关注健康公平,保障健康权益

在卫生改革与发展的过程中,健康公平与健康权益的问题不断引出争论,而且,出现的许多新问题也都与健康公平相关.获得基本医疗服务对于全体居民来说,并不仅仅具有提高劳动力素质的意义,而且还是人们充分发挥自身潜力的一个前提,是人们参与社会经济政治决策过程的一个前提,有着超出个人投资回报的社会效益.因此,在卫生改革过程中应该关注健康公平,合理保护居民的健康权益.     

江苏居民健康不平等及其分解:基于CHNS数据的分析

基于中国健康与营养调查中江苏地区的调查数据,采用集中指数及其分解技术,分析江苏居民健康不平等情况及相关影响因素对居民健康不平等的贡献度.结果发现,在存在居民健康不平等的情况下,居住在城市、家庭规模、医疗保险等变量能够缓解健康不平等趋势,而教育、年龄等变量对健康不平等趋势具有推动作用.     

和谐医患环境与公民健康权的保障

在健康权保障体系中,卫生资源配置的公平与效率的失衡是导致现阶段我国公民健康权不平等的关键。而作为一级经济主体的医疗机构,在促进卫生资源配置和享用的公平性作用上,则是无效率的,因此国家应积极运用法律、政策等外部手段,实现其协调性的复位,以服务于建设和谐医患环境的需要。     

卫生服务体系的运行特征及我国卫生政策的重整

公平与效率相统一、预防为主、信息不对称、系统协同性是卫生服务体系运行基本特征.在对我国卫生政策的回顾和分析的基础上,提出了从卫生政策的价值体系、作为卫生政策客体的政府在卫生服务提供过程中的责任与职能、卫生服务管理体制与运行机制三个方面重整卫生政策的基本思路.     

健康发展战略与卫生服务体系的整合

首先界定了健康发展战略与卫生服务体系.健康发展战略体现在两个方面,一是国家政治层面的健康观,发达国家往往通过立法的方式固定下来;二是国家健康行动纲领.健康观是项层设计,行动纲领是整体规划,卫生服务体系是布局设计.我国目前在健康发展战略和卫生服务体系两者之间缺乏协调和整合的种种表现及其原因,主要在于健康发展战略的不完善.要根据"科学发展观",抓住改革的契机,建立和完善国家健康发展的顶层设计,并连贯性地制定健康行动纲领,有计划地设计和变革现有的卫生服务体系.     

论影响卫生资源分配公平性的因素

公平分配卫生资源是促进社会公正的重要方面.观念、体制与政策是影响卫生资源公平分配的重要因素.重医疗、轻预防的观念使宏观卫生资源分配失去公平,而城市尤其是大中城市优先的制度安排、按医疗项目付费方式的弊端、医疗保障体制的不公平等体制与政策因素则使微观卫生资源分配失去公平.从观念因素、体制与政策因素两个方面入手,改进卫生资源分配的公平性,是我国提高全民健康水平、促进社会公正的必由之路.     

美国早期教育与保育不平等现状透视:中下层家庭的视角

美国中下层家庭在早期教育与保育问题上面临着困境,其中的核心难题是早期教育与保育的起点不平等、过程不平等和结果不平等。导致美国早期教育与保育不平等的直接原因,包括近年来不断增大的贫富差距和教育预算的阶级差异,早期教育与保育的高额成本和"四六"式成本分担机制,以及早期教育与保育的供需矛盾。在这一背景下,发展以质量为核心、以公平为导向的早期教育与保育成为改革的主要方向。美国早期教育与保育的不平等现状及其改革诉求对我国学前教育发展的启示是,进一步合理配置学前教育资源,保障适龄幼儿入园机会均等,提升与促进学前教育质量。     

