Download
1 / 116
1.18k likes | 1.4k Vues
第三章 社会因素与健康. Chapter 3 Social factors and health. Introduction Economy and health Culture and health Social environment and health. 概述 经济因素与健康 文化因素与健康 社会生活环境与健康. 内容 Contents. The connotation of social factors The basic rules and characteristics of social factor influencing health
E N D
第三章 社会因素与健康 Chapter 3 Social factors and health
Introduction Economy and health Culture and health Social environment and health 概述 经济因素与健康 文化因素与健康 社会生活环境与健康 内容Contents
The connotation of social factors The basic rules and characteristics of social factor influencing health The mechanism of social economic factor influencing health 社会因素的内涵 社会因素影响健康的基本规律和特点 社会因素影响健康的机制 第一节 概述Section one Introduction
自然环境 ( physical environment) 社会环境 (social environment) 社会的各项构成要素，包括环境、人口和文明程度(政 治、经济、文化等)。也可将社会因素分为两个方面，即 一、社会因素的内涵 Connotation of social factors
社会因素 Social factor 人 口 population 文 明 civilization 环 境 environment 生物 属性 社会 属性 物质 经济 文明 基础 自 然 社 会 精神 上层 文明 建筑 国民营养 国民收入 生产水平 生活方式 风俗习惯 宗教信仰 伦理道德 法律立法 卫生服务 文化教育 政治制度 地理气候 物理化学 生物生态 情 感 交 际 生 育 家 庭 婚 姻 阶 层 遗 传 免 疫 人际关系 家庭关系 公共关系 社 会 因 素 分 类 classification of social factors
二、社会因素影响健康的基本规律和特点The basic rules and characteristics Socio-economic factors are just one class of health determinants. Health status results from the interaction of biological, environmental, behavioral, lifestyle and psychological factors. A1 A2 A3 B1 B2 B3 A1 A2 A3 B1 B2 B3 A B III 多因多果 I单因多果 II多因单果 Cause-effect relationship
泛影响性 －－作用的重叠性 －－作用及影响的 非特异性 恒常性与积累性 交互作用 extensive effect －－ multiple pathways and overlap between these determinants －－nonspecificeffect constant and cumulativeeffect interaction The basic rules and characteristics
经 济 economy 营 养 nutrition 健 康 health 生 育 reproduction 教 育 education 社 会 因 素 交 互 作 用 示 意 图 interaction of social factors
三、社会因素影响健康的机制 Mechanism of social factors impact on health • Possible explanation for the association between social-economic factors and health. • Various models have been proposed which describe possible mechanisms through which socio-economic factors might impact on health. • Turrell.s model differentiates between three levels or stages of determinants of socio-economic health inequalities.
POSSIBLE MECHANISMS • There are several potential pathway mechanisms through which individual socioeconomic circumstances could influence health, including material, behavioral and psychosocial pathway. material pathway Socioeconomic factors health behavioral pathway psychosocial pathway
1. MATERIAL PATHWAY • The simplest explanations for the strong relationships between individual socio-economic factors and health. • Generally describe purchasing power, knowledge power and employment power as resources that elevate or sustain health status. • Variations in a person’s access to these material resources and to other life opportunities give rise to inequalities in health status.
2. BEHAVIOURAL PATHWAY • A second pathway relates to the clustering of risk behaviors. There is a social context to the behavior of particular groups, as behavior is not randomly distributed throughout the population but is socially clustered. • People who smoke, for instance, are also more likely to drink, and those who are more diet conscious are also more physically active. People of low socio-economic status are more likely to have unhealthy diets and more likely to smoke. • Therefore, these behaviors occur within a social context and are not just an expression of individual choice.
3. PSYCHOSOCIAL PATHWAY • Health may be affected by psychosocial mechanisms at the individual level (e.g. via nerve-endocrine and immune system responses). • The list of potentially contributing psychosocial factors is broad and includes a mix of stimuli or characteristics of the environment (such as demand/strain at work or elsewhere, job insecurity, social networks), and characteristics of the individual (such as coping patterns, perceptions and self esteem).
