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PublicHealthPracticeandImprovementFramework–PracticesandEssentialServices–公共衛(wèi)生實踐,改善框架-實踐和關鍵服務-,,Page?2,PublicHealthInfrastructureGoal公共衛(wèi)生基礎設施目標,Everyhealthdepartmentbetterprepared每一個衛(wèi)生部門都應該準備好Everycommunitybetterprotected每一個社區(qū)都受很好的保護,Whatdoesittaketobefullyprepared?如何才能做好充分的準備？,丹麥留學,Page?3,StepOne第一步,DevelopaCommunityHealthAssessmentPlan制定社區(qū)衛(wèi)生評估計劃GatherMostImportantData收集重要數(shù)據InterprettheData對數(shù)據進行分析Report撰寫報告brief,簡潔tothepoint,重點突出cleardata數(shù)據明晰specificrecommendations明確的建議,Page?4,AssessmentEssentialServices評價關鍵服務,,,Page?5,CausesofPrematureDeathintheU.S.19901990年美國過早死亡的原因,Cause原因%ofTotalDeaths總死亡Tobacco煙草38%Diet/activitypatterns飲食/運動模式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?在中國首要原因是什么?,Page?6,WhatisMostImportanttoMonitor?Somepossiblecriteria…監(jiān)測的重點是什么？一些可能的標準,Contributemosttoyearsofproductivelifelost?是否導致生產年的喪失？Affectsotherregionsandcountries?是否影響其他的區(qū)域和國家？Couldbeimprovedgreatlywithgooddata是否可以通過好的數(shù)據顯著改善健康狀況？,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___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年想要達到什么目標不？,objectivesforchange目標DevelopAnObjective(Bywhen,whatwillbechanged,byhowmuchchange,forwhatgroup?)_____________________________________________制定目標（何時、取得何種變化、變化多少、目標人群是哪個？）,Page?9,LeadingHealthIndicators主要的健康指標,Biologicalcausesofdeath,illness,injury導致死亡、疾病、傷害的生物學因素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,,Page?11,SlideDetails:MultipleDeterminantsofHealth健康的影響因素,Biology生物學Behavior行為Social,Family&CommunityNetworks社會,家庭和社區(qū)網絡Living&WorkingConditions工作生活環(huán)境Employment&occupation,Education,Socioeconomicstatus,Psychosocialfactors雇傭和職業(yè),教育,社會經濟狀況,社會心理因素Naturalandbuiltenvironment自然和人為環(huán)境Public&healthcareservices衛(wèi)生服務Social,economic,cultural&environmentalpolicies社會,經濟,文化和環(huán)境政策,Page?12,KeyComponentstoMonitorHealthStatus監(jiān)測衛(wèi)生現(xiàn)狀的關鍵指標,deathcertificatesifdetailed&accurate死亡登記(詳細,準確)immunizationregistries免疫接種登記largepopulationsurveys大人群調查healthinterview&examstudies健康訪談和體檢研究requiredreportingofkeyinfectiousdiseases主要傳染性疾病法定報告制度proxymeasures:infantmortality,averagelifespan替代指標:嬰兒死亡率,平均壽命integrationacrossdistricts,providers,diseases地區(qū),來源,疾病數(shù)據的整合electronicrecords:secure,simple,standardvariables,updatedregularly,wellstaffed電子記錄:安全,簡單,標準變量,經常更新,裝備先進,Page?13,AssessmentRecommendations評價建議,DevelopNationalHealthInformationInfrastructure建立國家衛(wèi)生信息基礎設施Regularlyassessthestateofthenation’spublichealthsystemanditscapacitytoprovidetheessentialpublichealthservicestoeverycommunity常規(guī)評價全國公共衛(wèi)生系統(tǒng)的現(xiàn)狀和為社區(qū)提供基本公共衛(wèi)生服務的能力Evaluatethestatusofthenationspublichealthlaboratorysystemperformance評價全國公共衛(wèi)生實驗室系統(tǒng)的運行狀況,Page?14,StepTwo第二步,DevelopaCommunityHealthImprovementPlan制定社區(qū)健康改善計劃National,國家級Provincial省級Local地方DevelopCommunicationLinksBetweenAllPartners在各合作方間建立交流機制,0,Page?15,PolicyDevelopment政策發(fā)展,Forproblemsthataffectlargepopulationsegments針對影響最大人群的問題Forproblemswithrootsinenvironmentorinstitutionsorbusinesses針對環(huán)境,體制或商業(yè)的根本Focusmoreonimprovingcommunitywideconditions,servicesandpractices.