Chapter3SocialFactorsandHealthObjectivesandRequirementsAcquaintedwiththeconceptofsocialsystem.Acquaintedwiththeconceptofsocialeconomy.MasterthecharacteristicsofsocialsysteminfluencinghealthMastertheconceptofeconomicstatus;theconcept,characteristics,andfunctionofculture.Understandhowsocialsysteminfluencehealth.Acquaintedwiththeinfluenceofsocialeconomyonhealth.Acquaintedwiththeapproachesofcultureinfluencinghealth.Mastertherelationbetweenfamilyandhealth.WHOconcept:Healthisastateofcompletelyphysical,mentalandsocialwell-beingandnotmerelyanabsenceofdiseaseorinfirmity.

1.Apersonhasagoodenergyandcanrespondtothevariedexperiencesoflifeandworkwithflexibility.2.Facesproblemsoptimistically,haspositiveattitudeandcouragetotakeonresponsibility.3.Abletocoordinatehislifeandtogetgoodrestandhighqualityofsleep.4.Bewell-adjustedandabletoadaptallkindsofenvironment.5.Hassomeimmunitytocommoncoldandinfectiousdisease.6.Weighiswithintherangeof“normality”fortheindividualageandsex.7.Hasgoodeyesightandbriskreaction.8.Hascleaningteethwithoutabsenceandache.9.Haslustroushairwithoutscurf.10.Hasstretchskinandmuscleandcaneasilycoordinatebodilymovement.第一節(jié)概述

SectiononeIntroductionTheconnotationofsocialfactorsThebasicrulesandcharacteristicsofsocialfactorinfluencinghealthThemechanismofsocialeconomicfactorinfluencinghealth社會(huì)因素的含義社會(huì)因素影響健康的基本特點(diǎn)和規(guī)律社會(huì)因素影響健康的機(jī)制

社會(huì)因素指的是構(gòu)成社會(huì)的各項(xiàng)要素，包括環(huán)境、人

口和文明總和?？蓪h(huán)境因素分為兩個(gè)方面:

Socialfactorsrefertotheelementsinsociety,includingenvironment,populationandcivilizationcombined.Environmentalfactorscanbedividedintotwoareas:自然環(huán)境(physicalenvironment)社會(huì)環(huán)境(socialenvironment)一、社會(huì)因素的含義Connotationofsocialfactors遺傳免疫

情感交際生育家庭婚姻階層國民營養(yǎng)國民收入生產(chǎn)水平生活方式風(fēng)俗習(xí)慣宗教信仰倫理道德法律立法衛(wèi)生服務(wù)文化教育政治制度地理氣候物理化學(xué)生物生態(tài)人際關(guān)系家庭關(guān)系公共關(guān)系

社會(huì)因素分類

classificationofsocialfactors社會(huì)因素Socialfactor人口population文明civilization環(huán)境environment

自然社會(huì)屬性社會(huì)生物屬性物質(zhì)經(jīng)濟(jì)文明基礎(chǔ)精神上層文明建筑

二、社會(huì)因素影響健康的基本特點(diǎn)和規(guī)律

Thebasicrulesandcharacteristics

AB1B2B3A1A2A3A1A2A3B1B2B3BI單因多果II多因單果III多因多果Cause-effectrelationshipBiologicalMedicalModel:單因單果（一）基本特點(diǎn)(characteristics)泛影響性

作用途徑的多樣性作用方式的重疊性效果的非特異性

恒常性與積累性

交互作用

extensiveeffect

multiplepathwaysoverlapbetweenthesedeterminantsnonspecificeffect

constantandcumulativeeffectinteraction

（二）基本規(guī)律principleeconomyandhealth（一）泛影響性。ExtensiveEffect

１、社會(huì)因素的多樣性與重疊性，使每種社會(huì)因素的作用難以顯示其特異性。２、由于遺傳及后天發(fā)展的差異，使每個(gè)人對(duì)同類型、同強(qiáng)度刺激的耐受性不同，從而使社會(huì)因素的致病作用及健康效應(yīng)的特異性不明顯。正負(fù)效應(yīng)難分。（二）恒常性與積累性。Constancyandcumulative

