卫生政策走向与公共健康及其伦理思考

政府通过决策决定卫生政策,卫生政策对于公共健康具有导向和引领作用.卫生政策走向直接影响公共健康,决定公共健康的发展方向.卫生政策与公共健康的关系是因果关系,前者决定后者.卫生政策需要有伦理学基础和伦理学专家的伦理论证,坚持公正、公平、公益的原则.     

卫生保健政策与医学伦理学

卫生保健政策是卫生资源、价值目标和伦理原则三者的结合。医学伦理学是卫生政策的重要基础。当代卫生事业的特点,卫生保健服务面临的挑战以及医学伦理主体与客体的变化,决定了医学伦理学在当代卫生保健政策中的特殊意义。在医学面临全民保健的阶段,一个科学的符合人民健康利益的卫生保健政策是不言而喻的。摆脱当前卫生政策面临的困难,要求必须在医学伦理学方面作出正确的选择。     

中国公共健康伦理学的理论自觉与范式转换

理论自觉不仅直接关乎中国特色公共健康伦理学的理论构建,也直接关乎中国公共健康伦理学的持续发展和现实功能的发挥。中国公共健康伦理学的理论自觉包括对学科关系、中西关系、古今关系以及理论与实践关系的自觉等四个基本维度;其问题域或基本理论结构包括本体论层面的基本问题、对象问题和范畴问题,认识论层面的视角和向度问题以及价值论层面的发展取向、价值追求和学者的价值选择问题。范式意识的自觉是中国公共健康伦理学理论自觉的方法论标志。当前,中国公共健康伦理学研究范式应该实现从西方范式向马克思主义范式、从个体论或整体论向个体论与整体论相结合的范式、从职业伦理或实践伦理向职业伦理与实践伦理相结合的范式转换。     

公共健康伦理何以可能

公共健康伦理学已有二十余年的发展历程,但公共健康伦理学的对象——公共健康伦理何以可能这一前提性的元理论问题一直没有得到正面解答,公共健康伦理学的学科合法性在很大程度上受到质疑。解答公共健康伦理何以可能的问题,应该立足于公共健康与伦理的关系,从二者之间的外在关系和内在关联两个方面寻找其所以可能的根据。公共健康伦理所以可能的外在根据,在于公共健康需要伦理导向,内在根据在于公共健康具有伦理属性。20世纪末不断爆发的公共健康危机唤起的伦理自觉,使公共健康伦理的可能性变成了现实性。     

遭遇公共健康的生命伦理学

由于传统的生命伦理学是建基于个人主义的价值观之上,它强调个人权利的优先性,而在公共健康实践中却经常会为了全体人口的健康对个人的自由、隐私等权利进行干预或限制。公共健康对公共善而非个人权利的强调对传统的生命伦理学构成了挑战。公共健康的这一挑战促使生命伦理学向多元化的方向发展。     

从"非典"看公共健康的意义--访丹尼尔·维克勒教授

丹尼尔·维克勒 (ＤａｎｉｅｌＷｉｋｌｅｒ) ,哈佛大学公共卫生学院教授 ;世界卫生组织第一位“伦理官员” ;国际生命伦理学会第二任会长 ;中国社会科学院应用伦理研究中心特邀研究员。主要从事生命伦理学研究 ,近期研究集中于人口健康问题 ,包括资源分配与全球公共健康等。主要著作有《哲学与健康政策研究》、《从机遇到选择 :基因学与公正》等。问 :公共健康研究的主要问题是什么 ?答 :首先我们要讨论公共健康的目的是什么。许多人一谈这一题目就想到如“非典”这样的传染病 ,还有水的清洁等问题 ,这些固然是重要的 ,但我认为更重要的是…     

健康伦理学的中国成果及意义

健康伦理学最早出现于中国学术界。从健康道德到健康伦理学,最初的研究主要集中在讨论经济社会的发展与人的健康的道德关系,到后来扩大到对社会政治、经济、文化、生态与人健康道德关系的全面研究,具有显著的中国原创性。近年来,世界卫生组织也开始使用"健康伦理"一词。健康伦理学旳意义在于弥合了医学伦理学、生命伦理学和公共健康伦理学之间的矛盾,为健康中国提供道德动力,也有利于破解器官捐献的伦理难题等。     

