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　　當前，我(wo)國(guo)新冠病毒肺(fei)炎疫(yi)(yi)情(qing)防控形(xing)勢持續向(xiang)好(hao)。疫(yi)(yi)情(qing)發生(sheng)(sheng)以(yi)來，在疫(yi)(yi)情(qing)成為全國(guo)性的(de)人民(min)(min)戰(zhan)爭、總體戰(zhan)和阻(zu)擊戰(zhan)之后(hou)，國(guo)家采取了(le)一系(xi)(xi)列(lie)的(de)公共衛(wei)生(sheng)(sheng)干(gan)預(yu)措施，取得較好(hao)的(de)效果(guo)，疫(yi)(yi)情(qing)得到迅速遏(e)制，堅定了(le)廣大民(min)(min)眾(zhong)的(de)抗(kang)疫(yi)(yi)信心，為國(guo)際上其他國(guo)家抗(kang)疫(yi)(yi)提供了(le)有效的(de)模式和經(jing)驗。這些公共衛(wei)生(sheng)(sheng)干(gan)預(yu)舉措的(de)有效實施，在一定程(cheng)度上體現(xian)了(le)我(wo)國(guo)公共衛(wei)生(sheng)(sheng)應急體系(xi)(xi)決策的(de)科學(xue)化(hua)，以(yi)及公共衛(wei)生(sheng)(sheng)應急體系(xi)(xi)與社會治理體系(xi)(xi)的(de)有機協同。

　　公(gong)共(gong)衛(wei)生應急體(ti)系是(shi)國(guo)家治理(li)體(ti)系的重(zhong)要(yao)(yao)(yao)組成部分，公(gong)共(gong)衛(wei)生安全(quan)是(shi)國(guo)家總(zong)體(ti)安全(quan)的重(zhong)要(yao)(yao)(yao)組成部分。中央強(qiang)調，針(zhen)對這次疫(yi)情(qing)(qing)暴露出來的短板和(he)不足，要(yao)(yao)(yao)完善重(zhong)大疫(yi)情(qing)(qing)防控體(ti)制(zhi)機制(zhi)，健全(quan)國(guo)家公(gong)共(gong)衛(wei)生應急管理(li)體(ti)系。這次抗擊新冠病(bing)毒肺炎疫(yi)情(qing)(qing)，是(shi)對我國(guo)治理(li)體(ti)系和(he)治理(li)能力的一次檢驗(yan)和(he)考(kao)驗(yan)，也是(shi)提(ti)高我國(guo)治理(li)體(ti)系和(he)治理(li)能力的一個(ge)契機。

　　在新的(de)形勢(shi)下，國際上提出了回(hui)歸社(she)會模式的(de)“公(gong)共健(jian)康(kang)(kang)3.0”和實現人類、動(dong)物(wu)和環境(jing)整體健(jian)康(kang)(kang)的(de)“One Health”理念;我(wo)國最近也已提出要將與人民健(jian)康(kang)(kang)密切相關的(de)生物(wu)安全(quan)納入國家安全(quan)范疇。從邏(luo)輯關系上，與臨床醫(yi)療主要處理個體健(jian)康(kang)(kang)問題相比(bi)，公(gong)共衛(wei)生主要關注人群健(jian)康(kang)(kang)，并以社(she)會動(dong)員和系統應對為主要模式。

　　健(jian)康(kang)中國(guo)的(de)戰略需求和預防為(wei)主的(de)衛(wei)生方(fang)針，加(jia)之本次疫(yi)情(qing)對國(guo)家經濟社會和人(ren)(ren)民健(jian)康(kang)帶來的(de)巨大影響，對我(wo)國(guo)公(gong)共衛(wei)生體系改革發展提出了迫切需求，而相關(guan)的(de)公(gong)共衛(wei)生教育與人(ren)(ren)才(cai)培養是(shi)最基(ji)礎性和根本性的(de)工作。

　　后疫情時代的公共健康人才培養需求

　　公共(gong)(gong)衛(wei)生和公共(gong)(gong)健康(kang)的英(ying)文均(jun)為(wei)Public Health，但公共(gong)(gong)衛(wei)生往往被理解(jie)為(wei)一個行(xing)業(ye)(主(zhu)要指衛(wei)生健康(kang))的概念，而不是一個社會系統的概念。為(wei)此(ci)，筆者將(jiang)嘗(chang)試從公共(gong)(gong)健康(kang)的角度進行(xing)討論，其(qi)中公共(gong)(gong)衛(wei)生人才(cai)是討論的主(zhu)體。

　　首先(xian)，需從行業模式(shi)(shi)向社會(hui)模式(shi)(shi)轉變(bian)。

　　當(dang)前公共衛生(sheng)正(zheng)在回歸社(she)會(hui)(hui)模式(shi)。筆者(zhe)觀察(cha)到，一些發達國家醫(yi)(yi)療(liao)投入居高(gao)不(bu)下，且在持續增(zeng)加，但仍存在包括重大疾病發生(sheng)增(zeng)加、健康指標(biao)和人(ren)均(jun)預(yu)期壽命下降(jiang)等問(wen)題，原因歸結為(wei)醫(yi)(yi)療(liao)與健康的脫節。人(ren)的健康影(ying)響因素中，單純醫(yi)(yi)療(liao)的貢獻占20%，社(she)會(hui)(hui)經濟(ji)因素、健康行為(wei)、物(wu)理環(huan)境等“影(ying)響健康的社(she)會(hui)(hui)決定因素”占80%，但很多國家往往把大部(bu)分(fen)資金投在占比20%的醫(yi)(yi)療(liao)上。

