1.2 History of the development of public health
Social-hygienic elements and prescriptions are found in the medicine of ancient socio-economic formations, but the isolation of social hygiene as a science is closely related to the development of industrial production.
The period from the Renaissance to 1850 marked the first stage in the modern development of public health (then this science was called “social hygiene”). During this period, serious research was accumulated on the interdependence of the health of the working population, their living and working conditions.
The first systematic manual on social hygiene was Frank's multi-volume work “System einer vollstandingen medizinischen Polizei”, written between 1779 and 1819.
The utopian socialist doctors who held leadership positions during the revolutions of 1848 and 1871 in France tried to scientifically justify public health measures, considering social medicine the key to improving society.
The bourgeois revolution of 1848 was important for the development of social medicine in Germany. One of the social hygienists of that time was Rudolf Virchow. He emphasized the close connection between medicine and politics. His work “Mitteilungen uber Oberschlesien herrschende Typhus-Epidemie” is considered one of the classics in German social hygiene. Virchow was known as a democratically minded doctor and researcher.
It is believed that the term “social medicine” was first proposed by the French physician Jules Guerin. Guerin believed that social medicine included “medical police, environmental hygiene and forensic medicine.”
Virchow's contemporary Neumann introduced the concept of “social medicine” into German literature. In his work “Die offentliche Gesundshitspflege und das Eigentum”, published in 1847, he convincingly proved the role of social factors in the development of public health.
At the end of the 19th century, the development of the main direction of public health to the present day was determined. This direction connects the development of public health with the general progress of scientific hygiene or, with biological and physical hygiene. The founder of this trend in Germany was M. von Pettenkofer. He included a section on “Social Hygiene” in the hygiene manual he published, considering it the subject of that area of \u200b\u200blife where the doctor meets with large groups of people. This direction gradually acquired a reformist character, as it was unable to offer radical sociotherapeutic measures.
The founder of social hygiene as a science in Germany was A. Grotjan. In 1904, Grotjan wrote: “Hygiene must... study in detail the influence of social relations and the social environment in which people are born, live, work, enjoy, continue their race and die. So it becomes social hygiene, which acts next to physical and biological hygiene as its complement.”
According to Grotjan, the subject of social-hygienic science is the analysis of the conditions under which the relationship between man and the environment occurs.
As a result of such studies, Grotjan came closer to the second side of the subject of public health, that is, to the development of norms that regulate the relationship between a person and the social environment so that they strengthen his health and benefit him.
England also had major public health figures in the 19th century. E. Chadwick saw the main reason for the poor health of the people in their poverty. His work “The sanitary conditions of laboring populations,” published in 1842, revealed the difficult living conditions of workers in England. J. Simon, being the chief physician of the English health service, conducted a series of studies of the main causes of mortality in the population. However, the first department of social medicine was created in England only in 1943 by J. Raylem at Oxford.
The development of social hygiene in Russia was most contributed by F.F. Erisman, P.I. Kurkin, Z.G. Frenkel, N.A. Semashko and Z.P. Soloviev.
Of the major Russian social hygienists, it is necessary to note G.A. Batkis, who was a famous researcher and author of a number of theoretical works on social hygiene, who developed original statistical methods for studying the sanitary condition of the population and a number of methods for operating medical institutions (a new system of active patronage for newborns, the method of anamnestic demographic studies, etc.).
1.3 Subject of public health
The nature of the health care system in each country is determined by the position and development of public health as a scientific discipline. The specific content of any public health course varies depending on national conditions and needs, as well as the differentiation achieved by the various medical sciences.
The classic definition of the content of public health, mentioned in a discussion organized by WHO on the topic “Health Organization as a Scientific Discipline”: “... public health is based on a “tripod” of social diagnosis, which is studied mainly by the methods of epidemiology, social pathology and social therapy , based on cooperation between society and health workers, as well as on administrative and health-preventive measures, laws, regulations, etc. at central and local government bodies."
From the point of view of the general classification of sciences, public health is on the border between natural science and social sciences, that is, it uses the methods and achievements of both groups. From the point of view of the classification of medical sciences (about the nature, restoration and promotion of human health, human groups and society), public health seeks to fill the gap between the two main groups of clinical (therapeutic) and preventive (hygienic) sciences, which has developed as a result of the development of medicine. It plays a synthesizing role, developing unifying principles of thinking and research in both areas of medical science and practice.
Public health provides a general picture of the state and dynamics of health and reproduction of the population and the factors determining them, and from this the necessary measures follow. No clinical or hygienic discipline can provide such a general picture. Public health as a science must organically combine a specific analysis of practical health problems with research into the patterns of social development, with problems of the national economy and culture. Therefore, only within the framework of public health can a scientific organization and scientific planning of health care be created.
The state of a person’s health is determined by the function of his physiological systems and organs, taking into account gender, age and psychological factors, and also depends on the influence of the external environment, including the social one, with the latter being of leading importance. Thus, human health depends on the influence of a complex set of social and biological factors.
The problem of the relationship between the social and the biological in human life is a fundamental methodological problem of modern medicine. This or that interpretation of natural phenomena and the essence of human health and illness, etiology, pathogenesis and other concepts in medicine depends on its solution. The socio-biological problem involves the identification of three groups of patterns and the corresponding aspects of medical knowledge:
1) social patterns from the point of view of their impact on health, namely, on the morbidity of people, on changes in demographic processes, on changes in the type of pathology in various social conditions;
2) general patterns for all living beings, including humans, manifested at the molecular biological, subcellular and cellular levels;
3) specific biological and mental (psychophysiological) patterns inherent only to humans (higher nervous activity, etc.).
The last two patterns appear and change only through social conditions. Social patterns for a person as a member of society are leading in his development as a biological individual and contribute to his progress.
The methodological basis of public health as a science is the study and correct interpretation of the causes, connections and interdependence between the state of public health and social relations, i.e. in the correct solution of the problem of the relationship between the social and the biological in society.
Social and hygienic factors influencing public health include working and living conditions of the population, housing conditions; level of wages, culture and education of the population, nutrition, family relationships, quality and availability of medical care.
