从公共卫生内涵看我国公共卫生走向

本文从分析公共卫生内涵入手，准确认识公共卫生的功能定位；针对今春我国SARS突发中凸现出的公共卫生体系存在的问题，提出我国公共卫生发展走向的设想：加强法制建设，改革公共卫生管理体制，完善公共卫生内部运行机制，加强公共卫生的政策和策略研究。     

新时代中国公共卫生内涵建设若干问题思考

围绕新时代健康中国发展战略背景下的公共卫生的内涵,对中国公共卫生内涵建设的若干问题进行梳理与思考。对新时代我国新型公共卫生服务体系构建、公共卫生内涵建设的目标任务及发展路径,以及公共卫生服务核心能力建设进行探讨,通过改进、变革以推动公共卫生事业发展。     

从公共卫生的内涵看设立公共卫生委员会的必要

公共卫生的内涵包括疾病控制、健康保护和健康促进三个方面,具有明显的正面外部效应,需要政府主导。与医疗服务、预防医学都有明显区别。通过分析其内涵和外延,针对我国目前公共卫生管理体系存在的缺陷,得出政府在公共卫生管理中要成立国家公共卫生委员会以统筹体制改革;实行垂直的一体化管理以有效配置资源。     

中国公共卫生财政支出分析

本文对我国新医改以来的公共卫生财政支出进行分析,发现主要存在以下问题：一是公共卫生纵向与横向投入不协同,不利于提升专业公共卫生机构在我国公共卫生体系中的地位;二是公共卫生领域的事权与支出责任划分,不利于“预防为主”目标的实现;三是专业公共卫生机构在卫生服务体系中的地位日益弱化,与“预防为主”的要求不相适应;四是人员激励不足,进一步弱化了专业公共卫生机构。据此,本文提出四点政策建议：一是提高公共卫生预算的优先层级,强化公共卫生财政支出的硬约束;二是优化公共卫生财政支出结构,加强公共卫生纵向投入与横向投入的协同;三是完善公共卫生领域的中央和地方事权与支出责任,增强中央财政在横向投入中的支出责任;四是进一步健全人员激励机制,稳步强化专业公共卫生机构。     

现代公共卫生的内涵及发展定位

近几年我国的公共卫生事业得到了飞速的发展，公共卫生事件及公共卫生体系的建设得到了普遍的关注。本文对现代公共卫生的感念及内涵以及其基本的功能进行分菥，并在此基础上探讨了现代公共卫生的发展定位。     

国内公共卫生服务均等化的理论探讨及研究现状

公共卫生服务均等化是当前社会经济生活中的热点,也是新医改方案明确提出的今后三年的五项重点工作之一。本文主要从对公共服务均等化时代内涵的理解入手,分析和总结我国公共卫生服务均等化的现状、存在的问题及公共财政体制对均等化的影响,认为实现公共卫生服务均等化,政府公共财政需承担更大的责任,同时要加快公共财政立法保证均等化的实现。     

协同治理视角下公共卫生应急管理体系现代化建设研究

通过回顾我国公共卫生应急管理体系的现状与挑战,认为我国应对突发卫生事件的法治化设计执行“碎片化”,利益主体权责边界未能完全清晰,协调机制“碎片化”“重处理、轻预防”的思路有待改进。阐述了我国公共卫生应急管理体系现代化的内涵,认为“人民至上”是公共卫生应急管理体系现代化的第一诉求,公共卫生应急管理体系现代化应包括公共管理法制化、防控执行精准化、防控与发展一体化、保障与供给多元化4个维度,在协同治理理论基础上,从宏观、微观、结构、运作4个方面构建公共卫生应急管理体系现代化建设的分析框架,提出要明晰各政府部门治理责任范围,引导各主体形成稳定预期,优化财政资金投入和结构,推进财政投入绩效管理,提升资金使用效率。     

我国社区公共卫生服务项目研究述评

国家出台的《基本公共卫生服务规范》等一系列决策为公共卫生服务项目的发展带来了机遇,笔者对社区公共卫生服务项目包的研究展开调查,试图从社区公共卫生服务项目的概念内涵、界定原则、界定方法等方面进行文献研究梳理及述评,并对我国具有代表性的几种社区公共卫生服务模式进行了归纳。     

全面推进我国基本公共卫生服务均等化的对策研究

公共卫生服务均等化是当前社会经济生活中的热点,也是新医改方案明确提出政府在2009-2011年卫生体制改革的五项重点工程之一。本文主要从对公共服务均等化时代内涵的理解入手,分析和总结我国公共卫生服务均等化的现状、存在的问题及相应对策建议,认为实现公共服务均等化,政府公共财政应需承担更大的责任。     

