[Objective]To systematically assess the public health governance capacity in Zhejiang Province,to conduct an in-depth analysis of its strengths and weaknesses,so as to provide scientific basis and strategic recommendations for further enhancement.[Methods]A systematic collection of policy documents,public information reports,and research literature related to public health governance capacity in Zhejiang Province from 2002 to 2023 was conducted(encompassing a total of 1 263 policy documents,138 pieces of information reports and 631 research articles).Based on the evaluation criteria suitable for public health systems previously developed by the research team,the basic status and magnitude of change in public health governance capacity in Zhejiang Province was evaluated.Additionally,normative gap analyses were employed to identify the strengths and weaknesses.[Results]Zhejiang Province ranked 4th nationwide in terms of public health governance capacity with a score of 733.4 points(1 000.0-point maximum).The province has effectively implemented the principle of health first(scoring 698.5 points in the assessment of health-first strategy implementation)and attached sufficient importance to health-related goals(scoring 658.2 points in the scientific rationality of goal setting).However,the implementation of inter-departmental coordination and incentive mechanisms only scored 178.7 points,the feasibility of management and monitoring mechanisms scored even lower at only 144.0 points,and the coverage of incentive mechanisms scored 286.0 points.[Conclusion]Zhejiang Province has effectively implemented its health first strategy and attached great importance to health targets,but still needs to strengthen cross-departmental coordination mechanisms and health-oriented incentives.

ObjectiveTo identify and clarify the key issues faced by tertiary hospitals in responding to public health emergencies.MethodsA literature review index system was constructed, and key issues were identified using hierarchical analysis.ResultsAfter a systematic literature review, 20 types of problems faced by tertiary hospitals in responding to public health emergencies were identified. Three key issues were ultimately identified by prioritizing the issues that needed to be addressed.ConclusionThe key issues of tertiary hospitals in responding to public health emergencies are concentrated in the areas of emergency response capabilities and competencies of medical staff, the number of emergency response personnel, and the standardization and specificity of training and drills. Tertiary hospitals should focus on these issues in developing public health emergency response systems to improve the effectiveness of their emergency response.

Objective To analyze the change in service capacity against major epidemics before and after coronavirus disease 2019(COVID-19)in China for the promotion of the capacity.Methods Via systematic search on the official websites and the law documents website of Peking University(PKULAW),we collected totally 1 756 policy documents relevant to major epidemic prevention and control issued during 2002-2020 by government departments and professional public health institutions in 31 provincial-level administrative divisions of China.Contents about the coverage and assessability of service capacity of major epidemic prevention and control were extracted from the documents and indexes for evaluating national and regional coverage and assessability were calculated based on the extracted contents.Paired signed-rank test was used to analyze changes in the indexes before and during COVID-19 epidemic.Results The coverage of major epidemic prevention and control services has reached 100％in the Chinese mainland in 2019.In comparison to those in 2019 before the emergence of COVID-19 epidemic,the national assessability indexes(％)for service capability of major epidemic prevention and control of pre-,ongoing-and post-stage increased in 2020 by 29.78％(65.59％vs.50.54％),17.54％(72.04％vs.61.29％)and 4.34％(38.71％vs.37.10％).the assessment index for service capability of major epidemic prevention and control of pre-stage increased from 78.79％to 89.39％for eastern region and that of ongoing-stage increased from 65.00％to 76.67％for western region(both P＜0.05);but there was no significant increase in regional assessment index for service capability of major epidemic prevention and control of post-stage.The national assessment index for service capacity of major epidemic prevention and control of whole process increased significantly from 66.00％in 2019 to 73.78％in 2020 after the emergence of COVID-19 epidemic(P＜0.001).Conclusion The overall service capacity of major epidemic prevention and control has improved after the emergence of COVID-19 epidemic in the Chinese Mainland but the service capacity needs to be improved in central and western regions;in addition,the post-event assessment on the service capacity should be concerned for the promotion of the service capacity.

