社會(huì)醫(yī)學(xué)SocialMedicine

哈爾濱醫(yī)科大學(xué)社會(huì)醫(yī)學(xué)教研室

第一章概論

ChapteroneIntroduction社會(huì)醫(yī)學(xué)的概念、性質(zhì)、內(nèi)容和任務(wù)社會(huì)醫(yī)學(xué)的發(fā)展社會(huì)醫(yī)學(xué)基本觀點(diǎn)社會(huì)醫(yī)學(xué)與其他學(xué)科的關(guān)系concept,nature,contentsandtasksDevelopmentBasicthinkingRelationwithothersubjectsWhatissocialmedicine?

什么是社會(huì)醫(yī)學(xué)？Medicinesociology社會(huì)學(xué)政治學(xué)經(jīng)濟(jì)學(xué)倫理學(xué)管理學(xué)基礎(chǔ)醫(yī)學(xué)臨床醫(yī)學(xué)預(yù)防醫(yī)學(xué)Whatismedicine?

什么是醫(yī)學(xué)Thesciencerelatedtothediagnosisunderstandingpreventiontreatmentofillness.Whatissocialmedicine?定義：是一門交叉學(xué)科，研究：1.社會(huì)因素健康和疾病2.制定社會(huì)衛(wèi)生策略和措施3.保護(hù)和促進(jìn)健康1.Interactionsandlawbetweenthesocialfactorsandhealth&disease;2.Stipulatesocialhealthstrategyandmeasures;3.Protecthealth&improvelifequality,givethefulldisplayofthesocialfunctionofhealth.

Humanbeingismoreofthesocialcreaturethantheanimal.itssocialattributeisthefundamentalnature.NewconceptofHealthbyWHO1948:

Healthisastateofcompletephysical,

mentalandsocialwell-beingandnotmerelytheabsenceofdiseaseorinfirmity.Whyweneedtolookatthesocialfactors?

人的本質(zhì)屬性：在于其社會(huì)屬性WHO：1948新的健康定義:健康是：身體心理社會(huì)的完好狀態(tài)，而不僅是沒有疾病或身體虛弱而已。人類的雙重屬性

ThedualnatureofhumanbeingsAristotle:humanbeingsare,bynature,socialanimals

社會(huì)屬性

Socialnature

生物屬性

BiologicalnatureDoesitmattertohealth?What’sRelationshipbetweensocialfactorsandhealth?

WHOputforward:SocialdeterminantsforHealth政治經(jīng)濟(jì)文化環(huán)境社會(huì)保障制度生活方式和行為衛(wèi)生保健體制霍普金斯大學(xué)的研究小組通過對(duì)伊拉克全國(guó)47個(gè)區(qū)進(jìn)行調(diào)查走訪形成的報(bào)告認(rèn)為，美國(guó)發(fā)動(dòng)伊拉克戰(zhàn)爭(zhēng)造成了65.5萬(wàn)伊拉克人死亡，平均每天死亡500人

人口爆炸?。。》侵揠y民美國(guó)哥倫比亞大學(xué)教授、聯(lián)合國(guó)前秘書長(zhǎng)安南的特別顧問JEFFREYSACHS先生SACHS教授說(shuō)：2003年的發(fā)展議題被擠出了國(guó)際議程，戰(zhàn)爭(zhēng)與反恐取代了發(fā)展。艾滋病每天奪去數(shù)以千計(jì)的生命，由于貧困買不起挽救生命的藥品而死亡；“911”災(zāi)難奪走了3000多人的生命，從而主宰了兩年多的世界議程。世界上每天有20，000多人死于貧困、疾病、災(zāi)害世界軍費(fèi)開支將達(dá)9000億美元，而用于發(fā)展援助為500億美元，用于艾滋病防治僅10億美元。RudolfVirchow:

Germanpathologist1.Socialandeconomicconditionsprofoundlyimpacthealth,diseaseandthepracticeofmedicine.2.Thehealthofthepopulationisamatterofsocialconcern.3.Societyshouldpromotehealththroughbothindividualandsocialmeans.