由于社會(huì)因素廣泛存在于人們的現(xiàn)實(shí)生活中，加之人類的社會(huì)屬性，社會(huì)因素對(duì)人類必然產(chǎn)生頻繁和持久的作用,而這些作用又有一定的累積性。社會(huì)因素作為應(yīng)激源很少是一次擊中的，往往經(jīng)過一個(gè)較長的過程。（三）交互作用。Interaction

社會(huì)因素作用人類健康常常是以交互作用的方式產(chǎn)生效應(yīng)，常常是一種社會(huì)因素可以直接影響人群健康，也可以作為其他社會(huì)因素的中介，或以其他社會(huì)因素為中介作用于健康。

三、社會(huì)因素影響健康的機(jī)制

Mechanismofsocialfactorsimpactonhealth

Possibleexplanationfortheassociationbetweensocialfactorsandhealth.Variousmodelshavebeenproposedwhichdescribepossiblemechanismsthroughwhichsocio-economicfactorsmightimpactonhealth.Turrell.smodeldifferentiatesbetweenthreelevelsorstagesofdeterminantsofsociohealthinequalities.PossibleMechanismsThebasicpotentialpathwaymechanismsincludesmaterial,behavioralandpsychosocial

pathway.healthmaterialpathwaybehavioralpathwaypsychosocialpathwaySocialfactors1.MaterialPathwayItisthesimplestexplanationsforthestrongrelationshipsbetweenindividualsocialfactorsandhealth.Generallydescribepurchasingpower,knowledgepowerandemploymentpowerasresourcesthatelevateorsustainhealthstatus.Variationsinaperson’saccesstothesematerialresourcesandtootherlifeopportunitiesgiverisetoinequalitiesinhealthstatus.2.BehavioralPathwayThesecondpathwayrelatestotheclusteringof

riskbehaviors.Thereisasocialcontexttothebehaviorofparticulargroups,asbehaviorisnotrandomlydistributedthroughoutthepopulationbutissociallyclustered.Peoplewhosmoke,forinstance,arealsomorelikelytodrink,andthosewhoaremoredietconsciousnessarealsomorephysicallyactive.Peopleoflowsocio-economicstatusaremorelikelytohaveunhealthydietsandmorelikelytosmoke.Therefore,thesebehaviorsoccurwithinasocialcontextandarenotjustanexpressionofindividualchoice.3.PsychosocialPathwayHealthmaybeaffectedbypsychosocialmechanismsattheindividuallevel(e.g.vianerve-endocrineandimmunesystemresponses).Thelistofpotentiallycontributingpsychosocialfactorsisbroadandincludesamixofstimuliorcharacteristicsoftheenvironment(suchasdemand/strainatworkorelsewhere,jobinsecurity,socialnetworks),andcharacteristicsoftheindividual(suchascoping-patterns[應(yīng)對(duì)方式],perceptions[感性認(rèn)識(shí);觀念]andself-esteem).健康health教育education營養(yǎng)nutrition生育reproduction經(jīng)濟(jì)economy

社會(huì)因素交互作用示意圖

interactionofsocialfactorsSection2SocialSystemandHealth1.ThebasicframeworkofsocialsystemSocialsystemEconomicsystemFamilysystemOriginalsystemDerivedsystemPoliticalsystemEducationsystemReligionsystem3.Healthcaresystemandhealth(1)Healthcaresystemiscomponentofsocialsystem.(2)Differenttypesofmedicalpayment1)socializedmedicalpayment2)medicalinsurancesystem3)medicalself-paymentsystem(3)TheeffectofdifferentmedicalpaymentsTypesofmedicalpaymentfairnessefficiencyServicequalitysocialized++++++Medicalinsurance+++++++Self-payment+++++++apoplexy:cause-effectframeworkMedicalinsuranceSelf-paymentSocialmedicinehighestlowerlowestVisitrateHospitalizationrateSection2Economyandhealth一、theeconomiclevelandhealthlevel二、thesocialstratificationandhealth

