中国农村疾病谱的变迁及其解释框架

The Change of Disease Spectrum in Chinese Rural Areas and Its Interpretive Framework

20世纪早期至新中国成立初期,农村居民深受传染病和营养不良类疾病的困扰;在一系列干预措施的实施下,农村传染病的发病率自20世纪70年代末开始下降,至今保持在低流行水平;20世纪90年代以来,农村慢性病的患病率快速上升,慢性病已经成为困扰农村居民的主要健康问题。在生命历程的研究视角下,结合医学人类学对生物—社会文化整体性的强调,慢性病可分为过度损耗类慢性病和过量摄取类慢性病。前者主要是社会的经历铭刻在身体之上,以关节炎、椎间盘疾病等为代表的慢性病是早年“苦日子”在人们身体留下的印记;后者则是生计转型之后,物质资源的丰富和身体消耗的减少同时发生,“好日子”的快速到来使得长久遭受饥饿和劳累的身体难以适应,高血压、糖尿病等是这种不适的身体呈现。从根本上说,过量摄取类慢性病看似源自当前“生活的甜蜜”,实则是早年经历的身体再现。厘清社会制度、生计模式、文化心态、身体习性和健康疾病之间的复杂关系,持有对中国农村疾病谱转变及其内在逻辑的清醒认识,有助于农村健康促进政策的合理制定和精准实施。

From the early 20th century back to the early days of the founding of New China in 1949, rural residents were deeply plagued by infectious diseases and malnutrition ones. Thanks to a series of interventions, the incidence of infectious diseases in rural areas has declined since the late 1970s, and maintained a low prevalence level to this day;since the 1990s, the prevalence of chronic diseases in rural areas has risen rapidly, and chronic diseases have become a major health problem that plagues rural residents. From the perspective of life cause research, with reference to the emphasis on bio-social-cultural holism in medical anthropology, chronic diseases can be divided into chronic diseases with excessive loss and chronic diseases with excessive intake. The former are mainly chronic diseases represented by arthritis and intervertebral disc disease, which are the imprints of “hardships” in the early years;the latter are a sign of physical inadaptability, including hypertension and diabetes which occur when the bodies that had suffered from hunger and fatigue for long fail to fit for the sudden enrichment of material resources and reduction of physical exertion after the life became better. Fundamentally speaking, chronic diseases with excessive intake seem to originate from the current “sweetness of life,” but in fact it is the physical reproduction of early experience. Clarifying the complex relations between social system, livelihood model, cultural mentality, physical habits, as well as health and disease, and being aware of the transformation of disease spectrum in Chinese rural areas and its internal logic, will contribute to the rational formulation and precise implementation of the policies that promote health in rural areas.