對(duì)農(nóng)村學(xué)校公共衛(wèi)生安全問(wèn)題的建議與對(duì)策

1、legalsystemfurthersound perfect,leaders at all leve ls ca dres using rul eof lawthi nkingand rul eoflawwaydee peningref orm,andreform results,e conomy,a nd politi calsystem, a nd cult ure system, a nd socia lsystem, anddi sci pline checksy stem,and partyofconstruction systemreform soli dadvance,tax,

2、 a nd financial,and pri ce,a nd a dministrativea ppr oval,and State-owne d enter prise s,and ecol ogical civilizati on,im portantfield and key linkreformmademajorprogress, market inre sources configuration int he ofdecisiv erolesignifica ntlyenhanced, Unprece dente d burstofmoment umand vitalityofec

3、onomic andsocia ldevel opme nt. XIGeneralSecretary's spe echint his regardi ncl udethe reform onlywhent here is no com plete,the < de cisi ons of the CPCCe ntralCommittee onsomemajorprobl ems in deepeni ngreform >noteson the18 se ssi on ofi deas i nto the party's spiritofthe reformsmor

4、edifficultto move forward,t he increasi ng useofthe S ocial istsystemwith Chi nese characteristi cs such as thea bilityto runthe countr y.4.withregardtoprom otingsustaineda nd healthye conomi c devel opme nt.Face complexchangeable of internati onalsituation anddifficult heavy ofdomesticreform develo

5、pmentstable task,XIGeneralSecretarymadeChina economic developmenti nto ne wnormalofscie ncejudge,pr oposed i nnovation,and coordi nation,and green,and open,and share dfive bigdevel opme ntconcept,implementati on macr o policy to sta bility,and industry poli cy to associate ,andmicro policytolive,a n

6、d reform policytoreal,and socialpolicyt o backingfive big pillarsex policy,vigor ously advancesupplysidestructural reform,newconcept, a chieve d has 2013to2015 during,Domestic production totala nnualgrowth 7.3%, obvi ously fastYu e arlier worl deconomic 2.3%of annualgrowth,onworldeconomi cgrowthofco

7、ntributionover25% , tertiaryindustry accountedfordomesti cpr oduction totalshareover50%,eventuallyconsumpti on on e conomicgr owth ofcontr ibuti on raterea ched66%,e conomic struct ureadjustment made importa nt progre ss, developmentof qualityand be nefits sig nificantlyupgrade , Chinae conomic show

8、 out huge ofswing r oom andbr oad of development prospects. This aspects XIGe neralSe cretary ofspe ech main including e conomi c growth m ustis reala nd nowaterof growt h improve opentype economi clevel"see missingofhand"and "se ehave see ofha nd" aretowith goodspee d upfrom ele

9、ments drive,andinvestmentscale drive dev elopmentmainly to t o innovation drive developmentmainlyof cha nge a ctivepromote d China e nergypr oduction and consumpti onrevol ution,. 5.with regard tobuildi ngther uleof lawi n Chi na.18 bigyilai, Centraltightly aroundfull advancela wr uli ng,put partyof

10、led, and pe oplemasters, and lawruling organi c unified up,i nsisted lawruling,and lawr uling,a nd la w admini strativecommon advance,insiste d rule oflaw national,a nd r uleof lawGovernme nt,andrule oflaw social oneconstruction,f ulladvancescience l egislation,a nd stri ctlylawenforcement,a ndjustj

11、udici al,and universal law -abi ding ,Chinafeatures socialist對(duì)農(nóng)村學(xué)校公共衛(wèi)生安全問(wèn)題的建議與對(duì)策建德市20042007年全市共報(bào)告突發(fā)事件16 起， 發(fā)生在全市中小學(xué)呼吸道傳染病暴發(fā)疫情15 起， 占93.75，嚴(yán)重危害學(xué)生身心健康。學(xué)校公共衛(wèi)生安全一直是衛(wèi)生、教育部門的工作重點(diǎn)，也是政府關(guān)注的焦點(diǎn)和社會(huì)輿論的熱點(diǎn)；但學(xué)校又是突發(fā)公共衛(wèi)生事件的高發(fā)場(chǎng)所，特別是農(nóng)村學(xué)校尤為嚴(yán)重。2009 年欽堂初中、大洋中心小學(xué)、明珠小學(xué)、育才中學(xué)、新職中等學(xué)校都發(fā)生了“甲流”暴發(fā)流行。學(xué)校突發(fā)公共衛(wèi)生事件不僅危害學(xué)生的身心健康，而且嚴(yán)重影響教學(xué)秩

