Experience at home and abroad shows that chronic diseases can be effectively prevented and controlled. Over the past 30 years, China's rapid economic and social development, continuous improvement of people's lives, and improvement of people's health awareness have laid the foundation for the prevention and treatment of chronic diseases. Over the years, China has accumulated a lot of successful experience in the work carried out in local and demonstration areas, and initially formed a strategy and work network for the prevention and control of chronic diseases with China characteristics. However, the prevention and treatment of chronic diseases still faces severe challenges, the whole society generally lacks understanding of the serious harm of chronic diseases, the working mechanism of government-led, multi-sectoral cooperation and social participation has not yet been established, the prevention and treatment network of chronic diseases is not perfect, the allocation of health resources is unreasonable, and the construction of talent team needs to be strengthened urgently. The "Twelfth Five-Year Plan" period is a crucial period to strengthen the prevention and treatment of chronic diseases. It is necessary to strengthen the prevention and treatment of chronic diseases as an important part of improving people's livelihood and promoting medical reform, and take effective measures to curb the high incidence of chronic diseases as soon as possible. (1) Adhere to government leadership, departmental cooperation and social participation. Guided by the spirit of deepening the reform of the medical and health system, we will gradually establish an inter-departmental coordination mechanism for the prevention and treatment of chronic diseases led by governments at all levels and closely coordinated by relevant departments, improve the comprehensive prevention and treatment system for chronic diseases that the disease prevention and control institutions, grassroots medical and health institutions and hospitals work together to mobilize social forces and the masses to participate extensively, and create a social environment conducive to the prevention and treatment of chronic diseases.
(two) adhere to focus, classification guidance, pay attention to the effect. Fully consider the level of social and economic development, the prevalence rate of chronic diseases and their risk factors in different regions, formulate specific prevention and control objectives and control strategies suitable for different regions, pay attention to vulnerable groups and floating population, and improve the accessibility, fairness and prevention and control effect of chronic diseases.
(three) adhere to the prevention first, the combination of prevention and control, and the center of gravity sinks. Taking all urban and rural residents as the service object, focusing on controlling the risk factors of chronic diseases, and taking health education, health promotion and patient management as the main means, we will strengthen the prevention and treatment role of primary medical and health institutions and promote the organic combination of prevention, intervention and treatment. Further improve the national chronic disease prevention and control service network and comprehensive prevention and control mechanism, establish a chronic disease monitoring and information management system, improve the ability of chronic disease prevention and control, strive to build a social support environment, implement departmental responsibilities, reduce the risk factors of chronic diseases, reduce premature death and disability, and control the level of social and economic burden caused by chronic diseases. Achieve the following specific goals by 20 15:
-The awareness rate of the core information on the prevention and treatment of chronic diseases has reached more than 50%, and the awareness rate of blood pressure and blood sugar for adults over 35 years old has reached 70% and 50% respectively.
—— The national healthy lifestyle campaign covers 50% of counties (cities, districts) in China, and the national comprehensive prevention and control demonstration zone covers more than 0/0% of counties (cities, districts) in China.
—— The national average daily salt intake has dropped below 9 grams; The smoking rate of adults is reduced to below 25%; The proportion of people who regularly participate in physical exercise has reached more than 32%; The obesity rate of adults should be controlled within 65438 02%, and the obesity rate of children and adolescents should not exceed 8%.
-The standardized management rate of patients with hypertension and diabetes reached 40%, and the control rate of blood pressure and blood sugar in the management population reached 60%; The increase rate of stroke incidence is controlled within 5%, and the mortality rate is reduced by 5%;
-Early diagnosis and treatment of key cancers should be carried out in 30% cancer-prone areas.
-The prevalence of chronic obstructive pulmonary disease over 40 years old should be controlled within 8%.
-School-age children's pit and fissure sealing coverage rate reached more than 20%, and the caries rate of 12-year-old children was controlled within 25%.
-90% of counties (cities, districts) in China are monitored for the cause of death of the whole population, 50% of counties (cities, districts) are monitored for chronic diseases and risk factors, and 0/5% of counties (cities, districts) are monitored for nutritional status.
