| BackgroundAs China enters into a new era of socialism with Chinese characteristics,the problem of imbalanced and insufficient development becomes more prominent,and various emergent public health events occur constantly.Public health emergencies are now more than mere medical problems,because if handled improperly,they may lead to problems that do harm to regional political stability,economic development,and social security and stability.A severe challenge that modern social management is facing now is how to prevent emergent public health events from occurring or developing into social crises,or even disasters.Both outbreak of SARS in a relatively far past and spreading of H7N9 virus and epidemic of dengue fever in recent years indicate that enhancing risk awareness and risk prevention has become an important issue facing China in the new era of socialism construction.However,in reality,crisis management is one of the major aspects of management,but usually ignored.Research on crisis management in China is still at the exploratory stage.How to strengthen management of crisis in the new age,and control and prevent public health emergencies from occurring and developing remains an important part of construction of public health system and social management system in the future.Under the circumstance of high risk of public health emergencies in Guangzhou’s urban and rural regions,and from the perspective of ensuring human’s health,evaluation indexes of vulnerability in crisis management of primary medical institutions while dealing with public health emergencies were set up in the present study to explore ways to assess the vulnerability.The present study will not only provide adequate scientific guidance for those medical institutions in response to,especially prevention of,emergent public health events,but also exert its practical effects on improvement of existing response mechanism.Objectives1.Establishing a conceptual framework for vulnerability assessment of public health emergencies in primary health care institutions.2.To set up a system of evaluation indexes of vulnerability in crisis management of Guangzhou’s primary medical institutions while dealing with emergent public health events;3.To clarify the current situation of crisis management of Guangzhou’s basic medical institutions while dealing with emergent public health events;4.To explore ways to assess vulnerability in crisis management of Guangzhou’s primary medical institutions in dealing with emergent public health events,and evaluate the vulnerability of samples surveyed;5.To propose strategies for Guangzhou’s primary medical institutions to improve response mechanism for dealing with emergent public health events.Methods1.Literature review:concept framework and evaluation dimensions were set up according to the definition of vulnerability by International Strategy for Disaster Reduction from the perspective of protecting people’s health by reviewing literature.relevant literature was retrieved from CNKI,Wanfang Data and other famous domestic bibliographic databases with period set from 2013 to 2017,and "Guangzhou+emergent public health events","Guangzhou+public health",and "Guangzhou+emergent health events" being subject terms.Current status of research on emergent public health events in Guangzhou was understood,and research field,features and weaknesses were analyzed by reviewing literature.2.Expert consultation:To carry out two rounds of expert consultation,the first round of consultation with experts on the preliminary drafting of the index system,to modify,delete,increase and merge some indicators;the second round of experts further confirm the entry targets,carry out another round of scoring,and finally determine the index.3.Factor analysis:Using factor analysis to test the construct validity of evaluation indicators,mainly includes the following three steps:①To test the applicability of factors.The KMO coefficient and Bartlett spherical test are used to verify the applicability of factor analysis.② Extraction of public factors.The 14 two level indexes of this study are extracted from the public factors,and the comparison analysis is consistent with the 3 first grade indexes of the research design,so as to determine whether the structure validity of the evaluation index is reasonable;③Explain the factor structure,that is,to explain the practical meaning of the extracted common factors.4.Analytic hierarchy process:The analytic hierarchy process(AHP)is used to determine the weight of each evaluation index.The basic steps are:① setting up a hierarchical structure;②constructing a judgment matrix,calculating the weight coefficient of the index;③the acceptance test of the weight coefficient.After setting up the index hierarchy and judgment matrix,the total target/sub objective ranking weight is calculated by yaahp software.5.On-the-spot investigation:①Overall 3,300 individuals from 33 community/villages of 33 street/towns(3 of each district,11 districts altogether)were surveyed with questionnaires with the use of cluster random sampling.Residents’ vulnerability in crisis management was analyzed.