Lafiyar Jama'a

An bayyana lafiya Jama'a a matsayin "sakamakon kiwon lafiya na rukuni na mutane, gami da rarraba irin waɗannan sakamakon a cikin rukuni".[1] Hanyar kiwon lafiya ce da ke da niyyar inganta lafiyar dukkan mutane. An bayyana shi kamar yadda ya kunshi abubuwa uku. Wadannan su ne "sakamakon kiwon lafiya, alamu na abubuwan da ke tabbatar da kiwon lafiya. "[1]

Abinda ake la'akari da shi da mahimmanci wajen cimma burin kiwon lafiyar jama'a shine rage rashin daidaito na kiwon lafiya ko bambance-bambance tsakanin kungiyoyin jama'a daban-daban saboda, a tsakanin sauran dalilai, abubuwan da ke tattare da kiwon lafiya (SDOH). SDOH ya haɗa da duk abubuwan (al'umma, muhalli, al'adu da jiki) waɗanda aka haifi al'ummomi daban-daban, suna girma, da aiki tare da su a duk rayuwarsu wanda zai iya samun tasiri a kan lafiyar jama'ar mutane.[1] Ma'anar kiwon lafiyar jama'a tana wakiltar canji a cikin mayar da hankali daga matakin mutum, halayyar mafi yawan magungunan gargajiya. Har ila yau, yana neman haɓaka ƙoƙarin gargajiya na hukumomin kiwon lafiya na jama'a ta hanyar magani dalilai masu yawa da aka nuna don tasiri ga lafiyar al'ummomi daban-daban. Hukumar Lafiya ta Duniya kan Masu Tabbatar da Lafiya ta Jama'a ta ruwaito a cikin 2008 cewa abubuwan SDOH suna da alhakin yawancin cututtuka da raunin, kuma waɗannan sune manyan abubuwan da ke haifar da rashin daidaito a duk ƙasashe.[2] A Amurka, an kiyasta SDOH don asusun kashi 70% na mutuwar da za a iya gujewa.[3]

Daga hangen nesa na kiwon lafiya na jama'a, an bayyana kiwon lafiya ba kawai a matsayin jihar da ba ta da cuta amma a matsayin "ikon mutane su daidaita, amsa, ko sarrafa ƙalubalen rayuwa da canje-canje". Hukumar Lafiya ta Duniya (WHO) ta bayyana kiwon lafiya a cikin ma'anarta a cikin 1946 a matsayin "yanayin cikakkiyar lafiyar jiki, tunani, da zamantakewa kuma ba kawai rashin cuta ko nakasa ba. "

## Mutanen da ke da lafiya 2020
Healthy People 2020 shafin yanar gizo ne wanda Ma'aikatar Lafiya da Ayyukan Dan Adam ta Amurka ke tallafawa, wanda ke wakiltar kokarin da aka yi na shekaru 34 na sha'awa da ofishin Babban Likita da sauransu. Ya gano batutuwa 42 da aka dauka a matsayin masu tantance lafiyar zamantakewa da kuma kimanin takamaiman manufofi 1200 da aka dauka don inganta lafiyar jama'a. Yana ba da hanyoyin haɗi zuwa binciken da ake samu na yanzu don batutuwa da aka zaɓa kuma yana ganowa da tallafawa buƙatar shiga cikin al'umma da ake ɗauka da muhimmanci don magance waɗannan matsalolin da gaske.