不患不均？容忍和支持经济不平等的心理学解释

不断加剧的经济不平等问题对个体和社会有着巨大危害,然而人们对经济不平等却有着较高的容忍性。基于个体心理的研究证据,本文提出认知和动机双重路径模型来解释个体容忍和支持经济不平等问题。在认知路径上,个体倾向于低估当前社会的经济不平等程度和将经济不平等评价为公平的;在动机路径上,个体预期经济不平等将带来自我利益的增加。未来研究应进一步整合多重心理机制间的关系,并探索有效干预手段以增加人们对减少经济不平等的支持。     

江苏居民健康不平等及其分解:基于CHNS数据的分析

基于中国健康与营养调查中江苏地区的调查数据,采用集中指数及其分解技术,分析江苏居民健康不平等情况及相关影响因素对居民健康不平等的贡献度。结果发现,在存在居民健康不平等的情况下,居住在城市、家庭规模、医疗保险等变量能够缓解健康不平等趋势,而教育、年龄等变量对健康不平等趋势具有推动作用。     

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.     

The Social Determinants of Health: Why Should We Care?

A growing body of empirical research examines the effects of the so-called “social determinants of health” (SDH) on health and health inequalities. Several high-profile publications have issued policy recommendations to reduce health inequalities based on a specific interpretation of this empirical research as well as a set of normative assumptions. This article questions the framework defined by these assumptions by focusing on two issues: first, the normative judgments about the (un)fairness of particular health inequalities; and second, the policy recommendations issued on this basis. We argue that the normative underpinnings of the approach are insufficiently supported and that the policy recommendations do not necessarily follow from the arguments provided. Furthermore, while many of the policies recommended—such as improving people's living conditions and reducing inequalities in wealth and power—are justified in their own right, the way these recommendations are tied to health is problematic.     

Between Country Variations in Self-Rated-Health and Associations with the Quality of Life of Older People: Evidence from the Global Ageing Survey

In social science and public health earlier research has persistently reported significant socio-economic inequalities in health, inequalities in the use of health care and self rated-health (SRH) among older adults. However, relatively little attention is paid to the link between SRH and the overall quality of life (QoL) of older adults. Utilising the data collected in the Global Ageing Survey (GLAS) 2006-07, the study explores the linkages between the self-rated-health and quality of life among older adults in 21 countries and territories in five major regions of the world. The QoL was assessed by two survey instruments designed to capture subjective as well as objective appraisals of individual quality of life. Both bivariate and multivariate analyses were performed to examine the influence of SRH on the QoL. The analyses reveal that there are health inequalities across different age cohorts and this remains consistent for all selected countries and territories. As expected the proportion reporting poor health increases with age in most countries. The net effect of health status on QoL has also been analysed subsequently in multivariate models using ordered logistic regression analysis and is adjusted for two main demographic variables - age and gender. Findings show that age plays an important role alongside with health on the overall quality of life. The study also reveals that females are found to be more likely to have been depressed compared to their male counterparts.     

Inequalities in health, inequalities in health care: four generations of discussion about justice and cost-effectiveness analysis

The focus of questions of justice in health policy has shifted during the last 20 years, beginning with questions about rights to health care, and then, by the late 1980s, turning to issues of rationing. More recently, attention has focused on alternatives to cost-effectiveness analysis. In addition, health inequalities, and not just inequalities in access to health care, have become the subject of moral analysis. This article examines how such trends have transformed the philosophical landscape and encouraged some in bioethics to seek guidance on normative questions from outside of the contours of traditional philosophical arguments about justice.     

Development of a Brief Group CBT Intervention to Reduce COVID-19 Related Distress Among School-Age Youth

School-aged youth have been significantly impacted by the COVID-19 pandemic. The effects of the pandemic will likely have long-standing effects on the well-being of youth, and access to mental health care is even more critical during this time. For the past 5 years, TRAILS (Transforming Research into Action to Improve the Lives of Students) has been working throughout the state to increase utilization of evidence-based mental health practices among K-12 school mental health professionals (SMHPs). By leveraging SMHPs who are widely accessible to students, TRAILS seeks to improve youth access to effective mental health care and reduce current mental health inequities. In March 2020, TRAILS responded to the COVID-19 pandemic by developing a group manual designed to be delivered virtually by SMHPs to help students develop effective coping skills to mitigate the impact of COVID-19. TRAILS focuses on promoting use of CBT and mindfulness, as these skills are ideally suited for school-based delivery, and thus the new manual, Coping with COVID-19 (CC-19), was grounded in these modalities. This article will describe the design, development, and deployment of the CC-19 program to address the mental health needs of students in the context of the pandemic. Early acceptability and penetration data will also be discussed.     

