Unit 1 Public Health and Preventive Medicine

READING A

PREVIEW

Public health evolved from a narrowly disease-centered to broader populationbased，multidisciplinary and multisectoral discipline that is "collective action for sustained improvement of the health of all people".The public health system plays a vital role in the development of health sector and protects the health of people.Globally，most countries are in a period of transition in their public health landscape due to new challenges.Practices in public health at a community-level must be strengthened worldwide.China has robust systems to respond to infectious diseases and is well placed to develop and strengthen community public health systems to tackle non-communicable diseases and health inequalities.Reform，modernization，and investment in a prevention-focused primary care system that integrates with public health services could improve health across the country and ensure that China's trajectory of improving health continues and leaves no one behind.Getting the development and reform right is important to China's social and economic development in the future，and we believe that China's experience in public health may provide many lessons for other countries.

Questions for Discussion

Q 1：What is the significance of community-level public health for disease prevention？

Q 2：What achievements has China made in disease prevention？

Text A　Development and Reform of Public Health in China

The term "public health" has always been vaguely defined.According to Winslow，a leading public health expert，public health is the science and art of preventing disease，prolonging life，and promoting health through the organized efforts and informed choices of society，organizations，public and private communities，and individuals.The United States，the United Kingdom，Australia，the World Health Organization（WHO）/ Western Pacific Region （WPR），and other countries or organizations have identified the basic functions of public health or the scope of basic services that should be delivered by the public health system.Internationally，public health consists of 3 categories of services：population-based public health services，including vector control and population-wide health education；individual-based preventive care，for instance，vaccination，premarital checkup and prenatal care；and individual-based curative care against conditions affecting the health of the public.Public health is closely linked to social and economic development，demographic structure，disease pattern and disease burden and existing administrative system.These factors vary considerably from country to country and region to region.

The public health system plays a vital role in the development of the health sector in China and improves the health of the Chinese people.Given that the history and structure of China's public health system has its own characteristics，it is worth looking at the development of public health in China.It is crucial to understand why and how China has achieved such a success，as this may be useful to other countries.

Public health in China has gone through four key phases：an initial phase centered on prevention，a deviant phase that focused more on treatment and less on prevention，a recovery phase after the SARS （severe acute respiratory syndrome）crisis，and a new phase towards equity and people-centeredness.In the most recent phase，the National Basic Public Health Service Program （NBPHSP）was implemented to address the threat of non-communicable diseases （NCDs）and some initial results were achieved.

The development of public health in China has been marked by both unique Chinese wisdom，remarkable achievements and twists and turns.Prevention is the main focus.Institutional flexibility，multi-agency collaboration，mass mobilization，and social participation were the main lessons learned from the early days of public health.Although China's public health system has shown great resilience since the 1980s，this may be due to the government's continued commitment to social development and people's livelihoods，as well as its flexible governance.

Since the outbreak of SARS in 2002，health-care reform in China has been squarely focused on community-level capacity building，in contrast to countries with less-than-ideal community surveillance systems.

Disease control and prevention based on community mobilization are fundamental in China.Back in the 1950s，the Chinese government initiated its all-in-all Patriotic Health Campaign，and has been keeping the pace for the intervening decades，increasing life expectancy from 35 years in 1949 to 77 years in 2019.Many diseases have been effectively controlled.In addition to the eradication of smallpox and elimination of polio，following the world's lead，China has eliminated or almost eliminated diseases such as malaria，leprosy，filariasis，and schistosomiasis.Most importantly，this feat has been accomplished by strengthening capacity and practice at the community level.In the early stages，the organizational mechanism of the system was the establishment of so-called stratified epidemic prevention stations，ranging from provincial to local to county levels.The system worked well with the National Immunization Program，which began in the late 1970s and allowed for effective control of vaccine-preventable diseases，especially for infants and children.However，we realized that our national-level scientific and technical support system was not sufficient to support the entire enterprise.To address this core need，a system similar to that of the US Center for Disease Control and Prevention （CDC）-known as the China CDC -was established in 2002，just before the SARS outbreak.To establish this new system，a national research organization，the Chinese Academy of Preventive Medicine，was transformed into the China CDC.Regional stations were retained and renamed as local CDCs，from provincial to local to county levels，unlike the US CDC system.Since then，China's four-level CDC system has been well built with comprehensive capacity and large workforce.

In the 2010s，in order to achieve a well-off society，the Chinese government pays unprecedented attention to the health sector，which brings a new wave of development opportunities for public health such as the continuation of the priority of NBPHSP.The development and reform of public health in China is based on its national condition，and has accumulated a wealth of experience，as well as facing many common worldwide challenges.Getting this development and reform right is important for China's social and economic development in the future，and China's experience in public health may provide many lessons for other countries.

