In recent years, the incidence of chronic noncommunicable diseases in China has gradually increased, and how to effectively manage chronic diseases has become an urgent problem to be solved. In chronic disease management, it is not only necessary for medical personnel to provide standardized and scientific medical programs, but also for patients to have good self-health management and obtain various social support and resources to implement proactive health management. In view of China's current problems such as low health literacy level at the patient level, insufficient self-management ability, lack of active health awareness, and limitations of chronic disease management mode at the community level, this paper, from the perspective of active health management, combined with the connotation of community empowerment and its application in chronic disease management, proposed the implementation strategy of community-based chronic disease management under the guidance of active health. The aim is to provide suggestions for chronic disease management in China.

近年来，我国慢性非传染性疾病发病率逐渐升高，如何进行慢性病的有效管理成为当前亟需解决的问题。慢性病管理中，不仅需要医务人员提供规范、科学的医疗方案，也需要患者具有良好的自我健康管理能力，并获得各种社会支持和资源实施主动性健康管理。针对我国目前患者层面健康素养水平不高、自我管理能力不足、主动健康意识缺乏以及社区层面社会组织参与度不足、慢性病管理模式的局限性等问题，本文从主动健康管理角度，结合社区赋能的内涵及在慢性病管理中的应用，提出了在主动健康导向下社区赋能对基层慢性病管理实施策略，旨在为我国慢性病管理的模式提供探讨建议。