增加卫生改革的伦理含金量——兼论卫生改革中的效率与公平

卫生改革需要有包括卫生改革伦理学理念在内的全方位改革理念的联手支撑。伦理含金量缺失或者不足,卫生改革实践就难以取得圆满成功。因此,目前展开的新一轮卫生改革,必须以“效率与公平合理兼顾”为核心准则,在完善政策、规划目标、组织实施等全过程中切实保证卫生改革伦理学理念准确到位和正常运作。     

关于召开第二届全国生命伦理学学术会议

为了在第一届全国生命伦理学学术会议的基础上,进一步对生命科学和生物技术伦理、涉及人和动物的生物医学研究伦理、公共卫生和卫生政策伦理以及生命伦理学的哲学和文化层面等研究成果进行检阅,探讨在这些领域以及临床工作中出现的伦理问题。以推动我国生命伦理学学术研究的发展及其在实践中的应用,     

湖北省医学伦理学研究会举行第三次学术讨论会

湖北省医学伦理学研究会第三次学术讨论会于1992年5月19日至22日在历史文化名城——襄樊市召开,来自全省各地的从事医学伦理学教学研究的理论工作者和卫生行政部门、各级医院的实际工作者共105名代表参加了会议,大会收到论文83篇。省医学伦理学研究会会长、湖北医学院党委书记张志善教授作了《影响卫生管理人员医德品质的两个问题》的学术报告。这次讨论会的主题是“卫生政策和医院管理中的道德导向”,有28名代表在大会     

A report on The National Council of Community Mental Health Centers

The National Council of Community Health Centers represents a professional development of great interest to clergy. Because mental health centers collaborate with community agencies and systems, their interventions on behalf of community mental health provide an occasion to work toward common goals. Their policy of shared responsibility with community leaders and consumers provides a unique opportunity for a practical integration of religious systems and the public arena. A number of pastors and mental health trained clergy are actively participating in this common effort on behalf of the nation's mental health.He has served five years as a member of the Council on Prevention of the National Council of Community Mental Health Centers.     

波前相差引导的个体化切削治疗近视

角膜的个体化切削是在PRK、LASIK、LASEK的基础上发展起来的一种新的屈光手术技术.其最大的优点是根据不同眼的特点对角膜进行切削,使其达到最佳的视觉效果.现回顾角膜屈光手术的发展,并运用哲学原理对个体化切削的依据、技术创新及其具体应用加以综述.     

Why 'Health' is not a Central Category for Public Health Policy

We normally think that public health policy is an important political activity. In turn, we normally understand the value of public health policy in terms of the promotion of health or some health-related good (such as opportunity for health), on the basis of the assumption that health is an important constituent or determinant of wellbeing. In this paper, I argue that the assumption that the value of public health policy should be understood in terms of health leads us to overlook important benefits generated by such policy. To capture these benefits we need to understand the ends of public health policy in terms of the promotion of 'physical safety'. I then go on to argue that the idea that 'health' is an important category for evaluating or estimating individuals' wellbeing in the normative context of social policy is confused. I then clarify the relationship between my arguments and QALY-based accounts of health assessment. In the final section of the paper, I defend this surprising conclusion against various attacks.     

我国妇幼保健机构公共卫生属性淡化的机制研究

妇幼卫生是公共卫生体系的重要组成部分,妇幼保健机构是妇幼卫生工作的实现主体,为了促进我国妇幼保健机构的健康和可持续发展,提高妇女、儿童健康水平,通过对妇幼保健机构的社会功能、行为动因和行为特征的系统分析,构建出妇幼保健机构公共卫生属性淡化的作用机制模型.公共卫生的实质是公共政策,建议政府要实现市场机制与政府宏观调控的有机结合,促进妇幼保健事业健康发展.     

