????????? Strategies for Disease Control and Prevention

1
?????????Strategies for Disease Control and
Prevention
?????????????? Department of epidemiology
,Harbin Medical University
2
????????? Health is the first Fortune
3

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4
???? (Brief Introduction)

• Strategies for Disease Control and Prevention
• The situation facing the field of public health
  in China
• Global health policy and primary health care
• Tertiary prevention of disease
• Disease Surveillance

• ?????????
• ?????????????
• ?????????????
• ???????
• ????

5
??? ????????? Strategies for Disease Control and
Prevention
6

• ?????????????
• Necessity and basis for developing prevention
  strategies

• Strategies and measures
• Strategies
• A comprehensive approach to guide the overall
  work
• Measures
• The specific methods of action, steps and plans

• (?)?????
• ??
• ???????????????????
• ??
• ????????????????????????

7

• ????
• ??????,??????,?????????????,??????,?????????

• The relationship between the two
• Strategic focus on the overall situation, the
  measures based on local

8

• To clear the problems
• What is the status of disease prevalence? What
  are the determinants that affect the popular?

• (?)??????
• ???????????????????????

9

• ??????????????????????????
• ?????????????????

• For the prevalence of the disease and what
  steps have been taken? Whether these measures are
  effective?
• How to better and more effectively carry out
  the next work?

10

• Necessity
• Social, economic and cultural context not only
  affects the individual's susceptibility, but also
  determines the characteristics of epidemics and
  trends

• (?) ???
• ???????????????????????,????????????????

11

• ????????????????????????????????

• There is no a model a fit all countries, all
  regions in disease prevention and control.

12

• ????????????????
• ?????????????????????,???????????????

• The prevalence of some disease has rapidly
  changing characteristics
• Strategic Planning must be objective to consider
  the existing available resources, looking at how
  rational and effective use of existing resources

13

• (?)?? Basis
• ???? Situation analysis
• ???????????????????????????????(?????????????
  )??????????????????
• ???? Response analysis
• ????????,????????,???????????????
• ???? Evidence-based health care
• ?????????????????,?????????????????????

14
? ??????????????? Health policy is the overall
strategy of prevention

• ????
• ??????????????????????????
• ?????
• ????????????,?????????????????

• Developed country
• Theory and practice of health promotion marked a
  new public health movement is in the ascendant
• Developing country
• Medical model to gradually adapt to changes in
  the trend to develop in line with their national
  conditions of community action plans

15

• ??
• ???????????
• ??????
• ??????,????,?????,???????,???????,???????,????
  ????????

• China
• Always give priority to prevention
• The basic guiding ideology

16
??????????? The guiding ideology of the rural
health work ?????????????,??????????,??????
??,????????,??????,????????,??????????,??????,????
,??????????????,???????????????,??????????????????
?
17
????????? Goal of rural health work
????????????????????????????????,?2010?,?????????
????????????????????????????
18
? ???? Macro Thought
(?)???? Medical model

• ????
• ?????????????????????
• 20???
• ??-??-??????

• Traditional medicine
• Healthy is a dynamic equilibrium state between
  people and the natural environment
• The of 20th century
• Biological - psychological - social medical model
  

19
?????????????? ???????????????????????????
The direction of research development from
diseases to health To a prevention-oriented
service model is in line with the best of modern
medical model service delivery model
20
(?)??????? Factors affecting health

• ?????????????
• ??(??????)????????????????????????????

• Unhealthy behaviors and lifestyle factors
• Hobbies (smoking, drinking etc.), sex,
  nutrition, customs and habits, physical activity,
  the pace of life and psychological stress

21

• ????
• ??????????????,?????????,???????????????????

• Environmental Factors
• The natural environment, the social
  environment and psychological environment, that
  except for biology, chemical , social and culture
  factor.

22

• ??????
• ???????????
• ?????????
• ?????????????

• Bio-genetic factors
• Biological, genetic, physiological,
  immunological
• Deficiencies in the health care system
• Medical and health facilities, systems and
  its application

23
(?)??????? A major social health concepts

• ?????????
• ????
• ?????????
• ???????

• Health is the common goal of the people and the
  government
• Health work with the social and economic
  development of synchronous

24

• Not only rely on "technological breakthrough" but
  also rely on "social breakthrough
• Not only rely on "medical technology" also depend
  on "political action"

• ??????
• ??????
• ??????
• ??????

25
(?)????????
Macro-epidemiology of ideas

• ????????????
• ?????????
• ??????????????

