《社會醫(yī)學(xué)》課件

1、 社 會 醫(yī) 學(xué)講課內(nèi)容一、社會醫(yī)學(xué)的定義二、社會醫(yī)學(xué)的研究內(nèi)容三、社會醫(yī)學(xué)的任務(wù)四、社會醫(yī)學(xué)的發(fā)展簡史五、社會醫(yī)學(xué)與相關(guān)學(xué)科一、社會醫(yī)學(xué)的定義提問： 你以前接觸過社會醫(yī)學(xué)嗎？ 你認(rèn)為社會醫(yī)學(xué)可能是研究什么的？ 社會醫(yī)學(xué)工作者可能會干哪些工作？一、社會醫(yī)學(xué)的定義 從社會的角度，應(yīng)用社會科學(xué)的理論和方法研究人類健康和疾病的一門醫(yī)學(xué)和社會學(xué)的交叉學(xué)科。Human behavior Culture Value Structure of society Social interaction Socialization Social institutions Dynamic of Society Soc

2、ial change Social life Sociology What is medicine?什么是醫(yī)學(xué)The science related to the diagnosis understanding prevention treatment of illness. What is social medicine?什么是社會醫(yī)學(xué)？Medicinesociology社會學(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)哪些人容易得肺結(jié)核病？性別？年齡？文化程度？婚姻狀況？收入？職業(yè)？居住條件？為什么這些人容易得?。坎∫颍ㄉ鐣模?貧困、受教育程度低、職業(yè)風(fēng)險、有病不醫(yī)（看病貴） 深層

3、次原因：社會保障制度、醫(yī)療服務(wù)體系社會后果：個體支出增加、收入減少，勞動力喪失、社會地位下降群體經(jīng)濟(jì)和社會生產(chǎn)力喪失GDP損失、貧富差距加大增長限制、發(fā)展延緩對付肺結(jié)核病，我們怎么辦？社會衛(wèi)生策略知識普及消除貧困普及社會保障改善醫(yī)療服務(wù)體系人類的雙重屬性The dual nature of human beings Aristotle : human beings are, by nature, social animals 社會屬性 Social nature 生物屬性 Biological natureDoes it matter to health?Whats Relationship

4、between social factors and health?WHO put forward: Social determinants for HealthPoliticsEconomyCultureEnvironmentSocial security systemLife style and behaviorsHealth care system政治經(jīng)濟(jì)文化環(huán)境社會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)的研究小組通過對伊拉克全國47個區(qū)進(jìn)行調(diào)查走訪形成的報告認(rèn)為，美國發(fā)動伊拉克戰(zhàn)爭造成了65.5萬伊拉克人死亡，平均每天死亡500人 人口爆炸！非洲難民美國哥倫比亞大學(xué)教授、聯(lián)合國

5、前秘書長安南的特別顧問JEFFREY SACHS先生SACHS教授說：2003年的發(fā)展議題被擠出了國際議程，戰(zhàn)爭與反恐取代了發(fā)展。 艾滋病每天奪去數(shù)以千計的生命，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。二、社會醫(yī)學(xué)的研究內(nèi)容3、社會衛(wèi)生對策及措施 社會處方三、社會醫(yī)學(xué)的任務(wù)The tasks of social medicine倡導(dǎo)積極的健康觀弘揚(yáng)正確的醫(yī)學(xué)模式發(fā)現(xiàn)社會衛(wèi)生問題制定衛(wèi)生政策

6、和策略常見病的社會防治促進(jìn)人群健康加強(qiáng)社會醫(yī)學(xué)教育四、社會醫(yī)學(xué)發(fā)展史The history of social medicineEmbryonic stage of social medicineEstablishment & development of social medicineDevelopment of social medicine in China社會醫(yī)學(xué)的萌芽 社會醫(yī)學(xué)的創(chuàng)立和發(fā)展我國社會醫(yī)學(xué)的發(fā)展 Embryonic stage of social medicine 萌芽時期 “Air, Water and Places” stress on the impacts of

7、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 ro

8、le of doctorsThe 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.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)說體現(xiàn)了整體醫(yī)學(xué)觀Embr

9、yonic stage of social medicine 萌芽時期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 cont

