三、公共卫生服务能力稳步提升
III. Public Health Service Capability Improving Steadily文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
中国坚持预防为主、防治结合，提高公共卫生服务的可获取性和均等性，加大传染病、慢性病、地方病等疾病预防控制力度，提升突发公共卫生事件应急能力，推行覆盖全民的基本公共卫生服务，均等化程度不断提高。文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
The Chinese government gives priority to prevention while combining prevention with treatment, and makes great efforts to ensure the people’s equal access to public health services. It devotes great efforts to preventing and controlling epidemic, chronic and endemic diseases, strengthening the quick response capacity on public health emergencies, and developing an increasingly equal and universal basic public health service system.文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
基本公共卫生服务覆盖率进一步提高。国家免费提供疫苗及接种服务，受益对象从儿童扩展到成人。截至2015年底，疫苗接种率以乡镇为单位总体保持在90%以上，多数免疫规划疫苗可预防传染病的发病与死亡率降至历史最低水平。2010年至2017年，人均基本公共卫生服务经费财政补助标准从15元提高到50元，服务项目从最初的9类41项扩大到12类47项。建立居民健康档案、健康教育、预防接种、儿童健康管理、孕产妇健康管理、老年人健康管理、慢性病患者健康管理、严重精神障碍患者管理、结核病患者健康管理、中医药健康管理、传染病和突发公共卫生事件报告和处理、卫生计生监督协管共12类服务项目，已基本覆盖居民生命全过程。截至2016年底，全国居民电子健康档案建档率达到76.9%，高血压、糖尿病患者健康管理人数分别达到9023万人和2781万人。孕产妇和3岁以下儿童系统管理率分别达到91.6%和91.1%。文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
The coverage of basic public health services has been further expanded. The government has extended free vaccinations from children only to adults. By the end of 2015, the vaccination rate of every town or township was at least 90 percent and the incidence of and mortality from diseases that can be prevented by programmed vaccines had fallen to the lowest level ever. From 2010 to 2017, the state subsidy for basic public health services has increased from RMB15 to RMB50 per person, and the services have also expanded from 41 in nine categories to 47 in 12 categories. The 12 categories span a person’s life circle, including citizens’ health archives, health education, vaccination, children’s health management, pregnancy and maternity health management, elderly people’s health management, health management of chronically ill patients, management of patients with severe mental disorders, health management of tuberculosis patients, TCM health management, reporting and handling of epidemic diseases and public health emergencies, and assisting management and supervision on health and family planning. By the end of 2016, the government had set up digital health archives for 76.9 percent of Chinese citizens, covering 90.23 million hypertension patients and 27.81 million diabetes sufferers. At the same time, 91.6 percent of pregnant and lying-in women and 91.1 percent of children under the age of three were brought under systematic management.文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
基本公共卫生服务的惠及面不断扩大。2012年，国家实现消除新生儿破伤风的目标。2014年，通过新生儿接种乙肝疫苗，5岁以下儿童乙肝表面抗原携带率从1992年的9.67%降至0.32%，提前实现世界卫生组织提出的于2017年将5岁以下人群乙肝表面抗原流行率降到1%以下的目标。流动人口的基本公共卫生服务利用状况持续改善，传染病防控工作普遍开展，流动儿童免疫接种率达90%以上。针对重大疾病、重要健康危险因素和重点人群健康问题，制定和实施重大公共卫生服务项目，为15岁以下人群补种乙肝疫苗、贫困地区儿童改善营养、农村孕产妇提供住院分娩、农村妇女“两癌”筛查、农村建设无害化卫生厕所等，累计覆盖近2亿人。2009年，国家启动“百万贫困白内障患者复明工程”，由政府提供补助为贫困白内障患者实施复明手术，截至2013年底，接受手术的人数已超175万人。
The scope of beneficiaries of the basic public health services has expanded steadily. By 2012, China had eliminated tetanus among all newborn babies. In 2014, through injection of hepatitis B vaccine to newborn babies, the prevalence of hepatitis B surface antigen in children under five years of age decreased from 9.67 percent in 1992 to 0.32 percent in 2014, achieving the WHO’s goal of reducing that figure to below 1 percent three years ahead of schedule. An increasing number of the floating population now have better access to basic public health services. Epidemic diseases have been effectively prevented and controlled among them, and more than 90 percent of their children have received vaccinations. Aiming at serious diseases, major risk factors affecting health and key groups, the state has formulated and implemented major public health service projects that cover nearly 200 million people, such as hepatitis B vaccination for people under 15 years of age who missed the vaccination earlier, nutrition improvement for children in impoverished areas, facilitating rural pregnant women’s delivery in hospital, screening for cervical and breast cancers among women in rural areas, and construction of hygienic toilet in rural areas. In 2009, the government launched the Regaining Eyesight Program for a Million Impoverished Cataract Patients, and had subsidized surgery for more than 1.75 million cataract patients by the end of 2013.
