《社會(huì)醫(yī)學(xué)》課件1社會(huì)醫(yī)學(xué)概論

1、第一章 社會(huì)醫(yī)學(xué)緒論 Chapter 1 Introduction什么是社會(huì)醫(yī)學(xué)？What is social medicine?為什么要學(xué)習(xí)社會(huì)醫(yī)學(xué)？Why do we have to learn it?如何學(xué)習(xí)社會(huì)醫(yī)學(xué)？How to learn social medicine?內(nèi) 容Contents社會(huì)醫(yī)學(xué)的概念、性質(zhì)、研究?jī)?nèi)容和任務(wù)社會(huì)醫(yī)學(xué)的發(fā)展社會(huì)醫(yī)學(xué)基本理論社會(huì)醫(yī)學(xué)與其他學(xué)科的關(guān)系concept, nature, contents and tasksDevelopment Basic thinking Relation with other subjects一、什么是社會(huì)醫(yī)學(xué)社會(huì)醫(yī)學(xué)

2、（Social Medicine） ：是從社會(huì)的角度研究醫(yī)學(xué)和健康問題的一門交叉學(xué)科；它研究社會(huì)因素與個(gè)體及群體健康和疾病之間相互作用及其規(guī)律，制定相應(yīng)的社會(huì)策略和措施，保護(hù)和增進(jìn)個(gè)體及群體的身心健康和社會(huì)活動(dòng)能力，提高生命質(zhì)量，充分發(fā)揮健康的社會(huì)功能，提高人群的健康水平。What is social medicine?什么是社會(huì)醫(yī)學(xué)？醫(yī)學(xué)Medicine社會(huì)學(xué)sociology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)社會(huì)醫(yī)學(xué)法規(guī) 政策生活方式 宗教 收入水平 文化社會(huì)階層 教育 人口 社會(huì)因素 What is medicine?什么是醫(yī)學(xué)The science related

3、to the diagnosis prevention treatment of illness. 社會(huì)醫(yī)學(xué)的學(xué)科性質(zhì) - 是醫(yī)學(xué)與社會(huì)科學(xué)相結(jié)合的一門交叉邊緣學(xué)科。 - 連接了自然科學(xué)和社會(huì)科學(xué)兩大領(lǐng)域。人類的雙重屬性The dual nature of human beings Aristotle : human beings are, by nature, social animals 人天生是社會(huì)動(dòng)物 生物屬性 Biological nature 社會(huì)屬性 Social nature Human being is more of the social creature than the

4、 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? 人的本質(zhì)屬性：在于其社會(huì)屬性WHO 新的健康定義: 健康是： 身體 心理 社會(huì) 的完好狀態(tài)

5、，而不僅是沒有疾病或身體虛弱而已。臨床醫(yī)學(xué)預(yù)防醫(yī)學(xué)醫(yī)學(xué)科學(xué)社會(huì)醫(yī)學(xué)知識(shí)來源社會(huì)科學(xué)社會(huì)學(xué)倫理學(xué)管理學(xué)基礎(chǔ)醫(yī)學(xué)經(jīng)濟(jì)學(xué)政治學(xué)社會(huì)醫(yī)學(xué)的知識(shí)來源:社會(huì)醫(yī)學(xué)的研究?jī)?nèi)容 Contents of social medicineSocial health status, mainly population health status;Influence factors ; especially social factors Social health strategies and measures; 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。

6、社會(huì)調(diào)查方法群體社會(huì)衛(wèi)生狀況社會(huì)衛(wèi)生問題尋找發(fā)現(xiàn)人群健康狀況重點(diǎn)保護(hù)人群重點(diǎn)防治對(duì)象研究對(duì)象主要主要找出1.危害人群健康狀況的主要危險(xiǎn)因素；2.采取的重點(diǎn)策略或干預(yù)措施?，F(xiàn)狀、分析、對(duì)策“社會(huì)診斷”三次衛(wèi)生革命的對(duì)象和手段的區(qū)別對(duì)象主要措施第一次傳染病、寄生蟲病、地方病殺蟲滅菌、免疫接種、抗菌藥物、環(huán)境衛(wèi)生工程第二次非傳染性疾病（心腦血管疾病、惡性腫瘤、意外傷害、精神病等）早診，加強(qiáng)監(jiān)測(cè)，改善生活環(huán)境，建立健康的行為生活方式，健康教育與促進(jìn)第三次提高生命質(zhì)量、促進(jìn)全人類健康長(zhǎng)壽和實(shí)現(xiàn)人人享有衛(wèi)生保健自我保健、家庭保健和發(fā)展社區(qū)衛(wèi)生服務(wù)社會(huì)醫(yī)學(xué)的任務(wù)The tasks of social med

