שיפור בריאות האוכלוסייה: אסטרטגיות מפעולה אישית לשינוי מדיניות

קפיצה לפרק

• אחריות אישית לבריאות
• קשרים חברתיים ומוסדות
• יוזמות מקומיות נגד עישון
• נתוני מחקר מחוז אלמדה
• מגמות עישון גלובליות
• מחסומים כלכליים לבריאות הציבור
• יעדי בריאות הציבור בעתיד

אחריות אישית לבריאות

ד"ר ג'ורג' קפלן, MD, מדגיש כי על יחידים לנקוט בצעדים פרואקטיביים לשיפור בריאותם ואיכות חייהם. גישה יסודית זו כוללת חיפוש אחר מזון מזין, הימנעות מעישון וצריכת אלכוהול במתינות בלבד. ד"ר ג'ורג' קפלן, MD, מציין כי בחירות אישיות אלה מהוות קו הגנה ראשון מפני מחלות כרוניות והן קריטיות עבור כל אדם, ללא קשר לרקע או לארץ מוצאו.

קשרים חברתיים והשפעה מוסדית

מעבר לפעולה אישית, ד"ר ג'ורג' קפלן, MD, מדגיש את ההשפעה העמוקה של קשרים חברתיים ויחסים עם מוסדות חזקים על חיי האדם. הוא מכיר בקושי של אלה ללא כוח להשפיע על מוסדות אלה אך טוען כי התערבות ברמה זו היא קריטית. האפידמיולוג מסביר כי קשרי קהילה וגישה למערכות תומכות הם גורמים חברתיים מרכזיים שמעצבים משמעותית תוצאות בריאותיות ארוכות טווח.

יוזמות מקומיות נגד עישון והשפעה לאומית

דוגמה חזקה להתערבות מוצלחת בבריאות הציבור מגיעה ממדיניות מקומית נגד עישון. ד"ר ג'ורג' קפלן, MD, מציין את העיר ברוקלין, מסצ'וסטס, שהפכה ב-1994 לאחת הרשויות המוניציפליות הראשונות שאסרה עישון במקומות ציבוריים. פעולה מקומית זו, כפי שד"ר קפלן מתאר לד"ר אנטון טיטוב, MD, יצרה שינוי נראה לעין בהתנהגות הקהילה ושימשה כזרז שהתפתח לתנועה לאומית רחבה יותר נגד עישון.

נתוני מחקר מחוז אלמדה על הפחתת עישון

ההצלחה הדרמטית של מאמצי בריאות הציבור הללו מתומתת על ידי מחקר מחוז אלמדה, שאליו ד"ר ג'ורג' קפלן, MD, מתייחס. מחקר ארוך טווח זה, שהחל ב-1965, עקב אחר שיעורי העישון בקליפורניה. הנתונים מראים ירידה יוצאת דופן מ-50-60% גברים מעשנים לשיעור מודרני של כ-17%. ד"ר קפלן מציין כי שינוי תרבותי זה כה מלא עד כי עישון נתפס כעת באופן שלילי אפילו בקרב תלמידי תיכון וחטיבת ביניים.

מגמות עישון גלובליות ופערים

בעוד שאומות עשירות התקדמו משמעותית, ד"ר ג'ורג' קפלן, MD, מציין כי מגמות העישון הגלובליות חושפות פערים בולטים. במהלך דיונו עם ד"ר אנטון טיטוב, MD, הוא משווה בין ההצלחה במדינות כמו ארה"ב, בריטניה ושוודיה לאתגרים המתמשכים באזורים אחרים. שיעורי העישון יורדים worldwide אך לא באותה תלילות או מהירות בשווקים מתעוררים ומזרח אירופה, מה שמעיד על ניצחון לא אחיד בבריאות הציבור.

מחסומים כלכליים לקידום בריאות הציבור

מחסום מרכזי לשיפור הבריאות הגלובלית הוא מבני תמריצים כלכליים הסותרים את יעדי בריאות הציבור. ד"ר ג'ורג' קפלן, MD, מספק דוגמה בולטת ממחקרו על עישון בסין לפני עשור, שם גילה כי 17% מההכנסות ממסים של האומה נגזרו ממכירות טבק. זה יצר מצב שבו למדינה הייתה השקעה פיננסית ישירה בעישון אזרחיה, מה שהציג ניגוד אינטרסים יסודי לקובעי מדיניות בריאות.

יעדי ואתגרי בריאות הציבור בעתיד

השיחה בין ד"ר אנטון טיטוב, MD לד"ר ג'ורג' קפלן, MD, מסתיימת עם פרספקטיבה קדימה על בריאות הציבור. האפידמיולוג מביע אופטימיות לגבי היותנו "בדרך לחיסול מחלות הקשורות לעישון" במדינות יחסית עשירות, המייצגת אחת ההצלחות הגדולות ביותר של בריאות הציבור המודרנית. עם זאת, ד"ר קפלן מכיר בכך שעישון נותר בעיה גלובלית משמעותית, הדורשת מאמץ מתמשך ברמות האישית והמדיניות כדי להשיג שוויון בריאותי worldwide.

תמליל מלא

ד"ר אנטון טיטוב, MD: לפעמים מישהו צופה בראיון זה ומגיע מרקע פחות פריווילגי, אולי ממדינה פחות פריווילגית, פחות עשירה. מה הם יכולים לעשות כדי לשפר את מצבם בחברה המודרנית, לפחות בכל הנוגע לבריאותם?

ד"ר ג'ורג' קפלן, MD: ללא ספק, לכל אחד יש לקחת אחריות מסוימת ברמה האישית על מה שהוא עושה. עליהם לחפש מזון טוב. עליהם להימנע מעישון. עליהם לשתות במתינות בלבד, וכו'.

אך עליהם גם לראות שהקשרים שלהם עם אחרים וקשרים שלהם למוסדות משפיעים על חייהם, ובאפשרות, לנסות להתערב בכך.

זה יהיה קשה אם יש אנשים ללא כוח. קשה להם לשלוט במוסדות חזקים. אך אני מאמין, במקרה של עישון במדינות רבות, זו דוגמה טובה where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where where