　　由此(ci)，國際上提出(chu)“公共健(jian)康3.0”概念(nian)，賦(fu)予公共衛(wei)生(sheng)機構(gou)權(quan)力，使他(ta)們有能(neng)力通過社(she)(she)會(hui)(hui)(hui)動(dong)員并充(chong)分利用(yong)數據(ju)和資(zi)源解決影響健(jian)康的(de)社(she)(she)會(hui)(hui)(hui)、環(huan)境和經濟因(yin)素，包括經濟發展、教育、運輸、餐(can)飲、環(huan)境、住(zhu)房、安全的(de)社(she)(she)區等(deng)。要求公共衛(wei)生(sheng)領(ling)導(dao)人(ren)(ren)不僅是政(zheng)府(fu)(fu)職能(neng)部門(men)(men)(men)負責人(ren)(ren)，同時還應該是所(suo)管轄地區的(de)首(shou)席健(jian)康戰(zhan)略(lve)(lve)官。公共健(jian)康3.0理念(nian)比較適合對(dui)(dui)重大疫情(qing)的(de)應對(dui)(dui)，特別是地方政(zheng)府(fu)(fu)衛(wei)生(sheng)部門(men)(men)(men)領(ling)導(dao)如(ru)何承擔(dan)首(shou)席健(jian)康戰(zhan)略(lve)(lve)官的(de)角色，如(ru)何與跨醫療機構(gou)以外的(de)其他(ta)部門(men)(men)(men)合作等(deng)。因(yin)此(ci)，隨著(zhu)公共衛(wei)生(sheng)從行業模(mo)式向社(she)(she)會(hui)(hui)(hui)模(mo)式轉變，對(dui)(dui)于(yu)培養復合型公共健(jian)康人(ren)(ren)才和首(shou)席健(jian)康戰(zhan)略(lve)(lve)官提出(chu)了(le)迫切需求。

　　其次，需從單純關注人的健康向(xiang)關注人—動物—環境(jing)整體健康轉變(bian)。

　　“One Health”(大健(jian)康(kang)(kang)或公共(gong)(gong)(gong)健(jian)康(kang)(kang))理(li)念(nian)隨(sui)著近年來(lai)新發(fa)突(tu)發(fa)傳染(ran)病和人(ren)(ren)畜共(gong)(gong)(gong)患(huan)病等新型流行性傳染(ran)病的(de)(de)不(bu)斷增加(jia)而興起，旨(zhi)在擴大人(ren)(ren)類(lei)、動(dong)物(wu)和環境三方健(jian)康(kang)(kang)領域(yu)的(de)(de)跨學科(ke)合(he)(he)作。要(yao)求公共(gong)(gong)(gong)衛生專(zhuan)業人(ren)(ren)員、臨床醫(yi)生和獸醫(yi)等人(ren)(ren)員之(zhi)間(jian)有更多的(de)(de)交(jiao)流與合(he)(he)作，要(yao)有系(xi)統性和全鏈條思(si)維，以實現整體健(jian)康(kang)(kang)的(de)(de)目標。由于近80%的(de)(de)急性傳染(ran)病來(lai)自(zi)動(dong)物(wu)，人(ren)(ren)和動(dong)物(wu)之(zhi)間(jian)的(de)(de)關(guan)系(xi)越(yue)來(lai)越(yue)密切。未(wei)來(lai)也對如(ru)何培(pei)養符合(he)(he)One Health理(li)念(nian)、從(cong)單純關(guan)注人(ren)(ren)的(de)(de)健(jian)康(kang)(kang)向同時關(guan)注人(ren)(ren)類(lei)—動(dong)物(wu)—環境整體健(jian)康(kang)(kang)轉變的(de)(de)公共(gong)(gong)(gong)健(jian)康(kang)(kang)人(ren)(ren)才(cai)提(ti)出(chu)了明(ming)確需求。

　　第三，新型生物技(ji)術和(he)數字(zi)技(ji)術將在公(gong)共健康保障中發揮更大的作(zuo)用。

　　當(dang)前(qian)，生(sheng)物安全的(de)概念已從生(sheng)物防御拓展到健(jian)(jian)康(kang)(kang)安全，其中(zhong)(zhong)應對重大(da)傳(chuan)染病(bing)(bing)(bing)(新發和突發傳(chuan)染病(bing)(bing)(bing))是核心任務。本次(ci)新冠(guan)肺炎疫情(qing)背(bei)后反映的(de)生(sheng)物安全問題可能重塑醫療衛(wei)生(sheng)格局，例(li)如更(geng)加(jia)重視病(bing)(bing)(bing)原檢測與(yu)溯源、生(sheng)物疫苗、抗病(bing)(bing)(bing)毒(du)創(chuang)新藥等生(sheng)物醫藥技(ji)(ji)術，也對健(jian)(jian)康(kang)(kang)醫療信息化的(de)需求更(geng)加(jia)迫切。國家(jia)科(ke)技(ji)(ji)戰略也提(ti)出(chu)，把生(sheng)物技(ji)(ji)術作為基盤技(ji)(ji)術擺在國家(jia)科(ke)技(ji)(ji)發展全局的(de)核心位置，形成我(wo)國科(ke)技(ji)(ji)創(chuang)新體(ti)系的(de)戰略布局，支撐(cheng)健(jian)(jian)康(kang)(kang)中(zhong)(zhong)國、美麗中(zhong)(zhong)國、平安中(zhong)(zhong)國的(de)建設發展。習(xi)近平總書記指(zhi)出(chu)，要鼓勵(li)運用大(da)數據(ju)、人(ren)工智能、云(yun)計算等數字技(ji)(ji)術，在疫情(qing)監測分析、病(bing)(bing)(bing)毒(du)溯源、防控救治、資(zi)源調配等方(fang)面(mian)更(geng)好發揮(hui)支撐(cheng)作用。因此，對培養人(ren)群健(jian)(jian)康(kang)(kang)相關的(de)疾控專家(jia)、公(gong)共(gong)衛(wei)生(sheng)醫生(sheng)、公(gong)共(gong)衛(wei)生(sheng)科(ke)學家(jia)、公(gong)共(gong)健(jian)(jian)康(kang)(kang)信息學和大(da)數據(ju)方(fang)面(mian)的(de)人(ren)才也提(ti)出(chu)了明(ming)確需求。