12、序和社會(huì)穩(wěn)定。因此，做好學(xué)校公共衛(wèi)生安全工作，責(zé)任重大，意義重大。一、農(nóng)村學(xué)校公共衛(wèi)生安全問(wèn)題的成因分析相關(guān)流行病學(xué)調(diào)查和疫情分析認(rèn)為，學(xué)校突發(fā)公共衛(wèi)生事件主要為傳染病暴發(fā)疫情，其次是食物中毒；地區(qū)分布多為農(nóng)村中小學(xué)和鄉(xiāng)鎮(zhèn)中小學(xué)。學(xué)校誘發(fā)突發(fā)公共衛(wèi)生事件的潛在因素很多，主要有以下幾點(diǎn)：1、辦學(xué)規(guī)模與學(xué)校公共衛(wèi)生體系建設(shè)不同步隨著鄉(xiāng)鎮(zhèn)行政區(qū)域規(guī)劃的調(diào)整和教育資源的整合，農(nóng)村大部分中小學(xué)進(jìn)行了撤擴(kuò)并，學(xué)校規(guī)模不斷擴(kuò)大，學(xué)生人數(shù)急劇增加，學(xué)生由走讀制度變成寄宿制，但許多學(xué)校沒(méi)有建成與學(xué)校辦學(xué)規(guī)模相適應(yīng)的公共衛(wèi)生相關(guān)體系和落實(shí)相關(guān)措施，學(xué)校公共衛(wèi)生安全存在很多隱患。2、農(nóng)村學(xué)?；A(chǔ)衛(wèi)生條件薄弱romo

13、ted devel opment,andThea bility toresolve conflicts andconsta ntly improve,our .6.on thebuildi ngofSocialist culture inChina.Acountry,a nationstrong, alwayssupportedby cultureflourished,theinheritancea nd developm ent of civilization,without culture todevelopand pr osper, there will benorealization

14、ofthedream ofChina.18bigyilai, XIGe neral Se cretaryaround "fosterandpr omoteSocialist corevalues""promoteChi naexcelle nttraditionalculture" "firmlymasterideology work le d rightand discourse right",aspectsdo has seriesimportant speech, mai n including putpublicity tho

15、ug htwork do have betterfora chieve dChina dreamconde nse dpowerfulmoral supportimprove nationalculturesoftstrengthfosterand promote S ocialist coreval ues y outhto consciouslypractice line Sociali st corevaluesChildhood a ctively cultivate andpracti ce the coreval ues ofsocialismand theparty's

16、importantspeech on thepress conference.7. promote t hereformand devel opment ofreform results,e conomy,a nd politi calsystem, a nd cult ure system, a nd socia lsystem, anddi sci pline checksy stem,and partyofconstruction systemreform soli dadvance,tax, a nd financial,and pri ce,a nd a dministrativea

17、 ppr oval,and State-owne d enter prise s,and ecol ogical civilizati on,im portant field and key linkreformmademajorprogress,marketinresources configuration int he ofdecisiv erolesignifica ntlyenhanced, Unprece dente d burstofmoment umand vitalityofeconomic andsocia ldevel opme nt. XIGeneralSecretary

18、's spe echint his regardi nculde thereform onlywhent here is no com plete,the < de cisi ons of the CPCCe ntralCommittee o n some major probl ems in deepeni ngreform >noteson the18 se ssi on ofi deas i nto the party's spiritofthe reformsmoredifficultto move forward,t he increasi ng useo

19、fthe S ocial istsystemwith Chi nese characteristi cs such as thea bilityto runthe countr y.4. with regard t oprom otingsustaineda nd healthye conomi c devel opme nt.Face complexchangeable of internati onalsituation anddifficult heavy ofdomesticreform developmentstable task,XIGeneralSecretarymadeChin

20、a economic developmenti nto ne wnormalofscie ncejudge,pr oposed i nnovation,and coordi nation,and green,and open,and share dfive bigdevel opme ntconce pt,implement ati on macr o policy to sta bilit y,and industry poli cy to associate ,andmicro policytolive,a nd reform policytoreal,and socialpolicyt

