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Reducing health inequalities in developing countries 减少发展中国家的卫生不平等
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0010
Rômulo Paes-Souza, P. Buss, M. Barreto
In the current international context of economic globalization, discussions have not only highlighted inequalities within individual countries, but also inequalities between countries. Inequalities between countries are related to the differences in economic and social development achieved by different countries, which are generated by the position that these countries have occupied during different phases of history within the global production system. The latter reflect historical aspects, and the international economic and political environments in relation to each country’s share of global resources and development opportunities. Policies for fighting poverty and inequality require local, national, and global approaches, but funding issues often hamper their feasibility.
在当前经济全球化的国际背景下,讨论不仅强调了个别国家内部的不平等,也强调了国家之间的不平等。国家之间的不平等与不同国家在经济和社会发展方面的差异有关,这种差异是由这些国家在全球生产体系的不同历史阶段所占据的地位所产生的。后者反映了与每个国家在全球资源和发展机会中所占份额有关的历史方面和国际经济和政治环境。消除贫困和不平等的政策需要地方、国家和全球的方法,但资金问题往往阻碍其可行性。
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引用次数: 1
Globalization 全球化
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0005
Kelley Lee
Globalization, defined as the closer interconnectedness of human societies across national borders and geographies, through a mixture of spatial, temporal, and cognitive changes, is having wide-ranging impacts on public health. This interconnectedness is characterized by restructuring of the world economy, increased population mobility, and advances in information and communication technology, all of which can have profound impacts on health determinants and outcomes. Contemporary globalization creates new opportunities to enhance human health and well-being, but can also be a potential source of negative externalities. In addition, the costs and benefits to health from globalization have been inequitably distributed. A ‘global public health’ approach seeks to better understand the changing patterns of health and disease, and their determinants, arising from globalization, and the interventions needed to effectively manage them. This requires greater attention to achieving collective action, underpinned by legal and regulatory frameworks, across populations and societies to tackle transboundary health determinants and outcomes. More effective global health governance, in turn, will contribute to more sustainable forms of globalization.
全球化的定义是,通过空间、时间和认知变化的混合,人类社会跨越国界和地理位置的更紧密的相互联系,正在对公共卫生产生广泛的影响。这种相互联系的特点是世界经济的结构调整、人口流动性增加以及信息和通信技术的进步,所有这些都可能对健康决定因素和结果产生深远影响。当代全球化为增进人类健康和福祉创造了新的机会,但也可能成为负面外部性的潜在来源。此外,全球化给健康带来的成本和收益分配不均。"全球公共卫生"办法旨在更好地了解全球化所产生的不断变化的健康和疾病模式及其决定因素,以及有效管理这些模式所需的干预措施。这就需要更加重视在法律和监管框架的支持下,跨人群和跨社会采取集体行动,以处理跨界卫生决定因素和结果。更有效的全球卫生治理反过来将有助于实现更可持续的全球化形式。
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引用次数: 0
Genomics and public health 基因组学与公共卫生
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0011
V. Ramsuran, T. Oliveira
The discipline of ‘public health genomics’ emerged as a need to provide ‘responsible and effective translation of genome-based knowledge and technologies for the benefit of the population’. It is becoming increasingly accepted that the one size fits all approach is going to be outdated soon. Targeted personalized medicines, therapies, and interventions approach will be the preferred form of treatment in the not too distant future. The fields of public health genomics, precision medicine, and precision public health have proven important aspects in improving population health. However, despite the advancements made, there are still improvements that need to be implemented to significantly improve health, especially within the developing countries. In this chapter we discuss the advancements made within the field and highlight challengers or future directions.