## Rashin daidaito na tattalin arziki
Kwanan nan, an sami karuwar sha'awa daga masu binciken cututtuka game da batun Rashin daidaito na tattalin arziki da alaƙar sa da lafiyar jama'a. Akwai kyakkyawar alaƙa tsakanin matsayin zamantakewa da kiwon lafiya. Wannan alaƙar ta nuna cewa ba kawai matalauta ne ke fama da rashin lafiya ba lokacin da kowa yake lafiya, saboda yanayin kamar cututtukan zuciya, ulcers, nau'in ciwon sukari na 2, rheumatoid arthritis, wasu nau'ikan ciwon daji, da tsufa da wuri suna nan a duk matakan zamantakewa da tattalin arziki. Duk da gaskiyar SES Gradient, akwai muhawara game da dalilinsa. Yawancin masu bincike (A. Leigh, C. Jencks, A. Clarkwest - duba kuma takardun aiki na Russell Sage) suna ganin takamaiman alaƙa tsakanin matsayin tattalin arziki da mutuwa saboda mafi girman albarkatun tattalin arziki na mafi kyawun, amma suna samun ɗan alaƙa saboda bambancin Matsayi na zamantakewa.

Sauran masu bincike kamar Richard G. Wilkinson, J. Lynch, da G.A. Kaplan sun gano cewa Matsayi zamantakewa da tattalin arziki yana shafar kiwon lafiya sosai har ma lokacin da suke sarrafa albarkatun tattalin arziki da samun damar kiwon lafiya. Mafi shahara don danganta matsayin zamantakewa da kiwon lafiya shine karatun Whitehall - jerin karatun da aka gudanar akan Ma'aikatan gwamnati a Landan. Binciken ya gano cewa, duk da gaskiyar cewa duk ma'aikatan gwamnati a Ingila suna da damar samun kiwon lafiya iri ɗaya, akwai kyakkyawar alaƙa tsakanin Matsayi na zamantakewa da kiwon lafiya. Binciken ya gano cewa wannan dangantakar ta kasance mai ƙarfi har ma lokacin da ake sarrafa halaye masu tasiri na kiwon lafiya kamar motsa jiki, shan sigari da shan giya. Bugu da ƙari, an lura cewa babu wani adadin kulawa ta likita da zai taimaka wajen rage yiwuwar wani ya kamu da ciwon sukari na 1 ko rheumatoid arthritis - duk da haka duka biyun sun fi yawa tsakanin mutanen da ke da matsayi na zamantakewa da tattalin arziki. A ƙarshe, an gano cewa daga cikin kasashe masu arziki a duniya (saiti wanda ya shimfiɗa daga Luxembourg zuwa Slovakia) babu wata alaƙa tsakanin arzikin ƙasa da lafiyar jama'a gaba ɗaya - yana nuna cewa bayan wani matakin, cikakkun matakan wadata ba su da tasiri sosai ga lafiyar jama'ar, amma matakan dangi a cikin ƙasa suna yin hakan. Ma'anar damuwa ta zamantakewa tana ƙoƙari ta bayyana yadda abubuwan da suka faru na zamantakewa kamar matsayi da zamantakewar zamantakewa zasu iya haifar da cututtuka da yawa da ke da alaƙa da gradient na SES. Matsayi mafi girma na rashin daidaito na tattalin arziki yana kara tsananta matsayi na zamantakewa kuma gabaɗaya yana rage ingancin dangantakar zamantakewa - wanda ke haifar da matakan damuwa da cututtukan da suka shafi damuwa. Richard Wilkinson ya gano cewa wannan gaskiya ne ba kawai ga talakawa ba, har ma da masu arziki. Rashin daidaito na tattalin arziki ba shi da kyau ga lafiyar kowa. Rashin daidaito ba kawai yana shafar lafiyar jama'ar mutane ba. David H. Abbott a Cibiyar Bincike ta Kasa ta Wisconsin ta gano cewa daga cikin nau'o'in dabbobi da yawa, ƙananan tsarin zamantakewa na daidaito suna da alaƙa da matakan hormones na damuwa tsakanin mutane masu ƙasƙanci. Binciken da Robert Sapolsky na Jami'ar Stanford ya yi ya ba da irin wannan binciken.

