会议速递

首届中英全球卫生对话在英国举行2013年3月11日,首届中英全球卫生对话在英国伦敦举行。中英双方就全民健康覆盖、全球疟疾防控、消灭脊髓灰质炎、后千年发展目标,以及全球卫生治理等议题进行了交流,并讨论了未来中英双方在全球卫生领域的合作。会议认为,中英开展全球卫生领域的合作,有利于进一步加强中英关系的发展,推动全球卫生发展的     

千年发展目标的回顾与展望

<正>2000年,189个国家签署《联合国千年宣言》,承诺到2015年实现8个目标(其中有3个与健康有关)。之后,卫生领域的千年发展目标取得了显著成就:卫生发展援助从2000年的116亿美元增加到2012年的331亿美元,并一直保持平稳增长;2000—2013年5岁以下儿童死亡率年均下降3.5%;2003—2013年孕产妇死亡率年均下降     

增加卫生投入保障全民健康

世界卫生组织宏观经济与卫生委员会关于《投资卫生领域 促进经济发展》的报告(以下简称《报告》),全面总结了世界各国处理健康改善与经济发展相互关系的经验与教训,深刻分析了当前与今后一段时期内增加卫生投入,促进宏观经济增长,实现联合国千年发展目标(MGDs)的形势与任务。我们完全赞同《报告》的基本观点与发展目标,并为之而共同努力。     

国内外职业卫生进展

近年,职业卫生领域颇为活跃,在概念、服务方向和发展目标上,都有些进展。以下谨就我们意识到的若干方面作一综述。一、职业卫生与职业医学的“辩证法”多少年来,人们曾为“职业卫生”(occupationalhealth)与“职业医学”(occupational medicine)的辨析产生过分歧。迄今,尚难取得共识。最近,当代著名职业医     

论更新观念与卫生体制改革

卫生体制改革 ,关系到宏观经济改革和社会发展的大局 ,关系到卫生事业的持续健康发展。在我国卫生领域即将进入历史性的变革时期 ,张文康部长多次强调 :思想观念的转变是卫生改革的前提和关键[1] 。显然 ,分析卫生领域思想观念不适应卫生体制改革的表现、论证思想观念更新对卫生体制改革的重要性、探讨卫生体制改革对思想观念更新目标的基本要求 ,是十分必要的。一、与卫生体制改革不适应的表现党的十五大以来 ,我国经济体制和社会发展的一系列深层次改革 ,迫切要求卫生领域进行相应的改革 ,建立与社会主义市场经济相适应的卫生服务体系。为…     

对中国实现卫生领域可持续发展目标的思考

该文基于文献,梳理了可持续发展目标的发展历程,简要描述了卫生领域可持续发展目标在中国的发展,提出实现可持续发展目标离不开有效的磋商机制和理念的变革,可靠的数据和稳健的卫生信息系统建设是实现卫生领域可持续发展目标的重要保障,以及利用与国际组织合作促进卫生领域可持续发展目标实现三方面思考。     

世界卫生组织：国家之间的健康差距正在逐渐缩小

《2013年世界卫生统计》显示,为实现千年发展目标所开展的工作中,最贫穷国家与最富裕国家之间的健康差距缩小,在降低儿童和孕产妇死亡、改善营养状况和降低因艾滋病毒感染、结核病和疟疾导致的死亡和疾病人数方面,已经取得了长足进步,但由于各项卫生进展比例失衡,不同国家之间以及国家内部还存在较大差距。     

新时期宏观卫生政策的理论支撑及选择

从新时期卫生工作的实际需要出发，作为未来宏观卫生政策的理论支撑及选择应该是：科学的发展观，健康是全面建设小康社会的重点；人力资本理论，健康和教育是人类资本的两大基石；社会资本理论，有利于营造良好的卫生投资环境，合理利用社会卫生资源，促进卫生事业可持续发展；政策科学理论，提高执政为民的执政能力和施政水平；医学模式的改变，对健康服务具有相当大的影响；千年发展目标(MDGs)：投资卫生领域，促进经济发展．     

各国政府卫生投入及其对中国的启示

2000年9月联合国千年首脑会议通过了千年发展目标(MDGs) ,在18个千年发展目标中有5个是与健康直接相关的目标 ,另外还有3个目标与健康有间接关联。政府卫生投入是反映一个国家或地区政府对健康发展支持程度的重要指标之一 ,本文分析了各国卫生总支出、政府卫生投入占卫生总支出的比例、政府卫生投入方向以及对中国的启示。一、各国卫生总支出与政府卫生支出概况澳大利亚1998～1999年度澳洲卫生总费用为475亿澳元 ,其中联邦政府占49%,州与地方政府占20%,非政府部门支出占31 %。政府在卫生筹资领域起重要作用。联邦政府共支出235亿元 ,其中…     

