heal tin cities -heal tin islands programme
TRANSCRIPT
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HEAL TIN CITIES - HEAL TIN ISLANDS PROGRAMME
The WHO progranune "Healthy Cities - Healthy Islands" for the Western Pacific Region has been developed in response to the need of Member States to integrate efforts of various stakeholders in improving the health of people living in urban areas and islands. It is implemented following the concepts and approach outlined in "New Horizons in Health", a WHO initiative for the Western Pacific Region which was adopted by the WHO Western Pacific Regional Committee in 1994. The objectives are:
(I) to minimize health hazards in urban areas/islands through the integration of health and environmental protection measures in the physical and economic planning process:
(2) to enhance the quality of the physical and social environment supportive of health in urban and island settings:
(3) to increase public awareness towards hcalthier behaviour, bfestyle and habIts:
(4) to improve the provision of health services through developing appropriate health care systems in urban areas and Islands: and
(5) to upgrade country capablllues and develop policies to improve health in urban areas and islands through better mtersectoral coordination and public participation .
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This document was origmally prepared by health officials of the Dongcheng District, Beijing, China in connection with the development of a plan of action for Healthy City - Dongcheng with the support of WHO .
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The documents in the Healthy Cities - Healthy Islands Series are published informally by the WHO Western Pacific Regional Environmental Health Centre. The findings, interpretations and conclusions are entirelv those of the authors.
Printed and distributed by·
World Health Organization Western Pacific Regional Environmental Health Centre (EHC) P.O. Box 12550 50782 Kuala Lumpur Malaysia
~/·:'",jl ,,, .:.'-'t." .. j i..L..-l':'l: . ..H;}i'
Tel: 60-3-9480311 iiIC/.iIa p~
CONTENTS
I. OVERALL AIM AND SPECIFIC OBJECTIVES
2.
3.
4.
5.
6.
7
I . I Overall Aim I .2 Specific Objectives
BACKGROUND AND CHALLENGE
21 2.2 2.3 2.4
Introduction General Situation Achievements and Experiences Existing Health Problems and Specific Priorities
TARGETS AND STRATEGIES
31 3 2
Overa II Targets Strategies
SET-UP OF A SPECIFIC PLAN
IMPLEMENTATION OF THE PLAN
INDICES FOR EVALUATING THE IMPLEMENTATION OF THE PLAN
BUDGET
ANNEX - TARGETS FOR URBAN HEALTH DEVELOPMENT IN DONGCHENG DISTRlCT
2
2 2
12 \3
16
16 16
18
23
29
29
30
A PLAN FOR URBAN HEALTH DEVELOPMENT
China has a rapidly developing economy. With rapid urbanization and growth of urban population, Dongcheng District is facing new problems, whicb should be studied and solved to realize the strategic WHO target for "Health for All by the Year 2000" in the urban areas.
Based on an analysis of a variety of data about the people's health status and physical and social environment, Dongcbeng District of Beijing is fast becoming a developed city. Dongcbeng District - WHO Coordinating Centre for Urban Health Development was established in March 1994. Several problems that influence people's health are erne. ging in Doogcbeng District. Guiding principles for the formulation of a plan for urban health development in a city should be to build a healthy city with healthy residents, healthy environment and healthy society to meet the cballenges of the 21st century. Accordingly, this plan for urban health development has been formulated and is described as follows.
I. OVERALL AIM AND SPEOFIC OBJECTIVES
The overall aim is to build Dongcheng into a healthy city with healthy residents, healthy environment and healthy community with involvement of everyone in urban health development to realize the strategic target of health for all by 2000.
1.2 Specific Objectives
1.2.1 Medical services can be easily and efficiently accessed by all people.
1.2.2 Public health services should be popularized, including health promotion, health education.. maternal and child health care, health care for the elderly and the disabled, and disease prevention and control
1.2.3 Monitoring and management of environment health should be strengthened, focusing on control of air pollution, safe water supply, safe food and an adequate diet, environmental sanitation.. spacious housing, heating, green environment, traffic safuty, sanitation of public places, occupational bealth, spiritual needs, healthy life-style, etc.
1.2.4 Public policies and intersectoral coordination should be enhanced to motivate and encourage all colrummities, governmental agencies and non-govemmeotal organizations to be involved in urban health development activities.
1.2.5 Health regulations,law-enforcement and administration ofpublic health should be strengthened.
1.2.6 Adequate financial support from government and non-govemmeotal organizatioos should be provided.
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2. BACKGROUND AND CHALLENGE
In order to formulate a plan for urban health development, a survey was carried out In
Dongcheng in 1994 with the support of the WHO Regional Office for the Western Pacific. Substantial data on social and economic development, health care service system and environmental status were collected. All these provided useful information in formulating the plan.
2. I Introduction
Dongcheng District is developing rapidly and is facing a lot of new problems and new challenges in urban health development. With a view of learning about both the posItive and negative influences on residents' health caused by rapid urban development, Dongcheng District Health Bureau accepted a research project assigned by the Environmental Health Centre of the WHO Regional Office for the Western Pacific in September 1994, and made a survey and analysis of the current status in social and economic development, environment and health In the District, identified existing problems, and worked out a plan for urban health development.
22 General Sitllatl(lr)
2.2.1 Dongcheng District is located in the centre of Beijing MuniCIpality, the capItal city of the People's Republic of China, and is an inner city of this ancient capital, with a total area of 25.38 square kilometres. Dongcheng has jurisdiction over ten subdistricts and 360 neIghbourhood committees, with a resident population of more than 640 000 comprising 323 974 males and 324 188 females. Its birth rate was 5.5/1 000 and mortality 6.511 000 in 1993, with a natural population growth of minus III 000. Population density is 27 893 per square kilometre, including transient residents of about 65000 and floating population of about 300 000. It has a labour force of 132 578, and 27 240 of them belong to the second industry and 105338 to the third industry. It has a selfemployed labour force of 19 363.
2.2.2 Age structure of population
According to 1993 statistics, the elderly who aged over 60 years totalled 87 722, accounting for 13.53% of the total population (Table I), which suggests Dongcheng has become an aging society.
Table I: Population Age Structure of Dongcheng by Years 1963-1993
Age Group 1963 1982 1988 1993
(years) No. % No. % No. % No. %
0-14 247730 40.96 III 257 17.08 107243 16.68 114362 17.65 15-59 309483 51.16 470227 72.17 466398 7253 44607& 68.82 60- 47674 7.88 70036 10.75 69409 10.79 87722 13.53 Total 604887 100.00 651 520 100.00 643050 100.00 648 162 100.00
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2.2.3 Situation of national economic development in the district
Since 1993, the economy and society in Dongcheng District have been developing rapidly, and the economic strength in the District has been enhanced further. There has been an increase in urban construction, and employees' and the people's living standard has improved. As compared with 1992, total value of industrial output in the District in 1993 increased by 34.10/ .. tota1 volmne of retail sales of social commodity hy 15.6%, and total turnover in commerce, catering and service trade, and repairing trades increased by 14.4% in the District. District revmue increased by 21.2% and average wage increased by 989 yuan per employee in 1993 . Total expenditure of the District increased by 20.9%, and that OIl capital COIlstructiOll and on culture, education and health by 13.7% and 16.6% respectively.
2.2.4 Environmental protection and environmental quality
2.2.4.1 Drinking water for residents
All the residents in Dongcheng District use tap water. Water source is drawn from Miyun Reservoir in the outer suburbs and from the WJderground, and is treated, disinfucted, and then distributed to the households through pipelines. According to the Regulations of Hygienic Inspection and Management of Drinking Water in Beijing, tap water is monitored periodicaUy, and more than 99.23% of tap water sampled met the national hygienic standards for drinking water. With the increase of high-rise buildings in the District receotly, water in the pipelines is pressurized again and cbanelled to the tanks on the top of the buildings, and then distributed to households. Results of tile monitoring of drinking water during 1990-1994 are listed in Tables 2 and 3.
