社会医学

,*,政策：政策是指政党和国家(或者政府)在一 定历史时期为实现某种政策目标或完 成某项任务而制定的行为规范和活动 指南，是进行政治决策的一种成果形式。 WHO卫生政策定义：“改善卫生状况的目标，这些目标中的重点，以及实现这些重点目标的主要途径。,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,社会医学,Social Medicine,社会医学教研室,第一章 概 论,Chapter one Introduction,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 tasks,Development,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,Human behavior,Culture,Value,Structure of,society,Social,interaction,Socialization,Social,institutions,Dynamic of,Society,Social change,Social life,Sociology,What is medicine?什么是医学,The science related to the,diagnosis,understanding,prevention,treatment of illness.,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 ,2. Stipulate social health strategy and measures;,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 nature,Does it matter to health?,Whats Relationship between social factors and health?WHO put forward: Social determinants for Health,Politics,Economy,Culture,Environment,Social security system,Life style and behaviors,Health 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,A,nalysis of social causes of diseases social etiology,Social 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 medicine,Synthetic research methods,Practicality 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 health,To improve social health status, enhance population health and quality of life,To,formulate health policy & strategies,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;,Basic thinking of social medicine,Harmonious relationship between health and social development,Two 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,USA,19000亿,1%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 diseases,Multisector participation,V.社会因素在疾病防治中的重要作用,VI.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,Embryonic stage of social medicine,Establishment & development of social medicine,Development 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 medicine,Scattered medical supervision; public health and forensic medicine should be integrated into Social medicine: divided into 4 parts:,Social physiology,Social pathology,Social hygiene,Social 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G,erman Pathologist: Rudolf Virchow,The kernel of medical science is social science,“Medicine is a social science,Politics is nothing more than medicine in broad sense,Best 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 pathology,Write :,“ 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 WWII,Social hygiene,Social medicine,Laterbecome 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 University,Professor John Ryle:,all public health, industrial health, social health and medical care belong to social medicine,In 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 developed,Emphasis on sociology, management and economics,Social 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 medicine,Community medicine,Medical sociology,Health management,Medical psychology,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,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 medicine,More practical,Operational,Both target at population level,Intermediate level,Share same origin with social medicine,The Practice of social medicine facilitate the development of theory of social medicine,Social medicine,More theoretical,Macro mainly at policy level,Offer guiding principle,Theory of social medicine be practiced in community medicine,More theoretical, offer principle and guidance to CM,Medical Sociology,Medical sociology belong to the disciplinary group of sociology;,C,oncerned with socialcauses and consequences of health andillness;,Social aspects of health and illness;,Social functions of health organizations &institutions,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,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?,参考文献 references,李鲁主编：社会医学 第二版,龚幼龙主编：社会医学第一版,WHO：social determinants of health；,World Bank：Macro economy and health；,WHO ：2002 world health report：Reducing risks，and Promoting Healthy Life Style,WBI： Getting Health Reform Right。 World Bank 2002,