《社会医学》课件

1、 社 会 医 学讲课内容一、社会医学的定义二、社会医学的研究内容三、社会医学的任务四、社会医学的发展简史五、社会医学与相关学科一、社会医学的定义提问： 你以前接触过社会医学吗？ 你认为社会医学可能是研究什么的？ 社会医学工作者可能会干哪些工作？一、社会医学的定义 从社会的角度，应用社会科学的理论和方法研究人类健康和疾病的一门医学和社会学的交叉学科。Human behavior Culture Value Structure of society Social interaction Socialization Social institutions Dynamic of Society Soc

2、ial change Social life Sociology What is medicine?什么是医学The science related to the diagnosis understanding prevention treatment of illness. What is social medicine?什么是社会医学？Medicinesociology社会学政治学经济学伦理学管理学基础医学临床医学预防医学哪些人容易得肺结核病？性别？年龄？文化程度？婚姻状况？收入？职业？居住条件？为什么这些人容易得病？病因（社会的）： 贫困、受教育程度低、职业风险、有病不医（看病贵） 深层

3、次原因：社会保障制度、医疗服务体系社会后果：个体支出增加、收入减少，劳动力丧失、社会地位下降群体经济和社会生产力丧失GDP损失、贫富差距加大增长限制、发展延缓对付肺结核病，我们怎么办？社会卫生策略知识普及消除贫困普及社会保障改善医疗服务体系人类的双重属性The dual nature of human beings Aristotle : human beings are, by nature, social animals 社会属性 Social nature 生物属性 Biological natureDoes it matter to health?Whats Relationship

4、between social factors and health?WHO put forward: Social determinants for HealthPoliticsEconomyCultureEnvironmentSocial security systemLife style and behaviorsHealth care system政治经济文化环境社会保障制度生活方式和行为卫生保健体制霍普金斯大学的研究小组通过对伊拉克全国47个区进行调查走访形成的报告认为，美国发动伊拉克战争造成了65.5万伊拉克人死亡，平均每天死亡500人 人口爆炸！非洲难民美国哥伦比亚大学教授、联合国

5、前秘书长安南的特别顾问JEFFREY SACHS先生SACHS教授说：2003年的发展议题被挤出了国际议程，战争与反恐取代了发展。 艾滋病每天夺去数以千计的生命，由于贫困买不起挽救生命的药品而死亡； “911”灾难夺走了3000多人的生命，从而主宰了两年多的世界议程。 世界上每天有20，000多人死于贫困、疾病、灾害 世界军费开支将达9000亿美元，而用于发展援助为500亿美元，用于艾滋病防治仅10亿美元。二、社会医学的研究内容3、社会卫生对策及措施 社会处方三、社会医学的任务The tasks of social medicine倡导积极的健康观弘扬正确的医学模式发现社会卫生问题制定卫生政策

6、和策略常见病的社会防治促进人群健康加强社会医学教育四、社会医学发展史The history of social medicineEmbryonic stage of social medicineEstablishment & development of social medicineDevelopment of social medicine in China社会医学的萌芽 社会医学的创立和发展我国社会医学的发展 Embryonic stage of social medicine 萌芽时期 “Air, Water and Places” stress on the impacts of

7、environment, wind direction, sunlight, water quality and citizens life style on peoples health.- “It is more important to know what sort of person has a disease than to know what sort of disease a person has.”Hippocrates, born in 460 bc , father of modern medicine. Pathogenesis of disease and the ro

8、le of doctorsThe external influences of food and drink and climatic factors of excessive heat and cold influence internal mechanisms. The role of the physician was to restore the equilibrium of health. The Humoural theory was a holistic view.饮食和气候等外部因素可以通过影响人类的内在机制而起左右。医生的职责是恢复健康平衡;四体液学说体现了整体医学观Embr

9、yonic stage of social medicine 萌芽时期1.Galen: focus on psychological factors upon health；2.Peter Frank: miserable life is the hotbed of diseases; “the National Supervision System”supervision plangovernment measures to protect public health First person put forward: adopt social health measures to cont