10、rol disease古羅馬醫(yī)師蓋倫：重視心理因素對健康的影響;德國社會衛(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)督計劃使政府采取措施保護(hù)公眾的健康; 第一個提出社會衛(wèi)生措施社會醫(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 So

11、cial medicine: 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)成一個整體：社會醫(yī)學(xué)分為四個部分；社會生理學(xué)；社會病理學(xué)；社會衛(wèi)生學(xué)；社會治療學(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 scien

12、cePolitics is nothing more than medicine in broad senseBest method of medicine is to combine medicine with social life and political activities醫(yī)學(xué)科學(xué)的核心是社會科學(xué)醫(yī)學(xué)是一門社會科學(xué)；任何社會都應(yīng)對居民的健康負(fù)責(zé)政治學(xué)是廣義上的醫(yī)學(xué)實現(xiàn)醫(yī)學(xué)目標(biāo)的最好的辦法是將醫(yī)學(xué)和社會生活和政治活動結(jié)合起來 德國：格羅蒂楊German A.GrotjahnPut forward theory of social pathologyWrite : “ social P

13、athology” suggests that disease should be studied from the standpoint of social view;Is a first person given lecture on social hygiene 提出社會病理學(xué)的理論和概念;用社會觀點(diǎn)研究人類疾病的原則首次在柏林大學(xué)開設(shè)社會衛(wèi)生學(xué)講座 Germany： Birthplace of social medicineBefore WWIISocial hygieneSocial medicineLaterbecome social medicine德國是社會醫(yī)學(xué)的發(fā)源地二戰(zhàn)前：

14、使用社會衛(wèi)生學(xué)和社會醫(yī)學(xué)后改為社會醫(yī)學(xué) 社會醫(yī)學(xué)在各國的發(fā)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

15、social medicineIn 1960s, social medicine was changed into community medicine 英國: 40s 開設(shè)社會醫(yī)學(xué), 在牛津大學(xué)成立社會醫(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、社會衛(wèi)生服務(wù)、公共醫(yī)療事業(yè)都屬于社會醫(yī)學(xué)的范疇；60s社會醫(yī)學(xué)改成社區(qū)醫(yī)學(xué)。 社會醫(yī)學(xué)在美國的發(fā)展In United StatesMedical sociology and family medicine developedEmphasis on sociology, management and economicsSocial medicin

16、e was included in the course of health management and health policy醫(yī)學(xué)社會學(xué)和家庭醫(yī)學(xué)得到了發(fā)展強(qiáng)調(diào)社會學(xué)、管理學(xué)和經(jīng)濟(jì)學(xué)社會醫(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 heal

17、th administration, social medicine was the main course；90% of medical college offered 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)了社會醫(yī)學(xué)課程Preventive medicineHealth management Community medicineMedical sociologyMedical psychology Clinical Medicine

18、社會醫(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) 社會醫(yī)學(xué) 社會醫(yī)學(xué)使預(yù)防醫(yī)學(xué)注入了生命活力 現(xiàn)代預(yù)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) 社會衛(wèi)生狀況 發(fā)現(xiàn)問題 社會因素與疾病

19、和健康 分析原因 社會衛(wèi)生措施 制訂政策 運(yùn)作、實施 解決問題 衛(wèi)生管理學(xué)社會醫(yī)學(xué)國內(nèi)兩者是姊妹學(xué)科或一個學(xué)科：社會醫(yī)學(xué)與衛(wèi)生事業(yè)管理（學(xué)位點(diǎn)）國外：health policy and managementCommunity 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 區(qū)別：社區(qū)醫(yī)學(xué)更側(cè)重于衛(wèi)生保健實踐Medical Sociology4、醫(yī)學(xué)社會學(xué)(Medical Sociology) 醫(yī)學(xué)社會學(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

20、都以社會因素作為重要研究內(nèi)容。其區(qū)別在于： （1）學(xué)科性質(zhì)不同； （2）起源及時代背景不同； （3）研究的對象不同。Medical Psychology聯(lián)系： 基于社會心理因素與健康的關(guān)系，兩門學(xué)科交叉。 區(qū)別： 學(xué)科歸屬不同 社會醫(yī)學(xué)與臨床醫(yī)學(xué)的比較社會醫(yī)學(xué)：群體 social medicine: mainly target at population level發(fā)現(xiàn)社會問題社會診斷 Identify social problemsocial diagnosis社會醫(yī)學(xué)分析了解社會成因 Social medical analysisfind out social causes社會醫(yī)學(xué)綜合處方