Table 2: Resuhs of Water Quality Mooitoring (Dongcheng, 1990-1994)
Samples collected from
Tap Water Tank Water
of High-rise
No. Samples
290 1 438
No. Items Tested
788 34498
% Up to Standard
99.23 98.02
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Table 3: Number of Water Samples Tested Exceeding the Limits in Hygienic Standards for Drinking Water
Items Tested
Ammonia Nitrogen Nitrous Nitrogen Nitric Nitrogen Hardness Oxygen Consumption Coliform Group Bacteria Count pH Phenolic Compound Total
2.2.4.2 Air pollution
Tap Water
6
6
Tank Water of High-rise
43 17 39 24 33 35 12 6 8
217
Due to the composition of fuel consumption, au pollution during heating periods originates mainly from coal-burrung, with sulfur dioxide, smoke and dust as major pollutants. During nonheating periods, air pollution levels are lower.
Air pollution caused by exhaust emission showed an ascending trend in recent years due to the sharp increase in the number of motor vehicles (Table 4).
Table 4: Environmental Air Quality and Noise (Dongcheng 1991-1993)
Items
Total suspended particles p.lgfM3) Sulfur dioxide (~g/M') Sulfate (mg! M') Nitrogen oxide (~g/M') Carbon monoxide (mg! M3
)
Precipitating dust (tonnes/day.km') Average area noise level [dB(A)] Average noise level [dB(A)]
on traffic lines
2.2.4.3 Noise
1991
350 149
1.08 110
7.2 18.1 61.8 70.2
1993 National standards
350 150-500 136 50-250
1.08 126 50-150
8.6 4-6 17.0 57.8 695
The environmental noise level of all subdistricts of Dongcheng has met the national standard since 1987. Noise levels averaged 57.8 dB(A). Noise is caused by industrial production, construction,
traffic and social activities.
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2.244 Rubbish management
Annually, 413 600 tormes of rubbish are produced in Dongcheng. There are 54 enclosed rubbish collection stations aU over the District, where 6O"A. of rubbish is stored and transported daily.
2.2.4.5 Greening of the Environment
Up to 1994, 5S9.6 hectares afthe land have been covered with greenery, accounting for 20.14% of the total district area, with an average occupancy of9.11 square metres of private greenery and 2.44 square metres of public greenery per capita
2.2.4.6 Public lavatories
There are I 597 public lavatories aU over the District, and 300 000 tonnes of faeces are collected and transported annually. Along with the influx of a large number of floating population into the District, the quantity offaeces collected and transported increased yearly (Table 5). Most afthe public lavatories were built in the 1960s and 19705 and were of low standard. A lot of new public lavatories with complete sanitary facilities bave been established in recent years, but there still is a gap as compared with those in advanced cities (Table 6).
Table 5: Amount of Faeces Collected and Transported by Year (toones) (Dongcheng, Beijing)
Year 1990
Amount of Faeces 293251
Table 6: Rating of Public Lavatories (Dongcbeng, Beijing, 1993)
Grade
1&11 III Lower than III Total
2.2.4.7 Housing for residents
No.
20 lOS
1469 1597
1991
291 40 I
%
1.3 6.8
92.0 1000
1992
296580
1993
302489
There are 71 927 resident households in the District and 160 490.5 rooms with a totaI built-up area of 2 356 202 square metres and floor space of I 726 895 square metres. 9 387 households live in storeyed buildings with 35 241 rooms which have a built-up area of 566 007 square metres and floor space of 432825 square metres. Average occupancy of housing accounts for 6 square metres per capita.
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2.2.5 Health status
2.2.5. I Incidence of infectious diseases
Incidence of infectious diseases in Dongcheng District has been kept stable with a rate of about 501100000 for the past 12 years. Incidence rate of viral hepatitis was 123/100000, no polio case was reported for ten years, and new registration rate oftubercu1osis was 11.97/100000. Incidence of infectious diseases was reduced by 80% from 2266.71100 000 in 1983 to 453.3/100 000 in 1993. Infectious diarrhoea accounted for more than 70% of total cases of infectious diseases, and viral hepatitis (33.6% for type A and 24.5% for type B) came next. A sampling study on antibodies against hepatitis A in 1989 showed an average antibody positivity of 65.07%, and 91.17% for the subjects over 30 years and only 8.20% for children aged under five at high risk. Average antibody positivity of less than 80% is insufficient to form an immune barrier against hepatitis A, so there exist conditions for its outbreak. Prevention of viral hepatitis and infectious diarrhoea is a focus of disease: control.
2.2.5.2 Mortality
Mortality in Dongcheng District has been kept relatively stable since I 980s, with rates of about 911 000 for neonates, 12/1 000 for infants, and zero for maternal. Overall mortality begins to increase at ages over 40, and most of deaths occurred at ages over 60. Mortality in males was higher than in females. Deaths from infectious disease lowered significantly, and deaths from chronic diseases, such as cardiovascular and cerebrovascular diseases and cancer, accounted for an increasing proportion. (Table 7, 8, 9 and 10).
Table 7: Age-specific Mortality (1/100 000) (Dongcheng, 1981-1993)
Age Group (years)
0-10-20-30-40-50-60-70-80 and over
1981
141.35 43.77 72.71 86.40
232.15 796.39
2279.11 5977.80
15683.74
1983
172.46 37.54 64.03 66.25
206.60 617.96
1916.03 5329.03
12785.13
1988 1993
194.18 56.37 26.69 1.50 37.19 27.05
II 1.32 67.71 146.53 213.07 635.58 411.76
2 141.75 I 791.62 6536.86 5603.73
19051.23 17865.74
Table 8: Sex-specific Mortality (1/100 000) (Dongcheng, 1983-1993)
Sex 1983
Male 566.32 Female 564.96
Table 9: Accident Mortality (11100 000) (Dongcheng, 1983-1992)
Year Rates
1983 27.21 1984 23.65 1985 26.71 1986 26.11 1987 23.65 1988 24.57 1989 21.69 1990 20.51 1991 17.10 1992 30.42
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1986
640.71 568.00
1990
656.57 595.39
Order of Place in Causes of Death
5 5 5 5 5 6 7 7 7 6
1993
671.86 631.28
Table 10: Cause-specific Mortality (Ill 00 000) (Dongcheng, Beijing, 1953-1993)
Year Overall
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Causes of death Cerebro- Cardio- Tumour Respir. Digest. TB vascular vascular I. 2. 3.
1953 333.80 40.93 54.13 19.36 55.45 24.86 40.71 1963 500.26 66.42 67.73 62.49 60.69 30.92 29.61 1973 523.50 117.10 110.41 96.67 52.83 22.06 16.90 1983 556.21 137.32 118.92 119.56 40.74 21.39 7.71 1991 626.26 146.17 172.12 116.94 54.66 22.67 2.34 1993 728.96 155.21 138.55 107.69 23.30 1.64
1. Respiratory diseases 2. Digestive diseases 3. Tuberculosis 4. Infectious diseases
Infect. dis .. other than TB
4.
Other
29.27 69.09 17.67 164.73 4.58 98.96 4.25 106.33 ; 16 108.64 7.10 199.48
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2.2.5.3 Incidence ofsocio-behavioural diseases
There are 2 830 patients with mental disorder, including I 872 cases of schizophrenia (64.35%),104 ofemotionaJ-mernal disturbance (3.66%), 81 oforganic-mental disturbance (2.85%), 642 of mental retardation (22.61%),107 of hysteria (3.77%), and 78 of others (2.76%). All the patients now have been \Dldertreatmeot, and 543 of them (19.1%) have recovered fully and I 256 (44.24%) ameliorated, 762 (26.84%) in chronic stage, and 278 (7.98%) in acute fit. Now. 955 of them (33.67%) can perform full-tirnejobs and 316 (I 1.24%) part-time jobs.
SexuaJly transmitted diseases (STD), mainly gonorrhea and condyloma a~ including a few cases of syphilis, showed an increasing trend in the District in recent years, but no case of AIDS or HIV earlier was found (fable II).
