Objective  To analyze the risk and management strategy of poverty and return to poverty in patients with the chronic diseases known as the "3 highs" in underdeveloped areas. 

Methods  This study used the field survey data of rural patients with the "3 highs" in an underdeveloped area as an example and has combined it with the social ecosystem theory. The paper then analyzes and explores the risks of poverty and return to poverty caused by illness among patients with the "3 highs" from three aspects: micro-system—patient's personal health literacy, meso-system—interaction between patients and healthy family members and the macro-system—medical policy for these patients. 

Results  A total of 198 patients with chronic diseases known as the "3 highs" in seven villages were included in the study, with an average age of 58 years.  The majority had hypertension (48.5%) and diabetes (41.4%). 126 people (63.6%) think that knowledge of prevention strategies can only help patients to take effective measures when they are ill, 11 people (5.6%) think that knowledge of prevention strate-gies is useless under normal health conditions, 91 people (46.0%) think that illness has an important impact on work and life, and 12 people (6.1%) spend more than 60% of family income on illness. 

Conclusion Patients with the "3 highs" are faced with poverty worries due to low health literacy, which is compounded by damaged family human capital, catastrophic expenditure caused by the deterioration of their condition and other reasons. We can consider starting from the three areas explored: raising these patients’ health literacy, improving the overall human capital of families with chronic diseases, and building a multi-field coordinated health security system to prevent these patients from becoming poor or returning to poverty due to illness.

1.杨伟民.对我国欠发达地区的界定及其特征分析[J].经济改革与发展, 1997, (4): 52-56. [Yang WM. Definition and char-acteristic analysis of underdeveloped areas in China [J]. Economic Reform and Development, 1997, (4): 52-56.] DOI: 10.16304/j.cnki.11-3952/f.1997.04.010.

2.高月,张艳,单岩, 等.老年慢性病患者用药依从性评估工具的研究进展[J].中国老年学杂志, 2021, 41(17): 3858-3861. [Gao Y, Zhang Y, Shan Y, et al. Research progress of medication compliance assessment tools for el-derly patients with chronic diseases[J]. Chinese Journal of Gerontology, 2021, 41(17): 3858-3861.] DOI: 10.3969/j.issn.1005-9202.2021.17.062.

3.莫雪凤.社区高血压患者健康自我管理模式的探讨[J]. 医学理论与实践, 2018, 31(24): 3766-3768. [Mo XF. Dis-cussion on health self-management model of hypertension patients in community[J]. The Journal of Medical Theory and Practice, 2018, 31(24): 3766-3768.] DOI: 10.19381/j.issn.1001-7585.2018.24.073.

4.高婷, 刘璟, 秦丹丹. 全面护理在糖尿病合并高血脂护理中的应用效果[J]. 中国继续医学教育, 2021, 13(23): 189-191. [Gao T, Liu J, Qin DD. Application effect of comprehensive nursing in nursing of patients with diabetes mellitus complicated with hyperlipidemia[J]. Continuing Medical Education in China, 2021, 13(23): 189-191.] DOI: 10.3969/j.issn.1674-9308.2021.23.053. 

5.练燕, Lily Dongxia Xiao, 任辉. 社会生态系统理论对建设我国以人为中心阿尔茨海默病照护者支持体系的启示[J]. 中国全科医学, 2016, 19(9): 997-1001, 1005. [Lian Y, Lily DXX, Ren H. Implications from the social ecosys-tem theory for the patient-centered supporting system for caregivers of alzheimer; disease in China[J]. Chinese General Practice, 2016, 19(9): 997-1001, 1005.] DOI: 10.3969/j.issn.1007-9572.2016.09.002.

6.文军. 社会工作模式: 理论与运用[M]. 北京: 高等教育出版社, 2010. [Wen J. Social work mode: theory and application[M]. Beijing: Higher Education Press, 2010.] 

7.Ostrom E. A diagnostic approach for going beyond panaceas[J]. Proc Natl Acad Sci U S A, 2007, 104(39): 15181-15187. DOI: 10.1073/pnas.0702288104.

8.黄明安, 陈钰. 慢性病管理研究进程的文献综述[J]. 当代经济, 2017, (16): 142-144. [Huang MA, Chen Y. Literature re-view of chronic disease management research process[J]. Contemporary Economics, 2017, (16): 142-144.] DOI: CNKI:SUN: DAJJ.0. 2017-16-055.

