好文分享與大家分享健康促進學校國際認證委員李大拔教授（香港中文大學健康教育與健康促進中心主任）文章：「公共衛生危機的社區行動：從COVID-19汲取的經驗教訓，將“健康場域”框架嵌入社區照護系統」
於此文章中，李教授提供一個實用指南，說明不同的場域（包括社區，政府，學校及職場）如何發揮作用。
有興趣的伙伴可至以下連結閱讀摘要，也可以點選摘要內部的連結下載全文。http://www.chep.cuhk.edu.hk/covid19
英文摘要：
Community Action against Public Health Crisis: Lessons learnt from COVID and embedding the Healthy Setting framework as community care system
Professor Albert LEE *
MB BS (Lond) MD (CUHK) MPH LLB (Hons-Lond) LLM (Arb &DR) FRCP (Lond & Ireland) HonFFPH (UK) FRACGP (Aus) FCIArb (UK) FACLM (Aus) FCLM (US) FHKAM(FamMed) M.EduRes & Prof.Study( Bristol) Accredited Mediator (CEDR-UK)
Background
This part of world (Asia Pacific region) is very unique which has greatest diversity in terms of socio-economic status. We have high income countries/territories that are well developed such as Australia, Japan, Hong Kong, Korea, New Zealand, Singapore, and Taiwan (GDP per capita well above US$ 20,000).[1] There are countries with fast growing economy such as China, Indonesia also with large population. There are countries/territories with small population, pacific Islands. There are low-income countries such as Laos, Cambodia (GDP per capital below US$3,000).[2] Conflicting views will arise with implementation of effective public health measures such as physical distancing, quarantine and isolation, and other ‘shut down’ measures. There are also different reasons to impose hygiene measures such as respiratory hygiene by face mask wearing and cut down social gathering, and hand hygiene measures by handwashing or use of sanitisers. Reasons can be opposition to restriction of personal freedom and free movements, lack of resources, shortage of supplies, diminution of jobs and income, and impact of economy. This reflects the importance of advancement of health literacy for both policy makers and community. The whole society still has narrow vision of public health without understanding the boarder dimensions of health promotion improving health into context of everyday life. If root of health promotion is implanted early on in life and continue to grow with personal development, the whole society would come to consensus with public health emergency and more supportive of managing determinants of health.
This is the core value of health promotion in different settings where people live, work, play and spending most of their time paving the way for health promotion facing emerging public health crisis for time to time. Would health promotion within the context of daily living play any role in tackling the different scale clusters of outbreaks of COVID-19 in different countries/territories in different continents, China, Hong Kong, Italy, Iran, Korea, Spain. [3]
Hospital setting only handles tip of iceberg of health problems but consuming over 90% of health expenditure.[4] With COVID-19, about 80% of cases are mild and would be managed at home if they do not have co-morbid conditions.[5] Remote assessment in primary care is possible with video conference which would facilitate some basic assessment.[6] Primary care providers delivering whole person care with continuing relationship with patients and family members can effectively promote health fitting into context of their daily lives. Primary care providers would also act as resource persons in the community as well as looking after other illness and sickness.[7] This would have big impact in building resiliency in the community.
During the outbreak of infectious disease, it is understandable to put focus on acute healthcare. However, the actions in community would help to cater the needs of majority of local population only if the community has well-established infra-structure for “Healthy Setting” approach to link primary health care with school, municipality and workplace to become the health resource hub for the community for primary, secondary and tertiary prevention. The next few sections are intended to be practical guides for settings such as primary healthcare, municipalities, schools and workplace to take proactive role in applying principles of health promotion in managing health crisis situation in the localities. This practical guide adopts bullet points format so step by step approach can be possible.
Section 1 discusses setting up community care system not just for crisis situation and also a long term sustainable community based care delivery model reserving the capacity of hospitals for critical conditions. Many preventive measures do need actions at local level to facilitate implementation. The Central Government would formulate relevant public policies and establish the relevant legislations, regulations and rules as central authority and delegate to local municipalities the authority to implement accordingly. This fits in the concept of Healthy City that the local authority engages the key stakeholders and identifies the local resources for related health actions. This would enable effective measures to be in place at the right time targeting the right persons in needs. Section 2 will focus on municipal response to health crisis and also for local municipality to establish an infrastructure for effective implementation of health promotion actions in near future.
School setting is learning community not just for students and also community. Advancing health literacy for students will have impact on whole community to be more responsive to the determinants of health. School being microcosm of the community and health actions in school setting would transfer the knowledge and skills to community. While good community care system can look one vulnerable population group, the elderly, the school setting would cater the needs for young children. This would put pressure and stress off form working population group. Section 3 will illustrate the role of school setting.
Human resource is asset to workplace. Quality human resource management cannot be in place without maintaining high quality of health and well-being for staff. Section 4 discusses how corporates would help their employees during health crisis period. This section will also conclude how different settings in the community would act in synergy to control the spread of infection.
Whenever there is an epidemic of disease, large proportion of population might not have received sufficient support to manage the emerging health crisis as most the efforts need to focus on those serious cases. If the appropriate community actions can take place adopting the principles of health promotion and health protection, this would help to reduce the incidence of the disease and reduce the burden of acute healthcare sector. It is time for community to start taking action to prepare for future health crisis.
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http://www.cuhk.edu.hk/med/hep/prof_alee/main.html Email: alee@cuhk.edu.hk
6 April, 2020, Hong Kong
References:
[1] World Economic Outlook. International Monetary Fund Oct 2019.
[2] Ibid
[3] WHO. Coronavirus disease 2019 (COVID-19) Situation Report. https://www.who.int/…/novel-coronavirus-2…/situation-reports Access 2 April 2020
[4] Lee A. Family Medicine and Community Health Care. In: Fong K and Tong KW (Eds). Community Care in Hong Kong: Current Practices, Practice-Research Studies, and Future Directions. Hong Kong: City University Press, 2014.
[5] Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;
Mcintosh K, Bloom A, Hirsch MS. Coronavirus disease 2019 (COVID 19). UpToDate, Last updated 16 March 2020, Wolters Kluwer. https://www.uptodate.com/…/coronavirus-disease-2019-covid-19 Access 26 March 2020;
CDC. Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus disease 2019 (2019-nCoV) Infection. Revision 30 March 2020. https://www.cdc.gov/…/clinical-guidance-management-patients… Access 1 April 2020;
WHO. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts Interim guidance 17 March 2020. Geneva: WHO. https://www.who.int/…/home-care-for-patients-with-suspected… Access 1 April 2020.
[6] Greenhalgh T, Koh GCH, Var J. Covid-19: a remote assessment in primary care. BMJ 2020; 368:m1182 doi: 10.1136/bmj.m1182
[7] Lee A, Chuh ATT. Facing the threat of Influenza Pandemic – Roles of and Implications to General Practitioners. BMC Public Health 2010; 10:661 http://www.biomedcentral.com/1471-2458/10/661