②The 11 districts of Guangzhou were classified into three categories according to their GDP ranking in 2016.Stratified random sampling was employed to select randomly 9 primary medical institutions(3 institutions from each category)as the samples.Vulnerability surveys on safety measures in crisis management were conducted in the 9 selected institutions.6.Comprehensive evaluation of vulnerability:①Relative ratio was applied to calculate residents’ comprehensive vulnerability index of each sample institution by comparing first-hand data obtained from investigation with the standard value of each index.②The score of each index of each sample institution was calculated mainly by quantifying statistics collected from the self-designed questionnaire:Survey on Vulnerability of Safety Measures of Guangzhou’s Primary Medical Institutions in Crisis Management Dealing with Emergent Public Health Events.The rule of scoring for all indicators was:1 point for "Yes",0 point for "Don’t know",and-1 point for"No".And the formula used to calculate the score of vulnerability of each sample primary medical institution is:Z=0.70*[0.09*(0.12C7+0.63C8+0.25C9)+0.12*(0.22C10+0.28C11+0.31C12+0.19C13)+......+0.12*(0.25C30+0.27C31+0.32 C32+0.22C33)](Z for the score of vulnerability of safety measures,C for total score of all indexes in each category).Results1.Construction of vulnerability index system of crisis management(1)A system with 3 primary indexes,14 secondary indexes and 39 tertiary indexes for assessing vulnerability of primary medical institutions while deal with emergent public health events was established through two rounds of consultation with experts.And the weight of each index was set.(2)The response rates of the two rounds of consultation were 86.67%and 92.31%.The authenticity of experts’ opinions was 0.6058 and 0.6259 respectively,while the coordination coefficients were 0.397 and 0.421(P<0.01).(3)The reliability was determined as 0.792 with the use of Cronbach’s alpha.It scored from 0.582 to 0.812 in the second test and was statistically significant(P<0.05).To test of the validity of the index system by conducting expert evaluation and factor analysis indicated that both the content and the structure had a high validity.2.Document analysis on emergent public health events in GangzhouAmong all kinds of emergent public health events having occurred in Guangzhou,the highest attention was paid to infectious diseases,which was followed by food poisoning and environment-related health emergencies.Document analysis revealed that factors causing frequent occurrence of infectious diseases in Guangzhou were mainly climate,geographical environment and population structure.3.Investigation into current status of population health vuln erabilityThe total rate of Guangzhou residents’ learning of basic health and disease prevention knowledge was 78.14%.That of key health and disease prevention knowledge was 74.77%,while the total rate of healthy behaviors was 48.14%.Those rates of urban citizens were the highest(81.80%,80.31%and 64.27%),followed by those of rural residents(79.64%,72.23%and 61.39%),while those of internal migrant workers were the lowest(51.73%,48.42%and 36.31%).4.Research on vulnerability of safety measures(1)More than 50%of the emergency command departments of public health emergencies have been set up,and only less than 50%of the network direct reports of infectious diseases and public health emergencies can be realized,and only 11.11%can share information with other departments.(2)Only 20%of the institutions have the conditions and ability to treat patients with infectious diseases in batches.Only 10%of the institutions have developed programme to receive and treat victims,and only 33.33%have an early warning system for public health emergencies.(3)Only 10%of the institutions have emergency guidance groups to set up emergencies,most of which are trained/drills for emergency ability,but the training courses or teaching materials are not standardized and unsystematic,and only 10%of the institutions will carry out full training.(4)Only one organization has stockpiles of drugs such as plague and cholera,and only a small amount of reserves or reserves are available for high-end emergency drugs or supplies.5.Comprehensive evaluation of vulnerability in crisis management(1)The population density index in the street to which W township hospital belonged in Conghua District ranked the highest(6.333).It was 115 times higher than that in the street to which H community health care center belonged in Yuexiu District.(2)The ratios of rural residents to all residents in areas to which D,C,J,and W township hospitals were larger than that of other regions,and rates of residents’learning of disease prevention knowledge and those of healthy behaviors in these areas were lower than those of downtown area.Therefore,crisis management of D,C,J and W township hospitals was more vulnerable than that of others while dealing with emergent public health events.