China's CDC lost 100 young and middle-aged backbones in three years
Shortcomings in the reform of the disease control system are imminent
An issue that has been neglected is attracting attention: the weakening of the public health talent team in my country.
The 2020 government work report adopted on May 28 added the expression "accelerating the construction of a public health talent team" to the original manuscript, which was added based on the opinions of NPC deputies and CPPCC members.
Lin Huiqing, member of the National Committee of the Chinese People's Political Consultative Conference and former vice minister of the Ministry of Education, said at the CPPCC group meeting that after the SARS epidemic in 2003, the hardware conditions of the disease control system have improved significantly, but a large number of professional talents have been lost. The essential".
Zeng Guang, a member of the high-level expert group of the National Health and Health Commission and chief epidemiologist of the Chinese Center for Disease Control and Prevention, has always been concerned about this issue. He has experienced many public health incidents from the SARS epidemic to the New Coronary Pneumonia epidemic, and through the "China Field Epidemiology Training Project", he trained a group of public health talents-many of whom participated in the prevention and control of the New Coronary Pneumonia epidemic.
At a seminar hosted by the Development Research Center of the State Council last year, Zeng Guang called out: There are as many as a hundred young and middle-aged backbones who have been lost by the Chinese Center for Disease Control and Prevention for only three years, and some local disease control agencies may have more brain drain. People generally hope to overcome the difficulties through reform.
At the two sessions, Wang Songling, academician of the Chinese Academy of Sciences, vice president of the Capital Medical University, and member of the National Committee of the Chinese People's Political Consultative Conference pointed out that the state's investment in the construction of public health teams is obviously insufficient, the social status of employees is low, the economic income is poor, and the brain drain is serious. "Reform is imminent."
"Insufficient government investment, shrinking system functions, and severe staff loss"
As a member of the National Committee of the Chinese People's Political Consultative Conference, Gao Fu, director of the Chinese Center for Disease Control and Academician of the Chinese Academy of Sciences, presented a set of figures at the two sessions to illustrate that "the development of the disease control cause is obviously lagging behind economic and social development": from 2010 to 2018, all levels The total number of staff in the CDC decreased by 3.9%, of which the number of licensed physicians as the main professional technology decreased by 10.8%, and the total number of staff in general hospitals increased by 64.3% during the same period. The proportion of disease control agencies in medical and health expenditure fell from 2.9% to 2.4%.
Gao Fu admitted that the disease control agency, as the main force of epidemic prevention and control, failed to fully play its role in the early warning and monitoring of new coronary pneumonia epidemic situation, epidemiological investigation, prevention and control measures, and faced inadequate capacity and professional voice. Insufficient and other issues.
"China Health and Family Planning Statistical Yearbook" shows that in 2004 and 2005 after SARS, the number of national disease control personnel increased temporarily, and then declined year by year. In 2006, 2010, 2012, 2015 and 2018, the most wasted, compared with the loss of 5,924, 1,220, 1,397, 1,437 and 2,904 respectively in the previous year. In January this year, Liu Zhiqiang, a researcher in the Research Office of the Office of the National Health and Health Commission, published a survey report on the disease control centers in six provinces. It was pointed out that the preventive medical examination fees, health testing fees, and entrusted health care for administrative undertakings were cancelled in 2017. Due to the impact of anti-epidemic service fees and other factors, the income of the CDC staff decreased significantly in 2018, and the staff turnover increased. Of the 2,904 people lost in 2018, 2,114 were professional technicians. This report uses the generalization of “insufficient government investment, shrinking system functions, and severe staff turnover”.
Xie Ru, a member of the National Committee of the Chinese People's Political Consultative Conference and vice-chairman of the Jiangxi Provincial Committee of the Chinese People's Political Consultative Conference, noted that public health expenditure as a proportion of medical and health expenditure fell from 17.7% in 2011 to 5.59% in 2018. The proportion of health personnel in disease control agencies accounted for the national health personnel, from 2.53% in 2009 to 1.53% in 2018.
She pointed out that after SARS, my country's public health and sudden infectious disease prevention and control system has made great progress, but structural problems such as emphasis on medical treatment and weak prevention at the grassroots level remain prominent. At present, there are no specialized disease control institutions and personnel below the county level, and grassroots medical and health institutions undertaking corresponding responsibilities are neither enthusiastic nor "powerless" in public health due to economic benefits and other reasons.
Huang Gairong, director of the Department of Geriatrics of Henan Provincial People's Hospital and member of the National Committee of the Chinese People's Political Consultative Conference, said that basic public health services include public health interventions provided by disease prevention and control agencies, community health service centers, township hospitals and other institutions to all residents. In this epidemic, most of the county-level public health institutions suffered from poor facilities and poor detection capabilities.
In 2018, the NPC Standing Committee’s Law Enforcement Inspection Team was led by four vice-chairmen to conduct law enforcement inspections of the Infectious Disease Prevention and Control Law. The resulting report cited many cases: the important port city of Khorgos, Xinjiang, was not professional at the time For disease prevention and control agencies, related work is "responsible for a department of the Municipal People's Hospital". Shaanxi Provincial Center for Disease Control lacks corresponding daily maintenance funds for hydropower, etc., and the annual funding gap is about 18 million yuan.
