基于继承与发展的公共卫生概念界定研究

Exploiting the concept of public health: an inheritance and development based study

目的在前期研究基础上,遴选公共卫生经典内涵,纳入公众健康核心理念,提出新时代各方统一的公共卫生定义,指导我国公共卫生理论和实践。方法通过专题小组讨论,明确应纳入的经典内涵和增加的核心理念;遵循逻辑学中公认的常用下定义方法和步骤,形成公共卫生定义和内涵外延;开展多重定性定量论证和全国范围的各方专题意向论证,明确接受程度,收集意见建议进行完善。结果通过遴选与完善经典内涵的过程,最终共"保留"8类经典内涵,"增加"4类公众健康核心理念,补充"公共卫生本意为公众健康"的强调;通过6轮"论证–完善–再论证–再完善"循环和3轮德尔菲论证,收集专家意见并修改完善;在此基础上,形成本研究的公共卫生概念界定:公共卫生(public health)是以保障公众健康与健康公平为导向的公共事业。由政府主导、社会协同、全体社会成员参与共享,运用健康相关理论与方法,预防和控制疾病与伤残,降低和消除健康风险,改善和促进人的生理、心理健康及社会适应能力,以提高全民健康水平与生命质量、维护社会稳定与发展。公共卫生本意为公众健康,其内涵已成为健康国家(地区)的基础。通过开展意向论证,调查全国七省的3 291名组织者和提供者以及全国10所高校的136名研究者,论证结果显示,公共卫生界定获得组织者、提供者、研究者等各方高度认可,其中定义的整体认可率达到98.7%,各块内涵外延的认可程度在97.6%~99.2%。结论新时代明确"何为公共卫生"意义重大,可以指导公共卫生理论和实践,有利于统一各方行动。本研究界定的公共卫生定义具有明确政府责任、强调健康公平、强调社会协同、明确公民义务等鲜明特点。

Objective To establish a general definition of public health through screening classic connotations of public health and embracing core concepts of public health for providing theoretical guidance to public health practice in China.Methods We first identified classical connotations to be followed and core concepts to be developed through panel discussion and proposed the definition of public health and its connotation and extension based on common methodology and procedures in logic studies. Then, six rounds of discussion meeting and three rounds of Delphi consultation were performed among experts to modify and improve the proposed definition of public health. Subsequently, questionnaire surveys were conducted among 3 291 administrators in governmental health departments and personnel in public health facilities in 7 provinces and 136 researchers in10 universities across China to collect their opinions on validation and modification for the proposed definition of public health.Results A general definition for public health was proposed based on the study: public health refers to public services and facilities for protection of population health and health equity and public health practice should be dominated by the government and with the contributions of all society. The proposed definition of public health involves 8 classic connotations retained and 4 core concepts supplemented. Public health practices include the prevention and control of diseases and disabilities, the reduction and elimination of health risks, the improvement and promotion of physical and mental health and social adaptability, the enhancement of health and life quality in populations, and the maintainment of social stability and development. The proposed macro definition of public health was approved by 98.7% of the respondents surveyed and 97.6% – 99.2% of the respondents from various provinces and universities reported the approval for the connotation and extension of the public health definition.Conclusion The redefinition of public health is of great significance for guiding contemporary practice of public health. The study proposes the general definition of public health characterized by the assignment of government responsibility and civic obligation and the emphasis on health equity and social coordination.