Study On Equity Of Public Health Services

There have been sorts of definitions of public health since 1920s. Those definitions described the significance and uniqueness of public health, which was defined as one of the social undertakings in different perspectives. From previous definitions, it can be concluded that public health services have main tasks of disease prevention and health promotion whenever the definitions took place, and also have a common character of social universality. However, because of the diversity of periods and countries, there are too many methodologies on equity of public health services, and it cannot be summed up as a single complete research system. This article sets an example of sanitation improvement in rural China, based on effective comprehensive study on equity of public health services, building relatively perfect method and structure for the future related scholars to use for reference.Setting sanitation improvement as the study case is not only because of its intention of disease prevention and health promotion, high social universality, and its intimate links with people’s lives, but also the significance of sanitation improvement which is ignored by the majority. As the three diseases (Aids, bacillary phthisis and helopyra) are getting more attentions from all over the world, lots of people have no idea that the overall death toll caused by diarrhoea has far exceeded the ones caused by the three diseases mentioned before. According to the data, there were about 2.4 million people (4.2% of total deaths per year) died for diseases like diarrhoea due to poor drinking water and bad sanitation situations. The key points to controlling diarrhoea are improving drinking water, sanitation situations and personal health behaviors.This article develops the study on equity of public health services from four perspectives, the equity visualization, equity assessment, equity influencing factors and policy suggestions on equity situation.According to the national statistical yearbooks and the health statistics yearbooks, the equity visualization shows the dataset which contains improved sanitations coverage rate of rural China from 31 provinces and autonomous regions. And the data are directly presented by using the ground color of each province on the map, where the histograms of demographics are placed as well, like economic development indicator (net income of rural people), average education level of local people (proportion of college students) and nations. The whole map was developed by high compatibility software Flash while a website was built for public using with cloud computing technology. The website is www.cnwc.org.The equity assessment is processed from three perspectives, health equity, equity of public health service utilization and distribution, and financing equity of public health service. Based on the data collected from provinces, concentration curves are pictured, like concentration curve of incidence of diarrhoea from 2003 to 2012, concentration curve of improved sanitation, concentration curve of income, and concentration curve of government investment in Medical Reform from 2009 to 2011, and the concentration index and absolute concentration index are calculated. Besides, according to the data from county level and individual level in 2011, concentration curve is drawn and concentration index is calculated. It is found that the regional differences of diarrhoea incidence are decreasing from year to year, and it rebounded from 2008. From 2003 to 2012, the differences in income of rural people decreased. From 2003 to 2008, the difference in sanitation improvement increased from the east to the west by years, which was improved from 2009 to 2012. This improvement was attributed to the Medical Reform from 2009 to 2011. During these three years, the government has invested 4.47 billion yuan in sanitation improvement. And the distribution of the investment was linked to the situation of each province. In China, the difference in intra-province is less than the difference in inter-province. The sanitation improvement has an obvious regional characteristic.The equity influencing factors are measured from three perspectives. First of all, on a macro-scale, the data are resolved by applying decomposition models of grouped data. First step of the model is to process multiple regression analysis and to find the influencing factors by using county level data from 2003 to 2012. And then, the concentration of province-scaled improved sanitation in the same years is resolved by the model built before, calculating the quantitative influential factors of sanitation improvement equity and the change of their contribution rate in the last decade. After resolving, it can be found that the sanitation improvement is influenced by the local economy status, the proportion of minorities, education level and the local temperature, where the economy status affects the most. However, along with the government policy of equalization of public health services, the contribution of economy status to the model has decreased; nonetheless, the model’s contribution reached nearly 50% in the end of 2012. Secondly, on a micro-scale, according to the investigation of family questionnaire on condition of improved sanitation using, health knowledge, attitude toward health knowledge and personal health behavior, applying binary Logistic regression, Pearson correlation analysis, the investigation results are profoundly studied. The result shows that the number of family members, annual per capita necessities expenditure, and subsidy for sanitation improvement are the main factors; besides, health knowledge, attitudes toward health knowledge and personal health behavior all have high relativity with sanitation improvement. Thirdly, from expert perspective, the gauge and questionnaires are designed based on bottleneck analysis framework of the United Nations Children’s Fund, containing four quantitative dimensions--political environment, supplement, requirement and quality. The questionnaires are published online, and sent to relevant staff in Patriotic Health Campaign Committee Office (PHCCO) from each province through telephone invitations. The overall available questionnaires are 109 from 29 provinces. Each province provides at least 3 and at most 14 results. According to the result, bottleneck problems of sanitation improvement can be concluded from not only each province but also over all the country. And then, the equity bottleneck model of sanitation improvement is developed, which contributes to the bottleneck of sanitation improvement over the country. Besides the institutions of sanitation improvement, there are other four main bottleneck problems of sanitation improvement equity, like relative training of sanitation improvement, rather than lack of people or money.Based on the assessment and the result of influence factor analysis on equity of sanitation improvement, this article proposes several policy making suggestions on equity situation. First of all, the emphasis of sanitation improvement should be altered to the west, and be strengthened in the middle region, changing the stagnant status of improved sanitation coverage of middle region from 2010. The government should keep on investing grass-roots unit, following the principle of "substantial fairness" providing more investments to poor areas, further reducing the difference of inter-province, improving the equity of sanitation improvement. With the steps of high-speed development, the difference on economic levels between western and eastern regions should be reduced; and at the meantime, it should be given more attentions and helps from government in the regions where have more minorities, lower education levels and worse weather conditions; the inequity of sanitation improvement caused by external factors should be overcome. In addition, the institutional reform of intra-province should be promoted, like setting the institution of sanitation improvement independent of health department. Effective propaganda and educational work should be advocated to improve health knowledge level of rural people, to increase management of excrement and urine, and to eliminate the urgency of feces exposure, in order to increase the requirement of sanitation improvement. For families with improved sanitations, following-up visit and timely detecting should be improved, to prevent discard or low utilization ratio of improved sanitations by poor using. The second point is to improve relevant training in the regions with limited coverage ratio of improved sanitations, including the cost, health knowledge, attitude towards health knowledge and personal health behavior, starting from the bottleneck problem, improving the equity of sanitation improvement and reducing regional difference.At the end of the article, conclusions are laid out, including the research structure of the study on equity of public health services, and the effective solutions to the following three questions: how to interpret the public health services? How to assess the equity of public health services? And what are the factors that influence the equity of public health services? And furthermore, a more practical study structure of public health services is extended, helping future scholars solving the same questions mentioned before, and providing them with suitable ideas and inspirations.