近百年中国传染病流行的主要社会因素研究
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摘要
研究目的：传染病能够对人类社会造成严重伤害,同时又受到国家政治体制、经济状况、文化习俗、人口密度、自然环境等一系列社会因素的影响,社会因素决定了传染病的流行程度。本研究拟通过回顾近百年中国传染病流行的社会因素情况,深入分析社会因素在传染病流行中的影响途径和影响力度,为未来传染病防控工作提供借鉴。
研究方法：本研究将运用文献研究法汇集近百年中国传染病流行基本资料,运用实证研究法、理论研究法等,分析社会因素对中国近百年传染病流行的决定性作用。
研究结果：本课题研究结果主要包括：
1.传染病的流行程度与流行趋势,是诸多社会因素共同作用的结果。民国时期,传染病是人类死亡原因的第一杀手,当时全国总人口以4.5亿计,城镇人口约占20%,为0.9亿；农村人口约占80%,为3.6亿,乡村死于法定疫病者,每年就高达197.64万,城市19.251万。我国当时全国总死亡率为30%。左右,其中15%是因传染病而致死的,疫死人数每年达到600万之多。新中国成立以后,确立以“预防为主”的卫生方针,基本消灭了鼠疫、霍乱、天花等烈性传染病,传染病的发病率由建国前十年的平均值4034.26(1/10万),到八十年代降低为平均245.4(1/10万),传染病在居民死亡原因的排名中也下降到第13位。社会因素影响、制约,甚至决定着传染病的发生与流行。
2.传染病严重破坏人类的正常社会生活秩序,导致一系列社会问题产生。据民国学者推算,民国时期,每因传染病死亡1人,即有22人感染,按照当时30%。的死亡率推算,全国4亿人口中患病者达到2640万人,患者医药费每日以最低数目1角计算,共计花费医药费为5280万元。相对比,以2003年防治SARS的相关资料为例,据资料显示,平均每个病人的治疗费用大概是10万元,按此计算,我国5000多个确诊病例就需要5个亿以上。根据有关部门统计,各级地方政府用于防治SARS的总费用数已超100亿元。从根本上说,传染病流行对社会造成的冲击甚至超过了局部战争带来的损失。
研究结论：
近代以来,中国逐步建立并完善公共卫生防疫体系建设,卫生防疫工作已经取得革命性胜利,包括：1.基本消灭烈性传染病；2.各种法定传染病得到较为稳定的控制；3.传染病死亡率大幅度下降；4.传染病防控体系逐步建立并完善；5.传染病在居民死亡原因排名中由第1位下降到目前的第13位。
但是,由于经济全球化发展、人口流动加剧、病毒出现抗药性、生态环境遭到破坏等社会因素,促使传染病正以更新、更强的态势对人类发起进攻,传染病防控出现新问题：1.传染病能够影响全球经济稳定与增长：2.传染病能够引起国家安全与稳定；3.传染病会影响一个国家在国际上的整体形象；4.传染病流行能够影响国际人口的流动。
政策建议：
政府对传染病的管理将成为传染病防控的关键。政府应始终将传染病防控问题置于当代国际政治、经济、文化与法律的大背景下,重视社会因素对传染病流行的决定性作用,明确政府在传染病防控体系中的主导作用,逐步建立与我国经济发展水平相适应的、公平有效的医疗卫生服务体系,特别是卫生防疫服务体系。
Objective:
Since the start of human being, infectious diseases have been coexisting with the development of human society all the time. The infectious diseases are just like a double-edged sword to the whole society. For one thing, they cause serious damages to the human society; for another, the prevalence of the infectious diseases usually results from a series of social factors, such as the political system, cultures and customs, population density, geographic environment, medical conditions and even religions in a country. This study aims to review the extents of the inluence the social factors have imposed on the prevalence of infectious diseases in the past one hundred years, undertake in-depth analysis in terms of the impacts that social factors have on the prevalence of infectious diseases and acquire historically precious experiences and lessons, and to provide guidance for preventing and controlling infectious diseases in the future.
Methods:
Literature review of the development of infectious disease during the past 100 years in China, empirical research and theoretical research methods were applied to recognize and reveal the trend on the prevalence of infectious diseases, and analyze how social factors affect the prevalence of infectious diseases.
Results:
1 The prevalence of infectious disease and its scale size are affected by many social factors. During the period of the Republic of China, infectious diseases are the first cause of death. The national mortality at that period was 30%o, among which 15%deaths were resulted from infectious disease. Considering the total population of 0.45 billion, more than 2,025,000 people died from the epidemic disease annually. Since the establishment of the People's Republic of China, the "prevention first" health policy was adopted, the highly infectious disease, such as the plague, cholera and smallpox had been eradicated. The prevalence of the infectious diseases had decreased from 4034.26 per 100,000 before the establishment of the Pepole's Republic of China to 245.4 per 100,000 in 1980s, along with that the rank of infectious disease in the cause of death dropped into 13th. The study showed that the social factors had influenced, regulated, and even determined the prevalence of infectious disease in the past 100 years in China.