(3)The score of vulnerability of safety measures in crisis management of sample institutions and that of comprehensive evaluation of crisis management were positively correlated with GDP per capita,that is,the higher the GDP per capita was,the larger the scores were and the lower the vulnerability was,and vice versa.The GDP per capita in the street where Y community health care center located was 327,000 Yuan,ranking the highest,while that in the street in which W township hospital was located was 56,500 Yuan,being the lowest.Conclusions1.The reliability and validity of crisis management evaluation index system for primary public health emergencies are relatively high.2.The prevention and study of infectious diseases,food poisoning and environmental hygiene emergencies should be focused on in Guangzhou.3.There is a great difference in knowledge of disease prevention and health behavior among different groups of people in Guangzhou.4.The emergency command mechanism of medical institutions for management of public health emergencies in Guangzhou has formed initially,and the communication mechanism of information reports is basically formed,but the channels of communication are not smooth enough,and the reporting system is not perfect enough.5.The emergency plan of some basic medical institutions is not comprehensive and full,the medical treatment ability of the disease caused by public health emergencies is low,the plan is not complete,and the monitoring and early warning ability of public health emergencies is low.6.The emergency personnel of public health emergency are not enough,and the medical institutions at the grass-roots level begin to pay attention to the education and training of emergency personnel for public health emergencies,but the training content is not systematic.7.Emergency drug supplies and emergency supplies are in poor condition.Measures to increase emergency beds are not perfect.8.The population density varies greatly in different regions of Guangzhou,and the population is concentrated in the central urban area,which leads to the increasing vulnerability of the crisis management of public health emergencies in the medical institutions at the grass-roots level.9.The disparity of economic development level between different regions in Guangzhou is relatively large,which makes the vulnerability of crisis management of public health emergencies in grass-roots medical institutions unbalanced.CountermeasuresWe should improve the response mechanism in crisis management of primary medical institutions in Guangzhou while dealing with emergent public health events by following the principles and methods Haddon model and combining them with vulnerability-related problems discovered in the present study.1.Before occurring of emergent public health events(1)Hosts:we should carry out risk evaluation of all kinds of emergent public health events,set up the threshold to initiate emergency treatment,and establish information network for monitoring,predicting and pre-warning emergencies.We should also set up emergency rescue system and conduct emergency response exercises.(2)Pathogenic factors/vectors:we should grasp the features and nature of vectors,their infectivity,potential infections,pathogenicity,hazard rating,potential transmission mode and hazard form.(3)External Environment:we should increase investment in public health at the primary level to narrow regional gap,establish logistic support system and medicines supply system,and formulate contingency plans.(4)Social and cultural environment:we should set up a three-level system for health education at the primary level.2.during occurring of emergent public health events(1)Hosts:we should make an all-round assessment of the events.We are also supposed to implement effective counter-emergency measures according to the contingency plan and establish organizing and commanding system and emergency medical treatment system.(2)Pathogenic factors/vectors:we are supposed to understand the transmission mode,hazard form and potential damages of the vectors.We should also grasp eradication and prevention of these factors,and social impact caused by them.(3)External environment:we should make out the number and distribution of hospitals in the region where events break out.We should also know clearly the number of hospital beds,medical treatment,inspection technology,storage of medicines and medical equipment,and capabilities of responding to emergent events.(4)Social and cultural environment:we should strengthen coordination and mutual trust between medical departments and health departments,and other relevant departments,and carry out health education to local residents to enhance their capability of protecting themselves from damages.We are also supposed to establish supervision mechanism of emergency response and public releasing system of the epidemic situation,and reinforce media management.3.After occurring of emergent public health events(1)Hosts:we should conduct an overall post-event assessment.(2)Pathogenic factors/vectors:we should carry out monitoring and investigation to vectors after the events and be alert to possibility of vectors’ potential existing in environment.(3)External environment:we should increase storage of medical resources in primary medical institutions,and speed up upgrading of medical equipment to provide better prevention and protection equipment and create beneficial environment.(4)Social and cultural environment:we are supposed to evaluate and improve existing systems.We should also recover what has been damaged and turn adversities into opportunities. |