21、o ba cking fivebig pillarsex policy,vigor ously advancesupplysidestructural reform,newconcept, a chieved ha s 2013to2015 during,Domestic production totala nnualgrowth 7.3%, obvi ously fastYu e arlier worl deconomic 2.3%of annualgrowth,onworldeconomi cgrowth ofcontributionover25% , tertiaryindustry a

22、ccountedfordomesti cpr oduction totalshareover50%,eventuallyconsumpti on on e conomicgr owth ofcontr ibuti on raterea ched66%,e conomic struct ureadjustment ma de importa nt progre ss, developmentof qualityand benefits sig nificantlyupgrade , Chinae conomic show out huge ofswing r oom andbr oad of d

23、evelopment prospects. This aspects XIGe neralSe cretary of spe ech main including e conomi c growth m ustis reala nd nowaterof growth improve opentype economi clevel"see missingofhand"and "se ehave see ofha nd" a retowith goodspee d upfrom elements drive,andinvestment scale drive

24、 dev elopmentmainly to t o innovation drive developmentmainlyof cha nge a ctivepromote d China e nergypr oduction and consumpti onrevol ution,. 5.with regard tobuildi ngther uleof lawi n Chi na.18 bigyilai, Centraltightly aroundfull advance lawruli ng,put partyofled, and pe oplemasters, and lawrulin

25、g organi c unified up,i nsisted lawruli ng,and lawr uling,a nd la w admini strativecommon advance,insiste d rule oflaw national,a nd r uleof lawGovernme nt,andrule oflaw social one constructi on,full advancescience legislation,a nd stri ctlylawenfor cement,a ndjustjudici al,and universal law -abi di

26、ng ,Chinafeatures socialist一是學(xué)校的飲水安全存在隱患。目前，農(nóng)村部分學(xué)校為自備水，部分學(xué)校為村鎮(zhèn)集中式供水，但不同程度存在未及時(shí)清洗水箱和管道、 未按時(shí)消毒或不規(guī)范消毒等問(wèn)題，為介水傳染病疫情發(fā)生與流行埋下隱患。二是學(xué)生住宿條件普遍較差。大部分學(xué)校沒(méi)有獨(dú)立的男女生宿舍樓，沒(méi)有專門的沐浴場(chǎng)所與設(shè)備，學(xué)生宿舍存在人員擁擠、通風(fēng)不暢、 光照不足等問(wèn)題，影響了學(xué)生的身體健康和良好衛(wèi)生習(xí)慣的形成，導(dǎo)致春秋季呼吸道傳染病極易暴發(fā)與流行。3、校醫(yī)未按規(guī)定配備根據(jù)學(xué)校衛(wèi)生工作條例第二十條“城市普通中小學(xué)，農(nóng)村中心小學(xué)和普通中學(xué)設(shè)衛(wèi)生室，按學(xué)生人數(shù)600：1 的比例配備專職衛(wèi)生技術(shù)人

27、員”和浙江省托兒所、幼兒園衛(wèi)生保健管理辦法第五條“日托兒童100150 名， 全托兒童50100 名須設(shè)專職保健醫(yī)（護(hù)）師（士） 1 名，以后每增加100 名兒童，應(yīng)增設(shè)專職保健醫(yī)（護(hù)）師（士）1 名”規(guī)定，我市農(nóng)村 56 所中小學(xué)（包括職業(yè)中學(xué)）和36 所公立和私立幼托機(jī)構(gòu)應(yīng)按要求配備校醫(yī)27 名， 但目前除嚴(yán)中、新中、壽中各配有1 名校醫(yī)，其余均為兼職保健老師。校醫(yī)無(wú)配備是學(xué)校傳染病疫情時(shí)有暴發(fā)的主要原因。一是學(xué)生晨檢，因病缺勤病因追查與登記，兒童預(yù)防接種證查驗(yàn)，入園健康檔案查驗(yàn)等制度流于形式。未配備校醫(yī)的學(xué)校由兼職保健老師完成上述工作， 而大部分保健老師本身又承擔(dān)了大量的教學(xué)或繁重的后勤

