National health is an important guarantee for social progress, economic development and national prosperity. China's constitution clearly stipulates that maintaining the health of all citizens and improving the health level of people of all ethnic groups is one of the important tasks of socialist construction. I. Necessary Conditions for Health The World Health Organization defined the concept of "health" in 1948. In its organic law, it points out that "health is the complete state of the whole physical, mental and social life, not just the absence of disease and infirmity" and that "the government is responsible for the health of the people, and only through appropriate health care and social measures can the government perform its duties." These sounds like fantasies in 1948, but as we approach the 2 1 century, we feel more targeted. The preconditions of health are peace, housing, education, social security, social relations, physical objects, income, women's rights, a stable ecosystem, sustainable resource utilization, social justice, respect for human rights and equality, all of which constitute the greatest threat to health. Human beings live in a complex environment, which has a long-term and potential impact on human health. The participation of individuals, families, communities and ethnic groups plays an increasingly important role in determining health, which is the result of social development. The determinants of health have become the new challenges we are facing in this century. Modernization has improved the automation level of production and life and enhanced the general nutrition level, but at the same time, the negative health effects such as increased social competition pressure, increased psychological burden, reduced physical expenditure and overnutrition began to appear. Traditional old infectious diseases such as tuberculosis; They are replaced by new infectious diseases and chronic non-infectious diseases, such as AIDS or hypertension, malignant tumors and so on. Faced with the new disease spectrum and death spectrum, doctors found that its pathogenesis and prevention methods could not be explained by biomedical models; Because drugs alone have no obvious effect on the prevention and treatment of these diseases. This led to the second health revolution. Two. The form and content of the third health revolution The focus of the first health revolution in history was infectious diseases, parasitic diseases and endemic diseases. The social health strategy is mainly to formulate national health measures and environmental health engineering measures, study the preparation of effective vaccines and biological products, carry out extensive immunization programs, and carry out disinfection, insecticidal and rodent control programs. Through comprehensive health measures, the incidence and mortality of acute and chronic infectious diseases have decreased significantly, and the average life expectancy has increased significantly. The second health revolution is aimed at chronic non-communicable diseases, mainly cardiovascular and cerebrovascular diseases, malignant tumors, accidental injuries, diabetes and mental illness. Through comprehensive health measures, develop early diagnosis technology, improve treatment effect, strengthen disease monitoring, especially control the risk factors closely related to the occurrence and development of diseases, improve the ecological and living environment, advocate the establishment of healthy behaviors and lifestyles, control smoking, alcoholism and drug abuse, advocate reasonable nutrition and physical exercise, and reduce the incidence and mortality of chronic non-communicable diseases through various health promotion and health education measures. The third health revolution aims to improve the quality of life, promote the health and longevity of all mankind, and realize the health care of the whole people. To sum up the experience and lessons of the first and second health revolutions, develop social medicine, and adapt the health cause to the objective needs of the transformation of medical model, we must change the old health concept, establish a new health concept, establish a big health concept, strengthen social health measures, vigorously prevent and control "civilized diseases" and "social diseases", promote self-care and family health care, develop community health services, and improve the quality of life and health level to a new level on the basis of social and economic development. Third, the biological, psychological and social medical model The medical model was originally a concept of mathematical logic, and later became the core of summarizing the world outlook and methodology of various disciplines. Medical model is produced in medical practice, which is the general understanding of medicine obtained by human beings in countless practices of fighting diseases and their own life process, and is the basic viewpoint guiding medical practice. The core of medical model is medical view, which is used to guide us to study the attribute, function, structure and development law of medicine. 1973, Lafrsmboise's concept of health field came into being. He believes that the factors affecting health include biological factors, environment, lifestyle and health service system. To carry out prevention work, we must start from the following four aspects. At the same time, the concept of health has been completely interpreted, which has become the theoretical basis for guiding modern medical practice. (1) Biological factors: Biological factors affecting individual health include natural maturity and aging, genetic factors, and complex exercise results in body organs. From the standpoint of preventive medicine, biological factors are the most difficult part to control or change artificially, which is what China people often say. What people can do is to strengthen physical exercise, pay attention to the changes of physical condition, receive regular health checks, and diagnose and treat diseases at an early stage. (2) Environmental factors refer to the external world with people as the main body, including natural environment and social environment. A. the natural environment is the material basis for human survival. Environmental pollution is bound to be harmful to human health. Its harm mechanism is complex, and it generally has the characteristics of low concentration, slow effect, long period, large scope, serious consequences and difficult recovery. For example, facilities related to sanitary conditions at home and workplace, all kinds of pollution, noise and safety. These environmental factors have different degrees of impact on health. At present, the most important issues are industrial pollution, food safety, children's safety and labor hygiene. B. Social environment: including politics, economy, culture, education and many other factors. These factors affect family functions, interpersonal relationships, work stress, social occasions and so on. The occurrence and outcome of diseases are directly or indirectly influenced and restricted by social environment. C. Psychological environment: refers to individuals living in a complex social environment and facing different scenes every day to test their values and personality temperament; Whether the mind is sound, whether it can withstand pressure, whether it has mental illness, etc. In fact, the familiar mental disorder is the health disorder caused by psychological factors, and this kind of disease is obviously increasing among contemporary people. The World Health Organization (WHO) estimates that the global prevalence of depression is 3% ~ 5%. About 13% ~ 20% people have experienced depression in their lives. Two thirds of them are of working age, which will affect their working ability and efficiency. Depression is a life-threatening disease. 