Open the bar
Public health is crucial to promoting public health, and under the new crown epidemic, how to build a strong public health system has become a topic of widespread concern in society.
Life Times and the School of Public Health of Shanghai Jiao Tong University jointly launched the "World Public Defender" column, inviting global experts to talk about the importance of public health to disease prevention and health promotion, and share insights on the development of public health in the mainland.
A new crown brought the public defenders to the front of the stage
Public health is related to the health of the people of a country or region, but in the past people did not pay much attention to it. The new crown epidemic is a major public health emergency with the fastest transmission speed, the widest scope of infection and the greatest difficulty in prevention and control since the founding of New China, which has made the public have a better understanding of public health and the importance of the public health system.
Life Times interviewed Professor Li Liming, the first director of the Chinese Center for Disease Control and Prevention and the first director of the Strategic Research Center for Public Health and Major Epidemic Prevention and Control of Peking University, to talk about how to optimize the public health system, strengthen service capabilities, and how to apply the excellent scientific research results of public health people to the lives of the people and improve public health awareness.
Li Liming, the first director of the Strategic Research Center for Public Health and Major Epidemic Prevention and Control at Peking University
The author of this article 丨 Life Times reporter Tian Yuting
This article was edited by 丨 Zhang Mian .hk
COVID-19 brings new understanding
What is the core of public health, what roles does it play, and what does it mean for people's health?
Li Liming: Public health is an organized social effort to prevent and control diseases, promote physical and mental health, improve the quality of life, and prolong healthy life. In the early 19th century, the Industrial Revolution led to a surge in the population of British cities, and residents discharged large amounts of sewage into the River Thames, causing serious pollution. There have been four major cholera outbreaks in London, with more than 10,000 deaths. The "miasma theory" at the time held that cholera was caused by "miasma," but clinician John Snow disagreed. He marked the addresses of the deceased on a map and found that all the cases had drunk water from the same well. He suggested sealing the well, and sure enough, cases dropped a week later, thus proving that cholera was transmitted by water, setting a precedent for epidemiological observational studies and cutting off transmission routes (interventions). The Spanish flu of 1918 killed tens of millions of people around the world and brought the First World War to an early end.
These examples show that public health has a huge impact on social stability, economic development and human progress. In mainland China, public health includes six disciplines: epidemiological and health statistics, environmental and occupational hygiene, nutrition and food hygiene, population health education and promotion, toxicology, social medicine and health management; its functions cover 9 aspects, including health monitoring and analysis, public health emergency response, disease prevention and health promotion.
What enlightenment has the epidemic brought to public health, and what changes have made the public's perception of public health?
Li Liming: This new crown "war epidemic" has brought a lot of new understanding to public health.
First, the epidemic has led to economic shutdowns in many countries, giving us a new understanding of the long-term, complex and arduous nature of the fight against diseases.
Second, how to live in harmony between man and nature is an eternal topic, and new pathogens from animals often lead to the world's infectious disease pandemic, which makes us have a new understanding of improving human bad behavior habits.
Third, based on the mainland's long-term experience in controlling infectious diseases, how to strengthen disease surveillance, medical prevention and integration, early identification of infectious sources, and prediction of infectious diseases has given us a new understanding of the health work policy of focusing on prevention and integrating health into all strategies.
The fourth is to persist in the mobilization of the whole society and create an environment for maintaining and promoting health, so that we have a new understanding of the nature of the patriotic health movement.
Fifth, the strong leadership of the Party Central Committee and the resolute implementation of policies have enabled us to achieve excellent results in epidemic prevention and control and have a new understanding of the superiority of the socialist system with Chinese characteristics.
Sixth, public health is an important guarantee for national security, social stability, economic development, and people's well-being, which has given us a new understanding of the party's purpose and concept of putting the people first and life first.
There are six directions for improving the public health system
What is the core of public health, what roles does it play, and what does it mean for people's health?