ObjectiveTo identify the key issues in emergency response to public health emergencies in the Yangtze River Delta region, and to provide a basis for the formulation of relevant policies.MethodLiterature on emergency response to public health emergencies in the Yangtze River Delta region was systematically reviewed and collected, and 18 main problems were identified after collecting and organizing the problems. A questionnaire survey and cluster analysis were used to identify the key issues.ResultsThe study of 18 major problems revealed that "insufficient reserve of emergency medical supplies", "insufficient financial investment to meet the needs of emergency response", "lack of a sound mechanism for the deployment of supplies, resulting in the untimely deployment of materials", were the key issues of emergency response to public health emergencies in the Yangtze River Delta region.ConclusionFuture development of the emergency response system in the Yangtze River Delta region should focus on accelerating the integration process of the Yangtze River Delta, establishing and improving information systems, optimizing the material storage and deployment network, prioritizing the fund investment and utilization mechanism, and improving the effectiveness of public health emergency response.

ObjectiveTo evaluate the current status of hypertension prevention and control management operation mechanisms in Chinese mainland, explore the impact of their improvement on hypertension prevention and control effects, and provide a reference for enhancing hypertension prevention and control management. MethodsPolicy documents related to hypertension prevention and control from January 1 2000 to December 31, 2018 in 31 provinces (municipalities and autonomous regions) in Chinese mainland were collected. The current status of hypertension prevention and control management operation mechanisms in Chinese mainland was systematically evaluated according to the appropriate public health system evaluation model and standard. A logistic regression model was used to analyze the impact of the improvement of management operation mechanisms on hypertension prevention and control effects. ResultsIn 2018, the appropriateness of hypertension prevention and control management operation mechanisms in Chinese mainland was 43.68%, with an increase of 21.64% compared to 2000, but there was still a gap of 48.61% from the appropriate standard. Among them, the appropriateness of coordination and incentive mechanisms was the lowest (14.03%), and the appropriateness of planning and evaluation mechanisms was the highest (63.04%). In terms of specific positioning, the coverage of medium and long-term plans (100.00%) and the completeness of content and form (94.45%) were relatively high, while the feasibility of management mechanisms was only 9.76%. The results of logistic regression analysis showed that the improvement of management operation mechanisms helped control blood pressure in hypertensive patients (OR = 1.012, P = 0.007) and maintain the stability of patients’ blood pressure (OR = 1.010, P = 0.029). Conclusion From 2000 to 2018, the construction of hypertension prevention and control management mechanisms in Chinese mainland tended to be improved, effectively promoting the improvement of hypertension prevention and control management levels. However, it is still necessary to further establish and improve coordination and incentive mechanisms and clarify the division of departmental responsibilities.

ObjectiveTo evaluate the capacity for hypertension prevention and control and to identify strengths, shortcomings and key control points of the capacity-building in 31 provincial-level administrative divisions (PLADs) in China.MethodsPolicy documents, information reports, and research literature on hypertension prevention and control in 31 PLADs of China published from January 1995 through December 2019 were systemically collected via searching relevant websites and statistical yearbooks for evaluating on hypertension prevention and control capacity across the 31 PLADs according to the standards for appropriate public health system. Normative gap analysis was used to explore strengths and shortcomings of the capacity-building and multiple linear regression and sensitivity analysis were used to clarify key control points of the capacity-building. ResultsThe average index for the appropriateness of hypertension prevention and control capacity-building was 47.10% among 31 PLADs of China in 2019, and the average annual increasing rate of the capacity-building was 18.75% from 2000 to 2019, showing a significant upward trend (Z = 6.067, P < 0.001). The strengths of hypertension prevention and control capacity-building for the PLADs include more complete organizational structure established, comprehensive coverage of medium- and long-term plans, and sound management and monitoring mechanisms; while the shortcomings are insufficient allocation of human and financial resources and low implementation of multi-dimensional management mechanisms such as management and coordination, medium- and long-term goals and evaluation criteria. The identified key control points for the five aspects in hypertension prevention and control capacity-building are effective motivation of personnel for resource allocation, the coordination for organizational framework, the coverage of incentive measures for management mechanism, practicable assessment criteria for management process evaluation, and the balance between supply and demand of medical service for service offering, with the estimated increment of 23.14%, 66.40%, 15.77%, 23.43% and 7.06%, respectively, in the indexes for the appropriateness of the capacity-building under the conditions of the five key control points being well managed. ConclusionThe capacity for hypertension prevention and control has been improved continuously in 31 PLADs of China during 2000 – 2019 but several aspects in hypertension prevention and control capacity-building still need to be improved for the promotion of the capacity-building.