“公共卫生基因组学”学科的出现是为了提供“负责任和有效地翻译基于基因组的知识和技术以造福人类”的需要。“一刀切”的方法很快就会过时,这一点越来越被人们所接受。在不久的将来,有针对性的个性化药物、治疗和干预方法将成为首选的治疗形式。公共卫生基因组学、精准医学和精准公共卫生等领域已被证明是改善人口健康的重要方面。然而,尽管取得了进展,但仍需要作出改进,以显著改善健康状况,特别是在发展中国家。在本章中,我们讨论了该领域的进展,并强调了挑战者或未来的方向。
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引用次数: 0
Physical activity and public health 体育活动与公共健康
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0063
Nyssa T. Hadgraft, N. Owen, P. Dempsey
There are well-established chronic disease prevention and broader public health benefits associated with being physically active. However, large proportions of the adult populations of developed countries and rapidly urbanizing developing countries are inactive. Additionally, many people’s lives are now characterized by large amounts of time spent sitting—at work, at home, and in automobiles. Widespread urbanization, particularly in low- and middle-income countries, has resulted in large segments of traditionally active rural populations moving into cities. Many previously manual tasks in the occupational and household sectors have become automated, making life easier and safer in many respects. However, a pervasive consequence of these developments is that large numbers of people globally are now going about their daily lives in environments that place them at risk of overweight and obesity, type 2 diabetes, cardiovascular disease, and other health problems. This represents a formidable set of public health challenges. In this context, the present chapter describes: key definitions and distinctions relating to physical activity, exercise, and sedentary behaviour; current evidence on relationships physical inactivity and sitting time with health outcomes, and associated public health recommendations; prevalence and trends in physical activity and sedentary behaviours, and some of the key issues for surveillance and measurement; and, how physical activity and sedentary behaviour may be understood in ways that will inform broad-based public health approaches. An interdisciplinary and intersectoral strategy is emphasized. This requires working with constituencies beyond the public health field, such as urban planning, architecture, occupational health and safety, and social policy.
锻炼身体对慢性疾病的预防和更广泛的公共健康都有好处。然而,在发达国家和快速城市化的发展中国家,有很大一部分成年人口不活动。此外,许多人现在的生活特点是花大量时间坐着——在工作中、在家里和在汽车里。广泛的城市化,特别是在低收入和中等收入国家,导致大量传统上活跃的农村人口进入城市。以前在职业和家庭领域的许多手工任务已经自动化,使生活在许多方面更容易和更安全。然而,这些发展的一个普遍后果是,全球许多人现在的日常生活环境使他们面临超重和肥胖、2型糖尿病、心血管疾病和其他健康问题的风险。这是一系列令人生畏的公共卫生挑战。在此背景下,本章描述:与身体活动、锻炼和久坐行为相关的关键定义和区别;缺乏身体活动和久坐时间与健康结果之间关系的现有证据,以及相关的公共卫生建议;身体活动和久坐行为的流行程度和趋势,以及监测和测量的一些关键问题;以及如何理解身体活动和久坐行为,从而为基础广泛的公共卫生方法提供信息。强调跨学科和部门间战略。这需要与公共卫生领域以外的领域合作,例如城市规划、建筑、职业卫生和安全以及社会政策。
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引用次数: 0
Sexually transmitted infections 性传播感染
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0070
N. Kojima, J. Klausner
Sexually transmitted infections (STIs) refer to a broad array of pathogens that are transmitted through vaginal, anal, or oral sex. While STI case rates are highest in adolescents and young adults, the most serious health outcomes occur later in life and are disproportionately borne by women and infants. For these reasons, STI prevention and control is an important public health investment for every country. This chapter summarizes the global epidemiology of STIs and their associated health consequences, and reports on factors affecting STI spread in the community. It also discusses STI prevention and control as a public health intervention, relying on many interrelated interventions working together to reduce STI incidence and prevalence in the community. Finally, it considers some of the most likely challenges and opportunities in STI prevention anticipated over the next few decades.
