Review and Prospect of China’s Medical and Health Policy Since the Founding of the People’s Republic of China: Analysis based on Policy Tools / 中国医学伦理学

Policy tools are ways to quantitative analysis of policy text content and the construction of a "Policy Tools-Policy Objectives (X-Y Dimension)" framework to explore long-term stability and late-stage innovation of policy development. This paper reviewed the development process of medical and health policies since the founding of the People’s Republic of China, and divided 1949-2021 into four stages of reform breeding, institutional transformation, reform improvement and continuous deepening. Screening 121 medical and health policy texts issued at the national level since the founding of the People’s Republic of China, quantitatively analyzing 5 957 policy text cells from the perspective of policy tools, counting the use of policy tools in various periods, and excavating the inherent logic of policy texts, policy tools and policy objectives to derive development characteristics of internal logic deduction. The development of China’s medical and health policy in the new period will serve the people’s health in the first place, adhere to the development direction of equalization of basic public service, strengthen the coordinated development of scientific and technological innovation and talent training, build a health and healthy development system with Chinese characteristics.

El hospital y el enfoque de derechos / The hospital and rights approach

La pandemia por SARS-CoV-2 puso de forma abrupta al sistema de salud en la agenda pública. Evidenciando sus problemas y requiriendo acciones de emergencia para poder dar cuenta del desafío de responder social y sanitariamente a esta crisis. La respuesta hospitalaria fue el eje y centro de atención de la pandemia, casi con exclusividad. Relegando las otras posibilidades o dispositivos asistenciales, como el primer nivel de atención y la salud comunitaria. Por lo tanto, nos proponemos reflexionar sobre esta organización sanitaria, tan arraigada en el modelo médico social y el marco del enfoque de derechos. Definiremos el hospital, describiremos sus antecedentes, sus características y propondremos como repensarlo críticamente para aportar a su crecimiento en el marco del enfoque de derechos. La salud como derecho es el marco legal, político y teórico que proponemos para abordar esta reflexión y al hospital, tanto como singularidad histórica como pluralidad o multiplicidad de organizaciones en función de cada contexto donde se desarrolla, como una organización social y sanitaria que formar parte de un conjunto de organizaciones y políticas destinadas a garantizar ese derecho (AU)

The SARS-CoV-2 pandemic abruptly put the health system on the public agenda. Evidencing their problems and requiring emergency actions to be able to account for the challenge of responding socially and healthily to this crisis. The hospital response was the axis and center of attention of the pandemic, almost exclusively. Relegating the other possibilities or assistance devices, such as the first level of care and community health. Therefore, we intend to reflect on this health organization, so rooted in the social medical model and the framework of the rights approach. We will define the hospital, describe its background, its characteristics and propose how to rethink it critically to contribute to its growth within the framework of the rights approach. Health as a right is the legal, political and theoretical framework that we propose to address this reflection and the hospital, both as a historical singularity and as a plurality or multiplicity of organizations depending on each context where it is developed, as a social and health organization that is part of a set of organizations and policies aimed at guaranteeing that right (AU)

Huerta urbana comunitaria, más que lechugas entre cemento. Producción social de territorios saludables / Community Urban Garden, More Than Lettuce among Cement. Social Production of Healthy Territories

Resumen Lo urbano no es incompatible con la agricultura, incluso mejora aspectos como la seguridad alimentaria, el amor hacia el territorio y la vida cotidiana, lo que refleja esperanza en la producción de una ciudad saludable. El artículo da cuenta de las reflexiones en torno al estudio de caso, el proceso de implementación del proyecto Huerta urbana comunitaria (HUC) de Villa Juanita del programa Buen Vivir en el Municipio de Villamaría, Caldas, Colombia.

Abstract The urban is not incompatible with agriculture, it even improves aspects, such as food security, love for the territory, and daily life, which reflects hope in the production of a healthy city. The article reports on the reflections around the case study, the implementation process of the Villa Juanita urban vegetable garden project of the Buen Vivir program in the municipality of Villamaría, Caldas, Colombia.

A extensão no curso de medicina como estratégia de formação para o Sistema Único de Saúde (SUS) / Extension project in medical course as a training strategy for the Brazilian Unified Health System (SUS) / La extensión del curso de medicina como estrategia de capacitación del Sistema Único de Salud (SUS)

Este relato tem por objetivo descrever a experiência de um projeto de extensão desenvolvido pelo curso de medicina da Universidade Federal de Sergipe, campus Lagarto. As atividades de ensino-aprendizagem tiveram o intuito de levar os estudantes a analisar criticamente as políticas e práticas de saúde desenvolvidas no âmbito da comunidade e das instituições estatais de saúde, constituindo-se um espaço de experimentação de práticas inovadoras a partir da adoção de metodologias de ensino-aprendizagem centradas no aluno, conforme orientado pelas Diretrizes Curriculares Nacionais. A implementação do programa contemplou ações envolvendo análise de documentos oficiais (leis e portarias) sobre as mudanças do novo modelo de financiamento de custeio da Atenção Primária à Saúde, a criação de um espaço de discussão virtual com as equipes de saúde e a produção de materiais informativos (físicos e virtuais), como vídeos e cartilhas. A realização do projeto apoiado na experiência de integração ensino-serviço-comunidade contribuiu para o esclarecimento de gestores e trabalhadores da área sobre as mudanças em curso, bem como para o desenvolvimento, nos discentes envolvidos, de competências tecnológicas e críticas focadas na qualidade do cuidado e voltadas à melhoria das condições de vida e saúde das populações. Esses fatores são concebidos como os principais paradigmas científicos atuais no campo das políticas públicas em saúde para superação de modelos de ensino que se mostram cada vez mais incapazes de atender à amplitude das necessidades sociais de saúde.