10、rol disease古罗马医师盖伦：重视心理因素对健康的影响;德国社会卫生学家:弗兰克: 悲惨的生活是疾病的温床; : 用医学监督计划使政府采取措施保护公众的健康; 第一个提出社会卫生措施社会医学的建立和发展Establishment and development of Social MedicineFrenchman Jules Guerin: first person Social medicineScattered medical supervision; public health and forensic medicine should be integrated into So

11、cial medicine: divided into 4 parts:Social physiologySocial pathologySocial hygieneSocial therapeutics法国医生儒勒.盖林第一次提出社会医学;建议将分散的医学监督、公共卫生、法医学构成一个整体：社会医学分为四个部分；社会生理学；社会病理学；社会卫生学；社会治疗学。德国病理学家 魏尔啸German Pathologist: Rudolf VirchowThe kernel of medical science is social science“Medicine is a social scien

12、cePolitics is nothing more than medicine in broad senseBest method of medicine is to combine medicine with social life and political activities医学科学的核心是社会科学医学是一门社会科学；任何社会都应对居民的健康负责政治学是广义上的医学实现医学目标的最好的办法是将医学和社会生活和政治活动结合起来 德国：格罗蒂杨German A.GrotjahnPut forward theory of social pathologyWrite : “ social P

13、athology” suggests that disease should be studied from the standpoint of social view;Is a first person given lecture on social hygiene 提出社会病理学的理论和概念;用社会观点研究人类疾病的原则首次在柏林大学开设社会卫生学讲座 Germany： Birthplace of social medicineBefore WWIISocial hygieneSocial medicineLaterbecome social medicine德国是社会医学的发源地二战前：

14、使用社会卫生学和社会医学后改为社会医学 社会医学在各国的发展Development of Social Medicine in different countries In UK, course of social medicine is offered, social medicine research institute was established in Oxford UniversityProfessor John Ryle: all public health, industrial health, social health and medical care belong to

15、social medicineIn 1960s, social medicine was changed into community medicine 英国: 40s 开设社会医学, 在牛津大学成立社会医学研究院；牛津大学赖尔教授:公共卫生、工业卫生、社会卫生服务、公共医疗事业都属于社会医学的范畴；60s社会医学改成社区医学。 社会医学在美国的发展In United StatesMedical sociology and family medicine developedEmphasis on sociology, management and economicsSocial medicin

16、e was included in the course of health management and health policy医学社会学和家庭医学得到了发展强调社会学、管理学和经济学社会医学包含在卫生管理学和卫生政策学的讲座内容中 社会医学在中国的发展Social medicine in ChinaIn 50s, course of Health Care Organization is a compulsory course for medical student,；In 80s, Ministry of Health set up 6 training centre of heal

17、th administration, social medicine was the main course；90% of medical college offered course in social medicine.50年代：保健组织学作为医学生的必修课，成立保健组织教研组80年代：卫生部成立6所卫生管理干部培训中心，社会医学成为主干课程90%以上的医学院开设了社会医学课程Preventive medicineHealth management Community medicineMedical sociologyMedical psychology Clinical Medicine

18、社会医学与其他相关学科的关系The relationship between social medicine and other related subjects 预防医学卫生管理学社区医学医学社会学医学心理学临床医学Preventive Medicine1、预防医学(Preventive Medicine) 传统预防医学 传染病(第一次卫生革命)（生物预防） 传统预防医学 社会医学 社会医学使预防医学注入了生命活力 现代预防医学(整体预防)慢性病(第二次卫生革命)成功Health Management2、卫生管理学(Health Management) 社会卫生状况 发现问题 社会因素与疾病

19、和健康 分析原因 社会卫生措施 制订政策 运作、实施 解决问题 卫生管理学社会医学国内两者是姊妹学科或一个学科：社会医学与卫生事业管理（学位点）国外：health policy and managementCommunity Medicine3、社区医学(Community Medicine) 联系与相同点： （1）群体观 （2）内容的一致性：社区是小社会 区别：社区医学更侧重于卫生保健实践Medical Sociology4、医学社会学(Medical Sociology) 医学社会学是研究医疗卫生服务中的人际关系（如医护关系、医患关系等）对医疗卫生工作的影响，以提高医疗卫生服务的效率。两者