　　當前我國公共健康人才培養存在的問題

　　健(jian)(jian)康中(zhong)國(guo)(guo)戰略(lve)強(qiang)調疾(ji)病(bing)預(yu)防和健(jian)(jian)康促進是最經濟(ji)最有效(xiao)的健(jian)(jian)康策略(lve)。但目前我國(guo)(guo)醫藥衛生(sheng)人才培(pei)養重(zhong)心和政府投入總體上仍存(cun)在“重(zhong)醫療、輕預(yu)防”的問題，尚未完(wan)成從(cong)以治病(bing)為中(zhong)心向以健(jian)(jian)康為中(zhong)心的轉變。

　　首先(xian)，我(wo)國公共衛生人(ren)才(cai)培養總體數量(liang)和(he)質(zhi)量(liang)不足，且因(yin)社會地位和(he)待遇不高造成人(ren)才(cai)流失嚴(yan)重(zhong)。

　　“健康(kang)中國(guo)(guo)(guo)(guo)(guo)(guo)”建設需要(yao)(yao)大量(liang)高素質公共(gong)衛(wei)(wei)(wei)生(sheng)(sheng)人(ren)(ren)(ren)(ren)(ren)才，現有公共(gong)衛(wei)(wei)(wei)生(sheng)(sheng)教育和(he)(he)人(ren)(ren)(ren)(ren)(ren)才供給不能(neng)適應新(xin)挑戰和(he)(he)新(xin)要(yao)(yao)求(qiu)。《全國(guo)(guo)(guo)(guo)(guo)(guo)醫(yi)(yi)療衛(wei)(wei)(wei)生(sheng)(sheng)服務體(ti)系(xi)規劃綱要(yao)(yao)(2015-2020年(nian))》提出“到2020年(nian)，我國(guo)(guo)(guo)(guo)(guo)(guo)每千(qian)常住人(ren)(ren)(ren)(ren)(ren)口(kou)(kou)公共(gong)衛(wei)(wei)(wei)生(sheng)(sheng)人(ren)(ren)(ren)(ren)(ren)員數達到0.83人(ren)(ren)(ren)(ren)(ren)”，而2017年(nian)我國(guo)(guo)(guo)(guo)(guo)(guo)每千(qian)常住人(ren)(ren)(ren)(ren)(ren)口(kou)(kou)公共(gong)衛(wei)(wei)(wei)生(sheng)(sheng)人(ren)(ren)(ren)(ren)(ren)員數僅(jin)(jin)有0.61人(ren)(ren)(ren)(ren)(ren), 缺口(kou)(kou)較(jiao)大。根據2018年(nian)中國(guo)(guo)(guo)(guo)(guo)(guo)衛(wei)(wei)(wei)生(sheng)(sheng)健康(kang)統計年(nian)鑒數據：人(ren)(ren)(ren)(ren)(ren)員規模方面(mian)，我國(guo)(guo)(guo)(guo)(guo)(guo)執業(ye)(ye)(助(zhu)理)醫(yi)(yi)師(shi)隊伍中，公共(gong)衛(wei)(wei)(wei)生(sheng)(sheng)醫(yi)(yi)師(shi)只有11.4萬(wan)人(ren)(ren)(ren)(ren)(ren)，僅(jin)(jin)占3%，遠小于(yu)(yu)口(kou)(kou)腔(qiang)醫(yi)(yi)師(shi)(21.7萬(wan)人(ren)(ren)(ren)(ren)(ren))、中醫(yi)(yi)醫(yi)(yi)師(shi)(57.6萬(wan)人(ren)(ren)(ren)(ren)(ren))和(he)(he)臨床醫(yi)(yi)師(shi)(270萬(wan)人(ren)(ren)(ren)(ren)(ren))。近幾年(nian)參加國(guo)(guo)(guo)(guo)(guo)(guo)家醫(yi)(yi)師(shi)資格考試(shi)的臨床、口(kou)(kou)腔(qiang)、中醫(yi)(yi)醫(yi)(yi)師(shi)的人(ren)(ren)(ren)(ren)(ren)數均在(zai)增加，唯獨公共(gong)衛(wei)(wei)(wei)生(sheng)(sheng)醫(yi)(yi)師(shi)的考生(sheng)(sheng)持續減(jian)少。學歷(li)結(jie)構方面(mian)，我國(guo)(guo)(guo)(guo)(guo)(guo)各級(ji)疾病預防控制(zhi)中心(xin)人(ren)(ren)(ren)(ren)(ren)員中，超半數(54%)人(ren)(ren)(ren)(ren)(ren)員僅(jin)(jin)為(wei)專科學歷(li)，約三(san)分之一(37%)為(wei)本科學歷(li)，具(ju)有研(yan)究生(sheng)(sheng)學歷(li)者(zhe)僅(jin)(jin)占7%。我國(guo)(guo)(guo)(guo)(guo)(guo)由(you)于(yu)(yu)預防醫(yi)(yi)學等公共(gong)衛(wei)(wei)(wei)生(sheng)(sheng)專業(ye)(ye)畢業(ye)(ye)生(sheng)(sheng)的待遇普(pu)遍不高、公共(gong)衛(wei)(wei)(wei)生(sheng)(sheng)人(ren)(ren)(ren)(ren)(ren)員職稱晉升相對困難(nan)、成就感和(he)(he)社會地(di)位較(jiao)低(di)，導致(zhi)公共(gong)衛(wei)(wei)(wei)生(sheng)(sheng)專業(ye)(ye)的生(sheng)(sheng)源質量(liang)存在(zai)較(jiao)大問題，畢業(ye)(ye)后(hou)轉行比例很(hen)高，人(ren)(ren)(ren)(ren)(ren)才流失(shi)嚴重(zhong)。