传染病疫情控制水平持续提升。国家已建成全球最大规模的法定传染病疫情和突发公共卫生事件的网络直报系统。法定传染病报告发病率平均降低19.4%。传染病早期发现和预警能力进一步增强，传染病信息报告系统覆盖近7.1万家医疗机构，系统用户超过16万，年报告个案信息约900万件。2016年，全国甲乙类传染病报告发病率、死亡率分别控制在215.7/10万和1.31/10万以下。建成国家、省、市、县四级疾控机构实验室检测网络，中国疾控中心流感、脊髓灰质炎、麻疹、乙脑等实验室成为世界卫生组织参比实验室。疫情形势总体平稳，未发生较大传染病流行。艾滋病整体疫情控制在低流行水平，重点地区疫情快速上升势头得到基本遏制。结核病防治工作成效显著，成功治疗率保持在90%以上。2016年，全国结核病报告发病数比2011年下降12.6%，结核病死亡率降至2.3/10万左右，达到发达国家水平；全国疟疾病例共报告3189例，其中本地感染病例仅有3例，比2010年的4262例大幅度减少，80%以上的疟疾流行县基本消除疟疾。重点寄生虫病防治效果持续巩固，截至2016年底，全国453个流行县均达到了血吸虫病传播控制或以上标准。
The ability to control epidemic diseases has continuously improved. The Chinese government has established the world’s largest online direct reporting system for notifiable epidemic diseases and public health emergencies. Reported incidence of epidemic diseases has dropped by 19.4 percent. The early detection and early warning capacities have been further improved. The epidemic disease reporting system covers 71,000 medical institutions, with 160,000 users and nine million annual individual reports. In 2016, the reported incidence and death rate of epidemic diseases in categories A and B was controlled below 215.7/100,000 and 1.31/100,000, respectively. The state has set up a laboratory network comprised of disease control and prevention institutions at national, provincial, city and county levels. The influenza, poliomyelitis, measles and meningitis B labs of the Chinese Center for Disease Control and Prevention have become WHO reference labs. On the whole, the epidemics are under control and there has been no widespread epidemic in China. The spread of HIV remains at a low level, and its rapid growth in certain areas has been checked. The efforts to prevent and treat tuberculosis have achieved good results, with a cure rate of over 90 percent. In 2016, the reported incidence of tuberculosis had decreased by 12.6 percent compared to 2011, and the mortality rate from tuberculosis had dropped to 2.3 per 100,000 patients, reaching the level of developed countries. In the same year, there were 3,189 malaria cases reported nationwide, with only three domestically infected. This was much lower than the 4,262 cases in 2010. The disease has now been eradicated in over 80 percent counties that once had a widespread malaria problem. The prevention and treatment of major parasitic diseases have achieved solid results. By the end of 2016, the transmission of schistosomiasis was brought under control in all the 453 counties where it once had been widespread.
慢性病防控效果显著增强。国家已建立慢性病和慢性病危险因素监测网络。老年人健康管理和高血压、糖尿病患者管理等作为国家基本公共卫生服务免费向公众提供，实施脑卒中、心血管疾病高危筛查、口腔疾病综合干预、癌症早诊早治等项目。截至2016年底，脑卒中高危人群筛查和干预项目累计筛查610余万人，发现高危人群82万人，开展随访干预95.2万人次；心血管病高危人群早期筛查与综合干预项目累计筛查338.9万人，发现高危人群77.6万人，随访管理52.4万人次；儿童口腔疾病综合干预项目为1亿儿童提供免费口腔检查，516.8万儿童免费窝沟封闭，222.9万儿童免费局部用氟；癌症早诊早治项目累计筛查214万高危人群，发现患者5.5万人，整体早诊率高于80%。
The effects of China’s practice in preventing and controlling chronic diseases have remarkably improved. China has set up a monitoring network for chronic diseases and risk factors. As a basic public health service, the health management of the aged and hypertension or diabetes patients is provided free to the public. The state runs many services, like screening for cerebral apoplexy and cardiovascular disease, comprehensive oral disease intervention, and early diagnosis and treatment of cancer. By the end of 2016, the service of screening for and intervention of cerebral apoplexy had been provided to more than 6.1 million people, 820,000 of whom were found to be at high risk, and 952,000 follow-up interventions were conducted. Early screening and comprehensive intervention of cardiovascular disease had been provided to 3.389 million people, 776,000 of whom were found to be at high risk, and 524,000 follow-up interventions were conducted. Comprehensive oral disease intervention had provided free oral examination to 100 million children. A total of 5.168 million children received free dental sealants treatment and 2.229 million children received free local fluoride varnish treatment. The early diagnosis and treatment of cancer service had been provided to 2.14 million high-risk people. Some 55,000 cancer patients were diagnosed through this service, and the overall early diagnosis rate reached 80 percent or above.