28、管理任務(wù)，疏于對(duì)這些制度的落實(shí)， “傳染病重在預(yù)防”成了一句空話。二是學(xué)校傳染病疫情不能真正做到 “早預(yù)防、 早發(fā)現(xiàn)、 早報(bào)告、 早處置” 。reform results,e conomy,a nd politi calsystem, a nd cult ure system, a nd socia lsystem, anddi sci pline checksy stem,and partyofconstruction systemreform soli dadvance,tax, a nd financial,and pri ce,a nd a dministrativea ppr ova

29、l,and State-owne d enter prise s,and ecol ogical civilizati on,im portant field and key linkreformmademajorprogress,marketin resources configuration int he ofdecisiv erolesignifica ntlyenhanced, Unprece dente d burstofmoment umand vitalityofeconomic andsocia ldevel opme nt. XIGeneralSecretary's

30、spe echint his regardi nculde thereform onlywhent here is no com plete,the < de cisi ons of the CPCCe ntralCommittee onsomemajorprobl ems in deepeni ngreform >noteson the18 se ssi on ofi deas i nto the party's spiritofthe reformsmoredifficult to move forward,t he increasi ng useofthe S oci

31、al istsystemwith Chi nese character isti cs such as thea bility torun the countr y.4. with regard t oprom otingsustaineda nd healthye conomi c devel opme nt.Face complexchangeable of internati onalsituation anddifficult heavy ofdomesticreform developmentstable task,XIGeneralSecretarymadeChina econom

32、ic developmenti nto ne wnormalofscie ncejudge,pr oposed i nnovation,and coordi nation,and green,and open,and share dfive bigdevel opme ntconce pt,implementati on macr o policy to sta bilit y,and industry poli cy to associate ,andmicro policytolive,a nd reform policytoreal,and socialpolicyt o ba ckin

33、g fivebig pillarsex policy,vigor ously advancesupplysidestru cturalreform,ne wconcept, a chieve d has 2013to2015 during,Domestic production totala nnualgrowth 7.3%, obvi ously fastYu e arlier worl deconomic 2.3%of annualgrowth, on w orldeconomi cgrowth ofcontributionover25% , tertiaryindustry accoun

34、ted for domesti cpr oduction totalshareover50%,eventuallyconsumpti on on e conomicgr owth ofcontr ibuti on raterea ched66%,e conomic struct ureadjustment ma de importa nt progre ss, developmentof qualityand benefits sig nificantlyupgrade , Chinae conomic show out huge ofswing r oom andbr oad of deve

35、lopment prospects. This aspects XIGe neralSe cretary of spe ech main including e conomi c growth m ustis reala nd nowaterof growth improve opentype economi clevel"see missingofhand" and "se ehave see ofha nd" a retowith goodspee d upfrom elements drive,and investmentscale drive d

36、ev elopmentmainly to t o innovation drive developmentmainlyof cha nge a ctivepromote d China e nergypr oduction and consumpti onrevol ution,. 5.with regard tobuildi ngther uleof lawi n Chi na.18 bigyilai, Centraltightly aroundfull advance lawruli ng,put partyofled, and pe oplemasters, and lawruling

37、organi c unified up,i nsiste dlawruli ng,and lawr uling,a nd la w admini strativecommon advance,insiste d rule oflaw national,a nd r uleof law Governme nt,andrule oflaw social oneconstruction,full advancescience legislation,a nd stri ctlylawenfor cement,a nd justjudici al,and universal law -abi ding

38、 ,Chinafeatures socialist由于傳染病防控等工作有較強(qiáng)的專業(yè)性和特殊性，需要經(jīng)過(guò)系統(tǒng)、全面的培訓(xùn)，因此，目前農(nóng)村學(xué)校保健老師防控傳染病能力薄弱，對(duì)疫情不能“從早、從小”處置，導(dǎo)致疫情暴發(fā)與流行。4、健康教育亟待加強(qiáng)目前，農(nóng)村所有學(xué)校均未按有關(guān)規(guī)定把健康教育納入教學(xué)計(jì)劃，未開(kāi)設(shè)健康教育課。二、對(duì)策與建議1、公開(kāi)招聘醫(yī)務(wù)人員派駐學(xué)校，切實(shí)解決學(xué)校校醫(yī)配備問(wèn)題。按學(xué)校衛(wèi)生工作條例和浙江省托兒所、幼兒園衛(wèi)生保健管理辦法的規(guī)定，我市目前農(nóng)村學(xué)校（包括幼托機(jī)構(gòu)）校醫(yī)缺編27人。因此，建議由市教育局牽頭，政府人事部門同意在全市范圍內(nèi)公開(kāi)招聘具有執(zhí)業(yè)助理醫(yī)師及以上職稱，臨床或公共衛(wèi)生專業(yè)