At the same time, public health is also influenced by climatic-geographical and hydrometeorological factors of the external environment.
A significant part of these conditions can be changed by society itself, depending on its socio-political and economic structure, and their impact on the health of the population can be both negative and positive.
Consequently, from a social and hygienic point of view, the health of the population can be characterized by the following basic data:
1) the state and dynamics of demographic processes: fertility, mortality, natural population growth and other indicators of natural movement;
2) the level and nature of morbidity among the population, as well as disability;
3) physical development of the population.
The study and comparison of these data in various socio-economic conditions allows us not only to judge the level of public health of the population, but also to analyze the social conditions and reasons that influence it.
In essence, all practical and theoretical activities in the field of medicine should have a social and hygienic orientation, since any medical science contains certain social and hygienic aspects. It is public health that provides the social and hygienic component of medical science and education, just as physiology substantiates their physiological direction, which is implemented in practice by many medical disciplines.
Department of Public Health and Healthcare
Course work
discipline: Public health and healthcare
Introduction
The sharp decline in living standards of the majority of Russian citizens over the years of reforms, instability in society, a decrease in the level of socially guaranteed medical care, growing unemployment, increased mental and emotional stress associated with a radical reform of all aspects of society have affected the health indicators of the Russian population. Almost 70% of the Russian population lives in a state of prolonged psycho-emotional and social stress, which depletes the adaptive and compensatory mechanisms that maintain people’s health.
The sharp increase in the incidence of the population is due, first of all, to changed living conditions. Research shows that the health of the nation depends only 15% on the state of the healthcare system, 20% on genetic factors, 25% on the environment, and 55% on socio-economic conditions and lifestyle.
The unfavorable environmental situation has a sharply negative impact on the health of the Russian population. About 40 million people live in cities where the concentration of harmful substances is 5-10 times higher than the maximum permissible limits. Only half of the country's residents use water for drinking purposes that meets the requirements of the state standard. The high level of chemical and bacterial contamination of drinking water has a direct impact on the morbidity of the population in many regions of the country, leading to outbreaks of intestinal infections and viral hepatitis A. When presenting the topic, you should pay attention to and characterize:
1) structure of morbidity;
2) methods for studying morbidity;
3) morbidity rates in recent years
Morbidity- a medical-statistical indicator that determines the totality of diseases first registered in a calendar year among the population living in a specific territory. It is one of the criteria for assessing the population.
Morbidity structure
Structure is the distribution of frequency indicators (intensity) among different population groups.
The heterogeneity of a population is characterized not only by the fact that each representative has some characteristics that distinguish it from others, but also by the fact that, according to a number of characteristics, it is possible to unite a certain number of people into groups.
One group includes individuals who have the same type or more or less similar indicators either according to biological, social, or sometimes natural factors. For example, the population is divided into children and adults, since there are fundamental differences between these groups on a number of indicators, while at the same time, within the groups there is a number of characteristics that unite them.
Thus, children, due to the lack of immunity or its insufficiency, suffer from so-called childhood infections (rubella, chicken pox, etc.), adults more often suffer from malignant neoplasms and cardiovascular diseases. Livestock workers, unlike other populations, constitute a group of people who are at high risk of suffering from zoonotic infections, etc.
The assessment of morbidity, taking into account a well-thought-out structural distribution, is of great importance for the selection of the most vulnerable groups of the population, the so-called risk groups, and the implementation of generally accepted priority measures to combat morbidity in the most affected group; In addition, at the analytical stage, assessment of the structural distribution of morbidity is of crucial diagnostic importance, since it becomes possible to conduct comparative studies.
It must be borne in mind that there is a standard scale of structural differentiation, based on the accumulated experience of anti-epidemic work, which is mandatory in all territories (administrative units), - without this it is impossible to compare and contrast different populations of the country (living in different regions, in cities and villages, in places with different social, environmental and natural characteristics).
But at the same time, taking into account the specific characteristics of the population, it is possible (necessary) to divide into some groups specific to a given population that reflect their particular characteristics. For example, the founder of population analytical studies, J. Snow, in order to clarify and prove the role of water in the spread of cholera, divided the population of London according to the principle of providing water to two different water supply companies, which differed in the location of water intake from the Thames River upstream of the city and downstream at the drainage site. . After the accident at the Chernobyl nuclear power plant, the population that found itself in the zone of the radioactive cloud was differentiated by the radiation dose and the degree of radioactive contamination of their places of residence.
Epidemiologists studying cardiovascular pathology, phthisiatricians, obstetricians dealing with the problem of neonatal infant mortality, etc. have their own system of structural division of the population.
Methods for studying morbidity 1. Continuous 2. Selective Solid- acceptable for operational purposes . Selective- used to identify the relationship between disease incidence and environmental factors. The sampling method was used during census years. An example of this is the study of morbidity in individual territories. The choice of method for studying the morbidity of the population in a particular territory or its individual groups is determined by the purpose and objectives of the study. Approximate information about the levels, structure and dynamics of morbidity can be obtained from the reports of treatment and prevention institutions and reports from the central administration using the continuous method. Identification of patterns, morbidity, and connections is possible only with the selective method by copying passport and medical data from primary accounting documents onto a statistical card. When assessing the level, structure and dynamics of morbidity among the population and its individual groups, it is recommended to compare with indicators for the Russian Federation, city, district, region. The unit of observation when studying general morbidity is the patient’s initial visit in the current calendar year regarding the disease.