20、都以社会因素作为重要研究内容。其区别在于： （1）学科性质不同； （2）起源及时代背景不同； （3）研究的对象不同。Medical Psychology联系： 基于社会心理因素与健康的关系，两门学科交叉。 区别： 学科归属不同 社会医学与临床医学的比较社会医学：群体 social medicine: mainly target at population level发现社会问题社会诊断 Identify social problemsocial diagnosis社会医学分析了解社会成因 Social medical analysisfind out social causes社会医学综合处方

21、 Social comprehensive therapy临床医学：主要针对个体 Clinical medicine: mainly target at individual level了解个体健康问题医学诊断 Identify individual health problem-medical diagnosis开展病因学分析: 主要是生物学病因分析 Etiological analysis: biological causes analysis制定医学处方 Provide medical prescription社会工作专业与社会医学 在你的专业中，需要社会医学吗？可以应用在哪些方面？本章

22、学习重点1、社会医学定义2、社会医学的研究内容是什么？3、社会的任务是什么？4、社会医学发展史上的几个重要人物与事件？社会医学授课内容、方式等1、授课内容2、授课方式：参与式教学3、纪律要求4、课程记分第二章医学模式与医学模式的转变讲课内容一、医学模式概述二、历史上几种主要的医学模式三、现代医学模式一、医学模式概述1、概念 模式（MODEL）：某一领域中科学地指导人们获取知识和解决问题的概念、假设和法则。 医学模式（MEDICAL MODEL）：人们关于健康和疾病的基本态度、基本观点和基本看法。 一、医学模式概述2、医学模式的主要内容1）对健康和生命的价值判断2）健康和疾病的确定3）对健康和疾

23、病归因和解释4）求医行为和治疗方式的选择5）对预后的估计二、 医学模式的演变过程Evolution of Medical Model：神灵主义的医学模式 ( Spiritualism medical model)自然哲学的医学模式 (Nature philosophical medical model)机械论的医学模式 (Mechanistic medical model)生物医学模式 (Biomedical model) 生物心理社会医学模式 (Bio-psycho-social medical model)。a.神灵主义医学模式Spiritualism medical modelHow t

24、o look at health and disease?Life and health is bestowed by the GodDisease is caused by supernatural powersOnce offend the gods, or disfavored by the gods , disease is in the form of the punishment by the gods Possession of evil spirits, demons or monsters etc生命和健康由神所赐；疾病是由超自然的力量所引起的；人触犯神灵时，疾病代表神灵的惩

25、罚；疾病是妖魔鬼怪附体。Spiritualism medical modelTreatment:Pray to God and spirits for bless, forgiveness & their protectionResort to natural plants or minerals for treatment, most is of emetic and cathartic Banish the spirits and ghosts that cause plague治疗方法：乞求神灵的祝福、宽恕和保护服用具有催吐和导泻作用的植物或矿物质驱逐瘟神疫鬼1、神灵主义医学模式spir

26、itualism medical model讨论：为何神灵主义医学模式至今仍具有重要的影响？为何神灵主义医学模式至今仍具有重要的影响？提供疾病标准化的、当事人及社会能接受的解释，提示处理方法及预后。医学仍存在许多未知的领域群众医学知识的缺乏医疗需求与供给的差距（无法购买昂贵的医疗服务）较强的心理安慰作用社会整合和社会控制作用文化继承与侵袭的长时间性 b.自然哲学的医学模式Naturalistic philosophical medicalTHE FIVE elements the physical universe, can be reduced to five elements：wood,

27、fire, earth, metal, and water. Physical universe as divisible into two broad categories that were both opposite and complementary. The two poles of material phenomena were labeled, Yin and Yang. 中国的阴阳五行学病理学说建立 世界是由什么组成的？What is the world made of? Chinese Philosophy Five Elements support and destroy

28、each other，coordinate to each otherMetal: cutting, hard, conductingWood: growing, flexible, rooted, strong Water: wet, cool, descendingFire: dry, hot, ascending, movingEarth: productive, fertile, potential for growth 中国哲学 五行相生相克、相关协调金木水火土阴和阳世界观相生相克中医对疾病的看法TCM view of diseasesIllness as an imbalance

