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PublicHealthPracticeandImprovementFramework–PracticesandEssentialServices–公共衛(wèi)生實(shí)踐,改善框架-實(shí)踐和關(guān)鍵服務(wù)-,,Page?2,PublicHealthInfrastructureGoal公共衛(wèi)生基礎(chǔ)設(shè)施目標(biāo),Everyhealthdepartmentbetterprepared每一個(gè)衛(wèi)生部門都應(yīng)該準(zhǔn)備好Everycommunitybetterprotected每一個(gè)社區(qū)都受很好的保護(hù),Whatdoesittaketobefullyprepared?如何才能做好充分的準(zhǔn)備？,丹麥留學(xué),Page?3,StepOne第一步,DevelopaCommunityHealthAssessmentPlan制定社區(qū)衛(wèi)生評(píng)估計(jì)劃GatherMostImportantData收集重要數(shù)據(jù)InterprettheData對(duì)數(shù)據(jù)進(jìn)行分析Report撰寫報(bào)告brief,簡(jiǎn)潔tothepoint,重點(diǎn)突出cleardata數(shù)據(jù)明晰specificrecommendations明確的建議,Page?4,AssessmentEssentialServices評(píng)價(jià)關(guān)鍵服務(wù),,,Page?5,CausesofPrematureDeathintheU.S.19901990年美國(guó)過早死亡的原因,Cause原因%ofTotalDeaths總死亡Tobacco煙草38%Diet/activitypatterns飲食/運(yùn)動(dòng)模式28%Alcohol酒精10%Microbialagents微生物8%Toxicagents毒物6%Firearms槍支4%Sexualbehavior性行為2%Motorvehicles交通事故2%Illicitdrugs非法毒品1%,,Source:McGinnis&Foege,JAMA1993,WhatwouldbetheleadingcausesinChina?在中國(guó)首要原因是什么?,Page?6,WhatisMostImportanttoMonitor?Somepossiblecriteria…監(jiān)測(cè)的重點(diǎn)是什么？一些可能的標(biāo)準(zhǔn),Contributemosttoyearsofproductivelifelost?是否導(dǎo)致生產(chǎn)年的喪失？Affectsotherregionsandcountries?是否影響其他的區(qū)域和國(guó)家？Couldbeimprovedgreatlywithgooddata是否可以通過好的數(shù)據(jù)顯著改善健康狀況？,0,Page?7,TopThreeHealthProblems?,___Agingproblems老齡化___Cancers癌癥___Childabuse/neglect,orphans虐待兒童___Diabetes糖尿病___DomesticViolence家庭暴力___Heartdisease/stroke心臟病/中風(fēng)___bloodpressure高血壓___HIV/AIDS艾滋病___Homicide他殺,___InfantDeath嬰兒死亡___InfectiousDiseases傳染病___Mentalhealthproblems精神病___Car/Bikeinjuries車禍___Rape性暴力___Lungdisease肺病___SexualDiseases性病___Suicide自殺___Other:__其他_____,Page?8,WhatWouldYouLiketoAchieveBy2010?到2010年想要達(dá)到什么目標(biāo)不？,objectivesforchange目標(biāo)DevelopAnObjective(Bywhen,whatwillbechanged,byhowmuchchange,forwhatgroup?)_____________________________________________制定目標(biāo)（何時(shí)、取得何種變化、變化多少、目標(biāo)人群是哪個(gè)？）,Page?9,LeadingHealthIndicators主要的健康指標(biāo),Biologicalcausesofdeath,illness,injury導(dǎo)致死亡、疾病、傷害的生物學(xué)因素BehaviorandLifestyle行為與生活方式Environment:qualityofair,water,food,land環(huán)境因素：空氣、水、食物、土地的質(zhì)量Immunizations免疫接種Accesstohealthcare衛(wèi)生保健的獲得,Page?10,ServicesNeedtoAddressAllDeterminantsofPublicHealth解決公共健康所有決定因素所需要的服務(wù),,Page?11,SlideDetails:MultipleDeterminantsofHealth健康的影響因素,Biology生物學(xué)Behavior行為Social,Family&CommunityNetworks社會(huì),家庭和社區(qū)網(wǎng)絡(luò)Living&WorkingConditions工作生活環(huán)境Employment&occupation,Education,Socioeconomicstatus,Psychosocialfactors雇傭和職業(yè),教育,社會(huì)經(jīng)濟(jì)狀況,社會(huì)心理因素Naturalandbuiltenvironment自然和人為環(huán)境Public&healthcareservices衛(wèi)生服務(wù)Social,economic,cultural&environmentalpolicies社會(huì),經(jīng)濟(jì),文化和環(huán)境政策,Page?12,KeyComponentstoMonitorHealthStatus監(jiān)測(cè)衛(wèi)生現(xiàn)狀的關(guān)鍵指標(biāo),deathcertificatesifdetailed&accurate死亡登記(詳細(xì),準(zhǔn)確)immunizationregistries免疫接種登記largepopulationsurveys大人群調(diào)查healthinterview&examstudies健康訪談和體檢研究requiredreportingofkeyinfectiousdiseases主要傳染性疾病法定報(bào)告制度proxymeasures:infantmortality,averagelifespan替代指標(biāo):嬰兒死亡率,平均壽命integrationacrossdistricts,providers,diseases地區(qū),來源,疾病數(shù)據(jù)的整合electronicrecords:secure,simple,standardvariables,updatedregularly,wellstaffed電子記錄:安全,簡(jiǎn)單,標(biāo)準(zhǔn)變量,經(jīng)常更新,裝備先進(jìn),Page?13,AssessmentRecommendations評(píng)價(jià)建議,DevelopNationalHealthInformationInfrastructure建立國(guó)家衛(wèi)生信息基礎(chǔ)設(shè)施Regularlyassessthestateofthenation’spublichealthsystemanditscapacitytoprovidetheessentialpublichealthservicestoeverycommunity常規(guī)評(píng)價(jià)全國(guó)公共衛(wèi)生系統(tǒng)的現(xiàn)狀和為社區(qū)提供基本公共衛(wèi)生服務(wù)的能力Evaluatethestatusofthenationspublichealthlaboratorysystemperformance評(píng)價(jià)全國(guó)公共衛(wèi)生實(shí)驗(yàn)室系統(tǒng)的運(yùn)行狀況,Page?14,StepTwo第二步,DevelopaCommunityHealthImprovementPlan制定社區(qū)健康改善計(jì)劃National,國(guó)家級(jí)Provincial省級(jí)Local地方DevelopCommunicationLinksBetweenAllPartners在各合作方間建立交流機(jī)制,0,Page?15,PolicyDevelopment政策發(fā)展,Forproblemsthataffectlargepopulationsegments針對(duì)影響最大人群的問題Forproblemswithrootsinenvironmentorinstitutionsorbusinesses針對(duì)環(huán)境,體制或商業(yè)的根本Focusmoreonimprovingcommunitywideconditions,servicesandpractices.重點(diǎn)在提高廣泛社區(qū)的狀況,服務(wù)和實(shí)踐Canbeusedtocreateamorecomprehensiveandlinkedpublichealthcaresystem.可以用于創(chuàng)造一個(gè)更綜合,緊密連接的公共衛(wèi)生系統(tǒng),Page?16,EssentialPolicyComponentsThatMustBePutinPlaceforSuccess成功的基本要素,,,,,,Enactment頒布,Enforcement實(shí)施,Planforcommunicationbetweendecisionmakers,andmobilizingsupport決策者和支持者之間的交流計(jì)劃,Planforcommunicationbetweenauthorities,andenoughresources當(dāng)局者和足夠資源之間的交流計(jì)劃,Planforeducationtoincreaseawareness,andmotivation提高意識(shí)和動(dòng)員水平的教育計(jì)劃,Compliance執(zhí)行,,,Page?17,ImportantPolicyComponents重要的政策要素,Isthereasystemforidentifyingandtrackingallpoliciesinplace?是否有確認(rèn)和跟蹤政策實(shí)施的系統(tǒng)?Ispolicycompliancemonitoredandenforced?Ifnot,thentheremaybenomotivationtocomply是否有政策監(jiān)測(cè)系統(tǒng)?Isitclearwhohasresponsibilityforeachlawandhowtogetthemtotakeaction?每項(xiàng)法律的負(fù)責(zé)人是否清楚,如何使他們行動(dòng)起來?Ispublicinformed?公眾是否知情?Doespublicbelieveitwillbeenforced?