Incidence rates in recent years
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Morbidity rate of the population by main classes of diseases in 2002 - 2009. |
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(registered patients diagnosed for the first time in life) |
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(Data from the Ministry of Health and Social Development of Russia, calculations by Rosstat) |
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Total, thousand people |
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All diseases |
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neoplasms |
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diseases of the nervous system |
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diseases of the circulatory system |
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respiratory diseases |
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digestive diseases |
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diseases of the genitourinary system |
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complications of pregnancy, childbirth and the postpartum period |
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Per 1000 population |
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All diseases |
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neoplasms |
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diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism |
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diseases of the endocrine system, nutritional disorders and metabolic disorders |
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diseases of the nervous system |
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diseases of the eye and its adnexa |
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diseases of the ear and mastoid process |
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diseases of the circulatory system |
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respiratory diseases |
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digestive diseases |
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diseases of the skin and subcutaneous tissue |
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diseases of the musculoskeletal system and connective tissue |
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diseases of the genitourinary system |
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complications of pregnancy, childbirth and the postpartum period 1) |
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congenital anomalies (malformations), deformations and chromosomal disorders |
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injuries, poisoning and some other consequences of external causes |
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1) Per 1000 women aged 15-49 years. |
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1. Current trends in morbidity in the Russian population
The overall incidence rate per 1000 population of the corresponding age has been trending upward in recent years. An increase in morbidity rates is observed in almost all classes of diseases. Morbidity structure in adults: 1st place - diseases of the circulatory system; respiratory diseases (in adolescents - 42.6%, in children - 58.6%); 2nd place in adults - respiratory diseases (15.9%), in adolescents - injuries and poisonings (6.5%), in children - diseases of the genitourinary system - (5%); 3rd place - in adults - diseases of the genitourinary system, in adolescents - eye diseases (6.7%), in children - injuries (4.1%).
Prevention and treatment of diseases of the circulatory system are currently one of the priority health problems. This is due to the significant losses that these diseases cause due to mortality and disability. Cardiovascular diseases cause a high level of mortality and disability among the population. Diseases of the cardiovascular system in the structure of causes of overall mortality account for more than half (55%) of all cases of death, disability (48.4%), and temporary disability (11.6%). In the Russian Federation, about 7.2 million people are currently registered as suffering from arterial hypertension, of which 2.5 million patients have complications in the form of coronary heart disease and 2.1 million patients have complications in the form of cerebrovascular diseases. However, according to experts, 25-30% of the population suffers from arterial hypertension, i.e. more than 40 million people.
Every year, about 500 thousand patients are registered for the first time in whom the leading or concomitant disease is arterial hypertension; 26.5% of patients under dispensary observation for diseases of the circulatory system suffer from this disease. The high prevalence of arterial hypertension in people of young and working age is of particular concern. The unfavorable situation is aggravated by the insufficient work of health authorities and institutions to reduce the prevalence of arterial hypertension. Delayed diagnosis and ineffective treatment lead to the development of severe forms of arterial hypertension and related cardiovascular diseases, requiring specialized cardiac care.
A significant increase in prices for imported medical equipment and many vital drugs has made them difficult to access for medical institutions and the wider population. The level of sanitary educational work among the population is very low. There is practically no promotion of a healthy lifestyle in the media; there is no information about the harmful effects of risk factors for cardiovascular diseases and methods for their correction. Insufficient awareness of the population about the causes, early manifestations and consequences of arterial hypertension causes the majority of people to lack motivation to maintain and improve their health, including monitoring blood pressure levels.
There is no system for monitoring and assessing risk factors for arterial hypertension and population mortality from its complications. The overall morbidity of the circulatory system, according to the appealability of the adult population, has increased. A similar picture persists in acute myocardial infarction. In the structure of general morbidity, diseases of the circulatory system took first place. The incidence of arterial hypertension has increased almost 1.5 times. There has also been a slight increase in the incidence of angina pectoris. Several categories of diseases determine the neurological morbidity of the population. These primarily include vascular diseases of the brain, diseases of the peripheral nervous system, and traumatic brain injury. Vascular diseases of the brain, due to their significant prevalence and severe consequences, occupy one of the first places in the structure of overall mortality of the population. According to statistics, the frequency of these diseases is 80.6 per 1000 population. Mortality in the acute stage of diseases is 20.8%. The mortality rate from cerebrovascular diseases is one of the highest in the world, and no downward trend is observed. At the same time, in many economically developed countries of the world, over the past 15-20 years there has been a steady decrease in mortality from cerebrovascular diseases. Experts attribute the most important reasons for this phenomenon to successes in the active detection and treatment of arterial hypertension on a national scale, and favorable changes in the lifestyle and nutrition of the population of these countries carried out at the state level.
2. Increase in diseases of the circulatory system per 1000 population
In Russia, the last 25 years have been characterized by the rapid spread of infectious, allergic respiratory diseases, and environmentally-related lung diseases, which is reflected in the original WHO documents. According to experts, the 21st century will become the century of pulmonary pathology due to drastic environmental changes, and this group of diseases will share first place with pathology of the cardiovascular system and neoplasms. Studies conducted in Russia indicate that more than 25% of patients visit general practitioners every day with diseases of the respiratory system, mainly of the upper section. The prevalence of respiratory tract pathology is global in nature and occupies one of the leading places in the structure of morbidity by classes and groups of diseases.
The incidence of respiratory diseases due to the vastness of the territory of the Russian Federation depends on the geographical location of the subject of the Federation. According to environmental monitoring data in 282 Russian cities, the average annual concentrations of dust, ammonia, hydrogen fluoride, nitrogen dioxide, soot and other technical substances exceed the maximum permissible concentrations by 2-3 times. When the concentrations of several pollutants studied increase, the level of increase in the risk of disease increases on average by 18-20% for respiratory diseases and by 6-22% for malignant tumors.
Among pulmonary diseases, chronic bronchitis and emphysema occupy an important place, and the growth trend of this pathology, although disrupted by fluctuations associated with influenza epidemics, attracts attention. This trend can probably be explained by an increase in the proportion of older people in the population and the number of smokers.
The level of diseases of the endocrine system and nutritional disorders has increased sharply.
Diabetes mellitus is an acute medical and social problem that requires radical measures from the state to organize modern diagnostic and therapeutic care. In recent years, the number of patients with diabetes mellitus in the Russian Federation has increased sharply. The register showed that the prevalence of insulin-dependent diabetes mellitus among the child population is 0.7, the incidence is 0.1 per 1000 children; among the teenage population 1.2 and 1.0 per 1000; among the adult population - 2.2 and 0.1 per 1000.
