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系統識別號 U0002-2206200609322500
中文論文名稱 蘇聯解體後對民眾健康之影響─以結核病為例
英文論文名稱 The Effects upon the Population Health after the Collapse of the Soviet Union─A Case Study of Tuberculosis
校院名稱 淡江大學
系所名稱(中) 俄羅斯研究所碩士班
系所名稱(英) Graduate Institute of Slavic Studies
學年度 94
學期 2
出版年 95
研究生中文姓名 何世崇
研究生英文姓名 Shih-Chung Ho
學號 693090077
學位類別 碩士
語文別 中文
口試日期 2006-06-02
論文頁數 112頁
口試委員 指導教授-馬良文
指導教授-呂宗學
委員-呂宗學
委員-彼薩列夫
委員-魏百谷
中文關鍵字 轉型經濟  結核病  危險因子  多重抗藥性結核病  人類免疫缺損病毒感染  統計方式 
英文關鍵字 Transitional economy  TB  risk factor  MDR-TB  HIV infection  statistics 
學科別分類 學科別社會科學區域研究
中文摘要 俄羅斯總體結核病流行病的惡化是在通貨膨脹、經濟改革環境及社會變遷為背景之下發生的。價格自由化加劇通貨膨脹;總經穩定化緊縮衛生預算、醫療投入減少;私有化及長期薪資欠款則進一步擴大所得差距。社會變遷產生許多社會經濟地位較低落的群體易於受到傳染病的感染。總體生活水準的下降導致俄羅斯結核病流行病情況的惡化。

結核病為與社會情況相當有關聯的疾病。俄羅斯結核病惡化的因素可以歸結於總體經濟瓦解、生活水準惡化、失業率及無家可歸人數上升,而這些危險因子又是政治、經濟及社會不穩定下的產物。經費不足及失業率上升導致X光受檢率下降、結核病部門人員老化及監獄受刑人出獄後之後續追蹤治療問題都是俄羅斯保健部結核病部門面臨的考驗。

俄羅斯結核病問題42%來自監獄,多重抗藥性問題亟待解決。此外,同時感染HIV及結核菌加速結核病的嚴重化。結核病採用不同統計方式〈例如將監獄受刑人、軍人、無家可歸者及移民納入八號統計〉對於俄羅斯結核病發生率及死亡率的上升也有重大的影響。

歐洲國家在過去十年間通報的結核病案例數在增加當中,尤其以中東歐國家及前蘇聯國家惡化情形較為嚴重。結核病在此地區增加的基本原因為:

一、管理不佳或過時的治療使得控管不當,導致抗藥性結核病例增加。
二、經濟衰退、貧窮、營養不良、酗酒及吸毒、擁擠的監獄、缺乏健康照顧的取得。
三、來自結核病盛行國家移民影響〈西歐〉。
四、HIV/AIDS感染加速結核病的傳播,感染HIV同時感染結核病導致高死亡率。

俄羅斯的情形又以第一、二、四項為主。

英文摘要 The deterioration of general TB epidemiological situation in Russia took place against a background of inflation, economic reform environment and a time of social change. Price liberalization deteriorated the situation of inflation. Macroeconomic stabilization tightened health budget and diminished medical inputs. Privatization and pro-longed wage arrears enlarged the income gap. Social environment change had caused a number of groups with low social-economic status to be easily affected by infectious diseases. The deterioration of standard of living made the TB situation even worse.

When it comes to tuberculosis, it is a disease that is bound to social conditions. Factors that affected the TB situation in Russia were macroeconomic destruction, worsening of standard of living, increasing number of unemployment and homeless, and these factors were due to political, economic, and social instability. Insufficient financing and the increase of unemployment rate, which caused the decline of X-ray coverage, aging of TB department medical member, and the follow-up treatment of patients from prisons are main tasks for the TB department (ministry of Public Health, RF) to face.

42% of the Russian TB problem is in prisons. The problem of MDR-TB is yet to be settled. Besides, HIV/TB coinfection speeds the deterioration of TB. The acceptance of different kind of statistics of TB epidemiology (for example, the inclusion of prisoners, armed forces, homeless, immigrants, in the list of form № 8) had a great influence on the raise of TB incidence and mortality rate in Russia.

