慢性病高发的背后，是社区医院和大型医院发展不平衡、基层防控能力人手短缺、救治技术尚未得到规范等导致的“多因一果”。本报记者通过采访官员、专家、基层卫生人员发现，五大原因导致慢性病防控失守。

High incidence of chronic diseases behind,Is the community hospital and large hospital development is not balanced/Base control ability shorthanded/Treatment technology has not been standard in"For more than a fruit".Our reporter through the interview official/experts/Grassroots health researchers found,Five main causes chronic disease prevention and control fort.

□原因1 - reason 1

社区医院投入不给力 Community hospital investment not to force

　　“今年我们48个空缺编制仅招了两个人，而且还是奔着户口来的。”

"This year we 48 vacancies establishment only recruit two men,And still rush to the account."

　　在中华医学会全科分会委员、方庄社区卫生服务中心主任吴浩眼里，政府有点偏爱大型医院。

In the Chinese medical association, member of general branch/Fangzhuang community health service center director wu hao's eyes,The government is a bit preference large hospital.

　　用吴浩的话说，“各级政府已经意识到慢性病的防控形势之严峻，但对大型综合医院的投入仍远远多于对基层卫生机构的投入”。

Wu hao with the words,"Governments at all levels have been aware of chronic disease control and prevention of severe situation,But for large general hospital investment is still far more than primary health institutions to investment".

　　吴浩分析，一方面，以治疗为主要功能的大医院在不断发展、不断建新院，同时，技术水平和人才储备都快速发展着；另一方面，社区医院却受政府投入不足、义务提供的公共卫生服务量剧增、进京指标受限等多种因素影响，人员积极性难以调动。

Wu hao analysis,On the one hand,To treat as the main function in the development of a large hospital/Constantly a new school,At the same time,The technical level and reserve of talents are the rapid development;On the other hand,Community hospitals have by the lack of government's input/Obligation to provide public health services in excursion/Besides index such as the limited under the influence of various factors,Personnel to mobilize the enthusiasm.

　　“今年我们48个空缺编制仅招了两个人，而且还是奔着户口来的。”吴浩说。

"This year we 48 vacancies establishment only recruit two men,And still rush to the account."Wu hao said.

　　2011年，市财政为公立医院拨款65.5亿元，是对基层卫生机构拨款的2.5倍左右。

In 2011,,The municipal finance for public hospital to allot 6.55 billion yuan,Is the primary health institutions appropriation of 2.5 times the left and right sides.

　　以吴浩所在的方庄社区卫生服务中心为例，三年间，年门诊量已由10万人次增至36万人次，日人均门诊量等同于三级医院的水平，上缴的财政收入则由2200万元增至8500万元，与3年前相比医务人员却没有增加，政府相关部门也增加了编制，但是急需的人招不进来。

Wu hao in the fangzhuang community health service center as an example,Three years,Years MenZhenLiang already by 100000 people to 360000 people,Day per capita MenZhenLiang equal to tertiary hospital level,Hand over to financial income is from 22 million yuan to 85 million yuan,And 3 years ago medical staff did not increase,Relevant government departments also increases the establishment,But people who need it recruit don't come in.

　　据了解，目前北京的社区医生平均年收入为7.4万元，但扣除各类保险外，到手的仅4000多元，刚工作的毕业生近2000元左右。

It is understood,At present Beijing community doctor average yearly income for 74000 yuan,But the deduction of all kinds of insurance,It's only 4000 yuan,Just work of the graduates of nearly 2000 yuan.

　　在新一轮医改大潮中，与各大医院的扩建、在郊区县建分院、获得改革政策扶持、不断引进新技术和人才形成鲜明对比的是，社区医院不仅出现有编无人、设备闲置、政府政策“不给力”等窘状，而且随着政府“社区首诊”的号召，逐年递增的门诊量和不断加码的公共卫生服务让社区医院倍感疲惫不堪，前行缺乏动力。

In the new round of reform in the spring,And each big hospital expansion/In JiaoOuXian built sorting/Get reform policy support/The introduction of new technologies and talent contrast,Community hospital not only there is no Ed/Equipment idle/The government's policy"Don't give force", etc JiongZhuang,And as the government"Community first diagnosis"'s call for,Increasing year by year the MenZhenLiang and continuous pyramid public health service let community hospital feeling tired,Forward lack of power.

□原因2 - reason 2

防控人手严重不足 Prevention and control are understaffed

　　社区医生连门诊病人都接待不过来，很难抽出时间做慢性病宣教及调查工作。

Community doctor even outpatient all receive not to come over,It is difficult to take the time to do chronic mission and investigation.

