翻译.docx

翻译.docx

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翻译

Ⅲ.外文翻译

外文翻译之一

CommunityMedicineintheRestructuredNHS

作者：

JohnSmith

国籍：

English

出处：

CommunityMedicine

原文正文：

InmanyareastheestablishmentofthenewDistrictHealthAuthoritiesentailsarearrangementofthewaysinwhichsomecommunityphysicianswillfunction.TheBritishMedicalAssociation'sCentralCommitteeforCommunityMedicine（CCCM）hasalreadycirculatedadocumentoutliningthetasksofcommunityphysiciansemployedbyDstrictHealthAuthorities.Thishasconcentratedonthemanagerialresponsibilities,theoperationalactivitiesandthesizeandnatureoftheworkforceneededtodischargethem.TheFacultyhassupportedtheCCCMdocument.Atthesametimeithaspreparedacomplementarypaper,baseduponviewsreceivedfromcommunityphysiciansintheregions,inwhichtheemphasisisplacedmoreupontheroleofcommunitymedicineintherestructuredservice.Wereproduceithereinthebeliefthatitwillbeofparticularhelptoanyofthespecialty'spractitionerswhocontinuetohavetoexpounditsraisond'etreinaprofessionallycompetitiveenvironment.

ThisdocumentoutlinestheroleandfunctionofcommunitymedicineandmakesrecommendationssothatthedisciplinemaycontinuetomakeamaximumcontributionduringandaftertheimpendingrestructuringoftheHealthServiceinEngland.Theserecommendationstakeaccountoftheimportanceofthetaskofcommunitymedicine,thelargernumberofdistrictauthoritiestobeserviced,theshortageofcommunityphysicians,thedifferingboundariesofhealthandlocalauthoritieswithsharedresponsibilitiestobedischargedbycommunityphysicians,andthecontinuingneedforspecialskillsindischargeoftheseparateidentifiedresponsibilitiesofcommunitymedicinedespitetheremovalafterrestructuringofspeciallabelledposts.

WHATISCOMMUNITYMEDICINE?

Communitymedicineisthatbranchofmedicalpracticethatisconcernedtopromote,maintainand,wherenecessary,restorethehealthofhumancommunities.Thepracticeofcommunitymedicineresemblesthatofclinicalmedicineinthatitconsistsoftheformulationandcommunicationofadviceonhowhealthproblemsmaybesolved.Itdiffersfromclinicalmedicineinthatcliniciansusuallyoffertheiradvicetoindividualsonrequestwhereascommunityphysiciansoffertheiradvicetocommunitiesandmostoftentaketheinitiativeindecidingbothwhentoadviseandtowhichagencyofthecommunityadviceshouldbedirected.

Communityphysiciansconsultwiththeircommunitiesthroughthemediumofthe

management,planninganddecision-makingagenciesofthecommunity'shealthandrelatedservicesandmostfrequentlythroughthemanagementstructureoftheNationalHealthService.ItistheNHSthatemployscommunityphysiciansasmembersofthemanagementteamsbuttheymustalsohaveresponsibilitiestowardsclinicalandothercolleaguesandtootheragenciesinvolvedinmattersrelatedtohealthandtothecommunitiesdirectly.

TheNHSisthemainagencyforthetreatmentofillnessandthecareofthesickandithasanimportantroteinthepreventionofdiseasealthoughmanyotheragenciesmakeimportantcontributionstoprevention.Itisimportantthatthejobspecificationandthestaffinglevelsincommunitymedicinetakefullaccountoftherangeoffunctionsandresponsibilitiesinvolved.Ofallbranchesofthepracticeofmedicine,communitymedicinehasthemostimpressiverecordintermsofthehealthimprovementsthathavetakenplacesincethespecialtyemergedunderitsoldnameofpublichealthinthemiddleofthelastcentury.Theproblemsthatfaceusnowaredifferentinkindbutequallyformidableifhealthimprovementistobemaintainedandequitablydistributedintheyearsahead.

BeforereorganizationoftheNHSin1974communityphysiciansweremainlyemployedbytheRegionalHospitalBoardsandLocalHealthAuthorities.Inbothsituations,theworkofthesedoctorswassupportedbyasubstantialstaffcomprisingbothclericalandsecretarialworkersandoftenresearchandotherstaffneededforcollectingandanalysingepidemiologicaldatarelatedtothehealthproblemsexperiencedinthecommunityoritshealthinstitutions.

Since1974,communityphysiciansworkinginAreasandDistrictshaveoftenbeenseriouslyshortofsuchsupportingstaffsincethenewadministrativebodiesoftenlackedthenecessaryresourcesorwereinsufficientlyawareoftheirimportance.

Thenewrestructuring,involvingthecreationofHealthDistricts,isbeingcarriedout

againstabackgroundofevenmoresevereeconomicconstraintsanditseemsespeciallynecessarytostatetheimportanceofprovidingappropriateresourcessothatthepracticeofcommunitymedicinemaymaketheimportantcontributionthatithastraditionallymadetothehealthofthecommunity.

