根據(jù)美國公共衛(wèi)生學(xué)會（the American Public Health Association, APHA）于2004年11月在華盛頓召開的第132次年會的最新報告指出：美國的衛(wèi)生事業(yè)在經(jīng)歷多年的穩(wěn)步上升之后，出現(xiàn)了下降趨勢的跡象，這樣不久之后也許會將美國的衛(wèi)生事業(yè)引向錯誤的方向。

   根據(jù)該報告，“美國的衛(wèi)生狀況：各州的衛(wèi)生排行榜”，揭示了三個重要不良趨勢：四十年來嬰兒死亡率首次升高，所有年齡組人群的肥胖流行率增加，在2003年～2004年有38個州的無保險人數(shù)增加。

   APHA執(zhí)行主任Georges Benjamin醫(yī)學(xué)博士告訴Medscape網(wǎng)站，那篇報告發(fā)現(xiàn)90年代衛(wèi)生事業(yè)得到了改善，大約以每年1.5％的速度最終增加了17.5％，但最令人不安的是，這種趨勢現(xiàn)在也許發(fā)生了逆轉(zhuǎn)。從新世紀(jì)開始，衛(wèi)生增長只有微不足道的0.2％，這個結(jié)果敲響了警鐘。

  Benjamin醫(yī)學(xué)博士評論：“盡管我們國家的健康狀況在過去15年中取得了長足進(jìn)步...，我們發(fā)現(xiàn)增長速度的戲劇性下降并不令人鼓舞。”他特別指出，嬰兒死亡率從每千人6.9增加到7.0，這個統(tǒng)計數(shù)據(jù)將美國的嬰兒死亡率置于世界第28位，同時還發(fā)現(xiàn)有14個州早產(chǎn)率超過13％。與這個具有警示作用的統(tǒng)計數(shù)據(jù)相關(guān)的是：1,260萬美國處于生育年齡的婦女沒有保險。

   Benjamin醫(yī)學(xué)博士說：“顯而易見，國家必須重視這種相關(guān)性。引起早產(chǎn)有多種因素，比如：貧窮、懷孕期間缺乏精心照顧、以及感染。但是對治療這些婦女的臨床醫(yī)生而言，這【早產(chǎn)比例的增加】是醫(yī)療保健體系處于危險狀態(tài)一個明證。”

   Benjamin醫(yī)學(xué)博士號召臨床醫(yī)師參加到有組織的醫(yī)學(xué)活動中，以敦促政策制訂者意識到當(dāng)前存在的問題，以及嬰兒死亡率、早產(chǎn)率的增加在未來十年中可能給經(jīng)濟(jì)和衛(wèi)生事業(yè)帶來的負(fù)面作用。

   Benjamin醫(yī)學(xué)博士說：“不用多久就可以知道你選舉出的政府官員，也不需要很多時間來參與，但是我們知道醫(yī)生的參與可以影響政策的走向。”由APHA、聯(lián)合健康基金會（United Health Foundation)、預(yù)防互助協(xié)會（Partnership for Prevention）共同作出的報告敲響的另一個警鐘是：在1990～2003年期間肥胖人數(shù)快速增加了97％。

   聯(lián)合健康基金會的副會長Reed Tuckson醫(yī)學(xué)博士說：“為了成功地戰(zhàn)勝肥胖的流行，我們必須動員我們的社區(qū)資源，并制定有效的公共政策。”他還補充說肥胖者大約占美國人口的22.8％，僅過去一年肥胖率就上升了3.2％。

   但是報告也著重指出，去年有幾項積極的發(fā)展可以促進(jìn)衛(wèi)生事業(yè)的發(fā)展。這包括每人花費在公共健康活動上的支出增加了17％，吸煙率下降了4％，心血管疾病的死亡率下降了2％。在絕大多數(shù)州傳染性疾病的發(fā)病率也有所下降。

    高中畢業(yè)率出現(xiàn)微小的增加，從67.3％上升到了68.3％。Benjamin醫(yī)學(xué)博士指出，考慮到教育與對健康問題認(rèn)識之間的聯(lián)系，這個發(fā)現(xiàn)是“令人鼓舞的”。年度報告權(quán)衡了18個與總體健康有關(guān)的指標(biāo)，包括吸煙率、早產(chǎn)死亡、高中畢業(yè)率和人均公共衛(wèi)生消費，從而描繪出各州健康狀況的構(gòu)成圖。在各州排名中，路易斯安那州作為最不健康的州已長期居于榜首，緊隨其后的是田納西州和密西西比州。排名居健康榜首的是明尼蘇達(dá)州、新罕布什爾州和佛蒙特州。