Table II: Incidence of Sexually Transmitted Diseases (1/100 000) (Dongcheng, Beijing, 1990-1994)
Year 1990 1991 1992
Incidence 5.35 4.06 6.35
2.2.5.4 Occupational health
1993 IQ94
4.63 365
There are 106 medium- and small-sized factories in Dongcheng District, with I ~J employees exposed to hazardous materials in 71 factories. Thanks to enhancement oflabour protectIOn. the incidence of occupational diseases is low. Exposure to hazards in factories of the Distnct IS hsted in Table 12.
Table 12: Exposure to Hazards in Factories of Dongcheng District, Beijing (1993)
Hazards
Dust Lead BeozIene Mercury Acids Noise Heat a-ray Total
No. factories
15 6
16 2 3
22 6 I
71
No. sites with hazards
39 9
16 3 3
61 7 2
140
No. employees exposed
486 141 268 21 30
785 202 30
1963
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2.2.55 Food hygiene and nlltnllon
There are 12 &6& food-related enterprises wIth a total of 32 992 employees. Every year, the employees in food trades are physically checked-up. Those suffering from diseases have been removed from their duties involving direct handling of fuod. All the employees have been trained on food hygiene with a participation of 100% biennially. According to the statistics in 1994, the number of food-related enterprises increased by 6.7 times as compared with that in 1980. The number of inspectors for food hygiene aCCO\Dlted for 3.6 times more than those in 19&0. Food monitoring showed & 1.4% offood samples met the national food hYgienic standards
Four dietary surveys in Dongcheng District during 1959-1990 revealed that average protein and calorie intake of the residents accounted for 102% and 105% of the national recommendatioos respectively, and reached sufficient levels. Calorie composition of protein and fut increased by 16.5% and 12. I % respectively, and that of carbohydrate decreased by 21.5%. Protein, fut and carbohydrate accounted for 12%, 2&% and 60% respectively, of the total calorie intake, being close to the levels in Japan and the United States. This indicated that dietary nutritional levels of the people of the District have unproved significantly Intake of salt and soy bean sauce (accounted for salt) decreased from 21.7 grams to 16.5 grams daily, but it still is more than the recommended daily allowable intake of salt set by WHO Oess than 10 grams) and Japan (SIX grams).
2.2.5 6 Surveillance of insects and rats
Indices of fly and cockroach in 1994 were 9.5% and 1.0%, and lowered by 30.5% and 20% respectively, as compared with those in 1993. But the mdex of mosquito in 1994 was 14.&%,23.&% higher than m 1993. Rat density in residential areas was 0 82%. 88.6% higher, and that in special trade was 4%. 44.2% lower when compared with 1993
2.2.5.7 School health
There are more than 110 000 pupils in primary and secondary schools of the District. Indices of body development in school children and youths in 1994 showed their height, weight and chest circumference unproved as compared with those in 1984. 41.7% of them bad a good lung function and 55.7% had a good heart fimction. It indicated pbysical development was better. Prevalence rates of several common diseases are listed in Table 13.
Table 13: Prevalence of Several Common Diseases in School Children and Youth in Dongcheng District (Beijing, 1991-1993)
Schools Diseases 1991 1992
Primary Moderate malnutrition 33.3 32.2 Obesity 11.6 10.2 Anaemia 12.6 Dental caries 74.0 76.8 Ascaris eggs detected in stools 4.4 7.8
Secondary Moderate malnutrition 38.9 37.9 Obesity 8.0 10.8 Anaemia l6.l Dental caries 51.6 54.6 Ascaris eggs detected in stools 5.9 10.1
1993
25.7 11.3 17.1 76.6 5.2
35.3 14.0 8.4
57.3 3.8
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2.2.5.8 Sanitation in public places
There are about 600 public places, including guest houses, hotels, public bathrooms, shopping centres, barbershops, swimming pools, cultural recreational places, etc. All of them met the national standards in hygienic inspection, and monitoring of varied samples collected showed 94.6% of them met the hygienic standard. Persons employed in the public places are checked up periodically, and 99.6% of them met health requirements.
2.2.5.9 Medical, preventive, health care and rehabilitation service
There are 32 medical and health care institutions in the Distnct, including 24 hospitals at various levels, a health and anti-epidemic station, a maternal and child health care institute, mstitutes for prevention and treatment of mental disorders, tuberculosis, venereal diseases, an inshtute for health education, an institute for drug control and inspection, and a vocational health school, with an average occupancy of23.81 health professionals and 9.16 hospital beds per I 000 population (Table 14).
Table 14: Basic Information of Hospitals in Dongcheng, Beijing, 1994
Level of hospitals No. beds No. professionals No. visits No. hospitalized
Central I 690 ( 330) 3913 ( 38.3) I 888054 ( 31.4) 22 795 ( 346) Municipal I 875 ( 36.6) 3341(33.1) I 847 978 ( 30.7) 25 094 ( 38.2) District I 290 ( 252) 2326 ( 23.0) I 769826 ( 29.4) 16309( 24.8) Community 267 ( 52) 514 ( 51) 512853( 85) I 565 ( 2.4) Total 5122(1000) 10 094 (100.0) 6018 7I 1(100.0) 64 673 (1000)
Figures in brackets are percentages (%) oftlie total.
There are several large hospitals in the District with a lot of facilities for medical and preventive health care.
There are more than 120 000 people enjoying free medical care service, accounting for 20% of the total population, about 200 000 (34%) enjoying labour insurance, about 150 000 enjoying the treatment for reimbursing their only-child's medical charge, and about 50 000 school children enjoying disease insurance. Only 21 % of the total population pay their own medical expenses.
A health care network at three levels has been established since 1950s in Dongcheng, and all the health work, such as perinatal, maternal, pre-school children, school children, the elderly, occupational health care, and rehabilitation for mental patients and the disabled, has been developing in a comprehensive way in the District. Life expectancy has reached 77.5 years for males and 79.2 for females.
2.2.6 Urban health management
2.2.6.1 Management bodies
Urban health in Dongcheng District is mainly managed by all the functionary oureaux of the District Government and all the governmental commissions and offices, such as Leading Group of Envirorunental Comprehensive Management, Commission of Patriotic Health Campaign, Primary Health Care Commission, Leading Groups of Prevention and Control of Endemic Disea"c:s and
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Infectious Diseases, Greening Commission, Family Planning Commission, Committee of Health Education and Red Cross Society, etc. with the governmental offices in all subdistricts taking a lead and all sectors shouldering their own responsibilities under the compliance oflaws.
2.2.6.2 Laws and regulations for health management
Urban health is managed in accordance with the laws and regulations promulgated by the State and Beijing Municipality.
2.2.6.3 Law-enforcement
There are more than 400 law-enforcement officials and a work team of I 400 members (including 980 workers sponsored by local people for keeping the environment clean in the District) to manage health. But the number of law-enforcement officials is not enough to conduct frequent inspection.
2.2.7 Culture and education
Average schooling of adults in Dongcheng District is ten years. 20% have higher education and 24% have high school education.
Among employees, there are 59.13% WIth high school education or above. 43.53% are engaged in white collar work and 56.47% m physical labour.
There are 242 schools of varied kinds (excluding formal universities) in the District with 14 829 faculty and staff and 115 994 students.
2.3 Achievements and Experiences
The achievements and experiences of health care in Dongcheng during the past few decades have provided valuable information in planning urban health development.
2.3.1 Rapid social and economic development is one of the most important factors contributing to the success in health development. There has been improvement in living standard of the residents, health resource, education levels and environmental conditions.
2.3.2 The governments at all levels have been taking major responsibilities for health development, such as including the targets for health development into governmental social and economic development programmes, providing major financial support for health development, setting up policies for public health and disease control, establishing the health priorities, organizing intersectoral coordination, motivating the whole community's invoJvcmcnt, formulating programmes for health promotion and environmental health, supervising and evaluating the implementation of hcaIth care system, promoting hcaIth insurance system, giving support to professional training and scientific research, etc.