4. Diseases of the endocrine system, nutritional disorders and metabolic disorders per 1000 population
The indicators of the epidemic situation regarding tuberculosis remain tense. In the Russian Federation, there is an unfavorable situation regarding the incidence of tuberculosis in the population. Considering the significant number of sources of tuberculosis infection among the population, the increase in the number of infected people, the spread of drug-resistant forms of tuberculosis, the state of the material base of the TB service, the social problems of society, as well as the impact of economic instability on the standard of living of the population and on the financing of anti-tuberculosis programs, growth is projected in the coming years morbidity and mortality rates from tuberculosis. The magnitude and growth rate of these indicators will depend on the timeliness and effectiveness of anti-tuberculosis measures at all levels.
In 2008, 120,021 cases of newly diagnosed active tuberculosis were registered (in 2007 – 117,738 cases). The tuberculosis incidence rate was 84.45 per 100 thousand population (in 2007 - 82.8 per 100 thousand) and was 2.5 times higher than the incidence rate before its growth began in 1989 (33.0 per 100 thousand . population). The incidence of tuberculosis in the rural population is higher - 90.84 per 100 thousand rural residents.
In 2008, 3,155 children under the age of 14 fell ill with active, newly diagnosed tuberculosis (3,372 children in 2007); The national average morbidity rate among children was 15.13 per 100 thousand of this age group (2007 – 16.01). Among children under the age of one year, the incidence was 6.92 per 100 thousand of this age group, in children 1-2 years old - 13.34 per 100 thousand, 3-6 years old - 21.5.
The incidence is high among adolescents 15-17 years old. The national average incidence rate of tuberculosis in this age group was 33.85 per 100 thousand in 2008 (2007 – 33.5). According to preliminary data from the Tuberculosis Monitoring Center, the mortality rate from tuberculosis in 2008 was 16.6 per 100 thousand population (2007 – 18.4, 2006 – 20.0).
The prevalence (morbidity) of all forms of tuberculosis is almost 2.1 times higher than the incidence rate. The mortality rate from tuberculosis has been declining over the past five years. Indicators characterizing the organization of detection and dispensary observation of tuberculosis patients have stabilized. The decline in the effectiveness of treatment for tuberculosis patients has stopped. The highest incidence of tuberculosis in 2009. occurred in the Primorsky Territory, the Republic of Tyva and the Jewish Autonomous Region (2.8-2.3 times higher than the Russian average), the Republic of Buryatia, Omsk, Kemerovo, Amur regions, Khabarovsk Territory, Irkutsk Region and Altai Territory ( 2.0-1.6 times higher). Malignant neoplasms remain one of the most difficult problems in medicine and public health.
5. Growth of neoplasms per 1000 population
According to official statistics, every fifth resident of Russia becomes ill with one of the forms of malignant tumors during their lifetime. In 2006, the incidence of malignant neoplasms continued to increase. In 2006, the incidence was 418.5 per 100 thousand. population compared to 382.6 per 100 thousand in 2002. At the same time, there is a deterioration in some indicators of the state of oncological care: low detection rate during preventive examinations - 11.8% in 2005, the proportion of visually localized tumors that are actively detected is decreasing; morphological verification of the diagnosis was 80.7% in 2006; The mortality rate in the 1st year from the moment of diagnosis remains higher than the Russian one - 33.2 for 2005; Mortality from malignant neoplasms in 2006 was 232.8 per 100 thousand. population (in 2002 - 220.8 per 100 thousand). The structure of morbidity is dominated by skin cancer (12.9%); cancer of the trachea, bronchi, lungs (11.9%); stomach cancer (10.7%); breast cancer (10.4%). Despite the relatively favorable situation in the country as a whole, in a number of constituent entities of the Russian Federation in 2009. The incidence of syphilis remained significant. Thus, in the Republic of Tyva it was 6.8 times higher than the Russian average.
High rates of syphilis incidence were observed in the Jewish Autonomous Region, the Republic of Khakassia, the Amur Region and the Trans-Baikal Territory (3.2-2.7 times higher), the Altai Republic, the Irkutsk Region, the Republic of Buryatia, the Kemerovo and Sakhalin Regions (2.4-2.7 times higher). 1.9 times higher). In 2008, 611,634 cases of sexually transmitted infections (STIs) were registered, which amounted to 403.5 per 100,000 population. In the structure of STI incidence, syphilis was 13.9%, gonococcal infection – 13.1%. The predominant part, as in previous years, was trichomoniasis (38.9%) and chlamydial infection (20.8%), the smallest were viral STIs (genital herpes - 5.3%, anogenital warts - 8.0%). Compared to 1997, the number of patients with STIs decreased by 3.2 times.
Over the past three years, in Russia as a whole, there has been a decrease in the number of patients with STIs, including syphilis - by 8.7%, gonococcal infection - by 12.0%, chlamydial infection - by 8.4%, trichomoniasis - by 16.5 %, genital herpes - by 3.0%, anogenital warts - an increase of 2.0%. The incidence of syphilis in Russia was not stable and varied over the years. The most intensive increase in morbidity rates was noted in the early 90s. twentieth century, the level of which during this period was more than twice as high as the pre-war one. The maximum incidence rates were noted in 1997 (277.3 per 100,000 population).
In 2009 13,995 people were registered with a disease caused by the human immunodeficiency virus (HIV), and 34,992 people with an asymptomatic infectious status caused by the human immunodeficiency virus (HIV), including children aged 0-17 years - 399 people and 703 people, respectively. More than half (60.0%) of all identified patients with HIV infection were registered in 10 constituent entities of the Russian Federation: in St. Petersburg, Chelyabinsk, Nizhny Novgorod, Ulyanovsk regions, Primorsky Territory, Rostov, Omsk, Sverdlovsk, Irkutsk regions and Perm Territory.
The average Russian prevalence rate of alcoholism (including alcoholic psychosis - AP) in 2005 was 1650.1 patients per 100 thousand population, or about 1.7% of its total population. The dynamics of this indicator over the past 5 years have been stable: the average annual increase in the indicator was 0.4%, the total increase over the last 5 years was 2.0% (Fig. 1). The prevalence of alcoholic psychosis (AP) had a more pronounced upward trend, increasing on average by 4.5% per year. Over the past 5 years, it has increased from 75.1 patients per 100 thousand population in 2000 to 93.6 in 2005, or by 24.7%.
