공중보건학 (제6판 최신 개정판)

머리말

세계보건기구(WHO)에서 건강은 인류 모두가 누려야 할 기본적인 권리로 규정하고 있으며, 우리나

라 헌법에서도 모든 국민은 건강에 관하여 보호를 받는다고 명시하고 있다. 국민의 건강은 무엇보다

도 국가나 지역사회의 공중보건수준에 의해 결정되기 때문에 공중보건학은 장차 국가면허를 취득해

보건의료분야에 종사하면서 국민의 건강유지 및 증진 업무를 맡게 될 보건의료인력의 경우 매우 중요

한 의미를 갖는다. 따라서 공중보건학은 보건의료분야의 전문인력을 양성하는 대학뿐만 아니라, 우리

의 일상생활에서 쉽게 접할 수 있는 각종 사회실무분야의 자격증 취득시험, 보건직 공무원 임용 및

승진시험 등에서도 기본 소양이 되는 매우 중요한 교과목으로 자리 잡고 있다.

본 교재는 대학의 보건관련학과에서 국가면허시험을 준비하는 학생들을 주 대상으로 하였으나, 개

인적으로 공부하는 수험생들에게도 도움이 될 수 있도록 교재내용의 대부분을 강의노트 형식으로 간

략하고 체계적으로 정리하였다. 또한 단원별로 충분한 연습문제를 준비해 교과내용에 대한 이해 여부

를 확인할 수 있도록 하였다. 교재내용은 국가시험 출제기준에 근거하여 제1편 공중보건학 개념, 제2

편 환경보건, 제3편 역학 및 질병관리, 제4편 보건관리 등으로 구성하였으며, 각 편은 다시 세부적인

장으로 나뉘어 있다. 제1편에서는 건강과 공중보건학에 관한 개괄적인 내용을 다루고 있으며, 제2편

에서는 환경위생, 환경보전, 식품위생, 산업보건 등 4개의 장으로 이루어져 있다. 특히, 환경보전 분야

에서는 오늘날 전 지구적인 관심의 대상으로 전 인류의 공동대처를 필요로 하는 산성비(acid rain),

오존층 고갈(ozone depletion) 및 지구온난화(global warming) 문제에 대하여 최근의 자료를 토대로

비교적 자세하게 기술하였다. 향후 이러한 광역대기오염 현상은 공중보건학적인 측면에서 지역사회구

성원을 비롯하여 전 인류의 건강과 일상생활에 보다 심각한 영향을 초래하게 될 것이다. 제3편에서는

역학, 감염병관리, 기생충질환관리, 만성질환관리 등 4개의 장으로 나누어 기술하였으며, 제4편은 보

건행정, 사회보장 그리고 각종 보건사업에 대한 내용으로 나누어 정리하였다. 교재의 내용은 최근의

보건 및 환경관련 법규의 개정에 맞추어 내용을 수정 및 보완하였으며, 보건통계자료를 인용하여 건

강문제를 보다 정확하게 이해할 수 있도록 하였다. 본문의 내용 중 난해하거나 주요 학술용어에 대해

서는 영어와 한자를 괄호 안에 기입하였으며, 다소 난해한 용어나 내용에 대해서는 그 이해를 도울

수 있도록 부가적인 정보를 첨가하였다. 그러나 강의일정에 따라 한정된 짧은 시간에 원고 집필이 이

루어지다보니 미처 참고문헌과 인터넷 자료의 경우 그 출처가 일부 명확하게 제시되지 못한 점을 밝

힌다. 아직 여러 가지로 미흡한 점들이 많지만 향후 각 분야의 선후배님들을 모시고 지속적인 첨삭이

이루어질 수 있었으면 한다.

마지막으로 본 교재를 집필할 수 있도록 도움을 주신 교수님들과 주위분들께 삼가 감사인사를 드리

며, 특히 출판이 가능하도록 배려해 주신 고려의학 최병진 사장님과 본서가 출간되기까지 여러 가지

로 도움을 주신 직원 선생님들께도 깊은 감사를 드린다.