Objective To explore the advantages and disadvantages of prevention and control capability of emerging infectious diseases of Heilongjiang, and provide a scientific references for improving it. Methods Policy documents, public information reports and research literature on the prevention and control of infectious diseases were collected until December 31, 2020. Based on the evaluation criteria and models of the suitable public health system, descriptive analysis and comparative analysis were used to systematically evaluate the level of prevention and control of emerging infectious diseases in Heilongjiang. Results Since 2002, the suitable degree of prevention and control of emerging infectious diseases has increased by 163.7 %. In 2020, the suitable degree score in Heilongjiang was 748.8, which was 7.3 % lower than the national average score. In terms of factors, Heilongjiang has a good basis for controlling health risk factors, which has the highest suitable degree score（724.1）. While the lowest suitable degree score of resource allocation（403.4） requires urgent attention. Conclusion The overall capability of prevention and control of emerging infectious diseases in Heilongjiang has gradually improved, but it is still at the middle and backward level, which needs to be improved. It is suggested to focus on public health literacy, resource allocation and management and operation mechanism.

ObjectiveTo compare the disparity in framework completeness of maternal health care (MHC) system between Beijing and Shanghai and to explore the feasibility of quantitative evaluation on the degree of framework completeness of MHC system.MethodsWe systematically and extensively collected documents on MHC issued by administrative agencies of Beijing and Shanghai municipality and relevant literatures published during 2000 – 2017. Then we extracted information on the MHC system′s department, institution and organizational structure from 649 retrieved documents and literatures (232 relevant to Beijing and 417 to Shanghai) and analyzed the information quantitatively to assess framework completeness of MHC system in the two municipalities. Spearman correlation and linear regression analysis were used to analyze the relationship between framework completeness of MHC system and maternal mortality rate (MMR).ResultsThe relevant information-derived index for framework completeness of MHC system increased from 52.9% in 2000 to 78.0% in 2017 in Beijing municipality; while, the index increased from 68.5% to 85.8% in Shanghai, with a gradually increasing trend. There was an inverse correlation between the index for framework completeness of MHC system and MMR in the two municipalities.ConclusionThe framework completeness of maternal health care system was improved and the improvement facilitated maternal health care practice in Beijing and Shanghai gradually during 2000 – 2017; but some supportive departments were not embedded into the MHC system′s framework and the completeness of subsystem need to be improved. The study verified the feasibility of quantitative assessment on framework completeness of maternal health care system.

Building a strong public health system has become an urgent task in the new era. Based on more than eight years of systematic research， we believe that five aspects need to be prioritized for a strong system. First， we should change the perspective on public health， using the word “gonggong jiankang” to replace “gonggong weisheng” and the word “gonggong jiankang tixi” to replace “gonggong weisheng tixi”， to lead the public health system development. Second， we should develop a suitable public health system and continuously improve the health capacity for governance. Third， we should make it clear that the goal of building a strong system is not far-fetched， and we need to consolidate the existing institutional advantages of China’s public health system： when encountering major problems， we can maintain a unified goal and mobilize the whole society to cooperate effectively to accomplish the goal. However， we need to make up for shortcomings one by one， especially to solve the key problem of lacking a strong coordination mechanism in daily work. Fourth， we should pursue excellence and consolidate the “suitable” mechanism proven in the process of coping with the COVID-19， so that efficient mechanisms to deal with major issues can be used in routine work， and efforts should be made to consolidate the advantages of prevention and control of infectious diseases and emergency response，so as to achieve the balanced development of regions categories and units.Finally， it is necessary to strengthen the coordination of government and research institutions， in the aspects of technological innovation， talent team building and accurate consulting services， and work together to pursue a suitable and strong system to realize the modernization of the health system and capacity for governance.

