社会医学的概念性质内容和任务ppt课件.ppt

第一章 绪论,Chapter 1 Introduction,内容Contents,社会医学的概念、性质、内容和任务社会医学的发展社会医学基本观点社会医学与其他学科的关系,concept,nature,contents and tasksDevelopment Basic thinking Relation with other subjects,What is social medicine?什么是社会医学？,Medicine,sociology,社会学政治学经济学伦理学管理学,基础医学临床医学预防医学,What is medicine?什么是医学,The science related to the diagnosis understanding prevention treatment of illness.,举例：肺结核病的流行现状,中国有三分之一的人口曾经感染过肺结核。每年约有130万新发肺结核病例。每年因肺结核死亡人数约为13万。2000年，全国活动性肺结核人数为500万，其中150万为痰涂片阳性。资料来源：2000年全国结核病流行病学调查,肺结核病：生物医学-个体,病因：肺结核杆菌疾病表现：症状、体征：咳嗽、咯痰三周。低热、盗汗、痰中带血、乏力检查：痰涂片、痰培养阳性；X光阴影治疗：联合化疗,哪些人容易得肺结核病？,性别？年龄？文化程度？婚姻状况？收入？职业？居住条件？,为什么这些人容易得病？,病因（社会的）：贫困、受教育程度低、职业风险、有病不医（看病贵）深层次原因：社会保障制度、医疗服务体系社会后果：个体支出增加、收入减少，劳动力丧失、社会地位下降群体经济和社会生产力丧失GDP损失、贫富差距加大增长限制、发展延缓,对付肺结核病，我们怎么办？,社会卫生策略知识普及消除贫困普及社会保障改善医疗服务体系,What is social medicine?,定义：是一门交叉学科，研究：1.社会因素 健康和疾病2.制定社会卫生策略和措施3.保护和促进健康,1.Interactions and law between the social factors and health 3.Protect health&improve life quality,give the full display of the social function of health.,Human being is more of the social creature than the animal.its social attribute is the fundamental nature.New concept of Health by WHO 1948:Health is a state of complete physical,mental and social well-being and not merely the absence of disease or infirmity.,Why we need to look at the social factors?,人的本质属性：在于其社会属性WHO：1948新的健康定义:健康是：身体 心理 社会 的完好状态，而不仅是没有疾病或身体虚弱而已。,人类的双重属性The dual nature of human beings,Aristotle:human beings are,by nature,social animals 社会属性 Social nature 生物属性 Biological natureDoes it matter to health?,Whats Relationship between social factors and health?WHO put forward:Social determinants for Health,PoliticsEconomyCultureEnvironmentSocial security systemLife style and behaviorsHealth care system,政治经济文化环境社会保障制度生活方式和行为卫生保健体制,霍普金斯大学的研究小组通过对伊拉克全国47个区进行调查走访形成的报告认为，美国发动伊拉克战争造成了65.5万伊拉克人死亡，平均每天死亡500人,人口爆炸！,非洲难民,美国哥伦比亚大学教授、联合国前秘书长安南的特别顾问JEFFREY SACHS先生,SACHS教授说：2003年的发展议题被挤出了国际议程，战争与反恐取代了发展。艾滋病每天夺去数以千计的生命，由于贫困买不起挽救生命的药品而死亡；“911”灾难夺走了3000多人的生命，从而主宰了两年多的世界议程。世界上每天有20，000多人死于贫困、疾病、灾害 世界军费开支将达9000亿美元，而用于发展援助为500亿美元，用于艾滋病防治仅10亿美元。,Rudolf Virchow:German pathologist,1.Social and economic conditions profoundly impact health,disease and the practice of medicine.2.The health of the population is a matter of social concern.3.Society should promote health through both individual and social means.,1.社会经济条件对健康、疾病和医学实践具有深刻的影响；2.群体的健康应该成为社会关注的内容;3.社会应该通过个人和社会的手段来改善人群健康。,社会医学的研究内容 Contents of social medicine:,Social health status,mainly population health status;Influence factors;especially social factors Social health strategies and measures;,研究社会卫生状况，主要 是人群健康状况;研究影响人群健康的因素，主要是社会因素;研究社会卫生策略与措施。