-Professionals in the prevention and treatment of chronic diseases account for more than 5% of professionals in disease control institutions at all levels. (1) Further promote the healthy lifestyle of the whole people. Make full use of mass media, widely publicize the knowledge of chronic disease prevention and treatment, integrate chronic disease prevention and treatment into daily life, and urge people to consciously develop good healthy behaviors and lifestyles. The health department should establish a national and provincial authoritative publishing platform for chronic disease information knowledge, regularly publish core health information, cooperate with radio, film and television, press and publication departments, organize major media to open health columns, and scientifically spread the knowledge of chronic disease prevention and treatment; Trade unions at all levels, Communist Youth League, Women's Federation, Association for Science and Technology, Federation of Industry and Commerce, Committee on Aging and various social academic organizations give full play to their respective advantages, and carry out public welfare publicity and social mobilization activities in accordance with standardized information organizations.
Scientifically guide a reasonable diet and actively develop and promote healthy foods with low salt, low fat, low sugar and low calorie. The agricultural sector should adjust and improve the grain production structure and guide the production of safe, nutritious, convenient and diverse agricultural products; The competent department of industry and information technology shall guide and support food processing enterprises to improve their production technology, promote the implementation of General Rules for Nutrition Labeling in prepackaged foods, and promote the development and production of healthy food; The commercial department advocates and encourages food sales enterprises to set up health food counters to guide consumers to choose health food; Food enterprises, collective catering and catering units organize business backbone personnel to learn and master the knowledge of reasonable nutritious meals, know the harm of unhealthy meals, gradually implement nutrition labels, and provide healthy food and catering.
Actively create a physical fitness environment. Sports departments should strengthen scientific guidance for mass sports activities and gradually improve the openness and utilization rate of various public sports facilities; The education department ensures that primary and secondary school students participate in at least 1 hour physical exercise every day during school; Environmental protection departments should strengthen environmental quality monitoring and evaluation, and strengthen comprehensive management of environmental pollution; Institutions, enterprises and institutions to establish an interval exercise system; The community actively promotes the working mode of healthy lifestyle instructors and social sports instructors.
Effectively strengthen tobacco control and implement the WHO Framework Convention on Tobacco Control. Promote local governments to speed up the legislative process of smoking ban in public places and the introduction of laws and regulations at the national level. Continue to increase publicity and education on tobacco control. Smoking is completely banned in public places, and party and government organs, medical and health institutions and educational institutions should take the lead in becoming smoke-free units. Encourage medical institutions to set up standardized smoking cessation clinics, provide clinical smoking cessation services, strengthen the training of medical personnel, and improve the ability and level of smoking cessation services. Publicize the harm of excessive drinking, carry out mental health education and popularize mental health knowledge.
(two) expand services, timely detection and management of high-risk groups. Expand the content and coverage of basic public health services, and strengthen the discovery and management of high-risk groups of chronic diseases (hypertension, blood sugar and blood lipid, smoking, alcoholism, obesity, overweight, etc.). Grassroots medical and health institutions should fully perform the comprehensive service functions of health education, prevention, health care, medical treatment and rehabilitation, establish standardized electronic health records for residents, timely grasp the epidemic situation and main problems of chronic diseases in the community, carry out health education in a targeted manner, and provide free health consultation and guidance for common chronic diseases. All kinds of medical institutions at all levels implement the system of first diagnosis and blood pressure measurement for people over 35 years old. More than 80% township hospitals carry out blood sugar measurement, more than 30% township hospitals carry out simple pulmonary function measurement, and 40% community health service centers and 20% township hospitals carry out oral preventive health care services. Government agencies, enterprises and institutions actively carry out the health examination system, take the core indicators of chronic diseases and oral examination as compulsory items, establish dynamic management files, and strengthen guidance and management. Conditional organs and units shall establish self-service detection points for health indicators and provide simple physical measurement equipment. Retail pharmacies should play an active role in the publicity and education of chronic disease prevention and treatment.
Grassroots medical and health institutions and unit clinics regularly monitor and follow up the high-risk groups found in health checkups and screening, and implement targeted intervention measures to effectively reduce the risk of illness. Disease prevention and control and health education institutions at all levels develop and popularize appropriate technologies for high-risk groups, discover and strengthen lifestyle interventions, and conduct supervision and evaluation.