• Epidemiology is the subject of macro study
• Group-level analysis
• Research aimed at macro-strategies and measures
  for groups

26
Hancock1985 ????????Hancock1985 proposed model
of human health
??????????? (Hancock 1985 ) Ecological systems
model of human health
27
??????????(Green LW 1999) Ecology
model of human health
28
???  ????????????? The situation
facing the field of public health in China
29

• Human health facing a wide range of threats
• Accession to WTO challenge to public health
• Respond to bio-terrorism and health emergencies
• Food safety can not be ignored

• ?????????????
• ??WTO??????????
• ?????????????
• ????????

30

• Injury into the Centers for Disease Control
  urgent
• The challenge of adolescent health
• Aging
• AIDS and tuberculosis

• ?????????????
• ??????????
• ???
• ???????

31
? ????????????? Human health facing a wide range
of threats

• ?????????
• ?????????
• ????
• ?????????
• ?????????

• Infectious diseases
• remain as serious hazard
• Bio-terrorist threat is not
• far away from us
• Psychological or mental
• illness is threatening an
• increasing number of
• young people

32
?? ??WTO???????? Challenge to public health
accession to WTO

• ???????
• WTO??????
• ?????????
• ????????????????????????

• The acceleration of
• globalization and the
• establishment of WTO
• pose a formidable
• challenge to public
• health
• International trade
• can have a major
• impact on public
• health by a complex
• process

33
?? ????????????? Respond to bio-terrorism and
health emergencies

• 9.11????????????????????????,???????????????????
  ???????????????

• Bioterrorism has been paid attention from
  different area in the world, It effect large
  area, infectious endangering a long time, easy
  produce, low cost and different to protect for
  sudden attack

34

• 2002?11?16????SARS????,?????,?????????????
  
• 2003?5?9?????????????????

• SARS occurred in Nov. 16, 2002, contagious,
  spread fast, spread to world wild in several
  months.
• Public Health Emergency Regulations
• formulated in 9 May, 2003.

35
? ???????? Food safety can not be ignored

• ???????????????
• Vicious international food safety incidents
  continue to occur

???? ?? ????0157H7 ?? ??
?? ??? ?? ??
36

• ??????????????
• ????????????????????

• China's insecurity and
• food-borne hazards
• Microbiological
• contamination is very
• conspicuous

37

• ????????????????
• ??????????????????????????????????????

• Agriculture, veterinary
• drug residues exceeding
• Chemical safety issues
• of vegetable basket

38
? ???????????? Injury into the Centers for
Disease Control urgent

• ??????700??
• ???????
• ??????????
• ????????,??1990??55???2020??73

• 700 million people worldwide each year die from
  injuries and violence
• Increased year after year the burden of disease

39

• ????????65/10?,?????80????????

• Injury mortality in China is 65/100 thousands,
  800 thousands people die from different kinds of
  injury.

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? ?????????? The challenge of adolescent
health

• ?????
• ???????????
• ????????????
• ??????

• Youth experience
• Physical development in leaps and bounds
• A series of complex process of growth and
  development
• Psychosocial development

41

• ???????????
• ????????????????
• ????????????
• ????????????,??????????????

• Several key issues
• Morphological and functional changes
• Improve the gender identity
• Understand physiological and psychological
  development

42

• Understand the significance of relationships,
  do friendly contact with person both same and
  different gender.
• Ability to establish social identity, to prepare
  for independent work.

• ?????????,????????,???????????
• ????????,???????

43
? ??? Aging

• ??1999????????????
• ??60???????????1.26?,??????10.2,????3.32???????

• In 1999 into the aging stage of the age structure
  
• The elderly population aged 60 and above continue
  to grow

44

• 2025?60???????2.8?,?????18.4,2050????4???
• ?????????????????????????????????????????????

• In 2025 and 2050 the number of elderly
  population aged 60 reach 0.28(18.4) and 0.4
  billions
• The rapid increasing stage in aging at different
  stages of development, elder and raging
  population increased quickly .

45

• ??????????????
• ??????????????????????

• The enormous impact to global aging
• A profound impact on economic, political and
  culture of China

46
? ??????? AIDS and tuberculosis

• ???
• ??2001?12?,?????????30736?,????1594?,??808?
• ?????????85??,?????0.06
• ???2010???????1000??

• AIDS
• As of 2001 the cumulative reported infections
• The current infections
• Expected infections by 2010

47

• ???
• ????22???????????
• ????????????
• ????????451?
• 2000?????TB????367/10?

• Tuberculosis
• One of the high-burden countries
• Second place in the world
• The current active pulmonary tuberculosis
• Active pulmonary TB prevalence rate in 2000

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(No Transcript)
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??? ????????????? Global health policy and
primary health care
50

• ?????????????
• ?????????
• ???????