The "leader" in the prevalence of alcoholism in 2005 was the Magadan region - 5409.2 patients per 100 thousand population, or 5.4% of its total population. High rates were noted in the Sakhalin region - 4433.0, Chukotka Autonomous Okrug - 3930.4, Novgorod region - 2971.6, Ivanovo region - 3157.4, Republic of Karelia - 2922.1, Kamchatka region - 2850.8, Nizhny Novgorod region - 2545.5 , Lipetsk - 2585.3, Bryansk - 2615.8, Kostroma regions - 2508.1. The prevalence of alcoholism is especially high (over 5% of the population) in the Koryak (5633.6) and Nenets (5258.1) autonomous districts. The lowest rates were observed in Ingushetia - 15.8 patients per 100 thousand population (104 times lower than the national average) and Dagestan - 363.3 per 100 thousand population. The highest incidence of alcoholism in 2005 was observed in the Chukotka Autonomous Okrug - 846 per 100 thousand population, or 0.8% of the total population of this district. High rates were recorded in Magadan - 575.9, Sakhalin - 615.9, Irkutsk - 322.7, Bryansk - 242.5, Perm - 240.7, Novgorod - 242.3, Ivanovo - 249.4 regions, as well as in republics - Karelia - 239.2, Yakutia - 303.6, Komi - 249.5. High rates were observed in most autonomous okrugs: Taimyr, Komi-Permyak, Evenki, Koryak, Nenets.
On the territory of the Russian Federation in 2009. compared to 2008 The epidemiological situation was characterized by a certain increase in the incidence of the population for a number of infectious diseases, including: acute intestinal infections, certain socially significant diseases, whooping cough, acute respiratory viral infections.
In December 2009 2 cases of measles were registered, no cases of diphtheria were registered (for the same month in 2008 - 3 cases of diphtheria, no cases of measles were registered). Compared to the corresponding month in 2008. 9.7% more patients were identified with disease caused by the human immunodeficiency virus, 1.6 times more with acute upper respiratory tract infections, and 76.3 times more with influenza.
Among those sick with infectious diseases in 2009. children aged 0-17 years were: for hepatitis A - 48.6%, mumps - 56.4%, acute intestinal infections - 66.1%, infectious meningitis - 73.1%, rubella - 76.8%, whooping cough - 97.1%.
There is a deterioration in maternal and especially child health. There is a known strict correlation between the decline in the health of women, especially pregnant women, and the increase in the likelihood of having sick children. More than a third of pregnant women (35.8%) suffered from anemia and almost a third (31.3%) of children were born sick.
The most common complications of pregnancy are: anemia of the mother and fetus, fetal underdevelopment, ectopic pregnancy, toxicosis of pregnant women, abortion, various pathological conditions of the placenta, hemolytic disease of the fetus and newborn.
It should be noted that in most cases, competent monitoring of pregnancy and provision of timely assistance to a pregnant woman can either prevent the development of complications or significantly alleviate their course.
7. Complications of pregnancy, childbirth and the postpartum period per 1000 women aged 15-49 years.
The number of people turning to psychologists during a crisis increased by 20 percent. Over 70% of the population of the Russian Federation lives in a state of prolonged psycho-emotional and social stress, causing an increase in depression, reactive psychoses, severe neuroses and psychosomatic disorders, a number of internal diseases, mental breakdowns, alcoholism and drug addiction, antisocial outbursts in individuals, increasing the risk of inadequate mass destructive reactions and explosions among the population. The number of patients with schizophrenia in Russia exceeds 500 thousand people, in Moscow there are 60 thousand of them. Moreover, 60% of such people (300 thousand) are disabled, their illness is accompanied by severe hallucinations and delusions. With the development of world civilization, the stress that people experience increases, and it becomes more difficult to cope with them, psychiatrists believe. The human brain cannot keep up with rapidly changing technologies - it develops more slowly. In addition, throughout the world, the risks of emergency situations have recently increased, humanity as a whole is aging, and in old age the appearance of mental disorders is possible 5-7 times more often than at a young age. In the occurrence of schizophrenia, the leading role is given to the genetic factor, but under negative social conditions and stress, the risk of this disease increases. Psychiatrists say that there are more schizophrenics in cities than in villages. All these negative factors, according to psychiatrists, can lead in less than 20 years to an increase in all mental disorders, including schizophrenia.
8. Diseases of the nervous system
Analysis of federal reports for 2005-2008. on the composition of patients discharged from the hospital showed that on average the share of injuries, poisonings and some other consequences of external causes ranges from 7.7% to 8.1% in the overall structure of hospital morbidity. In addition, on average, the share of undifferentiated diagnoses in the structure of this class of diseases during this period ranged from 58.8% to 63.2%. This does not mean that the diseases are not clinically identified. The structure of the reporting form itself does not allow us to recognize which nosological forms cannot be subjected to statistical analysis. According to federal statistical reporting, fractures caused hospitalization for this class of diseases in dynamics from 24.2% to 27.1%, with a noticeable decrease in this indicator in 2008.
Poisonings occupy the second position, and their share ranges from 7.8% to 9.8% with a noticeable decrease in this indicator in 2008. The share of thermal and chemical burns in dynamics ranges from 4.2% to 4.8% of hospitalizations. It should be noted that hospital mortality from diseases in the class “Injuries, poisonings and some other consequences of external causes” has a dynamic tendency to decrease annually. This reduction in mortality in the Russian Federation is insignificant and currently amounts to 0.1% annually.
9. Injuries, poisoning and some other consequences of external causes
Conclusion
Summing up the consideration of the morbidity rate of the population of Russia, it is necessary to note the deterioration in the quality of health of the population. This deterioration is expressed in the increase in the number of severe chronic diseases such as hypertension, coronary heart disease, angina pectoris, myocardial infarction, oncological pathology, and diseases of the genitourinary system. One of the most serious reasons for the current situation is the aging of the population and the burden of difficult events of the recent and distant past, which cause periodic emotional stress in many, especially older people. The result of these complex events is an increase in diseases in the elderly and old age. The increase in disability also speaks to this.
