三十五年來台灣兒童的健康水平

The Health Level of Children in Taiwan in the Past 35 Years

我國的婦女總生育率，現在已由三十五年前的每位婦女7.0，降到1998年的1.49。15歲以下的兒童人口，由1974年的575萬，附件1998年的486萬。在此高度「少子化」的社會裡，兒童的健康就格外重要，應予以檢討。等著分析三十五年來的我國兒童死亡率。於1965至1985年間，發現0～1歲人口的死亡率由24‰至7‰、1～4歲由4.7‰至0.9‰、5～14歲由0.7‰至0.4‰及15～24歲由1.6‰至1.1‰顯著下降。但1985年以後，即下降有限，停滯不前，維持在約兩倍高於日本、新加坡、瑞典、法國、德國、荷蘭及澳洲等先進國家。在此間我國兒童的主要死因，由過去的肺炎、腦膜炎及腸炎等傳染病，轉變為現在的周產期疾病、先天性畸形、事故與傷害及惡性腫瘤等慢性疾病。我國學童常見疾病的盛行率，如蛀牙，三十年前為30%至68%，現在昇為35%至92%。近視，過去為3%至4%，現在昇為12%至84%。肥胖也由過去的0%，升到現在的17%。兒童的受虐、暴力及懷孕等各種心智及行為的問題也在增加。兒童慢性疾病，有如心臟病、腎臟病及肝臟病等，其診斷常被延誤。舉例先天性心臟病，著者等研究發現，在學校做篩檢以前，未曾被告知者，竟高達20%。我國兒童重大疾病的治療成績，仍不及於歐美日等最先進國家。原因為台大、台北榮總及成大等各醫學中心，皆以成人為導向，缺少兒童醫學中心。我國兒童的健康水平，已十五年不再增進，表示我國現行醫療、保健體制及所做的努力，顯然有瓶頸，急待衝刺，設法改善。健康是兒童的權利，賦予兒童健康是成人的義務。著者建議：1)我國應早日籌設國家級兒童醫院，以肩負兒童轉診中心，照顧重症兒童；2)我國學校的衛生保健，應早日立法，落實學童衛生保健，以改善學童健康水平；3)中央應設兒童局，以整合各部會，落實兒童衛生及福利工作。

Children's health has become an increasingly important and pressing issue in Taiwan as the total fertility rate has droppen from 7.0per woman in 1956 to 1.49 in 1998,and the number of children below age 15 years has decreased from 5,715,148 in 1974 to 4,864,840 in 1998. Childhood mortality rates declined dramatically during 1965 to 1985: From 23.7‰ among infants to 6.8‰; from 4.7‰ to 0.9‰ in children aged 1-4 years; from 0.7‰ to 0.4‰ in those aged 5-14 years, and from 1.6‰ to 1.0‰ in those aged 15-24 years. The rate has changed little since 1985, however, and remains approximately twice as high as those of Japan, Singapore, Sweden, France, Germany, and Australia.Currently, the main causes of death among children in Taiwan are not infectious diseases, but rather are perinatal diseases, congenital anomalies, accidents and injuries, and malignant neoplasms. The most prevalent chronic diseases among children nowadays are tooth caries, occurring in 35% to 92%, myopia in 12% to 84%, and obesity in 15% to 17% of school children, respectively. Detection of chronic disease is often delayed. The hospital survival rates of children with complex and serious diseases remain unsatisfactory, owing to inadequate specialized manpower and facilities.To address the current health needs of children in Taiwan, a national children's medical center should be established, and a children's bureau should be founded at the central government for implementation of child health and welfare activities. Finally, laws should be passed to foster the establishment and growth of school health promotion programs.