　　其次，醫療系(xi)統和(he)公共衛生系(xi)統人(ren)才培養相(xiang)互獨立，不利(li)于重大疫情中防控、治療和(he)科研緊密結合。

　　我國多數醫(yi)學院(yuan)校公衛(wei)人(ren)才與(yu)醫(yi)療人(ren)才的(de)(de)(de)培養相對(dui)獨立，醫(yi)學教育中臨(lin)床(chuang)醫(yi)學和預防醫(yi)學的(de)(de)(de)教學交叉較少, 臨(lin)床(chuang)醫(yi)學背景學生(sheng)參與(yu)公共衛(wei)生(sheng)實踐的(de)(de)(de)機會(hui)很少。由于傳(chuan)染病(bing)的(de)(de)(de)突(tu)發性特點(dian)，我國疾病(bing)防控(kong)體系在無疫情(qing)時(shi)(shi)會(hui)長時(shi)(shi)間(jian)處于一種(zhong)“待(dai)命”狀態，疾控(kong)人(ren)員得不到充分的(de)(de)(de)鍛煉，意識容(rong)易淡薄(bo)、技(ji)能(neng)容(rong)易滑坡。而(er)醫(yi)院(yuan)經(jing)常高負荷工作，醫(yi)務人(ren)員臨(lin)床(chuang)技(ji)能(neng)反(fan)復錘煉，但公衛(wei)知識和技(ji)能(neng)薄(bo)弱。國家對(dui)公共衛(wei)生(sheng)執業醫(yi)師處方(fang)權的(de)(de)(de)限制，使其無法接觸臨(lin)床(chuang)工作，久而(er)久之，醫(yi)療系統和疾控(kong)系統之間(jian)的(de)(de)(de)鴻溝(gou)越來(lai)越大。在此次疫情(qing)發生(sheng)早期，臨(lin)床(chuang)醫(yi)生(sheng)從(cong)個案(an)診治中已經(jing)隱約(yue)感覺到問(wen)題的(de)(de)(de)嚴重性及人(ren)傳(chuan)人(ren)的(de)(de)(de)可能(neng)性，但沒有一支專業高效的(de)(de)(de)公共衛(wei)生(sheng)隊伍能(neng)夠(gou)及時(shi)(shi)在第(di)一時(shi)(shi)間(jian)深(shen)入現場，進行細致(zhi)、縝密的(de)(de)(de)流行病(bing)學調查和及時(shi)(shi)確(que)診問(wen)題。

　　第(di)三(san)，目(mu)前的問題不是取消公共衛(wei)生與(yu)預防(fang)醫學(xue)本(ben)科(ke)教育，而是應該以提(ti)高人才(cai)培養質量為根本(ben)宗(zong)旨(zhi)。

　　疫(yi)情(qing)下(xia)，有不少圍繞(rao)我國疾(ji)病(bing)防(fang)(fang)控體系(xi)改革和醫(yi)(yi)學(xue)教育改革的(de)(de)建議。目前有聲音建議逐步取消(xiao)公共衛(wei)生(sheng)與預防(fang)(fang)醫(yi)(yi)學(xue)本科專業，將(jiang)其定位于(yu)寬口徑、強基(ji)礎的(de)(de)醫(yi)(yi)學(xue)本科基(ji)礎之上(shang)的(de)(de)公衛(wei)研究生(sheng)教育。但筆(bi)者認為，這(zhe)種培(pei)養(yang)方式，在(zai)現階段難以滿足當前健康(kang)中國戰略和預防(fang)(fang)優先方針對(dui)公共衛(wei)生(sheng)人才的(de)(de)巨大需求(qiu)。

　　國(guo)(guo)際(ji)上(shang)公(gong)(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)人(ren)(ren)才(cai)(cai)培養有(you)兩大顯著趨勢：一(yi)是大力(li)發展(zhan)本科(ke)教(jiao)育。從碩(shuo)士(shi)起點培養公(gong)(gong)(gong)(gong)(gong)衛(wei)(wei)(wei)(wei)學生(sheng)(sheng)(sheng)是美國(guo)(guo)初期模(mo)式，但(dan)為(wei)(wei)應對(dui)公(gong)(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)人(ren)(ren)才(cai)(cai)不足的(de)(de)(de)(de)問題，從2004年(nian)(nian)起增(zeng)設(she)公(gong)(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)本科(ke)學位(wei)。根據美國(guo)(guo)公(gong)(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)學院和(he)(he)學位(wei)項目(mu)委員會(hui)(ASPPH)最新數據，2018年(nian)(nian)通過認證的(de)(de)(de)(de)院校/學位(wei)項目(mu)共(gong)(gong)培養61453名(ming)公(gong)(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)專(zhuan)業學生(sheng)(sheng)(sheng)，其(qi)中本科(ke)、碩(shuo)士(shi)和(he)(he)博士(shi)生(sheng)(sheng)(sheng)的(de)(de)(de)(de)比例(li)分(fen)別為(wei)(wei)37%、49%和(he)(he)14%，公(gong)(gong)(gong)(gong)(gong)衛(wei)(wei)(wei)(wei)本科(ke)畢(bi)業生(sheng)(sheng)(sheng)超過了三(san)分(fen)之一(yi)。二是大力(li)發展(zhan)公(gong)(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)碩(shuo)士(shi)和(he)(he)其(qi)他相關(guan)學科(ke)的(de)(de)(de)(de)雙(shuang)學位(wei)聯合教(jiao)育，培養交(jiao)叉(cha)型和(he)(he)復(fu)合型人(ren)(ren)才(cai)(cai)。與(yu)公(gong)(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)碩(shuo)士(shi)(MPH)交(jiao)叉(cha)的(de)(de)(de)(de)學位(wei)領域包括臨床(chuang)醫學、口腔醫學、文學、護(hu)理學、法律(lv)、社會(hui)工(gong)作、工(gong)商(shang)管理、獸醫等。我(wo)國(guo)(guo)可以借鑒國(guo)(guo)際(ji)經驗(yan)并考慮國(guo)(guo)情，以提(ti)高公(gong)(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)(wei)(wei)生(sheng)(sheng)(sheng)與(yu)預防醫學的(de)(de)(de)(de)人(ren)(ren)才(cai)(cai)培養質量為(wei)(wei)核心任(ren)務。