2.The Infectious diseases could severely damage the normal social life and cause a series of social problems. It was reported that in the period of the Republic of China, there would be 22 people infected per one death from the infectious disease. Considering the mortality rate of 30%o and the total population of 0.4 billion, the patients with infectious disease would be estimated by 26,400,000 every year. If the daily cost was 0.1 RMB Yuan per patient, the total cost would be 52,800,000RMB Yuan. Compared with the burden of infectious disease before the establishment of the People's Republic of China, the recent example of SARS in 2003 continued to show the impact of infectious disease on the current social development. The average costs per SAS patient was nearly 100,000RMB Yuan. Considering more than 5,000 cases were confirmed, the total cost was nearly 0.5 billion RMB Yuan. Moreover, the total budget related with the prevention and treatment of SAS in the different level of Chinese government was nearly 10 billion RMB Yuan. Overall, the impact of the infectious diseases on social development was even more than the loss that the local war brought.
Conclusions:
Since after the establishment of the People's Republic of China, anti-epidemic work already make a revolutionary success through establishing and improving gradually the prevention system in the public health.1. The highly infectious diseases were primarily eradicated; 2. Various notified infectious disease were controlled, and at a relatively stable stage; 3. The mortality rate of the Infectious disease dropped substantially; 4. The system of the prevention and control for the Infectious disease was gradually established and improved; 5. The rank of infectious disease in the cause of deaths dropped from the first to the current 13th.
But, with the economic globalization, the increasing of migrant population, and destroyed ecological environment, the infectious diseases are prompting to an update, stronger attack to the human being. The prevention and control of infectious disease is facing several new problems:1. Infectious disease can affect the stability and growth of global economy.; 2. Infectious diseases can affect the security and stability in a country; 3. Infection can influence the nation's overall image; 4. Communicable diseases can affect the flow of international population.
Policy Suggestions:
The management of infectious disease by the government should be the key on the prevention and control of infectious disease. The government should always emphasize the determined role of social factors on the infectious diseases, and clarify the leadership of government in the prevention and control of infectious disease prevention, and gradually establish an fair, effective health service system, especially in the field if anti-epidemic service system.
Innovation:
This is the first comprehensive review of the trend and influence factors of the infectious disease in the past 100 years in China. The determinant role of social factors on the prevalence of infectious disease was analyzed by using the social medical theory and methodology.
研究方法：本研究将运用文献研究法汇集近百年中国传染病流行基本资料,运用实证研究法、理论研究法等,分析社会因素对中国近百年传染病流行的决定性作用。
研究结果：本课题研究结果主要包括：
1.传染病的流行程度与流行趋势,是诸多社会因素共同作用的结果。民国时期,传染病是人类死亡原因的第一杀手,当时全国总人口以4.5亿计,城镇人口约占20%,为0.9亿；农村人口约占80%,为3.6亿,乡村死于法定疫病者,每年就高达197.64万,城市19.251万。我国当时全国总死亡率为30%。左右,其中15%是因传染病而致死的,疫死人数每年达到600万之多。新中国成立以后,确立以“预防为主”的卫生方针,基本消灭了鼠疫、霍乱、天花等烈性传染病,传染病的发病率由建国前十年的平均值4034.26(1/10万),到八十年代降低为平均245.4(1/10万),传染病在居民死亡原因的排名中也下降到第13位。社会因素影响、制约,甚至决定着传染病的发生与流行。
2.传染病严重破坏人类的正常社会生活秩序,导致一系列社会问题产生。据民国学者推算,民国时期,每因传染病死亡1人,即有22人感染,按照当时30%。的死亡率推算,全国4亿人口中患病者达到2640万人,患者医药费每日以最低数目1角计算,共计花费医药费为5280万元。相对比,以2003年防治SARS的相关资料为例,据资料显示,平均每个病人的治疗费用大概是10万元,按此计算,我国5000多个确诊病例就需要5个亿以上。根据有关部门统计,各级地方政府用于防治SARS的总费用数已超100亿元。从根本上说,传染病流行对社会造成的冲击甚至超过了局部战争带来的损失。
研究结论：
近代以来,中国逐步建立并完善公共卫生防疫体系建设,卫生防疫工作已经取得革命性胜利,包括：1.基本消灭烈性传染病；2.各种法定传染病得到较为稳定的控制；3.传染病死亡率大幅度下降；4.传染病防控体系逐步建立并完善；5.传染病在居民死亡原因排名中由第1位下降到目前的第13位。
但是,由于经济全球化发展、人口流动加剧、病毒出现抗药性、生态环境遭到破坏等社会因素,促使传染病正以更新、更强的态势对人类发起进攻,传染病防控出现新问题：1.传染病能够影响全球经济稳定与增长：2.传染病能够引起国家安全与稳定；3.传染病会影响一个国家在国际上的整体形象；4.传染病流行能够影响国际人口的流动。
政策建议：
政府对传染病的管理将成为传染病防控的关键。政府应始终将传染病防控问题置于当代国际政治、经济、文化与法律的大背景下,重视社会因素对传染病流行的决定性作用,明确政府在传染病防控体系中的主导作用,逐步建立与我国经济发展水平相适应的、公平有效的医疗卫生服务体系,特别是卫生防疫服务体系。
Objective:
Since the start of human being, infectious diseases have been coexisting with the development of human society all the time. The infectious diseases are just like a double-edged sword to the whole society. For one thing, they cause serious damages to the human society; for another, the prevalence of the infectious diseases usually results from a series of social factors, such as the political system, cultures and customs, population density, geographic environment, medical conditions and even religions in a country. This study aims to review the extents of the inluence the social factors have imposed on the prevalence of infectious diseases in the past one hundred years, undertake in-depth analysis in terms of the impacts that social factors have on the prevalence of infectious diseases and acquire historically precious experiences and lessons, and to provide guidance for preventing and controlling infectious diseases in the future.