Since1974,therehasbeenamanpowershortagewithinthespecialtyofcommunity

medicine.However,recruitmenthasimprovedandeveryregionnowhasafunctioningtrainingprogramme.

THEROLEOFTHESPECIALTYANDTHECOMMUNITYPHYSICIAN

Theemergenceofcommunitymedicineasaspecialtyin1974,coincidingwiththereorganizationoftheNHS,hasledtoitsbeingassociatedwiththelesssuccessfulstructuralandmanagementchangesbroughtaboutatthattime.However,thespecialtywasnotcreatedoutofNHSreorganizationbutfromtheintegrationofthreewell-establishedstreamsofmedicalpractice:

first,publichealthwithitsrootsinthepracticeofpreventivemedicine,healtheducation,epidemiologyandthecontrolofdiseaseamongwholepopulations;second,medicaladministrationwhichhaddevelopedrapidlyfromthebeginningoftheNHSasthedisciplineresponsiblefortheplanning,deliveryandmonitoringofhospitalandspecialistservicestothewholecountry;andthird,universitydepartmentsofpublichealthandsocialmedicinewhoseteachingandresearchinepidemiologyandthedeliveryofhealthcareprovidedthetheoreticalbasisforadvancesinmuchmedicalpractice.Thesethreestreamswereevolvingandchanging.Eachcouldclaimtriumphsofitsown,butallforesawthe

futureneedtoworktogether.Thespecialty,therefore,notonlycreateditselfwithnew

challengesinmind,butitalsoinheritedtheresponsibilitiesofguardingthepublicagainsthealthhazards,ofpreventingdiseaseandofteachingboththepublicandtheprofessionthemeaningofhealthandthemeansforitspursuit.

Communityphysicianscanbesaidtohavethreecomplementarymedicalroles;specialist,managerandadviser.

Asspecialists,communityphysiciansareabletoofferacombinationofmedicalbackgroundwithaknowledgeofepidemiology,behaviouralscienceandmanagementtechniquestoprovideanimportantcontributiontohealthcareplanning.Theirmedicalbackgroundhelpsthemtomaintaincloseworkingrelationshipswithclinicalcolleaguesinhealthservicedevelopmentandsoensuresthattheiradviceisbasedoncurrentmedicalpractice.Theirepidemiologicaltrainingequipsthemforaspecialistroleinthepromotionofhealthandthepreventionandcontrolofdiseaseinthecommunityandintheevaluationofhealthservices.

Asmanagers,theircombinationofmedicalknowledgeandmanagementskillsenablesthemtodevelopwithothersinmanagement,policiesandplansforimprovingthehealthofthepopulation.Inaddition,theyhavetopromotethedevelopmentofjointplanningandmanagementbetweenhealthandlocalauthorities.Theyhaveaparticularmanagerialresponsibilityforactivitiesconcernedwiththepromotionofhealthandthepreventionofdiseaseanddisability.Thecommunityphysicians'roleasmanagersinvolvesthemintheadministrationofthehealthservice,whetherornotasachiefofficermemberofamanagementteam,sinceallcommunityphysiciansareasmuchconcernedwithimplementingaswithmakingpolicy.

Asadviserscommunityphysicianshaveanumberofresponsibilities.Theyhavetoprovidespecialistmedicaladvicetothehealthauthoritywhichemploysthemandtodepartmentsofeducation,socialservices,environmentalhealthandhousingoftherelatedlocalauthorities.

Theyarealsoresponsibleforadvisingthecommunityservedbytheiremployinghealthauthorityaboutallmattersaffectinghealth.

Thefulldevelopmentofthespecialtysince1974hasbeenhandicappedbythecomplexityofthepresentstructureoftheNationalHealthServiceinEngland.Scarcemanpowerandskillshavebeendilutedbytheneedtostaffthreetiers--district,areaandregion.

Oneconsequencehasbeenthat,inthemain,eachdistricthashadonlyonespecialist—theDistrictCommunityPhysician.Singleindividuals,withlittleinthewayofsupportingstaff,havehadanalmostimpossibletaskintryingtodischargethedutiesandresponsibilitieslaiduponthem.Thenewsimplifiedstructurewillprovideabetteropportunitytopracticecommunitymedicineandthechancetodeploythelimitedmanpowerofthespecialtyinawaywhichwillallowitsskillstobefullyapplied.

Therole,functionsandrelationshipsofDistrictHealthAuthorities（DHAs）willbe

similartothoseofthepresentsingle-districtAreaHealthAuthorities（AHAs）.Theywillberesponsiblefortheplanningandmanagementofhealthservicesforthepopulationofthedistrict;decideondistrictpoliciesandprioritieswithinthecontextofnationalandregionalpolicy;andassesstheadequacyofservicesprovided.EachDHAwillappointaDistrictManagementTeam（DMT）ofchiefofficersofwhomtheDistrictMedicalOfficer（DMO）willbeone.

TheprincipalexternalrelationshipsofDHAswillbewiththeirmatchingCommunityHealthCouncil（CHC）,withdistrictcouncils（orLondonboroughcouncils）whoseterritorylieswhollyorpartlywithinthehealthdistrictboundaryand,outsidemetropolitanareas,wi