　　提高我國公共健康人才培養質量的政策建議

　　重(zhong)大傳(chuan)染病(bing)和生物安(an)全(quan)(quan)風(feng)險(xian)是事(shi)關國家安(an)全(quan)(quan)和發展、事(shi)關社會大局穩定的(de)(de)重(zhong)大風(feng)險(xian)挑戰。重(zhong)大傳(chuan)染病(bing)防(fang)(fang)控可類比軍事(shi)國防(fang)(fang)，需要最優秀的(de)(de)人(ren)才(cai)(cai)(cai)。總體上(shang)，建議從國家安(an)全(quan)(quan)和全(quan)(quan)民(min)健(jian)(jian)康(kang)的(de)(de)戰略高度重(zhong)視公共(gong)(gong)(gong)健(jian)(jian)康(kang)人(ren)才(cai)(cai)(cai)培(pei)養。在公共(gong)(gong)(gong)健(jian)(jian)康(kang)3.0、One Health、生物安(an)全(quan)(quan)與健(jian)(jian)康(kang)安(an)全(quan)(quan)等(deng)理(li)念下(xia)，把公共(gong)(gong)(gong)衛(wei)生與預防(fang)(fang)醫學、臨(lin)床醫學、人(ren)畜共(gong)(gong)(gong)患(huan)病(bing)、環境與健(jian)(jian)康(kang)等(deng)與人(ren)群健(jian)(jian)康(kang)相(xiang)關的(de)(de)人(ren)才(cai)(cai)(cai)統稱為公共(gong)(gong)(gong)健(jian)(jian)康(kang)人(ren)才(cai)(cai)(cai)，其中(zhong)公共(gong)(gong)(gong)衛(wei)生與預防(fang)(fang)醫學是主體。從大健(jian)(jian)康(kang)和國家安(an)全(quan)(quan)的(de)(de)高度，系統規劃我國公共(gong)(gong)(gong)健(jian)(jian)康(kang)人(ren)才(cai)(cai)(cai)的(de)(de)教(jiao)育與培(pei)養。

　　第一(yi)，構建(jian)以大健康為中心(xin)、覆蓋院校教育(yu)——畢業后教育(yu)——繼(ji)續教育(yu)全鏈條(tiao)的公共健康人才培養(yang)體(ti)系。

　　在(zai)基本原則方面(mian)，院(yuan)校教(jiao)(jiao)育的(de)本科(ke)生(sheng)(sheng)(sheng)(sheng)強(qiang)調(diao)“核心能力(li)”，學術學位(wei)研究(jiu)生(sheng)(sheng)(sheng)(sheng)強(qiang)調(diao)“創新能力(li)”，專(zhuan)業(ye)學位(wei)研究(jiu)生(sheng)(sheng)(sheng)(sheng)和繼續(xu)教(jiao)(jiao)育強(qiang)調(diao)“崗位(wei)勝任(ren)力(li)”。在(zai)畢業(ye)后教(jiao)(jiao)育階段建(jian)立(li)公(gong)(gong)共(gong)(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)(sheng)醫(yi)(yi)師規范化培訓(xun)制度，納入住(zhu)院(yuan)醫(yi)(yi)師規范化培訓(xun)體(ti)系(xi)統一管理(li)。在(zai)院(yuan)校教(jiao)(jiao)育方面(mian)，將培養(yang)(yang)實踐導(dao)向的(de)公(gong)(gong)共(gong)(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)(sheng)碩士(shi)專(zhuan)業(ye)學位(wei)(MPH)作為主(zhu)流學位(wei)，但建(jian)議(yi)MPH招生(sheng)(sheng)(sheng)(sheng)不(bu)限于醫(yi)(yi)療(liao)衛(wei)生(sheng)(sheng)(sheng)(sheng)行(xing)(xing)業(ye)，將入口拓寬至相(xiang)關行(xing)(xing)業(ye)，寬口徑培養(yang)(yang)公(gong)(gong)共(gong)(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)(sheng)復合型(xing)人(ren)(ren)才(cai)。建(jian)議(yi)減少學術型(xing)碩士(shi)并逐漸過渡為學術型(xing)博士(shi)為主(zhu)，建(jian)議(yi)逐步加(jia)大公(gong)(gong)共(gong)(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)博士(shi)的(de)培養(yang)(yang)。為了(le)提(ti)高我國疾(ji)控人(ren)(ren)員的(de)人(ren)(ren)才(cai)培養(yang)(yang)質量，建(jian)議(yi)逐步減少公(gong)(gong)共(gong)(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)(sheng)和預防醫(yi)(yi)學專(zhuan)科(ke)生(sheng)(sheng)(sheng)(sheng)招生(sheng)(sheng)(sheng)(sheng)，盡快(kuai)實現公(gong)(gong)共(gong)(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)(sheng)與(yu)預防醫(yi)(yi)學本科(ke)生(sheng)(sheng)(sheng)(sheng)起點培養(yang)(yang)，從而提(ti)高公(gong)(gong)共(gong)(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)(sheng)生(sheng)(sheng)(sheng)(sheng)源(yuan)質量。在(zai)國家醫(yi)(yi)學人(ren)(ren)才(cai)管理(li)層(ceng)面(mian)，將公(gong)(gong)共(gong)(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)(sheng)醫(yi)(yi)師與(yu)臨床醫(yi)(yi)師置(zhi)于同等重要的(de)位(wei)置(zhi)。