21、 Social comprehensive therapy臨床醫(yī)學(xué)：主要針對個體 Clinical medicine: mainly target at individual level了解個體健康問題醫(yī)學(xué)診斷 Identify individual health problem-medical diagnosis開展病因?qū)W分析: 主要是生物學(xué)病因分析 Etiological analysis: biological causes analysis制定醫(yī)學(xué)處方 Provide medical prescription社會工作專業(yè)與社會醫(yī)學(xué) 在你的專業(yè)中，需要社會醫(yī)學(xué)嗎？可以應(yīng)用在哪些方面？本章

22、學(xué)習(xí)重點(diǎn)1、社會醫(yī)學(xué)定義2、社會醫(yī)學(xué)的研究內(nèi)容是什么？3、社會的任務(wù)是什么？4、社會醫(yī)學(xué)發(fā)展史上的幾個重要人物與事件？社會醫(yī)學(xué)授課內(nèi)容、方式等1、授課內(nèi)容2、授課方式：參與式教學(xué)3、紀(jì)律要求4、課程記分第二章醫(yī)學(xué)模式與醫(yī)學(xué)模式的轉(zhuǎn)變講課內(nèi)容一、醫(yī)學(xué)模式概述二、歷史上幾種主要的醫(yī)學(xué)模式三、現(xiàn)代醫(yī)學(xué)模式一、醫(yī)學(xué)模式概述1、概念 模式（MODEL）：某一領(lǐng)域中科學(xué)地指導(dǎo)人們獲取知識和解決問題的概念、假設(shè)和法則。 醫(yī)學(xué)模式（MEDICAL MODEL）：人們關(guān)于健康和疾病的基本態(tài)度、基本觀點(diǎn)和基本看法。 一、醫(yī)學(xué)模式概述2、醫(yī)學(xué)模式的主要內(nèi)容1）對健康和生命的價值判斷2）健康和疾病的確定3）對健康和疾

23、病歸因和解釋4）求醫(yī)行為和治療方式的選擇5）對預(yù)后的估計二、 醫(yī)學(xué)模式的演變過程Evolution of Medical Model：神靈主義的醫(yī)學(xué)模式 ( Spiritualism medical model)自然哲學(xué)的醫(yī)學(xué)模式 (Nature philosophical medical model)機(jī)械論的醫(yī)學(xué)模式 (Mechanistic medical model)生物醫(yī)學(xué)模式 (Biomedical model) 生物心理社會醫(yī)學(xué)模式 (Bio-psycho-social medical model)。a.神靈主義醫(yī)學(xué)模式Spiritualism medical modelHow t

24、o look at health and disease?Life and health is bestowed by the GodDisease is caused by supernatural powersOnce offend the gods, or disfavored by the gods , disease is in the form of the punishment by the gods Possession of evil spirits, demons or monsters etc生命和健康由神所賜；疾病是由超自然的力量所引起的；人觸犯神靈時，疾病代表神靈的懲

25、罰；疾病是妖魔鬼怪附體。Spiritualism medical modelTreatment:Pray to God and spirits for bless, forgiveness & their protectionResort to natural plants or minerals for treatment, most is of emetic and cathartic Banish the spirits and ghosts that cause plague治療方法：乞求神靈的祝福、寬恕和保護(hù)服用具有催吐和導(dǎo)瀉作用的植物或礦物質(zhì)驅(qū)逐瘟神疫鬼1、神靈主義醫(yī)學(xué)模式spir

26、itualism medical model討論：為何神靈主義醫(yī)學(xué)模式至今仍具有重要的影響？為何神靈主義醫(yī)學(xué)模式至今仍具有重要的影響？提供疾病標(biāo)準(zhǔn)化的、當(dāng)事人及社會能接受的解釋，提示處理方法及預(yù)后。醫(yī)學(xué)仍存在許多未知的領(lǐng)域群眾醫(yī)學(xué)知識的缺乏醫(yī)療需求與供給的差距（無法購買昂貴的醫(yī)療服務(wù)）較強(qiáng)的心理安慰作用社會整合和社會控制作用文化繼承與侵襲的長時間性 b.自然哲學(xué)的醫(yī)學(xué)模式Naturalistic philosophical medicalTHE FIVE elements the physical universe, can be reduced to five elements：wood,