To reduce the incidence of diseases, as well as mortality from them, caused by exposure to polluted atmospheric air, first of all, it is necessary to take measures to reduce emissions from vehicles and power plants.
The development of the national project “Health” had a significant impact on the demographic situation in the country. Over two years, the birth rate increased by 11%, and the mortality rate decreased by 9%. However, the negative trends in Russia’s population decline will continue for now, and it will take many more years to overcome this demographic trend. Thus, modern pathology indicates a variety of manifestations and forms of morbidity in the population, which can lead to a decrease in labor and intellectual potential, to significant limitations in the biological and social functions of certain groups of the population, including their participation in improving the socio-economic situation in the country. There is a need for a more active orientation of the entire medical care service towards these new manifestations in the nature of the morbidity of the population. In order to ensure sustainable socio-economic development of the Russian Federation, one of the priorities of state policy should be to preserve and strengthen the health of the population based on the formation of a healthy lifestyle and increasing the availability and quality of medical care.
References
1. Trauma. Russian encyclopedia of labor protection.
2. International Classification of Diseases ICD-10. Electronic version.
3. Website of the Federal State Statistics Service
4. Health of the population of Russia and the activities of healthcare institutions in 2001: Statistical materials. M.: Ministry of Health of the Russian Federation, 2002.
5. Medvedev S.Yu., Perelman M.I. Tuberculosis in Russia. "Tuberculosis and vaccine prevention", No. 1 January-February 2002
6. Application of methods of statistical analysis for the study of public health and healthcare, ed. Corresponding member RAMS Prof. V.Z. Kucherenko. GEOTAR-Medicine. 2006
7. Lisitsyn Yu.P. Public health and healthcare: Textbook for students of medical universities - M.: GEOTAR - Media, 2007.
8. . Fundamentals of the legislation of the Russian Federation on protecting the health of citizens. – M., 1993 (additional 2005).
Lecture 1Public health and healthcare as a science and subject of teaching (definition, objectives, principles, methods).
The name of the discipline “Public Health and Healthcare”, in contrast to the old established disciplines: therapy, surgery, hygiene, pediatrics, obstetrics and gynecology, etc., has undergone changes since the formation and development of the discipline. In the historical aspect, the following terms were used to denote the subject: “Social hygiene”, “Social hygiene and organization of health care”, “Theory and organization of health care”, “Medical sociology”, “Sociology of medicine”, “Public health”, “Public health”. Since 2000, the discipline has become known as “Public Health and Healthcare.”
This situation can be explained by the peculiarities of the subject itself, its structure, tasks, history, and most importantly, the place it occupies in medicine, being an example of complexity, a combination of theory and practice of healing, prevention, social diagnostics, rehabilitation, sociology, social psychology and anthropology , statistics, general hygiene, as well as a number of other sciences, disciplines and problems of natural science and human history.
This subject should be more consistent with the development of social policy of society and the state, social programs. And here, only through hygienic approaches, although they are very important, cannot solve the problem of protecting, protecting and increasing public health and healthcare. We need decisions concerning all aspects of social policy in the field of health care, decisions of a strategic nature. And discipline, more than others, is designed to help accomplish these tasks. It is essentially the science of healthcare strategy and tactics, since on the basis of public health research it develops proposals of an organizational, medical and social nature aimed at raising the level of public health and the quality of medical care. We are talking about science, about strategy also because the only goal of a healthcare strategy is to increase the level of health and medical care based on the rational use of forces, means and resources, material and other capabilities of society and the state and its healthcare system. But it is the development of proposals to achieve this goal that meets the purpose of the subject.
So, the subject, our science, discipline is studying the patterns of public health and healthcare in order to develop scientifically based proposals of a strategic and tactical nature to protect and improve the level of public health and the quality of medical and social care. The subject is not limited to just one discipline - it extends to all medicine, the entire healthcare business. In fact, it is difficult today to imagine therapists, pediatricians, surgeons, psychiatrists and other physicians who would not be involved in assessing the health of their patients, issues of organizing medical care, prevention, clinical examination, examination of quality, work ability, etc. in their work, within the framework of their specialties, i.e. private issues of our discipline. Our science, our subject, like others, can be divided into two sections - one focuses on solving predominantly general strategic problems of protecting and improving health, healthcare, the other - private, mainly tactical, specialized.
The rapid growth in the development of medical science has armed doctors with new, modern methods for diagnosing complex diseases and effective means of treatment. All this simultaneously requires the development of new organizational forms, conditions, and sometimes the creation of completely new, previously non-existent medical institutions. There is a need to change the management system of medical institutions and the placement of medical personnel; There is a need to revise the regulatory framework for healthcare, expand the independence of heads of medical institutions and the rights of doctors. As a consequence of all that has been said, conditions are being created for revising the economic problems of healthcare, introducing intradepartmental economic accounting, economic incentives for the quality work of medical personnel, etc.
These problems determine the place and importance of science in the further improvement of domestic healthcare.
The unity of theory and practice of domestic health care is expressed in the unity of theoretical and practical tasks, methodological techniques of public health and health care organization.
Thus, of leading importance in science is the question of studying the effectiveness of the impact on the health of the population of all activities carried out by the state, and the role of healthcare and individual medical institutions in this, i.e. This discipline reveals the significance of the entire socio-economic life of the country and determines ways to improve medical care for the population.
Objectives of the subject Public health and healthcare:
studying the health status of the population and the influence of social conditions on it, developing methodology and methods for studying population health;
theoretical justification of state policy in the field of health care, development and practical implementation of health care principles;
research and development for health care practice of organizational forms and methods of medical care to the population and health care management that correspond to this policy;
critical analysis of theories in medicine and healthcare;
training and education of medical workers on a broad social and hygienic basis.
Statistical method is widely used in most studies: it allows you to objectively determine the level of health of the population, determine the efficiency and quality of work of medical institutions.
Historical method allows the study to trace the state of the problem being studied at different historical stages of the country's development.