Methods:
Literature review of the development of infectious disease during the past 100 years in China, empirical research and theoretical research methods were applied to recognize and reveal the trend on the prevalence of infectious diseases, and analyze how social factors affect the prevalence of infectious diseases.
Results:
1 The prevalence of infectious disease and its scale size are affected by many social factors. During the period of the Republic of China, infectious diseases are the first cause of death. The national mortality at that period was 30%o, among which 15%deaths were resulted from infectious disease. Considering the total population of 0.45 billion, more than 2,025,000 people died from the epidemic disease annually. Since the establishment of the People's Republic of China, the "prevention first" health policy was adopted, the highly infectious disease, such as the plague, cholera and smallpox had been eradicated. The prevalence of the infectious diseases had decreased from 4034.26 per 100,000 before the establishment of the Pepole's Republic of China to 245.4 per 100,000 in 1980s, along with that the rank of infectious disease in the cause of death dropped into 13th. The study showed that the social factors had influenced, regulated, and even determined the prevalence of infectious disease in the past 100 years in China.
2.The Infectious diseases could severely damage the normal social life and cause a series of social problems. It was reported that in the period of the Republic of China, there would be 22 people infected per one death from the infectious disease. Considering the mortality rate of 30%o and the total population of 0.4 billion, the patients with infectious disease would be estimated by 26,400,000 every year. If the daily cost was 0.1 RMB Yuan per patient, the total cost would be 52,800,000RMB Yuan. Compared with the burden of infectious disease before the establishment of the People's Republic of China, the recent example of SARS in 2003 continued to show the impact of infectious disease on the current social development. The average costs per SAS patient was nearly 100,000RMB Yuan. Considering more than 5,000 cases were confirmed, the total cost was nearly 0.5 billion RMB Yuan. Moreover, the total budget related with the prevention and treatment of SAS in the different level of Chinese government was nearly 10 billion RMB Yuan. Overall, the impact of the infectious diseases on social development was even more than the loss that the local war brought.
Conclusions:
Since after the establishment of the People's Republic of China, anti-epidemic work already make a revolutionary success through establishing and improving gradually the prevention system in the public health.1. The highly infectious diseases were primarily eradicated; 2. Various notified infectious disease were controlled, and at a relatively stable stage; 3. The mortality rate of the Infectious disease dropped substantially; 4. The system of the prevention and control for the Infectious disease was gradually established and improved; 5. The rank of infectious disease in the cause of deaths dropped from the first to the current 13th.
But, with the economic globalization, the increasing of migrant population, and destroyed ecological environment, the infectious diseases are prompting to an update, stronger attack to the human being. The prevention and control of infectious disease is facing several new problems:1. Infectious disease can affect the stability and growth of global economy.; 2. Infectious diseases can affect the security and stability in a country; 3. Infection can influence the nation's overall image; 4. Communicable diseases can affect the flow of international population.
Policy Suggestions:
The management of infectious disease by the government should be the key on the prevention and control of infectious disease. The government should always emphasize the determined role of social factors on the infectious diseases, and clarify the leadership of government in the prevention and control of infectious disease prevention, and gradually establish an fair, effective health service system, especially in the field if anti-epidemic service system.
Innovation:
This is the first comprehensive review of the trend and influence factors of the infectious disease in the past 100 years in China. The determinant role of social factors on the prevalence of infectious disease was analyzed by using the social medical theory and methodology.
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