In areas with high incidence of cancer, appropriate technologies for key cancer screening should be developed, early screening and early treatment should be carried out, and hepatitis B and human papillomavirus vaccination should be strengthened in combination with national immunization planning policies. Conditional areas to carry out detection and intervention of high-risk groups of chronic obstructive pulmonary disease and stroke.
(3) Standardize prevention and treatment to improve the diagnosis, treatment and rehabilitation of chronic diseases. Institutions for the prevention and treatment of cardiovascular and cerebrovascular diseases, tumors, diabetes and other special diseases should promote appropriate technologies for the prevention and treatment of chronic diseases, and timely carry out standardized training for the diagnosis and treatment of specialists at all levels in this institution, so as to gradually realize the standardized diagnosis and treatment and rehabilitation of chronic diseases. Hospitals at all levels should strictly follow the technical specifications and guidelines for diagnosis and treatment formulated by the health administrative department, improve the professional training system for specialists, and pay attention to early intervention in rehabilitation treatment. While providing standardized diagnosis, treatment and rehabilitation, it is necessary to strengthen consultation and guidance and popular science propaganda for patients and their families.
Grassroots medical and health institutions have strengthened management services and oral health care services for patients with chronic diseases such as hypertension, diabetes and chronic obstructive pulmonary disease, carried out follow-up and rehabilitation guidance for cancer patients, and actively promoted appropriate technologies for preventing oral diseases such as pit and fissure sealing in children. With the increase of equal investment in basic public health services, the scope of services is constantly expanded, the connotation of services is deepened, the self-management model of patients with chronic diseases is actively promoted, and efforts are made to improve the standardized management rate and control rate of patients. Actively explore the family service mode of general practitioners.
In the prevention and treatment of chronic diseases, we should pay equal attention to both traditional Chinese and western medicine, and give full play to the characteristics of traditional Chinese medicine, which is "simple, experienced and cheap" and "preventing diseases". The health department should further consolidate and improve the system of essential drugs, appropriately increase the varieties of drugs used for chronic diseases in the list of essential drugs, establish a cooperative mechanism for monitoring and processing information on the shortage of essential drugs, and improve the national reserve system of essential drugs to ensure the provision of suitable therapeutic drugs for patients with chronic diseases. Food and drug supervision and management departments should strictly examine and approve drugs for the prevention and treatment of chronic diseases, strengthen supervision and inspection, and ensure drug safety.
(four) clear responsibilities, strengthen the effective coordination of the prevention and treatment of chronic diseases. Improve the chronic disease prevention and control network, optimize the work pattern, integrate the functions of professional public health institutions, hospitals and primary medical and health institutions, create complementary responsibilities, and promote the combination of chronic disease prevention and control. Health administrative departments should innovate working methods and improve management level; Provincial, city and county disease prevention and control institutions and public hospitals set up special departments and personnel to perform the duties of chronic disease prevention and control; Grass-roots medical and health institutions strengthen the prevention and control functions of chronic diseases and improve their service capabilities.
The establishment of disease prevention and control institutions, hospitals, specialized disease prevention and control institutions, grassroots medical and health institutions in the prevention and treatment of chronic diseases division of responsibilities and hierarchical management mechanism, clear responsibilities and tasks. Disease prevention and control institutions and professional disease prevention and control institutions shall assist the administrative department of health in formulating and implementing prevention and control plans and programs for chronic diseases and related diseases, and provide operational guidance and technical management; Hospitals carry out chronic disease information registration reports, provide diagnosis, treatment and rehabilitation services for critically ill patients with chronic diseases, and provide technical guidance for primary medical and health institutions to carry out diagnosis, treatment and rehabilitation services for chronic diseases; Establish a two-way referral mechanism with grassroots medical and health institutions; Grassroots medical and health institutions are responsible for the implementation and implementation of prevention and control measures related to chronic diseases.
Health education institutions are responsible for studying the strategies and methods of chronic disease health education, disseminating the core information of chronic disease prevention and control, and guiding other institutions to carry out chronic disease health education activities. Maternal and child health care institutions are responsible for providing advice and guidance on the prevention of chronic diseases in women and children.