The "Healthy China 2030" initiative，which began in 2016，promotes the integration of prevention and clinical medicine.Prevention is regarded as the most effective measure for disease control.Capacity building at the community level is an ongoing priority in Healthy China 2030.In order to achieve Healthy China 2030 goals，political will is essential to adequate financial support and coordination with stakeholders and the public.Communitylevel clinics and county-level CDCs are also encouraged to collaborate in the management of non-communicable diseases.Private sector organizations and non-governmental organizations are encouraged to participate in health care reform at the community level.Nevertheless，there is considerable work to do.For example，rabies remains a problem in China，which is not commensurate with the country's level of development.With such a large，geographically diverse country with inequality in economic development，diseases such as rabies will need to be addressed in the future.One Health concepts and practices are needed for any measure of success.There are a number of zoonotic diseases that need to be managed through coordination between the health and agricultural sectors，particularly in rural areas where there are gaps in public health practices at the community level.Tobacco use remains a huge problem in China，and community-level public health practice should be called upon to play a key role for longterm solutions.

Globally，most countries are in a period of transition in their public health landscape due to common new challenges.The development and reform of public health in China needs to be further deepened.Firstly，the accelerating aging population has put a number of countries at a considerable disadvantage in terms of health care reform.Developing countries are experiencing a much more rapid aging process than rich countries，and China is the fastest one in the coming decades.This is a serious potential risk to the financial sustainability of China's health sector in a broader sense.Furthermore，lower fertility intentions may exacerbate the risk.It is similar to the situation in the Next Eleven （Next-11）countries where healthcare expenditure has risen sharply，due to a higher proportion of the elderly and lower fertility rates.Secondly，NCDs are recognized as the key health challenge worldwide，and have emerged as the number one health threat in China.Unlike infectious diseases which have a relatively short acute phase and a short cure time，NCDs will place a huge and long-term burden on patients and society.Moreover，the prevalence of NCDs is disproportionately high among older people，some of whom often have more than one NCD.The emerging NCDs burden coupled with an aging population means that sustainability challenges in the public health system will be very serious，even in the richest Organization for Economic Co-operation and Development countries.Thirdly，social and economic transformation have accelerated urbanization and lifestyle changes，leading to many risk factors such as obesity，sedentary lifestyles，stress，tobacco/alcohol/other substances abuse，and exposure to pollution.The incidence of NCDs is also rising due to these individual or environmental factors.Fourthly，globalization has accelerated the spread of infectious diseases，imposing challenges to public health.Many countries，including China，are facing the dual burden of NCDs and infectious diseases at the same time.

In a nutshell，the evolution and reform of China's public health is based on its national condition.During the process，China accumulates rich experience but also faces many common worldwide challenges which may be even more pronounced in China.

Public health in China needs to focus on prevention，strengthen multi-agency coordination mechanism，and improve the quality of public health services in the future.However，it is expected that the government's continuous attention to the health sector and its stable macro environment will be greatly helpful to address those challenges.Getting this development and reform right is important to China's social and economic development in the future.China's experience in public health may provide many lessons for other countries.

Practices in public health at a community-level must be strengthened worldwide.Disease knows no borders and we should work together to tackle the common enemies of mankind.China needs the world and vice versa.

Words and Expressions

crucial 至关重要的

For executive function and social skills，existing research leans against the crucial causal position but is insufficient to differentiate the other 2.

acute 急性的

Avoidance and treatment of hypoxemia is a cornerstone of acute resuscitation and yet the optimal approach to oxygen therapy in the acute care setting is uncertain.

syndrome 综合征

The shape of the face is affected in 30%-40% of known genetic syndromes.

implement 实施

All nurses have responsibilities to enculturate evidence-based practice （EBP）and translate and implement research findings into nursing care，practices，and procedures.

reform 改革

Major health policy creation or changes，including governmental and private policies affecting health care delivery，are based on health care reform（s）.

squarely 直接地

They placed the blame squarely on the president.

surveillance 监视，监测

Two important measurements for the evaluation of a public health surveillance system are sensitivity and predictive value positive （PVP）.

fundamental 基本的，关键的

Efforts are underway to heighten nurses' awareness of values that motivate fundamental care and thereby increase their attention to effective provision of fundamental care.

eradication 根除

Because of the success of global measles control programs，the World Health Organization（WHO），along with its partner agencies，is once again considering the possibility of setting a target date for measles eradication.

smallpox 天花

Widespread vaccination programs led to the global eradication of smallpox，which was certified by the World Health Organization （WHO），and，since 1978，there has been no case of smallpox anywhere in the world.

elimination 消除

Since 2005，malaria cases have been declining globally with many countries having eliminated malaria and several other countries heading towards malaria elimination.

polio 脊髓灰质炎

The Global Polio Eradication Initiative since 1988 has seen the impact of poliovirus decline from frequent global epidemics in the early 1900s to being now only endemic in two countries today.

malaria 疟疾

Important strides have been made within the past decade toward malaria elimination in many regions，and with this progress，the feasibility of eradication is once again under discussion.

leprosy 麻风病

Leprosy is often not suspected because it is no longer emphasized in the medical curricula.