29、of two types of energy yin and yang which simultaneously exist in everyone and everything and within each other. Yin represents the cold, slow, or passive principle, yang represents the hot, excited, or active principle. Health is a balanced state and that disease is due to an internal imbalance of

30、yin and yang. 中医理论的发病机制致病的外因：external causes of diseases The Causes of disharmony External Causes : Six external evilswind,cold, heatdamp, dryness,fire 失调的原因 外因：六淫风寒暑湿燥火西方疾病学说：Western theory of diseasesall matter could be reduced to the basic elements earth, fire, air and water cold, hot, dry and we

31、t;four humour of phlegm, blood, black bile and yellow bile. Health-mutual balanceDisease-disorder自然界万物之源: 水、火、土、气对应冷、热、干、湿人体内的：粘液、血液、黄胆汁、黑胆汁相对应健康、疾病、性格与四体液的数量、比例变化有关引起体液失衡的原因有先天、环境以及营养失调等 Humoural theory by HippocratesFour *bodily* fluids: phlegm, blood, yellow bile and black bile. Disease, in essen

32、ce, becomes a state in which one of these four bodily fluids (humour) *overpowers* the others. 四体液学说：粘液、血液、黄胆汁、黑胆汁疾病的本质是：体液之间的失衡状态 The role of Hippocrates on Modern MedicineCauses of disease could be internal, relating to faulty aspects of diet and exercise External factors: relating to the forces o

33、f climate, winds, water and the seasons.致病因素内因：饮食和锻炼方面存在问题外因：环境因素：气候的变化，风、水、季节等自然哲学的医学模式西方世界Naturalistic philosophical medical Hippocrates： Airs, Waters, and Places , instead of ascribing diseases to divine origin, discusses their environmental causes.A towns weather, drinking water, and site along

34、the paths of favorable winds can help a physician ascertain the general health of citizens. 希波克拉底：空气、水、地域探讨环境、天气、水、风向等与健康的关系The role of Hippocrates on Modern Medicine Hippocrates reject that: diseases have a supernatural cause. first person to perceive a relationship between cause and effect in a me

35、chanistic wayProviding the foundation for modern scientific notions of disease causation. 疾病的致病因素的研究推进的医学的发展，否认疾病的产生是超自然力量导致的；以机械的眼光看待疾病的因果关系为现代医学的疾病因果理论奠定了基础Significance of HippocratesThe theory of humour is the first theory which attempts to *integrate* a natural theory of metaphysics with empiric

36、al first-hand observations of disease. It essentially marks the origin of the *integration* of Western medicine with early Greek naturalistic science . The pathogenesis of disease is no longer mystical and inexplicable unnatural causes (demons, gods, etc.)第一次将纯粹的哲学与对疾病的观察结合起来标志着西医与希腊自然哲学的结合疾病的发病机理不再

37、是神秘的、无法解释的超自然力量Significance of Hippocratespreceded to it: a primarily mystical approach to disease which was characterized by the worship of gods, the fending off of evil demons it successfully separated Western medicine from-a primarily mystical approach to disease . marks the beginning of a ration

38、al pathophysiology 希波克拉底之前：疾病是由神秘的超自然力量导致希波克拉底及其创立的学说将西医与原始的神秘主义分割开来标志理性病理生理学的真正开端c.机械论的医学模式Mechanistic Medical ModelMechanistic view of the bodyIll health is treated as the mechanical failure of some part of one or more of these interdependent systems and the medical task is to repair the damage.背景

39、BackgroundA Shift in IdeasGrowing acceptance of a developing scientific model.Development of research, observation, technologyNew ways of thinking about disease and the body.思想观念的转变对不断发展的科学模式的日益认可研究、观察、技术等科学和技术的不断发展从新的角度来看待疾病和健康机械论的医学模式Mechanistic Medical Model R. Descartes 笛卡尔From the point of view

40、 of movement:Human body is a machine with more parts, but not more alive, than any man-made automata, meaning a machine that moves itself. 从运动的角度：人体是由许多部分组成的机器,是自己发动自己的机器笛卡尔的二元理论Dualistic Interaction of Body and MindTo Descartes, man was a mind united with a body, the two interacting with each other