• The basic meaning of access to health care for
  all
• The concept of primary health care
• The new public health campaigns

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? ????????????? The basic meaning of access to
health care for all

• ????????????????
• ????????????????,????????????,????????????????,???
  ????

• Be able to stay healthy in live and work place
• Use more effective approaches and through better
  means to prevent disease, reduce the bit brought
  by disease and disability, enter adult, old in
  better way and die peacefully

52

• ???????????
• ????
• ???????,?????????,??????????
• ???????????????????,????,?????????????

• An even distribution of health resources in all
  member of society
• Enjoy primary health care by all person and
  family through self participate
• People know they have the power to avoidable
  disease, to win health, and understand that
  disease are inevitable.

53
? ????????? The concept of primary health care
???????????????????????,????????????????????,????
????????????????????????????????
54
The concept of primary health care

• Primary health care is essential health care
  based on practical, scientifically sound and
  socially acceptable methods and technology made
  universally accessible to individuals and
  families in the community through their full
  participation and at a cost that the community
  and country can afford to maintain at every stage
  of their development in the spirit of
  self-reliance and self-determination.

International Conference on Primary Health Care,
Alma- Ata, USSR, 612 September 1978
55

• The overall objective
• Deepen reform, improve the system, improve the
  function, implement a variety of security system
  and address the basic problems

• ???
• ??????,??????????,??????,???????????????,????????
  ???????

56

• ????????????????,?????????????????????????????

• Efforts to control the infection disease, endemic
  disease, enable the rural residence access to
  basic health care services suitable the economic
  and social development

57

• ????????????????
• ?2010?,?????????????2000????????1/4?1/5
• ???????2000??????12?

• Continuously improve health and quality of life
• By 2010, the maternal and the infant mortality
  have declined ¼ and 1/5 of 2000
• The average life expectancy increased 1-2 years
  based on 2000

58

• ????
• ??????????,???????????????????????????,????????,??
  ????????????????,???????????????????????????????,?
  ?????.

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• The main task
• The implementation of disease prevention and
  control measures, focus on infection diseases,
  endemic diseases, parasitic disease, occupational
  disease, and importance disease, Strengthen the
  metal health work, prevent different accident,
  stabilization of EPI coverage, enhance the
  coverage of modern methods to control
  TB.prevention, management of chronic
  non-communicable diseases.

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• ?????????????????????,????????,??????????????????

• Improve the diagnosis and treatment level of
  common disease in health institute in rural area
  , regulate medical services, to provide safe and
  effective basic medical service

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• ????????????,????????????,????????????????,???????
  ?,????????????

• To strengthen the management of pregnancy
  maternal and child, continuously improve the
  delivery rate in hospital, decreasing the
  maternal and infant mortality, improve the health
  situation of children, increase the level of
  health care for maternal and children.

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• ???????????,?????????????????,????????????,??????,
  ??????????????

• Create a health towns, improve working and living
  environment

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• ???????????,????????????????,?????????????????????
  ?????,???????????,??????????????????,?????????????
  
• Carry out health education and health promotion,
  advocate a civilized and healthy lifestyle

64

• ????????????????????????,???????????????????,?????
  ???????????????

• Intensify supervision on public health,
  medicine, and health related products, control
  the main public health problem threaten the
  health of rural residence according to law, do
  effort to manage food safety, public institute
  and labor health.

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• ?????????,???????????,?????????????

• Make full use of Traditional Chinese Medicine
  Resources, to full play the role of features and
  advantage of Chinese Medicine, and improve the
  service health of Chinese Medicine continuously

66

• ???????????,???????????,??????????????,???????????
  ??????

• Improvement and development of rural cooperative
  medical care, exploring

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• ????
• ????
• ????
• ????
• ????
• ????

• Implementation strategy
• Management at different levels
• Implemented step by step
• Classification guide
• Social participation
• Coordinated development

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? ??????? The new public health campaigns

• Health promotion
• To control and improve their own health
• Field involved
• Development of healthy public policy

• ????
• ??????????????????
• ????
• ?????????

69

• ???????
• ???????
• ???????
• ????????

• Create a supportive
• environment
• Strengthen
• community action
• Development of
• individual skills
• Reorient health
• services

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??? ????Tertiary prevention of disease

• primary prevention (????)
• secondary prevention(????)
• tertiary prevention (????)

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primary prevention (????)

• DefinitionPrimary prevention is called
  causal prophylaxis . Measures will be adopted for
  etiological factor (risk factors) when diseases
  do not happen and it is also basic measures of
  prophylaxis and eliminating of diseases.