9.葛均波, 徐永健, 王辰. 内科学(第9版)[M]. 北京:人民卫生出版社, 2015. [Ge JB, Xu YJ, Wang C. Internal medi-cine 9th edition[M]. Beijing: People's Medical Publishing House, 2015.]

10.陈灏珠.实用心脏病学(第五版)[M].上海: 上海科学技术出版社, 2016. [Chen HZ. Practice of cardiology 5th edi-tion[M]. Shanghai: Shanghai Scientfic & Technocal Publishers, 2016.]

11.《中国居民营养与慢性病状况报告（2020年）》[J]. 营养学报, 2020, 42(6): 521. [Report on nutrition and chronic diseases of Chinese residents (2020)[J]. Acta Nutrimenta Sinica, 2020, 42(6): 521.] https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjExMjMwEhB5aW5neXhiMjAyMDA2MDAxGgh3YWxvdGU3Ng%3D%3D.

12.杨艳英, 罗艳艳. 糖尿病患者健康素养的研究进展[J]. 糖尿病新世界, 2021, 24(3): 192-194, 198. [Yang YY, Luo YY. Research progress of health literacy of diabetic patients[J]. Diabetes New World, 2021, 24(3): 192-194, 198.] DOI: 10.16658/j.cnki.1672-4062.2021.03.192.

13.Hottenga JJ, Boomsma DI, Kupper N, et al.  Heritability and stability of resting blood pressure[J]. Twin Res Hum Genet, 2005, 8(5): 499-508. DOI: 10.1375/18324270 5774310123.

14.中国成人血脂异常防治指南修订联合委员会. 中国成人血脂异常防治指南(2016年修订版)[J]. 中华全科医师杂志, 2017, 16(1): 15-35. [Joint Committee Issued Chinese Guideline for the Management of Dyslipidemia. 2016 Chinese guideline for the management of dyslipidemia in adults[J]. Chinese Journal of General Practitioners, 2017, 16(1): 15-35.] DOI: 10.3760/cma.j.issn.1671-7368.2017.01.006.

15.戴红彦. 遗传因素和基因表达异常与糖尿病[J].糖尿病新世界, 2016, 19(17): 197-199. [Dai HY. Genetic factors and abnormal gene expression and diabetes[J]. Diabetes New World, 2016, 19(17): 197-199.] DOI: 10.16658/j.cnki.1672-4062.2016.17.197.

16.黄开腾,张丽芬.从贫困类型划分看精准扶贫分类扶持的政策调整[J]. 山东社会科学, 2018, (3): 74-80.  [Huang KT, Zhang LF. From the perspective of poverty classification, the policy adjustment of precise poverty alle-viation classification support[J]. Shandong Social Science, 2018, (3): 74-80.] DOI: 10.14112/j.cnki.37-1053/c.2018.03.011.

17.左停, 徐小言. 农村“贫困-疾病”恶性循环与精准扶贫中链式健康保障体系建设[J]. 西南民族大学学报（人文社科版）, 2017, 38(1): 1-8. [Zuo T, Xu XY. The vicious circle of "poverty-disease" in rural areas and the construc-tion of chain health security system in precision poverty alleviation[J]. Journal of Southwest University for Nationalities, 2017, 38(1): 1-8.] DOI: CNKI:SUN:XNZS.0.2017-01-001.

18.李秋华. 鹤庆县城乡居民大病保险制度运行中的问题和建议研究[D].昆明: 云南财经大学, 2020. [Li QH. Study on the problems and suggestions in the operation of serious illness insurance system for urban and rural residents in Heqing county[D]. Kunming: Yunnan University of Finance and Economics, 2020.]

19.Becker GS , Murphy KM , Spenkuch JL. The manipulation of children's preferences, old-age support, and investment in children's human capital[J]. Journa of Labor Economics, 2016, 34(2): 3-30. DOI: 10.1086/683778.

20.程斌. 农村居民大病保险的运行分析[J].中国卫生经济, 2018, 37(4): 25-27. [Cheng B. Operational analysis on critical illness medical insurance for rural residents[J]. Chinese Health Economics, 2018, 37(4): 25-27.] DOI: 10.7664/CHE20180408. 

21.张明丽, 范艳玲. 因病支出型贫困家庭的社会救助问题研究——以武汉市为例[J]. 经济研究参考, 2020, (24): 33-47. [Zhang ML, Fan YL. Research on the social assistance of poverty-stricken families with expenditure due to illness-taking Wuhan as an example [J]. Review of Economic Research, 2020, (24): 33-47.] DOI: 10.16110/j.cnki.issn2095-3151.2020.24.004.