一、Therelationshipbetweeneconomyandhealth

Intheory,thereisdialecticalrelationshipbetweeneconomicdevelopmentandhealthstatus.theeconomicdevelopmentprovidessubstantialsupporttoimprovepeople’shealthstandard.thepopulationhealthtakesonancrucialfactorfortheimprovementandeconomicprosperity.經(jīng)濟(jì)因素并非經(jīng)濟(jì)收入的代名詞，它還包括人類的：它既是人類社會(huì)發(fā)展的主體形式，又是人類賴以生存和保持健康的基本條件。Economicfactorsarenotsynonymouswitheconomicincome,italsoincludeshumanbeings:food,clothes,house-living,traffics,andsoon.itisthemainformofdevelopmentofhumansociety,butalsoofhumansurvivalandtomaintainahealthyfundamentals.

TakeSaudiArabiaAsexampletoshowthisideaDevelopmentlevelofeconomyandhealth

經(jīng)濟(jì)發(fā)展水平與健康PositiveimpactofeconomicdevelopmentonhealthNegativeimpactofeconomicdevelopmentonhealthPositiveimpactofhealthoneconomicdevelopment經(jīng)濟(jì)發(fā)展水平對(duì)健康的促進(jìn)作用經(jīng)濟(jì)發(fā)展對(duì)健康的負(fù)面作用健康水平的提高對(duì)經(jīng)濟(jì)發(fā)展的正向作用（一）經(jīng)濟(jì)發(fā)展水平與健康水平具有正相關(guān)關(guān)系

Question1:ThereispositiverelationshipbetweeneconomiclevelandthehealthlevelEvidence1:Relationshipbetweentheindicatorsofhealthstatusandeconomicdevelopmentinsomecountries

nationsGNPCBRCMRIMRE0

國家人均GNP出生率死亡率嬰兒死亡率平均期望壽命

(美元)‰‰‰(歲)

瑞典2483013124.878

日本314501074.379

美國247501598.076

澳大利亞175101576.178

中國4901864469

斯里蘭卡60021619.473

墨西哥37502753472

巴西30202585866

埃及6603086264

印度2902997460

坦桑尼亞10045159249

摘自：美國人口咨詢局編印《1995年世界人口數(shù)據(jù)表》Evidence2:foreconomyandhealthrelationtheoryEvidence3:thechangingtrendoftherelation

betweeneconomyandhealth?thechangingtrendoftherelation

betweeneconomyandhealth

Conclusion:takesonanpositivelinearrelationship.GDPrateHealthlevelTimepassingnumbersQuestion2:howdoeseconomyinfluencehealth?economyIncomeSocialstatusEducationbackgroundHealthresourcesNutrition

nutritionandhealthstatus1.總攝入熱量，與平均期望壽命呈正相關(guān)。

Totalenergyintakeandlifeexpectancyhaspositivecorrelation2.食物營養(yǎng)結(jié)構(gòu)(nutritionstructure)：Protein:Fat

:Carbohydrate=

3:4:13,蛋白質(zhì)以動(dòng)物蛋白及植物蛋白各占50％為宜CanIwouldbetallerthanwhatIamnow?

表4—3每人每日攝入熱量(Calorie

intake)和平均期望壽命的關(guān)系

平均期望熱量(kcal)

壽命(歲)國家數(shù)

＜17501750-19902000-24902500-2900＞3000

＜353615282—

45—2822195—

55—2229165—

65—44一一81224

合計(jì)130510612424

注：1cal＝4.1840kl資料來源：顧杏元主編社會(huì)醫(yī)學(xué)天津科學(xué)技術(shù)

出版社1995

(一)Summeryforpositiverelationbetweeneconomiclevelandthehealthlevel（小結(jié)）1.Theeconomyprovidesessentialconditionsforenergyandnutrients.2.Adequateincomeguaranteestheabilityofthemedicalcareresources.3.Economicdevelopmentprovideswithagoodworkingandlivingenvironment.4.Goodeconomicconditionisabaseforhighereducationbackground,whichcanbebettertopursuithealthierlifestyle.

