1落后过时生物医学模式统治我国健康领域的现状不能在继续了上篇.doc

落后过时生物医学模式统治我国医疗卫生领域的现状不能再继续下去了 （上） 黄建始 摘要： 生物医学模式在上世纪曾对人类的健康做出了不可磨灭的伟大贡献。然而，当人类跨进21世纪后，全球化和城市化的趋势使疾病发生和流行的危险因素不断增加，对人类健康的最大挑战主要来自慢性非传染性疾病，用单因单病，病在细胞为特征的生物医学模式来指导慢病的预防和控制则显得力不从心，在新形势下应对传染病的威胁也显得单薄无力。正反两方面的实践都证明了以单因单病，病在细胞为特征的生物医学模式已经落后过时了。上世纪七十年代，健康领域的科学家根据数十年主要是公共卫生和预防医学科学研究的成果，提出了生物-心理-社会的新医学模式。35年前（1974年），加拿大政府发布了拉龙德（Lalonde）报告指出国民健康并不仅仅是由医疗服务单方面所决定的。决定健康的主要因素有四个方面：生物学的，环境的，生活方式和习惯的和医疗卫生系统的因素。19年前（1990），伊文斯和斯多达特（Evans Stoddart）提出决定健康的多因素模式。这是一个比生物医学模式更加系统完善地认识人类健康规律的新模式,即生物-心理-社会-环境医学模式，指出要健康，光预防和控制生物学因素是远远不够的，要同时改变环境和个人行为。 结合刚出台的我国医改实施方案，至少有个事关国民健康的关键性问题被忽略了，是通过保障和促进健康，还是通过只关注病有所医来提高全民健康水平侵害或牺牲部分人的利益这看似高尚的实际上极端错误的。中国最宝贵、最稀缺的医疗资源是维护和促进国人健康离不开的专业医护人员，不是进口药，不是手术室耗材，不是高级医疗设备，更不是实验室检查试剂。恶劣的从医环境表现以违背规律，不尊重医护人员的方式管理医疗市场。医疗资源浪费明确财政性卫生经费占国民生产总值比重Abstract The bio-medical Model has been contributed significantly to the improvement of the human’s health during the last century. However, the globalization and the urbanization lead to the increase of risk factors contributing to the occurrence and spreading of diseases in the 21st century. The greatest challenges to the human’s health are from chronic non-infectious diseases today. The prevention and control of chronic diseases under the bio-medical model (characterized by single etiology-single disease, pathology of diseases originated from the cell) seems to be powerless. Even the previously proved effective infectious disease control strategies under the bio-medical model now are not working well. Many evidences suggest that bio-medical model now is out of the date. A new bio-psycho-social-model has been proposed in the 1970s based on several decades’ research in public health and preventive medicine. The Lalonde report was released 35 years ago （1974）by the Canadian government, pointed out that the determinants of health include biological factors, environmental factors, behavioral and lifestyle factors，and health care system factors. In 1990，Evans and Stoddart proposed a multiple factors model determining health. This