1、社會醫學Social Medicine 社會醫學教研室 第一章 概 論Chapter one Introduction社會醫學的概念、性質、內容和任務社會醫學的發展社會醫學基本觀點社會醫學與其他學科的關系concept, nature, contents and tasksDevelopment Basic thinking Relation with other subjectsWhat is social medicine?什么是社會醫學？Medicinesociology社會學政治學經濟學倫理學管理學基礎醫學臨床醫學預防醫學Human behavior Culture Value Str

2、ucture of society Social interaction Socialization Social institutions Dynamic of Society Social change Social life Sociology What is medicine?什么是醫學The science related to the diagnosis understanding prevention treatment of illness. Human being is more of the social creature than the animal. its soci

3、al 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? 人的本質屬性：在于其社會屬性WHO： 1948新的健康定義: 健康是： 身體 心理 社會 的完好狀態，而不僅是沒有疾病或身體

4、虛弱而已。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?霍普金斯大學的研究小組通過對伊拉克全國47個區進行調查走訪形成的報告認為，美國發動伊拉克戰爭造成了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教授、聯合國前秘書長安南的特別顧問JEFFREY SACHS先生SACHS教授說：2003

5、年的發展議題被擠出了國際議程，戰爭與反恐取代了發展。 艾滋病每天奪去數以千計的生命，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、災害 世界軍費開支將達9000億美元，而用于發展援助為500億美元，用于艾滋病防治僅10億美元。Rudolf Virchow: German pathologist1. Social and economic conditions profoundly impact health, disease and the practice of medicine. 2.

6、 The health of the population is a matter of social concern. 3. Society should promote health through both individual and social means. 1. 社會經濟條件對健康、疾病和醫學實踐具有深刻的影響；2. 群體的健康應該成為社會關注的內容;3. 社會應該通過個人和社會的手段來改善人群健康。 社會醫學的核心內容 Core Contents Identify social health problems diagnosis of problems Analysis of

7、social causes of diseases social etiologySocial medicine prescription- social strategy - 社會醫學診斷- 社會病因分析- 社會醫學處方 社會醫學與臨床醫學的比較社會醫學：群體 social medicine: mainly target at population level發現社會問題社會診斷 Identify social problemsocial diagnosis社會醫學分析了解社會成因 Social medical analysisfind out social causes社會醫學綜合處方 S

8、ocial comprehensive therapy臨床醫學：主要針對個體 Clinical medicine: mainly target at individual level了解個體健康問題醫學診斷 Identify individual health problem-medical diagnosis開展病因學分析: 主要是生物學病因分析 Etiological analysis: biological causes analysis制定醫學處方 Provide medical prescription社會醫學的任務The tasks of social medicineAdvoca

9、te positive concept of healthTo improve social health status, enhance population health and quality of life To formulate health policy & strategiesTo conduct preventive care services for special population and specific disease 倡導積極的健康觀改善社會衛生狀況;提高人群健康水平和生命質量;制定衛生政策和策略；開展特殊人群和特種疾病的預防保健工作; Basic thinki

10、ng of social medicineHarmonious relationship between health and social developmentTwo way interaction between health and social economic developmentI.協調發展的觀念II.雙向作用的觀念美國學者Mushkin計算出了美國在19001960年人口死亡率下降帶來的經濟收益約為8200億疾病對人力資本和勞動生產率造成損失的“3D”框架 (Death, Disability， Debility）Basic thinking of social medici

11、nePositive concept of healthBio-psycho-social medical modelIII. 現代醫學模式下的積極健康觀USA19000億1%最不健康2020慢病病人70 70%健康人10%吸煙已成為全球第二號殺手IV.關注高危人群&高危因素High risk factors & populationBasic thinking of social medicineBasic thinking of social medicineImportant role of social factors in prevention and treatment of di

12、seasesMultisector participationV.社會因素在疾病防治中的重要作用VI.多部門參與人事人口&計劃生育勞動&社會保障教育計劃、財政藥品監督管理衛生社會醫學發展史The history of social medicineEmbryonic stage of social medicineEstablishment & development of social medicineDevelopment of social medicine in China社會醫學的萌芽 社會醫學的創立和發展我國社會醫學的發展 Pathogenesis of disease and t

13、he role 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在機制而起左右。醫生的職責是恢復健康平衡;四體液學說體現了整體醫學

14、觀 Embryonic stage of social 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 con

15、trol disease古羅馬醫師蓋倫：重視心理因素對健康的影響;德國社會衛生學家:弗蘭克: 悲慘的生活是疾病的溫床; : 用醫學監督計劃使政府采取措施保護公眾的健康; 第一個提出社會衛生措施德國病理學家 魏爾嘯German Pathologist: Rudolf VirchowThe kernel of medical science is social science“Medicine is a social sciencePolitics is nothing more than medicine in broad senseBest method of medicine is to c

16、ombine medicine with social life and political activities醫學科學的核心是社會科學醫學是一門社會科學；任何社會都應對居民的健康負責政治學是廣義上的醫學實現醫學目標的最好的辦法是將醫學和社會生活和政治活動結合起來 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 social view;I

17、s a first person given lecture on social hygiene 提出社會病理學的理論和概念;用社會觀點研究人類疾病的原則首次在柏林大學開設社會衛生學講座 Germany： Birthplace of social medicineBefore WWIISocial hygieneSocial medicineLaterbecome social medicine德國是社會醫學的發源地二戰前：使用社會衛生學和社會醫學后改為社會醫學 社會醫學在各國的發展Development of Social Medicine in different countries In

18、 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 英國: 40s 開

19、設社會醫學, 在牛津大學成立社會醫學研究院；牛津大學賴爾教授:公共衛生、工業衛生、社會衛生服務、公共醫療事業都屬于社會醫學的范疇；60s社會醫學改成社區醫學。 社會醫學在美國的發展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醫學社會學和家庭醫學得到了發展強調社會

20、學、管理學和經濟學社會醫學包含在衛生管理學和衛生政策學的講座內容中 社會醫學在中國的發展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 offered

21、course in social medicine.50年代：保健組織學作為醫學生的必修課，成立保健組織教研組80年代：衛生部成立6所衛生管理干部培訓中心，社會醫學成為主干課程90%以上的醫學院開設了社會醫學課程Preventive medicineCommunity medicineMedical sociologyHealth managementMedical psychology 社會醫學與其他相關學科的關系The relationship between social medicine and other related subjects 預防醫學社區醫學醫學社會學衛生管理學 醫學心

22、理學Preventive MedicinePreventive 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 medicineSocial

23、Medicine Vs Community MedicineCommunity medicineMore practical OperationalBoth target at population levelIntermediate levelShare same origin with social medicineThe Practice of social medicine facilitate the development of theory of social medicine Social medicineMore theoretical Macro mainly at policy levelOffer guiding principleTheory of social medicine be practiced in community medicineMore theoretical, offer principle and guidance to CM Medical SociologyMedical sociology belong to the disciplinary group of sociology;C