2023年12月4日至5日，由中国国家卫生健康委员会和世界卫生组织驻华代表处支持、北京大学公共卫生学院和全球卫生研究院举办的“构建新时代高质量的初级卫生保健，实现人人享有健康”国际研讨会在北京召开。来自中国、西班牙、新西兰、韩国、蒙古、中国香港、中国澳门等国家和地区的政府部门、学术机构，以及国际组织的领导和专家，200余人共同线下出席了本次国际研讨会。

在开幕式上，中国人民政治协商会议全国委员会副主席蒋作君、国家卫生健康委员会副主任、党组副书记雷海潮、世界卫生组织西太平洋地区办公室代理区域主任苏珊娜·雅克布博士、北京大学常务副校长、医学部主任乔杰院士分别致辞。论坛开幕式由北京大学医学部副主任王嘉东教授主持。

蒋作君指出，健康是经济社会发展的天然动力，也是人类文明进步的永恒追求，以人民为中心，完善健康治理，反映了各国的共同愿望，也是新时代的大势所趋。联合国可持续发展议程时间已经过半。尽管全球人口的健康状况有了显著改善，但人人享有健康的目标任重道远，面对不安全和不公平的全球卫生挑战，需要推动初级卫生保健的高质量发展。他强调，初级卫生保健在中国源远流长，中国的初级卫生保健事业在可及、公平、保障三个方面，走出了中国道路，凝练了中国经验。他希望以本次研讨会为契机，积极响应习近平主席在2021年全球健康峰会上提出共建人类卫生健康共同体的重要倡议，深入探讨以人为本的健康发展理念和以健康为中心的治理思路和新举措。对此他提出四点建议，一是要强化以人民为中心的发展理念，促进服务的连续性，提升服务的便捷性；二是要更好体现预防为主的工作方针，把以治病为中心转变为以健康为中心，扩大卫生健康治理范畴；三是要加大对高质量初级卫生保健的宣传倡导。初级卫生保健不是低劣保健，而是最好最合适的保健，为推进健康中国建设和携手推动构建人类卫生健康共同体做出贡献。四是要加强国际交流与合作。疾病无国界，尤其是传染病防控，是人类面临的全球性问题，必须加强国际交流与合作，开展全球行动与全球应对。

中国人民政治协商会议全国委员会副主席蒋作君讲话

雷海潮指出，中国始终践行以人民为中心的发展理念，高度重视促进初级卫生保健高质量发展，将加强基层医疗卫生服务体系建设、促进基本公共卫生服务均等化作为深化医改和全面推进健康中国建设的重要内容予以推进。雷海潮强调，要贯彻落实“以基层为重点”的新时代党的卫生健康工作方针，落实政府责任，持续增强基层卫生健康服务能力，推动基层医疗卫生机构基础设施建设和设备配备提档升级，激发基层活力，提升基层医疗卫生服务质效，深入推进家庭医生签约服务，发挥信息化技术优势，加强国际交流合作，为实现全民健康覆盖、共建人类卫生健康共同体贡献中国力量和中国方案。

国家卫生健康委员会副主任、党组副书记雷海潮讲话

苏珊娜·雅克布对研讨会的召开表示祝贺，并表示，健康对每个国家、每个社区和每个人都至关重要。自世界卫生组织成立75年来，在公共卫生领域取得了显著进展。世界关注中国对全球初级卫生保健发展的贡献以及通过改革取得的显著进展。她指出，我们今天面临着前所未有的健康挑战。应对挑战，我们需要强大的初级卫生保健，利用创新和技术进步，采取人人享有健康和健康融入所有政策的方针，并通过全生命周期方式实现最大水平的健康和福祉。苏珊娜说，这将是一个激动人心的新篇章的开始，世界卫生组织很高兴在这一旅程中与大家同行。苏珊娜还强调，我们必须更加努力地超越国家、争取全球利益，这是共同繁荣和安全的最终保证。