   Benjamin醫(yī)學(xué)博士說各州之間總體健康的巨大差異，與貧困水平和未接受保險患者的數(shù)量密切相關(guān)，兩者共同形成了對公共衛(wèi)生工作人員和醫(yī)療提供者的一個持久挑戰(zhàn)。例如，在美國俄勒岡州貧困兒童的數(shù)量在過去10年中由12.4％上升到20.1％，而同期在密西西比州則下降了13％。

   APHA第132次年會新聞發(fā)布會。

 Infant Mortality, Obesity Increasing in U.S.

 — After years of steady progress toward improved health in the U.S., there are signs of a
downturn that may soon translate into movement in the wrong direction, according to a new report

   released here at the 132nd annual meeting of the American Public Health Association (APHA).
The report, "America's Health State: State Health Rankings," uncovers three key troubling trends: the first rise in infant mortality rates in four decades, the rapidly increasing prevalence of obesity in all age groups, and the number of uninsured individuals, which increased in 38 states between 2003 and 2004.

   Most disturbing perhaps is the big-picture finding that the health improvements of the 1990s,
during which overall health improved at an annual rate of 1.5% for a total gain of 17.5%, is
headed for reversal. Since the start of the millennium, health improvement has been a negligible 0.2%, a finding that should set off alarms, APHA Executive Director Georges Benjamin, MD, told Medscape.

  "Despite the significant improvement in our nation's health over the last 15 years..., the trends we're seeing now — especially this dramatic slowdown in the rate of improvement — are not encouraging," Dr. Benjamin said.

   In particular, he cited the increase in infant mortality from 6.9 to 7.0 births per 1,000, a
statistic that puts the U.S. 28th internationally in infant mortality, as well as the finding
that 14 states have preterm birth rates that exceed 13%. That alarming statistic is likely
associated with the fact that 12.6 million American women of child-bearing age are uninsured.
"Clearly, there is a connection there that cannot be ignored, and this is something we must
address as a nation," Dr. Benjamin said. "Prematurity has many factors, from poverty to
inadequate prenatal care and infections, but for the clinicians who treat these women, this
[increasing prevalence of preterm births] is clear evidence of a healthcare system in crisis," he said.

   Dr. Benjamin urged physicians to get involved in organized medicine activities directed toward increasing policy-makers' awareness of both the current problems and the consequences that high infant mortality and poor preterm birth statistics herald — economically and in health status — for the decade ahead.

   "It really doesn't take long to get to know your elected officials, and it doesn't take a lot of time to get involved — and we know that physician involvement can make a difference" in how policy is shaped, Dr. Benjamin said.

   Another alarming finding of the report, jointly produced by the APHA, United Health Foundation, and Partnership for Prevention, was the meteoric rise in obesity, which increased by 97% between 1990 and 2003.

   "To successfully combat this [obesity] epidemic, we must mobilize our community resources and develop effective public policies," said Reed Tuckson, MD, vice president for United Health
Foundation, adding that an estimated 22.8% of the U.S. population is obese and that the obesity
rate rose 3.2% in the last year alone.

  However, the report highlights several positive developments in the last year that have the
potential to yield overall health improvement. These include the 17% increase in per-capita
spending on public health activities, a 4% decrease in smoking prevalence, and a 2% decrease in
deaths from cardiovascular disease. Incidence of infectious disease also declined in most states.

  There was also a slight upward tick in high school graduation rates, from 67.3% to 68.3%, a
finding that Dr. Benjamin called "somewhat encouraging," given the known association between
education and health issues awareness.

  The great disparities in overall health among the states, which correlates closely with poverty levels and the number of uninsured  patients, combines to present a persistent challenge for public health workers and physician providers, Dr. Benjamin said. In Oregon, for example, the percentage of children in poverty increased from 12.4% to 20.1% during the past decade compared with a 13% decrease in child poverty in Mississippi.

   APHA 132nd Annual Meeting: News conference. Presented Nov. 9, 2004.