차례

제1편 공중보건학 개념

Ⅰ. 건강과 질병 ···········································4

1. 건강의 정의 ··············································4

2. 질병의 정의 ··············································5

Ⅱ. 공중보건학의 개념 ·································8

1. 공중보건학의 정의 ····································8

2. 공중보건사업 ·············································9

3. 공중보건학의 관련학문 ·····························9

Ⅲ. 공중보건수준의 평가 ···························11

1. 공중보건수준의 평가지표 ·······················11

2. 보건수준 평가의 3대 지표 ·····················11

3. 국내 보건수준의 추이 ····························12

Ⅳ. 우리나라 공중보건의 과제와 전망 ······14

1. 사망양상의 변화 ·····································14

2. 우리나라 공중보건의 과제 ······················16

3. 우리나라 보건의료의 전망 ······················16

4. 당면과제에 대한 해결방안 ······················16

Ⅴ. 공중보건학의 발전사 ···························17

1. 고대기 ·····················································17

2. 중세기 ·····················································17

3. 여명기 ·····················································17

4. 확립기 ·····················································18

5. 발전기 ·····················································19

Ⅵ. 보건의료 ···············································20

1. 일차보건의료 ··········································20

2. 보건의료의 개념 ·····································24

3. 보건의료체계 ··········································25

Ⅶ. 건강증진 ···············································28

1. 국제적인 대두배경 ··································28

2. 건강증진의 정의 ·····································29

3. 오타와헌장 ··············································29

4. WHO 건강증진의 원칙 ··························30

5. 우리나라의 건강증진사업 ·······················30

제2편 환경보건

제1장 환경위생 ···············································40

Ⅰ. 환경위생의 개념 ··································40

1. 정의(WHO) ············································40

2. 환경위생의 발전 ·····································40

3. 환경위생사업 ··········································41

Ⅱ. 기후와 일광 ·········································41

1. 기후 ························································41

2. 일광 ························································42

Ⅲ. 온열환경 ···············································44

1. 기온 ························································45

2. 기습 ························································46

3. 기류 ························································49

4. 복사열 ·····················································49

5. 온열요소의 종합작용 ······························51

6. 체온조절 ·················································54

Ⅳ. 공기 ······················································55

1. 공기의 성분과 오염 ································55

2. 공기의 성분과 건강 ································57

3. 기압과 건강장애 ·····································59

4. 실내공기오염과 군집독 ···························59

Ⅴ. 상수 ······················································63

1. 물의 중요성과 보건문제 ·························63

2. 먹는물의 수질기준 ··································65

3. 상수 처리 ···············································72

4. 일반정수법 ··············································73

5. 특수정수법 ··············································79

6. 수영장 및 공공욕장 ································80

Ⅵ. 하수 ······················································81

1. 하수와 보건 ············································81

2. 하수도 ·····················································81

3. 하수 처리 ···············································83

4. 하수의 오염도 측정 ································87

Ⅶ. 폐기물 및 분뇨처리 ·····························88

1. 폐기물 처리 ············································88

2. 분뇨 처리 ···············································92

Ⅷ. 의복 및 주택보건 ································93

1. 의복보건 ·················································93

2. 주택보건 ·················································95

Ⅸ. 구충, 구서 ············································98

1. 위생해충의 정의와 종류 ·························98

2. 해충에 의한 보건위생상의 피해 ·············98

3. 위생해충의 구제 ·····································99

4. 주요 위생해충의 생태와 피해 ················99

5. 위생해충의 병인론 ································105

6. 쥐의 특성과 구서법 ······························105

Ⅹ. 소독 ····················································107

1. 소독과 멸균 ··········································107

2. 소독방법 ···············································107

3. 물리적 소독법 ······································108