重點在提高廣泛社區(qū)的狀況,服務和實踐Canbeusedtocreateamorecomprehensiveandlinkedpublichealthcaresystem.可以用于創(chuàng)造一個更綜合,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實施,Planforcommunicationbetweendecisionmakers,andmobilizingsupport決策者和支持者之間的交流計劃,Planforcommunicationbetweenauthorities,andenoughresources當局者和足夠資源之間的交流計劃,Planforeducationtoincreaseawareness,andmotivation提高意識和動員水平的教育計劃,Compliance執(zhí)行,,,Page?17,ImportantPolicyComponents重要的政策要素,Isthereasystemforidentifyingandtrackingallpoliciesinplace?是否有確認和跟蹤政策實施的系統(tǒng)?Ispolicycompliancemonitoredandenforced?Ifnot,thentheremaybenomotivationtocomply是否有政策監(jiān)測系統(tǒng)?Isitclearwhohasresponsibilityforeachlawandhowtogetthemtotakeaction?每項法律的負責人是否清楚,如何使他們行動起來?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.任命一個全國委員會建立國家公共衛(wèi)生法律改革的框架Supportbold,large-scaledemonstrationstotestnewapproachestoincreasetheefficiencyandeffectivenessofhealthcaredeliverysystems支持大規(guī)模演示,以檢驗新方法提高衛(wèi)生服務系統(tǒng)的有效性,Page?19,AssuranceEssentialServices基本服務保證,Enforcepublichealthlawsandpolicies加強公共衛(wèi)生法律和政策Assureacompetentpublichealthandpersonalhealthcareworkforce保證一支有力的公共衛(wèi)生和個人醫(yī)療服務的隊伍Linkpeopletoneededpersonalhealthservicesandassuretheprovisionofhealthcarewhenotherwiseunavailable將個人和個人所需的健康服務連接起來Evaluatecompliance,servicedelivery,healthoutcomesandneedforchange評價依從性,服務,健康產出和改善要求,Page?20,OverviewofHealthPromotionStrategies健康促進策略回顧,Education:changeknowledge,attitudes,beliefs,readiness,intentionsandbehaviors教育：改變知識、態(tài)度、信仰、愿望、目的和行為Policy:discourageunhealthypractices,improveinfrastructureandenvironment政策：不鼓勵那些不健康的作法，促進基層單位和環(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)生問題的自我評價,Astronggovernmentalpublichealthinfrastructureforleadershipandservices?強大的政府公共衛(wèi)生基礎設施Up-to-dateandlinkedsystemsforunderstandinghealthstatusandtrends?理解健康狀況和趨勢的實時監(jiān)測系統(tǒng)Clearsystemofhealthpoliciesthatassureadequateandsustainedcommunityhealth?確保適當和持續(xù)的社區(qū)健康的衛(wèi)生政策系統(tǒng)Systemsinplacetoprotectandenhancethepublic’shealth?保護和加強公眾健康的合適系統(tǒng),Page?22,Mobilizecommunitypartnershipstoidentifyandsolvehealthproblems動員社區(qū),確認和解決衛(wèi)生問題,Governmentscannotworkalonetotacklebigandcomplexproblems政府不能在解決大的復雜問題上單槍匹馬Poverty,poorfood,inadequatewagesandlackofphysicalexerciserequirecommunitypartnerships貧窮,差的食物,不適當?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)生隊伍:能否在各個層次上提供核心功能和關鍵服務,Isthereawelldevelopedplantoprovideeachservice?是否有提供各種服務的成熟計劃?Arethereenoughpeopleandresources?是否有足夠的人員和資源?Arepeoplesufficientlytrained?人員是否經過充分培訓?Isitintegratedwithotheressentialservices?是否與其它基本服務相整合?Istheregoodworkingrelationshipbetweenthelocal,regionalandnationalpublichealthsystems?在地方,地區(qū)和全國的公共衛(wèi)生系統(tǒng)之間是否存在良好的工作關系?Istheregoodcommunicationwithothersectorsthataffecthealthsuchasstoresandschools?與影響健康的其它部門,例如商店和學校,之間是否存在良好的溝通與交流?,