(5) Do a good demonstration to improve the comprehensive prevention and control ability of chronic diseases. Actively create a demonstration area for comprehensive prevention and control of chronic diseases, attach importance to community investigation and diagnosis, clarify the main health problems and risk factors in this area, apply appropriate technologies, and formulate strategies, measures and long-term management models suitable for local prevention and control of chronic diseases. All localities should regularly summarize and promote the experience in the construction of demonstration areas and promote the comprehensive prevention and treatment of chronic diseases. By 20 15, all provinces (autonomous regions and municipalities) and more than 50% prefecture-level cities in eastern provinces will establish national-level demonstration zones for comprehensive prevention and control of chronic diseases.
Give full play to the role of existing health promotion committees at all levels in patriotic health campaign committee and other places, and enrich and deepen the health connotation of health creation activities. Take health creation and health creation as the platform, strengthen the organization and coordination of comprehensive prevention and control of chronic diseases, take the prevention and control of chronic diseases as an important part of the assessment criteria of health towns and the health promotion actions of health cities and regions, and build 1 or more national-level demonstration zones for comprehensive prevention and control of chronic diseases in areas where national health cities are created. Through policy guidance, improve environmental quality, increase green space and fitness places, and build a healthy environment; Advocate reasonable diet, moderate exercise, control alcohol and tobacco, and cultivate healthy people.
We will continue to promote the cooperative project of comprehensive prevention and control of chronic diseases between provincial local governments and the Ministry of Health, and carry out in-depth cooperation in policy research, publicity and education, intervention and control, monitoring and evaluation, capacity building, scientific research and international exchanges of comprehensive prevention and control of chronic diseases through the construction of provincial departments, so as to improve the comprehensive prevention and control level of chronic diseases in the provinces where the project cooperates.
(six) * * * enjoy resources, improve the management of chronic disease monitoring information. Make overall use of existing resources, improve the level of chronic disease monitoring and information management, establish a database for monitoring the incidence, illness, death and risk factors of chronic diseases, and improve the management system of information management, resource sharing and information release. Gradually build a comprehensive monitoring point for chronic diseases, standardize the information management of birth and death of the population, and organize the registration report of stroke, acute myocardial infarction, malignant tumor and cause of death in the jurisdiction. Establish a survey system for chronic diseases and health influencing factors, and regularly organize special surveys on chronic diseases and risk factors, nutrition and health of residents. Combined with the construction of residents' health records and regional health information platform, we will strengthen the collection, analysis and utilization of chronic disease information and master the epidemic laws and characteristics of chronic diseases.
(7) Strengthen scientific research and promote technical cooperation and international exchanges. Strengthen basic research, applied research and translational medicine research on chronic diseases. Science and technology departments should increase their support for research on the prevention and treatment of chronic diseases in relevant science and technology plans, and improve their scientific and technological support capacity for the prevention and treatment of chronic diseases. Strengthen the construction of research and transformation bases for the prevention and treatment of chronic diseases, focus on the research of technologies and strategies for the prevention and treatment of chronic diseases, diagnosis and treatment equipment, new vaccines and innovative drugs, develop health education and health promotion tools, strengthen the transformation and utilization of scientific research results, and promote appropriate technologies such as prevention, early diagnosis, early treatment and standardized treatment of chronic diseases.
Strengthen exchanges and cooperation at home and abroad, actively participate in the global action of chronic disease prevention and control, and carry out extensive cooperation with international organizations, academic research institutions and universities in personnel training, technical cooperation and scientific research. Strengthen exchanges with developing countries and establish a win-win international cooperation mechanism. (a) to strengthen organizational leadership and promote the implementation of the plan. All localities regard promoting the health of the whole people as a new strategy to change the development mode and realize scientific development, integrate into various public policies, strengthen the organization and leadership of the prevention and control of chronic diseases, incorporate the prevention and control of chronic diseases into the overall planning of local economic and social development, establish a target responsibility system and implement performance management. China Center for Disease Control and Prevention, National Cancer Center and National Cardiovascular Center have formulated special action plans to guide local governments to promote the implementation of the plans. All localities should focus on the overall planning objectives and key tasks, formulate local prevention and control plans and annual work plans in combination with the actual situation, seriously study policies and measures to promote the realization of planning objectives, effectively solve problems and difficulties in prevention and control work, implement measures such as policy guarantee, staffing, capital investment, supervision and reward, vigorously strengthen social mobilization, and strive to form a joint force of government social prevention and control work.