1、環(huán)境污染和破壞嚴(yán)重，大量化學(xué)合成物進(jìn)入人類生活。SeriousenvironmentalpollutionanduseofChemosynthesisproductsinourdailylife（二）經(jīng)濟(jì)發(fā)展對(duì)健康的負(fù)面作用

Negativeimpactofeconomicdevelopmentonhealth

2、心理壓力突出,導(dǎo)致不良生活行為。Unhealthybehaviorsandgreatmentalstrainandpressure3、社會(huì)負(fù)性事件增多、造成大量人口死亡和傷殘。Socialnegativeeventsincreased,resultinginalargenumberofdeathanddisability.4、社會(huì)流動(dòng)人口增加增加了傳染病的傳播幾率和防控難度。Forpopulationincreaseinsocialmobility,itgetmoredifficulttopreventandcontrolthespreadofinfectiousdiseases.全國流動(dòng)人口數(shù)量從１９９３年的７０００萬增加到２００３年的１．４億，１０年內(nèi)翻了一番，超過了全國人口總數(shù)的１０％，約占農(nóng)村勞動(dòng)力的３０％。（二）經(jīng)濟(jì)發(fā)展對(duì)健康的負(fù)面作用（小結(jié)）

Negativeimpactofeconomicdevelopmentonhealth1、環(huán)境污染和破壞嚴(yán)重，大量化學(xué)合成物進(jìn)入人類生活。SeriousenvironmentalpollutionanduseofChemosynthesisproductsinourdailylife2、心理壓力突出,導(dǎo)致不良生活行為。Unhealthybehaviorsandgreatmentalstrainandpressure3、社會(huì)負(fù)性事件增多、造成大量人口死亡和傷殘。Socialnegativeeventsincreased,resultinginalargenumberofdeathanddisability.4、社會(huì)流動(dòng)人口增加增加了傳染病的傳播幾率和防控難度。Forpopulationincreaseinsocialmobility,itgetmoredifficulttopreventandcontrolthespreadofinfectiousdiseases.Question3:

what’stheproblemscausedbyeconomy?

1.Environmentalpollutionanddestruction2.Changinglifestyle－syndromeofair-condition3.migration—redeye's;hepatitis;infectiousskin

disease.4.Psychologicalproblem

intensivecompetition--spiritualpressure--mentaldisease-suicideBloom等(2001)也認(rèn)為人均期望壽命每增加1年，將會(huì)使產(chǎn)出上升4％。Thereexistsacorrelationbetweenbetterhealthandhighereconomicgrowth(Figure10)forhealthdeterminesjobproductivity,thecapacitytolearninschoolandthecapabilitytogrowintellectually,physicallyandemotionally.Eliminationofdiseaseandimprovementofindividualhealthwillenhanceincome-earningcapacityoverthreetimes.（三）健康水平的提高對(duì)經(jīng)濟(jì)發(fā)展的促進(jìn)作用(三)增進(jìn)健康可以從四個(gè)不同方面促進(jìn)經(jīng)濟(jì)增長：

thepromotiontoeconomygrowthbythehealthstatus1.健康狀況影響個(gè)人的勞動(dòng)市場的表現(xiàn).thehealthstatusinfluencethepresenceoflaborMarket.2.促進(jìn)對(duì)自然資源的利用.Topromotetheutilizationofnaturalresources.3.促進(jìn)教育收益的實(shí)現(xiàn).Toimpetustheeducationalprofit.4.減少疾病的直接或間接損失,從而促進(jìn)經(jīng)濟(jì)增長.Todiminishthedirectorindirectlossesofdiseases.ConceptandconnotationofsocialclassCategoryofSocialclassindifferentcountriesRelationshipbetweensocialclassandhealth社會(huì)階層的含義社會(huì)階層的分類社會(huì)階層與健康的關(guān)系二、社會(huì)階層與健康Socialclassandhealth