　　第二，推動公共衛生與預防醫(yi)學專業認證制度，建(jian)立國家標準，提高人才培養質量。

　　由于不(bu)同(tong)的公(gong)共(gong)(gong)衛生(sheng)(sheng)學(xue)院(yuan)(yuan)的教學(xue)培養內容(rong)不(bu)一，且不(bu)像臨床醫學(xue)人才培養質量(liang)與臨床醫師專業(ye)能(neng)力較容(rong)易(yi)受社會認同(tong)，國際(ji)上近年一直(zhi)積極(ji)推動公(gong)共(gong)(gong)衛生(sheng)(sheng)學(xue)院(yuan)(yuan)的評估和公(gong)共(gong)(gong)衛生(sheng)(sheng)醫師的專業(ye)認證(zheng)。主(zhu)要(yao)方(fang)式有兩(liang)種：一是針對公(gong)共(gong)(gong)衛生(sheng)(sheng)學(xue)院(yuan)(yuan)的評估;二是針對公(gong)共(gong)(gong)衛生(sheng)(sheng)學(xue)院(yuan)(yuan)畢業(ye)生(sheng)(sheng)的專業(ye)認證(zheng)考試。

　　根據健康(kang)中國(guo)發展需(xu)求，可(ke)(ke)以(yi)考(kao)(kao)慮(lv)逐(zhu)步推(tui)(tui)進(jin)(jin)公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)學(xue)(xue)院(yuan)的(de)評(ping)(ping)估和(he)公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)醫師的(de)專業認證(zheng)(zheng)。在學(xue)(xue)院(yuan)評(ping)(ping)估方(fang)(fang)面(mian)，建議由教育部設立(li)公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)學(xue)(xue)院(yuan)評(ping)(ping)估機構(gou)，對所有(you)(you)公(gong)(gong)(gong)(gong)衛(wei)(wei)學(xue)(xue)院(yuan)教學(xue)(xue)質量和(he)培(pei)養(yang)(yang)模式進(jin)(jin)行論(lun)證(zheng)(zheng)和(he)評(ping)(ping)估，這(zhe)些論(lun)證(zheng)(zheng)信息可(ke)(ke)提(ti)供(gong)給各級疾控部門和(he)公(gong)(gong)(gong)(gong)衛(wei)(wei)機構(gou)選才作參考(kao)(kao)。對于公(gong)(gong)(gong)(gong)衛(wei)(wei)人才培(pei)養(yang)(yang)不能(neng)(neng)達標(biao)(biao)的(de)學(xue)(xue)院(yuan)，要(yao)求制定整(zheng)改(gai)和(he)調(diao)整(zheng)方(fang)(fang)案，全面(mian)提(ti)高我(wo)國(guo)的(de)公(gong)(gong)(gong)(gong)衛(wei)(wei)人才培(pei)養(yang)(yang)質量;在畢業生(sheng)(sheng)資(zi)格認定方(fang)(fang)面(mian)，目(mu)前，我(wo)國(guo)公(gong)(gong)(gong)(gong)衛(wei)(wei)學(xue)(xue)院(yuan)畢業生(sheng)(sheng)不需(xu)要(yao)參加論(lun)證(zheng)(zheng)考(kao)(kao)試(shi)，就可(ke)(ke)以(yi)從事公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)相(xiang)關工(gong)作。國(guo)際上近年(nian)來已經開(kai)始推(tui)(tui)動公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)專業認證(zheng)(zheng)考(kao)(kao)試(shi)并(bing)規定只有(you)(you)通過認定的(de)公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)學(xue)(xue)院(yuan)的(de)畢業生(sheng)(sheng)才能(neng)(neng)報考(kao)(kao)，以(yi)了解公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)學(xue)(xue)院(yuan)畢業生(sheng)(sheng)是否真的(de)具備公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)核(he)心(xin)知識(shi)和(he)能(neng)(neng)力(li)，并(bing)期望通過認證(zheng)(zheng)考(kao)(kao)試(shi)制度促使各公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)學(xue)(xue)院(yuan)調(diao)整(zheng)教學(xue)(xue)方(fang)(fang)向和(he)培(pei)養(yang)(yang)方(fang)(fang)案。這(zhe)與我(wo)國(guo)的(de)公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)執業醫師考(kao)(kao)試(shi)是類似的(de)。我(wo)國(guo)目(mu)前有(you)(you)教育部臨床(chuang)醫學(xue)(xue)、護理(li)學(xue)(xue)專業認證(zheng)(zheng)，但(dan)尚未(wei)推(tui)(tui)動公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)與預防(fang)醫學(xue)(xue)專業認證(zheng)(zheng)，建議設立(li)國(guo)家(jia)標(biao)(biao)準(zhun)，盡快推(tui)(tui)動對我(wo)國(guo)目(mu)前公(gong)(gong)(gong)(gong)共(gong)(gong)衛(wei)(wei)生(sheng)(sheng)學(xue)(xue)院(yuan)的(de)評(ping)(ping)估。

　　第三，為應對多元(yuan)化(hua)健康影響(xiang)因素，注重核心(xin)知識能(neng)力課程和跨(kua)領域學位課程并重。

　　2019年《國(guo)務院(yuan)關于(yu)實施健(jian)康(kang)(kang)中(zhong)國(guo)行動的意見》將“居(ju)民主要(yao)健(jian)康(kang)(kang)影(ying)(ying)響因(yin)素得到有效控(kong)制(zhi)”納(na)入(ru)總(zong)體目(mu)標(biao)之一。而在(zai)2016年《“健(jian)康(kang)(kang)中(zhong)國(guo)2030”規劃綱要(yao)》中(zhong)對應的表述是“健(jian)康(kang)(kang)危險因(yin)素”。從“危險因(yin)素”到“影(ying)(ying)響因(yin)素”，一詞的改變(bian)(bian)反映了我國(guo)公(gong)共衛生理(li)念也正(zheng)在(zai)發生變(bian)(bian)化。