• (1)????????,????????????????(?????)????,?????????
  ????????

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(2)????(basic principle)

• ????
• ????
• ????
• ????

• appropriate amount of movement
• Smoking Cessation and limit of alcohol
• rational diet
• psychological equilibrium

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(3)??(content)

• ????
• ????

• Promoting of health Protection of health

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?????(Promoting of health)

• definition People are kept from or grown
  downwards to expose to causative agent by
  creating the environment of promoting of health
  at the same time change the susceptibility and
  protect health people from diseases.

• ?????????????????????????????,????????,????????
  ?

75
??(Forms)

• ????
• ????
• ???????

• health education
• self health care
• environment protection
• and surveillance

76
?????(health protection)

• ??????(????)??????????????????,??????????????

• Measures carried out for diseases that have
  identify cause of disease and specific protection
  means play a principal role in protecting and
  eliminating the cause of diseases.

77
(4)????(bilateral policy)

• ?? ?????????????????????????,??????,??????

• DefinitionGeneral protection for the whole
  people and intensive protection for high risk of
  people are combined. the two facets can
  complement at the same time the efficiency are
  raised.

78

• ?????????
• ????????

• the former is called whole population strategies
• the later is called high risk of strategy

79
?? Purpose

• ?????????????????????????,????????????

• The aim of crowd policy is that make the whole
  population to decrease the exposal level of risk
  factors of disease

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• ??????????????????????????,???????????

• the aim of high risk of policy is that eliminate
  the special exposal to risk factor of some
  disease by health protection.

81
??(Methods)

• ??
• ??
• ??????
• ?????????

• Census
• Screening
• Regular health examination
• Set up special prophylactic-therapy institutes

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2?????(secondary prevention)

• ????????,????????????,????????????????

• Definition to discover early and diagnose
  early and treat early is the measure that
  prevent and slow down the development of disease.

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3?????( tertiary prevention )

• ????????????????????????,??????,????,???????
  ??????????????

• It also called clinic prophylaxis that
  can prevent disability and promote recovery of
  function and increase survival quality and
  prolong lifetime and decrease fatality rate. it
  is mainly consist of symptomatic treatment
  convalescent care.

84
?????????????
85
?????????
86
??? ????(disease surveillance )

• ? ???????
• ? ???????
• ? ?????????
• ? ??????????

• definition of disease surveillance
• category of disease surveillance
• concepts of disease surveillance
• contents and methods of disease surveillance

87

• ? ??????
• ? ???????????
• ? ??????????

• disease surveillance system
• information technology of application in the
  surveillance
• ethological surveillance and bibasic surveillance

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? ???????definition of disease surveillance

• Data about dynamic distribution and
  risk factor of disease are collected. Then the
  analysis of the data are reported and feedback
  communicated to the people who should know the
  results so that we can adopt the measures of
  interference and evaluate the effect.

• ???????????????????????????,????????????,???
  ????????,????????????????

89
? ???????The category of the disease surveillance

• ?????
• ( contagious disease surveillance )

90

• ??????? ????????????????????????????????????

• the WTO classified the malaria, influenza,
  poliomyelitis, epidemic typhus and relapsing
  fever as international contagious disease
  surveillance.

91

• ???????????????,???????????????????????

• Our country contain dengue fever besides
  international contagious disease surveillance and
  Ministry of Public Health also classify AIDS as
  territory quarantine surveillance disease.

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?????? non-communicable disease surveillance

• ????
• ???
• ??
• ?????
• ????
• ???????

• Birth Defects
• Occupational diseases
• Miscarriage
• Smoking and health
• Nutritional surveillance
• Infant mortality surveillance

93

• ???????????
• ?????
• ?????????????????

• Community and school health education
  surveillance
• Regular prenatal surveillance
• Food hygiene and environment water quality and
  medicine meteorological surveillance

94
? ?????????concepts of disease surveillance

• passive surveillance
• the inferiority units routinely report
  monitoring data and the higher units receive
  passively.

• ????
• ???????????????,?????????

95

• ????
• ??????,????????????????????????????

• Active surveillance
• Because of special requirement ,the higher
  units by their own or ask the inferiority units
  to investigate and collect the data according to
  the rule strictly.

96

• ?????????????????,?????????????,?????????????????

• Routine reportIt is the national and local
  routine report system such as the legal
  communicable diseases surveillance system of our
  country. Omitional rate and the quality of
  surveillance are inevitable.

97

• ???????????????,??????????????????????????????