## Rashin daidaito na ƙasa
Akwai bambancin da aka rubuta a cikin sakamakon kiwon lafiya ta hanyar bambancin ƙasa a kasashe da yawa a duniya. Wannan ya haɗa da Amurka, tare da ƙarin amfani da kiwon lafiya & farashin bambancin ƙasa, har zuwa matakin Yankin Bayyanawa na Asibiti (wanda aka ayyana a matsayin kasuwar kiwon lafiya ta yanki, wanda zai iya ƙetare iyakokin jihohi, wanda akwai 306 a Amurka). Koyaya, wadatar bayanai na alamun kiwon lafiya don yankunan ƙasa yana da iyaka a cikin lambobi, tushen bayanai da sikelin ƙasa. A cikin ƙasashe 38 na OECD, yanki, ko kuma daidai da manyan ƙungiyoyi na ƙasa, shine mafi girman matakin ƙasa don alamun mutuwa da cututtukan cututtuka. Samun alamun kiwon lafiya a ƙananan yankuna ya kasance mai ƙarancin gaske, kuma ya bambanta sosai ta hanyar ma'anar ƙasa, alamun kiwo, shekarun yawan jama'a da shekarun da ake da su. A duk lokuta, iyakokin ƙasa sun yi amfani da ma'anar gudanarwa kawai.

Akwai muhawara mai gudana game da gudummawar dangi na launin fata, jinsi, talauci, matakin ilimi da wuri ga waɗannan bambance-bambance. Ofishin Epidemiology na Ofishin Lafiya na Maternal da Child yana ba da shawarar yin amfani da tsarin nazari (Fixed Effects ko hybrid Fixed Effects) don bincike kan bambance-bambance na kiwon lafiya don rage tasirin rikice-rikice na masu canji na unguwa (geographic) akan sakamakon. [ana buƙatar ƙa'ida]&#x5B;**&#x5D;

## Masu sukar
Lafiyar jama'a ta kasance ƙarƙashin zargi da ke gudana da kuma tunanin ta.

## Yankunan da ke cikin ƙasa

### Shirye-shiryen Iyali
Shirye-shiryen tsara iyali (ciki har da maganin hana daukar ciki, Ilimin jima'i, da inganta jima'i mai aminci) suna taka muhimmiyar rawa a lafiyar jama'a. Shirye-shiryen Iyali yana daya daga cikin abubuwan da suka fi tsada a cikin magani. Shirye-shiryen iyali yana adana rayuka da kuɗi ta hanyar rage ciki ba tare da niyya ba da kuma yaduwar cututtukan da ake samu ta hanyar jima'i.

Misali, Hukumar Kula da Ci Gaban Kasa da Kasa ta Amurka ta lissafa a matsayin fa'idodi na shirin tsara iyali na kasa da kasa: 

* "Kariya ga lafiyar mata ta hanyar rage daukar ciki mai haɗari"
* "Kariya ga lafiyar yara ta hanyar ba da isasshen lokaci tsakanin ciki"
* "Yakin HIV / AIDS ta hanyar samar da bayanai, shawarwari, da kuma samun damar yin amfani da kwaroron roba na maza da mata".
* "Rage zubar da ciki"
* "Taimakon haƙƙin mata da damar samun ilimi, aiki, da cikakken shiga cikin al'umma"
* "Kariya ga muhalli ta hanyar daidaita yawan jama'a"

### Lafiyar kwakwalwa
Akwai manyan hanyoyi guda uku na yawan jama'a game da lafiyar kwakwalwa: tsoma baki na tsarin kiwon lafiya; tsoma baki na aikin kiwon lafiya na jama'a; da kuma tsoma baki na zamantakewa, tattalin arziki, da kuma manufofin muhalli. Tsarin kula da kiwon lafiya da shugabannin asibiti ne ke shiga tsakani. Misalan waɗannan tsoma baki sun haɗa da haɓaka ingancin sabis na kiwon lafiyar kwakwalwa na asibiti, samar da shawarwari da horo ga abokan hulɗa na al'umma, da raba bayanan kiwon lafiya don sanar da manufofi, aiki, da tsarawa don lafiyar kwakwalwa ta jama'a. Harkokin kiwon lafiya na jama'a suna shiga tsakani ne daga jami'an sashen kiwon lafiya. Wadannan tsoma baki sun hada da bayar da shawarwari don sauye-sauyen manufofi, fara sanarwar sabis na jama'a don rage wulakanci na rashin lafiyar kwakwalwa, da kuma gudanar da fadakarwa don kara samun damar albarkatun lafiyar kwakwalwa na al'umma. Zaɓaɓɓun jami'ai da masu tsara manufofin gudanarwa suna aiwatar da tsoma baki na manufofin zamantakewa, tattalin arziki, da muhalli. Wadannan na iya haɗawa da rage rashin tsaro na kudi da gidaje, canza Yanayin da aka gina don ƙara sararin samaniya na birane da rage gurɓataccen hayaniya na dare, da rage ƙyamar tsarin da aka tsara ga waɗanda ke fama da rashin lafiya.

