SocialMedicine第.ppt

,社会医学Social Medicine,哈尔滨医科大学社会医学教研室吴群红教授,What is social medicine?,Medicine,Social science,社会学政治学经济学人类学管理学,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.,What is social medicine?,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,and upgrading the general health status of the people of the society.,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,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：新的健康定义:WHO,1948：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,伊战以来，已有超过75万伊拉克人逃离家园，全局势使伊拉克失业率高达60。四年来，驻伊美军死亡人数超过3200名，2.4万余人受伤。3520亿美元:伊战爆发以来，美国投入伊拉克的军费已高达3520亿美元。伊境内平均每周发生的暴力事件达1000多起，超过去年5月至8月的800起更多,人口爆炸！,非洲难民,美国哥伦比亚大学教授、联合国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;,2、社会医学的研究内容 Contents of social medicine:,Social health status,mainly population health status;Influencing factors;especially social factors Social health strategies and measures;,（1）研究社会卫生状况，主要 是人群健康状况;（2）研究影响人群健康的因 素，主要是社会因素;（3）研究社会卫生策略与 措施;,社会医学的核心内容 Core Contents,Diagnosis of social medicine-identify problems Analysis of social cause of disease 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 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 Etiological analysis制定医学处方 Medial prescription,社会医学的性质 The Nature of Social Medicine,-Interdisciplinary subjectsocial science and medicine-Synthetic 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,3.社会医学的任务The tasks of social medicine,Advocate positive concept of health,protect and increase physical and mental health and social activity capacityTo improve social health status,enhance population health and quality of life formulate health policy&strategies carry out community health services and primary health care.To 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;,4.Basic thinking of social medicine,Harmonious relationship between health and social developmentTwo way interaction between health and social economic development,协调发展的观念双向作用的观念,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.,人力资本,智力资本体力资本,4.Basic thinking of social medicine,Positive concept of healthBio-psycho-social medical model,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,关注高危人群&高危因素,High risk factors&population,全球十大健康危险因素：即营养不良、不安全性行为、高血压、吸烟、酗酒、不安全饮用水及不良卫生设施和卫生习惯、铁缺乏、室内烟尘污染、高胆固醇、肥胖等。,4.Basic thinking of social medicine,4.Basic thinking of social medicine,Determinant role of social factors in prevention and treatment of diseasesAll sectors involvement in health works,社会因素在疾病防治中的重要作用多部门参与,人事,人口&计划生育,劳动&社会保障,教育,计划、财政,药品监督管理,卫生,社会医学发展史The history of social medicine,the embryonic stage of social medicinedevelopment 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,希波克拉底,Embryonic stage-Hippocrates,“Air,Water and Places”environment,wind direction,sunlight water quality and citizens life style-it is more important to know the person having the disease than to know the disease the person has；,Hippocrates,born in 460 bc,father of modern medicine.,The role of Hippocrates on Modern Medicine,Hippocrates reject the notion that diseases have a supernatural cause.the first to perceive a relationship between cause and effect in a mechanistic way,providing the foundation for modern scientific notions of disease causation.,疾病的致病因素的研究推进的医学的发展，否认疾病的产生是超自然力量导致的；以机械的眼光看待疾病的因果关系为现代医学的疾病因果理论奠定了基础,“Humoural theory”,The Hippocrates developed the theory,as a physiological explanation of health and disease.all matter could be reduced to the basic elements earth,fire,air and water cold,hot,dry and wet;four humours of phlegm,blood,black bile and yellow bile.The elements,constituents and humoursHealth-mutual balanceDisease-disorder,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 one.,饮食和环境因素影响内在机制医生的职责是恢复健康平衡;希波拉底的医学观是整体医学观,Significance of Hippocrates,Before：mystical approach to disease characterized by the worship of gods,the fending off of evil demons separate Western medicine from-a primarily mystical approach to disease.marks the beginning of a rational*pathophysiology,希波克拉底之前：疾病是由神秘的超自然力量导致的；希波克拉底及其创立的学说将西医与原始的神秘主义分割开来标志理性病理生理学的真正开端,Embryonic stage of social medicine,1.Galen:ancient Doctor in Rome:focus on psychological factors upon health；2.Peter Frank:German social hygienist:miserable life is the hotbed of diseases;“the National Supervision System”supervision plangovernment measures to protect public health3.First person: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;提出社会卫生措施,社会医学的建立和发展Establishment and development of Social Medicine,1848 Frenchman Jules Guerin:first personSocial medicineScattered medical supervision;public health and forensic medicine should be integrated into Social medicine:divided into 4 parts:Social physiology:Social pathology:Social 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,theory of social pathologyBook：social Pathology suggests：disease should be studied from the standpoint of social viewIs a first person given lecture on social hygiene,德国 格罗蒂杨: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,preventive medicinecommunity medicinemedical sociologyhealth care managementmedical psychology,社会医学与其他相关学科的关系The relationship of social medicine with other related subjects,预防医学社区医学医学社会学卫生管理学 医学心理学,Preventive Medicine,Preventive medicine studies how natural and social factors affect peoples health:How Disease occurred and spread put prevention fist Three-stage preventive measures focus on medical prevention Bio-preventive strategy mainly Social medicine grow out of preventive medicine,Social Medicine Vs Community Medicine,Community medicineMore practical OperationalBoth target at population levelIntermediate levelEnjoy same origin with social medicineThe Practice of social medicine facilitate the development of theory of social medicine,Social medicineMore theoretical macro mainly at policy levelOffer guiding principleTheory of social medicine be practiced in community medicineMore theoretical,offer principle and guidance to CMOffer methodology,Medical Sociology,Medical sociology belong to the disciplinary group of sociologyconcerned with socialcauses and consequences of health andillness social aspects of health and illness social functions of health organizations andinstitutions I healthcare systems vs.social systems social behavior of health workers and users patterns of health services patterns of health services,属于社会学的分支关注健康和疾病的社会原因和结果从社会角度研究健康和疾病研究卫生组织和机构的社会职能卫生系统和社会系统的关系医生和患者的社会行为利用卫生服务的格局,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 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,research and teaching group set up in all medical collegeIn 80s,Ministry of Health set up 6 training centers social medicine was the main course90%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,参考文献：references,李鲁主编：社会医学 第二版WHO：social determinants of health；World Bank：Macro economy and health；龚幼龙主编：社会医学第一版,WHO：2002 world health report：Reducing risks，and Promoting Healthy Life StyleWBI：Getting Health Reform Right。World Bank 2002,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,