社會(huì)階層是西方社會(huì)學(xué)的一個(gè)重要概念，主要是指由財(cái)富、權(quán)力、和聲望不同造成的社會(huì)地位、生活方式等方面不同的社會(huì)層次。社會(huì)階層

socialclass資料來源:中國社會(huì)科學(xué)院社會(huì)學(xué)研究所研究員陸學(xué)藝研究報(bào)告構(gòu)成比(%)Resource:Variationsinpopulationhealthstatus:resultsfromaUnitedKingdomnationalquestionnairesurvey【視覺模擬】PaulKind,PaulDolan,,ClaireGudex,andAlanWilliams,UKBMJ.1998March7不同階層的人群健康狀況有明顯的不同,其發(fā)生作用的路徑是：行為生活方式、資源的利用能力。

Disparityofhealthstatueamongdifferentpopulationsinvarioussocialclass

Evidenceforeconomyandhealthrelationtheory---2Annualincomehospitalizationdayslessthan2000.44200-2990.34300-3990.37400-4990.78morethan5000.52citizendoctorconsultation(times)thepoor2.3subsistence2.6therich3.2well-off2.6Section3SocialCultureandHealth“oncepeople’slivingconditionsexceedatleastthenecessaryrequirement,andtheyknowhowtouselivingmaterials,thenculturefactorsbecomemoreandmoreimportanttohealth.”(6threportofWHO)“Cultureiseverywhere,itaffectspeople’sthoughts,activitiesandtheirhealth.”(Keledo

Kelukeho,aculturalhumanistandsociologistofU.S.A)Theculture-relateddiseasesCultureCoronaryheartdiseaseCerebrovasculardiseasetuberculosishepatitis1.conationaboutculture(1)StructureofcultureculturespiritualwealthmaterialwealthreligionandfaiththoughtsandconsciousnessMorals,customs,andnormPhilosophyandart生理健康心理健康思想文化文化規(guī)范文化智能文化科技知識(shí)物質(zhì)文化生活資料生產(chǎn)資料生活環(huán)境勞動(dòng)條件精神生活心理狀態(tài)生活方式與行為社會(huì)組織制度政治法律形式倫理道德風(fēng)俗習(xí)慣語言、教育思想意識(shí)觀念形態(tài)宗教信仰文學(xué)藝術(shù)等(1)Sociality:formedbygroupsinsteadofindividual(2)Historicity:changeableinsteadofstatic(3)Inheritance:onceformed,itwouldbeinheritedfromgenerationtogeneration(4)Complexity:intersectingandinterconnectedwithvariousfactorsofculture.(5)Transitivity:onceproduced,willbecopied,followedandused(2)Characteristicsofculture(3)CultureroleinsocietyThemarkofsocietyorraceboundaryAdjustindividualbehaviorasnormThebaseofsocietyunificationMolding(塑造)thesociety２．CultureandhealthPhilosophyandhealthEducationandhealthMusicandhealthCustomsandhabitsandhealthMoralandhealthReligionandhealthSocialPsychology,behaviorandHealthnormsandhealth（１）Philosophyandhealth

YIN-YANGtheoryAstronomy,geographyandpersonbeaunitedone;YING-YANGisthesourceofchangesincosmos.ThetheoryYING-YANGisbasedonthecoordinativebalanceontheoppositionandunification,whichistheconditionformankindexistenceandhealth.OnceYING-YANGlosesequilibrium,calamityordiseasewouldoccurred.

（2）Educationandhealth1)What’stherelationbetweeneducationbackgroundanddeathrate?2)Whymother’seducationbackgroundaffectinfantmortality?3)What’sthesituationinyourcountryorregion?1)Linearrelationofthetwovariables（educationandmortality）educationalyearsilliterate0deathrate2)Myviewaboutmother’seducationinfluencingoninfantmortalityMoremedicalknowledgeaboutpreparationduringpregnancy,birth-born,andchild-care.Tobebetterdiscriminatingabilitytodangerousfactors,topreventchild’sdisease.Morecoordinativeabilitywithdoctor.Canyougiveusmorethinkingaboutit?3)what’syouropinionaboutmotherinfluencinginfanthealth?(3)MusicanddiseasetreatmentGaston,whoisAmericanmusic-treatingfather,pointout:“themusicisakindofhumanfeeling,andisnotonlybecausemankindcreateit,butalsomankinddevelopstherelationwithit”Musicandhealth

