关注特殊人群的健康问题——社会环境和行为相关危险因素的防控

Concerning Health Issues of Special Populations:Prevention and Control of Hazard Factors Related to Social Environment and Behavior

  • 摘要: 环境与职业医学是一门重要的预防医学学科,环境与职业卫生是公共卫生领域的重要组成部分。2000年全国高等院校教科书《劳动卫生与职业病学》一书中指出,不论预防医学或公共卫生,其首要任务是识别、评价、预测和控制不良环境或劳动条件中存在的有害因素,以防止对人们健康的损害1;而广义的环境医学还需考虑社会环境因素对人群健康的影响,从而采取综合干预措施。何谓健康?早在1946年世界卫生组织(WHO)成立之初,定义为:"是身体、精神和社会适应上的完好状态,而不仅仅是没有疾病或虚弱",已经明确了要避免精神、身体同社会分离的错误2。在即将进入21世纪之前,WHO第一次在发展中国家举办了健康研讨会,会议强调了健康促进概念,并付诸实践3。时代在发展,经济在飞跃,生活模式在改变,对医学模式转变的认识在深化,社会环境和行为因素在疾病的发生发展中起着重要作用。公共卫生学的范畴与日俱新,20世纪之前主要探讨各种传染病或相关环境存在的危险因子,到20世纪之后慢性病防治、HIV/AIDS控制、医疗关怀体系、生殖健康、暴力防控、心理与行为健康及健康教育推广等受到了极大的关注4。事实上,发达国家和我国沿海地区不良生活方式及其所致疾患已占死亡因素的首位,如吸烟、酗酒、吸毒、不安全性行为、压力过大及肥胖和心理疾患等。这些不良因素始终存在于公共场所和职业场所,要及时发现自然环境和社会环境中的物理性、化学性、生物性、心理性和生活性的不利因素,研究应对的干预策略,以符合创建21世纪健康城市、健康岛屿、健康场所的战略目标。值得指出的是,人们的行为"内控性"责任甚巨,如自律能力下降,抗御"他控"缺乏,会增加不良因素带来的负面影响5-6。上海2010年世博会虽已拉下帷幕,但"城市让生活更美好"的主题永远是这个时代追求的重要目标之一;上海市还提出把上海建设成健康城市,让人们享受美好的健康生活。然而,艾滋病已成为破坏人类健康的重大疾病之一,当然也是在公共场所和职业场所劳动、服务、活动的各类特殊群体不可忽视的健康问题。上海作为我国特大城市,正为建设4个"中心"奋进,必然有大量流动人口涌入,他们为上海的建设和服务付出了不可估量的辛劳,但是由于环境和生活的改变,乃使他们成为弱势人群,而不可避免地面临着包括艾滋病在内的各种危险因子的挑战。他们之中相当一部分人员对艾滋病性病知识的掌握、自我保护能力、不安全性行为现况、就医需求与可及性,尤其是遭受人格歧视等情况,都亟待我们阐明,只有如此,才能做出针对性的健康干预。因此,对建筑工地、娱乐场所和其他公共场所中人员及其与艾滋病相关的健康问题的调查与探讨,也是环境和职业卫生领域医务工作者所共同关注的问题。事实上,中华人民共和国国务院2006年第5号文件已号召所有农民工输入地对农民工进城后的健康问题要给予重视和关怀7,又在2010年号召企业界投入到艾滋病斗争行列。迄今,有一批企业不仅支持非政府组织的有益活动,关怀艾滋病患者、感染者及其家人,提供社会公益性活动和健康教育宣传的经费资助,而且在企业内员工中做好艾滋病知识宣传,规范自身行为,保护隐私,反对歧视,保证艾滋病病人及HIV感染者的工作权利和待遇公平,甚至设立专门医疗保险,营造和谐环境8。今后,我们将会同一些企业继续做好相关调查评估,总结有效经验予以及时报道。

     

    Abstract: The priority purpose of environmental and occupational health is to identify, control, evaluate and predict harmful factors in environment and workplaces under unfit conditions and to consider the effects of social environmental factors on public health, and then to adopt comprehensive measures in order to prevent impairment to human health.The definition of "Health" was already stipulated by the World Health Organization (WHO) in 1946 when it was set up and defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".However, the concept of "Health" is changing and developing with the economic and industrial progress, with the awareness of green environment, with the new patterns of living style and with the deepened recognition of medical pattern changes.Hence the social environmental and behavioral factors are playing important roles in disease occurrence and development.Especially, after entering the second half of the 20th century and the 21st century, the focus of public health is no longer restricted to infectious diseases and relevant damage factors in environment, but extends to chronic diseases, HIV/AIDS, medical care system, reproductive health, violent action, psychological and behavioral status and health promotion.In fact, bad living style and its related diseases in developed countries and costal areas of China have become a predominant cause of death, such as smoking, alcoholism, drug abuse, unsafe sexual behavior, heavily stress, obesity and psychological diseases, etc.Those bad factors (including physical, chemical, biological, psychological and living factors from natural and social environment) usually exist in public places or occupational places, which should be immediately found, and in tervention strategies should be further investigated and provided to meet with the 21st century strategic goal of creating health cities, health islands and health places.The World Expo 2010 Shanghai has been closed but its theme "Better City, Better Life" is forever one of the important goals of the era.Especially, the Shanghai Municipal Government has called on to build Shanghai into a health city to let all residents enjoy a healthy life.However, AIDS has potentially impacted the health of people in Shanghai as one of the serious infectious diseases;of course, the disease is also an undeniable health issue for different groups of labor, service and activity in public and occupational places.Because Shanghai as one of the largest cities of China is now constructing "Four Centers' with great efforts, a large amount of floating people are naturally entering the city, who are devoting their great efforts to the construction and service of Shanghai.In the meantime, the rapid change of their living environment and conditions has inevitably made them vulnerable to HIV/AIDS and other harmful factors.The rates for AIDS knowledge, self-protection ability, unsafe sexual behavior status, requirement of and access to medical service, discrimination and stigma among a certain amount of them are eagerly in vestigated so that the direct strategy for health intervention could be made.Thus, the studies and discussions on the people in construction sites, entertainment places and other public places and their health issues related to AIDS are commonly concerned by medical staff on the environmental and occupational frontline.

     

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