(two) to perform departmental duties and implement comprehensive measures. Strengthen inter-departmental coordination and communication, establish an inter-ministerial joint conference system for chronic disease prevention and control, improve the working mechanism with clear division of labor, proper responsibilities and effective supervision, coordinate and solve major problems in chronic disease prevention and control, and implement various prevention and control measures.
The health department has formulated a plan for the prevention and treatment of chronic diseases, which takes the prevention and treatment of chronic diseases as the core content of equalization of basic public health services, completes the connection between the new rural cooperative medical system and public health services, and realizes the effective combination of prevention and treatment. Study and establish major projects for comprehensive prevention and treatment of chronic diseases, and do a good job in organization and coordination, technical guidance, health education and behavioral intervention, prevention, monitoring and evaluation. Evaluate the effect of prevention and control, popularize appropriate technologies, and guide the society and relevant departments to carry out chronic disease prevention and control.
The development and reform department will incorporate the relevant contents of chronic disease prevention into the economic and social development plan, strengthen the capacity building of chronic disease prevention and control, and ensure the basic conditions for chronic disease prevention and control.
The education department will incorporate knowledge of nutrition, chronic diseases and oral hygiene into the teaching content of health education in primary and secondary schools, and supervise, manage and guarantee the time and quality of campus exercise for primary and secondary school students.
The civil affairs department will further improve the medical assistance policy for poor patients with chronic diseases and their families, and gradually increase the assistance. Those who meet the local medical assistance conditions will be actively included in the scope of medical assistance.
The financial department shall arrange necessary funds for the prevention and treatment of chronic diseases according to the level of economic and social development, changes in disease spectrum and changes in disease burden.
Human resources and social security departments actively improve the basic medical insurance policy, do a good job in the connection between basic medical insurance and public health services, gradually improve the level of protection, and reduce the burden of medical expenses of insured persons.
The sports department implements the National Fitness Regulations, actively promotes the National Fitness Plan (20 1 1-20 15), and guides and carries out mass sports activities.
Science and technology, industry and information technology, environmental protection, agriculture, commerce, radio and television, news, food and drug supervision and management departments shall, in accordance with the division of functions, cooperate closely and perform their duties.
(3) Increase public investment and broaden financing channels. Establish social multi-channel financing mechanism for the prevention and treatment of chronic diseases. Give full play to the basic role of public finance in the prevention and treatment of chronic diseases. According to the level of economic and social development and the prevalence of chronic diseases, continuously increase public financial input, gradually expand the scope of services, improve service standards, increase support for the prevention and treatment of chronic diseases in western and poverty-stricken areas, improve investment methods, evaluate investment effects, and improve capital efficiency. Encourage all sectors of society to invest, and guide international organizations, enterprises, institutions and individuals to actively participate in providing public welfare support for the prevention and treatment of chronic diseases.
(4) Strengthen personnel training and improve service ability. Implement the medium-and long-term health talent planning, build a talent team combining medical specialty with social work, and meet the needs of chronic disease prevention and treatment. Strengthen the training of practical talents for the prevention and treatment of chronic diseases and oral diseases at the grassroots level, improve the service ability of grassroots medical and health personnel, and effectively strengthen policy guarantees to attract, use and retain grassroots medical and health personnel; Strengthen the cultivation of compound talents for the prevention and treatment of chronic diseases, pay special attention to cultivating talents who are familiar with both clinical medical skills and public health knowledge, strengthen the content of chronic disease prevention and treatment in the standardized training of general practitioners, residents and public health doctors, and improve the prevention and treatment skills; Strengthen the training of rehabilitation therapists, improve the level of rehabilitation medical services for patients with chronic diseases, and reduce the disability rate and degree of chronic diseases; Strengthen the training of academic leaders and innovative talents, and comprehensively improve the level of scientific prevention and treatment of chronic diseases. Encourage and support social workers to participate in the prevention and treatment of chronic diseases.
(five) to strengthen supervision and monitoring, the implementation of assessment. Establish a monitoring and notification system for planning implementation, formulate a monitoring index system for planning implementation, strengthen supervision and inspection, find problems in time, and constantly improve policies. The implementation of the planning progress and effect evaluation system, the Ministry of Health will establish an evaluation system in conjunction with relevant departments, organize evaluation, scientifically analyze the input-output benefits, and comprehensively evaluate the effects of policies and measures according to the implementation of the plan.