European countries have registered rising tuberculosis (TB) over the last decade, and the situation in the countries of central and eastern Europe and the former Soviet countries is particularly serious. The principal reasons for the increase in TB in the region are:

1.poorly managed and outdated practices, which cause the increase in MDR-TB.
2.economic recession, poverty, malnutrition, alcohol/drug abuse, overcrowded prisons, lack of access to health care.
3.immigration from TB high-burden countries(to western Europe countries).
4.increasing rates of HIV infection, HIV/TB coinfection leads to high mortality rate.

Reasons 1,2,4 discussed above are the case in Russia.
論文目次 目錄


第一章 緒論 …………………………………………………………1

第一節 研究動機……………………………………………………1
第二節 研究目的……………………………………………………2
第三節 研究方法、研究理論及範圍………………………………4
第四節 研究限制……………………………………………………7

第二章 經濟轉型期間俄羅斯經濟社會環境對公共衛生的影響…9

第一節 經濟轉型期間俄羅斯經濟環境……………………………9
第二節 經濟轉型期間俄羅斯社會環境……………………………23
第三節 經濟社會環境變遷對於俄羅斯公共衛生影響……………28
第四節 小結…………………………………………………………36

第三章 俄羅斯結核病問題描述……………………………………38

第一節 疾病自然史及三段五及預防措施…………………………38
第二節 結核病指標…………………………………………………41
第三節 結核病概述…………………………………………………43
第四節 俄羅斯防治結核病史………………………………………51
第五節 俄羅斯結核病問題描述……………………………………53
第六節 小結…………………………………………………………65

第四章 俄羅斯經濟社會變遷造成結核病健康危險因子…………67

第一節 經濟轉型對於俄羅斯結核病防治所造成影響……………67
第二節 俄羅斯結核病危險群………………………………………73
第三節 社會心理及新物質解釋探討........................79
第四節 社會經濟及傳染疾病流行之決定因素……………………81
第五節 小結…………………………………………………………91

第五章 結論…………………………………………………………93

第一節 討論…………………………………………………………93
第二節 經濟社會環境及醫療面探討………………………………93
第三節 後續研究的建議……………………………………………97

參考書目 ………………………………………………………………99


圖表目錄

圖1.1 俄羅斯經濟轉型期間結核病發生率、失業率及難民遊民增加對照圖 …………………………………………………………………6
圖3.1 俄羅斯結核病發生率〈1985~2000〉 〈每十萬人口〉……55
圖3.2 俄羅斯兒童發生率〈1985~1999〉 〈每十萬人口〉………56
圖3.3 俄羅斯結核病死亡率〈1985~2000〉 〈每十萬人口〉……58
圖3.4 俄羅斯結核病盛行率〈1987~2000〉 〈每十萬人口〉……59
圖3.5 1997年俄羅斯各地區結核病發生率...................60
圖3.6 俄羅斯內政部職員結核病發生率指標〈1987~2000〉 〈每十萬人口〉………………………………………………………………61
圖4.1 俄羅斯及西伯利亞聯邦區結核病死亡率〈1987~2000〉〈每十萬人口〉………………………………………………………………78


表2.1 蘇聯經濟年平均成長率〈1961~85〉 〈物質生產淨額〉..10
表2.2 蘇聯薪資年成長率〈%〉 〈1986~1991〉...............11
表2.3 通貨及貸款〈年平均成長率〉 〈1981~1990〉..........12
表2.4 通貨年增長率〈十億名目盧布〉 〈1985~1990〉........13
表2.5 俄羅斯的通貨膨脹〈1992~1994〉.....................15
表2.6 俄羅斯通貨膨脹率〈1991~1994〉.....................17
表2.7 俄羅斯總體經濟〈1992~1999〉.......................23
表2.8 俄羅斯人均酒類消費〈1984~1994〉...................25
表2.9 1989至2002年人口減少數概要.......................31
表3.1 2004年全球結核病發生率及死亡率 ………………………44
表4.1經濟轉型措施對健康機構的影響 ……………………………68