　　為應(ying)(ying)(ying)對多元化的(de)(de)健(jian)(jian)康影(ying)響(xiang)因素(su)，建議注重(zhong)公(gong)(gong)(gong)共(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)教育(yu)核心(xin)知識能(neng)(neng)力(li)課程和(he)跨(kua)領(ling)域(yu)學(xue)(xue)位課程并(bing)重(zhong)。國際(ji)上公(gong)(gong)(gong)共(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)教育(yu)強(qiang)調(diao)公(gong)(gong)(gong)共(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)碩士(MPH)學(xue)(xue)位，其(qi)課程同時重(zhong)視(shi)流(liu)行病學(xue)(xue)、生(sheng)(sheng)(sheng)物統(tong)(tong)計(ji)、環境(jing)衛(wei)生(sheng)(sheng)(sheng)、衛(wei)生(sheng)(sheng)(sheng)政策與管理(li)、社(she)會行為科學(xue)(xue)五(wu)項核心(xin)知識能(neng)(neng)力(li)，以(yi)及(ji)信息傳播與大(da)(da)數(shu)據、領(ling)導能(neng)(neng)力(li)、公(gong)(gong)(gong)共(gong)(gong)健(jian)(jian)康生(sheng)(sheng)(sheng)物學(xue)(xue)、系(xi)統(tong)(tong)性思維(wei)等跨(kua)領(ling)域(yu)專業素(su)養。培養的(de)(de)公(gong)(gong)(gong)共(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)人(ren)(ren)才，能(neng)(neng)了解多層面(mian)的(de)(de)健(jian)(jian)康影(ying)響(xiang)因素(su)，并(bing)且在面(mian)對健(jian)(jian)康問題時，可以(yi)提出不同方面(mian)的(de)(de)解決(jue)方案。目(mu)前我國公(gong)(gong)(gong)共(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)學(xue)(xue)院課程設置(zhi)重(zhong)預防、輕(qing)應(ying)(ying)(ying)急(ji)，重(zhong)公(gong)(gong)(gong)衛(wei)專業本身、綜合學(xue)(xue)科培養不足，公(gong)(gong)(gong)衛(wei)和(he)文(wen)、理(li)、醫、工(gong)、經的(de)(de)融合不足。因此，現(xian)有公(gong)(gong)(gong)共(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)學(xue)(xue)院的(de)(de)課程設置(zhi)應(ying)(ying)(ying)做(zuo)調(diao)整(zheng)，特(te)別是綜合型大(da)(da)學(xue)(xue)的(de)(de)公(gong)(gong)(gong)共(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)學(xue)(xue)院，借助政治(zhi)、社(she)會、經濟、公(gong)(gong)(gong)共(gong)(gong)管理(li)、大(da)(da)數(shu)據等多學(xue)(xue)科交(jiao)叉(cha)的(de)(de)優勢(shi)，重(zhong)視(shi)應(ying)(ying)(ying)急(ji)防疫(yi)方面(mian)的(de)(de)人(ren)(ren)才培養和(he)雙學(xue)(xue)位教育(yu)，快速培養一(yi)批(pi)既懂得公(gong)(gong)(gong)共(gong)(gong)衛(wei)生(sheng)(sheng)(sheng)，又(you)懂得系(xi)統(tong)(tong)防疫(yi)、應(ying)(ying)(ying)急(ji)響(xiang)應(ying)(ying)(ying)的(de)(de)人(ren)(ren)才隊伍。

　　第四，在院(yuan)校教(jiao)育(yu)、畢業(ye)后教(jiao)育(yu)和(he)實(shi)際工作中(zhong)加強醫(yi)療體系和(he)疾控體系的(de)建制性交(jiao)流。

　　建(jian)議(yi)(yi)醫(yi)(yi)學(xue)院(yuan)加強(qiang)與疾(ji)(ji)控(kong)(kong)(kong)部門(men)的(de)(de)合作，包括本科生(sheng)(sheng)、研究生(sheng)(sheng)培養以及以疾(ji)(ji)病(bing)防(fang)控(kong)(kong)(kong)為導(dao)向(xiang)的(de)(de)科學(xue)研究等方面。建(jian)議(yi)(yi)推動(dong)(dong)省級疾(ji)(ji)病(bing)預(yu)防(fang)與控(kong)(kong)(kong)制(zhi)中心(CDC)與設有公衛學(xue)院(yuan)高(gao)校的(de)(de)密切結(jie)合。建(jian)議(yi)(yi)在臨床(chuang)醫(yi)(yi)生(sheng)(sheng)教(jiao)育(yu)(yu)培養過(guo)程中強(qiang)化疾(ji)(ji)病(bing)預(yu)防(fang)控(kong)(kong)(kong)制(zhi)教(jiao)育(yu)(yu)。使臨床(chuang)醫(yi)(yi)生(sheng)(sheng)具(ju)備早(zao)(zao)(zao)期(qi)發(fa)現傳染病(bing)個案(an)的(de)(de)能(neng)力，及早(zao)(zao)(zao)上報疾(ji)(ji)控(kong)(kong)(kong)部門(men)并積極參與控(kong)(kong)(kong)制(zhi)疫(yi)情，可(ke)避(bi)免之后多米(mi)諾骨牌式的(de)(de)社會經濟巨大損(sun)失(shi)。早(zao)(zao)(zao)期(qi)發(fa)現慢性(xing)病(bing)征兆，及早(zao)(zao)(zao)告知患者(zhe)并控(kong)(kong)(kong)制(zhi)進展，可(ke)避(bi)免后期(qi)連(lian)鎖反應(ying)式的(de)(de)個體損(sun)失(shi)。國外主要通(tong)過(guo)住院(yuan)醫(yi)(yi)師規范(fan)化培訓之前的(de)(de)一(yi)年公共衛生(sheng)(sheng)碩(shuo)士(MPH)教(jiao)育(yu)(yu)，培養身處人(ren)群接觸(chu)第一(yi)線(xian)的(de)(de)臨床(chuang)醫(yi)(yi)生(sheng)(sheng)具(ju)備相(xiang)應(ying)的(de)(de)公共衛生(sheng)(sheng)知識和處理能(neng)力。建(jian)議(yi)(yi)我國可(ke)參考推動(dong)(dong)臨床(chuang)醫(yi)(yi)生(sheng)(sheng)的(de)(de)MPH教(jiao)育(yu)(yu)。鑒于(yu)醫(yi)(yi)療和疾(ji)(ji)控(kong)(kong)(kong)系統(tong)相(xiang)互(hu)獨立和缺(que)乏(fa)建(jian)制(zhi)性(xing)交流(liu)的(de)(de)現狀，建(jian)議(yi)(yi)探索設立相(xiang)關(guan)的(de)(de)學(xue)者(zhe)計(ji)劃(hua)和科研項目，建(jian)立人(ren)才從醫(yi)(yi)院(yuan)向(xiang)疾(ji)(ji)控(kong)(kong)(kong)中心流(liu)動(dong)(dong)的(de)(de)激勵機制(zhi)，促進疾(ji)(ji)控(kong)(kong)(kong)中心高(gao)素質人(ren)才儲備，以在關(guan)鍵時刻(ke)指(zhi)導(dao)醫(yi)(yi)院(yuan)的(de)(de)疫(yi)情控(kong)(kong)(kong)制(zhi)工作。