2.3.3 Health resource, including human resource, technologies, facilities and equipment and drug supplies, has been developed significantly at all levels of the District.
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2.3.4 A concept of macro-health has been developed and practised in the District, which aims:
2.3.4.1 to motivate the whole community's involvement and coordination between health sector and other sectors and between governmental and non-governmental organizations in health development;
2.3.4.2 to combine medical care service and preventive care service, and to place prevention first;
2.3.4.3 to develop a medical and health care network at three levels;
2.3.4.4 to formulate and implement programmes for health care, disease prevention and environmental management;
2.3.4.5 to set up laws and regulations for health management and to strengthen law-enforcement; and
2.3.4.6 to develop health resource.
2.3.5 Combination of western medicine with Chinese traditional medicine has been successfully practised in treatment and prevention of disease.
2.3.6 Health status of the residents in Dongcheng has improved since 1950s. (For detailed statistics please see paragraph 2 2)
2.4 Existing Health Problems and Specific Priorities
According to a health survey In Dongcheng District in 1994, health problems were identified as follows:
2.4.1 Unbalanced distribution of health resource
The large hospitals had most of the senior professional personnel, financial investments and high-tech equipment as compared to the community hospitals and institutions of preventive health care.
More patients were treated in large hospitals than in community hospitals. (See Tables 14 and 15.)
Table 15: Medical Care Service Delivered by Hospital at Different Levels (Dongcheng, Beijing, 1994)
Hospitals
Central Municipal District Community
% of visits
31.4 30.7 29.4
8.5
% of hospitalization
34.6 38.2 24.8
2.4
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24.2 RapId increase of medical costs
The cost of medical services increased annually by about 20% during the past few years
because of the following reasons:
2.4.2.1 Wide-use of high-tech equipment and new and imported drugs in the diagnosis and treatment of
disease.
24.22 Increase of drug prescription and prolongation of hospital stay.
2.4.23 Changes of disease spectrum and aging population. (Medical expense of the elderly is five to
ten times as high as that of the young).
2.4.2.4 HIgher use oflarge hospitals than of conununity hospitals.
2.4.2.5 Full coverage of free medical care servIce for employees ofgovemrnent organization, Institutions and enterprises caused overuse of drugs and medical service.
2.4.3 LImited coverage of health care insurance
At present, only 60% of the residents in the District are covered by health care insurance. A large number of pre-school children are not covered.
244 Changes of disease spectrum and aging population
Chronic diseases, such as cerebrovascular diseases, cardiovascular diseases and cancer, are the leading causes of deaths in the District, in recent years.
Most of the vaccine-preventable diseases have been under control, but viral hepatitis, infant pneumonia and diarrhoea are still taking away a lot oflives and risk of STD and AIDS is increasing (Table 16).
Table 16: Incidence of Some Infectious Diseases (11100 000) (Dongcheng, 1990-1994)
Diseases 1990 1991 1992 1993 1994
Hepatitis 93.9 96.6 104.9 121.0 98.6 Dysentery 440.8 418.5 340.2 276.6 441.6 Others 51.4 41.1 55.9 52.8 74.4 Overall 586.1 556.2 501.0 450.4 614.6
Aging of population and rapid flow of inunigrants from other parts of the country into the City has increased the health burden of the District. The proportion of people aged over 60 years has increased, accounting for 1.9% in 1963 to 13.5% in 1993 of the total population in the District. Transient residents from rural areas throughout the country totalled 300 000, equivalent to 40010 of the permanent residents of the District.
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2.4.5 Environmental problems
2.4.5.1 Greening of the environment
The beautification and greening of the environment is a key link to the physical and mental health of people. Green areas cannot meet the requiremEJrts of rapid urban derelopment. There is little land in urban areas that can be covered with greenery.
2.4.5.2 Public health facilities
The needs of public health facilities for urban residents exceed current available resources. Most public lavatories were built in 19605 and 19705 and need to be renovated. Public lavatories with good facilities are insufficient.
2.4.5. 3 Environmental pollution
With the increase of high-rise buildings, drinking water in the tanks on the top of the buildings can be polluted by paint.
Wastewater drainage from factories into underground water sources can cause pollution of drinking water.
Air pollution from coal burning during heating periods in winter gives rise to sulfur dioxide, smoke and dust. Air pollution is also caused hy exhaust emission due to the sharp increase in the number of motor vehicles.
Noise pollution is caused by industrial production, traffic and social activities.
Pollution is also caused by construction waste, municipal solid waste, and waste that has not been disposed of regularly.
2.4.5.4 Housing and space for physical exercises
ResidEJrts are not able to increase their living space because of rapid population growth . . Average occupancy of housing per capita in the District is small and there is not enough space for physical exercises and outdoor activities.
2.4.5.5 Food hygiene and safe water supplies
Food trade has increased rapidly with urban development, but inspection teams for food hygiene have not kept pace with the growth of food eoterprises. Coverage and frequency of food inspection are low. EquiplllEllt and capabilities for food inspection cannot meet the requirements of the rapid derelopment of the food trade in the District. There exist problems in cleaning and disinfection of tableware in food stands on the streets.
2.4.6 Social derelopmeot
2.4.6.1 Changes oflife..style (including physical inactivity, cigarette smoking, excessive alcohol drinking, consumption of artificial beverages, unhealthy dietary habits, etc.)
Economic dereloplllEllt makes people afIIumt and changes their life-style. Wheat flour and rice hare become the staple food of the residents, and com, millet and soy bean have become
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supplementary and non-staple food. There is increase in dietary intake of animal food and oils. Salt intake still tends to be high. Diet composition and nutrition appear to be unbalanced.
2.4.6.2 Stress and pressure from working and studying
A considerable number of people in the city suffer from stress and heavy mental pressure as a result of working or studying.
2.4.6.3 Modem cultural recreation
Increase of modem cultural recreational places, such as karaoke hall, dancing hall, etc. and prolongation of recreational time at night can cause negative effects on health.
3_ TARGETS AND STRATEGIES
3 . I Overall Targets
3.1.2 Primary health care and corresponding referral system should cover all the population of the District.
3 1.3 A system of financial support for health care should be developed to ensure all strata of society have an equal opportunity to access health care services.
3.1.4 Particular population groups, such as mothers and babies, female employees, pre-school and school children, the elderly, the disabled, and other people at high-risk, should be given special attention in health care.
3.1.5 Preferential allocation of health resource should be given to the under-privileged people and under-served areas.
3. I .6 Safe drinking water should be provided to everyone and waste disposal systems should be constructed to improve sanitation and to ensure a healthy life.
3.1.7 Housing and basic sanitary facilities should be improved.
31.8 Adequate foodstuff for the residents should be provided to ensure proper nutrition.
3. 1.9 Human and financial resource for health services should be developed.
3. I. I 0 The community's involvement in health planning and development, including the sharing of responsibilities should be mobilized.
3. 1.11 Relevant technologies should be developed.
3.2 Strategies
3.2.1 Motivation action of government at all levels to assume major responsibilities and leadership, to improve and enhance intersectoral coordination, sueh as District Patriotic Health Campaign Committee, Primary Health Care Commission, Disease Prevention and Control Committee, Greening
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l:ommittee, Family Planning Commission, Environmental Protection Commission, Red Cross Society, etc. and mobilize the community's involvement in planning and implementing health development.
3.2.2 Extend macro-health policies in a comprehensive way to build a healthy city with healthy residents, healthy environment and healthy community.
3.2.3 Infrastructure for health care system at all levels should be redesigned. Conummity health care will be delivered by general practitioners and primary health care workers at the lowest level, and people are encouraged to fully use it. The other two higher levels will provide support and more specialized service and should be used with restraint.
3.2.4 Reform health care insurance system and make it more efficiart and extend to a broad coverage of the residents to control the rapid increase of medical expenses. Specific measures, such as restricting drug prescription, shortening hospital stay, and assessing the use of high-tech in diagnosis and treatment should be instituted.
3.2.5 Health promotion and health education should be popularized to change unhealthy lifu.-style and harmful dietary habits of people, e.g. too much salt and fut in diet, cigarette smoking, physical inactivity.