參考文獻 參考書目

中文

書籍

1. Schaefer, Richard T.著,劉鶴群、連文山、房智慧譯〈2002〉,《社會學》,台北:麥格羅希爾國際股份有限公司台灣分公司。
2. 尹慶耀〈1995〉,《獨立國協研究:以俄羅斯為中心》,台北:幼獅文化事業公司。
3. 江英隆主編〈2002〉,《結核病防治工作手冊》,台北:行政院衛生署疾病管制局。
4. 吳玉山〈2000〉,《俄羅斯轉型1992-1999─一個政治經濟學的分析》,台北:五南圖書出版有限公司。
5. 吳玉山〈1996〉,《遠離社會主義:中國大陸、蘇聯和波蘭的經濟轉型》,台北:中正書局。
6. 呂宗學譯〈1988〉,《馬克思主義看醫療保健》,台北:南方出版社。
7. 宋鎮照〈1995〉,《發展政治經濟學:理論與實踐》,台北:五南圖書出版公司。
8. 彼得‧史托克著,蔡繼光譯〈2002〉,《國際遷徙與移民,解讀「離國出走」》,台北:書林出版社。
9. 林武雄著〈2002〉,《流行病學》,台北:健康文化事業股份有限公司。
10. 林靜靜〈2001〉,《肺病診療室》,台北:天下遠見出版股份有限公司。
11. 胡幼慧〈1991〉,《社會流行病學》,台北:巨流圖書公司。
12. 高安邦〈2002〉,《政治經濟學》,台北:五南圖書出版股份有限公司。
13. 崔西‧季德著,錢基蓮譯〈2005〉,《愛無國界─法默醫師的傳奇故事》,台北:天下遠見出版股份有限公司。
14. 陳建仁〈1999〉,《流行病學:原理與方法》,台北:聯經出版事業公司。
15. 陸南泉、姜長斌、徐葵、李靜杰主編〈2002〉,《蘇聯興亡史論》,北京:人民出版社。
16. 楊志良〈1990〉,《公共衛生新論〈增訂版〉》,台北:巨流圖書公司。
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18. 潘德禮主編〈2003〉,《俄羅斯十年:政治‧經濟‧外交〈下卷〉》,北京:世界知識出版社。
19. 盧瑞芳、謝啟瑞合著〈2000〉,《醫療經濟學》,台北:學富文化事業有限公司。
20. 蘇維鈞〈2004〉,《肺結核大反撲的自保之道》,台北:元氣齋出版社有限公司。

期刊

1. 司晏芳〈2003〉,「小心肺結核病捲土重來」,《康健》,55,58-59。
2. 何衞〈2004〉,「對原蘇聯國家經濟轉軌進程中若干問題認識」,《俄羅斯中亞東歐研究》,5,34-41。
3. 吳怡君〈2005〉,「台灣結核病現況及政府的防治措施」,《台灣醫界》,48:2,74-77。
4. 李玉珍〈1992〉,「俄羅斯經改初探」,《問題與研究》,31:11,62-72。
5. 李志學〈2004〉,「休克療法啟示錄」,《俄羅斯中亞東歐研究》,2,30-33。
6. 徐坡岭〈2004〉,「俄羅斯轉軌以來經濟走勢的公共選擇分析」,《俄羅斯中亞東歐研究》,3,28-35。
7. 朗光輝、張鑾英〈2005〉,「兒童結核病」,《台灣醫界》,4:4,11-17。
8. 馬蔚云〈2004〉,「論俄羅斯經濟轉軌過程中的效率與公平問題」,《俄羅斯中亞東歐研究》,1,36-42。
9. 畢英賢〈1992〉,「俄羅斯政經現況與發展趨向」,《問題與研究》,31:10,24-32。
10. 莊志杰〈2004〉,「結核病院內感染」,《健康世界》,220:4,31-33。
11. 許建邦〈2002〉,「有效防治結核病」,《常春》,227:2,138-139。
12. 劉美玲〈2001〉,「肺結核捲土重來的大麻煩」,《常春》,235:10,132-134。
13. 薩公強〈1993〉,「俄羅斯國營企業私有化述評」,《問題與研究》,32:3,55-68。
14. 顧景怡〈2004〉,「結核病為何愈演愈烈?」,《康健》,66:5,114-126。