中国西南贫困农村地区社会性别与卫生公平若干问题分析

在过去的二十年里,中国的经济得到了巨大的发展,中国已经在千年发展目标(MDGS)的扶贫、基础教育和降低儿童死亡等方面取得了实质性的进展。但是,在千年发展目标的一些其他方面,中国仍面临着挑战,包括性别平等和妇女赋权、妇幼保健、性病/艾滋病防治等方面。由于卫生费用增长过快,贫困人口的健康公平性也受到影响,在这种情况下,农村妇女由于社会地位较低,获得的资源较少,她们的健康情况不容轻易乐观。有证据表明,农村妇女的产前保健、安全分娩、生殖道感染防治等主要卫生服务需求没有得到充分的满足[1]。文章以笔者对中国西南贫困农村地区两县的提高性别与卫生公平试点研究为基础,利用抽样调查资料,分析贫困农村地区社会性别与卫生公平方面的若干问题,为提高政府和卫生服务提供方的责任意识、促进社区参与、改善性别公平提供参考。     

Health care for children: perspectives for community health services

The study aims at analysing the community health nursing practice in the care of children and to point out the perspectives for the coming millennium. The study was conducted by review of the literature. It provides a brief synthesis of the current social context and a short historic reflection about health practices with children and community health nursing practice. It is observed that the practice of nursing is conducted according to the official Health Assistance Program for Children. Despite its goals, however, the program has not been efficient. In this way it will be valued the multiprofessional work in the accompaniment of the growth and development, domiciliary visit, and "groups of mothers" in which the nurse will be a co-participant of the staff, with the great contribution that health professionals with preventions and promotions background frequently offer.     

Developing effective policy and practice for health promotion in Scotland

Scotland has recently embarked on a new phase of policy and infrastructure development for improving population health and reducing health inequalities that broadly conforms to the Ottawa Charter and WHO's strategic framework for the prevention and control of non-communicable diseases. The new phase is characterised by an integrated, cross-government approach to improving health with strengthened political and Scottish Executive leadership and investment since devolution. A comprehensive policy framework for improving young people's health and reducing inequalities has been developed across education, health, environment and social justice. It builds on an earlier phase of relative stability and continuity in the health promotion infrastructure with policy focused on CVD and cancer prevention and tackling the behavioural risk factors (smoking, alcohol, diet, physical activity) as well as sexual health and mental health and wellbeing. These national strategies are currently being implemented across Scotland. They combine promotion, prevention, treatment and protection goals and target both population-level and high-risk groups. Crosscutting government objectives and headline targets for addressing poverty, disadvantage and health inequalities now supplement the NHS health improvement targets on smoking, alcohol, physical activity, teenage pregnancy and child immunization. Within the health service, prevention efforts are largely concerned with primary care development (anticipatory care) and health system reform to maximize their impact on reducing health inequalities. Efforts to tackle the social determinants of health and reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government with Community Planning Partnerships as the main vehicle. National level mechanisms for integrated funding, planning and performance reporting to deliver shared priority outcomes have yet to be developed. The development of health improvement strategies has been founded upon a rich source of population health data to monitor changes and improvements, epidemiological studies and evaluation work. The key issues have been to find ways of intervening to accelerate the rate of improvement and to stem the growing health inequalities. A further challenge is to ensure that the lessons from reviews and evaluations of past programmes and strategies are not lost, but help to guide improvements in the complex delivery system and to inform future policy direction. Within the health service, prevention efforts are largely concerned with primary care development and health system reform. Efforts to reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government.     

Health objectives for the nation: moving toward the 1990s

The 1990 Objectives are an outgrowth of the 1979 Surgeon General's Report, Healthy People, which identified a set of five broad goals for improving the health of the American public through the decade of the 1980s. A year later, more than 500 health experts from the government and the private sector met to develop specific quantifiable objectives for each of the areas outlined in Healthy People. Fifteen topics, including improved nutrition, were used to formulate a framework for 227 objectives that give directions for a national program of health promotion and disease prevention. In 1980, the Public Health Service published the report Promoting Health/Preventing Disease: Objectives for the Nation. A mid-course review of the 1990 objectives has been conducted, and the results were published in 1986. In the nutrition area, it is apparent that some overall progress has been made, but data are insufficient to assess progress on several objectives, and others are unlikely of achievement by 1990. Ultimately, however, the success of the objectives depends on the recognition that they are national, not federal, goals that require commitment to their implementation by both the public and the private sector.     

