Lee Albert, Kiyu Andrew, Milman Helia Molina, Jimenez Jorge
Centre for Health Education and Health Promotion, Department of Community and Family Medicine, The Chinese University of Hong Kong, School of Public Health, Prince of Wales Hospital, Shatin, New Territory, Hong Kong.
J Urban Health. 2007 May;84(3 Suppl):i75-85. doi: 10.1007/s11524-007-9175-5.
To improve population health, one must put emphasis on reducing health inequities and enhancing health protection and disease prevention, and early diagnosis and treatment of diseases by tackling the determinants of health at the downstream, midstream, and upstream levels. There is strong theoretical and empirical evidence for the association between strong national primary care systems and improved health indicators. The setting approach to promote health such as healthy schools, healthy cities also aims to address the determinants of health and build the capacity of individuals, families, and communities to create strong human and social capitals. The notion of human and social capitals begins to offer explanations why certain communities are unable to achieve better health than other communities with similar demography. In this paper, a review of studies conducted in different countries illustrate how a well-developed primary health care system would reduce all causes of mortalities, improve health status, reduce hospitalization, and be cost saving despite a disparity in socioeconomic conditions. The intervention strategy recommended in this paper is developing a model of comprehensive primary health care system by joining up different settings integrating the efforts of different parties within and outside the health sector. Different components of primary health care team would then work more closely with individuals and families and different healthy settings. This synergistic effect would help to strengthen human and social capital development. The model can then combine the efforts of upstream, midstream, and downstream approaches to improve population health and reduce health inequity. Otherwise, health would easily be jeopardized as a result of rapid urbanization.
为改善人群健康状况，必须重视减少健康不平等现象，加强健康保护和疾病预防，并通过在下游、中游和上游层面解决健康的决定因素，实现疾病的早期诊断和治疗。强有力的国家初级保健系统与改善健康指标之间的关联有着充分的理论和实证依据。诸如健康学校、健康城市等促进健康的环境方法，其目的也在于解决健康的决定因素，并建设个人、家庭和社区创造强大人力和社会资本的能力。人力和社会资本的概念开始为某些社区为何无法比其他人口结构相似的社区实现更好的健康状况提供解释。在本文中，对不同国家开展的研究进行的综述表明，尽管社会经济条件存在差异，但完善的初级卫生保健系统如何能够降低所有死因，改善健康状况，减少住院率，并节省成本。本文推荐的干预策略是通过整合卫生部门内外不同各方的努力，将不同环境结合起来，构建一个综合初级卫生保健系统的模式。初级卫生保健团队的不同组成部分随后将与个人和家庭以及不同的健康环境更紧密地合作。这种协同效应将有助于加强人力和社会资本的发展。该模式随后可以整合上游、中游和下游方法的努力，以改善人群健康状况并减少健康不平等。否则，快速城市化可能会轻易危及健康。