世界卫生组织西太平洋地区办公室代理区域主任苏珊娜·雅克布博士讲话

乔杰指出，新冠全球大流行再次清晰地告诉我们，面对全球公共卫生危机，没有一个国家可以独善其身。加强全球卫生合作，推动强化初级卫生保健体系建设，解决影响人类健康的重大公共卫生挑战和健康不公平，才是人间正道。北大医学将始终牢记“健康所系，性命相托”的誓言，在全科医学人才培养体系、培养模式的建设上起到了示范引领作用，初步构成了辐射全国的政府-学校-社区三位一体的全科医学人才培养体系，有效推动了相关合作省市的全科医学师资培训工作进展。面对新时代卫生健康服务高质量的发展需求，北大医学将坚持需求导向，探索高质量基层医疗卫生服务人才培养创新模式；坚持系统观念，持续完善大学医防协同体系建设；坚持胸怀天下，积极推动国际交流合作。

北京大学常务副校长、医学部主任乔杰院士讲话

北京大学医学部副主任王嘉东教授主持

北京大学全球卫生研究院院长任明辉教授介绍了《初级卫生保健高质量发展北京倡议》的起草过程和主要内容。蒋作君副主席、雷海潮副主任、苏珊娜·雅克布博士、世界卫生组织助理总干事布鲁斯·艾尔沃德博士、乔杰常务副校长、国家卫健委基层卫生司司长傅卫、世界卫生组织驻华代表马丁·泰勒博士，以及北京大学公共卫生学院院长詹思延教授和任明辉共同启动了《北京倡议》正式发布。

【延伸阅读】

初级卫生保健高质量发展北京倡议

Beijing Initiative on Quality Primary Health Care Development

我们，参加2023年12月4日至5日在中国北京举行的初级卫生保健高质量发展国际研讨会的全体人员，一致同意坚持《阿拉木图宣言》和《阿斯塔纳宣言》的原则，即初级卫生保健是增强人们健康与福祉的最有效方法。联合国可持续发展目标以及2023年联合国大会全民健康覆盖高级别会议的政治宣言重申了初级卫生保健的时代意义。我们再次强调，在不同的国家和地区，初级卫生保健的原则不仅有效，而且非常关键。

We, the participants of theInternational Symposium onQuality Primary Health Care Development,held on Dec 4-5, 2023in Beijing, China, unanimously agree with insisting the principles of the Declaration of Alma-Ata and the Declaration of Astana that primary health care is the most effective way to improve people's health and well-being. The United Nations’ Sustainable Development Goals and the Political Declaration of the United Nations General Assembly’s 2023 high-level meeting on Universal Health Coveragehavereaffirmed the importance of primary health care in our time. We reemphasize that in all countries and regions, the approach of primary health care is not only valid but critical.

初级卫生保健的重要性在人类面临重大社会转型和传染性疾病大流行挑战期间尤为显著。在应对全球人口老龄化、气候变化所引发的健康问题、普遍存在且日益增加的非传染性疾病和精神卫生负担，以及解决医药产品可及的“最后一公里”上，初级卫生保健有着独特的优势。

The importance of primary health care is particularly evidentas human beings experience profoundchallenges, including social transitions and the pandemic caused by infectious diseases. Primary health care has its unique advantage in addressing challenges to global health posed by ageing and climate change, prevailing and constantly increasing burden of non-communicable diseases and mental health, and the "last-mile" of access to health care and medical products.

自《阿拉木图宣言》以来，世界各国在实施初级卫生保健、改善国民健康方面，不同程度地积累了适合各自社会经济环境的宝贵经验。这些经验是人类的共同财富，也是实现与健康相关的2030可持续发展目标的重要基础。中国是世界上最早的开展基层为主导的初级卫生保健雏形的国家之一。中国的三级医疗预防保健网、赤脚医生、合作医疗和中西医结合制度，被世界卫生组织和联合国儿童基金会总结为适宜人力、适宜技术。中国通过实施《“健康中国2030”规划纲要》和卫生体系改革，深入开展爱国卫生运动和健康中国行动等，不断践行初级卫生保健的理念和实践，坚定地支持在所有社会经济发展条件下推行初级卫生保健。

Since the adoption of the Alma Ata Declaration, countries around the world have accumulatedvaluableexperiencein implementing primary health care and improving people’s healthacross diversesocioeconomic settings. Such experience constitutes a common treasure of human beings and an important foundation for achieving the health-related 2030 Sustainable Development Goals.China is one of the earliest countries in the world providing the model of community-led primary health care.China's three-level health service network, barefoot doctors, cooperative medical scheme, and integration of traditional Chinese and Western medicine wasconcluded by the World Health Organization and the United Nations Children's Fund as appropriateworkforce and appropriate technology. With coordinated and continuous effort such as the patriotic health campaign, the implementation of health system reformand Healthy China 2030 strategy, China continues to adhere to the approach of primary health care in practice and firmly supports the promotion of primary health care at all stages of socioeconomic development.

