Can China’s disease control reform curb brain drain？

This article comes from WeChat WeChat official account:Mr. Sai (ID: Mr Science 100), Author: Lu Feng, editor: Ye Shuisong, original title: "China’s disease control in past lives, can the brain drain be curbed after the reform", title from: vision china.

Public health, disease control system, disease control center, preventive medicine, not to mention ordinary people, even many medical people have few estimates that these four words can be clearly stated and clearly understood.

In fact, the development of public health work has been accompanied by the reform of the disease control system. Under the leadership of the Health and Health Commission, the CDC, as the main technical department, undertakes most of the public health and disease prevention and control work, and preventive medicine is the main professional talent recruited by each CDC every year.To sum up, the four words are independent and inseparable. No matter how some people deny their relationship, they all accompany and complement each other in the development of China’s disease control system.

From the historical experience of our country, it is the development of preventive medicine that leads the development of the whole disease control system. At present, the difficulties encountered by the disease control system are also the difficulties encountered by preventive medical talents, and the reform of the disease control system should also focus on the reform of the talent team.

First, the birth of health and epidemic prevention stations and preventive medicine, and some achievements.

In 1950, the former Ministry of Health put forward the policy of "prevention first" and set up public health specialty in some medical colleges and universities.

In August, 1954, the Ministry of Health held the 10th National Conference on Higher Medical Education, and determined that the educational system of preventive medicine was five years, which was implemented from 1955. Since then, preventive medicine has grown "slowly" as a medical subject in colleges and universities.

Publicity pictures of "Send the plague"

At the same time, in 1953, China established health and epidemic prevention stations nationwide. From the province to every county, more than 2,000 health and epidemic prevention stations will be built soon. After that, the prevention and control of "four pests" and "plague, cholera, smallpox, parasitic diseases, hemorrhagic fever, measles and other infectious diseases" were mostly carried out by local health and epidemic prevention stations, and for a long time afterwards, it was the most brilliant era of public health work in China.

Second, under the tide of market economy, public health has obvious shortcomings.

In the late 1970s and early 1980s, under the background of marketization, health and epidemic prevention stations at all levels were supported by policies, so they actively participated in the market economy.

Until around 2000, it was the golden age for the development of epidemic prevention stations, especially in the economically developed coastal areas. All kinds of medical talents were proud to enter epidemic prevention stations, but at this time, there was a shortcoming in the development of public health work in the country. The epidemic prevention stations in economically developed areas were attractive, but the underdeveloped areas could not attract talents, and the development of public health work was difficult.

At that time, many areas in southern China suffered from schistosomiasis.

Even the economically developed coastal areas have a large number of talents, but they mainly participate in the market economy and pay no attention to the public health work of public welfare.

Three, the establishment of disease control centers at all levels throughout the country, after two major epidemics.

In 2002, China National Center for Disease Control and Prevention was established, which was formed by stripping the health supervision function from the original health and epidemic prevention station and setting up health supervision stations in various places instead. At this time, the CDC is a public welfare state-funded institution.Because of the huge income gap with hospitals, a large number of five-year preventive medical talents left CDC to engage in clinical work in hospitals..

Until 2009, the professional talents of CDC were almost exhausted. In the first five years of 2009, all medical majors can engage in clinical diagnosis and treatment, subject to the direction of registration. Preventive medicine belongs to the medical profession and can be admitted as a medical practitioner. After practicing, it can be registered in all directions of clinical medicine.

In 2009, the Law on Medical Practitioners was revised, and the registration direction of preventive medicine was fixed, and only the public health direction was registered, which completely blocked the possibility of preventive medical students engaging in clinical diagnosis and treatment.

When SARS broke out in 2003, public health was raised to the level of national security. In the following years, CDC at all levels made great efforts to build institutions and expand their personnel, but they still couldn’t stop the brain drain. However, SARS came and went in a hurry, leaving no time for people to reflect.