## Gudanar da kiwon lafiya na jama'a (PHM)
Ɗaya daga cikin hanyoyin da za a inganta lafiyar jama'a ita ce ta hanyar kula da lafiyar jama'ar (PHM), wanda aka bayyana a matsayin "ƙwarewar fasaha na ƙoƙari wanda ke amfani da mutane da yawa, ƙungiyoyi da al'adu don taimakawa inganta alamu na cututtukan (watau, rashin lafiya da rauni) da kuma halayyar amfani da kiwon lafiya na ƙayyadaddun jama'a". PHM ya bambanta da kula da cututtuka ta hanyar hada da wasu yanayi da cututtuttuka masu tsanani, ta hanyar amfani da "maɓallin lamba da daidaitawa guda ɗaya", da kuma "tsinkaya mai ban mamaki a cikin yanayin asibiti da yawa". PHM an dauke shi da girma fiye da kula da cututtuka saboda ya hada da "gwamnatin kulawa mai zurfi ga mutane a matakin mafi girman haɗari" da kuma "gwamnati na kiwon lafiya na mutum... ga waɗanda ke cikin ƙananan matakan haɗarin kiwon lafiya". An buga labarai da yawa masu alaƙa da PHM a cikin Population Health Management, mujallar hukuma ta DMAA: The Care Continuum Alliance . 

An ba da shawarar taswirar hanya mai zuwa don taimakawa kungiyoyin kiwon lafiya su kewaya hanyar zuwa aiwatar da ingantaccen kula da lafiyar jama'a: 

* Kafa takamaiman rajistar marasa lafiyarajistar masu haƙuri
* Tabbatar da mai ba da haƙuri
* Bayyana ainihin masu ƙididdiga a cikin rajistar marasa lafiya
* Kulawa da auna ma'aunin asibiti da tsada
* Bi Jagororin aikin asibiti na asali
* Shiga cikin fadakarwa na kula da haɗari
* Samun bayanan waje
* Sadarwa da marasa lafiya
* Koyar da marasa lafiya kuma ku yi aiki da su
* Kafa da bin jagororin aiki na asibiti masu rikitarwa
* Haɗin kai yadda ya kamata tsakanin ƙungiyar kulawa da mai haƙuri
* Binciken takamaiman sakamako

## Canjin kiwon lafiya da lafiyar jama'a
Gyaran kiwon lafiya yana haifar da canji ga tsarin biyan kuɗin asibiti na gargajiya. Kafin gabatar da Dokar Kare Marasa Lafiya da Kulawa mai araha (PPACA), an biya asibitoci bisa ga yawan hanyoyin ta hanyar samfuran kuɗi don sabis. A karkashin PPACA, samfuran biyan kuɗi suna canzawa daga girma zuwa darajar. Ana gina sabbin samfuran biyan kuɗi game da biyan kuɗi don aiki, tsarin biyan kuɗi mai mahimmanci, wanda ke sanya ƙarfafa kuɗi a kusa da sakamakon haƙuri kuma ya canza yadda asibitocin Amurka dole ne su gudanar da kasuwanci don ci gaba da samun kuɗi. Baya ga mayar da hankali kan inganta kwarewar kulawa da rage farashin, asibitoci dole ne su mai da hankali kan bunkasa lafiyar jama'a (IHI Triple Aim ).