3.2.6 National fitness programme and disease-<:ontrol programmes, will be formulated based on the changes of disease spectrum in the populatioo, including health care for mothers and children, the elderly, and all those at high-risk, such as immigrants.
3.2.7 Management of environmental health and environmental protection should be focused on the following fields:
3.2.7.1 Control of air pollution caused by coal-burning and motor vehicle exhaust emission.
3.2.7.2 Monitoring and managemart of safe water supplies, especially in high-rise buildings.
3.2.7.3 Provision of safe food and ensuring proper nutritioo.
3.2.7.4 Sanitatioo of public places and schools.
3.2.7.5 Establishment of a waste disposal system.
3.2.7.6 Improvement of housing and increase of space for physical exercises and other activities.
3.2.7.7 Expansioo of green areas in the District.
3.2.8 Health resources, including human resources and !\mils, should be distributed and allocated rationaUy to support community health care service, primary health care fucilities, appropriate tedmiques, programmes for disease prevention, and management of enviroomental health.
3.2.9 Use of Chinese traditional medicine in health care should be encouraged.
3.2.10 Health management of the immigrants in the Distria should be strmgtheoed.
3.2.] I Professional personnel training and scientific research in health care and health development should be strengthened to develop human resource and tedmiques.
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3.2.12 Relevant regulations for health management should be fonnulated and law-enforcement should be enhanced.
4. SET-UP OF A SPECIFIC PLAN
·u To set up a health development plan and 16 specific targets for "Health for AIl by the Year 2000", to establish a researcb organization for urban health development by the District government, and to convene a meeting of health work annually for work arrangement and examination (see Annex).
4.2 To set up "Responsibilities ofGovemment Sectors and Social Organizations in Realizing Health for All by the Year 2000" in order to realize active involvement of the whole society in health work.
The responsibilities involve more than 40 sectors, and each sector should incorporate their work into health development according to their duties and play an active role. An evaluation method will be fonnulated by District Conunission of Primary Health Care to promote health development.
·u To adhere to the policy of macro-health and to manage environmental health in a comprehensive way, and to set up detailed plans of implementation by aU relevant sectors.
Targets for controlling smoke and dust by the year 2000 are listed in Table 17.
Table 17: Targets in Setting-up Smoke- and Dust-Control Areas (Dongcheng)
Items 1993 1995
Total number of furnaces, kilns 7737 7780 and stoves No. of boilers 636 640
(> 0.7 mega-watts) No. of boilers up to the 426 499
standard for smoke and dust % of boilers up to the standard 67 78
for smoke and dust No. of furnaces, kilns, and 7041 7391
stoves up to the standard for blackness
% of furnaces, kilns and stoves 91 93 up to the standard for blackness
2000
7780
640
544
90
7391
95
Moulded coal (e.g. briquette) should be used extensively in family beating and in organizations and institutions to control smoke and dust (Table 18).
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Table 18: Targets to Popularize the Use of Moulded Coal (Dongcheng, Beijing)
Items
% of households to use moulded coal
% of restaurants to use moulded coal
% of organizations to use moulded coal
1993
100
85
15
1995
100
90
30
Targets to control car exhaust emission are listed in Table 19.
Table 19: Targets for Control of Car Exhaust Emission (Dongcheng, Beijing)
Items
% of cars with exhaust emission detected
% of cars meeting the standard for exhaust emission
1995
50
70
2000
100
100
100
2000
80
95
To develop central beating is a major measure to protect the environmeut and control air pollution. Currently, central heating covers a total area of680 000 square metres. Central heating will cover 1.2 million square metres by 1997, with urban construction, renovation and development. Twenty boiler rooms and 16 boilers will be eliminated by 1997, which will improve air quality in Dongcheng, and even in Beijing. Targets for central heating are listed in Table 20.
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Table 20: Planned Targets for Central Heating (Dongcheng, Beijing)
Areas
Xiaohuangzhuang Dongyingfang No 3-6 Areas
in Hepingli No.6 Area
Answaidajie No 5 Area
Anwaidajie
Power ofl>oilers
(Mega -wattslhour)
7 5.6
10.5
7
7
No. of boilers
4
3 3
3
3
Area coverage
(M')
360000 120000 280000
220000
220000
Expected completion
date
1995-1997 1995-1997 1995-1997
1995-1997
1995-1997
Environmental noise should be reduced to below 55 d8(A). It is targeted that 95% of noise sources should meet the standard at the factory boundary (Table 21).
Table 21: Targets for Noise Control at Factory Boundary (Doogcheng)
Items 1993 1995 2000
No. of noise sources I 517 1203 1500 No. of noise sources 1423 I 119 I 425
meeting the standard % of noise sources 93.8 93.8 95
meeting the standard at factory boundary
There are 54 enclosed rubbish collectioo statioos in the District. Another six such rubbish statioos will be built by the year 2000 to meet the needs of rubbish storage and transportatioo (Table 22)
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Table 22: Targets for Rubbish Storage and Transportation (Dongcheng, Beijing)
hems 1993
No. of rubbish stations \0
1995
54 AmOWlt of domestic rubbish 410000 420000 transported (tormes)
AmoWlt of rubbish 246000 350000 transported from enclosed stations (tonnes)
% of rubbish storage and 60 83.3 transportation in enclosed stations
2000
60 450000
450000
100
Green areas will be expanded by five hectares and 5 000 trees will be planted annually in the District by 2000. Targets for greening are listed in Table 23.
Table 23: Targets for Construction of Green Areas (Dongcheng, Beijing)
Items 1993
Urban green areas 5846.4 (X I 000 M')
Green coverage (%) 20.22 Per capital public 2.24 green areas (M')
Per capita green 9 areas (M')
1995 2000
5992.5 6133.7
21.23 22.24 2.38 2.51
9.11 10.23
To improve housing conditions, floor space per capita will be increased and renovation of dilapidated housing will be expedited (fable 24),
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Table 24: Targets for Housing Improvement (Dongcheng, Beijing)
Items 1993 1995 2000
Average occupancy of 6 7 8 floor space per capita (M')
% renovation of dilapidated 40 45 60 housing
4.4 Health Service
4.4.1 Enhance construction of community health care service and practise general practitiooer system.
By the year 2000, 50 to 100 general practitioners will be trained in Dongcheng to proVIde professionals for community medical care service, with an investment of 500 000 RMB yuan from the District government.
4.4.2 Establish centre for disease control and prevention, and three centres for chronic disease control (e.g. prevention and treatment of cerebrovascular diseases, cardiovascular diseases and cancer).
4.4.3 Strengthen law-enforcement teams for public health surveillance and inspection, and improve health care network at grassroot level. Staff for health law-ilflforcement will be doubled in three years.
4.4.4 Establish a CE>ltre for maternal and child health care and one centre for health care and rehabilitation for the elderly.
4.4.5 Formulate a three-year plan for mernaJ health work.
4.4.6 Establish an office building for WHO-Dongcheng Coordinating Centre for Urban Health Development to conduct research on primary health care and train technical professiooals.
4.4.1 Streamline district-affiliated hospitals for implementing the targets for commlDlity medical, preventive and health care, and rehabilitatioo.
4.4.8 Control the increase of free medical expense, formulate a catalogue of prescription drugs, reduce hospital stay and set up beds for one-day-stay.
4.4.9 Evaluate the use oflarge-sized medical equipment and maximize reasonable use.
4.4.10 Establish a new hospital of Chinese traditional medicine and use herbal medicine, acupuncture and massage in the treatment.
4.4 .11 Conduct studies on food hygiene and nutrition, improve status of food hygiene, promote a reasonable diet, and therefore lower incidence of diseases caused by contaminated food and unhealthy diet.
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4.5 Establish subdistrict centres for primary health care by all Subdistrict Governmental Offices and ten community service centres to develop primary health care and to provide welfare service for the local residents.
4.6 Develop health education actively by preparing plans and evaluating the effectiveness of health education on the residents, enterprises, institutions, factories, governmental bodies, schools, kindergartens and nurseries, etc.
