我国健康城市建设指标体系比较分析

本研究选取北京、上海、广州和杭州4个城市作为研究对象,通过查阅各城市的健康城市建设规划,对其所选取的指标体系进行归类、总结,并与WHO的指标体系进行比较。通过比较,得到健康城市指标体系建设的三十项共性指标;然而指标体系不应只包括结果指标,也应包括行动指标,同时建议将政策管理指标也纳入指标体系,对健康城市的建设进行监督指导,旨在为我国其他城市开展健康城市建设,尤其是指标体系的构建提供借鉴。     

对我国城市健康养老评价指标体系的分析与思考

[目的]通过对《全球老年友好城市建设指南》(简称《指南》)和《“健康中国2030”规划纲要》(简称《纲要》)中的指标体系以及国内与城市健康养老评价指标体系相关的文献及资料进行分析、归纳和总结,为构建一套既符合国际标准又适应中国国情的城市健康养老评价指标体系提供借鉴。[方法]采用“老年友好城市、健康城市、康养城市、长寿之乡、指标”等作为关键词,基于中国知网、万方数据库,以及政府官网和国家卫生健康委员会网站等,搜索国内与城市健康养老评价指标相关的文献和资料。[结果]《指南》和《纲要》中的指标均涉及健康生活、健康服务和健康环境3个方面;同时,二者也存在一定的差异:《指南》侧重于从微观角度评价老年人群的住、行、环境、社会参与、尊重和包容、就业、信息交流和健康服务等8个方面;《纲要》则侧重于从宏观角度评价全体人群的健康水平、健康生活、健康服务与保障、健康环境和健康产业等5个方面。同时,通过对纳入的21篇文献的分析可知,我国有关老年友好城市评价指标体系构建的研究相对较少,尚未在全国范围内建立起一套系统完整的指标体系;现有的健康城市、康养城市和长寿之乡指标体系均基于我国国情构建,可以借鉴其中城市健康和养老方面的相关指标。[结论]未来在构建城市健康养老评价指标体系时,应以《指南》和《纲要》为指导,并结合我国既有的相关指标体系,该指标体系应该是科学全面的、既与国际接轨又符合中国国情需要的城市健康养老评价指标体系。     

德尔菲法构建大城市青年生殖健康素养评价指标体系分析

构建大城市15~24岁青年人群生殖健康素养评价指标体系,为评估工具开发及相关健康促进实践提供理论依据.方法 通过资料回顾、文献评阅及专家小组讨论,拟定生殖健康素养评价指标体系框架和条目池,编制咨询表并选择20名多领域专家,经2轮德尔菲专家咨询对评价指标进行完善并计算权重.结果 2轮咨询的专家权威系数分别为0.791和0.817,回表率均达100%,变异系数范围分别为0.061~0.162和0.012~0.142,协调系数由0.170上升至0.375(P<0.01),专家意见一致可信.最终形成含生殖健康决定因素、疾病和问题危险因素、卫生服务利用3个一级指标,体现信息获取、理解、评价和应用4种能力的12个二级指标,以及体现生殖健康评价关键内容的45个三级指标的评价体系.结论 建立了15~24岁青年生殖健康素养评价指标体系,可用于指导该人群生殖健康素养评估工具和干预材料的开发.     

流动人口生殖健康服务质量评价指标体系的研究与构建

目的:确立多因素、多水平的流动人口生殖健康服务质量评价体系,为评估我国城市流动人口生殖健康服务质量提供理论依据和实证工具。方法:采用文献资料查询、专家咨询等方法构建指标框架,筛选指标并建立评价指标体系,运用层次分析法计算出指标的权重。结果:初步构建出流动人口生殖健康服务质量测评体系共计61项,其中一级指标3项,二级指标11项,三级指标47项,并通过预调查进行了指标验证。结论:指标体系构建基于三环节评价理论、德尔菲法和层次分析法,体系构建过程科学、严谨。专家对指标的重要性意见比较一致,指标体系具有合理性、代表性和效度,指标预测结果可取。     

公共建筑冷却塔军团菌病健康风险评价指标体系的构建

目的建立冷却塔军团菌病健康风险综合评价指标体系,为人群健康风险提供定量评价方法。方法通过文献回顾、现场监测和现场调查进行基础指标筛选,以专家访谈和会议研讨的形式确立指标体系结构,利用序关系法计算指标权重并完成冷却塔军团菌病健康风险评价指标体系的构建。结果确定了综合评价指标体系,包括一级指标3项,二级指标10项,专家协调系数W值为0.699(P0.001)。结论序关系法应用于冷却塔军团菌健康风险评价指标体系具有较强的可操作性与实用性,并为进一步建立风险预警模型奠定基础。     