,社会医学的核心内容 Core Contents,Identify social health problems diagnosis of problems Analysis of social causes of diseases social etiologySocial medicine prescription-social strategy,-社会医学诊断-社会病因分析-社会医学处方,社会医学与临床医学的比较,社会医学：群体 social medicine:mainly target at population level发现社会问题社会诊断 Identify social problemsocial diagnosis社会医学分析了解社会成因 Social medical analysisfind out social causes社会医学综合处方 Social comprehensive therapy,临床医学：主要针对个体 Clinical medicine:mainly target at individual level了解个体健康问题医学诊断 Identify individual health problem-medical diagnosis开展病因学分析:主要是生物学病因分析 Etiological analysis:biological causes analysis制定医学处方 Provide medical prescription,社会医学的性质 The Nature of Social Medicine,Interdisciplinary subjectsocial science and medicineSynthetic research methodsPracticality of social medicine,医学和社会学的交叉学科采用综合的研究方法社会医学的实践性,社会医学的任务The tasks of social medicine,Advocate positive concept of healthTo improve social health status,enhance population health and quality of life To formulate health policy&strategiesTo conduct preventive care services for special population and specific disease,倡导积极的健康观改善社会卫生状况;提高人群健康水平和生命质量;制定卫生政策和策略；开展特殊人群和特种疾病的预防保健工作;,Basic thinking of social medicine,Harmonious relationship between health and social developmentTwo way interaction between health and social economic development,I.协调发展的观念II.双向作用的观念,美国学者Mushkin计算出了美国在19001960年人口死亡率下降带来的经济收益约为8200亿疾病对人力资本和劳动生产率造成损失的“3D”框架(Death,Disability，Debility）,Basic thinking of social medicine,Positive concept of healthBio-psycho-social medical model,III.现代医学模式下的积极健康观,USA19000亿,1%最不健康,20,20慢病病人,70,70%健康人,10%,吸烟已成为全球第二号杀手,IV.关注高危人群&高危因素,High risk factors&population,Basic thinking of social medicine,Basic thinking of social medicine,Important role of social factors in prevention and treatment of diseasesMultisector participation,V.社会因素在疾病防治中的重要作用VI.多部门参与,物价,人口&计划生育,人力资源&社会保障,教育,发改委、财政,药品监督管理,卫生,社会医学发展史The history of social medicine,Embryonic stage of social medicineEstablishment&development of social medicineDevelopment of social medicine in China,社会医学的萌芽 社会医学的创立和发展我国社会医学的发展,Embryonic stage of social medicine:Hippocrates,“Air,Water and Places”stress on the impacts of environment,wind direction,sunlight,water quality and citizens life style on peoples health.-“It is more important to know what sort of person has a disease than to know what sort of disease a person has.”,Hippocrates,born in 460 bc,father of modern medicine.,Pathogenesis of disease and the role of doctors,The external influences of food and drink and climatic factors of excessive heat and cold influence internal mechanisms.The role of the physician was to restore the equilibrium of health.The Humoural theory was a holistic view.,饮食和气候等外部因素可以通过影响人类的内在机制而起左右。医生的职责是恢复健康平衡;四体液学说体现了整体医学观,Embryonic stage of social medicine,1.Galen:focus on psychological factors upon health；2.Peter Frank:miserable life is the hotbed of diseases;“the National Supervision System”supervision plangovernment measures to protect public health First person put forward:adopt social health measures to control disease,古罗马医师盖伦：重视心理因素对健康的影响;德国社会卫生学家:弗兰克:悲惨的生活是疾病的温床;:用医学监督计划使政府采取措施保护公众的健康;第一个提出社会卫生措施,社会医学的建立和发展Establishment and development of Social Medicine,Frenchman Jules Guerin:first person Social medicineScattered medical supervision;public health and forensic medicine should be integrated into Social medicine:divided into 4 parts:Social physiologySocial pathologySocial hygieneSocial therapeutics,法国医生儒勒.