公共卫生领域非传统安全威胁及应对

医学公共卫生领域非传统安全威胁历来是而且当今仍然是威胁人类自身生存的重大社会安全问题.重大传染病的暴发、自杀、现代医学高科技等现象动辄呈现出全球化趋势,尤其是SARS的爆发,突出了公共卫生的重要性,给我国公共卫生的管理及政策制定提出了更高要求:应真正建立起以"预防为主"的公共卫生体系,加强中国与国际的安全合作,加强公民的医学和健康教育.这是由公共卫生本身的性质和时代的发展共同决定的.     

Bringing the Public Health Approach to the Problem of Suicide

Suicide and suicidal behavior are public health problems that should be addressed through a systematic public health approach. The need for such an approach can be found, for example, in Pierre, SD, where the suicide rate is 13 times the national rate; in the African American community, where the suicide rate among Black youths more than doubled between 1980 and 1995; and across the United States, where suicides outnumbered homicides in 1995. The U.S. Public Health Service is applying the public health approach to suicide by preparing the first-ever Surgeon General's Report on Mental Health, and by holding an October conference in Reno aimed at advancing a national strategy for suicide prevention.     

公共卫生教育的发展及其与临床医学重整的困境

近代以来人类健康的改善公共卫生的作用居功至伟。1916年约翰霍普金斯大学建立了世界上第一所公共卫生学院,是公共卫生和医学机构分离的开始。尽管公共卫生的研究成果很多,公共卫生和医学在教育和实践上的分裂,削弱了公共卫生在维护大众健康中的作用,在传染病再次成为社会的威胁和医疗费用不断上涨时,因此弥补这个分裂更为重要。如今已经为此做出许多努力,但收效不大。     

国家卫生财政政策补助对象的顺序选择

论述了国家卫生财政政策补助对象的选择问题,公共卫生服务物品提供机构与医疗服务物品提供机构之间的选择、医疗机构与患者之间的选择、公共卫生服务物品提供机构与居民之间的选择以及医疗机构与医生之间的选择,提出了卫生财政政策补助对象的选择顺序,公共卫生服务物品生产和分配机构,医疗保障机构,患者,医生,医疗机构。     

Assessing Perceived Health and Associated Health-Promoting Behaviors: An Investigation of Methods Used to Assess Health Status

Health assessments have been integral in the development of health behavior and policy recommendations. As the nation's health status improves, information about positive health is needed to continue development of appropriate behavior and policy recommendations. In this study, perceived health, health behaviors, health care usage, and how participants defined health were assessed. Using reported health-promoting behaviors, respondents were grouped into high-, middle-, and low-health groups. Analyses found statistically significant differences ( p <.05) for all health behaviors reported and for life satisfaction. Each group's understanding of health also differed significantly. Results document the discriminating value and importance of positive health-promoting behaviors beyond their traditional role in prevention. Recommendations for health professionals' use of positive health assessments are discussed.     

Expanding Roles: A Survey of Public Health Genetic Counselors

According to the 2008 National Society of Genetic Counselors (NSGC) Professional Status Survey (PSS), 31 genetic counselor respondents reported spending at least 50% of their time in the area of public health. The NSGC Public Health Special Interest Group (PHSIG) had 49 dues-paying members in 2009. The purpose of this study was to identify the work settings and public health activities in which genetic counselors participate. A novel online survey was disseminated over the NSGC PHSIG Listserv. Forty-one percent (n = 13) of public health genetic counselor respondents worked in a university medical system, while 53% (n = 17) were grant-funded and held a non-clinical appointment. The most common public health activities included educating healthcare professionals (82%) and community members (61%), research (55%), grant writing (55%) and grant administration (36%). Most respondents (82%) reported learning certain public health skills outside of their genetic counseling training programs. Differences in work settings were found, with a significantly greater percentage of public health genetic counselors working in government agencies. Genetic counselors have opportunities to become involved in public health activities as the scope of public health genetics grows. Furthermore, genetic counseling competencies are compatible with the Institute of Medicine’s “10 Essential Public Health Services.” The NSGC and genetic counseling training programs are encouraged to offer more public health learning opportunities for genetic counselors and genetic counseling students interested in this specialty area.