27、fire, earth, metal, and water. Physical universe as divisible into two broad categories that were both opposite and complementary. The two poles of material phenomena were labeled, Yin and Yang. 中國的陰陽五行學(xué)病理學(xué)說建立 世界是由什么組成的？What is the world made of? Chinese Philosophy Five Elements support and destroy

28、each other，coordinate to each otherMetal: cutting, hard, conductingWood: growing, flexible, rooted, strong Water: wet, cool, descendingFire: dry, hot, ascending, movingEarth: productive, fertile, potential for growth 中國哲學(xué) 五行相生相克、相關(guān)協(xié)調(diào)金木水火土陰和陽世界觀相生相克中醫(yī)對疾病的看法TCM view of diseasesIllness as an imbalance

29、of two types of energy yin and yang which simultaneously exist in everyone and everything and within each other. Yin represents the cold, slow, or passive principle, yang represents the hot, excited, or active principle. Health is a balanced state and that disease is due to an internal imbalance of

30、yin and yang. 中醫(yī)理論的發(fā)病機(jī)制致病的外因：external causes of diseases The Causes of disharmony External Causes : Six external evilswind,cold, heatdamp, dryness,fire 失調(diào)的原因 外因：六淫風(fēng)寒暑濕燥火西方疾病學(xué)說：Western theory of diseasesall matter could be reduced to the basic elements earth, fire, air and water cold, hot, dry and we

31、t;four humour of phlegm, blood, black bile and yellow bile. Health-mutual balanceDisease-disorder自然界萬物之源: 水、火、土、氣對應(yīng)冷、熱、干、濕人體內(nèi)的：粘液、血液、黃膽汁、黑膽汁相對應(yīng)健康、疾病、性格與四體液的數(shù)量、比例變化有關(guān)引起體液失衡的原因有先天、環(huán)境以及營養(yǎng)失調(diào)等 Humoural theory by HippocratesFour *bodily* fluids: phlegm, blood, yellow bile and black bile. Disease, in essen

32、ce, becomes a state in which one of these four bodily fluids (humour) *overpowers* the others. 四體液學(xué)說：粘液、血液、黃膽汁、黑膽汁疾病的本質(zhì)是：體液之間的失衡狀態(tài) The role of Hippocrates on Modern MedicineCauses of disease could be internal, relating to faulty aspects of diet and exercise External factors: relating to the forces o

33、f climate, winds, water and the seasons.致病因素內(nèi)因：飲食和鍛煉方面存在問題外因：環(huán)境因素：氣候的變化，風(fēng)、水、季節(jié)等自然哲學(xué)的醫(yī)學(xué)模式西方世界Naturalistic philosophical medical Hippocrates： Airs, Waters, and Places , instead of ascribing diseases to divine origin, discusses their environmental causes.A towns weather, drinking water, and site along

34、the paths of favorable winds can help a physician ascertain the general health of citizens. 希波克拉底：空氣、水、地域探討環(huán)境、天氣、水、風(fēng)向等與健康的關(guān)系The role of Hippocrates on Modern Medicine Hippocrates reject that: diseases have a supernatural cause. first person to perceive a relationship between cause and effect in a me

35、chanistic wayProviding the foundation for modern scientific notions of disease causation. 疾病的致病因素的研究推進(jìn)的醫(yī)學(xué)的發(fā)展，否認(rèn)疾病的產(chǎn)生是超自然力量導(dǎo)致的；以機(jī)械的眼光看待疾病的因果關(guān)系為現(xiàn)代醫(yī)學(xué)的疾病因果理論奠定了基礎(chǔ)Significance of HippocratesThe theory of humour is the first theory which attempts to *integrate* a natural theory of metaphysics with empiric

36、al first-hand observations of disease. It essentially marks the origin of the *integration* of Western medicine with early Greek naturalistic science . The pathogenesis of disease is no longer mystical and inexplicable unnatural causes (demons, gods, etc.)第一次將純粹的哲學(xué)與對疾病的觀察結(jié)合起來標(biāo)志著西醫(yī)與希臘自然哲學(xué)的結(jié)合疾病的發(fā)病機(jī)理不再

