1、为什么要修订疾病防制策略？为什么要修订疾病防制策略？二、全球卫生策略和初级卫生保健二、全球卫生策略和初级卫生保健“Health for all by the year 2000”vat least 5%of gross national product should be spent on health;vat least 90%of children should have a weight for age that corresponds to the reference values;vsafe water should be available in the home or withi
2、n 15 minutes walking distance,and adequate sanitary facilities should be available in the home or immediate vicinity;vpeople should have access to trained personnel for attending pregnancy and childbirth;andvchild care should be available up to at least one year of age.“Health for all by the year 20
3、00”全球卫生策略确切的含义：全球卫生策略确切的含义：Declaration of Alma-AtavAn International Conference on Primary Health Care was held from 6-12 September 1978 in Alma-Ata,capital of the Kazahhistan.v134 governments and 67 UN organizations,specialized agencies and non-governmental organizations in official relation with WH
4、O and UNICEF attended.vDeclaration of Alma-Ata.What is Primary Health Care(PHC)?PHC is essential health care made universally accessible to individuals and families in the community by means acceptable to them,through their full participation and at a cost that the community and country can afford.C
5、ase study:the GambiavIn the Gambia,in west Africa,a study by the United Kingdom Medical Research Council of 40 villages beginning in 1981 over a 15-year period compared infant and child mortality between villages with and without primary health care(PHC).A routine primary health care activities at T
6、hmor Bang Health Center,Koh Kong Province,Cambodia.Case study:Extra services to the PHC villages included a paid Community Health Nurse for about every five villages,as well as a Village Health Worker and a trained Traditional Birth Attendant.Maternal and child health services with a vaccination pro
7、gram were accessible to residents in both PHC and non-PHC villages.There were marked improvements in infant and child(5 years)mortality in both PHC and non-PHC villages.vAfter the establishment of PHC in 1983,infant mortality in the PHC villages dropped from 134/1000 in 19821983 to 69/1000 in 199219
8、94,and from 155/1000 to 91/1000 in the non-PHC villages over the same period.The change in death rates for children aged 14 years between the two groups was not as marked.Case study:Case study:Supervision of the PHC system weakened after 1994,and infant mortality rates in the PHC villages rose to 89
9、/1000 in 19941996.The rates in non-PHC villages fell to 78/1000 for the same period.Mortality rates rose significantly when PHC services were weakened.History of Chinas primary health service systemv1949 to 1980:80%of urban residents covered by work units;90%of rural residents were covered by cooper
10、ative health plans.v1985 to 2002:The health system was turned over to the market and became dependent on fee-for-service.Current Policy of Chinas Primary Health Service Systemv2003 to now:Rural:The New Rural Health Cooperative began.80%of farmers are covered now.Urban:Community Health System was sta
11、rted in 2006 in major cities and all cities should have the system in place by 2010.Urban community health services steadily improvedvBy the end of 2006,over 23,000 community health centers had been in place nationwide,an increase of 5,528 over 2005;v24 provinces nationwide have specified the averag
12、e financial input per person in community-based public health services.。v19861986年经国务院批准，确定年经国务院批准，确定4 4月月2525日为日为“全国儿童预防接全国儿童预防接种日种日”。v党和国家领导人多次在党和国家领导人多次在“全全国儿童预防接种日国儿童预防接种日”现场为现场为儿童喂服糖丸，为计划免疫儿童喂服糖丸，为计划免疫题词，体现了党和政府对计题词，体现了党和政府对计划免疫工作的重视和关怀，划免疫工作的重视和关怀，也推动了计划免疫的广泛宣也推动了计划免疫的广泛宣传。传。v 常规免疫滑坡趋势没有得到遏制，贫
13、困地区和流动人口常规免疫滑坡趋势没有得到遏制，贫困地区和流动人口聚集地免疫覆盖率低聚集地免疫覆盖率低v 仍然维持无脊灰状态，但疫苗可预防疾病发病有反弹（仍然维持无脊灰状态，但疫苗可预防疾病发病有反弹（如麻疹）如麻疹）v 中央重视程度提高（领导人出席中央重视程度提高（领导人出席4.254.25活动和增加投入）活动和增加投入）v 承诺承诺20122012年消除麻疹，乙肝疫苗纳入计划免疫取得较大年消除麻疹，乙肝疫苗纳入计划免疫取得较大进展进展v 免疫规划国际合作项目减少免疫规划国际合作项目减少发病率（/10万）%100%对照组发病率接种组发病率对照组发病率）疫苗保护率（接种组发病率对照组发病率疫苗效
14、果指数%100%某疫苗应接种人数数按免疫程序完成接种人）某疫苗接种率（%100%调查的适龄儿童接种人数四苗均符合免疫程序的）四苗覆盖率（%100%某设备装备数某设备正常运转数）冷链设备完好率（不关心生化恐怖的可能因素不关心生化恐怖的可能因素 这些事件也可能发生在这些事件也可能发生在我们身边我们身边!这些事件就是这些事件就是 生化恐怖事件！生化恐怖事件！There are three levels of prevention：QPrimary preventionQSecondary preventionQTertiary preventionPrevention Cube 健康促进健康促进 S
15、creening is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease.Unlike most medicine,in screening,tests are performed on those without any clinical indication of disease.Breast cancer screeningBreast cancerAll women aged 50-64 invited once eve
16、ry three years;women older than 65 on request Cervical cancerAll women aged 20-64 invited once every three or five years Bladder cancerOccupational exposure HIV antibodyAll women receiving antenatal careChild health screening PhenylketonuriaAll newborn baby Congenital hypothyroidismAll newborn baby Physical examinationAll newborn baby 三、三级预防三、三级预防 (tertiary prevention)Cardiovascular disease care 一、疾病监测一、疾病监测(surveillance of disease)症状监测症状监测 以医院为基础的监测系统以医院为基础的监测系统