公眾是否相信政策可行?,Page?18,PolicyRecommendations政策建議,Appointanationalcommissiontodevelopaframeworkforstatepublichealthlawreform.任命一個(gè)全國(guó)委員會(huì)建立國(guó)家公共衛(wèi)生法律改革的框架Supportbold,large-scaledemonstrationstotestnewapproachestoincreasetheefficiencyandeffectivenessofhealthcaredeliverysystems支持大規(guī)模演示,以檢驗(yàn)新方法提高衛(wèi)生服務(wù)系統(tǒng)的有效性,Page?19,AssuranceEssentialServices基本服務(wù)保證,Enforcepublichealthlawsandpolicies加強(qiáng)公共衛(wèi)生法律和政策Assureacompetentpublichealthandpersonalhealthcareworkforce保證一支有力的公共衛(wèi)生和個(gè)人醫(yī)療服務(wù)的隊(duì)伍L(zhǎng)inkpeopletoneededpersonalhealthservicesandassuretheprovisionofhealthcarewhenotherwiseunavailable將個(gè)人和個(gè)人所需的健康服務(wù)連接起來Evaluatecompliance,servicedelivery,healthoutcomesandneedforchange評(píng)價(jià)依從性,服務(wù),健康產(chǎn)出和改善要求,Page?20,OverviewofHealthPromotionStrategies健康促進(jìn)策略回顧,Education:changeknowledge,attitudes,beliefs,readiness,intentionsandbehaviors教育：改變知識(shí)、態(tài)度、信仰、愿望、目的和行為Policy:discourageunhealthypractices,improveinfrastructureandenvironment政策：不鼓勵(lì)那些不健康的作法，促進(jìn)基層單位和環(huán)境的改善Environment:maketheenvironmentsafertoprovidehealthyconditions環(huán)境：使之更加安全，以提供健康的環(huán)境條件,Page?21,Self-AssessmentforSelectedHealthIssue衛(wèi)生問題的自我評(píng)價(jià),Astronggovernmentalpublichealthinfrastructureforleadershipandservices?強(qiáng)大的政府公共衛(wèi)生基礎(chǔ)設(shè)施Up-to-dateandlinkedsystemsforunderstandinghealthstatusandtrends?理解健康狀況和趨勢(shì)的實(shí)時(shí)監(jiān)測(cè)系統(tǒng)Clearsystemofhealthpoliciesthatassureadequateandsustainedcommunityhealth?確保適當(dāng)和持續(xù)的社區(qū)健康的衛(wèi)生政策系統(tǒng)Systemsinplacetoprotectandenhancethepublic’shealth?保護(hù)和加強(qiáng)公眾健康的合適系統(tǒng),Page?22,Mobilizecommunitypartnershipstoidentifyandsolvehealthproblems動(dòng)員社區(qū),確認(rèn)和解決衛(wèi)生問題,Governmentscannotworkalonetotacklebigandcomplexproblems政府不能在解決大的復(fù)雜問題上單槍匹馬Poverty,poorfood,inadequatewagesandlackofphysicalexerciserequirecommunitypartnerships貧窮,差的食物,不適當(dāng)?shù)墓べY以及缺少體育鍛煉方面需要社區(qū)配合Example:sextrade例如:性交易,Page?23,ThePublicHealthWorkforce:IsitReadytoProvidetheCoreFunctionsandEssentialServicesatALLLevels?公共衛(wèi)生隊(duì)伍:能否在各個(gè)層次上提供核心功能和關(guān)鍵服務(wù),Isthereawelldevelopedplantoprovideeachservice?是否有提供各種服務(wù)的成熟計(jì)劃?Arethereenoughpeopleandresources?是否有足夠的人員和資源?Arepeoplesufficientlytrained?人員是否經(jīng)過充分培訓(xùn)?Isitintegratedwithotheressentialservices?是否與其它基本服務(wù)相整合?Istheregoodworkingrelationshipbetweenthelocal,regionalandnationalpublichealthsystems?在地方,地區(qū)和全國(guó)的公共衛(wèi)生系統(tǒng)之間是否存在良好的工作關(guān)系?Istheregoodcommunicationwithothersectorsthataffecthealthsuchasstoresandschools?與影響健康的其它部門,例如商店和學(xué)校,之間是否存在良好的溝通與交流?,