基于继承与发展的公共卫生概念界定研究

目的在前期研究基础上,遴选公共卫生经典内涵,纳入公众健康核心理念,提出新时代各方统一的公共卫生定义,指导我国公共卫生理论和实践。方法通过专题小组讨论,明确应纳入的经典内涵和增加的核心理念;遵循逻辑学中公认的常用下定义方法和步骤,形成公共卫生定义和内涵外延;开展多重定性定量论证和全国范围的各方专题意向论证,明确接受程度,收集意见建议进行完善。结果通过遴选与完善经典内涵的过程,最终共"保留"8类经典内涵,"增加"4类公众健康核心理念,补充"公共卫生本意为公众健康"的强调;通过6轮"论证–完善–再论证–再完善"循环和3轮德尔菲论证,收集专家意见并修改完善;在此基础上,形成本研究的公共卫生概念界定:公共卫生(public health)是以保障公众健康与健康公平为导向的公共事业。由政府主导、社会协同、全体社会成员参与共享,运用健康相关理论与方法,预防和控制疾病与伤残,降低和消除健康风险,改善和促进人的生理、心理健康及社会适应能力,以提高全民健康水平与生命质量、维护社会稳定与发展。公共卫生本意为公众健康,其内涵已成为健康国家(地区)的基础。通过开展意向论证,调查全国七省的3 291名组织者和提供者以及全国10所高校的136名研究者,论证结果显示,公共卫生界定获得组织者、提供者、研究者等各方高度认可,其中定义的整体认可率达到98.7%,各块内涵外延的认可程度在97.6%～99.2%。结论新时代明确"何为公共卫生"意义重大,可以指导公共卫生理论和实践,有利于统一各方行动。本研究界定的公共卫生定义具有明确政府责任、强调健康公平、强调社会协同、明确公民义务等鲜明特点。     

Responsibilities and resources of on-call public health doctors

We investigated the resource available for public health doctors to carry out statutory responsibilities out-of-hours by a postal questionnaire survey of consultants in communicable disease control (CsCDC) in England and Wales. The questionnaire requested details of local District Health Authority (DHA) population profile, major incident and outbreak policies, the background of the CCDC, out-of-hours communication, access and resources, reference materials and medical equipment carried by the public health doctor on duty. The CsCDC from 96% (121/126) DHAs in England and Wales responded. Whilst 85% (101/119) of public health doctors carried policies on infectious disease when on duty, only 28% (32/116) carried policies on dealing with chemical incidents and 25% (28/111) carried the District policy to deal with radiation hazards. Twenty-six per cent (32/121) of public health physicians had no access to their District headquarters. There is a wide variation in the standard of resources available to on-call public health doctors in England and Wales; following Department of Health and Department of the Environment guidance, Health Authorities need to ensure that they have adequate arrangements in the event of any major incident or outbreak.     

补偿政府公共卫生投入不足--开启政府购买公共卫生服务产品的途径

事关公众健康的公共卫生事务涉及到政府的责任，改变公共财政对具有明显外部效应的公共卫生服务产品投入不足的状况，除了政府调整财政预算，加大对卫生的投入外，政府在提供公共卫生服务产品时，应改变传统的直接投入生产供给公共卫生服务产品为采用政府购买公共卫生服务产品的方式，这是降低成本，减少消耗，用以补偿政府公共财政对公共卫生投入不足的重要途径，政府采用购买公共卫生服务产品时，需要合理引导与利用多种形式投资于公共卫生服务与产品，培养社会自主公共卫生意识，合理引导公共卫生服务产品的公益性消费，利用公共权力宏观调控公共卫生服务产品分配比例，并负有公共卫生政策引导，制度购买规则和监督公共卫生服务产品配置与使用等的责任。     

基层公共卫生人员心身健康状况分析

目的了解基层公共卫生人员心身健康状况及影响因素,为提高其健康水平和工作质量提供科学依据。方法应用中国心身健康量表,采用分层整群抽样的方式,抽取胶州、嘉祥、兖州和邹城疾病预防控制中心及下属防保站的公共卫生人员584名进行问卷调查。结果基层公共卫生人员心身障碍发生率为39.43%,其中最高为骨骼系统14.17%,其次为神经系统12.73%;呼吸系统、心血管系统、焦虑、抑郁、精神病性5项因子评分小于全国常模;运用二分类Logistic逐步回归分析显示,从事本行业年限的增加是引起眼和耳疾病的危险性因素（OR=1.067）,职务的增高是导致心血管系统（OR=1.878）、消化系统（OR=1.675）、精神病性（OR=1.841）疾患的危险性因素;核心家庭（OR=0.136）、扩展家庭（OR=0.143）是降低抑郁发生的保护性因素。结论相关部门应采取综合措施,从工作和家庭环境等方面入手,提高基层公共卫生人员的心身健康水平。     

公共卫生和公共卫生突发事件

该文从理论角度阐述什么是现代公共卫生观念 ,公共卫生应在公共卫生突发事件处理中发挥什么作用和怎样发挥作用 ,希望对确定我国现代公共卫生理论体系有所启发     

Collaborative work in public health? Reflections on the experience of public health networks

This paper aims to stimulate critical reflection and debate on the future development of multidisciplinary and collaborative public health practice. Focusing on the early experience of public health networks, it suggests that various processes of professional boundary maintenance combined with perceptions of public health amongst the wider community of practitioners may constrain the establishment of new ways of collaborative working between specialist public health practitioners and the wider public health workforce within and beyond the NHS.     