37、是神秘的、無法解釋的超自然力量Significance of Hippocratespreceded to it: a primarily mystical approach to disease which was characterized by the worship of gods, the fending off of evil demons it successfully separated Western medicine from-a primarily mystical approach to disease . marks the beginning of a ration

38、al pathophysiology 希波克拉底之前：疾病是由神秘的超自然力量導(dǎo)致希波克拉底及其創(chuàng)立的學(xué)說將西醫(yī)與原始的神秘主義分割開來標(biāo)志理性病理生理學(xué)的真正開端c.機(jī)械論的醫(yī)學(xué)模式Mechanistic Medical ModelMechanistic view of the bodyIll health is treated as the mechanical failure of some part of one or more of these interdependent systems and the medical task is to repair the damage.背景

39、BackgroundA Shift in IdeasGrowing acceptance of a developing scientific model.Development of research, observation, technologyNew ways of thinking about disease and the body.思想觀念的轉(zhuǎn)變對不斷發(fā)展的科學(xué)模式的日益認(rèn)可研究、觀察、技術(shù)等科學(xué)和技術(shù)的不斷發(fā)展從新的角度來看待疾病和健康機(jī)械論的醫(yī)學(xué)模式Mechanistic Medical Model R. Descartes 笛卡爾From the point of view

40、 of movement:Human body is a machine with more parts, but not more alive, than any man-made automata, meaning a machine that moves itself. 從運(yùn)動的角度：人體是由許多部分組成的機(jī)器,是自己發(fā)動自己的機(jī)器笛卡爾的二元理論Dualistic Interaction of Body and MindTo Descartes, man was a mind united with a body, the two interacting with each other

41、. Mind and body are two separate things which makes the consideration dualistic. These two things or parts interact, and each affects the other. Medicine should pay more attention to body than its mind.代表人物及其主要觀點(diǎn)：Descartes: Animal is MachineLamterry: Human is Machine, a machine start up itselfRegard

42、 life activities as machine movementProtect health is just as the same way of protecting a machineDiseases: in a state when machine breakdown and body out of order, therefore need to be repaired笛卡爾：動物是機(jī)器拉美特利；人是機(jī)器 是自己發(fā)動自己的機(jī)器。將生命活動比作機(jī)器的運(yùn)動對健康的保護(hù)與保護(hù)機(jī)器的原理一致疾病：機(jī)器出現(xiàn)故障和失靈醫(yī)學(xué)：對出現(xiàn)故障的部分和零件的修補(bǔ) d. Biomedical mode

43、lMind/Body dualism: Medicine should focus on measuring cells biochemical changes by precise technique, explain symptom, interfere changes to recover the health;Reductionism: disintegrates human body to different organ, cells and molecular, the physical and chemical changes at molecular levels can ex

44、plain the causality of functional changes of body;Disease is regarded as a static results between its cause and effects 二元論：人的身體和精神應(yīng)有合理的分工，醫(yī)學(xué)應(yīng)研究如何通過精密的技術(shù)測量細(xì)胞生物化學(xué)的變化，來解釋病人的癥狀與體征，干預(yù)這些變化來恢復(fù)健康；還原論：將人體分解為器官、細(xì)胞、分子，復(fù)雜的生命現(xiàn)象必須用物理的、化學(xué)的方法來解釋功能改變的因果關(guān)系；疾病是靜止的因果結(jié)局。生物醫(yī)學(xué)模式下生命科學(xué)的大發(fā)展Boom of Life scienceGerm theoryPhy

45、siologyAnatomyHistologyEmbryologyPathologyImmunologyGeneticsMolecular Biology細(xì)菌學(xué)理論生理學(xué)解剖學(xué)組織學(xué)胚胎學(xué)病理學(xué)免疫學(xué)遺傳學(xué)分子生物學(xué)Achievements under bio-medical model外科學(xué)三大難題被攻破Three big issues in surgeryacheInfectionBlood loss外科手術(shù) 三大難題：疼痛感染失血 巴斯德：細(xì)菌理論P(yáng)asteur : Germ Theorydiseases were transmitted by micro-organisms germs