• Sentinel surveillanceAccording to the
  prevalence of certain diseases , sentinel
  physicians set up across the country conduct the
  surveillance for the high risk groups by
  targeted, time, quantitative surveillance.

98

• Surveillance Case In the large-scale disease
  surveillance, we must determine a unified, strong
  operational clinical diagnostic criteria to
  observe the dynamic distribution of the disease,
  so cases identified determine by the way are
  called surveillance case .

• ??????????????,???????????????????????????????,??
  ??????

99

• ?????????????????????????

• Direct indicatorthe number of deaths, morbidity,
  mortality, etc are received by surveillance.

100

• Indirect indicatorsIn special times,
  surveillance of direct indicators are not readily
  available, such as to diagnose an influenza case
  is very difficult, and influenza deaths and
  pneumonia deaths is sometimes difficult to
  distinguish, the United States a long time uses
  influenza and pneumonia death as a surveillance
  of flu outbreak.

• ?????????,???????????,??????????????????,????????
  ?????????,????????????????????????????

101

• ????
• ?????????????????
• ????
• ????????,????????????

• Static groupsthe crowds do not immigrate and
  emigrate in the course of the study.
• Dynamic populations In disease
  surveillance, people are frequently move out,
  move in.

102
????????Disease Frequency Index Calculation

• Static groups use the average population as the
  denominator
• Dynamic crowd use man-hour as the denominator

• ??????????????
• ????????????

103
? ??????????The content and methods of disease
surveillance
1.???????(collection of the information)

• The data of morbidity report and death
  registration
• The data of epidemics and case investigation
• The data of etiological and serology
  surveillance

• ???????????
• ???????????
• ??????????

104

• Dynamic data of diseases in person, time, place
• The data of sociology
• The data of demography
• The data of meteorology and biology

• ???????????????
• ?????
• ?????
• ?????????

105
2.???????? Sorting and analysis of data

• ???????
• ??????????????
• ???????????
• ???????????????????????????????

• Determine the natural history of disease
• Find the changed tendency of diseases and
  influential factor
• Assure the frail link of the epidemics
• Reveal the composition of the population in
  different regions, the frequency of birth and
  death, infant and maternal health indicators

106

• ???????????????????????????

• Describe the incidence of different diseases and
  the population picture and the death spectrum of
  urban and rural residents

107

• ??????????????????????????????????????????

• Reflect the immunization status of key target
  groups and serum antibody levels as well as to
  evaluate the major economic and social benefits
  of preventive measures.

108
3.???????????exchange of information and
feedback of monitoring

• Develop of information exchange of information
• Assess of strategy, check the effect of
  prevention
• correctness of strategy
• evaluation of economic effectiveness

• ????????
• ????,??????
• ???????
• ???????

109
4?????????Economic evaluation index

• Cost - benefit difference
• Expressed in present value in monetary terms
  or measures of the effectiveness of responses
  minus the cost savings after consuming all the
  funds.

• ??????
• ????????????????????(??)???????????

110
?????? (Cost - benefit ratio)

• ???????????????????????????????

• economic benefit that is received after the
  strategy and measure are adopted is equivalent to
  a multiple of the cost .

111
? ??????disease surveillance system

• ???????????
• ???????????
• ????????????
• ??????????????

• Population based surveillance systems
• Hospital-based surveillance systems
• Laboratory based surveillance systems
• National legal notificable infectious disease
  surveillance systems

112
??????
113
? ??????????????? Information technology
application in surveillance

• ??
• ???????????????
• ??????????????
• GIS(??????)?????????

• Characteristic
• Surveillance system data, network sharing is
  more convenient
• Facilitate the surveillance of communication and
  exchange within the system
• GIS (Geographic Information System) system
  enables better visualization of data

114

• ?????????
• ????????????
• ??????????
• ???????

• On-line data collection applications
• To provide a basis for evaluation of health
  protect
• the exchange of data between surveillance systems
• Pass data to the community

115
? ?????????? Behavioral monitoring and
second-generation surveillance

• 1 ?????
• ?????????,??????????
• ?????????????????????????

• 1 behavioral surveillance
• Applicable both to infectious diseases, also
  applies to non-communicable diseases
• Surveillance indicators of infectious diseases is
  a variety of behaviors that make the route of
  transmission true

116

• ???????????????????????

• Non-communicable disease surveillance is to
  monitor some of the major bad habits such acts

117
2? ?????Second-generation surveillance

• combine serological and behavioral
  surveillance, in order to achieve the purpose of
  increasing sensitivity and the efficiency of
  surveillance.

• ????????????????????,????????????????

118
? ?Thank You