15% of patients with severe depression end up with suicide. (3) Lifestyle: Lifestyle, also known as healthy behavior, refers to people's own bad behaviors and lifestyles that bring direct or indirect harm to personal, family and even social health. It has a wide range of effects on human body, accumulation and constancy, and has a very wide range of effects on health. Such as unreasonable diet, smoking, alcoholism, sedentary inactivity, promiscuity, drug abuse and so on. According to the statistics of the centers for disease control in the United States, it is found that changing these deviant behaviors that are harmful to health can effectively reduce the chance of illness and thus greatly prolong life. After 30 years of hard work, the death rate of cardiovascular diseases in the United States has dropped by 50%, and two thirds of them have been achieved through improving behavior and lifestyle. 1992 The Victoria Health Declaration put forward by the International Heart Health Conference pointed out that the four cornerstones of health "reasonable diet, moderate exercise, quitting smoking and drinking, and psychological balance" are all suggestions for self-care of behavior and lifestyle. (4) Health service system: including prevention, treatment and rehabilitation. The function and layout of health services directly affect the health of local residents, and the quality and effect of health services also affect the health of residents. Usually, the medical and health service system in economically developed areas is relatively perfect, while the three-level medical and health network in underdeveloped areas is not fully functional, and the health level and life expectancy of residents are also low. These four types of 12-factor models are highly respected health models in social medicine today, which have made correct theoretical annotations for the concept of health formulated by the World Health Organization when it was founded. It enlightens the society and medical profession to pay special attention to the important influence of social environment and lifestyle on health, and become a favorable weapon for the second health revolution in the world. 199 1 year-old (who) global 1 year-old population classification survey of major causes of death (%) biological factors 15 environmental factors 17 health service factors 8 behavioral lifestyle factors 60 total 100 four. The concept of health and disease is based on a certain medical model. In the past, people suffered from infectious diseases and lost their health, but when the infectious diseases were cured, people recovered their health. This view of disease based on the occurrence, change and outcome of infectious diseases is a manifestation of single cause and single fruit. "Health without disease" is called negative health view, that is, the health view of biomedical model. The causes of chronic diseases, non-communicable diseases and some degenerative diseases are very complicated. Usually, these disease forms are called multi-cause single fruit or multi-cause multi-fruit. In order to reduce this kind of diseases, we should not rely solely on treatment, but should rely more on social prevention, reduce and eliminate health risk factors, and achieve individual physical and mental balance and harmony with the environment in order to obtain health. Therefore, health can only be "a complete state of physical, mental and social life, not just the absence of disease and weakness." The relative concept of health and disease: all living things will get sick and go through the process of growth, aging and death. Therefore, health and disease can be regarded as a continuous and unified scale. Health is one end, and death is the other. Everyone is somewhere between the two ends of the disease-health continuum, and it changes with time. Surveys in different regions show that the number of people who think they are healthy does not exceed 19% of the total population. However, most people live in sub-health or subclinical state. They are the objects we need to pay attention to, and they are also the key groups of health education and clinical prevention. Sub-health state: refers to a physiological state in which there is no obvious disease, but the vitality and adaptability are reduced to varying degrees. It is caused by the low physiological function and metabolic process of various systems of the body, and it is a state of reduced physiological function between health and disease, also known as "third state" or "gray state". Subclinical disease: also known as "asymptomatic disease". It is believed that disease is a process of life phenomenon that changes conditions. In the process of disease, not only the body is damaged, but also there are physiological reactions of defense, adaptation and compensation. Such pathological reaction and physiological reaction must be combined in the process of disease, which is a process and outcome that is difficult to be divided artificially. As for "disease", Dr. Engel believes that "disease can be regarded as the failure or disorder of the whole organism or other systems in growth, development, function and regulation." Medicine is a science, and it must be admitted that many diseases are still under study, and there are incurable diseases; At the same time, it is acknowledged that medicine can't surpass the body and can only help people live a healthy life in a limited time. 1999 1 1 In Atlanta, USA, the 72nd annual meeting of the American Heart Association emphasized that doctors' help to patients is very limited when they are sick. Even if the disease is cured, the patient can't recover. Therefore, a good doctor is a doctor who keeps people from getting sick. The concept of "beyond secondary prevention" is put forward. Instead of waiting for patients to have treatment and secondary prevention, it is better to actively identify high-risk patients with risk factors and carry out serious primary prevention, such as screening hypertension, hyperlipidemia, obesity and diabetes as soon as possible, preventing cardiovascular, cerebrovascular and renal complications or preventing the above risk factors earlier, so as to make the concept of prevention more active and powerful, become a real "preventive disease" and benefit mankind.
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