This report describes the experience of an extension project developed by the medical course of the Federal University of Sergipe, Lagarto campus. The teaching-learning activities sought to lead students to critically analyze health policies and practices developed within the community and state health institutions, constituting a space for experimentation with innovative practices based on student-centered methodologies, as established by the National Curriculum Guidelines. Its implementation included actions involving the analysis of official documents (laws and ordinances) about changes to the new model to finance Primary Health Care, the creation of a virtual discussion spaces with health teams and the production of informative materials (physical and virtual), such as videos and booklets. Supported by the experience of teaching-service-community integration, its execution contributed to clarify the changes underway, as well as to develop technological and critical skills focused on the quality of care aimed at improving the living conditions and health status of the population. These factors are the main current scientific paradigms in the field of public health policies to overcome teaching models that are increasingly unable to meet the social health needs.

El propósito del informe es reportar la experiencia de un proyecto de extensión desarrollado por la carrera de Medicina de la Universidad Federal de Sergipe, en el campus de Lagarto. Las actividades de enseñanza-aprendizaje tuvieron como objetivo llevar a los estudiantes a analizar críticamente las políticas y prácticas de salud desarrolladas dentro de la comunidad y las instituciones estatales de salud, constituyendo un espacio para experimentar con prácticas innovadoras basadas en la adopción de metodologías de enseñanza-aprendizaje centradas en el alumno como sujeto del aprendizaje según plantean las Directrices Curriculares Nacionales. La implementación del programa incluyó acciones de análisis de documentos oficiales (leyes y ordenanzas) sobre cambios al nuevo modelo de financiamiento de la Atención Primaria de Salud, la creación de un espacio de discusión virtual con equipos de salud y la producción de materiales informativos (físicos y virtuales) como videos y folletos. La realización del proyecto a partir de la experiencia de integración docencia-servicio-comunidad contribuyó al esclarecimiento de los directivos y trabajadores del área sobre los cambios en curso, así como al desarrollo de habilidades tecnológicas y críticas en los estudiantes involucrados, enfocadas en la calidad de atención para mejorar las condiciones de vida y salud de las poblaciones. Estos factores son considerados uno de los principales paradigmas científicos actuales en el campo de las políticas públicas de salud para superar modelos de enseñanza que son cada vez más incapaces de atender la expansión de las necesidades sociosanitarias.

Superación de la violencia de género en las relaciones de pareja: historias de vida / Overcoming gender violence within intimate relations: Life histories

Resumen Estudio cualitativo cuyo objetivo fue interpretar los relatos de las experiencias de vida de personas que han superado la violencia en las relaciones de pareja. Los contextos de violencia social y estructural se entrecruzan con la vida de pareja de ambos participantes. En su salud mental, la violencia, el valor de lo económico, episodios depresivos, y la distribución asimétrica de poder han marcado sus relaciones. Las políticas de salud mental pueden incluir la prevención y atención primaria de esta violencia.

Abstract It is a qualitative study, whose objective was to interpret the stories of people's life experiences, who have overcome violence in their intimate relations. The contexts of social and structural violence intersect with the life of both participants' partners. In their mental health, violence, the value of economics, depressive episodes, and the asymmetrical distribution of power have marked their relationships. Mental health policies may include prevention and primary care of this violence.

The reform and faith regained:A study on the changes of medical and health policy under the framework of initiative alliance / 中国卫生政策研究

Based on the advocacy coalition framework,the game between policy alliances with different beliefs is regarded as a key factor contributing to the long-term policy changes. At the same time, the policy changes are seen as the product of the antagonism of the core faith of the alliance, the policy-oriented learning and the internal and external shocks of the coalitions. The change of China's health care policy has always been accompanied by the debate on whether fairness or efficiency should be given priority between"government-led"and"market-oriented"coalitions. Its evolving characteristics are consistent with the explanatory logic of the advocacy coalition framework. Based on the advocacy coalition framework this paper makes a comprehensive of review of the historical literature on Chinese medical and health policy,it founds out that advocacy coalitions with different beliefs are critical to the re-form and return of the health care policy, policy-oriented learning promotes the gradual change of the policy, while internal and external shocks provide opportunities for policy paradigm change. Besides,the more passive and lack of active initiatives of policy change,the government's bias of the public welfare feature of the medical business coupled with the underdevelopment of market economy are the main causes for lagging medical policy and frequent industry chaos. To this end,it is recommended to highlight the forward-looking policy,strengthen the internal drive,create a more liberal debate environment for the coalitions,promote the learning of policy orientation among coalitions to en-hance the scientific and effective medical and health policy change.

Cultivating a New Community of Clinical Researchers in Japan / 医学教育

1) Japanese clinical research and population-based medicine have different origins and have lived separate lives. After 100 years of mutual isolation, their paths are about to cross.<BR>2) Clinical research is not confined to clinical trials and translational research, but covers a wider area that includes outcomes research, economic evaluation, and studies of the quality of care.<BR>3) Government policymakers very recently turned their attention to clinical research, and set up administrative schemes to provide large-scale funding.<BR>4) However, unlike the US, Japan cannot catch this wave because it does not have the necessary intellectual infrastructure of trained clinical investigators.<BR>5) Population-based medicine and clinical research have similar emphases and core values. Both are concerned with measuring frequencies, with socially relevant outcomes, and with the impact of research on clinical practice and health policy.