Funds for health education will increase by 5 000 yuan every year and account for 60 000 yuan by the year 2000 in the District.
4.7 Plan an evaluation method for implementing the target for Health for All by the Year 2000 in Dongcheng District.
4.8 Plan a national fitness programme and measures for its implementation, which will be supervised by relevant sectors.
4.9 Enhance the formulation of health management regulations.
5. IMPLEMENTATION OF THE PLAN
Doogcheng Government will formulate a plan ofbealth development for the whole District with its Cbairman taking the lead and responsible for the overall plan. Each deputy chairman WIll be responsible for the work set by the plan under hislber own authority.
Local bealth plans will be formulated respectively by all ten subordinate agencies, i.e., neigbbowbood offices, according to the bealth development plan of the whole District.
Measures for implementing the plans should be formulated by the District and Subdistrict governments which should take firm leadership.
The plan and its implementing measures should be categorized by the District Commission of Primary Health Care into varied parts for the 20 conunission member organizations, including departments of public health, education, culture, sports, environmental health, environmental
. protectim, housing administration, horticulture and aiforestatioo, labour and personnel, industrial and commercial administration, COJJIIIIlIIlica public security, civil affiUB. trade, propaganda. planning and econany, statistics, finance and ccmtructioo, for them to be implemented.
Social organizatims related to urban health development. such as Aging Committee, Red Cross Society, Trade Unioo. Women's Federation, Patriotic Health Campaign Committee, etc. will formuJate their own responsibilities and measures for the implemmtatioo of the plan.
All the responsibilities set in the plan should be taken by all sectors of the District government as follows:
· 2~ .
5. I Health Sector
5.1.1 The health sector of the District is responsible for the routine work of the Office for the District Commission of Primary Health Care in formulating annual and quarterly working scheme and criteria for evaluation of primary health care in the District. reporting of implementation of work to the Commissioo, and technical direction in primary health care.
5. I .2 Set up the procedures in management of an information network.
5.1.3 Mobilize and organize the public to participate in all individual, fiunily and community health activities under the leadership of the District Commission of Primary Health Care and in cooperation with relevant sectors; deliver health education and health direction to the masses and inform them the factors affecting health.
5.1.4 Provide medical, preventive, health care and rehabilitation service for the people quickly and systematically and develop prevention and treatment of major diseases.
5.1.5 Improve the scientific level of health management, distribute health resource reasonably, improve efficiency in the use of health resource and uplift social and economic benefits in the health sefVlce.
5.1.6 Put all health laws and regulations into effect, such as "Law of Food Hygiene", "Law of Infectious Disease Control", "Regulations of Health Management of Public Places", "Regulations of Inspecting and Monitoring of Drinking Water", "Regulations of Disinfection Management", etc.; strengthen supervision of health law-enforcement; and adopt strong measures to lower incidence of infectious diseases and food poisoning.
5.1.7 Enhance the studies on needs for preventive and health care sefVlce.
5.1.8 Enhance continuing education for on-the-job professionals and training for technical personnel.
5.1.9 Strengthen international and domestic cooperation and exchanges of research in medical science and technology and primary health care, and secure international health resources for the District's primary health care.
5.2 Education Sector
5.2.1 Improve people's level ofcubure and education.
5.2.2 Provide medical and health care professionals to develop health education in primary and secondary schools, nurseries and kindergartens in a planned way with diversified contents and forms.
5.2.3 Put ~Regulations of School Hygiene" into effect in cooperating with the health sector, carry out health surveillance, deliver dental and eye care, defuct correction. prevention and treatment of diseases, and provide immunization for students following fixed schedules.
5.2.4 Keep school yards clean, make drinking water safe and dining halls hygienic, and create a sanitary and beautiful environment conducive to study and protect students from infectious diseases and food poisoning.
5.25 Strengthen physical exercises among students to improve their physical constitution.
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5.2.6 Organize the participation of teachers and students in the activities of primary health care and improve their personal health care consciousness and abilities.
5.2.7 Pay attention to the publicity and education in psychological health of students and provide them with psychological counselling.
5.3 Office of Spiritual Civilization
5.3.1 To promote activities in building up spiritual civilization, including cultural construction in enterprises, communities, school yards, fumilies and streets, and to generate more civil enterprises, institutions, communities, school yards and families.
5.3.2 Inculcate ethics, social responsibility and culture, and intensify people's public spirit as residents in this capital city and arouse their enthusiasm and initiatives in helping to reconstruct the capital.
5.3.3 PubhclZe the deeds of model workers.
5.3.4 Study and fonnulate a plan for building Dongcheng into a splTltually CIVIlized District and to provide spintual guarantee for implementing the target for Health for All by the Year 2000.
5.4 Culture. Propaganda and Sports Sectors
5.4.1 Instill knowledge of primary health care among the people, make them know the significance, alms and contents of primary health care, promote their involvement in it, enhance their consciousness and improve their capabilities in family and personal health care.
5.4.2 Combine physical exercises with health activities, publicize sports and health, and organize activities for public health and sports.
5.4.3 Ban the publication and sale of books and audio-visual products hannful to the physical and mental health of people, especially of teenagers.
~.~ Sectors of Public Undertakings. such as Civil Construction. Environmental Protection. Environmental Health Housing Administration. Greening of the Environment etc.
5.5.1 Mruntain and repair housing, improve housing conditions and ensure their safuty. Pay attention to ventilation, lighting, convenience, recreational space for children, comfort for the elderly and the disabled in the design of new residences and renovation of dilapidated houses according to the District's plan. Make available rooms for medical and health care in new residential buildings which are far away from hospitals.
5.5.2 Keep drinking water tanks on the top of high-rise buildings clean with strict management. Draw drinking water to households in sing!e-storeyed houses gradually on the premise of sufficient water pressure. Protect drinking water from contamination.
5.5.3 Dispose offaeces, rubbish and sewerage adequately, improve sanitation of public toilets, build and maintain facilities of drinIcing water pipelines and sewerage. and implement daily sanitary wmk.
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5.5.4 Strengthen environmental protection, disposal of waste gas, wastewater and waste solids, and noise control. hnprove the quality of the environment.
5.5.5 Strengthen greening, beautifying and cleaning of the environment. Increase green areas to a greater extent yearly.
5.6 Trade and Commerce Sector
5.6.1 Enforce laws and regulatioos promulgated by the State and Beijing MWlicipaiity, such as "Law of Food Hygiene", "Law of Drug Administration", "Law of Infectious Disease Control", "Regulatioos of Health Management in Public Places", etc.
5.6.2 Strengthen health management offood in its production, supply, transportatioo and distribution to maintain nutrition, hygiene and quality of fOod. Strictly to furbid the marketing of banned fuod in the city, prevent fOod from cootaminatioo and ensure aU goods 00 the markets do not endanger human health.
5.6.3 Institute concrete measures for abiding by the above-mentioned requirements in accordance with the characteristics of the sector.
5.7 Industrial and Commercial Administration Sectors
5.7.1 Actively publicize relevant laws and regulatioos for the managers and self-employed busmessmen.
5.7.2 Enhance bea1th inspectioo and supervisioo in concerted efforts with the health sector.
5.7.3 Investigate unlawful business activities, such as production and sale of fraudulent, take, bad, putrid and spoiled food, etc., and deal with them according to the law. Strengthen market administratioo and crack down on illegal behaviour such as speculatioo and profiteering.
5.8 Labour and Personnel Sector
5.8.1 Adopt measures for labour protection, pay attentioo to occupatiooal health and control dust and toxic exposure in production. Enhance educatioo, inspection and supervisioo ofproductioo safety fur employees and protect them from occupational poisooing. heat stroke and industrial accidents.