1.社會(huì)經(jīng)濟(jì)條件對(duì)健康、疾病和醫(yī)學(xué)實(shí)踐具有深刻的影響；2.群體的健康應(yīng)該成為社會(huì)關(guān)注的內(nèi)容;3.社會(huì)應(yīng)該通過個(gè)人和社會(huì)的手段來(lái)改善人群健康。社會(huì)醫(yī)學(xué)的研究?jī)?nèi)容

Contentsofsocialmedicine:Socialhealthstatus,mainlypopulationhealthstatus;Influencefactors;especiallysocialfactors

Socialhealthstrategiesandmeasures;研究社會(huì)衛(wèi)生狀況，主要是人群健康狀況;研究影響人群健康的因素，主要是社會(huì)因素;研究社會(huì)衛(wèi)生策略與措施。

社會(huì)醫(yī)學(xué)的核心內(nèi)容

CoreContents

Identifysocialhealthproblems—diagnosisofproblemsAnalysisofsocialcausesofdiseases—socialetiologySocialmedicineprescription--socialstrategy----社會(huì)醫(yī)學(xué)診斷----社會(huì)病因分析----社會(huì)醫(yī)學(xué)處方

社會(huì)醫(yī)學(xué)與臨床醫(yī)學(xué)的比較社會(huì)醫(yī)學(xué)：群體

socialmedicine:mainlytargetatpopulationlevel發(fā)現(xiàn)社會(huì)問題－－社會(huì)診斷

Identifysocialproblem—socialdiagnosis社會(huì)醫(yī)學(xué)分析－－了解社會(huì)成因

Socialmedicalanalysis—findoutsocialcauses社會(huì)醫(yī)學(xué)綜合處方

Socialcomprehensivetherapy臨床醫(yī)學(xué)：主要針對(duì)個(gè)體

Clinicalmedicine:mainlytargetatindividuallevel了解個(gè)體健康問題－－醫(yī)學(xué)診斷

Identifyindividualhealthproblem---medicaldiagnosis開展病因?qū)W分析:主要是生物學(xué)病因分析

Etiologicalanalysis:biologicalcausesanalysis制定醫(yī)學(xué)處方

Providemedicalprescription

社會(huì)醫(yī)學(xué)的性質(zhì)

TheNatureofSocialMedicineInterdisciplinarysubject—socialscienceandmedicineSyntheticresearchmethodsPracticalityofsocialmedicine醫(yī)學(xué)和社會(huì)學(xué)的交叉學(xué)科采用綜合的研究方法社會(huì)醫(yī)學(xué)的實(shí)踐性社會(huì)醫(yī)學(xué)的任務(wù)

ThetasksofsocialmedicineAdvocatepositiveconceptofhealthToimprovesocialhealthstatus,enhancepopulationhealthandqualityoflifeToformulatehealthpolicy&strategiesToconductpreventivecareservicesforspecialpopulationandspecificdisease

倡導(dǎo)積極的健康觀改善社會(huì)衛(wèi)生狀況;提高人群健康水平和生命質(zhì)量;制定衛(wèi)生政策和策略；開展特殊人群和特種疾病的預(yù)防保健工作;

BasicthinkingofsocialmedicineHarmoniousrelationshipbetweenhealthandsocialdevelopmentTwowayinteractionbetweenhealthandsocialeconomicdevelopmentI.協(xié)調(diào)發(fā)展的觀念I(lǐng)I.雙向作用的觀念美國(guó)學(xué)者M(jìn)ushkin計(jì)算出了美國(guó)在1900—1960年人口死亡率下降帶來(lái)的經(jīng)濟(jì)收益約為8200億疾病對(duì)人力資本和勞動(dòng)生產(chǎn)率造成損失的“3D”框架

(Death,Disability，Debility）BasicthinkingofsocialmedicinePositiveconceptofhealth—Bio-psycho-socialmedicalmodelIII.現(xiàn)代醫(yī)學(xué)模式下的積極健康觀USA19000億1%最不健康20％20％慢病病人70％70%健康人10%吸煙已成為全球第二號(hào)殺手IV.關(guān)注高危人群&高危因素Highriskfactors&populationBasicthinkingofsocialmedicineBasicthinkingofsocialmedicineImportantroleofsocialfactorsinpreventionandtreatmentofdiseasesMultisectorparticipationV.社會(huì)因素在疾病防治中的重要作用VI.多部門參與人事人口&計(jì)劃生育勞動(dòng)&社會(huì)保障教育計(jì)劃、財(cái)政藥品監(jiān)督管理衛(wèi)生社會(huì)醫(yī)學(xué)發(fā)展史

