臺東縣社區健康營造推動的現況與困難之研究

The Current Situations and Difficulties of Promoting the Health Community Building in Taitung County

本研究是以台東縣社區健康營造主要推動者為對象，來了解在一個缺乏社區資源、種族多元的縣市，社區健康營造的政策會有怎樣不同的推動情形與困難。並以深入訪談的方式收集資料，共計訪問32人，研究結果發現：（一）台東縣社區健康營造中心主要由衛生所和醫院所承辦。衛生所往往因為社區沒有其他合適的團體，而在衛生當局的鼓勵之下來承辦。醫院則為了傳播醫院的形象，與增加營運利潤的目的來推動。（二）推動的策略首重衛生所人員能力的提昇，社區有限資源的整合。強調從文化傳統切入，以社區總體營造的理念，結合健康與經濟產業來推動。重視民眾對健康的自覺與自決，並且強調創造性與永續發展，重視辦理衛教宣導活動與健康講座，並且鼓勵青少年與公務人員擔任自己社區的志工。（三）推動的困難除了健康議題本身難以成為社區的優先議題以外，主要與其縣內 原住民人口多且原住民健康問題的複雜性，以及社會資源的不足有關。此外政治派系的鬥爭、原住民菁英壟斷資源、營造中心承辦人員時常更換、認知與執行之間能力的落差，以及政策規劃單位對於社區健康營造計畫的規劃與管理的不善所衍生的問題等。台東縣民眾的健康問題與經濟的不足，和原住民的社會文化結構有關，很難只從健康問題的單獨營造而改善。應該從健康政策面，進行中央跨部會相關經費的整合，權力下放但增強地方所不足的能力與經費著手。深入了解健康對原住民的意義，並且加強青少年的健康教育與志工的運用與培訓。

This research is to realize the policy of the health community building (HCB) through the promoters of the HCB in Taitung County where is considered to be lack of community resources with multiple races. This research collects information by using the method of interview. There are 32 persons were interviewed. The results of this research are: 1. The centers for HCB in Taitung County is primarily undertaken by health centers and hospitals. The reasons for health centers to undertake the HCB project is that there are no other proper organizations to undertake the project. Therefore, the health centers are encouraged by the Department of Health, Taitung County Government to undertake the HCB. However, the reason for hospitals to undertake the HCB project is to increase their profits. 2. The policies to promote the HCB are focused on increasing the capability of the promoters of the health centers, integrating the limited community resources, emphasizing the traditional culture, combining health and economic industry, emphasizing the health awareness and self-determination, focusing on the creativity and continuing development, emphasizing health education, and also encourage the teenagers and government employees to be their community volunteers. 3. Besides the issue of health is hard to be the primary issue to be emphasized in the community, the other difficulties to promote the HCB project are: lots of natives in the communities and their health problems are complexity, and the lack of society resources. The political fighting, the monopolization of resources by the native elites, the change of the promoters in the HCB, the gap between knowledge and practice, as well as not well planned and managed by the policy-maker for the HCB are also the difficulties to promote the HCB project. The health problems of the people of Taitung County are related to the poor economy and the social culture of the natives. It is hard to solve the health problem barely from the HCB. The health problem of the people of Taitung County should be resolved from health policy, integrating related funds from federal and local government, empowering the capability and enhancing the fund in the local government. It is suggested that we should realize the meaning of health to the natives, strengthen the health education for the teenagers and the utilization and training of the volunteers.