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ホームIMICライブラリMMWR抄訳2011年(Vol.60)10項目の公衆衛生の偉大な業績-アメリカ、2001・・・

MMWR抄訳

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2011/05/20Vol. 60 / No. 19

MMWR60(19):619-623
Ten Great Public Health Achievements - United States, 2001-2010

10項目の公衆衛生の偉大な業績-アメリカ、2001~2010年

20世紀中、アメリカ住民における出生時の余命は1900年の47.3歳から2000年には76.8歳へと62%延長し、どのライフステージでも健康状態が著明に改善した。1999年、MMWRはこれらの改善に寄与した10項目の公衆衛生の業績を強調した報告を発表した。今回は新たに、21世紀の最初の10年間(2001~2010年)にアメリカで起こった10項目の注目すべき公衆衛生活動の業績を報告する。

  • ワクチン予防可能疾患: 結合型肺炎球菌ワクチンやロタウイルスワクチンの導入などにより、ワクチン予防可能疾患の罹患率・入院率・死亡率・関連する医療費がかなり低下した。
  • 感染性疾患の予防と管理: 州・地域の公衆衛生インフラの改善と革新的な的を絞った予防対策により、感染性疾患の管理が著明に進歩した。
  • タバコ規制:包括的禁煙法を制定した州が増加し、タバコ税の増税なども実施された。
  • 母子衛生: 穀物製品への葉酸添加の義務化により神経管欠損症の新生児数が有意に減少し、新生児の遺伝性・代謝性疾患スクリーニングの技術的改善と実施拡大により早期からの救命治療や介入が可能になった。
  • 自動車に関連した安全性: シートベルト着用やチャイルドシート使用の義務化などにより、自動車事故による死亡/損傷の発生率が低下した。
  • 心血管疾患予防: コントロール不良の高血圧症・コレステロール値上昇・喫煙といった心血管危険因子の保有率の低下や治療・医薬品などの改善により、冠動脈性心疾患と脳卒中による死亡率がさらに低下した。
  • 労働安全: 労働環境の改善などにより作業関連損傷のリスクが著明に低下した。
  • 癌予防: 連邦・州・地域保健局などの連携により癌のスクリーニング検査の質と利用が著明に改善した。
  • 小児鉛中毒予防: 各州での包括的な鉛中毒予防法の施行などにより、血中鉛濃度>=10μg/dLの1~5歳の小児の割合が低下した。
  • 公衆衛生準備および対応: 公衆衛生システムの地域差を解消するため2001年以降最初の5年間には主に公衆衛生システムの拡充(備品の購入など)、次の5年間にはシステムの研究・疫学・サーベイランス・対応能力の改善を焦点とした取り組みを行い、罹患者数・入院数・死亡者数が減少した。

1999年から2009年にかけてアメリカにおける年齢調整死亡率(10万人あたり)は881.9人から741.0人に低下し、20世紀からの低下傾向が持続した。この低下には、今回報告した公衆衛生活動の進歩が貢献している。効果的な公衆衛生活動としては、従来から行われているサーベイランスシステムの確立やガイドラインの普及、有効な公衆衛生プログラムの開発などがあるが、近年の公衆衛生活動では法律の施行も重要な役割を演じている。

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