高水平健康城市建设实施评价指标体系构建及实证研究

目的 立足全方位、高水平的健康战略体系，全面构建卫生健康投入产出基本框架，为全民卫生健康领域建设高效、均衡的实施提供参考。方法 在对健康领域指标进行梳理的基础上，结合战略实施目标和发展路径，融合社会、经济、人口的时代性特征，全面构建卫生健康综合评价指标体系，并以厦门市为例进行实证评价与分析。结果 构建包括健康人力投入、资本投入、科技投入、系统投入、人群产出、环境产出、服务产出7个维度58项三级指标的卫生健康综合评价指标体系。从实证评价结果可以看出，构建的综合评价指标体系可以全面反映全民健康背景下卫生健康发展的全面性和效率性，为各地相关战略的实施提供依据。结论 确立的综合评价指标体系符合卫生健康战略发展内涵，可以为各地实施战略效果评估、促进战略高效实施提供参考。     

中美国家健康战略比较分析及启示

本研究从战略目标、战略内容和主要指标等三方面,比较分析了美国"健康公民计划"与"健康中国2030"的异同,结合我国社会经济环境,提出了注重健康战略的针对性、动态性和持续性;在全覆盖的基础上有重点地保障人群;确定阶段实施重心,并重视信息监测系统的建设;制定可操作的监督和评价体系及适宜的指标值等建议,以期为"健康中国"战略的推行和进一步完善提供启示。     

构建区域卫生健康工作评价指标体系的研究

目的构建一套与"健康中国"战略相符合,全面反映我国居民健康状况的评价指标体系。方法本文采用文献研究、专题小组讨论、思维逻辑、德尔菲法和层次分析法等一系列方法,对国内外文献进行分析归纳,构建指标库,并计算指标权重,最终构建出居民健康促进效果的评价指标体系。结果按照"三级预防"理念,对区域卫生健康工作进行梳理,构建包含全人群全生命周期区域卫生健康工作和区域卫生健康工作保障措施两个层级的指标体系,其中二级指标9个,三级指标42个。结论以健康效果为导向的卫生评价体系是符合国家政策方针的产物,可以有效的评价区域医疗卫生工作,评判医疗资源的公平性、可及性与连续性,对我国医疗卫生事业的发展具有推动作用。     

贵阳市健康城市建设评价指标体系构建及实证应用

目的探索建立健康城市建设评价指标体系,并对指标体系进行实证分析。方法通过文献研究构建指标体系的预选指标,运用德尔菲法对指标进行筛选和优化,采用等级和法确定指标权重,对贵阳市2015—2017年指标数据无量纲化处理后进行实证分析。结果经过2轮专家咨询,专家意见一致,构建了由健康环境、健康社会、健康服务、健康人群、健康文化5个一级指标,25个二级指标,54个三级指标构成的指标体系。实证分析显示,2015—2017年贵阳市城市健康总体评分呈逐年上升趋势。结论该指标体系具有较好的适用性、综合性和可靠性,评价指标内容契合贵阳市健康城市建设的基本理念。     

核设施环境影响人体健康评价初步探讨

目的 目前我国尚无核设施环境影响人体健康评价方面的技术导则和相关标准。本文对核设施环境影响人体健康评价体系进行初步探讨,搭建初步研究框架。方法 根据核设施相关环境影响报告书的标准格式与内容,参照国家环保部发布的非核设施环境影响人体健康评价的技术导则征求意见稿,应用人类辐射危害评价的相关内容及方法构建评价体系。结果 根据建立的评价工作程序和评价基本内容开展评价工作,采用健康危险度评价方法,根据我国核设施和人群结构特点,选择适合我国核设施环境影响人体健康的评价模型及参数,确定辐射危险系数,最后计算人体不同部位致癌的危害概率和全身的危害概率水平。根据健康危险度的评价结果,制定针对周围环境人群的减缓措施。结论 进行核设施环境影响人体健康评价,对我国核设施决策、管理及公众可接受度方面具有重要意义。     

Ranking community health status to stimulate discussion of local public health issues: the Wisconsin County Health Rankings

United Health Foundation's America's Health Rankings, which ranks the states from "least healthy" to "healthiest," receives wide press coverage and promotes discussion of public health issues. The University of Wisconsin Population Health Institute used the United Health Foundation's model to develop the Wisconsin County Health Rankings ("Health Rankings") from existing county-level data. The institute first released the rankings in 2004. A survey of the Wisconsin county health officers indicated that they intend to use the rankings for needs assessment, program planning, and discussion with county health boards. The institute implemented many of the health officers' suggestions for improvement of the rankings in subsequent editions. The methods employed to create the rankings should be applicable in other states.     