地方病流行趋势得到有效控制。截至2015年底，全国水源性高碘地区有90.8%的县非碘盐食用率在90%以上，94.2%的县保持消除碘缺乏病状态，在全球128个采取食盐加碘措施的国家和地区中处于领先水平。95.4%的大骨节病病区村达到消除标准，94.2%的克山病病区县达到控制标准。燃煤污染型地方性氟中毒地区的所有县改炉改灶率达到98.4%，饮水型地方性氟中毒地区有93.6%的农村人口实施了降氟改水工程。燃煤污染型地方性砷中毒地区全部完成改炉改灶，查明的饮水型地方性砷中毒地区全部完成改水。
The spread of endemic diseases is under effective control. By the end of 2015, 90.8 percent of counties whose water sources contained excess iodine had reached the benchmark that 90 percent of salt consumed was iodine-free, and 94.2 percent of the nation’s counties had eradicated iodine deficiency, ranking among the top of all 128 countries and regions officially using iodized salt. Kaschin-Beck disease has been eradicated in 95.4 percent of villages where it was once widespread, and Keshan disease has been put under control in 94.2 percent of the counties where it was once prevalent. In the counties that suffered from endemic fluorosis caused by coal burning, 98.4 percent of coal stoves have been transformed, and in the areas suffering from drinking water-caused endemic fluorosis, 93.6 percent of the rural population now have access to de-fluoridated drinking water. Areas suffering from arsenic poisoning through coal burning have had their stoves transformed, and all people in water-related arsenic poisoning areas now have access to safe drinking water.
精神卫生服务不断完善。国家公布实施《中华人民共和国精神卫生法》，将精神卫生工作纳入法治化轨道。截至2015年底，全国共有精神卫生服务机构2936家，开设床位数43.3万张，分别比2010年增长77.9%、89.9%；共有精神科执业（助理）医师2.77万人，比2012年底的2.31万人增加20.2%。把严重精神障碍纳入新农合和城镇居民医保重大疾病保障范围，实施中央补助地方严重精神障碍管理治疗项目，部分地区出台救治救助专项政策，减轻了患者负担。加强严重精神障碍患者报告登记和救治救助管理。2012年至2016年，全国在册的严重精神障碍患者数由308万例增加到540万例，患者管理率由59.1%提高到88.7%。加强对抑郁症、焦虑症等常见精神障碍和心理行为问题的干预，加大对重点人群心理问题早期发现和及时干预力度，提高突发事件心理危机的干预能力和水平，全面推进精神障碍社区康复服务。
Mental health services have been improved constantly. The state issued the Mental Health Law of the People’s Republic of China, putting the related work within the legal framework. At the end of 2015, China had 2,936 mental health institutions with 433,000 beds - increases of 77.9 percent and 89.9 percent, respectively compared with 2010. There were 27,700 practicing (assistant) psychiatrists nationwide, an increase of 20.2 percent over the 23,100 at the end of 2012. Severe mental disorders have been included as serious diseases under the new type of rural cooperative medical care and basic medical insurance for non-working urban residents. The central government has provided subsidies to local hospitals to help with the management of and treatment for severe mental disorders. Special aid and treatment policies have been drawn up in some local areas. The patients’ expenditures have been greatly reduced. The government has enhanced the management of patients with severe mental disorders, including case reporting and registration, assistance and treatment. Between 2012 and 2016, the number of registered patients with severe mental illnesses increased from 3.08 million to 5.4 million nationwide. From 59.1 percent to 88.7 percent, more and more patients were put under management. The state has enhanced the intervention in common mental disorders or psychological problems, like depression and anxiety. It has intensified the efforts to promptly detect and treat psychological problems among key groups, built up the psychological intervention capacity in emergency events, and promoted the community rehabilitation services for mental disorders.
突发公共卫生事件应急能力全面加强。应急法制基本建立，应急机制不断优化。在全国分区域设置4类36支国家级和近2万支、20多万人的地方卫生应急处置队伍。2014年，国家公共卫生应急核心能力达标率升至91.5%，远超全球70%的平均水平。近年来，国家加快卫生应急体系建设，有效地应对了人感染H7N9禽流感、埃博拉出血热、中东呼吸综合征、寨卡病毒等突发急性传染病疫情，以及四川汶川地震、天津港火灾爆炸事故等一系列重大灾害事故的紧急医学救援和灾后卫生防疫。
The ability to quickly respond to public health emergencies has been strengthened in a comprehensive way. The legal system for emergency response has taken initial shape, and the response mechanism has been optimized. Thirty-six national teams and nearly 20,000 local teams, with over 200,000 members for four categories of emergencies, have been set up in different regions. In 2014, China’s core public health emergency response capacity achieved 91.5 percent of the requirements of the International Health Regulations, better than the world’s average of 70 percent. In recent years, the state has accelerated the construction of a public health emergency response system, which not only effectively handled such epidemic emergencies as human infections of the avian influenza A (H7N9) virus, Ebola hemorrhagic fever, Middle East respiratory syndrome and Zika fever, but also promptly carried out emergency medical rescue and post-disaster epidemic prevention in such disasters and accidents as the 2008 Wenchuan earthquake and the 2015 Tianjin Port explosions.