Economic method allows us to establish the influence of the economy on healthcare and healthcare on the state’s economy, to determine the most optimal ways to use public funds to effectively protect the health of the population. Issues of planning the financial activities of health authorities and medical institutions, the most rational use of funds, assessing the effectiveness of health care actions to improve the health of the population and the impact of these actions on the economy - all this constitutes the subject of economic research in the field of health care.
Experimental method includes setting up various experiments to find new, most rational forms and methods of operation of medical institutions and individual health services. It should be noted that most studies predominantly use a complex methodology using most of these methods. So, if the task is to study the level and state of outpatient care to the population and determine ways to improve it, then the morbidity rate of the population, attendance at outpatient clinics is studied using a statistical method, its level in different periods and its dynamics are analyzed historically. The proposed new forms in the work of the clinic are analyzed using the experimental method: their economic feasibility and effectiveness are checked.
The study can be used timing technique actions of medical workers, time spent by patients receiving medical care, observation methods are often widely used, survey method (interview, questionnaire method) population or personnel.
As a subject of teaching, Public Health and Healthcare primarily contributes to improving the quality of training of future specialists - doctors; developing their skills not only to be able to correctly diagnose and treat a patient, but also the ability to organize a high level of medical care, the ability to clearly organize their activities.
The structure of the subject is currently presented as follows:
History of healthcare
Theoretical problems of health care and medicine. Conditions and lifestyle of the population: sanitation (valeology); social and hygienic problems; general theories and concepts of medicine and healthcare.
The state of public health and methods of studying it. Medical (sanitary) statistics.
Problems of social assistance. Social Security and Health Insurance.
Organization of medical care for the population.
Economics, planning, health care financing.
Insurance medicine.
Healthcare management. Automated control systems in healthcare.
Healthcare abroad; activities of WHO and other international medical organizations.
At the beginning of the 20th century, the young doctor Alfred Grotjan began publishing a journal on social hygiene in 1903, in 1905 he founded a scientific society on social hygiene and medical statistics in Berlin, and in 1912 he achieved an associate professorship and in 1920 - the establishment of a department social hygiene at the University of Berlin.
Thus began the history of the subject and science of social hygiene, which gained independence and joined a number of other medical disciplines.
Following the department of A. Grotjahn, similar units began to be created in Germany and other countries. Their leaders are A. Fischer, S. Neumann, F. Prinzing, E. Resle and others, as well as their predecessors and followers involved in the problems of public health and medical statistics (W. Farr, J. Graupt, J. Pringle, A. Teleski, B. Hayes, etc.), went beyond the existing areas: hygiene, microbiology, bacteriology, professional medicine, and other disciplines and focused their attention on social conditions and factors determining the health of the population, on the development of proposals and requirements for the organization of government measures to protect the health of the population, especially workers, to implement social and government policies, including effective medical (sanitary) legislation, health insurance, and social security.
In English-speaking countries, the subject is called public health or healthcare, preventive medicine, in French-speaking countries - social medicine, medical sociology, in the USA, earlier than in other countries, it began to be designated as sociology of medicine or sociology of health care. In Eastern European countries, our subject was called differently, most often as in the USSR - “organization of health care”, “theory and organization of health care”, “social hygiene”, “social hygiene and organization of health care”, etc. Recently, the term " medical sociology", "social medicine" (Romania, Yugoslavia, etc.).
In Russia, major contributions to the development of social medicine were made by M. V. Lomonosov, N. I. Pirogov, S. P. Botkin, I. M. Sechenov, T. A. Zakharyin, D. S. Samoilovich, A. P. Dobroslavin , F. F. Erisman.
The formation and flourishing of social hygiene (as it was called until 1941) during the period of Soviet power are associated with the names of major figures in Soviet health care N. A. Semashko, Z. P. Solovyov. On their initiative, departments of social hygiene and healthcare organization began to be created in medical institutes. The first such department was created by N. A. Semashko in 1922 at the Faculty of Medicine of the First Moscow State University. In 1923, under the leadership of Z. P. Solovyov, a department was created at the II Moscow State University and under the leadership of A. F. Nikitin at the I Leningrad Medical Institute. Until 1929, such departments were organized in all medical institutes.
In 1923, the Institute of Social Hygiene of the People's Commissariat of Health of the RSFSR was organized, which became the scientific and organizational base for all departments of social hygiene and health care organization. Scientists social hygienists are conducting important research to study sanitary and demographic processes in the country (A. M. Merkov, S. A. Tomilin, P. M. Kozlov, S. A. Novoselsky, L. S. Kaminsky), new methods are being developed studying population health (P. A. Kuvshinnikov, G. A. Batkis, etc.). In the 30s, G. A. Batkis published a textbook for departments of social hygiene, which students of all medical institutes studied for many years.
During the Great Patriotic War, the departments of social hygiene were renamed the departments of “health care organization.” All the attention of the departments during these years was focused on issues of medical and sanitary support at the front and the organization of medical care in the rear, and the prevention of outbreaks of infectious diseases. In the post-war years, the work of departments in connection with practical healthcare intensified. Against the backdrop of increasing development of theoretical problems of health care, sociological and demographic research, research in the field of health care organization is expanding and deepening, aimed at developing scientifically based standards for health care planning, studying the needs of the population for various types of medical care; Comprehensive research is being widely developed to study the causes of the prevalence of various non-communicable diseases, in particular cardiovascular pathology, malignant neoplasms, injuries, etc.
A great contribution to the development of science and teaching in these years was made by: 3. G. Frenkel, B. Ya. Smulevich, S. V. Kurashov, N. A. Vinogradov, A. F. Serenko, S. Ya. Freidlin, Yu. A. Dobrovolsky, Yu. P. Lisitsin and others.
In 1966, the departments of health care organization began to be called the departments of social hygiene and health care organization, and in 1986, the departments of social medicine and health care organization.
At the present stage of development of our healthcare, when introducing a new economic mechanism into the management of medical institutions and during the transition to health insurance, the future doctor is required to acquire a significant amount of theoretical knowledge and practical organizational skills. Every doctor must be a good organizer of his business, be able to clearly organize the work of the medical personnel subordinate to him, and know medical and labor legislation; master the elements of economics and management. An important role in fulfilling this task belongs to Public health and healthcare organization as a science and subject of teaching in the higher medical school system.