ObjectiveTo analyze the status quo and balanced development of major chronic disease service provision capabilities in the Yangtze River Delta region of China, and to provide a reference for promoting high-quality and balanced development of major chronic disease prevention and control capabilities in the region. MethodsWe retrieved documents on prevention and control of major chronic diseases published by local administrations in the Yangtze River Delta region (including Shanghai municipality and three provinces of Jiangsu, Zhejiang and Anhui) during the period from January 2009 through December 2019. Taking a page from service provision elements for an appropriate public health system, service coverage rate (SCR) and assessable service coverage rate (ASCR) were constructed for quantitative analysis on major chronic disease service provision capability of the municipality and the three provinces in the region. Coupling coordination degree model was adopted to assess the balance of the service provision capacity development in the Yangtze River Delta region. ResultsThe overall SCR and ASCR of major chronic disease service provision for the Yangtze River Delta region increased from 21.2% and 10.0% in 2009 to 82.8% and 51.5% in 2019. In the year of 2019, the prevention level-specific SCR and ASCR were the highest for tertiary prevention; the administrative division-specific SCR of tertiary prevention was the highest (96.0%) for Shanghai municipality and the lowest (71.0%) for Anhui province, while, the administrative division-specific ASCR of tertiary prevention was the highest (71.0%) for Jiangsu province and the lowest (33.0%) for Zhejiang province. The overall index value for coupling coordination degree of SCR and ASCR of the Yangtze River Delta region increased from 38.97 and 11.58 in 2009 to 90. 73 and 70.72 in 2019; the overall scores of 2019 for the balance of SCR of primary, secondary and tertiary prevention in the region were 9, 9 and 10, and the overall scores for the balance of ASCR were 7, 7 and 8 respectively. ConclusionIn the Yangtze River Delta region during the period of 2009 – 2019, the major chronic disease service provision capacity and the balance for the capacity development increased yearly; the service provision capacity was higher for tertiary prevention than that for primary and secondary prevention and the development balance was higher for SCR than that for ASCR.

ObjectiveTo analyze operational effectiveness and mechanism of management system for severe mental disorder (SMD) prevention and control in China for providing references to subsequent policy formulation. MethodsThrough searching official websites, we retrieved policy documents relevant to management on SMDs issued by governmental departments and professional institutions as of December 31, 2018 in 31 provincial-level administrative divisions (PLADs) across mainland China and analyzed the completeness and operation mechanism of the management scheme from four perspectives: management and monitoring, planning and evaluation, financing and compensation, and coordination and motivation based on evaluation standards for effectiveness of a public health system. The indicator data on management of SMD from 2014 through 2018 were also collected from National Severe Mental Disorder Information System and research literatures. The relationships between management implementation and effectiveness were analyzed using fixed effects model. ResultsFor 31 PLADs in 2018, the average appropriate degree of SMD management scheme was 43.87%, with an increment of 22.08% to that in 2014 and a gap of 48.39% to the appropriate standard (85%). The dimensional appropriate degree of the SMD management scheme was the highest (64.96%) for financing and compensation mechanism but the lowest (23.69%) for coordination and motivation mechanism. For the dimension of management and monitoring in 2018 at national level, the completeness degree of content and form was relatively high (89.29%) but the degree of clarity for responsibility assignment was relatively low (24.91%), and the degree of management procedure feasibility was only 6.48%; for the dimension of planning and evaluation, the coverage of long-term planning was as high as 96.24%. The results of fixed effect model analysis showed that after adjusting for gross domestic product, significant increase of 1.00 % for completeness of regional SMD scheme, 1.54% for average standardized management rate, and 0.28% for average regular medication of SMD patients were observed (all P < 0.05). ConclusionThe management mechanism of severe mental disorders has been steadily improved in China from 2014 to 2018; for the management scheme, the coverage of management standards and medium and long-term planning were relatively high, but the coordination and motivation mechanism and t responsibility assignment need to be improved.