7、icineAdvocate positive concept of health and new medical modelTo improve social health status, enhance population health and quality of life To formulate health policy & strategiesTo conduct preventive care services for special population and social diseases control 倡導(dǎo)積極的健康觀和現(xiàn)代醫(yī)學(xué)模式；改善社會(huì)衛(wèi)生狀況;提高人群健康水平

8、和生命質(zhì)量;制定衛(wèi)生政策和策略；開展健康弱勢(shì)人群保健和社會(huì)病控制。二、社會(huì)醫(yī)學(xué)的發(fā)展The history of social medicineEmbryonic stage of social medicineEstablishment & development of social medicineDevelopment of social medicine in China社會(huì)醫(yī)學(xué)的萌芽 社會(huì)醫(yī)學(xué)的創(chuàng)立和發(fā)展我國社會(huì)醫(yī)學(xué)的發(fā)展 Embryonic stage of social medicine:萌芽階段 Hippocrates stress on the impacts of envi

9、ronment, wind direction, sunlight, water quality and citizens life style on peoples health.環(huán)境、風(fēng)向、光照、水質(zhì)、生活方式- “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. Embryonic stage of soc

10、ial medicine1.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古羅馬醫(yī)師蓋倫：重視心理

11、因素對(duì)健康的影響;德國社會(huì)衛(wèi)生學(xué)家:弗蘭克: 悲慘的生活是疾病的溫床; : 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)提出采取社會(huì)衛(wèi)生措施進(jìn)行疾病控制社會(huì)醫(yī)學(xué)的建立和發(fā)展Establishment and development of Social MedicineFrenchman Jules Guerin: first person Social medicineScattered medical supervision; public health and forensic medicine should be integrated into Social medicine:

12、divided into 4 parts:Social physiologySocial pathologySocial hygieneSocial therapeutics法國醫(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)。德國病理學(xué)家 魏爾嘯German Pathologist: Rudolf VirchowThe kernel of medical science is social science“Medicine is a social scienceBest method o

13、f medicine is to combine medicine with social life and political activities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)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 德國：格羅蒂楊German A.GrotjahnPut forward theory of social pathologyWrite : “ social Pathology” suggests that disease should be studied from the standpoint of socia

14、l view;Is a first person given lecture on social hygiene 提出社會(huì)病理學(xué)的理論和概念;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： Birthplace of social medicine德國是社會(huì)醫(yī)學(xué)的發(fā)源地Before WWIISocial hygieneSocial medicineLaterbecome social medicine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)在各國的發(fā)展Development of Social Medicine in different coun

15、tries 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

16、國: 20c40s , 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)在美國的發(fā)展In United StatesMedical sociology and family medicine developedEmphasis on sociology, management and economicsSocial medicine was included in the course of health management and health policy醫(yī)學(xué)社會(huì)學(xué)和家庭醫(yī)學(xué)得到了發(fā)

17、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)在中國的發(fā)展Social medicine in ChinaIn 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 off

18、ered course in social medicine.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 三、社會(huì)醫(yī)學(xué)的基本觀點(diǎn)Harmonious relationship between health and social developmentTwo way interaction between health and social economic developmentI.衛(wèi)生事業(yè)與社會(huì)協(xié)調(diào)發(fā)展的觀念I(lǐng)I.健康與社會(huì)經(jīng)濟(jì)發(fā)展雙向作用的觀念美國學(xué)者M(jìn)ushkin計(jì)算出了

19、美國在19001960年人口死亡率下降帶來的經(jīng)濟(jì)收益約為8200億20世紀(jì)80年代中期，國內(nèi)研究同樣發(fā)現(xiàn)，我國國民生產(chǎn)總值的增加，至少有20%是通過人群健康狀況的改善而獲得的。Basic thinking of social medicinePositive concept of healthBio-psycho-social medical modelIII. 生理、心理、社會(huì)健康的觀點(diǎn)WHO: 健康不僅僅是沒有疾病或虛弱，而是一種身體、心理和社會(huì)的完好狀態(tài)。Health is a state of complete physical，mental，and social well-being