性传播感染(STIs)是指通过阴道、肛门或口交传播的一系列病原体。虽然性传播感染发病率在青少年和青壮年中最高,但最严重的健康后果发生在生命后期,妇女和婴儿承担的比例过高。由于这些原因,性传播感染预防和控制对每个国家来说都是一项重要的公共卫生投资。本章概述了性传播感染的全球流行病学及其相关的健康后果,并报告了影响性传播感染在社区传播的因素。它还讨论了作为一项公共卫生干预措施的性传播感染预防和控制,依靠许多相互关联的干预措施共同努力减少社区中的性传播感染发病率和流行率。最后,它考虑了未来几十年预计在性传播感染预防方面最可能面临的一些挑战和机遇。
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引用次数: 1
Global health in the era of sustainable development 可持续发展时代的全球卫生
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0107
F. Fleck
This chapter provides an overview of progress made in public health during the first two decades of the twenty-first century and charts the way forward to further improvements. It introduces the World Health Organization’s (WHO) current 5-year strategy, explains how this strategy is aligned with the 2030 Agenda for Sustainable Development, and how impact will be measured at the national level. Based on the Sustainable Development Goals, the WHO has set its triple billion targets to achieve by 2023. These are: one billion more people benefitting from universal health coverage; one billion more people better protected from health emergencies; and one billion more people enjoying better health and well-being. Components of each of these goals are described here, and the chapter concludes with the cross-cutting areas of monitoring and evaluation, and data and innovation that are vital to achieving measurable health impact in every country, regardless of income level.
本章概述了二十一世纪头二十年在公共卫生方面取得的进展,并指明了进一步改进的前进方向。它介绍了世界卫生组织(世卫组织)目前的五年战略,解释了该战略如何与《2030年可持续发展议程》保持一致,以及如何在国家一级衡量影响。根据可持续发展目标,世卫组织制定了到2023年实现30亿人口的目标。这些目标是:有10亿多人受益于全民健康覆盖;受突发卫生事件保护的人数增加10亿;10亿人享有更好的健康和福祉。本章最后介绍了监测和评价的交叉领域以及数据和创新,这些领域对于在每个国家实现可衡量的健康影响至关重要,无论其收入水平如何。
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引用次数: 0
Emerging and re-emerging infections 新发和再发感染
Pub Date : 2021-11-01 DOI: 10.1093/med/9780199661756.003.0217
D. L. Heymann, Vernon J.M. Lee
Emerging infections are newly identified infections in humans—and are most often zoonotic—caused by infectious organisms that breach the species barrier between animals and humans. Re-emerging infections are known organisms that infect humans, but are identified after a period of absence from human populations. Re-emerging infections also often result from breaches in the species barrier. In addition to direct health outcomes of sickness and death, they also affect the economy, and may spread globally. This chapter discusses factors that influence the emergence of infectious diseases including weak public health infrastructure; failure of safety procedures and regulations; population shifts including rapid population increases and uncontrolled urbanization; anthropogenic activities and climate change; civil disturbance, human displacement, and natural disasters; human behaviours; and deliberate use to cause fear and harm. To address these threats, national public health systems must be strengthened to detect and respond to infectious diseases when and where they emerge, or re-emerge; and a safety net of global networks is required if and when the countries in which they emerge or re-emerge are unable to stop their international spread.
新发感染是指在人类中新发现的感染,通常是人畜共患感染,由突破动物与人类之间物种屏障的传染性生物引起。再次出现的感染是已知的感染人类的生物体,但在人群中消失一段时间后才被发现。再次出现的感染也常常是由于物种屏障的破坏。除了疾病和死亡的直接健康后果外,它们还影响经济,并可能在全球蔓延。本章讨论影响传染病出现的因素,包括薄弱的公共卫生基础设施;违反安全程序和规定;人口转移,包括人口快速增长和不受控制的城市化;人为活动与气候变化;内乱、人口流离失所和自然灾害;人类行为;以及故意使用来制造恐惧和伤害。为应对这些威胁,必须加强国家公共卫生系统,以便在传染病出现或再次出现的时间和地点发现并作出反应;如果出现或再次出现疫情的国家无法阻止疫情的国际传播,就需要建立一个全球网络安全网。
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引用次数: 0
Prisoners 囚犯
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0093
T. Butler, P. Schofield
This chapter provides a public health analysis of imprisonment (the loss of personal freedom for short or long periods—including life sentences): the individual and population effects upon morbidity and mortality including suicide and homicide, drug addiction, and mental health. These effects impact the life course of former prisoners and their families, employment, and life expectancy, and have intergenerational impacts upon the children of incarcerated parents. While international data are presented for comparison of the magnitude and characteristics of imprisonment worldwide, this chapter examines the United States most closely. America is an atypical but instructive case study: the nation with the world’s largest number of prisoners and highest rate of imprisonment. Mass incarceration is not seen in other developed democratic nations but the case of America represents an important natural experiment, demonstrating precisely how high rates of imprisonment can become socially ‘toxic’, with damaging consequences for population health, societal well-being, and human rights.