5.8.2 Urge entetprises to have periodic medical examinations fur their employees.
5.8.3 Provide medical and health care persormel and fucilities to workers.
5.8.4 Provide employment opportWlity fur the recovered mental patients.
5.9 Conummicatioo. Public Security and Civil Affirirs Sectors
5.9.1 Manage traffic strictly, streamline traffic order and prevent traffic accidents.
5.9.2 Train motorists 00 oo-the-spot treatment of trauma and first-aid.
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5.9.3 Manage the floating population and crack down strictly on prostitution and drug abuse.
5.9.4 Register births and deaths in coordination with other relevant sectors, and obtain necessary statistical data of population annually from local police stations needed for primary health care work.
5.9.5 Enforce "Beijing Municipal Regulation for Dog Raising" seriously, to ban raising ofdogs in urban areas, and to protect the people from dog bites and occurrence of rabies.
5.9.6 Offer preventive management for mental patients in coordination with relevant sectors and provide working and treatment stations for the patients to speed up their recovery.
5.9.7 Include primary health care in community service, build and manage institutions for nursing the elderly and the disabled, and deliver rehabilitation service for the disabled as well as secure employment for them.
5.9.8 Pay close attmtion to better childbirth managemmt and better care of babies in coordination with relevant sectors. Ensure the implementation of premarital medical check-up and health education.
5.10 Planning, Economy, Finance and Statistics Sectors
5. 10 I Pay attention to meeting the objectives set in the District health plan while studying and formulating an economic and social development programme.
5.10.2 Combine health development with social and economic goals. Allocate health expense to account for 5% of the gross national product or for 8% oftotal financial expenditure.
5.10.3 Study how to reasonably allocate and efficiemly use health resource in order to sustain key projects, strengthen grassroots and preventive health care and improve social and economic efficiency of health investment.
5.10.4 Provide relevant infonnation for governmental research work.
5.10.5 Provide financial support for the rehabilitation of mental patients.
5.11 Subdistrict Governmental Office
5.11.1 Formulate amlUallocal plan for implementing the target for Health for All by the Year 2000.
5.11.2 Establish an organization network for primary health care in the District.
5.11.3 Integrate primary health care into community service, develop all health care work in coordination with local hospitals and set up primary health care stations in accordance with practical needs.
5.11.4 Offices ofneigbbourhood patriotic health campaign committee, red cross society and fiuniIy planning commission should closely ooopei3te with eacb other in primary health care.
5.11.5 Invest funds for developing local primary health care annually by the subdistrict govemmeotaJ offices.
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5.11.6 Strengthen hygienic management for food enterpnses.
5.11.7 Treat and rehabilitate mental patients, establish working and treatment stations for them and set up supervisory and nursing groups in the neighbourhood committees to care for them.
5.12 Patriotic Health CampaIgn Committee
5.12.1 Formulate a work plan based on the targets set by the District and the patriotic health campaign committee at upper level and coordinate the work with all sectors and member organizations of the District Patriotic Health Campaign Committee.
5.12.2 Develop social management of public health and organize public health supervision, sanitary inspection and evaluation.
5.12.3 Instill scientific knowledge on health, inculcate good healthy habits in the public, publicize anti-smoking campaigns, and increase the number of no-smoking premises.
5.12.4 Carry out mass practIces of eliminating flies, mosquitoes, rats and cockroaches.
5.13 Familv Plarullng Conmllssion
5. 13. I Control population gro\\ th and mcrease the proportIOn of people practising planned parenthood
5.13.2 Conduct premarital medical check-up in coordination with health sector and increase proportion of young couples receiving premarital education.
5.13.3 Disseminate knowledge of contraceptIon, ensure adequate supplies of contraceptive drugs and device, promote pre-contraception management, increase efficiency of birth control, and reduce induced abortion.
5.13.4 Increase proportions of those taking leave after contraceptive operations and to disseminate health care know-how.
5.13.5 Increase the registration of women in theIr early gestation.
5. 13.6 Carry out seriously the rule that couples can take leave for late marriage and encourage more women to breast feed.
5.13.7 Disseminate premarital education for young couples and increase the proportion of couples with knowledge of better birth care.
5.13.8 Publicize health insurance and increase the number of insured.
5.13.9 Teach the basics of population and family planning in schools in coordination with health, legal and research sectors. Offer basic knowledge and training ofpopu1ation theory, policy, laws and reguhitions, and special protection in five stages of life (i.e. adolesc:ent, newly-wed, gestational and delivery, lactational and climacteric stages).
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5.14 Trade Union_ Communist Youth League, Women's Federation
5.14.1 Organize employees, young people and women to take an active part in primary heahh care, develop psychological health counselling. carry out social and public heahh education and abide by all health laws and regulations.
5.14.2 Protect women labour.
5.14.3 Supervise all sectors and units in implementation of employee labour protection, defend workers' health and prevent the occurrence of diseases
5.15 Red Cross Society
5.15.1 Publicize the work of the Red Cross Society, i.e. rescue the dying and heal the wOWlded, help the distressed and those in peril, respect the aged and belp the disabled and others as pleasure.
5. 15.2 Publicize extensively how to carry out first aid in emergencies, focus on rescue procedures, and offer first aid training to the public.
5.15.3 Strengthen health education among teenagers, print publicity materials focusing on smoking and bealth, first aid, disease prevention and health care.
5.15.4 Be involved in primary heahh care in the District, and give Red Cross members a major role in primary health care.
5. I 6 Committee for the Elderly
5.) 6.1 Organize the elderly to gain knowledge ofheahh care and rehabilitation, improve their quality oflife, enhance their awamtess and ability of personal heahh care and improve their heahh status.
5. ) 6.2 Enrich the lives of the aged, run a university for the aged and organize heahhy activities for them.
6. INDICES FOR EVALUATING THE IMPLEMENTATION OF THE PLAN
The indices for evaluation are listed in the Annex. The evaluation is indicated in two stages: in 1995 and 2000.
7. BUDGET
The District Government will invest about \30 million RMB yuan each year to implement the plan.
1.
1.1
1.2
1.3
2.
2.1 22 2.3 2.4 2.5
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TARGETS FOR URBAN HEALTH DEVELOPMENT IN DONGCHENG DISTRICT (f ARGETS FOR HEALTH FOR ALL BY THE YEAR 2000)
Indices 1995 2000
The Strategic Target for Health for All by the Year 2000 should be included in the objectives of governmental work and overall plan for socioeconomic development
The strategic target for Health for All by the Year 2000 (HF N2000) approved and 100 100 promulgated by the Standing Committee of District People's Congress should be included in the objectives of govemmental work and overall plan for socioeconomic development (%)
A strategic programme and annual plans for HF N2000 should be set lip by District 100 100 Government, and periodical evaluation of the implementation of the plan (%)
Percentage of enhancement of leadership and management system for primary health 100 100 care (%)
Health Resource for Realization of Primary Health Care
Proportion of governmental expenditure for appropriations to health undertakings (%) 6 8 Average cost for preventive health care (RMB yuan per capita) 3 5 Coverage of public medical insurance system (%) ? ?