4. 화학적 소독법 ······································110

제2장 환경보전 ·············································114

Ⅰ. 환경오염과 환경보전 ·························114

1. 환경오염 ···············································114

2. 환경보전 ···············································115

Ⅱ. 대기오염 ·············································117

1. 대기오염의 개념 ···································117

2. 대기오염기준 ········································119

3. 대기오염과 기상 ···································122

4. 대기오염 사건 ······································125

5. 대기오염 현상과 영향 ··························127

6. 자동차대기오염 ·····································134

7. 광역대기오염 ········································139

8. 엘니뇨와 라니냐 현상 ··························151

Ⅲ. 수질오염 ··········································· 153

1. 수질오염의 개념 ································· 153

2. 수질오염원 ············································154

3. 주요 수질오염 물질과 영향 ·················154

4. 수질오염 지표 ······································156

5. 수질기준 ···············································160

6. 수질오염의 영향과 사례 ·······················164

7. 생물학적 농축과 독성도 평가 ··············166

8. 수질오염 방지대책 ································167

Ⅳ. 소음 및 진동 ·····································168

1. 소음･진동의 개념 ·································168

2. 소음･진동의 척도 ·································171

3. 소음･진동의 영향 ·································174

4. 소음･진동기준 ······································176

Ⅴ. 악취 ····················································177

1. 악취의 정의 ··········································177

2. 악취의 발생원 ······································177

3. 악취의 측정 ··········································177

4. 악취의 영향 ··········································177

5. 악취의 배출허용기준 ····························178

제3장 산업보건 ·············································179

Ⅰ. 산업보건의 개념 ································179

1. 산업보건의 정의 ···································179

2. 산업보건의 중요성 ································179

3. 산업보건의 목적 ···································179

4. 산업보건의 발전과정 ····························180

Ⅱ. 산업장의 작업환경관리 및 보건관리 ·184

1. 작업환경의 측정과 관리 ·······················184

2. 근로자의 건강관리와 건강진단 ············186

3. 산업보건교육과 건강증진사업 ··············187

4. 근로자의 영양관리 ································188

5. 작업관리 ···············································189

6. 산업피로관리 ········································191

Ⅲ. 산업재해와 재해지표 ·························193

1. 재해의 개념 ··········································193

2. 산업재해지표 ········································194

3. 재해방지대책 ········································198

Ⅳ. 직업병의 관리 ····································199

1. 직업병의 개요 ······································199

2. 물리적 환경에 기인하는 직업병 ·········199

3. 작업장의 분진에 의한 질병 ·················207

4. 공업중독 ···············································207

5. 신체부담업무로 인한 질병 ···················212

6. 직업병의 예방 및 근로자의

보건관리대책 ········································213

제4장 식품위생 ·············································214

Ⅰ. 식품위생의 개념 ································214

1. 식품위생의 정의 ···································214

2. 식품위생관리 ········································214

Ⅱ. 식품에 의한 건강장해 ·······················215

1. 식품매개감염병 ·····································215

2. 인수공통감염병 ·····································216

3. 식중독 ···················································217

4. 식품관련 기생충질환 ····························218

Ⅲ. 식중독 ················································219

1. 세균성 식중독 ······································219

2. 바이러스성 식중독 ······························223

3. 화학적 식중독 ······································223

4. 자연독에 의한 식중독 ··························225

5. 곰팡이독 식중독 ···································226

Ⅳ. 식품의 변질과 보존 ···························227

1. 식품변질의 개념 ···································227

2. 식품의 보존방법 ···································228

Ⅴ. 식품의 위생관리 ································229

1. 식품위생행정의 강화 ····························229

2. 식품안전관리인증기준(HACCP) 제도 ·· 229

3. 식중독 발생신고 ·································231

제3편 역학 및 질병관리

제1장 역학 ···················································237

Ⅰ. 역학의 개념 ·······································237

1. 역학의 정의와 역할 ······························237

2. 의학과 역학의 비교 ······························238

3. 역학조사의 고전 사례 ··························238

Ⅱ. 질병발생의 역학적 개념 ····················240

1. 다인설 ···················································240

2. 질병발생의 인과관계 판단 ·················242

Ⅲ. 역학적 연구방법 ································243

1. 역학조사의 개념 ···································243

2. 기술역학 ···············································244

3. 분석역학 ···············································244

4. 실험역학 ···············································250

5. 이론역학 ···············································251

Ⅳ. 질병발생의 빈도 및 위험도 산출 ······253

1. 비, 분율, 비율 ······································253

2. 유병률과 발생률 ···································254

3. 질병발생의 위험도 산출 ·······················254

Ⅴ. 역학적 연구의 평가 ···························255

1. 바람직한 역학적 진단검사법의 기준 ····255

2. 타당도 평가 ··········································256

3. 신뢰도 평가 ··········································257

4. 타당도와 신뢰도의 관계 ·······················257

5. 역학조사의 오차방지 ····························258

제2장 감염병의 관리 ····································259

Ⅰ. 감염병의 개념 ····································259

1. 용어 정의 ·············································259

2. 새로운 전염병의 유행 사례 ·················259

3. 전염병 발생설의 변천 ··························261

4. 감염병의 유행 ······································262

Ⅱ. 감염병의 생성과정 ·····························263

1. 감염병 생성의 6단계 구성요소 ············263

2. 병원체 ···················································263

3. 병원소 ···················································266

4. 병원소로부터 병원체의 탈출 ················268

5. 전파 ······················································269

6. 새로운 숙주에 침입 ······························271

7. 감수성 숙주의 감염 ······························272

Ⅲ. 감염병 유행의 감시 및 역학조사 ······275

1. 감염병 감시체계 운영 ··························275

2. 우리나라 감염병 위기경보수준 4단계 ··276

3. 감염병 유행의 역학조사 ·······················277

4. 유행조사의 순서 ···································277

5. 감염병 유행의 유형 ······························278

Ⅳ. 감염병의 일반적인 관리 ····················278

1. 전파예방 ···············································279

2. 숙주의 면역증강 ···································287

Ⅴ. 급성감염병의 관리 ·····························289

1. 소화기계 감염병 ···································289

2. 호흡기계 감염병 ···································293

3. 절지동물매개감염병 ······························298

4. 동물매개감염병 ·····································303

Ⅵ. 만성감염병의 관리 ·····························306

1. 결핵 ······················································306

2. 한센병 ···················································309

3. 성병 ······················································309

4. 후천성면역결핍증(AIDS, 에이즈) ·········312

5. 트라코마 ···············································315

6. 간염 ······················································315

제3장 기생충질환의 관리 ······························317

Ⅰ. 기생충질환의 개념 ·····························317

1. 기생충(parasite) ··································317

2. 기생충질환의 발생원인 ·······················317

3. 우리나라 기생충질환의 발생특성 ·········317

4. 기생충질환의 인체감염경로 ··················318

5. 기생충질환의 진단 ································318

6. 기생충의 분류 ······································319

Ⅱ. 기생충질환의 종류 ·····························319

1. 선충류 ···················································319

2. 흡충류 ···················································323

3. 조충류 ···················································325

4. 원충류 ···················································327

Ⅲ. 기생충질환의 관리 및 추이 ···············329

1. 행정적인 관리 ······································329

2. 기생충감염의 추이변화 ·························329

제4장 만성질환의 관리 ·································330

Ⅰ. 만성질환의 개념 ································330

1. 만성질환의 특성 ···································330

2. 만성질환의 발생현황 ····························331

Ⅱ. 만성질환의 종류 ································332

1. 악성신생물(암) ······································332

2. 순환기계질환 ········································338

3. 당뇨병 ···················································345

Ⅲ. 만성질환의 예방대책 ·························346

제4편 보건관리

제1장 보건행정 ·············································354

Ⅰ. 보건행정의 개념 ································354

1. 보건행정의 정의 ···································354

2. 보건행정의 필요성 ································354

3. 보건행정의 범위 ···································354

4. 보건행정의 특성 ···································355

5. 보건행정의 원리 ···································355

Ⅱ. 우리나라의 보건행정사 ······················358

1. 삼국시대(935년 이전) ··························358