我们认为，初级卫生保健应该是高质量的。它体现为以人为本、整合的、全面的、连续的、以社区为基础的；是全民可及、可负担、可接受的；其服务应当主要由训练有素、能力充分、有效激励、高度负责的基层卫生机构人员提供；初级卫生保健应当成为卫生体系韧性和实现全民健康覆盖的基石，并随着时代发展和科技进步，不断赋予新的内涵。建成高质量初级卫生保健是各国政府所有部门、社会所有各方面力量的共同责任。

We believe that primary health careshould be quality assured. By quality, we mean primary health care should be people-centered, integrated, comprehensive, continuous, and embedded in the community; it should be accessible, affordable, and acceptable to all people; primary care services should be provided by well-trained, competent, effectively motivated, and highly committed health personnel; primary care services should act as the cornerstone of a resilient health system and the foundation of universal health coverage.And more importantly, it should continue to adapt and develop,in particular taking advantage of technological advancement. Building quality primary health care is the shared responsibility of all government departments and all sectors of society.

我们倡议各国开展并加强如下行动，以推进初级卫生保健的高质量发展。

To promote highquality development of primary health care,we call on all countries to carry out and strengthen the following actions:

1. 落实政府承诺和责任

Fulfill political commitment and accountability

我们呼吁以促进个人和全民健康福祉为目标，落实政府领导、保障、管理和监督责任，统筹发展和改革创新，构建优质、高效、系统、连续、整合型初级卫生保健体系，坚持预防为主、防治结合，促进所有人机会均等地享有可及、可负担的基本医疗卫生服务，推动初级卫生保健高质量发展。

We call on all political leaders and governments to uphold the goal of improving the health and well-being of individuals and populations, fulfilltheir responsibilities in leadership, safeguarding and supervision, and stewardhealth development andreform, to build a strong and high-quality primary health care system as part of integrated people-centered health services. All political leaders and governments shouldput prevention first and integrate prevention and treatment, promote equal opportunities for all people to enjoy accessible and affordable essential health services, and promote high quality development of primary health care.

1. 通过多部门协同将健康融入所有政策

Achieve “health in all policies (HiAP)” through multisectoral coordination

我们倡导“将健康融入所有政策”，强调公共政策对公众健康的重要作用。各部门各行业应加强沟通协作，将健康理念融入各项政策及其制定过程，形成促进健康的合力。应该建立健康影响评估评价制度，完善监管机制和问责机制，保障将“健康融入所有政策”落地见效。

We advocate the approach of "health in all policies (HiAP)" and emphasize the important role of public policies for public health. Allsectors and industries should strengthen communication and collaboration, integrate health into various policies and their formulation processes, and form synergy to promote health. We support the establishment of a system of health impact assessment and evaluation, improve the mechanism of supervision and accountability, and ensure that HiAP is implemented and enforced.

1. 建立可持续的筹资

Establish sustainable financing

我们倡导建立可持续的初级卫生保健筹资策略，加大和保障卫生事业的公共经费投入。应该建立公平为导向的筹资机制，明确公共财政覆盖的基本卫生服务包，统筹多渠道的疾病预防和治疗等卫生经费，确保基层卫生机构和一线服务提供者的经费充足。逐渐转向战略性购买以及按人头付费为核心的、价值为导向的复合型支付方式。应用健康保险基金为预防服务供资。我们呼吁应该为低收入国家初级卫生发展提供可持续的资金支持。

We advocate the establishment of a sustainable financing strategy for primary health care and increasing and ensuringadequate public funding. We advocate the establishment of an equity-oriented financing mechanism, specification ofa primary health service package that can be expanded over time and adapted to national and local context, coordination of multi-channel health funding for disease prevention and treatment and ensuring that funding for primary carefacilities and front-line service providers are fully paid in their budgets. We call forstrategic purchasing and step-wise shift towards a value-oriented blended payment method with capitation as the base. We call for using health insurance funds to purchase preventive services.We call for provision of sustainable financing support to low-income countriesfor development in primary health care.

