Frieden T R
New York City Health Department, New York, NY 10013, USA.
Int J Tuberc Lung Dis. 2009 Apr;13(4):421-8.
Tuberculosis (TB) control in many ways exemplifies evidence-based public health practice, rigorously implemented, with appropriate emphasis on the central importance of political support for success. With more than 30 million patients treated in the past decade, TB control has important implications for managing both communicable and non-communicable diseases. Simple diagnostic tests, meticulously proven standardized treatment regimens with assured drug supply, supportive case management and a superb information system that tracks the progress of every patient, all facilitate effective program implementation. TB control shows that public health programs, including those that require long-term treatment in the primary care system, can be effective in poor countries; however, TB rates are heavily influenced by the social, environmental and epidemiologic context, emphasizing that treatment is not enough and that socio-economic factors may be more important determinants of epidemiologic trends than treatment programs. TB control is effective when it combines two essential components: a practical, implementable, proven technical package, and political commitment. Political commitment is also essential to implement other interventions that can improve health, including healthier air, water and food, as well as programs to prevent or reduce tobacco smoking, cardiovascular disease, cancer, obesity and other growing public health problems. By implementing evidence-based practices, ensuring operational excellence, using information systems that facilitate accountability and evaluation, and obtaining and maintaining political support, we can address the public health challenges of the twenty-first century.
结核病控制在很多方面堪称循证公共卫生实践的典范，得到了严格实施，并适当强调了政治支持对取得成功的核心重要性。在过去十年里，有超过3000万患者得到治疗，结核病控制对管理传染病和非传染病都具有重要意义。简单的诊断测试、经过精心验证且有可靠药物供应的标准化治疗方案、支持性的病例管理以及能跟踪每位患者进展情况的一流信息系统，都有助于有效实施该项目。结核病控制表明，包括那些在初级保健系统中需要长期治疗的项目在内的公共卫生项目，在贫穷国家也可以取得成效；然而，结核病发病率受社会、环境和流行病学背景的严重影响，这凸显出仅靠治疗是不够的，而且社会经济因素可能比治疗项目更是流行病学趋势的重要决定因素。结核病控制在结合两个基本要素时才会有效：一个切实可行、经过验证的技术方案和政治承诺。政治承诺对于实施其他能够改善健康状况的干预措施也至关重要，这些干预措施包括更清洁的空气、水和食物，以及预防或减少吸烟、心血管疾病、癌症、肥胖症和其他日益严重的公共卫生问题的项目。通过实施循证实践、确保卓越运营、使用便于问责和评估的信息系统以及获得并维持政治支持，我们能够应对21世纪的公共卫生挑战。