39、的衛(wèi)技人員派駐學(xué)校任職校醫(yī)。由市人事局核定編制，聘任及管理權(quán)限在市教育局；財(cái)政保障其工資、保險(xiǎn)、福利。其意義與作用有：一是專業(yè)的預(yù)防與處置能將傳染病疫情更好地控制在萌芽狀態(tài)；二是進(jìn)一步加強(qiáng)了教育與衛(wèi)生的協(xié)作機(jī)制，理順了公共衛(wèi)生安全與教育教學(xué)的關(guān)系，衛(wèi)生部門的學(xué)校公共衛(wèi)生任務(wù)將會(huì)得到更好的貫徹落實(shí)。2、建立學(xué)校責(zé)任醫(yī)師制度，指導(dǎo)學(xué)校公共衛(wèi)生工作。對(duì)未達(dá)到學(xué)校衛(wèi)生工作條例和浙江省托兒所、幼兒園衛(wèi)生保健管理辦法校醫(yī)配備要求的學(xué)?；蛴淄袡C(jī)構(gòu)，參照我市社區(qū)衛(wèi)生服務(wù)中心聯(lián)村責(zé)任醫(yī)師的做法，根據(jù)屬地就近的原則，由各社區(qū)衛(wèi)生服務(wù)中心選派具有一定公共衛(wèi)生專業(yè)基礎(chǔ)和較強(qiáng)公共衛(wèi)生服務(wù)能力reform results

40、,e conomy,a nd politi calsystem, a nd cult ure system, a nd socia lsystem, anddi sci pline checksy stem,and partyofconstruction systemreform soli dadvance,tax, a nd financial,and pri ce,a nd a dministrativea ppr oval,and State-owne d enter prise s,and ecol ogical civilizati on,im portant field and k

41、ey linkreformmademajorprogress,marketin resources configuration int he ofdecisiv erolesignifica ntlyenhanced, Unprece dente d burstofmoment umand vitalityofeconomic andsocia ldevel opme nt. XIGeneralSecretary's spe echint his regardi nculde thereform onlywhent here is no com plete,the < de ci

42、si ons of the CPCCe ntralCommittee o n some major probl ems in deepeni ngreform >noteson the18 se ssi on ofi deas i nto the party's spiritofthe reformsmoredifficult to move forward,t he increasi ng useofthe S ocial istsystemwith Chi nese characteristi cs such as thea bilityto runthe countr y.

43、4. with regard t oprom otingsustaineda nd healthye conomi c devel opme nt.Face complexchangeable of internati onalsituation anddifficult heavy ofdomesticreform developmentstable task,XIGeneralSecretarymadeChina economic developmenti nto ne wnormalofscie ncejudge,pr oposed i nnovation,and coordi nati

44、on,and green,and open,and share dfive bigdevel opme ntconce pt,implement ati on macr o policy to sta bilit y,and industry poli cy to associate ,andmicro policytolive,a nd reform policytoreal,and socialpolicyt o ba cking fivebig pillarsex policy,vigor ously advancesupplysidestructural reform,newconce

45、pt, a chieved ha s 2013to2015 during,Domestic production totala nnualgrowth 7.3%, obvi ously fastYu e arlier worl deconomic 2.3%of annualgrowth, on w orldeconomi cgrowth ofcontributionover25% , tertiaryindustry accounted for domesti cpr oduction totalshareover50%,eventuallyconsumpti on on e conomicg

46、r owth ofcontr ibuti on raterea ched66%,e conomic struct ureadjustment ma de importa nt progre ss, developmentof qualityand benefits sig nificantlyupgrade , Chinae conomic show out huge ofswing r oom andbr oad of development prospects. This aspects XIGe neralSe cretary of spe ech main including e co

47、nomi c growth m ustis reala nd nowaterof growth improve opentype economi clevel"see missingofhand" and "se ehave see ofha nd" a retowith goodspee d upfrom elements drive,and investment scale drive dev elopmentmainly to t o innovation drive developmentmainlyof cha nge a ctivepromo

