissions that include health economic information among other data. There is a generally widespread expectation towards more systematic and formalized requirements for health economic and outcomes research data appearing within the next 3–5 years in the region.