ThehistoryofsocialmedicineEmbryonicstageofsocialmedicineEstablishment&developmentofsocialmedicineDevelopmentofsocialmedicineinChina社會(huì)醫(yī)學(xué)的萌芽社會(huì)醫(yī)學(xué)的創(chuàng)立和發(fā)展我國(guó)社會(huì)醫(yī)學(xué)的發(fā)展Embryonicstageofsocialmedicine:

Hippocrates

“Air,WaterandPlaces”stressontheimpactsofenvironment,winddirection,sunlight,waterqualityandcitizen’slifestyleonpeople’shealth.--“Itismoreimportanttoknowwhatsortofpersonhasadiseasethantoknowwhatsortofdiseaseapersonhas.”Hippocrates,bornin460bc,fatherofmodernmedicine.PathogenesisofdiseaseandtheroleofdoctorsTheexternalinfluencesoffoodanddrinkandclimaticfactorsofexcessiveheatandcoldinfluenceinternalmechanisms.Theroleofthephysicianwastorestoretheequilibriumofhealth.TheHumouraltheorywasaholisticview.飲食和氣候等外部因素可以通過影響人類的內(nèi)在機(jī)制而起左右。醫(yī)生的職責(zé)是恢復(fù)健康平衡;四體液學(xué)說(shuō)體現(xiàn)了整體醫(yī)學(xué)觀Embryonicstageofsocialmedicine1.

Galen:focusonpsychologicalfactorsuponhealth；2.PeterFrank:miserablelifeisthehotbedofdiseases;“theNationalSupervisionSystem”—supervisionplan—governmentmeasurestoprotectpublichealthFirstpersonputforward:adoptsocialhealthmeasurestocontroldisease古羅馬醫(yī)師蓋倫：重視心理因素對(duì)健康的影響;德國(guó)社會(huì)衛(wèi)生學(xué)家:弗蘭克:

悲慘的生活是疾病的溫床;<全國(guó)醫(yī)學(xué)監(jiān)督體制>:

用醫(yī)學(xué)監(jiān)督計(jì)劃使政府采取措施保護(hù)公眾的健康;

第一個(gè)提出社會(huì)衛(wèi)生措施社會(huì)醫(yī)學(xué)的建立和發(fā)展

EstablishmentanddevelopmentofSocialMedicineFrenchmanJulesGuerin:firstperson–SocialmedicineScatteredmedicalsupervision;publichealthandforensicmedicineshouldbeintegratedintoSocialmedicine:dividedinto4parts:SocialphysiologySocialpathologySocialhygieneSocialtherapeutics法國(guó)醫(yī)生儒勒.蓋林—第一次提出社會(huì)醫(yī)學(xué);建議將分散的醫(yī)學(xué)監(jiān)督、公共衛(wèi)生、法醫(yī)學(xué)構(gòu)成一個(gè)整體：社會(huì)醫(yī)學(xué)——分為四個(gè)部分；社會(huì)生理學(xué)；社會(huì)病理學(xué)；社會(huì)衛(wèi)生學(xué)；社會(huì)治療學(xué)。德國(guó)病理學(xué)家魏爾嘯

GermanPathologist:RudolfVirchow醫(yī)學(xué)科學(xué)的核心是社會(huì)科學(xué)醫(yī)學(xué)是一門社會(huì)科學(xué)；任何社會(huì)都應(yīng)對(duì)居民的健康負(fù)責(zé)政治學(xué)是廣義上的醫(yī)學(xué)實(shí)現(xiàn)醫(yī)學(xué)目標(biāo)的最好的辦法是將醫(yī)學(xué)和社會(huì)生活和政治活動(dòng)結(jié)合起來(lái)