2. 고려시대(936~1392) ···························358

3. 조선시대(1392~1910) ·························358

4. 한일합병시대(1910~1945) ··················360

5. 8・15 해방 이후 미군정(1945~1948) 360

6. 대한민국 정부수립(1948) 이후 ············360

Ⅲ. 우리나라의 보건행정체계 ··················361

1. 중앙보건행정 ········································361

2. 지방보건행정 ········································362

Ⅳ. 국제보건관련기구 ·······························364

1. 국제공중보건사무국 ······························364

2. 국제연합부흥행정처 ······························364

3. 범미보건기구 ······································364

4. 세계보건기구 ········································365

5. 유엔환경계획 ········································366

6. 국제연합아동긴급기금 ···························366

제2장 사회보장 ·············································367

Ⅰ. 사회보장의 개념 ································367

1. 사회보장의 정의 ···································367

2. 사회보장의 기능 ···································367

3. 사회보장의 역사 ···································367

4. 사회보장제도의 종류 ····························368

Ⅱ. 의료보장제도 ······································369

1. 의료보장제도의 개념 ····························369

2. 국민건강보험제도 ·································371

3. 의료급여제도 ········································377

4. 국민의료비의 증가요인 ·······················378

제3장 보건사업 ·············································379

Ⅰ. 모자보건 ·············································379

1. 모자보건의 개념 ···································379

2. 모자보건지표 ········································381

3. 모성보건 ···············································383

4. 영유아보건 ············································387

Ⅱ. 인구 및 가족계획 ······························390

1. 인구의 개념 ··········································390

2. 인구론의 발전 ······································390

3. 인구의 구성 ··········································392

4. 인구성장 ···············································394

5. 인구조사 ···············································396

6. 인구현황과 문제 ···································399

7. 가족계획 ···············································404

Ⅲ. 보건교육 및 학교보건 ·······················411

1. 보건교육의 개념 ···································411

2. 보건교육의 방법 ···································412

3. 보건교육의 대상 및 습득과정 ··············414

4. 보건교육의 수행 ···································414

5. 학교보건 ···············································416

Ⅳ. 보건영양 ·············································424

1. 영양소의 3대 작용 ·······························424

2. 영양소의 종류와 기능 ··························424

3. 열량 대사 ·············································431

4. 영양상태 판정을 위한 신체계측치 및

비만 판정 ·············································432

5. 식생활과 영양권장량 ····························436

Ⅴ. 노인보건 ·············································438

1. 노인의 개념 ··········································438

2. 노인문제 ···············································439

3. 노화현상의 특징 ···································439

4. 노인성 질환 ··········································440

5. 노인의 건강관리 ···································442

Ⅵ. 정신보건 ·············································442

1. 개념 ······················································442

2. 정신장애의 원인 ···································443

3. 정신장애의 종류 ···································444

4. 발육단계별 정신보건 ····························445

5. 정신보건의 대책 ···································446

Ⅶ. 보건통계 ·············································446

1. 기본 개념 ·············································446

2. 자료 정리 ·············································450

3. 자료의 요약 ··········································451

4. 정규분포 ···············································454

5. 기타 확률분포 ······································455

6. 통계분석의 응용 ···································456

7. 보건지표 ···············································457

연습문제 ·······················································465

참고문헌 ·······················································533

찾아보기 ·······················································537

공중보건학 (제6판 최신 개정판)

정가 35,000원

ISBN 979-11-89210-04-5

2004년 8월 25일 초 판 발 행

2005년 8월 20일 제 2 판 발 행

2008년 4월 1일 제 3 판 발 행

2010년 3월 6일 제 4 판 발 행

2013년 3월 10일 제 5 판 발 행

2017년 8월 25일 제 5 판 수정 4쇄 발 행

2019년 3월 5일 제 6 판 발 행

2020년 3월 10일 제 6 판 수정 2쇄 발 행

2021년 8월 15일 제 6 판 수정 3쇄 발 행

저 자 : 강 공 언 ․ 박 상 정 ․ 송 현 제

정 정 근 ․ 조 혜 경 ․ 홍 성 노

발행자 : 최 병 진

발 행 처 : 도서출판 고 려 의 학

판형 : 국배판 | 564페이지