In 2009, the new medical reform mentioned public health, but did not mention CDC. From beginning to end, CDC, as the main force of public health work, remained calm as usual, and the proportion of preventive medical students changing careers continued to expand.

The key to the problem is not only the low treatment of disease control, butThe huge gap between preventive medicine and clinicians’ income, both of which are five-year medicine.Preventive medicine also needs to be a licensed physician. The training in school is not inferior to clinical medicine, but the career development after graduation is quite different. This is the root of brain drain.

At the beginning of 2020, the news media connected experts from CDC to judge the epidemic trend.

At the end of 2019, the epidemic broke out in COVID-19, and the people of the whole country fought a beautiful war against the epidemic.

Four, the National Bureau of Disease Control and Prevention was established, but the direction of reform is unknown.

The candidates for the director and three deputy directors of the National Bureau of Disease Control and Prevention were released.

On April 28, 2021, the candidates for the director and three deputy directors of the National Bureau of Disease Control and Prevention were released.This also marks the birth of a new national bureau. The full name of the former CDC was National Health Commission CDC, but the name of this official announcement is National CDC, which has no prefix of Health and Health Commission.

As a practitioner of a grassroots CDC and a preventive medical student, this news is undoubtedly exciting. The call for reform of the CDC system has been going on for a long time, but how to change it has always been a "very difficult thing". Now, finally, a real hammer institution has emerged.However, we should be clear that even if the National CDC is established, it is impossible to completely solve this "very difficult thing".

The establishment of the National Bureau of Disease Control and Prevention represents the country’s attention to the construction of China’s disease prevention and control system, but the construction of the disease prevention and control system can not be summarized by the establishment of a bureau. The key depends on how to set up the network structure of the national disease control system.

Judging from the only official propaganda materials at present, the direction of the reform of China’s disease control system is not clear, and it is not known whether it has been completed or not. At present, judging from the establishment of the National Bureau of Disease Control, the reform of China’s disease control institutions will mainly be divided into two major directions.One is similar to the national medical insurance bureau and independent of the health and health commission.In this way, all provinces, cities and counties need to set up according to this, from the Health and Health Commission to allocate relevant leaders and staff to the newly established CDC at all levels, and all future work will be carried out independently of the Health and Health Commission. Of course, there will also be problems related to the personnel and function setting of the health supervision office and the CDC, which is something to be considered after the general direction is clear;The other is similar to state administration of traditional chinese medicine, although it is listed as a new bureau, it is still managed by the National Health and Wellness Committee.In this way, although all provinces, cities and counties will be listed on the CDC, there will be changes in personnel and job responsibilities, but they are still affiliated to the Health and Health Commission, and in fact they are still a team.

At present, the major reform directions are only the above two. No matter how to change, it is an exploration and improvement of the construction of our disease control system. What we individuals need to do is to fully support the reform of the country.

Disease prevention and control and medical treatment have the same goal, and both pursue human health. At present, the direction of industry efforts is also the integration and complementarity of medical prevention and treatment, but the means and methods in their actual work are quite different, and the integration is very difficult. At present, the responsibilities and capabilities of disease prevention and control institutions at all levels are completely different, which is also the most important reason why reform is a "very difficult thing".

National, provincial, municipal and district(county)At present, villages and towns are the five-level network of administrative division in China, so is the disease control system, which is like a network. As long as this network is not damaged or missed, the disease control system can play its functional role.

This reform needs to weigh the needs of all levels of the five-level system, so that the reformed five-level system can exert its maximum efficiency and avoid any leakage.

At present, no matter which level of the five-level system is facing a serious brain drain, the urgent task of reform must be to attract, train and retain talents. Reform is a powerful driving force for social development, and the country has undoubtedly taken a solid step on the road of reform in the construction of disease control system. As preventive medical students, we also look forward to the early official announcement of the national reform plan.

This article comes from WeChat WeChat official account:Mr. Sai (ID: Mr Science 100), Author: Lu Feng