20、 and not merely the absence of disease or infirmity.一級(jí)健康（軀體）：滿足生存條件；沒病即健康。二級(jí)健康（身心）：滿意的生活；有職業(yè)收入，享用科技成果，自由自在的生活。三級(jí)健康（主動(dòng)）：最高層次的健康，接受過適當(dāng)訓(xùn)練，掌握高深知識(shí)和技術(shù)，過著能為社會(huì)作貢獻(xiàn)的生活。IV.關(guān)注高危人群&高危因素High risk factors & populationBasic thinking of social medicine高危險(xiǎn)性高危險(xiǎn)性：是指對(duì)人群健康產(chǎn)生有害影響和不利作用的可能性很大。高危人群：容易受疾病侵?jǐn)_的人群。包括處于高危險(xiǎn)環(huán)境的人群、對(duì)環(huán)

21、境有高危反應(yīng)的人群，以及有高危行為的人群高危環(huán)境：包括自然、社會(huì)和心理環(huán)境高危反應(yīng)：機(jī)體對(duì)刺激缺乏適應(yīng)或耐受，當(dāng)身心和社會(huì)刺激達(dá)到一定強(qiáng)度和持續(xù)時(shí)間后導(dǎo)致一些疾病Basic thinking of social medicineImportant role of social factors in prevention and treatment of diseasesMultisector participationV.社會(huì)因素在疾病防治中的決定作用VI.衛(wèi)生工作要求全社會(huì)參與物價(jià)人口&計(jì)劃生育人力資源&社會(huì)保障教育發(fā)改委、財(cái)政藥品監(jiān)督管理衛(wèi)生Preventive medicineHealt

22、h management Community medicineMedical sociologyMedical psychology Clinical Medicine四、社會(huì)醫(yī)學(xué)與其他相關(guān)學(xué)科的關(guān)系The relationship between social medicine and other related subjects 預(yù)防醫(yī)學(xué)衛(wèi)生管理學(xué)社區(qū)醫(yī)學(xué)醫(yī)學(xué)社會(huì)學(xué)醫(yī)學(xué)心理學(xué)臨床醫(yī)學(xué)Preventive Medicine1、預(yù)防醫(yī)學(xué)(Preventive Medicine) 傳統(tǒng)預(yù)防醫(yī)學(xué) 傳染病(第一次衛(wèi)生革命)（生物預(yù)防） 傳統(tǒng)預(yù)防醫(yī)學(xué) 社會(huì)醫(yī)學(xué) 社會(huì)醫(yī)學(xué)使預(yù)防醫(yī)學(xué)注入了生命活力 現(xiàn)代預(yù)

23、防醫(yī)學(xué)(整體預(yù)防)慢性病(第二次衛(wèi)生革命)成功Health Management2、衛(wèi)生管理學(xué)(Health Management) 社會(huì)衛(wèi)生狀況 發(fā)現(xiàn)問題 社會(huì)因素與疾病和健康 分析原因 社會(huì)衛(wèi)生措施 制訂政策 運(yùn)作、實(shí)施 解決問題 衛(wèi)生管理學(xué)社會(huì)醫(yī)學(xué)國內(nèi)兩者是姊妹學(xué)科或一個(gè)學(xué)科：社會(huì)醫(yī)學(xué)與衛(wèi)生事業(yè)管理（學(xué)位點(diǎn)）國外：health policy and management衛(wèi)生事業(yè)與管理Community Medicine3、社區(qū)醫(yī)學(xué)(Community Medicine) 聯(lián)系與相同點(diǎn)： （1）群體觀 （2）內(nèi)容的一致性：社區(qū)是小社會(huì) 區(qū)別：社區(qū)醫(yī)學(xué)更側(cè)重于衛(wèi)生保健實(shí)踐Medical Sociology4、醫(yī)學(xué)社會(huì)學(xué)(Medical Sociology) 醫(yī)學(xué)社會(huì)學(xué)是研究醫(yī)療衛(wèi)生服務(wù)中的人際關(guān)系（如醫(yī)護(hù)關(guān)系、醫(yī)患關(guān)系等）對(duì)醫(yī)療衛(wèi)生工作的影響，以提高醫(yī)療衛(wèi)生服務(wù)的效率。兩者都以社會(huì)因素作為重要研究?jī)?nèi)容。其區(qū)別在于： （1）學(xué)科性質(zhì)不同； （2）起源及時(shí)代背景不同； （3）研究的對(duì)象不同。Medical Psycho