Economic Level and health Social class and health Nutrition and health 经济发展水平与健康 社会阶层与健康 居民营养与健康 第二节 经济因素与健康Section two Economy and health
经济因素并非经济水平的代名词，它还包括人类的：经济因素并非经济水平的代名词，它还包括人类的： 它既是人类社会发展的主体形式，又是人类赖以生存和保持健康的基本条件。
Development level of economy and health经济发展水平与健康 • Positive impact of economic development on health • Negative impact of economic development on health • Interaction between economic development and health • 经济发展水平对健康的促进作用 • 经济发展对健康的负面作用 • 健康水平的提高和经济发展的促进向作用
Positive impact of economic development on health 经济发展水平对健康的促进作用 Improved nutrition 改善居民营养 Better Inhabited environment 改善居住环境 Increased investment to health 增加卫生投入
Relationship between the indicators of health status and economic development in some countries nations GNP CBR CMR IMR E0国家 人均GNP 出生率 死亡率 婴儿死亡率 平均期望寿命 (美元) ‰‰‰ (岁) 瑞 典 24830 13 12 4.8 78日 本 31450 10 7 4.3 79 美 国 24750 15 9 8.0 76 澳大利亚 17510 15 7 6.1 78 中 国 490 18 6 44 69斯里兰卡 600 21 6 19.4 73 墨西哥 3750 27 5 34 72 巴 西 3020 25 8 58 66 埃 及 660 30 8 62 64 印 度 290 29 9 74 60 坦桑尼亚 100 45 15 92 49 摘自：美国人口咨询局编印《1995年世界人口数据表》
Negative impact of economic development on health 经济发展 对健康的负面作用 1. Serious environmental pollution and use of Chemosynthesis products in our daily life 环境污染和破坏严重，大量化学合成物进入人类生活
2. Unhealthy behaviors and great mental strain and pressure 不良行为和心理压力突出
4． Incremental floating population 社会流动人口增加 全国流动人口数量从１９９３年的７０００万增加到２００３年的１．４亿，１０年内翻了一番，超过了全国人口总数的１０％，约占农村劳动力的３０％。
新的传染病不断地出现 Newly emerging infectious diseases
positive impact of improved health level on development of economy 健康水平的提高对经济发展的促进作用 劳动能力、体力、技能和智力的提高，促进经济的发展 Improvement of labor capacity, physical power, skills and intelligence will impel the development of economy.
There exists a correlation between better health and higher economic growth (Figure 10) for health determines job productivity, the capacity to learn in school and the capability to grow intellectually, physically and emotionally. • Elimination of disease and improvement of individual health will enhance income-earning capacity over three times. Bloom 等(2001)也认为人均期望寿命每增加1年，将会使产出上升4 ％。
增进健康可以从四个不同方面促进经济增长： 1. 健康状况影响个人的劳动市场的表现 2. 促进对自然资源的利用 3. 促进教育收益的实现 4. 减少疾病的直接或间接损失从而促进经济增长 Bloom 等(2001)也认为人均期望寿命每增加1年，将会使产出上升4％
Concept and connotation of social class Category of Social class in different countries Relationship between social class and health --社会阶层的概念 和含义 --不同国家对社会阶层的分类 -- 社会阶层与健康的关系 二、社会阶层与健康 Social class and health
西方社会学的一个重要概念，主要是指由财富、权力、和威望不同造成的社会地位、生活方式等方面不同的基本层次。西方社会学的一个重要概念，主要是指由财富、权力、和威望不同造成的社会地位、生活方式等方面不同的基本层次。 社会阶层 social class
Disparity of health statue among different populations in various social class 不同阶层的人群健康状况有明显的不同
城市中的肥胖人群 Obesity patients is increasing in urban areas. 黄河边的儿童与妇女 The children and women who live along the Yellow River.