慢性腹痛

慢性腹痛病史较长,性质不定.引起慢性腹痛的原因很多,除器质性疾病外,一些功能性疾病也引起,如最终找不出具体原因,则可称之为功能性腹痛综合征.诊断比较困难,也容易误诊,甚至误治,外科医生应特别慎重.误诊的思维原因包括对引起慢性腹痛的原因认识不全面,思维惰性,辩证思维不周密和思维简化等.     

卫生经济伦理学对医疗完全市场化的质疑

不管处于什么发展水平的国家,都需要进行持续的卫生保健改革,这已成为整个社会政治改革的一部分,卫生保健改革已经融入整个世界的社会大变革中。卫生经济问题无一不具有道德成分,无一能离开伦理政策得以解决。我们对中国医疗卫生体制改革的伦理学展望中,提倡一种“公平优先,兼顾效率”的价值观。我们需要正确认识市场的目标、价值和规律,正确理解和发挥政府和市场的调节作用,促进医疗卫生体制改革的健康发展。     

Intersectional experiences of discrimination in a low‐resource urban community: An exploratory latent class analysis

There have been increasing calls for the application of an intersectionality framework to understand and address discrimination and health inequities among diverse communities. Yet there have been theoretical debates regarding to whom intersectionality applies and how intersectional experiences of discrimination are associated with health outcomes. The current study aimed to contribute to these theoretical debates and inform practical applications to reduce health inequities. Data were drawn from a community health survey in New Haven, CT (N = 1,293 adults) and analysed using latent class analysis. Results yielded 4 classes. Members of the 4 classes were similar sociodemographically. Three classes of participants reported experiencing discrimination, and members of these classes had greater stress, higher rates of smoking and sleep disruption, and worse overall health than members of the class reporting no discrimination. Members of 2 classes made multiple, or intersectional, attributions for discrimination, and members of these classes reported the most frequent discrimination. Findings suggest that community members who are sociodemographically similar may have diverse discrimination experiences. Multilevel interventions that address multiple forms of discrimination (e.g., racism and sexism) may hold promise for reducing discrimination and, ultimately, health inequities within low‐resource urban community settings.     

Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force

Abstract

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient’s ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities.     

国际健康目标与卫生改革的新导向——重视预防保健的作用

由于认识到卫生系统的大部分资源主要花费在疾病的治疗上,这种资源配置不当不仅导致巨额医疗费用负担和低效率,并没有获得好的健康结果;因此,近年许多发达国家的健康目标与卫生改革出现了一个新的导向,日益重视预防保健的作用;并采取优先选择的方式,确保资源优先配置给对人群健康最需要、资源投入最具有成本效果的保健服务。这种改革已取得了一些成效。这一改革导向对我国正在进行的医药卫生体制改革的制度设计与政策开发提供了启示。     

Toward a Culturally Responsive Model of Mental Health Literacy: Facilitating Help‐Seeking Among East Asian Immigrants to North America

Studies have consistently found that East Asian immigrants in North America are less likely to use mental health services even when they experience levels of distress comparable to Euro‐Americans. Although cultural factors that may prevent East Asian immigrants from seeking mental health care have been identified, few studies have explored ways to foster appropriate help‐seeking and use of mental health services. Recent work on mental health literacy provides a potential framework for strategies to increase appropriate help‐seeking and use of services. This paper reviews the literature on help‐seeking for mental health problems among East Asian immigrants living in Western countries to critically assess the relevance of the mental health literacy approach as a framework for interventions to improve appropriate use of services. Modifications needed to develop a culturally responsive framework for mental health literacy are identified.