英文

書籍


1. Åslund, Anders (2002), Building Capitalism: The Transformation of the Former Soviet Bloc, UK: Cambridge University Press.
2. Åslund, Anders (ed.), (1994), Economic Transformation in Russia, London: Pinter.
3. Åslund, Anders (1991), Gorbachev's Struggle for Economic Reform, New York: Cornell University Press.
4. Åslund, Anders (1995), How Russia Became a Market Economy, Washington, D.C. : Brookings Institution.
5. Åslund, Anders (1995), “The Politics of Economic Reform: Remaining Tasks,” in Åslund, Anders (ed.) Russian Economic Reform at Risk, London and New York: Pinter.
6. Azizian, Rouben, Zhang, Yongjin (eds.), (1998) “Security Issues in China’s Relationship with Central Asian States,” Ethnic Challenges Beyond Borders : Chinese and Russian Perspectives of the Central Asian Conundrum, New York: St. Martin's Press.
7. Baum, Fran (2002),“Introduction,”The New Public Health, Singapore: Oxford University Press.
8. Boycko, M. , Shleifer, A. , Vishny, R. W. (1994), “The Progress of Russian Privatization,” in Åslund, Anders (ed.) Economic Transformation in Russia, London: Pinter.
9. Caporaso, James A. , Levine, David P. (1992), Theories of Political Economy, Cambridge: Cambridge University Press.
10. Carey, Charles W. (ed.), (2003), Life under Soviet Communism, USA: Greenhaven Press.
11. Christopher, Davis (2001), “The Health Sector: Illness, Medical Care, and Mortality,” in Granville, B. , Oppenheimer, P. (eds.), Russia’s Post-Communist Economy, New York: Oxford University Press.
12. Christopher, Davis (2004),“Transition, Health Production, and Medical System Effectiveness”in Cornia, Giovanni Andrea, Paniccia, Renato (eds.), The Mortality Crisis in Transitional Economies, New York: Oxford University Press.
13. Chubais, A. , Vishnevskaya, M. (1994), “Privatization in Russia: An Overview,” in Åslund, Anders (ed.), Economic Transformation in Russia, London: Pinter.
14. Commander, Simon, Tolstopiatenko, Andrei (2001), “The Labour Market,” in Granville, B. , Oppenheimer, P. (eds.), Russia’s Post-Communist Economy, New York: Oxford University Press.
15. Cornia, Giovanni Andrea (2004), “Short-term, Long-term, and Hysteresis Mortality Models: A Review”in Cornia Giovanni Andrea, Paniccia Renato (eds.), The Mortality Crisis in Transitional Economies, New York: Oxford University Press.
16. Earle, John S. , Estrin, Saul (2001), “Privatization and the Structure of Enterprise Ownership,” in Granville, B. , Oppenheimer, P. (eds.), Russia’s Post-Communist Economy, New York: Oxford University Press.
17. Fedorov, Boris G. (1995), “Macroeconomic Policy and Stabilization in Russia,” in Aslund, Anders (ed.), Russian Economic Reform at Risk, London and New York: Pinter.
18. Fedorov, Boris G. , Kazmin, Andrei I. (1994), “1993: The First Experiences of the Russian Financial and Monetary Stabilization Policy,” in Åslund, Anders (ed.), Economic Transformation in Russia, London: Pinter.
19. Fujiwara, P. , Frieden T. (1995), “Tuberculosis Epidemiology and Control in the Inner City,” New York: Little, Brown and Company.
20. Gleissberg, Virginia (1999), Tuberculosis─ An Interdisciplinary Perspective, Singapore: Imperial College Press.
21. Goldman, Marshall I. (1992), What Went Wrong with Perestroika, USA: Norton.
22. Granville C. (2001), “The Political and Societal Environment of Economic Policy,” in Granville, B. , Oppenheimer, P. (eds.), Russia’s Post-Communist Economy, New York: Oxford University Press.
23. Granville, B. (2001), “The Problem of Monetary Stabilization,” in Granville, B. , Oppenheimer, P. (eds.), Russia’s Post-Communist Economy, New York: Oxford University Press.
24. Gregory, Paul R. , Stuart, Robert C. (1998), Russian and Soviet Economic Performance and Structure, Sixth Edition, USA: Addison-Wesley Educational Publishers.
