中国公共卫生安全规制改革研究
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摘要
随着现代社会工业化进程的推进,公共卫生安全已成为全球性的问题,不仅关系到一国国民的生命健康和安全保障,对国家的经济发展和政治稳定也有着至关重要的意义。世界卫生组织(WHO)自1948年成立以来就一直致力于全球公共卫生安全的维护,然而21世纪的公共卫生安全已远超出妇幼保健及传染性疾病控制等传统樊篱,环境卫生、食品安全、健康教育与促进、精神及心理健康等内容在广义的层面丰富了其内涵。公共卫生内容的拓展使政府公共卫生安全规制的改革面临着更大的挑战。面临各类自然灾害、生态环境的破坏、频繁暴露的食品药品问题等多样化的成因,以及随着社会的发展与变革导致人类行为、生产方式以及疾病谱的改变,政府除了必须改变传统的公共卫生观念,对于公共卫生财政投入失衡以及安全规制质量低下和协作体制不顺等问题也必须进行重新审视及对策研究。
文章从公共卫生安全的内涵和定位出发,在对国内外相关文献梳理的基础之上,根据外部性及伦理性等相关理论构建了公共卫生安全规制的博弈模型,并经过对中国公共卫生安全规制改革的历程和现状进行分析后,分别指出当前公共卫生安全规制体制和体系中存在的问题。此外,文章也对英国、美国、德国和日本在公共卫生安全保障方面获得的规制改革经验加以剖析和比较,结合中国的规制改革现状和以上各国的经验借鉴,提出提高中国公共卫生安全规制改革绩效的建议：应拓宽规制的观念和范畴,健全规制机构并明确其职能,完善法律法制体系,加强常规与应急公共卫生体系建设的双重规制,在增强公共卫生安全筹资及投入科学性与合理性的同时,亦应协调公共卫生体系内以及与非政府组织间的发展,加快我国公共卫生安全规制改革的步伐以确保人民健康和国家公共卫生安全。
With the promotion of modern social industrialization, public health safety has developed into a global but not only a domestic problem. It concerns individual health and safety guard within a country as well as the economic development and politics stabilization of a country. WHO has been devoting itself to defending global public health safety since its establishment in 1948, however, the public health safety in 21st century has already gone far beyond it traditional limits of maternity and child care and communicable disease, lots of other elements including environmental sanitation, food safety, health education and promotion, and emotional and psychological health have enriched its intension in a broad sense. The extension of its content brings more and bigger challenges to the government of its reform in public health safety regulation. Facing various natural disasters, ruins of ecological condition, frequent food and drugs problems, and human living and productive behaviors changes and spectrum of disease transform resulted by the social evolution and revolution, the government must reexamine and restudy the problem of unbalanced public financial input, low quality of safety regulation besides changing its traditional concept about public health.
The dissertation sets out from the connotation and orientation of public health and its safety, constructs a model of public health safety regulation on the basis of related domestic and international literature, confirms the necessity of regulation from various angles as features of public health safety, evidence-based public health theory and public product theory, etc. The dissertation points out problems existing in the present Chinese public heath regulation system and structure after analysis of the progress and current situation of this regulation reform. Besides, the dissertation analyzes and compares experiences acquired in safeguarding public health from foreign countries as Britain, the United States of America, German and Japan, puts forward suggestions, combining the current regulation reform of China, on improving the reform effects of Chinese public health safety regulation:the government should expand its cognition and domain on public health regulation, perfect the related law system and dual regulation on both regular and urgent public health system construction, strengthen the scientific and reasonable financial input, coordinate the simultaneous development of public health system and non-governmental organization, so to guarantee people's health and national public health safety with faster steps of public health safety reform.
文章从公共卫生安全的内涵和定位出发,在对国内外相关文献梳理的基础之上,根据外部性及伦理性等相关理论构建了公共卫生安全规制的博弈模型,并经过对中国公共卫生安全规制改革的历程和现状进行分析后,分别指出当前公共卫生安全规制体制和体系中存在的问题。此外,文章也对英国、美国、德国和日本在公共卫生安全保障方面获得的规制改革经验加以剖析和比较,结合中国的规制改革现状和以上各国的经验借鉴,提出提高中国公共卫生安全规制改革绩效的建议：应拓宽规制的观念和范畴,健全规制机构并明确其职能,完善法律法制体系,加强常规与应急公共卫生体系建设的双重规制,在增强公共卫生安全筹资及投入科学性与合理性的同时,亦应协调公共卫生体系内以及与非政府组织间的发展,加快我国公共卫生安全规制改革的步伐以确保人民健康和国家公共卫生安全。
With the promotion of modern social industrialization, public health safety has developed into a global but not only a domestic problem. It concerns individual health and safety guard within a country as well as the economic development and politics stabilization of a country. WHO has been devoting itself to defending global public health safety since its establishment in 1948, however, the public health safety in 21st century has already gone far beyond it traditional limits of maternity and child care and communicable disease, lots of other elements including environmental sanitation, food safety, health education and promotion, and emotional and psychological health have enriched its intension in a broad sense. The extension of its content brings more and bigger challenges to the government of its reform in public health safety regulation. Facing various natural disasters, ruins of ecological condition, frequent food and drugs problems, and human living and productive behaviors changes and spectrum of disease transform resulted by the social evolution and revolution, the government must reexamine and restudy the problem of unbalanced public financial input, low quality of safety regulation besides changing its traditional concept about public health.
The dissertation sets out from the connotation and orientation of public health and its safety, constructs a model of public health safety regulation on the basis of related domestic and international literature, confirms the necessity of regulation from various angles as features of public health safety, evidence-based public health theory and public product theory, etc. The dissertation points out problems existing in the present Chinese public heath regulation system and structure after analysis of the progress and current situation of this regulation reform. Besides, the dissertation analyzes and compares experiences acquired in safeguarding public health from foreign countries as Britain, the United States of America, German and Japan, puts forward suggestions, combining the current regulation reform of China, on improving the reform effects of Chinese public health safety regulation:the government should expand its cognition and domain on public health regulation, perfect the related law system and dual regulation on both regular and urgent public health system construction, strengthen the scientific and reasonable financial input, coordinate the simultaneous development of public health system and non-governmental organization, so to guarantee people's health and national public health safety with faster steps of public health safety reform.
引文
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