ObjectiveTo analyze current situation, development trend and regional disparity about effective utilization of infectious disease surveillance system and the effect of the utilization on infectious disease prevention and control in China. MethodsRelevant literatures and reports on infectious disease risk monitoring and early warning issued during 2004 – 2019 by infectious disease surveillance system in 31 provincial-level administrative divisions in China were systemically retrieved through searching websites of governmental agencies, professional organizations, China National Knowledge Infrastructure and Web of Science. The data on infectious disease incidence were extracted from China Health Statistics Yearbook for years from 2005 to 2020. The information collected were quantitatively analyzed to assess effective utilization of the infectious disease monitoring system. Spearman correlation and linear regression were adopted to explore the association of effective utilization of surveillance systems and infectious disease morbidity. ResultsThe average index for countrywide effective utilization of infectious disease surveillance system was 9.64% in 2019, with an increment of 1 338.81% compared with that in 2004; the average index for eastern region was relatively higher (11.73%) than that for other regions of China. Correlation and regression analysis showed that there was a reverse correlation between the effective utilization of infectious disease surveillance system and the incidence of infectious diseases at regional and national level, with the nationwide correlation coefficient of − 0.88 (P < 0.01) and standardized regression coefficient of − 6.87 (P < 0.001). ConclusionThe utilization of infectious disease surveillance system has been improved steadily during 2004 – 2019 in China, but regional difference for the utilization still exists and continuous efforts should be made for effective utilization of the surveillance system.

Background Creating an enabling environment (EE) can help foster the development and health of children. The Chinese government implemented a new health care reform (NHR) in 2009 in a move to promote an EE for health. The purpose of this study was to evaluate the impact of the NHR on EE for children's health. Methods An interrupted time-series analysis was used to evaluate the changes in the EE before and after 2009 in China. This study analysed the EE through five quantitative indicators, including policy element coverage rate (PECR), service meeting with children's needs rate (SMCNR), multisector participation rate (MPR), and accountability mechanism clarity rate (AMCR), based on the content analysis of available public policy documents (updated as of 2019) from 31 provinces in mainland China, and the number of health care personnel of maternity and child care centres per 10 000 population (HP per 10000 population), based on the 2002-2019 China Health Statistical Yearbook and China Statistical Yearbook. Results The average values of PECR, SMCNR, and MPR increased rapidly to 90.96%, 82.46%, and 81.31%, respectively, in 2019, representing a higher value compared to the AMCR (7.38%). The NHR promoted the EE, in which HP per 10000 population showed the fastest increase (beta(1) =0.03, P< 0.01; beta(3) =0.10, P<0.01), followed by SMCNR (beta(1) =0.94, P<0.01; beta(3) =1.83, P<0.01), AMCR (beta(1) =0.13, P<0.01; beta(3) =0.24, P=0.14), MPR (beta(1) =1.35, P<0.01; beta(3) =2.47, P<0.01) and PECR (beta(1) =1.43, P<0.01; beta(3) =1.47, P<0.01). Conclusions The NHR has a positive impact on the EE, especially on the human resources and service provision for children. Efforts should be intensified to improve the clarity of the accountability mechanism of the health-related sectors.

目的 分析2019年我国31个省(自治区、直辖市)和东、中、西部疫苗可预防性疾病(vaccine preventable disease,VPD)一级预防服务能力水平、2004—2019年的变化趋势及其与发病率的关系,为提升预防服务能力,究善VPDs防控工作提供参考.方法 收集31个省(自治区、直辖市)2004—2019年所有涉及VPDs的法律法规和政策等公开文件,基于文本分析方法量化计算一级预防服务能力和变化趋势,并运用相关分析检验其与VPDs发病率的相关性.结果 2019年我国VPDs一级预防服务能力达到57.02％,与2004年相比增长61.44％,但健康教育、疾病和危险因素监测、危险因素控制或行为干预的服务可考核率仅为40.80％、29.98％、18.60％;东、中、西部地区VPDs一级预防服务能力分别为69.09％、52.15％、49.19％,东部服务覆盖程度与可考核程度均超过中、西部;我国层面的VPDs一级预防服务能力与发病率之间呈现负相关(r?=?-?0.693,P<0.01).结论 2004年以来我国VPDs一级预防服务能力具有提升,但是各地区之间能力存在差异,进一步提升VPDs预防服务能力需要"扩面"与"提质"兼顾.