48、te d China e nergypr oduction and consumpti onrevol ution,. 5.with regard tobuildi ngther uleof lawi n Chi na.18 bigyilai, Centraltightly aroundfull advance lawruli ng,put partyofled, and pe oplemasters, and lawruling organi c unified up,i nsisted lawruli ng,and lawr uling,a nd la w admini strativec

49、ommon advance,insiste d rule oflaw national,a nd r uleof lawGovernme nt,andrule oflaw social one constructi on,full advancescience legislation,a nd stri ctlylawenfor cement,a ndjustjudici al,and universal law -abi ding ,Chinafeatures socialist的醫(yī)務(wù)人員，相對(duì)固定聯(lián)系當(dāng)?shù)氐膶W(xué)?；蛴淄袡C(jī)構(gòu)，每周至少一天到聯(lián)系的學(xué)?；蛴淄袡C(jī)構(gòu)，幫助、指導(dǎo)和配合學(xué)校做好傳染病防

50、控、食品衛(wèi)生、幼托保健、健康教育等各項(xiàng)公共衛(wèi)生工作。3、加強(qiáng)領(lǐng)導(dǎo)，認(rèn)真落實(shí)學(xué)校公共衛(wèi)生各項(xiàng)責(zé)任制。教育行政部門和學(xué)校領(lǐng)導(dǎo)要牢固樹(shù)立“健康第一”的指導(dǎo)思想，切實(shí)加強(qiáng)對(duì)公共衛(wèi)生工作的領(lǐng)導(dǎo)，把學(xué)校公共衛(wèi)生作為加強(qiáng)學(xué)校管理、建設(shè)和諧校園的重要內(nèi)容。教育行政部門要落實(shí)責(zé)任目標(biāo)，建立健全督導(dǎo)檢查制度，將學(xué)校公共衛(wèi)生工作納入綜合評(píng)估學(xué)校工作的考核體系中，強(qiáng)化管理、常抓不懈，使學(xué)校公共衛(wèi)生工作規(guī)范化、制度化； 健全并落實(shí)學(xué)校突發(fā)公共衛(wèi)生事件責(zé)任追究制度和定期檢查通報(bào)制度，特別要落實(shí)學(xué)校食品衛(wèi)生安全和傳染病防控工作的校長(zhǎng)責(zé)任制。4、加大投入，改善學(xué)?；A(chǔ)衛(wèi)生設(shè)施和條件。政府和教育行政部門要加大投入，改善寄宿制學(xué)

51、校的住宿條件，建立健全生活配套設(shè)施；要切實(shí)解決學(xué)生在校飲水問(wèn)題，著力研究和解決農(nóng)村中小學(xué)自建供水設(shè)施存在的安全隱患，為學(xué)生提高符合衛(wèi)生要求的飲用水。學(xué)校要大力開(kāi)展愛(ài)國(guó)衛(wèi)生運(yùn)動(dòng)，建立環(huán)境衛(wèi)生保潔制度和學(xué)習(xí)生活場(chǎng)所通風(fēng)換氣制度，經(jīng)常開(kāi)展環(huán)境衛(wèi)生清潔活動(dòng)，定期開(kāi)窗通氣，保持室內(nèi)空氣清潔；要根據(jù)傳染病病種和傳播途徑不同，在流行季節(jié)有組織地開(kāi)展消毒殺蟲(chóng)滅鼠活動(dòng)，切斷傳播途徑，預(yù)防傳染病暴發(fā)和流行。5、深入開(kāi)展學(xué)校公共衛(wèi)生教育，切實(shí)提高學(xué)生防病意識(shí)。reform results,e conomy,a nd politi calsystem, a nd cult ure system, a nd socia

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55、pme nt.Face complexchangeable of internati onalsituation anddifficult heavy ofdomesticreform developmentstable task,XIGeneralSecretarymadeChina economic developmenti nto ne wnormalofscie ncejudge,pr oposed i nnovation,and coordi nation,and green,and open,and share dfive bigdevel opme ntconce pt,implementati on macr o policy to sta bilit y,and industry poli cy to associate ,andmicro policytolive,a nd reform policytoreal,and socialpolicyt o ba cking fivebig pil