　　市疾控中心慢病所所长董忠介绍，建国初期，我国及本市疾控工作的关注重点是传染病的防控，直到1998年，慢病所才正式成立，2002年才做了第一次全市范围内的慢病抽样监测。时至今日，虽然从国家到地方，都已经意识到慢病防控工作的重要性，但初步构建起来的防控体系尚未进入到有效运转状态。

City CDC slow disease of director of institute of DongZhong is introduced,After the founding of the,Our country and local disease control attention is focused on prevention and control of infectious diseases,Until 1998,Slow disease have to formally established,2002 years to do the first time within the scope of the slow disease sampling monitoring.today,Although the country to place,All have realized the importance of slow disease prevention and control work,But preliminary building up prevention and control system has not access to effective running condition.

　　按照卫生部门要求，到2015年，慢病防控人员要占全部疾控人员的5%，但市疾控中心总计600余人，慢病所只有11人，仅占总人数的1.8%。而区县疾控更是“惨不忍睹”，很多区县仅有两三个人。处于慢病防控刚起步的阶段，本市全人群的慢性病监测、抽样调查、慢性病宣教等工作尤其繁重，但不足百人的防控力量与2000万常住人口相比，如九牛一毛。

According to the health department requirements,By 2015,Slow disease prevention and control personnel should account for 5% of all disease control personnel,But city CDC total of more than 600 people,Slow disease have only 11 people,Only account for 1.8% of the total number.And the area county is for disease control"horrible",Many districts and counties only two or three people.In a slow disease prevention and control just the beginning stages,This city all the crowd of chronic disease monitoring/Sampling survey/Chronic diseases such as mission work especially hard,But less than one hundred people's prevention and control power and 20 million compared to the resident population,Like a drop in the bucket.

　　董忠介绍，在本市医疗模式中，基层是慢性病防控的网底，很多相关的调查、干预、管理都要下沉到社区。“社区医生确实很辛苦，除了公共卫生任务外，还要承担许多预防保健工作，但慢病防控关键在社区，如果这个网底不牢固，使不上劲儿的话，那这道重要关口怎么防得住？”董忠表示，基层防控力量本就薄弱。此外，因社区医院归市社管中心管理，因此在相关工作的协调、部署、结果的反馈上，双方也并不畅通。

DongZhong introduced,In this city in the medical model,Basic is a chronic disease prevention and control WangDe,A lot of related research/intervention/Management will sink to the community."Community doctors really hard,In addition to the task of public health,And you have many prevention health care work,But slow disease prevention and control key in the community,If the WangDe not strong,Make no effort on words,That the word important passes how to prevent have to live?"DongZhong said,Grass-roots power control and prevention the weak.In addition,For community hospitals to city club tube center management,So in the related work coordinated/deployment/Results the feedback,Both sides is not clear.

　　除了疾控中心的慢病防控人手严重不足外，社区医院医务人员的数量也有较大缺口，2.2万余社区卫生技术人员要管理2000万常住人口的健康谈何容易？北京市卫生局基层卫生处处长许峻峰表示，按照家庭医生式服务模式的最新服务比，每1800人需配备1个服务团队，本市仍有1万名医务人员的缺口。

In addition to the centers for disease control and prevention and control slow disease are understaffed outside,The number of community hospital medical staff also have big gap,More than 22000 community health technical personnel to manage 20 million permanent population health easier said than done?The municipal bureau of health grassroots health marshal XuJunFeng said,According to the family doctor type service mode of the latest service ratio,Every 1800 people need to have a service team,The city there are still 10000 medical personnel's gap.

□原因3 - reason 3

救治技术尚无规范 There is no standard treatment technology

　　我国不同医院以及各地区间冠状动脉搭桥手术存在明显差距：死亡率最低的医院仅0.7%，而某些医院死亡率高达5.8%。

In different hospitals and various interval coronary artery bypass graft surgery, there are some apparent differences:The lowest mortality rates hospital only 0.7%,And some hospital mortality rate as high as 5.8%.

　　慢性病呈逐年高发趋势，但我国的慢性病防控体系起步晚，且治疗技术也未完全规范化。

Chronic disease is more high trend,But China's chronic disease prevention and control system starting late,And treatment technology is also not completely standardization.