46、 that float in the air1870s Pasteur demonstrates that germs are the cause rather than the product of disease1880s Robert Koch - Doctrine of Specific etiologyeach disease is always caused by a particular micro organism 巴斯德：疾病是由漂浮在空氣中的病源微生物引起的1870，巴斯德證明了細(xì)菌是導(dǎo)致疾病的原因而不是結(jié)果1880科赫：提出特異致病因子的病因理論認(rèn)為每一個疾病總是由特異的

47、病源微生物所引起的魏爾嘯：德國病理學(xué)家Rudolf Virchow, German pathologistFather of Cellular PathologyDisease can be manifested at microorganism level.All diseases have relation to cell, the source of all kinds of diseases is cells abnormal activities分子病理學(xué)之父疾病可以在更微觀的 分子水平上呈現(xiàn)出來疾病是由于異常的 細(xì)胞造成的Ecological model of disease宿主h

48、ost環(huán)境environment病源體pathogenDefects of biomedicine modeEngel (1980)： biomedical model neglects the whole because it excludes everything but biological factors. It is preoccupied with the body and disease at the expense of the patient as a person.modern allopathic medicine often fails to address the e

49、motional and spiritual needs of those who suffer from infirmity 恩格爾指出:生物醫(yī)學(xué)不完整,它只考慮了生物因素,而忽視了其他因素；它的注意力只放在身體和疾病上,而忽視了病人,現(xiàn)代醫(yī)學(xué)的疾病觀使其無法滿足病人精神和情感需要。HolisticRather than a new approach, the bio-psycho-social model is actually a return to holismInteraction of body and mindMulti-causalitySocially connected i

50、ndividual Preventative - health maintenance 整體醫(yī)學(xué)觀 身體和精神的整合 多因多果-病因鏈 個人與社會的聯(lián)系 從預(yù)防醫(yī)學(xué)到健康維護(hù)三、生物心理社會醫(yī)學(xué)模式 （Biopsychosocial medical model）（一）生物心理社會醫(yī)學(xué)模式的產(chǎn)生背景 The background of bio-psycho-social medical model疾病譜轉(zhuǎn)變健康需求提高和多樣化醫(yī)學(xué)的社會化醫(yī)學(xué)學(xué)科的內(nèi)部融合與外部交叉發(fā)展健康影響因素的多元化醫(yī)學(xué)的進(jìn)一步社會化世界各國衛(wèi)生保健的經(jīng)驗（二）現(xiàn)代醫(yī)學(xué)模式的形成過程 Emerging of Bio-psy

51、cho-social medical modelGeorge Engel, alternative to the limited, predominant biomedical model.Bio-medical-model, accounts for disease by its biochemical factors without considering social or psychological dimensions, separates mind from body. It is a reduced, myopic view. Emphasize the hierarchical

52、, independent relationships of biological, individual, family, and community systems.美國內(nèi)科醫(yī)生：恩格爾提出由生物心理社會醫(yī)學(xué)模式來替代生物醫(yī)學(xué)模式生物醫(yī)學(xué)模式關(guān)注導(dǎo)致疾病的生物化學(xué)因素而忽視社會、心理的緯度，是一個簡化的、近視的觀點(diǎn)強(qiáng)調(diào)生物學(xué)、個人、家庭、社區(qū)和社會系統(tǒng)多層次關(guān)系對疾病的影響Emerging of Bio-psycho-social medical modelIt includes the patient as well as the illness；Emphasize close atte

53、ntion to be placed on the medical illness and the role the illness plays in the emotional life of the patient, and the interpersonal dynamics of the family. 現(xiàn)代醫(yī)學(xué)模式：不僅關(guān)注疾病更關(guān)注病人；醫(yī)學(xué)不僅應(yīng)關(guān)注疾病的本身，還應(yīng)該關(guān)注疾病對人心理和情感的影響，了解病人家庭的關(guān)系狀況布魯姆的環(huán)境健康醫(yī)學(xué)模式 p17 （Environment health medical model）拉隆達(dá)和德威爾的綜合健康醫(yī)學(xué)模式（Comprehensive

