中国公共卫生应急管理体系：2002 年至 2012 年的趋势。
The public health emergency management system in China: trends from 2002 to 2012.
机构信息
Research Institute of Health Development Strategies & Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 177 box, 130 Dong'an Road, Shanghai, 200032, China.
Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), School of Public Health, Fudan University, Shanghai, China.
出版信息
BMC Public Health. 2018 Apr 11;18(1):474. doi: 10.1186/s12889-018-5284-1.
BACKGROUND
Public health emergencies have challenged the public health emergency management systems (PHEMSs) of many countries critically and frequently since this century. As the world's most populated country and the second biggest economy in the world, China used to have a fragile PHEMS; however, the government took forceful actions to build PHEMS after the 2003 SARS outbreak. After more than one decade's efforts, we tried to assess the improvements and problems of China's PHEMS between 2002 and 2012.
METHODS
We conducted two rounds of national surveys and collected the data of the year 2002 and 2012, including all 32 provincial, 139 municipal, and 489 county CDCs. The municipal and county CDCs were selected by systematic random sampling. Twenty-one indicators of four stages (preparation, readiness, response and recovery) from the National Assessment Criteria for CDC Performance were chosen to assess the ten-year trends.
RESULTS
At the preparation stage, organization, mechanisms, workforce, and stockpile across all levels and regions were significantly improved after one decade's efforts. At the readiness stage, the capability for formulating an emergency plan was also significantly improved during the same period. At the response stage, internet-based direct reporting was 98.8%, and coping scores were nearly full points of ten in 2012. At the recovery stage, the capabilities were generally lower than expected.
CONCLUSIONS
Due to forceful leadership, sounder regulations, and intensive resources, China's PHEMS has been improved at the preparation, readiness, and response stages; however, the recovery stage was still weak and could not meet the requirements of crisis management and preventive governance. In addition, CDCs in the Western region and counties lagged behind in performance on most indicators. Future priorities should include developing the recovery stage, establishing a closed feedback loop, and strengthening the capabilities of CDCs in Western region and counties.
背景
自本世纪以来，公共卫生突发事件频繁地对许多国家的公共卫生应急管理系统（PHEMS）提出了严峻挑战。中国作为世界上人口最多的国家和世界第二大经济体，过去的 PHEMS 较为脆弱；然而，政府在 2003 年 SARS 爆发后采取了强有力的行动来建立 PHEMS。经过十多年的努力，我们试图评估 2002 年至 2012 年期间中国 PHEMS 的改进和问题。
方法
我们进行了两轮全国性调查，并收集了 2002 年和 2012 年的数据，包括所有 32 个省级、139 个市级和 489 个县级疾控中心。市级和县级疾控中心通过系统随机抽样选择。选择了《国家疾控中心绩效评估标准》中的四个阶段（准备、就绪、应对和恢复）的 21 个指标来评估十年趋势。
结果
在准备阶段，经过十年的努力，各级和各地区的组织、机制、劳动力和储备都有了显著改善。在准备阶段，制定应急预案的能力也得到了显著提高。在应对阶段，基于互联网的直接报告率达到 98.8%，应对得分在 2012 年接近满分。在恢复阶段，能力普遍低于预期。
结论
由于强有力的领导、健全的法规和密集的资源，中国的 PHEMS 在准备、准备和应对阶段得到了改善；然而，恢复阶段仍然薄弱，无法满足危机管理和预防治理的要求。此外，西部地区和县级疾控中心在大多数指标上的表现都落后。未来的重点应包括发展恢复阶段，建立封闭的反馈循环，并加强西部地区和县级疾控中心的能力。
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