本章提供了监禁(短期或长期丧失人身自由——包括无期徒刑)的公共卫生分析:个人和人口对发病率和死亡率的影响,包括自杀和杀人、吸毒和精神健康。这些影响影响前囚犯及其家庭的生命历程、就业和预期寿命,并对被监禁父母的子女产生代际影响。虽然提供了国际数据来比较世界各地监禁的规模和特征,但本章对美国的考察最为密切。美国是一个非典型但具有指导意义的案例:世界上囚犯数量最多、监禁率最高的国家。大规模监禁在其他发达民主国家并不常见,但美国的案例代表了一个重要的自然实验,它准确地展示了高监禁率如何成为社会“有毒”,对人口健康、社会福祉和人权造成破坏性后果。
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引用次数: 0
Methodological issues in the design and analysis of cluster randomized trials 聚类随机试验设计和分析中的方法学问题
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0032
K. Baisley, R. J. Hayes, L. H. Moulton
Randomized controlled trials are the accepted gold standard for evaluating the effects of interventions to improve health. In the majority of such trials, individuals are randomly allocated to the experimental conditions under study, for example, to treatment and control arms. However, in some situations it is more appropriate to randomly allocate groups of individuals to the treatment arms. These groups are referred to as clusters, and trials of this kind are known as cluster randomized trials (CRTs). Examples of clusters include schools, villages, workplaces, or health facilities, but there are many other possible choices. In some CRTs, all individuals within the selected clusters are automatically included. In others, there may be additional eligibility criteria. Similarly, the impact of the intervention may be measured in all individuals in the cluster, or in a random subsample. This chapter aims to discuss methodological issues that arise in the design and analysis of CRTs
随机对照试验是评估干预措施改善健康效果的公认金标准。在大多数此类试验中,个体被随机分配到所研究的实验条件中,例如,分配到治疗组和控制组。然而,在某些情况下,将个体随机分配到治疗组更为合适。这些组被称为集群,这类试验被称为集群随机试验(crt)。群集的例子包括学校、村庄、工作场所或卫生设施,但还有许多其他可能的选择。在一些crt中,所选集群中的所有个体都自动包含在内。在其他情况下,可能有额外的资格标准。同样,干预的影响可以在群集中的所有个体或随机子样本中测量。本章旨在讨论在crt的设计和分析中出现的方法学问题
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引用次数: 0
Public health policy in developed countries 发达国家的公共卫生政策
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0022
J. Powles, H. Gouda
Public health policies might thus be thought of as the policies that guide these ‘organized efforts’ to protect and improve health. The scope of such policies depends a good deal, however, on what is considered to be entailed by ‘organized efforts’. and on how centrally ‘organized efforts’ are understood to be related to efforts that are more decentralized, more informal, less organized, perhaps even ‘spontaneous’. The relative importance and legitimacy of centralized versus decentralized uses of knowledge in protecting and enhancing health is a common underlying theme in discussion of public health policy. This chapter discusses public health policy, and differences in outcomes, across different developed countries.
因此,公共卫生政策可以被认为是指导这些“有组织的努力”以保护和改善健康的政策。然而,这些政策的范围在很大程度上取决于“有组织的努力”所包含的内容。以及集中的“有组织的努力”是如何被理解为与更分散的、更非正式的、更没有组织的、甚至可能是“自发的”努力相关联的。在讨论公共卫生政策时,集中使用知识与分散使用知识在保护和增进健康方面的相对重要性和合法性是一个共同的基本主题。本章讨论不同发达国家的公共卫生政策和结果差异。
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引用次数: 0
期刊
Oxford Textbook of Global Public Health
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