1)ToproducephysiologicalreactionMusicrhythmphysiologicalresponseheartratemusclepotential電位pulsespeedbloodpressureendocrineBrainwave2)Aspecialkindofcommunicationwithnon-phoneticconnotation.3)Helpfulinclinicaltreatment.(TitanicsonginOperatingroom)4)Toproducestrengthandpower.(4)CustomsandhabitsandhealthCustomscontactwiththeperson’sdailylifeclosely,relatingtotheirhealth.

ex.Eatingcustom

Goodhabitarebeneficialtohealth,andbadoneswilldoharmforcrowd’shealth.

ex.Spittingateasetuberclerodbacteriainphlegmcanspreadamongthecrowds.(5)MoralandHealthThemoralisthetotalofbehaviornormonbothpersontoperson,andpersontosociety.Itisaspiritpowerdependingonthesocialpublic,faithandeducation.Theroleofmoraltohealthliesinitsprotectingfunction.(6)Religionandhealth

1)Religionisashadeandup-sidedownreflectioninpeople’sbrainbyrulingpeople’snaturepowerandsocialpower;andisasocialconsciousnesscontrollingpeople’sfatebysupernaturalentity,namelythespirit’sfaithandsocialpower.2)Twosidesofreligioneffectonhealththepositivefunction:faithtreasurement

regionfolloweroftentakeitaslifelongfaith,andcontroltheirbehavior.Ex,Judaism:skinwreathbecutofffrompenis.

thenegative

functionsomereligiouscustomsharmfultohealth.Ex.Hinduism.WashanddrinkthewaterofaGangesRivercholeradiseasespreadinIndiafor6timesinhistory.(7)SocialPsychology,behaviorandHealth1)PositivefunctionofpsychologyChineseconfuciustheme“thedoctrineofthemean”Kal.Marx:“afinemood,comparedwithtengoodmedicine,canrelievethephysicalexhaustionsandpainmore”

biologicalexplanationforthefunctionofgoodmoodenhancingimmunesystemgoodmoodnerveendocrine:endocrinesecrete（分泌）informationnumerator:hormone,neuropeptides(神經(jīng)肽),etc.cellimmunity:enhancethe

immunityfunctionNegativepsychologyisthestimulusfordiseaseAnimportantfactortocausethementalandsuicidesorroworstainmentalitymediumimpactcoronaryheartdiseasehypertensionbronchialasthma(哮喘)Abscess,(膿腫)cancer2)Negativefunctionofpsychology(8)Behaviorandhealth

People’behaviormeansthateverybodywiththecapabilityofcognitionandthoughtcanmakemotileresponse.

healthybehavior

unhealthybehavior

intrinsicbehaviorExtrinsicbehaviorbehavior1)

Behaviorimprovinghealth1.ThecharacterizedstandardsBeneficialRegularityHarmonyCommunalityadaptability2.TheapproachtohealthinbehaviorReasonablefoodProperexercisesQuitsmokingwhilealcohollimitBalanceofpsychologicalstatus2)Behaviorendangeringhealth1)charactersofBehaviorendangeringhealthLong-periodTheacquiredhabitbeoffreewillBeofobvioushealthdanger2)DangeroushabitstohealthBadpersonallifehabitBadpersonalandpubliclifehabitBadaddictionbehaviorBadsexualbehavior(9)normsandhealthExample:1.gambling2.freak-out3.smoking4.sexual-lifewithoutmarriage四、家庭、婚姻與健康

Section4themarriageregulationandhealthstatus（一）家庭及其類型家庭是以血緣或收養(yǎng)關(guān)系為紐帶而結(jié)成的社會(huì)生活的基本單位。最基本的家庭類型核心家庭直系家庭

聯(lián)合家庭不完整家庭(單身、單親、丁克)FamilystructureandhealthFamilystructure:familymembercompositionMarkedbymarriageandkinshipTypes:Corefamily,e