The new management regulation for hospital wastes

The paper characterizes the main goals of the new regulations on the management of the hospital wastes. The motivations for which the previous regulations have been repealed are shown. The new possibilities of management and disposal are explained. The instruments are described by means of which the new regulations, maintaining the maximum protection of the health and the environment, aimed at the rationalization and the control of the costs, and to the attainment of it objectives, in agreement with the European directives of prevention of the production of wastes and recovery of matter and energy, through the attainment and the upgrade of the differentiated collection.     

Are we there yet? Assessing achievement of vaccine-preventable disease goals in WHO's Western Pacific Region

Accelerated disease control goals have long been appreciated for their role in galvanizing commitment and bringing a sense of urgency for disease prevention. WHO's Western Pacific Region has 14 on-going communicable disease reduction goals including 1 targeting eradication, 10 targeting elimination, and 3 control initiatives. These goals cover mother-to-child transmission of HIV, congenital syphilis, tuberculosis, leprosy, five parasitic diseases and four vaccine-preventable diseases (VPD). The initiatives have distinct objectives, approaches, and means in which to measure achievement of the goals.     

Progress toward attainment of the Healthy People 2000 objectives in the U.S. Army: measured by health risk appraisal results

BACKGROUND: Healthy People 2000 (HP2000) is a national agenda of health promotion and disease prevention objectives, with specific health behavior goals in 22 priority areas. The U.S. Army Health Risk Appraisal (HRA) is a self-administered health-habits survey, inquiring about tobacco and alcohol use, physical activity, nutrition, and safety-related practices, given to more than 400,000 active-duty U.S. Army soldiers in the 1990s. This article compares the health behaviors of U.S. Army soldiers, as measured by the HRA, with the HP2000 objectives. METHODS: We compared cross-sectional analyses of self-reported health behaviors of active-duty Army personnel responding to HRA questionnaires in 1991 (n=78,256) and in 1997-1998 (n=59,771) with corresponding HP2000 objectives. We also calculated longitudinal changes for personnel who took more than one HRA (n=86,393). RESULTS: By 1997-1998, the Army exceeded HP2000 physical fitness goals by at least 50% and also exceeded goals for eating high-fiber foods and using bicycle helmets. The Army did not meet goals for nutrition, tobacco use, and seat-belt use. CONCLUSIONS: The Army has made good progress toward the HP2000 goals. However, improvement is needed to meet the tobacco, nutrition, and safety goals.     

Using social health insurance to meet policy goals

Social health insurance, with contributions based on incomes and access to services on need is being considered as an option for health care finance in many countries. The argument in this paper starts from the premise that the choice of health care financing mechanisms should start with a clear focus on policy goals, with different options judged against the extent to which these are met. These are likely to include objectives of access to care for those in need, quality of care, incentives for efficient provision and cost control. Different systems will meet the objectives of mobilising resources, providing insurance against risk and redistribution resources to differing extents. It is argued that a particular problem in health care finance is shifting rights to resources over time. It is also important to be clear about the distinction between affordability of and payment mechanisms for health care. The choice of funding mechanisms may have little effect on other policy goals, such as economic development. However, they may differ in the degree to which they allow specific health policy goals to be met. Different mechanisms for collecting and managing funds, and for paying for services are discussed. The paper concludes with concerns that too much emphasis is placed on structures and not how they work, that a lack of cost control may be a serious risk in developing social health insurance and that it is important to have clear mechanisms for setting priorities if policy goals are to be met.     

Setting national health goals and targets in the context of a fiscal crisis: the politics of social choice in New Zealand.

The setting of national health goals and targets in New Zealand has taken place in the context of fiscal crisis. The mandate for State intervention for social goals has also been under a sustained ideological challenge. These circumstances, together with other developments within the New Zealand health service, prepared the way for the development of the first set of health goals and targets. Six criteria were used to identify health problems for which goals and targets could be set. Ten areas were included, and specific, timed and quantified targets were set in each area for the year 2000 with shorter term targets for 1995. The Minister of Health gave priority to three areas: tobacco control, secondary prevention of cervical cancer, and reduction of road accident injury and death. An important aspect of the program is that the goals and targets are to be the focus of the annual contract between the Minister of Health (the primary funder of health care) and the Area Health Boards (the primary providers of health care). A matrix of policy options is presented for resource allocation and public health. The case study described represents one solution to the set of policy choices presented by fiscal and ideological challenge; the "new managerialism" has been allied with the "new public health." The authors argue that a combination of ideological renewal and fiscal probity has preserved a vigorous role for the State in health and health care. This matrix of policy options also underlines the necessity to consider health outcomes, as well as organizational goals, in the evaluation of the performance of health systems.