54、health medical model）環(huán)境因素生活方式及行為因素生物遺傳因素醫(yī)療衛(wèi)生服務(wù)因素 衛(wèi)生服務(wù)和衛(wèi)生政策分析相結(jié)合綜合內(nèi)因衛(wèi)生服務(wù)遺 傳成熟老化生物遺傳職 業(yè)危險因素環(huán)境因素行 為生活方式社 會心 理自 然健 康康 復(fù)治 療預(yù) 防生 活危害因素消費(fèi)形式圖2-4 綜合健康醫(yī)學(xué)模式（四）恩格爾：生物心理社會醫(yī)學(xué)模式 Engel ： Biopsychosocial medical model （三）現(xiàn)代醫(yī)學(xué)模式代表觀點(diǎn)1）整體的觀點(diǎn)2）系統(tǒng)論的觀點(diǎn)3）多元論的觀點(diǎn)（四）生物心理社會醫(yī)學(xué)模式對 醫(yī)學(xué)和社會的作用（ Impact of biopsychosocial medical mode

55、l on medicine and society)現(xiàn)代醫(yī)學(xué)模式對醫(yī)學(xué)實踐和社會的意義Significance of modern medical model臨床醫(yī)學(xué) 預(yù)防醫(yī)學(xué)醫(yī)學(xué)教育可持續(xù)發(fā)展醫(yī)學(xué)目的Clinical medicinePreventive medicineMedical educationSustainable developmentGoal of medicine二十一世紀(jì)醫(yī)生的職能： 五星級醫(yī)生（ five star doctor）衛(wèi)生服務(wù)的提供者診療方案的制定者健康教育的指導(dǎo)者社區(qū)衛(wèi)生的領(lǐng)導(dǎo)者衛(wèi)生事務(wù)的協(xié)調(diào)者Care Provider Decision MakerHea

56、lth EducatorCommunity LeaderService Manager現(xiàn)代醫(yī)學(xué)模式對衛(wèi)生服務(wù)的影響四個擴(kuò)大 治療預(yù)防 生理心理 院內(nèi)院外 技術(shù)社會第三章社會醫(yī)學(xué)基本理論和觀點(diǎn)講課內(nèi)容一、健康的概念二、健康與疾病的社會性三、高危險性觀點(diǎn)四、衛(wèi)生事業(yè)發(fā)展與社會發(fā)展同步的觀點(diǎn)五、健康公平六、大衛(wèi)生的觀點(diǎn)七、社會診斷與社會處方八、社會資本的衛(wèi)生保健功能 消極的健康觀 積極的健康觀 高水平康強(qiáng)觀 1) 健康：一、健康的概念 “l(fā)ack of disease ” “WHO”High level wellnessIf you show no signs or symptoms of illn

57、ess, you are healthy. Health is seen as a state of being. 21“l(fā)ack of disease” WHO：health is a state of complete of physical, mental, and social well-being and not merely the absence of disease or infirmity.身體健康 軀體的結(jié)構(gòu)完好和功能正常。 physical fitness Muscular strength Flexibility Muscular endurance Body comp

58、osition Cardiorespiratory endurance10心理健康： 智力正常情緒愉快： 體溫正常生理健康 情緒愉快心理健康良好的人際關(guān)系適應(yīng)環(huán)境堅強(qiáng)的意志品質(zhì)完整與健康的人格12心理健康 正確認(rèn)識自我三個方面 正確認(rèn)識環(huán)境 及時適應(yīng)環(huán)境 社會適應(yīng)能力社會參與時的完好狀態(tài)每個人的能力應(yīng)在社會系統(tǒng)內(nèi)得到充分的發(fā)揮；作為健康的人應(yīng)能夠扮演與其身份相適應(yīng)的角色；每個人的行為與社會規(guī)范相一致。High level wellness 高水平康強(qiáng)的概念 高水平康強(qiáng)的內(nèi)容 影響高水平康強(qiáng)的因素17 高水平康強(qiáng) 健康是一個動態(tài)的不斷努力發(fā)揮個人最大潛能的過程； 健康的綜合性，包含生理、情緒、精

59、神、智力、社會 、職業(yè)、環(huán)境七個方面； 核心是自我的責(zé)任性。23Ongoing growth in all dimensions of wellness Strong sense of personal responsibility for wellness Sense of humor and positive outlook on life Quest for cultural support for wellness living Mindset for achieving personal excellence Ability to cope and find balance duri

60、ng lifes challenges Continual quest for meaning and purpose in lifelifestyle habits that contribute to optimal healthNot sick (neutral point of no discernable illness)Measures and signs of health and well-being20High-level wellnessHealth-robbing lifestyle practices Feelings of stress and inability t