The law enforcement inspection report also pointed out the problem of brain drain. For example, the Disease Control Center of Ganzi Prefecture, Sichuan Province, "In recent years, 26 undergraduates have been introduced and 14 have resigned."
"First-rate talents engage in clinical practice, second-rate talents do public health"?
"Reform the disease prevention and control system" is the task of this year's government work report. One of the suggestions of the former Beijing Municipal Health and Family Planning Commission Party Committee Secretary and CPPCC National Committee member Fang Laiying is to establish a "national epidemic prevention officer" system, refer to the management of civil servants for disease control agencies, implement a special subsidy system for epidemic prevention personnel, and encourage excellent personnel to enter the disease control system .
"Units with technology as their core competence, such as disease control centers, cannot simply apply the personnel remuneration system of administrative institutions, and it is recommended that special positions and positions be separated," he said.
Gao Xiaomei, deputy director of the Social and Legal System Committee of the National Committee of the Chinese People's Political Consultative Conference, and vice chairman of the Central Committee of the National Revolutionary Committee, referred to the issue of the talent team as a "hidden but invisible" problem. She said that public health doctors are one of the four types of doctors in my country, but the professional status of public health doctors is seriously low and unattractive, and the team size is much smaller than the other three types of doctors. At present, there are no hard-and-fast rules for the qualifications of public health physicians, which is significantly different from the qualifications of clinicians. There is a saying in the industry that “first-rate talents engage in clinical practice and second-rate talents do public health”. We should strengthen the professional construction of public health personnel, change the practice status of public health physicians, and truly enhance the social status of public health physicians.
She believes that the duties of public health doctors should be accurately set, and the prescription rights required by public health doctors should be granted. The scope of duties of public health physicians should not only be emergency, but also prevent; not only to manage infectious diseases, but also to prevent and control chronic diseases and geriatric diseases.
Wang Songling also suggested that the admission system for public health institutions and the licensing system for public health professionals can be gradually implemented to make the public health system more scientific and professional.
"Increase the voice of professionals"
After the outbreak of the new coronary pneumonia epidemic, Zhong Nanshan, leader of the high-level expert group of the National Health and Health Commission and an academician of the Chinese Academy of Engineering, once proposed the idea of giving the CDC certain administrative powers. Many people agree with this. Fang Laiying believes that the terms of reference of disease control agencies should be adjusted so that they have corresponding administrative enforcement powers. Wei Dingmei, deputy mayor of Guiyang City and member of the National Committee of the Chinese People's Political Consultative Conference, proposed to amend the law, granting the disease control department the authority to publish early warning information and administrative supervision and law enforcement.
Zeng Guang told reporters that the Chinese Center for Disease Control and Prevention lacked the supervision power over all regions and generally carried out its work "discussedly and persuasively". In the 1990s, the disease control agency and the health supervision agency were separated. "Units that originally had investigative powers and certain supervisory powers did not have that part of the power; an originally good system was divided into two systems."
Gao Fu pointed out that the key to the reform of the disease control system is not whether it has "administrative power", but whether the technical work can be free from administrative interference and maintain independent technicality and authority. At present, the disease control agencies assume the responsibility of proposing prevention and control strategies, but the lack of decision-making power and discourse power to deal with epidemic situations leads to the disconnection of administrative decision-making and technical strategies. Disease control experts can only exercise the right to make recommendations and cannot participate in decision-making in depth.
In his view, the existing problems are: China's disease control administrative functions are scattered, and the national health and health administration's disease control and emergency functions are scattered in the disease control bureau, medical administration, emergency management office and other departments. There is more interference in the details of prevention and control, and lack of overall coordination. From a national point of view, there is only a relationship between guidance and guidance between the upper and lower levels of disease control agencies, and it is difficult to form an effective joint force when dealing with epidemic situations.
In this regard, Gao Fu also suggested that strengthening the management of higher-level disease control agencies to lower-level disease control agencies, the implementation of vertical business management of major public health service projects that belong to the central financial authority, to achieve a "game of chess" for the national disease control system.
Cen Xu, a member of the National Committee of the Chinese People's Political Consultative Conference and the former assistant director of the General Political Department of the People's Liberation Army, proposed that CDCs should be given "appropriate administrative powers". Autonomous disease control administrative agencies, or give CDC certain powers to release epidemic information and participate in epidemic prevention and control decision-making functions, "increasing professional voice".
He summarized the problems of the disease control system as "unclear functional positioning, unscientific division of responsibilities, insensitive rapid response, and unreliable bottom-level network." He said that the exposure of these problems provides a target for what and how to change.
Fang Laiying, who has experienced SARS, emphasized that to "review" after the "big test", you must not only see the results, but also see the short board and learn lessons. There is an urgent need to study the construction of the national public health system. "The current situation of insufficient establishment, insufficient funds and insufficient personnel in national and local disease prevention and control institutions must be changed as soon as possible."
Zhang Qiaoli, member of the National Committee of the Chinese People's Political Consultative Conference and director of the Center for Disease Control and Prevention of Dongguan City, Guangdong Province, appealed at the two sessions, hoping to clarify the government's responsibility for investment protection in the field of public health. She also said that she hopes that there will be no more attention when there is an epidemic and neglect when there is no epidemic.
China Youth Daily · China Youth Network reporter Zhang Guo