翻译.docx

1、翻译.外文翻译外文翻译之一Community Medicine in the Restructured NHS作者：John Smith国籍：English出处：Community Medicine原文正文：In many areas the establishment of the new District Health Authorities entails a rearrangement of the ways in which some community physicians will function. The British Medical Associations Centra

2、l Committee for Community Medicine (CCCM) has already circulated a document outlining the tasks of community physicians employed by Dstrict Health Authorities. This has concentrated on the managerial responsibilities, the operational activities and the size and nature of the workforce needed to disc

3、harge them. The Faculty has supported the CCCM document. At the same time it has prepared a complementary paper,based upon views received from community physicians in the regions, in which the emphasis is placed more upon the role of community medicine in the restructured service. We reproduce it he

4、re in the belief that it will be of particular help to any of the specialtys practitioners who continue to have to expound its raison detre in a professionally competitive environment.This document outlines the role and function of community medicine and makes recommendations so that the discipline

5、may continue to make a maximum contribution during and after the impending restructuring of the Health Service in England.These recommendations take account of the importance of the task of community medicine, the larger number of district authorities to be serviced, the shortage of community physic

6、ians,the differingboundaries of health and local authorities with shared responsibilities to be discharged by community physicians, and the continuing need for special skills in discharge of the separate identified responsibilities of community medicine despite the removal after restructuring of spe

7、cial labelled posts.WHAT IS COMMUNITY MEDICINE?Community medicine is that branch of medical practice that is concerned to promote, maintain and, where necessary, restore the health of human communities. The practice of community medicine resembles that of clinical medicine in that it consists of the

8、 formulation and communication of advice on how health problems may be solved. It differs from clinical medicine in that clinicians usually offer their advice to individuals on request whereas community physicians offer their advice to communities and most often take the initiative in deciding both

9、when to advise and to which agency of the community advice should be directed.Community physicians consult with their communities through the medium of themanagement, planning and decision-making agencies of the communitys health and related services and most frequently through the management struct

10、ure of the National Health Service. It is the NHS that employs community physicians as members of the management teams but they must also have responsibilities towards clinical and other colleagues and to other agencies involved in matters related to health and to the communities directly.The NHS is

11、 the main agency for the treatment of illness and the care of the sick and it has an important rote in the prevention of disease although many other agencies make important contributions to prevention. It is important that the job specification and the staffing levels in community medicine take full

12、 account of the range of functions and responsibilities involved. Of all branches of the practice of medicine, community medicine has the most impressive record in terms of the health improvements that have taken place since the specialty emerged under its old name of public health in the middle of

13、the last century. The problems that face us now are different in kind but equally formidable if health improvement is to be maintained and equitably distributed in the years ahead.Before reorganization of the NHS in 1974 community physicians were mainly employed by the Regional Hospital Boards and L

14、ocal Health Authorities. In both situations, the work of these doctors was supported by a substantial staff comprising both clerical and secretarial workers and often research and other staffneededfor collecting and analysing epidemiological data related to the health problems experienced in the com

15、munity or its health institutions.Since 1974, community physicians working in Areas and Districts have often been seriously short of such supporting staff since the new administrative bodies often lacked the necessary resources or were insufficientlyaware of their importance.The new restructuring, i

16、nvolving the creation of Health Districts, is being carried outagainst a background of even more severe economic constraints and it seems especially necessary to state the importance of providing appropriate resources so that the practice of community medicine may make the important contribution tha

17、t it has traditionally made to the health of the community.Since 1974, there has been a manpower shortage within the specialty of communitymedicine. However, recruitment has improved and every region now has a functioning training programme. THE ROLE OF THE SPECIALTY AND THE COMMUNITY PHYSICIANThe e

18、mergence of community medicine as a specialty in 1974, coinciding with the reorganization of the NHS, has led to its being associated with the less successful structural and management changes brought about at that time. However, the specialty was not created out of NHS reorganization but from the i

19、ntegration of three well-established streams of medical practice: first, public health with its roots in the practice of preventive medicine, health education, epidemiology and the control of disease among whole populations; second, medical administration which had developed rapidly from the beginni

20、ng of the NHS as the discipline responsible for the planning, delivery and monitoring of hospital and specialist services to the whole country; and third, university departments of public health and social medicine whose teaching and research in epidemiology and the delivery of health care provided

21、the theoretical basis for advances in much medical practice. These three streams were evolving and changing. Each could claim triumphs of its own, but all foresaw thefuture need to work together. The specialty, therefore, not only created itself with newchallenges in mind, but it also inherited the

22、responsibilities of guarding the public against health hazards, of preventing disease and of teaching both the public and the profession the meaning of health and the means for its pursuit.Community physicians can be said to have three complementary medical roles; specialist, manager and adviser.As

23、specialists, community physicians are able to offer a combination of medical background with a knowledge of epidemiology, behavioural science and management techniques to provide an important contribution to health care planning. Their medical background helps them to maintain close working relation

24、ships with clinical colleagues in health service development and so ensures that their advice is based on current medical practice. Their epidemiological training equips them for a specialist role in the promotion of health and the prevention and control of disease in the community and in the evalua

25、tion of health services.As managers, their combination of medical knowledge and management skills enables them to develop with others in management, policies and plans for improving the health of the population. In addition, they have to promote the development of joint planning and management betwe

26、en health and local authorities. They have a particular managerial responsibility for activities concerned with the promotion of health and the prevention of disease and disability. The community physicians role as managers involves them in the administration of the health service, whether or not as

27、 a chief officer member of a management team, since all community physicians are as much concerned with implementing as with making policy.As advisers community physicians have a number of responsibilities. They have to provide specialist medical advice to the health authority which employs them and

28、 to departments of education, social services, environmental health and housing of the related local authorities.They are also responsible for advising the community served by their employing health authority about all matters affecting health.The full development of the specialty since 1974 has bee

29、n handicapped by the complexity of the present structure of the National Health Service in England. Scarce manpower and skills have been diluted by the need to staff three tiers-district, area and region. One consequence has been that, in the main, each district has had only one specialistthe Distri

30、ct Community Physician. Single individuals, with little in the way of supporting staff, have had an almost impossible task in trying to discharge the duties and responsibilities laid upon them. The new simplified structure will provide a better opportunity to practice community medicine and the chan

31、ce to deploy the limited manpower of the specialty in a way which will allow its skills to be fully applied.The role, functions and relationships of District Health Authorities (DHAs) will besimilar to those of the present single-district Area Health Authorities (AHAs). They will be responsible for

32、the planning and management of health services for the population of the district; decide on district policies and priorities within the context of national and regional policy; and assess the adequacy of services provided. Each DHA will appoint a District Management Team (DMT) of chief officers of

33、whom the District Medical Officer (DMO) will be one.The principal external relationships of DHAs will be with their matching Community Health Council (CHC), with district councils (or London borough councils) whose territory lies wholly or partly within the health district boundary and, outside metropolitan areas, wi