1. 赋能社区和个人

Empower communities and individuals

我们呼吁人们提升健康意识，人人参与、人人尽力、人人享有。应该把社区打造为健康的生态和生活环境，横向惠及全人群，纵向覆盖全生命周期，以预防为主，减少疾病发生；通过社区便捷的医疗卫生服务，使得疾病早诊断、早治疗、早康复。

We call on raisinghealth awareness to ensure that everyone participates in, makes their best contribution to, and enjoyshealth improvement. We advocate communities to create a healthy ecosystem and living environment that benefits the entire population horizontally and covers the entire life cycle vertically. Wecall fora focus on prevention to reduce the occurrence of diseases. We advocate provision ofaccessible health services in the community, toachieve early diagnosis, early treatment, and early rehabilitation of diseases and health conditions.

1. 提供以社区为基础的整合型服务

Provide community-based integrated care

我们提倡建立覆盖全民的、基于社区的整合型初级卫生保健服务，以满足各年龄段、各类人群的日常卫生健康需要；以初级卫生保健服务为核心，协调患者和社区居民全方位的卫生健康服务，实现跨所有场所（包括家庭、生活社区、医疗卫生机构、长期照护机构等）的预防、治疗、康复、护理和安宁疗护的连续和整合，探索医防融合的卫生服务模式创新；我们呼吁将初级卫生保健纳入疫病大流行等突发公共卫生应急准备、防范和响应的核心服务内容。

We advocate the establishment of community-based integrated primary health services that cover the entire population and meet the daily health needs of people of all ages and from all population groups. We advocate the establishment of primary care services as the core, to coordinate all-round health services for patients and community residents and achieve the continuity and integration of prevention, treatment, nursing, rehabilitation and palliative care across all settings (including families, living communities, health care institutions, and long-term care institutions), exploration of innovative health service models to integrate medical treatment and prevention. We call upon integration of primary health care into thecore componentsin preparedness, prevention and response to pandemic and other public health emergencies.

1. 以良好的治理促进健康服务和社会服务衔接融合

Promote the connection and integration of health services and social services through good governance

我们呼吁做实基层治理网络、提升治理效能，增进初级卫生保健与公共服务衔接，促进人群健康目标改进。在社区属地范围内，发挥政府、自治组织等资源调配作用，调动社会组织、志愿者、经济组织等参与积极性，增进健康协调人、家庭医生团队等枢纽功能，提高健康素养，加强自我健康管理小组建设，将养老、助残、儿童、妇幼、心理健康等公共服务深度融入初级卫生保健服务。

We call for good health governance functions and better alignment between implementation and policies, to empower and promote community engagement and participation. We call for strengthening community-level governance, enhancing the connection between primary health care services and social services, and promoting the improvement of population health. Within the community catchment, governments, autonomous organizations and others should play fully the role of resource allocation, enhance hub function of primary care providers such as health coordinators and family doctor teams, improve health literacy, strengthen the construction of self-management groups, and cooperate with civil societies, volunteers, and economic organizations, to deeply integrate public services such as elderly care, disability assistance, and mental health, psychological counseling into primary care services.

1. 加强人力资源的培训、配置和激励及医学教育

Enhance training, allocation and motivation of health workforce, and medical education

我们支持增加农村、偏远和欠发达地区人员配置，促进人力资源配置的公平性，加强初级卫生保健服务配置适宜的人力资源。应加大全科医生/家庭医生培养和培训力度，建立全科医生/家庭医生培养和使用激励机制。应该为在基层卫生机构工作的卫生人员创造良好的工作环境，提供合理的报酬，调动其积极性以便有效满足居民的基本医疗卫生服务需求。

We support increasing allocation of health workforce in rural, remote and underdeveloped areas, promoting equity in human resource allocation, and strengthening primary health care services with appropriate human resources allocation. The training of general practitioners/family doctors should be strengthened, and an incentive mechanism for the training and employment of general practitioners/family doctors should be established. We call for creating a good working environment for health personnel working in primary health care settings, providing reasonable remuneration, to motivate providers to effectively meet the basic health service needs of people.