Yayin da shiga cikin samfuran biyan kuɗi masu mahimmanci kamar ƙungiyoyin kulawa masu lissafi (ACOs) ke ƙaruwa, waɗannan shirye-shiryen za su taimaka wajen fitar da lafiyar jama'a. A cikin samfurin ACO, asibitoci dole ne su hadu da takamaiman ma'auni na inganci, mayar da hankali kan rigakafi, da kuma kula da marasa lafiya tare da cututtukan da ba su da tsanani. Ana biyan masu ba da sabis ƙarin kuɗi don kiyaye marasa lafiya da lafiya da kuma fita daga asibiti. Bincike ya nuna cewa yawan shigar da marasa lafiya ya ragu a cikin shekaru goma da suka gabata a cikin al'ummomin da suka fara amfani da samfurin ACO kuma sun aiwatar da matakan kiwon lafiya na jama'a don magance marasa lafiya "marasa lafiya" a cikin yanayin marasa lafiya. Binciken da aka gudanar a yankin Chicago ya nuna raguwar yawan amfani da marasa lafiya a duk faɗin shekarun da suka gabata, wanda shine matsakaicin raguwar 5% a cikin shigar marasa lafiya.

Asibitoci suna samun fa'ida ta kudi don mayar da hankali kan kula da lafiyar jama'a da kiyaye mutane a cikin al'umma. Manufar kula da lafiyar jama'a ita ce inganta sakamakon mai haƙuri da kara yawan kuɗin kiwon lafiya. Sauran manufofi sun haɗa da hana cututtuka, rufe gibin kulawa, da kuma tanadin kuɗi ga masu ba da sabis. A cikin 'yan shekarun da suka gabata, an yi ƙoƙari sosai don haɓaka ayyukan kiwon lafiya, asibitocin al'umma a yankunan da ke da yawan mazauna da ke amfani da sashen gaggawa a matsayin kulawa ta farko, da kuma matsayin mai kula da haƙuri don daidaita ayyukan kiwon lafiyar a duk faɗin ci gaba.

Ana iya ɗaukar kiwon lafiya a matsayin babban birnin; babban birnin kiwon lafiya wani ɓangare ne na Babban birnin ɗan adam kamar yadda aka bayyana ta hanyar tsarin Grossman. Ana iya la'akari da kiwon lafiya a matsayin mai saka hannun jari da kuma amfani mai kyau. Abubuwa irin su kiba da shan sigari suna da mummunar tasiri ga babban birnin kiwon lafiya, yayin da ilimi, albashi, da shekaru na iya tasiri ga babban kuɗin kiwon lafiya. Lokacin da mutane suka fi lafiya ta hanyar kulawa ta rigakafi, suna da damar rayuwa mai tsawo da lafiya, yin aiki da yawa da shiga cikin tattalin arziki, da kuma samar da ƙarin bisa ga aikin da aka yi. Wadannan dalilai duk suna da damar kara yawan kudaden shiga. Wasu jihohi, kamar New York, sun aiwatar da shirye-shiryen jihar don magance lafiyar jama'a. A cikin jihar New York akwai irin waɗannan shirye-shirye 11. Wadannan shirye-shiryen suna aiki don magance bukatun mutane a yankin su, tare da taimakawa kungiyoyin al'umma da ayyukan zamantakewa don tattara bayanai, magance bambancin kiwon lafiya, da bincika abubuwan da suka shafi shaidar da za su haifar da ingantaccen lafiya ga kowa da kowa.

## Dubi kuma
 

## Manazarta

## Ƙarin karantawa

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## Haɗin waje

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* Rahoton Sakatariyar Binciken Manufofin Kanada game da lafiyar jama'a
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* Gidan yanar gizon Cibiyar Lafiya ta Jama'ashafin yanar gizon