Improving the Environmental Quality Component of the County Health Rankings Model

Objectives. We examined the association between environmental quality measures and health outcomes by using the County Health Rankings data, and tested whether a revised environmental quality measure for 1 state could improve the models.Methods. We conducted state-by-state, county-level linear regression analyses to determine how often the model’s 4 health determinants (social and economic factors, health behaviors, clinical care, and physical environment) were associated with mortality and morbidity outcomes. We then developed a revised measure of environmental quality for West Virginia, and tested whether the revised measure was superior to the original measure.Results. Measures of social and economic conditions, and health behaviors, were related to health outcomes in 58% to 88% of state models; measures of environmental quality were related to outcomes in 0% to 8% of models. In West Virginia, the original measure of environmental quality was unrelated to any of the 8 health outcome measures, but the revised measure was significantly related to all 8.Conclusions. The County Health Rankings model underestimates the impact of the physical environment on public health outcomes. Suggestions for other data sources that may contribute to improved measurement of the physical environment are provided.A recent significant effort to characterize population health across counties in the United States is that of the County Health Rankings model developed by the University of Wisconsin’s Population Health Institute1 based on the United Health Foundation America’s Health Rankings for states.2 The model equally weights 2 health outcomes–morbidity and mortality–to form a total county health outcome score and identifies and weights 4 primary determinants of health. These determinants include social and economic factors (measured by education, employment, poverty, family and social support, single-parent households, and community safety) at 40% weight, health behaviors (tobacco use, obesity, physical inactivity, alcohol use, and unsafe intercourse) at 30% weight, clinical care (quality of care and access to care) at 20% weight, and physical environment (environmental quality and the built environment) at 10% weight. Considerations for choosing health determinants and assigning weights included existing studies, potential community modifiability of determinants, county availability and reliability of measures, and expert analysis paired with feedback.1Not included in the model are genetic determinants of health. In an often-cited model, McGinnis et al.3 assigned 30% weight to genetic influences on health. The Working Paper for the County Health Rankings team recognized that genetics influence health outcomes, but the paper indicated that the contribution of genetic factors was excluded from the model because they were considered to be nonmodifiable and nonmeasurable.4Our study summarizes evidence regarding the interdependence of genetic structure and physical environment, along with evidence of increased exposure to environmental toxicants that has occurred during recent decades. We then conducted an analysis of the 2012 County Health Rankings data to test the hypothesis that the impact of environmental quality as measured in the County Health Rankings model is significantly underestimated. We tested the hypothesis by conducting a case study of 1 state to incorporate additional state-specific environmental quality indicators into a revised environmental quality measure.     

区级卫生监督机构绩效评估指标体系研究

作者通过文献查阅、焦点小组访谈和专家咨询论证方法研制区级卫生监督机构绩效评估指标体系。研究所得绩效评估指标体系包括要素系统、指标系统和操作系统三个部分。其中,要素系统包括投入、产出、结果、效率和解释变量五个部分,指标系统包括39个一般指标,12个关键指标,操作系统给出了每个指标的概念、作用、统计口径和数据搜集方法。     

A critique of the World Health Organisation's evaluation of health system performance

The World Health Organisation's (WHO) approach to the measurement of health system efficiency is briefly described. Four arguments are then presented. First, equity of finance should not be a criterion for the evaluation of a health system and, more generally, the same objectives and importance weights should not be imposed upon all countries. Secondly, the numerical value of the importance weights do not reflect their true importance in the country rankings. Thirdly, the model for combining the different objectives into a single index of system performance is problematical and alternative models are shown to alter system rankings. The WHO statistical analysis is replicated and used to support the fourth argument which is that, contrary to the author's assertion, their methods cannot separate true inefficiency from random error. The procedure is also subject to omitted variable bias. The econometric model for all countries has very poor predictive power for the subset of OECD countries and it is outperformed by two simpler algorithms. Country rankings based upon the model are correspondingly unreliable. It is concluded that, despite these problems, the study is a landmark in the evolution of system evaluation, but one which requires significant revision.     