Resource: Variations in population health status: results from a United Kingdom national questionnaire survey Paul Kind, Paul Dolan,, Claire Gudex, and Alan Williams, UKBMJ. 1998 March 7
构成比(%) 资料来源:中国社会科学院社会学研究所研究员 陆学艺 研究报告
三、社会营养与健康Social nutrition and health(一)营养状况与健康Nutrition status and health(二) 营养政策与健康Nutrition policy and health
1. 总摄入热量，与平均期望寿命呈正相关 Total energy intake and life expectancy has positive correlation 2.食物营养结构：Pr、脂肪、碳水化合物(3:4:13), 蛋白质以动物蛋白及植物蛋白各占50％为宜
表4—3 每人每日摄入热量和平均期望寿命的关系平均期望 热 量(kcal)寿命(岁) 国家数＜1750 1750-1990 2000-2490 2500-2900 ＞3000 ＜35 36 1 5 28 2 —45— 28 2 2 19 5 —55— 22 2 9 16 5 —65— 44 一 一 8 12 24 合计 130 5 10 61 24 24 注：1cal＝4.1840kl 资料来源：顾杏元主编 社会医学 天津科学技术 出版社1995
缺铁性贫血的发生与某些微量元素缺乏密切相关。营养性贫血的婴幼儿中，叶酸缺乏者为48．1％，铁缺乏者27．85％。有85％的营养性贫血新生儿血清中的铁、铜、锌等微量元素含量降低。缺铁性贫血的发生与某些微量元素缺乏密切相关。营养性贫血的婴幼儿中，叶酸缺乏者为48．1％，铁缺乏者27．85％。有85％的营养性贫血新生儿血清中的铁、铜、锌等微量元素含量降低。
（二）社会营养政策与健康 • 粮食生产政策 • 引导食物消费
农业政策的主要内容 任何国家都应努力发展农业，为国民提供足够数量的粮食。 由于农业生产利润低，农业的发展，需要国家从政策、经济上给予支持 The main content of agriculture policy Any country should develop agriculture, and provide sufficient food for its citizens. Because the profit of agriculture is low , the development of agriculture should obtain policy, economic support from government . 粮食生产政策crop production policy
调整粮食产业结构 对农药使用的控制 Adjusting structure of grain production and limiting use of pesticide
膳食营养推荐标准 recommended &dietary allowance 引导食物消费guiding consumer food choices
世界卫生组织在第六次报告中指出: 一旦人们的生活水平达到或超过起码的需求，有条件决定生活资料的使用方式，文化因素对健康的作用就越来越重要了。 The sixth report of WHO: Once living standard has reaching or surpass essential requirements, when one is free to decide on living materials: cultural factors play more role in influencing health 第三节 文化因素与健康Cultural factors and health
（一）文化的概念 广义的文化是社会物质财富和精神财富的总和。 狭义的文化即精神文化，包括思想意识、宗教信仰、文学艺术、道德规范、习俗、教育、科学技术和知识等。 Definition of culture Broadly speaking: Combination of material wealth and spiritual wealth created by the society. Narrowly speaking: ideology, literature & arts, moral and social norms, folk culture, education, science and technology and knowledge 一、文化的内涵Connotation of culture
文化的认知成分 包括知识和信仰 文化的规范部分 包括价值观和社会规范 文化的符号部分 语言等 Culture involves at least three components: what people think, what they do, and the material products they produce. Material and Non-material Culture （二）文化的组成 Component of culture
智能文化: 包括科学技术、生产生活知识等； 规范文化: 包括社会制度、教育、法律、风俗、习惯、伦理道德等； 思想文化:包括文学、艺术、宗教信仰、思想意识等。 Intellectual knowledge: science and technology etc. Social norms and regulation: social system, law & regulation, folk culture, ethics Arts and humanities: literature, arts, religion, ideology etc. （三）文化的类型types of culture
图4-5 不同文化类型对人群健康的作用模式 文 化 智能文化 规范文化 思想文化 科技知识 思想意识 观念形态 宗教信仰 文学艺术 等 社会组织制度 政治法律形式 伦 理 道 德 风 俗 习 惯 语 言 教 育 等 物质文化 生活资料 生产资料 生活环境 劳动条件 生活方式 与行为 精神生活 心理状态 生理健康 心理健康
①历史性 ②现实性 ③渗透性 ④继承性 ⑤社会性 historic realistic penetrability Inheritability sociality （四）文化的基本特征The Characteristics of culture