　　第五，加強對地方衛生健康管理部門(men)負責人的疾病防控和(he)應(ying)急防疫方面的教育培訓。

　　公共(gong)健(jian)(jian)康3.0理(li)(li)念要求(qiu)(qiu)地(di)方(fang)公共(gong)衛(wei)(wei)生(sheng)(sheng)領(ling)導人(ren)(ren)要成為(wei)(wei)“首席健(jian)(jian)康戰略官”。疫情暴發后，作(zuo)為(wei)(wei)政(zheng)府管(guan)理(li)(li)體(ti)(ti)系(xi)中最(zui)專業的(de)(de)各級衛(wei)(wei)生(sheng)(sheng)健(jian)(jian)康管(guan)理(li)(li)部(bu)(bu)(bu)門(men)干(gan)部(bu)(bu)(bu)是關鍵隊伍(wu)，是公共(gong)衛(wei)(wei)生(sheng)(sheng)事件(jian)中的(de)(de)早期指揮主(zhu)體(ti)(ti)，需(xu)要對所在(zai)地(di)的(de)(de)衛(wei)(wei)生(sheng)(sheng)疫情有整體(ti)(ti)了(le)解并作(zuo)防控(kong)布局，這(zhe)對負(fu)責人(ren)(ren)的(de)(de)專業背(bei)(bei)景(jing)提出(chu)了(le)明(ming)確要求(qiu)(qiu)。在(zai)我國(guo)當前(qian)推進國(guo)家(jia)治理(li)(li)能(neng)力(li)現代化(hua)(hua)的(de)(de)背(bei)(bei)景(jing)下，讓政(zheng)府領(ling)導干(gan)部(bu)(bu)(bu)特別是一(yi)把手(shou)切實理(li)(li)解疾病(bing)預防控(kong)制(zhi)，包括防控(kong)突發傳染(ran)病(bing)、慢性(xing)病(bing)和環境(jing)危害，對人(ren)(ren)民健(jian)(jian)康、社會穩定(ding)和經濟發展(zhan)有著極(ji)其重大的(de)(de)意(yi)義。考慮(lv)到地(di)方(fang)衛(wei)(wei)生(sheng)(sheng)健(jian)(jian)康管(guan)理(li)(li)部(bu)(bu)(bu)門(men)是一(yi)種專業性(xing)極(ji)高的(de)(de)技術(shu)行(xing)政(zheng)部(bu)(bu)(bu)門(men)，為(wei)(wei)避免“延誤(wu)戰機(ji)、誤(wu)判錯判”，應該要求(qiu)(qiu)公共(gong)衛(wei)(wei)生(sheng)(sheng)行(xing)政(zheng)負(fu)責人(ren)(ren)需(xu)具(ju)有醫學和公衛(wei)(wei)的(de)(de)教(jiao)(jiao)育(yu)和實踐(jian)背(bei)(bei)景(jing)。同時，建議國(guo)家(jia)層面(mian)出(chu)臺具(ju)體(ti)(ti)舉(ju)措(cuo)，加(jia)強(qiang)對地(di)方(fang)衛(wei)(wei)生(sheng)(sheng)健(jian)(jian)康行(xing)政(zheng)管(guan)理(li)(li)部(bu)(bu)(bu)門(men)負(fu)責人(ren)(ren)在(zai)疾病(bing)防控(kong)和應急防疫方(fang)面(mian)的(de)(de)定(ding)期教(jiao)(jiao)育(yu)培訓(xun)(xun)，經常性(xing)強(qiang)化(hua)(hua)疾控(kong)意(yi)識，逐步成為(wei)(wei)一(yi)種建制(zhi)化(hua)(hua)的(de)(de)學習和培訓(xun)(xun)機(ji)制(zhi)。

　　總之，應(ying)該(gai)高(gao)度(du)重視后疫(yi)情時代我國(guo)公共健康人(ren)才培養，建立現代化的疾病防控體(ti)系和(he)高(gao)質量人(ren)才隊伍體(ti)系，強化公共衛(wei)生應(ying)急體(ti)系在(zai)國(guo)家治理體(ti)系的地位和(he)作用，保障我國(guo)經濟和(he)社(she)會的可(ke)持續發展。

　　(作者(zhe)為北京大學常務副校長、醫學部主任(ren)，中國(guo)工程院院士)