Li Liming: The epidemic is a major test and test, exposing some shortcomings in the mainland's public health and disease prevention and control, such as incomplete legislation, lax law enforcement, lack of discourse power in disease control, and lack of effective coordination mechanisms. The quality of disease control work depends on the ability and level of the talent team, at this stage we need to focus on cultivating a group of high-level public health talents who can "hammer and make a decision". Foreign public health colleges are independent of medical schools, and students also study management, humanities, law, etc., so the rich disciplinary settings of mainland comprehensive universities are very important for the cultivation of talents in the future.
In May last year, the National Bureau of Disease Control and Prevention was established, marking the official launch of the reform of the mainland's modern disease control system. General Secretary Xi Jinping pointed out that prevention is the most economical and effective health strategy; only by building a strong public health system, improving the early warning and response mechanism, comprehensively improving the prevention, control and treatment capabilities, weaving a dense protective network, and building a solid separation wall can we effectively provide a strong guarantee for safeguarding people's health. This passage fully embodies the concept of "great health, great health", and the construction and improvement of the mainland public health system must be based on this.
On January 23, 2002, the inaugural meeting of the Chinese Center for Disease Control and Prevention was held in the Great Hall of the People, with li Liming, the first director on the left, and Zhu Zhinan, the first party secretary, on the right
On May 13, 2021, the National Bureau of Disease Control and Prevention was officially listed
In my opinion, the key to the improvement of the public health system is to build a concept, and the reform should focus on the renewal of the public's and even social concepts and the improvement of cognition. Specifically, the following points should be done:
Clear positioning
Although the epidemic has greatly changed the public's perception of public health, the health education and popular science knowledge that everyone can usually contact are far from enough. The government and society should clearly understand that public health and disease prevention and control are not only the responsibilities of the National Health Commission or the Disease Control Bureau, but the responsibilities of the whole society.
Development policy
Policies to improve public health need to be integrated into all aspects of government work, such as health legislation, environmental protection, wildlife surveillance and management, and food safety.
Medical and preventive integration
The integration of medical care and prevention is a concrete embodiment of the transformation from "disease-centered" to "health-centered" and an inevitable requirement of the healthy China strategy. Provide residents with health services that "prevent diseases before they occur, prevent changes from existing diseases, and prevent recovery after healing", and closely integrate prevention and treatment in all links, so as to better meet the needs of the people for health services.
Talent development
China Medical University has surveyed the staff of the Liaoning Provincial Center for Disease Control and Prevention and found that their fatigue levels are generally high, and they need more methods to help them reduce occupational stress and improve their efficiency. The cultivation of public health personnel and the improvement of working conditions and treatment urgently need to be paid attention to.
Co-ordination
How to ensure the "trinity" of clinical-disease control-scientific research to carry out work, adhere to the "combination of peacetime and wartime" ("peacetime" to strengthen management, "wartime" do not over-defend, should be based on the situation to carry out accurate prevention and control) is the key to improving the ability of public health services.
Refined management
Public health and major epidemic prevention and control have tested government coordination and social fine management. Public health should be incorporated into the local governance system, and the allocation of medical and health resources should be integrated and optimized.
How long is it expected that the mainland's public health reform will produce good results, and what qualitative breakthroughs will it bring to the mainland's public health cause?
Li Liming: The reform of the mainland public health system is complex and arduous, the task is heavy and the road is long, and it cannot be measured in time, but we can look at changes, results, development, and trends. In general, although there will be many difficulties and obstacles, the overall process will be a spiraling process.
In the future, the development of public health in the mainland will have the following major characteristics.
1. Health care services throughout the life cycle. Public health services should vary from time to time and place to person, refuse to "one size fits all", and pay attention to health care services that are "from cradle to grave" throughout the whole process of life.
2. Support for environmental health. Smoke-free environment, road safety environment, human-animal-ecological environment harmony... Create an environment for the people to cultivate good health literacy and behavior habits.
3. The concept of global health. Governments and international organizations should strive to promote the fairness and justice of social health services and build a community with a shared future for human health.