filariasis 丝虫病

Filariases are infections caused by distinct species of nematodes.

schistosomiasis 血吸虫病

Despite accelerating progress towards schistosomiasis control in sub-Saharan Africa，several age groups have been eclipsed by current treatment and monitoring strategies that mainly focus on school-aged children.

strengthen 加强，强化

Supraspinatus strengthening is an important part of shoulder rehabilitation programs.

entire 全部的，完全的

When dysplasia is identified in a gallbladder，many experts recommend submission of the entire gallbladder for histologic examination.

enterprise 企业，事业单位

Enterprise imaging governance is an emerging need in health enterprises today.

outbreak 暴发

A main goal of syndromic surveillance systems is to detect outbreaks rapidly and the number of studies evaluating outbreak detection has increased recently.

workforce 全体员工，劳动力

A suitably skilled workforce that is of an appropriate size is essential for the provision of healthcare services.

integration 整合，一体化

This integration process requires the appropriate allocation of cognitive resources to both the gesture and speech modalities.

priority 优先，优先事项

Nurses participated in organizational and societal level priority setting through discussion about the priorities.

adequate 足够的，适当的

Detailed knowledge about the different types of impingement and the underlying causes is essential to provide adequate treatment.

coordination 协调

Clearly identified professionals who are appointed for care coordination are invaluable for ensuring efficient coordination of health care services.

stakeholder 利益相关者，有权益关系者

Health care innovations tailored to stakeholder context are more readily adopted.

collaborate 合作

Coalitions implementing health promotion initiatives are composed of organizations that collaborate with one another.

nevertheless 尽管如此

Nevertheless，many researchers have tried to solve these problems，and it is hoped that transgenic animals in combination with newer immunosuppressive treatment will make xenotransplantation a realistic possibility.

geographically 在地理上

Overview of geographically explicit momentary assessment research，applied to the study of mental health and well-being，which allows for cross-validation，extension，and enrichment of research on place and health.

diverse 各种各样的，不同的

A DNA-encoded chemical library （DECL）is built with combinatorial chemistry，which works by bringing chemical fragments together to generate diverse structures.

tobacco 烟草

The oral cavities of tobacco smokers and users of smokeless tobacco products are exposed to high concentrations of nicotine.

tackle 处理，解决

Immune cell-based therapies are emerging as a promising tool to tackle malignancies，both solid tumors and selected hematological tumors.

Language Points

infectious diseases 感染性疾病

A disease （such as influenza，malaria，meningitis，rabies，or tetanus）caused by the entrance into the body of pathogenic agents or microorganisms （such as bacteria，viruses，protozoans，or fungi）which grow and multiply there.Including communicable diseases and non-communicable diseases.

Infectious diseases have for centuries ranked with wars and famine as major challenges to human progress and survival.

communicable diseases 传染病

An infectious disease （as cholera，hepatitis，influenza，malaria，measles，or tuberculosis）that is transmissible by contact with infected individuals or their bodily discharges or fluids （as respiratory droplets，blood，or semen），by contact with contaminated surfaces or objects，by ingestion of contaminated food or water，or by direct or indirect contact with disease vectors （as mosquitoes，fleas，or mice）.

The terms communicable disease and contagious disease are often used interchangeably.However，communicable diseases such as malaria or schistosomiasis that are spread by contact with disease vectors are not typically considered to be "contagious" diseases since they cannot be spread from direct contact with another person.

zoonotic diseases 人畜共患病

Zoonotic diseases are defined by the World Health Organization as，"those diseases and infections naturally transmitted between man and other vertebrate animals."

Global economics and advances in technolgy have contributed to the emergence or reemergence of infectious diseases and to the spread of zoonotic diseases that would otherwise have been confined to local areas.

EXERCISES

Task 1：Vocabulary Application

Fill in the blanks with the words given below.Change the form where necessary.

1.Particularly，leadership in district hospitals needs to ___________ in order to decrease the burden of perinatal ___________ .

2.The social and ___________ changes accompanying the Anthropocene （人类纪）require changes in how ___________ are anticipated，conceived，and managed.

3.Hepatitis C infection is a serious public health ___________，and the World Health Organization has recommended the ___________ of public health threats from viral hepatitis，including hepatitis C，by 2030.

4.The 2016 President's Cancer Panel Connected Health report calls for thoroughly characterizing the team structures and processes involved in ___________ care for people with___________ conditions.

5.During the last ___________，policy makers in a large number of countries have attempted various ___________ of their health care systems.

Task 2：Writing

For this part，you are allowed 30 minutes to write a composition on the topic Epidemics.You should write at least 120 words，and base your composition on the outline below：

1）Epidemics can be seen everywhere in our lives.

2）What harm will epidemics bring？

3）What measures should we take to control epidemics？

Task 3：Oral Presentation

Mankind has a wealth of experience in combating pandemics.Combining epidemiological knowledge，give an example about pandemics and describe the corresponding epidemic prevention measures from the perspective of public health.