　　同仁医院心血管中心主任马长生介绍，房颤是心脏病心律失常的一种，成人发病率接近1%，随着年龄增长，患病率急剧升高，75岁以上老人发病率增至10%。目前，我国房颤人群有800万人，但整体防治水平不容乐观，大众对房颤的知识知之甚少，甚至专业的心血管医师对房颤的诊疗也存在误区，这使得大部分房颤病人没有得到有效救治。

Tongren hospital cardiovascular MaChangSheng, director of the center is introduced,Atrial fibrillation is a kind of heart arrhythmia,The adult incidence close to 1%,With the age growth and,Prevalence increased sharply,More than 75 - year - old old man incidence increased to 10%.At present,Af in our country people have 8 million people,But the overall control level is not optimistic,The public knew very little knowledge of atrial fibrillation,Even professional cardiovascular physician to diagnosis and treatment of atrial fibrillation also exist misunderstandings,This makes the most of patients with af did not get effective treatment.

　　房颤治疗现状并非孤例。今年8月，国家心血管病中心阜外医院院长胡盛寿在一次会议上公布了一项他领衔的研究结果，该研究覆盖全国17省市的8700余患者，结果显示，我国不同医院手术的效果不同，死亡率也不同。

Atrial fibrillation treatment status is not isolated cases.August,National cardiovascular disease center director HuChengShou fortune recourse international hospital in a meeting announced a he led the results of the study,The study covered the whole country and the provinces and cities more than 8700 patients,Results show that,The effect of hospital operation in various different,Mortality is also different.

北京市卫生局疾控处 The municipal bureau of health disease control place

　　相关负责人坦言，目前本市只有心血管的治疗技术较为成熟，包括心脏搭桥等手术的治疗都已经很规范，但其他高发的慢性病，如脑血管和癌症等尚无标准统一的规范，二、三级医院的医生经验不同，在面对患者时使用的治疗方法和技术也不同，这将直接影响治疗或手术效果。

The relevant person in charge said,At present this city only cardiovascular treatment technology is relatively mature,Including such as heart bypass surgery treatment is standard,But other higher risk of chronic disease,Such as cerebrovascular and cancer and there is no standard unified standard,two/Tertiary hospital doctor experience different,In the face of patients use treatment method and technology is also different,This will directly influence the therapy or surgery effect.

□原因4 - reason 4

多部门配合不顺畅 Many departments cooperate to be not smooth

　　本市的控烟情况仍“不容乐观”，全人群吸烟率和被动吸烟率未降反升。

This municipality's smoke control situation still"Not optimistic",All the smoking rate and passive smoking not drop back up.

　　今年5月8日，卫生部联合发改委、体育、教育、科技、环保、农业等15个部门联合印发《中国慢性病防治工作规划(2012-2015)》，提出“十二五”时期是加强慢性病防治的关键时期，并对15部门承担的相关职责进行分工。

On May 8, this year,The ministry of health joint development and reform commission/sports/education/Science and technology/Environmental protection/Agriculture and so on 15 departments jointly issued by[China's chronic disease prevention and control planning(2012-2015)],Put forward"1025"Period is to strengthen the prevention and control of chronic diseases of the critical period,And the 15 department to assume the responsibilities related to carry on the division of labor.

　　但因尚无具体的执行方案出台，且多部门的配合并不顺畅。

But because there is no specific executive to come,And many department cooperation is not smooth.

　　记者获悉，在本市打造低油低盐的健康餐厅工作中，因无市级层面烹饪协会等部门的介入，各区县疾控中心的工作人员走访了多家餐厅都吃了“闭门羹”，担心已经适应了目前高油高盐高热量菜品的消费者，一旦发现菜的味道

The reporter learns,In the city makes low oil low salt health restaurant work,Because does not have the municipal level cooking association and other departments intervention,Each area county CDC staff visited many restaurants ate"Given a cold shoulder",Worry have had to adapt to the current high oil high salt high heat food consumers,Once found the taste of food

　　清淡了，会影响其经营。“在公众还没意识到慢性病的危害时，多部门联手创造一个健康的环境就尤为重要，但无奈没有牵头单位，餐饮机构大都不愿配合”。截至目前，全市仅22家示范餐厅记录每周油、盐、酱油等调味品的用量，逐步减少总用量。“我们的目标是大面积推广，但目前的速度太慢了”。

Light the,Will affect their business."In the public is not aware of the dangers of chronic disease when,Many department to create a healthy environment becomes more and more important,But but didn't lead unit,Most of the food service institutions to cooperate".So far,The only 22 home demonstration restaurant record oil every week/salt/Such as the dosage of soy sauce seasoning,Gradually to reduce the total amount."Our goal is to promote large area,But the current rate is too slow".