盖林第一次提出社会医学;建议将分散的医学监督、公共卫生、法医学构成一个整体：社会医学分为四个部分；社会生理学；社会病理学；社会卫生学；社会治疗学。,德国病理学家 魏尔啸German Pathologist:Rudolf Virchow,The kernel of medical science is social science“Medicine is a social sciencePolitics is nothing more than medicine in broad senseBest method of medicine is to combine medicine with social life and political activities,医学科学的核心是社会科学医学是一门社会科学；任何社会都应对居民的健康负责政治学是广义上的医学实现医学目标的最好的办法是将医学和社会生活和政治活动结合起来,德国：格罗蒂杨German A.Grotjahn,Put forward theory of social pathologyWrite:“social Pathology”suggests that disease should be studied from the standpoint of social view;Is a first person given lecture on social hygiene,提出社会病理学的理论和概念;用社会观点研究人类疾病的原则首次在柏林大学开设社会卫生学讲座,Germany：Birthplace of social medicine,Before WWIISocial hygieneSocial medicineLaterbecome social medicine,德国是社会医学的发源地二战前：使用社会卫生学和社会医学后改为社会医学,社会医学在各国的发展Development of Social Medicine in different countries,In UK,course of social medicine is offered,social medicine research institute was established in Oxford UniversityProfessor John Ryle:all public health,industrial health,social health and medical care belong to social medicineIn 1960s,social medicine was changed into community medicine,英国:40s 开设社会医学,在牛津大学成立社会医学研究院；牛津大学赖尔教授:公共卫生、工业卫生、社会卫生服务、公共医疗事业都属于社会医学的范畴；60s社会医学改成社区医学。,社会医学在美国的发展In United States,Medical sociology and family medicine developedEmphasis on sociology,management and economicsSocial medicine was included in the course of health management and health policy,医学社会学和家庭医学得到了发展强调社会学、管理学和经济学社会医学包含在卫生管理学和卫生政策学的讲座内容中,社会医学在中国的发展Social medicine in China,In 50s,course of Health Care Organization is a compulsory course for medical student,；In 80s,Ministry of Health set up 6 training centre of health administration,social medicine was the main course；90%of medical college offered course in social medicine.,50年代：保健组织学作为医学生的必修课，成立保健组织教研组80年代：卫生部成立6所卫生管理干部培训中心，社会医学成为主干课程90%以上的医学院开设了社会医学课程,Preventive medicineHealth management Community medicineMedical sociologyMedical psychology Clinical Medicine,社会医学与其他相关学科的关系The relationship between social medicine and other related subjects,预防医学卫生管理学社区医学医学社会学医学心理学临床医学,Preventive Medicine,1、预防医学(Preventive Medicine)传统预防医学 传染病(第一次卫生革命)（生物预防）传统预防医学 社会医学 社会医学使预防医学注入了生命活力,现代预防医学(整体预防),慢性病(第二次卫生革命),成功,Health Management,2、卫生管理学(Health Management)社会卫生状况 发现问题 社会因素与疾病和健康 分析原因 社会卫生措施 制订政策 运作、实施 解决问题 卫生管理学,社会医学,国内两者是姊妹学科或一个学科：社会医学与卫生事业管理（学位点）国外：health policy and management,Community Medicine,3、社区医学(Community Medicine)联系与相同点：（1）群体观（2）内容的一致性：社区是小社会 区别：社区医学更侧重于卫生保健实践,Medical Sociology,4、医学社会学(Medical Sociology)医学社会学是研究医疗卫生服务中的人际关系（如医护关系、医患关系等）对医疗卫生工作的影响，以提高医疗卫生服务的效率。两者都以社会因素作为重要研究内容。其区别在于：（1）学科性质不同；（2）起源及时代背景不同；（3）研究的对象不同。,Medical Psychology,5、医学心理学（Medical Psychology）联系：基于社会心理因素与健康的关系，两门学科交叉。区别：学科归属不同 关于身心医学,Clinical Medicine,6、临床医学（Clinical Medicine）临床医学的基本知识是社会医学理论重要依据 临床医生学习社会医学的意义：认识人的社会属性 认识致病因素及疗效影响因素的复杂性 重视社会心理行为因素对健康和疾病的影响,Question:思考题：why we should learn social medicine?,What is the nature of this subject?社会医学的学科性质是什么？why it is necessary and important for medical students?医学院校的学生学习社会医学的必要性和重要性?,