41、. Mind and body are two separate things which makes the consideration dualistic. These two things or parts interact, and each affects the other. Medicine should pay more attention to body than its mind.代表人物及其主要观点：Descartes: Animal is MachineLamterry: Human is Machine, a machine start up itselfRegard

42、 life activities as machine movementProtect health is just as the same way of protecting a machineDiseases: in a state when machine breakdown and body out of order, therefore need to be repaired笛卡尔：动物是机器拉美特利；人是机器 是自己发动自己的机器。将生命活动比作机器的运动对健康的保护与保护机器的原理一致疾病：机器出现故障和失灵医学：对出现故障的部分和零件的修补 d. Biomedical mode

43、lMind/Body dualism: Medicine should focus on measuring cells biochemical changes by precise technique, explain symptom, interfere changes to recover the health;Reductionism: disintegrates human body to different organ, cells and molecular, the physical and chemical changes at molecular levels can ex

44、plain the causality of functional changes of body;Disease is regarded as a static results between its cause and effects 二元论：人的身体和精神应有合理的分工，医学应研究如何通过精密的技术测量细胞生物化学的变化，来解释病人的症状与体征，干预这些变化来恢复健康；还原论：将人体分解为器官、细胞、分子，复杂的生命现象必须用物理的、化学的方法来解释功能改变的因果关系；疾病是静止的因果结局。生物医学模式下生命科学的大发展Boom of Life scienceGerm theoryPhy

45、siologyAnatomyHistologyEmbryologyPathologyImmunologyGeneticsMolecular Biology细菌学理论生理学解剖学组织学胚胎学病理学免疫学遗传学分子生物学Achievements under bio-medical model外科学三大难题被攻破Three big issues in surgeryacheInfectionBlood loss外科手术 三大难题：疼痛感染失血 巴斯德：细菌理论Pasteur : Germ Theorydiseases were transmitted by micro-organisms germs

46、 that float in the air1870s Pasteur demonstrates that germs are the cause rather than the product of disease1880s Robert Koch - Doctrine of Specific etiologyeach disease is always caused by a particular micro organism 巴斯德：疾病是由漂浮在空气中的病源微生物引起的1870，巴斯德证明了细菌是导致疾病的原因而不是结果1880科赫：提出特异致病因子的病因理论认为每一个疾病总是由特异的

47、病源微生物所引起的魏尔啸：德国病理学家Rudolf Virchow, German pathologistFather of Cellular PathologyDisease can be manifested at microorganism level.All diseases have relation to cell, the source of all kinds of diseases is cells abnormal activities分子病理学之父疾病可以在更微观的 分子水平上呈现出来疾病是由于异常的 细胞造成的Ecological model of disease宿主h

48、ost环境environment病源体pathogenDefects of biomedicine modeEngel (1980)： biomedical model neglects the whole because it excludes everything but biological factors. It is preoccupied with the body and disease at the expense of the patient as a person.modern allopathic medicine often fails to address the e

49、motional and spiritual needs of those who suffer from infirmity 恩格尔指出:生物医学不完整,它只考虑了生物因素,而忽视了其他因素；它的注意力只放在身体和疾病上,而忽视了病人,现代医学的疾病观使其无法满足病人精神和情感需要。HolisticRather than a new approach, the bio-psycho-social model is actually a return to holismInteraction of body and mindMulti-causalitySocially connected i

50、ndividual Preventative - health maintenance 整体医学观 身体和精神的整合 多因多果-病因链 个人与社会的联系 从预防医学到健康维护三、生物心理社会医学模式 （Biopsychosocial medical model）（一）生物心理社会医学模式的产生背景 The background of bio-psycho-social medical model疾病谱转变健康需求提高和多样化医学的社会化医学学科的内部融合与外部交叉发展健康影响因素的多元化医学的进一步社会化世界各国卫生保健的经验（二）现代医学模式的形成过程 Emerging of Bio-psy

51、cho-social medical modelGeorge Engel, alternative to the limited, predominant biomedical model.Bio-medical-model, accounts for disease by its biochemical factors without considering social or psychological dimensions, separates mind from body. It is a reduced, myopic view. Emphasize the hierarchical