　　同时，相关负责人坦言，尽管国家去年已经出台了禁止在室内公共场所吸烟的要求，但本市的控烟情况仍“不容乐观”，全人群吸烟率和被动吸烟率却未降反升，分别由2008年的29%和42.8%涨到2011年的29.4%和50.7%。这位负责人称，全民健康生活方式的打造将惠及每一个人，但目前因各职能部门并未重视起来，因此在具体的执行和配合过程中，经常出现“磨合不当”、“各管一段”，甚至“爱答不理”做表面文章的现象。

At the same time,The relevant person in charge said,Although the national last year has issued a ban on indoor smoking requirements,But this municipality's smoke control situation still"Not optimistic",All the smoking rate and passive smoking did not drop back up,Respectively by 29% in 2008 and 42.8% up to 29.4% in 2011 and 50.7%.The officials say,The national health way of life build will benefit everyone,But at present because of the functional departments did not attach importance to it,So in specific implementation and cooperate in the process,Often appear"Running in improper"/"Each tube a",even"AiDaBuLi"Do superficial phenomenon.

□原因5 - reason 5

全科医学教育起步晚 General medical education starting late

　　与抢手的热门专业相比，选择全科医学的学生并不多。

Compared with popular professional,Choose general medical students is not much.

　　在基层医院工作的全科医生在慢性病的防控中起着至关重要的作用。

At the basic level hospital general practitioners in the prevention and control of chronic diseases plays an important role in the.

　　“全科医学以前是被忽略的。”北大医学部教育处副处长续岩介绍，我国的全科医学教育起步较晚，1999年，教育部才将全科医学作为第14个临床二级学科列入医学院校的教学体系之中。自那时起，我国才真正把全科医学作为一个学科来重视。

"General medical used to be ignored."Peking University, deputy director of the department of medicine and education section for rock is introduced,China's general medical education started late,In 1999,,The ministry of education will general medical as the secondary discipline on 14th clinical medical college of the teaching system.Since then,Our country really put the general medical as a subject to pay attention to.

　　续岩介绍，一级学科包括临床医学、基础医学、口腔医学、预防医学、护理学等，临床医学下有相应的二级学科，包括内外妇儿耳鼻喉等，医学院校的学生多为“5+3”制，即5年的一级学科后，选择一个二级学科进行3年的分科培训。自1999年后，5年临床专业毕业的本科生可以在内外妇儿及全科医学等二级学科中选择自己的专业方向。但与抢手的热门专业相比，选择全科医学的学生并不多。

Renewal rock is introduced,Level 1 subject including clinical medicine/Basic medicine/Oral medicine/Preventive medicine/Nursing, etc,Clinical medicine under the corresponding secondary discipline,Including internal and external fu ent, etc,Medical colleges and universities students for more"5 + 3"system,That is five years after the first level subject,Choose a secondary subject 3 years of branch training.Since 1999,5 years of clinical professional graduate students can be in internal and external fu and general medicine in the secondary discipline choose their own professional direction.But compared with popular professional,Choose general medical students is not much.

　　经过3年二级学科的学习，真正进入社区医院的学生在上岗前，还必须前往三甲综合医院接受为期3年的住院医师规范化培训，这意味着，我国第一批高等院校毕业、经过8年制系统教育的全科医学毕业生真正进入到基层卫生服务机构，为居民问诊、开药方，至少要等到2015年。

After three years of secondary discipline study,Really into the community hospital students in front of Posting,Must also go to top comprehensive hospital three-year resident standardization training,This means that,Is China's first batch of colleges and universities graduation/After eight years education system of general medical graduates really into the basic health service agencies,For residents interrogation/prescribe,At least until 2015.

　　目前，国家已着手建立全科医学教育体系。自去年起，教育部批准了全科医学的硕士招生，北大医学部共招了10人。“但如何让他们真正走上基层教育的岗位，这就需要国家有大环境，去我们想让他们去的地方，留我们想让他们留的地方，服务好我们想让他们服务的人群。”续岩说。(记者王海欣)

At present,Countries have to establish general medical education system.Since last year,The ministry of education approved the general medical master recruit students,Peking University faculty of medicine for a total of 10 people."But how to make their real on basic education of post,This needs countries have environment,To we wanted them to go to place,Leave we want them to leave the place,Good service we want them to service the crowd."Renewal rock said.(Reporter WangHaiXin)