国际卫生系统绩效评价框架的特点及启示

卫生系统绩效改进是各国卫生事业发展的优先事项。通过总结世界卫生组织、经济合作与发展组织、世界银行等国际组织,以及英国、美国、荷兰等典型国家的卫生系统绩效评价框架特点,为我国开展相关工作提供参考。卫生系统绩效评价框架的构建多参考投入产出模型和健康决定因素模型。卫生系统绩效评价框架呈现多元化、综合化发展趋势,且随着卫生发展阶段的不同而不断更新完善。各国卫生系统绩效评价框架有其自身特点,但也存在一定的规律性。卫生系统绩效评价框架应及时反映本国卫生发展的变化和国际理念的更新;完善数据信息系统,建立公开透明的卫生系统绩效评价动态监测机制;充分发挥卫生系统绩效评价的工具作用,有效推进卫生体系改革。     

Defining undernutrition for public health purposes in the United States

Lack of consistency among definitions of undernutrition used for different public health purposes in the United States hinders an effective diagnosis of the problem and the design of interventions to prevent and treat undernutrition. No single-case definition of undernutrition is appropriate for all purposes. These purposes include surveillance of the prevalence of undernutrition in the population, epidemiological research on risk factors and consequences of undernutrition within population subgroups and communities, and screening, monitoring and evaluation of nutritional programs. We recommend that a cut-off of -2.0 SD (2.3 percentile) for weight-for-age, height-for-age, and weight-for-height on National Center for Health Statistics (NCHS) reference growth charts be used to estimate and monitor the prevalence of undernutrition in the United States, in accordance with guidelines of the World Health Organization. Epidemiological research on population-based risk factors for undernutrition and its functional consequences is required to identify the appropriate nutritional indicator and cut-off for screening and monitoring and evaluation of interventions.     

健康素养型医疗机构评价工具的研究进展

健康素养型医疗机构(health literate health care organization, HLHO)建设是提升居民健康素养的必要途径。《健康中国行动（2019—2030年）》把医疗机构及医务人员在“健康知识普及”行动中发挥重要作用列为行动目标及评价指标。通过回顾国内外文献,从应用目的、评价内容及方法、评价标准、信效度和应用现况对纳入的7项HLHO评价工具进行介绍,并对工具的评价维度、调查对象与应用场景进行比较分析,以期为评价医疗机构在居民健康素养促进中的作用以及为践行《健康中国行动》中的相关内容提供参考。     

人群健康综合测量——健康期望寿命的发展及应用

健康期望寿命是人群健康综合测量的代表性指标,本文介绍了其产生与发展的历程,总结了健康状态期望寿命与健康调整期望寿命两大类指标的特点：前者为两分或多分型指标,计算简便易于解释和理解;后者为权重调整型指标,在指标设计层面更为科学全面,但测算过程复杂。文章介绍了健康调整期望寿命、健康寿命年等指标在世界卫生组织、欧盟等国际组织及地区的应用现状,分析了各自的优劣及前景,并建议我国未来应重视健康期望寿命的研究和应用。     

Structural racism and adverse maternal health outcomes: A systematic review

In the United States, racial disparities in adverse maternal health outcomes remain a pressing issue, with Black women experiencing a 3–4 times higher risk of maternal mortality and a 2–3 times higher risk of severe maternal morbidity. Despite recent encouraging efforts, fundamental determinants of these alarming inequities (e.g. structural racism) remain understudied. Approaches that address these structural drivers are needed to then intervene upon root causes of adverse maternal outcomes and their disparities and to ultimately improve maternal health across the U.S. In this paper, we offer a conceptual framework for studies of structural racism and maternal health disparities and systematically synthesize the current empirical epidemiologic literature on the links between structural racism measures and adverse maternal health outcomes. For the systematic review, we searched electronic databases (Pubmed, Web of Science, and EMBASE) to identify peer-reviewed U.S. based quantitative articles published between 1990 and 2021 that assessed the link between measures of structural racism and indicators of maternal morbidity/mortality. Our search yielded 2394 studies and after removing duplicates, 1408 were included in the title and abstract screening, of which 18 were included in the full text screening. Only 6 studies met all the specified inclusion criteria for this review. Results revealed that depending on population sub-group analyzed, measures used, and covariates considered, there was evidence that structural racism may increase the risk of adverse maternal health outcomes. This review also highlighted several areas for methodological and theoretical development in this body of work. Future work should more comprehensively assess structural racism in a way that informs policy and interventions, which can ameliorate its negative consequences on racial/ethnic disparities in maternal morbidity/mortality.     

Barriers to mental health care for hispanic americans: A literature review and discussion

The Hispanic American population, the second largest and fastest growing minority population in the United States, faces barriers to access to both medical health and mental health care. This paper examines both financial and cultural barriers to utilization of mental health care services; it is a broad review of the literature and is not intended to be comprehensively detailed. The research review suggests that the financial barrier is a major determinant of mental health service access for Hispanic American populations. Also, nonfinancial barriers such as acculturation are examined. A two-part plant is suggested to reduce both financial and nonfinancial barriers. Very little literature on utilization of substance abuse services was found; suggestions for further research are thus proposed. Bernard S. Arons, M.D., is with the Division of Applied and Services Research, National Institute of Mental Health.