Good research should play a greater role
You have been working in the field of public health for many years, what research have you mainly carried out, and what are your major achievements?
Li Liming: In the mainland, millions of people die every year due to chronic diseases, accounting for more than 80% of the deaths. Cardiovascular and cerebrovascular diseases, cancer, and chronic respiratory diseases are the main lethal chronic diseases. In the past, the etiological evidence of chronic diseases in mainland China mostly came from Western countries, and the racial race, living environment, and behavior habits were different, and the applicability of etiological evidence was debatable, which affected the prevention and treatment of chronic diseases on the mainland to a certain extent.
In 2004, just after the END OF THE SARS epidemic, I accompanied gao Qiang, then Minister of Health, to the United Kingdom to sign the China-UK Cooperation On-the-Spot Study of Chronic Diseases (CKB) project, which included the Chinese Center for Disease Control and Prevention, the Chinese Academy of Medical Sciences, Peking University and the University of Oxford in the United Kingdom. The project has completed the physical, psychological and social behavior survey of more than 500,000 people in 5 urban areas and 5 rural areas in China, and all their blood samples have been preserved for long-term research. This is unprecedented in the history of public health in the mainland, and since then the mainland has finally had a research cohort of adult populations with advanced research design, leading sample size, high-quality project implementation, as well as a basic database and biological sample bank for population health.
For more than a decade, the CKB project was one of my priorities. Twin cohort study, Fujian Tulou genealogy cohort study... We have successively established a special population cohort with continental diversity, living in the same natural social environment, and even sharing a set of genetic genes, with natural control advantages and a large base, which is a treasure trove for research on the causes of chronic diseases. The CKB program had barely published academic articles in the first 10 years of its work, in order to nurture, accumulate and ensure quality control of large-scale research. After 2014, the project entered the harvest period and published hundreds of papers in top medical journals at home and abroad. The project has also promoted the prevention and treatment of chronic diseases in the project provinces and project areas, and to a certain extent improved the overall level of chronic disease prevention and control in the mainland. In recent years, with the aging of the population, the acceleration of industrialization and urbanization, the number of chronic diseases and deaths has continued to grow, and the CKB project has also entered a new stage of development.
On December 12, 2020, the Strategic Research Center for Public Health and Major Epidemic Prevention and Control of Peking University was established, which is a milestone work of Peking University's family and country sentiment in the new situation, and will focus on evidence-based health decision-making research, scientific research on the prevention and control of infectious diseases and chronic disease prevention and control, public opinion research, education and training and public science popularization, and the CKB project was included in it. We have set up a scientific advisory committee, an academic committee and a management committee, as a national think tank, which can provide scientific basis for the government's evidence-based health decision-making and provide technical support for accurate prevention and control.
The inaugural meeting of the Strategic Research Center for Public Health and Major Epidemic Prevention and Control of Peking University, from left to right: Li Liming, director of the Center, Ma Xiaowei, director of the National Health Commission, and Yan Jiangying, deputy director of the State Food and Drug Administration
On January 26, 2020, Li Liming (front row, third from left) and others trained epidemic prevention volunteers
What is the practical significance of these research results for ordinary people, and what benefits can be derived from them?
Li Liming: In recent years, we have published a lot of research, such as the daily intake of 100 grams of fresh fruit, the risk of cardiovascular disease death is reduced by about 1/3; diabetes significantly increases the risk of death from cardiovascular diseases, tumors, chronic kidney diseases and other diseases; the impact of eating fruits, eggs, spicy food and tea drinking on chronic diseases... The research results of the CKB project provide many prevention and control measures and means to reduce the risk of chronic diseases, have public health and health economics significance, and are accepted by the people.
In order to make these achievements better serve the public and improve the health literacy of the whole people, it is inseparable from the support of health media, and it is necessary to spread health knowledge to more people and develop a healthy lifestyle through scientific and rigorous science popularization. ▲
Editor: Wang Xiaoqing