Ethical perspectives for public and environmental health: fostering autonomy and the right to know

In this paper we develop an ethical perspective for public and environmental health practice in consideration of the "right to know" by contrasting consequential and deontological perspectives with relational ethics grounded in the concept of fostering autonomy. From the consequential perspective, disclosure of public and environmental health risks to the public depends on the expected or possible consequences. We discuss three major concerns with this perspective: respect for persons, justice, and ignorance. From a deontological perspective, the "right to know" means that there is a "duty" to communicate about all public health risks and consideration of the principles of prevention, precaution, and environmental justice. Relational ethics develops from consideration of a mutual limitation of the traditional perspectives. Relational ethics is grounded in the relationship between the public and public/environmental health providers. In this paper we develop a model for this relationship, which we call "fostering autonomy through mutually respectful relationships." Fostering autonomy is both an end in public health practice and a means to promote the principles of prevention, precaution, and environmental justice. We discuss these principles as they relate to practical issues of major disasters and contaminants in food, such as DDT, toxaphene, chlordane, and mercury.     

The future of public health programming

Aim  The aim of this paper is to provide a summary of the present state of discussion concerning a way forward for public health programming that is more empowering and more effective at achieving its goals as we move into the future. Method  A discussion expressing the views of the author supported by the relevant literature drawn from a wide range of sources on public health programming. Discussion  The first part of the paper discusses the present state of public health programming and why it has had only modest success in achieving its goals. The second part discusses why the planning of public health programmes in the future will have to take into account at least three important agendas. The third part of the paper discusses why the delivery of public health programming in the future will have to include the following design elements: engage communities to share priorities; build community capacity; mechanisms for flexible funding; evaluate sharing information and ideas; be creative to expand on successful local initiatives. Conclusion  The paper concludes with a reflection on the most rational way forward and on the role of practitioners in achieving a more empowering and effective public health. The paper will be of interest to the planners and evaluators of public health programmes interested in improving the effectiveness of public health.     

Emergency preparedness training for public health nurses: a pilot study

The Columbia Center for Public Health Preparedness, in partnership with the New York City Department of Health, recently developed an emergency preparedness training program for public health workers. A pilot training program was conducted for a group of school health nurses and evaluated using a pre/posttest design. A surprising finding was that 90% of the nurses reported at least one barrier to their ability to report to duty in the event of a public health emergency. The most frequently cited barriers included child/elder care responsibilities, lack of transportation, and personal health issues. These findings suggest that it may be prudent to identify and address potential barriers to public health workforce responsiveness to ensure the availability of the workforce during emergencies.     

Facts,fallacies and fears: The public and the health professionals at odds

Risk assessment as well as risk perception and risk communication are essential skills for the occupational health professional. However, in view of the widespread failure of employed groups and the general public to reach national conclusions on risk, we are clearly failing in our duty to the wider world. This paper reviews the basis of public ignorance and disquiet as well as the essential elements needed for effective risk communication. Examples include the Brent Spar saga, electromagnetic fields, and bovine spongiform encephalopathy. The way public perceptions can effect symptomatology is discussed as well as low political and legal opinions can influence the risk debate. A way forward is proposed.     

Local perspectives on empowerment and responsibility in the new public health

The new public health is compelling because it uses the discourse of empowerment and participatory methodologies to promote health citizenship, but it has also been criticized for reinforcing an individual locus of responsibility while overlooking the role of the state in providing healthy environments. Thus far, much of the discourse surrounding the new public has tended to be the purview of public health experts and professionals. This study uses the interpretive approach to health communication to understand how debates regarding rights and responsibilities inherent in the new public health are appropriated by six employees at two community-based organizations that provide support to HIV-positive (HIV+) people in South India. I ask the question: How is the term "empowerment" understood by these individuals? Three primary dimensions of power emerged from my study: power from self-acceptance and inner strength, power from family and society, and power from self-reliance. In talking about empowerment, participants implicitly and explicitly made assumptions about who was responsible for health and health care; they argued that the individual and community were responsible for health, and reframed "rights" in terms of duty and citizenship. The discussion speculates on reasons for the heightened sense of personal responsibility, as well as implications it has for community health practice.