德國(guó)：格羅蒂楊

GermanA.GrotjahnPutforwardtheoryofsocialpathologyWrite:“socialPathology”

suggeststhatdiseaseshouldbestudiedfromthestandpointofsocialview;Isafirstpersongivenlectureonsocialhygiene提出社會(huì)病理學(xué)的理論和概念;<社會(huì)病理學(xué)>用社會(huì)觀點(diǎn)研究人類疾病的原則首次在柏林大學(xué)開設(shè)社會(huì)衛(wèi)生學(xué)講座Germany：BirthplaceofsocialmedicineBeforeWWIISocialhygieneSocialmedicineLater－－becomesocialmedicine德國(guó)是社會(huì)醫(yī)學(xué)的發(fā)源地二戰(zhàn)前：使用社會(huì)衛(wèi)生學(xué)和社會(huì)醫(yī)學(xué)后改為社會(huì)醫(yī)學(xué)

社會(huì)醫(yī)學(xué)在各國(guó)的發(fā)展

DevelopmentofSocialMedicinein

differentcountriesInUK,courseofsocialmedicineisoffered,socialmedicineresearchinstitutewasestablishedinOxfordUniversityProfessorJohnRyle:allpublichealth,industrialhealth,socialhealthandmedicalcarebelongtosocialmedicineIn1960s,socialmedicinewaschangedintocommunitymedicine

英國(guó):40s開設(shè)社會(huì)醫(yī)學(xué),在牛津大學(xué)成立社會(huì)醫(yī)學(xué)研究院；牛津大學(xué)賴爾教授:公共衛(wèi)生、工業(yè)衛(wèi)生、社會(huì)衛(wèi)生服務(wù)、公共醫(yī)療事業(yè)都屬于社會(huì)醫(yī)學(xué)的范疇；60s社會(huì)醫(yī)學(xué)改成社區(qū)醫(yī)學(xué)。

社會(huì)醫(yī)學(xué)在美國(guó)的發(fā)展

InUnitedStatesMedicalsociologyandfamilymedicinedevelopedEmphasisonsociology,managementandeconomicsSocialmedicinewasincludedinthecourseofhealthmanagementandhealthpolicy醫(yī)學(xué)社會(huì)學(xué)和家庭醫(yī)學(xué)得到了發(fā)展強(qiáng)調(diào)社會(huì)學(xué)、管理學(xué)和經(jīng)濟(jì)學(xué)社會(huì)醫(yī)學(xué)包含在衛(wèi)生管理學(xué)和衛(wèi)生政策學(xué)的講座內(nèi)容中

社會(huì)醫(yī)學(xué)在中國(guó)的發(fā)展

SocialmedicineinChinaIn50s,courseofHealthCareOrganizationisacompulsorycourseformedicalstudent,；In80s,MinistryofHealthsetup6trainingcentreofhealthadministration,socialmedicinewasthemaincourse；90%ofmedicalcollegeofferedcourseinsocialmedicine.50年代：《保健組織學(xué)》作為醫(yī)學(xué)生的必修課，成立保健組織教研組80年代：衛(wèi)生部成立6所衛(wèi)生管理干部培訓(xùn)中心，社會(huì)醫(yī)學(xué)成為主干課程90%以上的醫(yī)學(xué)院開設(shè)了社會(huì)醫(yī)學(xué)課程PreventivemedicineCommunitymedicineMedicalsociologyHealthmanagementMedicalpsychology

社會(huì)醫(yī)學(xué)與其他相關(guān)學(xué)科的關(guān)系

Therelationshipbetweensocialmedicine

andotherrelatedsubjects預(yù)防醫(yī)學(xué)社區(qū)醫(yī)學(xué)醫(yī)學(xué)社會(huì)學(xué)衛(wèi)生管理學(xué)醫(yī)學(xué)心理學(xué)PreventiveMedicinePreventivemedicinestudieshownaturalandsocialfactorsaffectpeople’shealth:HowDiseaseoccurredandspread

putpreventionfistThree-stagepreventivemeasuresfocusonmedicalprevention

Bio-preventivestrategymainly

Socialmedicinegrowoutofpreventivemedicine

SocialMedicineVsC