1. 推广传统医学和替代医学在疾病预防和疾患疗愈中的应用

Expand application of traditional and alternative medicine for disease prevention and illness healing

我们赞同传统医学是初级卫生保健的组成部分，把传统医学和替代医学的适宜技术应用于社区，基层医疗卫生机构提供从预防、保健到治疗、康复的有效医学服务；在基层卫生服务专业人员的指导下，人们可以主动使用传统和替代医学预防、治疗疾病。

We recognize traditional medicine as an integral part of primary health care, and support the application of appropriate technologies of traditional medicine and alternative medicine to the community. We support that primary care institutions should provide effective alternative medicine services from prevention and health care to treatment and rehabilitation.We support thatpeople voluntarily use traditional and alternative medicine to prevent and treat diseases, under the guidance of community health servicesprofessionals.

1. 数字赋能初级卫生保健

Empowerprimary health care with digital technology

我们倡议进一步加强数字技术在初级卫生保健中的应用，增进初级卫生保健服务的优质化、个性化、精准化和便捷性。推进以居民电子健康档案为核心的健康信息互通共享。发展人工智能辅助诊断、远程医疗等手段，助力卫生可及性和诊疗质量提升。发展线上预约、云端问诊、电子处方流转、智能药房、线上支付、远程健康教育等应用和可穿戴健康设备，助力健康全程管理和自我健康管理。在释放数字技术红利过程中持续强化监管，规避潜在风险。

We advocate strengthened application of digital technology in primary health care,to improve the quality, individualization, precision and convenience of primary health care services. We advocate promotion of the exchange and sharing of health information with residents’ electronic health records as the core. We advocate development of artificial intelligence-assisted diagnosis, telemedicine and other means to help improve the quality of diagnosis and treatment. We call for further development of online appointment booking, cloud-based consultation, electronic prescription, smart pharmacy, online payment, remote health education and other applications and wearable health devices to facilitate comprehensive health management and self-managementofhealth. With rapid scale up, we call for effective governance and regulation to harness digital innovation to minimize risks while maximizing benefits.

1. 确保医药产品和适宜技术的可及

Ensure access to medicinal products and appropriate technologies

我们强调初级卫生保健在保障以基本药物为重点的药品、疫苗、适宜技术等在全人群，特别是弱势群体可及中的关键作用。医药产品供给体系应该与初级卫生保健制度深度融合，助力基层卫生服务提供者更好地服务于全生命周期医药产品公平可及和适宜技术应用，推广产检包、营养包等整合型初级卫生保健服务产品的创新。

We emphasize the key role of primary health care in ensuring that medicines, vaccines, appropriate technologies, are accessible to the entire population, especially the vulnerable groups. We call for further integration of the pharmaceutical product supply system and the primary health care system;we support primary health service providers to better serve the equitable accessibility of pharmaceutical products throughout the life cycle and appropriate technology applications, and exploration ofthe innovation and promotion of integrated primary health care, such as prenatal care packages and nutrition packages.

1. 增进全球伙伴关系与国际卫生合作

Strengthen global partnership and international health cooperation

我们呼吁建立多层次、多形式的国际合作交流渠道，加强全球初级卫生保健伙伴关系，开展经验交流、技术推广、人才培养、卫生援助、资源开发等方面务实合作，维护、改善、促进所有人群尤其是儿童、青少年、孕产妇、老年人、残疾人和贫困脆弱等人群的健康，有效预防、管理、控制传染性疾病、慢性非传染性疾病以及其他主要健康问题，不让一个人掉队，促进实现全民健康覆盖。

We call for the establishment of multi-level and multi-form international cooperation and exchange channels,strengthening of global partnerships on primary health care, and pragmatic cooperation in experience exchange, technology promotion, personnel training, health assistance, resource mobilization; maintaining, improving, and promotingthe health of all population groups, in particular children, adolescents, pregnant women, the elderly, disabled people, the poor and other vulnerable groups, effectively prevent, manage, and control communicable diseases, non-communicable diseases, and other major health challenges, leaving no one behind and promoting universal health coverage.

（北京大学公共卫生学院）

编辑：玉洁