ObjectiveTo compare the disparity in the completeness of maternal health care (MHC) system between Beijing and Shanghai and to explore the feasibility of quantitative evaluation on the degree of the completeness.MethodsWe systematically and extensively collected documents and materials on MHC issued by administrative agencies of Beijing and Shanghai municipality published during 2000 – 2017. Then we extracted relevant information from 649 retrieved documents (232 relevant to Beijing and 417 to Shanghai) and analyzed the information quantitatively to assess the completeness of MHC system in the two municipalities. Spearman correlation and linear regression analysis were used to analyze the relationship between the completeness of MHC system and maternal mortality rate (MMR).ResultsThe relevant information-derived index for the completeness of MHC system increased from 32.4% in 2000 to 50.6% in 2017 in Beijing municipality; while, the index increased from 41.1% to 64.6% in Shanghai, respectively. For the two municipal MHC systems, the framework completeness was at a high level but the coordination and responsibility assignment among various functional institutions of the system were at a low level. There was an inverse correlation between the index for the completeness of MHC system and MMR in the two municipalities.ConclusionThe completeness of maternal health care system were improved and the improvement facilitated maternal health care practice in Beijing and Shanghai gradually during 2000 – 2017; but the coordination and responsibility assignment among various functional institutions of the system should be promoted. The study verified the feasibility of quantitative assessment on the completeness of maternal health care system.

《上海预防医学》杂志第五届编委会第二次全体会议在上海市顺利召开.会议总结了第五届编委会成立以来的工作成绩,分析了存在的问题,讨论了下一步工作的方向.会议宣布了优秀编委、优秀审稿专家和优秀论文名单.讨论环节和会议总结由执行主编姜庆五教授主持,呼吁编委们继续努力,积极帮助杂志组织学术性和创新性更佳的一流稿件,持续不懈地为杂志的进一步提升和发展做出更大的贡献.

遵循卫生系统宏观模型、模型构建等原理,构建包含8个一级指标、31个二级指标、44个三级指标的适宜公共健康体系定量标准,各方认可度94.1％～100.0％,为公共健康体系建设提供关于"何为适宜"的定量评判标准.

基于"适宜"理念,提出"适宜公共健康体系"的理念,突出"以人为本、生命至上",强调公共健康体系应在与所在国家(地区)的经济、政治、文化、社会、生态文明建设的相互适应和相互促进中形成符合自身实际的发展路径.

遵循卫生系统宏观模型思路和原理,明确提出适宜公共健康体系应具备的8个要素,包括强而有力的社会环境支撑、动态把握公众需要的能力、把控健康风险因素的水平、适宜的人财物等资源配置、成熟并且协调的组织体系、行之有效的管理运行机制、健全的公共健康服务功能、公共健康具体任务的关注程度.8个要素又可进一步细化为63个可操作的具体定位.各方认可度为88.8％～93.9％.首次为公共健康体系建设提供了"何为适宜"的定性评判标准.

Objective To explore classical connotation of public health concept at home and abroad for developing a contemporary definition of public health. Methods Through online searching on websites such as China National Knowledge Infrastructure, Institute of Science Information (ISI) Web of Science and manual retrieval, we retrieved relevant studies in journals, books and government/professional institution documents published up to the end of January 2018 and then concluded 28 national and 31 international definitions of public health. Retest reliability was used to evaluate the reliability of the definitions; content analysis was adopted to analyze classical connotations of the definitions and an impact indicator was established to assess the significance of the classical connotations. Results Through the analysis on the 59 definitions, 257 connotations were initially generalized and 12 domains of classical connotations were derived with stepwise classifying and clustering analysis. The retest reliability of the classical connotations ranged 0.800 – 1.000, indicating that the analytical results were reliable and stable. The top five classical connotations with great significance were ensuring and promoting public health, organizing the society to work together, preventing and controlling various diseases and disabilities, being a field of science and art, and exerting interventions at population. Conclusion Ensuring and promoting the health of general population is the key connotation for the definition of public health and to develop a contemporary definition of public health is important for guiding theoretical research and practice of public health in all societies.