25. Hardt John P. (2003), Russia’s Uncertain Economic Future, With a Comprehensive Subject Index, London: M. E. Sharpe, Inc. .
26. Illarionov, A. , Layard, R. , Orszag, P. (1994), “The Conditions of Life,” in Åslund, Anders (ed.), Economic Transformation in Russia, London: Pinter.
27. Keleher, Helen (2004), “Public and Population Health: Strategic Responses,”in Keleher, Helen, Murphy, Berni (eds.), Understanding health: a determinants approach, Oxford: Oxford University Press.
28. Lewin Moshe (2005), The Soviet Century, New York: Verso.
29. Marmot Michael, Bobak Martin (2004), “Psychosocial and Biological Mechanisms behind the Recent Mortality Crisis in Central and Eastern Europe,” in Cornia, Giovanni Andrea, Paniccia, Renato (eds.), The Mortality Crisis in Transitional Economies, New York: Oxford University Press.
30. McKee, Martin (2001), “The Health Consequences of the Collapse of the Soviet Union”in Leon, David A. , Walt Gill (eds.), Poverty, Inequality, and Health: An International Perspective, New York: Oxford University Press.
31. Moslalewicz, Jacek, Wojtyniak, Bogdan, Rabczenko, Daniel (2004), “Alcohol as a Cause of Mortality in Societies Undergoing Rapid transition to Market Economy,”in Cornia, Giovanni Andrea, Paniccia, Renato (eds.), The Mortality Crisis in Transitional Economies, New York: Oxford University Press.
32. Nelson, Lynn D. , Kuzes, Irina Y. (1995), Radical Reform in Yeltsin's Russia : Political, Economic, and Social Dimemsions, New York: M. E. Sharpe.
33. Paniccia, Renato (2004), “Transition, Impoverishment, and Mortality: How Large an Impact?”in Cornia, Giovanni Andrea, Paniccia, Renato (eds.), The Mortality Crisis in Transitional Economies, New York: Oxford University Press.
34. Reidrath, Daniel D. (2004), “Social Determinants of Heaith,”in Keleher, Helen, Murphy, Berni (eds.), Understanding health: a determinants approach, Oxford: Oxford University Press.
35. Sachs, J. (1994), “Prospects for Monetary Stabilization in Russia,” in Åslund, Anders (ed.), Economic Transformation in Russia, London: Pinter.
36. Sachs, J. (1995), “Why Russia Has Failed to Stabilize,” in Åslund, Anders (ed.), Russian Economic Reform at Risk, London and New York: Pinter.
37. Stroev, E. , Bliakhman, L.S., Krotov, M. (1999), Russia and Eurasia at the Crossroads, Experience and Problems of Economic Reforms in the Commonwealth of Independent States, Italy: Springer.
38. Tchernina, Natalia (2004),“Rising Unemployment and Coping Strategies: the Case of the Novosibirsk Oblast,”in Cornia, Giovanni Andrea, Paniccia, Renato (eds.), The Mortality Crisis in Transitional Economies, New York: Oxford University Press.
39. The social Crisis in the Russian Federation (2000), Paris: OECD Centre for Co-operation with Non-Members.
40. Tikhomirov, V. (2000), The Political Economy of Post-Soviet Russia, New York: St. Martin’s Press.
41. Transition report 2003: Integration and Regional Cooperation (2003), London: European Bank for Reconstruction and Development.
42. Vasiliev, S. A. (1995), “The Political Economy of Russia’s Reform,” in Aslund, Anders (ed.), Russian Economic Reform at Risk, London and New York: Pinter.
43. Westwood, J. W. (2002), Endurance and Endeavour, New York: Oxford University Press.


期刊

1. Boev, B. (2003), ”Narcotics Abuse in Russia─Analysis and Forecasting of the Demographic Consequences,” Russian Education and Society, 45: 3, 43-58.
2. Coker, Richard J. , Atun, Rifat A. , Mckee, Martin (2004), “Health-care System Frailties and Public Health Control of Communicable Disease on the European Union’s New Eastern Border,” Lancet, 363: 4, 1389-1392.
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報紙

1. 'TB an Epidemic in Russia's Prisons, 'Salt Lake Tribune Online(Salt Lake), 1999.12.04
2. New York Times, 1998/9/18, page A3.

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