新中国人口健康转变:卫生治理与健康策略协同演进的成就  

Population Health Transition in China:Achievements in the Co-evolution of Health Governance and Health Strategies

作　　者：张震[1] Zhang Zhen

机构地区：[1]复旦大学人口研究所

出　　处：《中国人口科学》2022年第5期32-47,126,127,共18页Chinese Journal of Population Science

摘　　要：新中国70余年见证了一个长期积贫积弱的人口大国健康状况迅速改善、预期寿命持续增长的卓越历程。大量文献从多学科角度对中国人口健康改善历程进行了广泛和深入的探讨,揭示了医学、收入、营养、教育等健康策略的积极作用。文章在对中国健康转变的历史纵向和国际横向比较后发现,这些健康策略不能完全解释中国预期寿命和寿命均等化相对于经济发展水平的超前发展,以及与国际趋势相反的区域健康趋同和城乡健康差距缩小等健康成就。据此,文章在传统的健康策略框架基础上,提出卫生治理与健康策略协同演进的分析框架,从这个框架可以看出,面对不断变化的健康策略因素,中国均在卫生治理领域进行积极的适应性应对,多元化的参与者在政府引导下进行的多样性创新遵循着公共健康集体行动的内在逻辑,从而能以有限的资源实现全民健康的显著改善。More than 70 years of the People’s Republic of China have witnessed the remarkable journey of a large population with a long history of poverty and weakness to achieve rapid improvement in health status and sustained growth in life expectancy.A large number of literature has extensively and thoroughly explored China’s population health improvement journey from a multidisciplinary perspective,revealing the positive effects of medical,income,nutritional,educational,and other health strategies.In a historical longitudinal and international cross-sectional comparisons of China’s health transformation,this paper finds that these health strategies cannot fully explain China’s health achievements beyond the international experiences,whether it be the overturning of life expectancy and life expectancy parity relative to the level of economic development,or the regional health convergence and narrowing of the urban-rural health gap in contrast to international trends.Accordingly,this paper proposes an analytical framework for the synergistic evolution of health governance and health strategies based on the traditional health strategy framework,from which it can be seen that China is actively responding adaptively in health governance areas in the face of changing health strategy factors,and that the diversity of innovations undertaken by diverse players under government guidance follows the internal logic of collective action for public health,thus being able to the diversity of government-led innovations by a diverse group of actors follows the logic of collective action for public health,enabling significant improvements in the health of the population with limited resources.

关 键 词：健康转变 死亡率转变 预期寿命 健康策略 卫生治理 

分 类 号：C924.2[社会学—人口学] R19[医药卫生—卫生事业管理]