52、, independent relationships of biological, individual, family, and community systems.美国内科医生：恩格尔提出由生物心理社会医学模式来替代生物医学模式生物医学模式关注导致疾病的生物化学因素而忽视社会、心理的纬度，是一个简化的、近视的观点强调生物学、个人、家庭、社区和社会系统多层次关系对疾病的影响Emerging of Bio-psycho-social medical modelIt includes the patient as well as the illness；Emphasize close atte

53、ntion to be placed on the medical illness and the role the illness plays in the emotional life of the patient, and the interpersonal dynamics of the family. 现代医学模式：不仅关注疾病更关注病人；医学不仅应关注疾病的本身，还应该关注疾病对人心理和情感的影响，了解病人家庭的关系状况布鲁姆的环境健康医学模式 p17 （Environment health medical model）拉隆达和德威尔的综合健康医学模式（Comprehensive

54、health medical model）环境因素生活方式及行为因素生物遗传因素医疗卫生服务因素 卫生服务和卫生政策分析相结合综合内因卫生服务遗 传成熟老化生物遗传职 业危险因素环境因素行 为生活方式社 会心 理自 然健 康康 复治 疗预 防生 活危害因素消费形式图2-4 综合健康医学模式（四）恩格尔：生物心理社会医学模式 Engel ： Biopsychosocial medical model （三）现代医学模式代表观点1）整体的观点2）系统论的观点3）多元论的观点（四）生物心理社会医学模式对 医学和社会的作用（ Impact of biopsychosocial medical mode

55、l on medicine and society)现代医学模式对医学实践和社会的意义Significance of modern medical model临床医学 预防医学医学教育可持续发展医学目的Clinical medicinePreventive medicineMedical educationSustainable developmentGoal of medicine二十一世纪医生的职能： 五星级医生（ five star doctor）卫生服务的提供者诊疗方案的制定者健康教育的指导者社区卫生的领导者卫生事务的协调者Care Provider Decision MakerHea

56、lth EducatorCommunity LeaderService Manager现代医学模式对卫生服务的影响四个扩大 治疗预防 生理心理 院内院外 技术社会第三章社会医学基本理论和观点讲课内容一、健康的概念二、健康与疾病的社会性三、高危险性观点四、卫生事业发展与社会发展同步的观点五、健康公平六、大卫生的观点七、社会诊断与社会处方八、社会资本的卫生保健功能 消极的健康观 积极的健康观 高水平康强观 1) 健康：一、健康的概念 “lack of disease ” “WHO”High level wellnessIf you show no signs or symptoms of illn

57、ess, you are healthy. Health is seen as a state of being. 21“lack of disease” WHO：health is a state of complete of physical, mental, and social well-being and not merely the absence of disease or infirmity.身体健康 躯体的结构完好和功能正常。 physical fitness Muscular strength Flexibility Muscular endurance Body comp

58、osition Cardiorespiratory endurance10心理健康： 智力正常情绪愉快： 体温正常生理健康 情绪愉快心理健康良好的人际关系适应环境坚强的意志品质完整与健康的人格12心理健康 正确认识自我三个方面 正确认识环境 及时适应环境 社会适应能力社会参与时的完好状态每个人的能力应在社会系统内得到充分的发挥；作为健康的人应能够扮演与其身份相适应的角色；每个人的行为与社会规范相一致。High level wellness 高水平康强的概念 高水平康强的内容 影响高水平康强的因素17 高水平康强 健康是一个动态的不断努力发挥个人最大潜能的过程； 健康的综合性，包含生理、情绪、精

59、神、智力、社会 、职业、环境七个方面； 核心是自我的责任性。23Ongoing growth in all dimensions of wellness Strong sense of personal responsibility for wellness Sense of humor and positive outlook on life Quest for cultural support for wellness living Mindset for achieving personal excellence Ability to cope and find balance duri

60、ng lifes challenges Continual quest for meaning and purpose in lifelifestyle habits that contribute to optimal healthNot sick (neutral point of no discernable illness)Measures and signs of health and well-being20High-level wellnessHealth-robbing lifestyle practices Feelings of stress and inability t