Coverage of first-aid medical network (%) 100 100 Coverage of community medical care service (%) 100 100
ANNEX
Responsible sectors
Planning & Economic Commission
PHC Office
Statistics Bureau
Financial Bureau Health Bureau
Health Bureau
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Annex
Indices 1995 2000 Responsible sectors
3. Development of Health Education
3.1 Proportion of dissemination of health education in primary and secondary schools (%) 100 100 Education Bureau 3.2 Proportion of dissemination of health education in residents (%) 90 100 Health Bureau 3.3 Proportion of students in primary and secondary schools who are aware of health 80 90 Subdistrict
knowledge (%) Offices 3.4 Proportion of students in primary and secondary schools who have formed healthy 80 90 Patriotic
behaviour (%) Health 3.5 Proportion of permanent residents who are aware of basic health knowledge (%) 80 90 Campaign
Committee 3.6. Proportion of permanent residents who have formed healthy behaviour (%) 70 80 3.7 Proportion of permanent households which meet the criteria for primary health care (%) 60 70 Culture
Bureau 3.8 Propoltion of employees who are aware of basic health knowledge (%) 80 90 Propaganda
Sector 3.9 Proportion of employees who have fonned healthy behaviour (%) 75 80 Red Cross Society 3.10 Coverage of no-smoking public places (%) 85 100 3.11 Proportion of health education in young children (%) 50 80
4. Promotion of Community Health Care
4.1 Coverage of community health care service (%) 7 ? Education 4.2 Coverage of general practitioners service (%) 7 ? Bureau
• 32 •
ANNEX
Indices 1995 2000 Responsible sectors
4.3 Percentage of promotion of eye health care (%) in school children and youths 100 100 4.4 Percentage of dental caries being filled in school children and youths 70 85 Neighbourhood
Committee 4.5 Percentage of promotion of health guide to the elderly (%) 80 90 Public Security 4.6. Proportion of mental patients under management (%) 100 100 Bureau 4.7 Proportion of rehabilitation for patients with mental disorders 80 90 Civil Affairs 4.8 Proportion of patients with hypertension under systematic. management (%) 80 90 Bureau
5. Health Surveillance and Inspection of Public Places
5.1 Coverage of hygienic inspection of public places (%) 100 100 Education Proportion of hygienic inspection of public places up to standard (%) 90 90 Bureau Frequency of hygienic inspection of public places (times per year) 1·2 2 Aging Committee Proportion of hygienic monitoring of public places up to standard (%) 80 90 Health Bureau
5.2 Coverage of hygienic inspection of medical and health care institutions (%) 100 100 Frequency of hygienic inspection of medical and health care institutions (times per year) 1·2 2 Proportion of hygienic monitoring of medical and health care institutions up to standard 80 90
(%) 5.3 Coverage of hygienic inspection of kindergartens and nurseries (%) 100 100
Frequency of hygienic inspection of kindergartens and nurseries (times per year) 1-2 2 Proportion of hygienic monitoring of kindergartens and nurseries up to standard (%) 80 95
5.4 Coverage of hygienic inspection of primary and secondary schools (%) 100 100 Frequency of hygienic inspection of primary and secondary schools (times per year) 1-2 2 Proportion of hygienic monitoring of primary and secondary schools up to standard (%) 80 90
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Annex
Indices 1995 2000 Responsible sectors
5.5 Proportion of domestic rubbish management up to standard (%) 95 100 Environmental Sanitation Bureau
5.6 Proportion of public toilets up to standard (%) 90 100 Patriotic 5.7 Proportion of public toilets of Grades I, II or III (%) 73 85 Health Campaign 5.8 Proportion of faeces being treated (%) 90 90 Committee
6. Hygienic Surveillance and Monitoring of Drinking Water and Foodstuff'
6.1 Proportion of drinking water up to standard (%) 95 99 Health 6.2 Proportion ofhouseholcls with private use of tap water (%) 80 90 Bureau 6.3 Proportion of secondary water supply up to standard (%) 95 100 Construction
Committee Housing 6.4 Coverage of hygienic inspection of key food enterprises (%) 100 100 Administr.
Frequency of hygienic inspection of key food enterprises (times per year) 1-2 2 Commercial Commission
Proportion offoodstuff up to standard (%) 80 90 Industrial Commercial Proportion of products in food processing enterprises up to standard (%) 100 100 Administr. Proportion of foodstuff in foreign-oriented hotels and restaurants up to standard (%) 90 95 Proportion offoodstuffin medium- and small-sized enterprises up to standard (%l 75 80
6.5 Proportion of tableware disinfection in foreign-oriented hotels and restaurants up to 95 98 standard (%)
Proportion of tableware disinfection in medium- and small-sized restaurants up to 75 85 standard (%)
Proportion of tableware disinfection in food stands on tile streets up to standard (%) 60 80
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ANNEX
Indices 1995 2000 Responsible sectors
6.6 Incidence of food poisoning (1/ I 00 000) 15 10 6.7 Proportion of the causes offood poisoning being studied clearly (%) 85 95
7. Hygienic Surveillance and Control of Hazardous Operations in Industrial Enterprises
7.1 Proportion of monitoring of operation sites exposed to du.st up to standard (%) 71 80 Health Bureau 7.2 Proportion of monitoring of operation exposed to toxic and hazardous materials lip to 71 90 Labour Bureau
standard (%)
7.3 Proportion of patients with occupational diseases under systematic management (%) 90 90 Trade Union
8. Lowering Mortality in Children
8.1 Proportion of systematic management of child health (%) 95 100 Health Bureau Coverage of systematic management of child health care (%) 90 95 Trade Union
8.2 Coverage ofplaIUled immunization offour kinds of vaccine for chddren (%) 99 99 Women's Coverage of hepatitis B vaccination for children in full course (%) 90 95 Federation
8.3 Infant mortality (Ill 000) 12 II Neonatal mortality (1/1 000) 9 8.5 Perinatal mortality (1/1 000) <125 <12
8.4 Mortality of children under five years old (1/1 000) 13 12 8.5 Proportion of screening for neonatal diseases (%) 95 98
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ANNEX
Indices 1995 2000 Responsible sectors
9. Maternal Health Care
9.1 Coverage of pre-marital check-up 100 100
9.2 Proportion offemale employees enjoying special health care during their menstrual, 80 85 gestational, puerperal and lactational stages (%)
Proportion of treatment for four gynaecological diseases in female employees (%) 80 85 9.3 Proportion of systematic management of health care for pregnant women (%) 99 99
Coverage of systematic management of health care for pregnant women 95 99 9.4 Maternal mortality (1/100 000) 20 20 9.5 Proportion of periodical screening for gynaecological diseases in woman residents aged 60 65
over 40 (%) Proportion of periodical screening for gynaecological diseases ill woman employees In 80 85 enterprises and institutions aged over 40 (%)
9.6 Proportion of technical management for birth control (%) 100 100 Family Planning in Medical care institutions (%) Commission positive acid-fast bacilli in sputum smear under supervision of chemotherapy (%) Health
9.7 Proportion of infants under four months with breast feeding (%) 50 70 Bureau Proportion of neonates with breast feeding only (%) 60 80
10. Lowering Incidence of Notifiable Infectious Diseases
10.1 Proportion of under-reporting of infectious diseases <I Health 10.2 Overall incidence of notifiable infectious diseases (I1100 000) 420-500 300-400 Bureau
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ANNEX
Indices 1995 2000 Responsible sectors
Incidence of hepatitis (11100 000) 96-123 80-100 Patriotic Incidence of poliomyelitis (11100 000) 0 0 Health Proportion of cases of tuberculosis 90 95 Campaign
10.3 Proportion of ORS (Oral Rehydration Salts) use in patients of infectious diarrhoea (%) 90 95 Committee
II. Envirorunental Protection
11.1 Proportion of area noise control meeting the standard (%) 55 55 En vironmenta I 11.2 Average daily concentration oftetal suspended particles ()lg per standardized square 350 350 Protection
metres) Bureau 11.3 Average daily concentration of sulfur dioxide ()lg per standardized square metres) 150 150 11.4 Proportion of treated industrial liquid waste meeting the standard (%) 50 60
12. Greening of the Urban Environment
12.1 Coverage of green areas (%) 20.8 20.8 Horticulture 12.2 Average occupancy of public green areas per capita (square metres) 2.4 2.5 & Afforestation 12.3 Average occupancy of green areas per capita (square metres) 9 10 Bureau
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Annex
Indices 1995 2000 Responsible sectors
13. Housing
13.1 Average occupancy of floor space per capita (square metres) 7 8 Construction Commission
13.2 Proportion of dilapidated housing under renovation (%) 45 60 Housing Administration
14. Education Level of Population
14.1 Percentage of literacy in people aged above 15 (%) 95 95 Education 14.2 Proportion of population with university and college education to the total population (%) 25 30 Bureau
15. Average Life Expectancy (yea rs) for males 74.95 77.5 All sectors for females 75.53 79.2 concerned
16. To Reduce Accident Injury
16.1 To reduce traffic accidents (%) ? ? Communication 16.2 To reduce accident deaths (%) ? ? Bureau
Red Cross Society