STATE BUDGET EDUCATIONAL INSTITUTION
HIGHER PROFESSIONAL EDUCATION
“KRASNOYARSK STATE MEDICAL UNIVERSITY named after Professor V.F. Voino-Yasenetsky"
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
College of Pharmacy
Specialty 060501 Nursing
Qualification Nurse
TO THEORETICAL LESSONS
In the discipline "Public health and healthcare"
Agreed at a meeting of the Central Committee
Protocol number…………….
"___"____________ 2015
Chairman of the Central Medical Committee Nursing
………………Cheremisina A.A.
Compiled by:
………… Korman Y.V.
Krasnoyarsk 2015
Lecture 1
Subject. 1.1. Public health and public health as a scientific discipline
Lecture outline:
1. Public health and healthcare as a scientific discipline about the patterns of public health, the impact of social conditions and environmental factors, lifestyle on health, ways to protect and improve it.
2. Problems of social policy in the country. Fundamentals of domestic health care policy. Legislative framework of the industry. Health care problems in the most important socio-political and government documents (Constitution of the Russian Federation, Legislative acts, decisions, regulations, etc.).
3. Healthcare as a system of measures to preserve, strengthen and restore the health of the population. Main directions of health care reform.
Information block:
Public health and healthcare as a scientific discipline about the patterns of public health, the impact of social conditions and environmental factors, lifestyle on health, ways to protect and improve it. The relationship between the social and the biological in medicine. Basic theoretical concepts of medicine and healthcare.
The role of the discipline “Public Health and Healthcare” in the practical activities of a dentist, healthcare authorities and institutions, in planning, management, and organization of work in healthcare. The main methods of research in the discipline: statistical, historical, experimental, sociological, economic-mathematical, modeling, method of expert assessments, epidemiological, etc.
The emergence and development of social hygiene and health care organization (public medicine) in foreign countries and in Russia.
Problems of social policy in the country. Fundamentals of domestic health care policy. Legislative framework of the industry. Health care problems in the most important socio-political and government documents (Constitution of the Russian Federation, Legislative acts, decisions, regulations, etc.). Healthcare as a system of measures to preserve, strengthen and restore the health of the population. Main directions of health care reform.
Theoretical aspects of medical ethics and medical deontology. Ethical and deontological traditions of domestic medicine. Bioethics in the activities of a dentist: the procedure for using new methods of prevention, diagnosis and treatment, conducting biomedical research, etc.
Health as an object of the health service.
Health levels:
1. The health of an individual is individual.
2. The health of groups of people is collective.
Health of small groups (social, ethnic, professional background).
The health of the population by belonging to the administrative-territorial unit (population of the city, village, district).
Public health - the health of society, the population as a whole (national, global scale).
1. Definition of the concept - individual health.
The Constitution of the World Health Organization (WHO) includes a definition of health as a state of complete physical, spiritual and social well-being, and not just the absence of disease or infirmity.
For practical use, we will use the definition of health as a human condition that has physical, psychological and social parameters, each of which can be represented as a continuum with positive and negative poles.
The positive pole (good health) is characterized by the ability to withstand the effects of adverse factors, and the negative pole (poor health) is characterized by morbidity and mortality.
Individual health is assessed according to subjective (well-being, self-esteem) and objective (deviation from the norm, severe heredity, presence of genetic risk, reserve capabilities, physical and mental state) criteria.
In a comprehensive assessment of individual health, the population is divided into health groups:
Group 1 - healthy individuals (who have not been sick for a year or who rarely see a doctor without losing their ability to work);
Group 2 - practically healthy individuals with functional and some morphological changes or who were rarely ill during the year (isolated cases of acute diseases);
Group 3 - patients with frequent acute diseases (more than 4 cases and 40 days of disability per year);
Group 4 - patients with long-term chronic diseases (compensated state);
Group 5 - patients with exacerbation of long-term diseases (subcompensated state).
2. Definition of the concept – public health.
Definitions given by the Ministry of Health of the Russian Federation:
Public health is a medical and social resource and potential of society that contributes to ensuring national security.
Population health is a medical, demographic and social category that reflects the physical, mental, and social well-being of people carrying out their life activities within certain social communities.
The basis for assessing the state of public health is accounting and analysis of:
Number of cases of diseases, injuries and poisonings detected for the first time or aggravated cases of chronic pathology;
The number of disabled people newly identified and registered in total;
Numbers of deaths;
Physical development data.
3. Factors determining public health.
Risk factors are potentially hazardous to health factors of a behavioral, biological, genetic, environmental, social, environmental and work environment that increase the likelihood of developing diseases, their progression and unfavorable outcome.
In contrast to the direct causes of the occurrence and development of diseases, risk factors create an unfavorable background, i.e. contribute to the occurrence and development of the disease. However, it should be borne in mind that these categories are closely interrelated with each other.
Yu.P. Lisitsin (1989) determined that the influence of factors determining health correlates in the following proportion:
Lifestyle accounts for 50-55%;
For internal hereditary-biological factors (predisposition to hereditary diseases) - 18-22%;
Environmental factors (air, water, soil pollution with carcinogenic and other harmful substances, sudden changes in atmospheric phenomena, radiation, geographic location of the area) - 17-20%;
The level of development of healthcare facilities (providing the population with medicines, quality and timeliness of medical care, development of the material and technical base, carrying out preventive measures) is 8-12 percent.
3.1. Lifestyle is the main factor determining health.
Lifestyle is qualified as a system of the most essential, typical characteristics of the way of activity or activity of people, in the unity of its quantitative and qualitative aspects, which are a reflection of the level of development of productive forces and production relations.
Lifestyle generalizes and includes four categories: economic – “standard of living”, sociological – “quality of life”, socio-psychological – “lifestyle” and socio-economic – “way of life”.
1. Lifestyle is the conditions in which people’s life activities take place (social and cultural life, everyday life, work).
2. Lifestyle - individual characteristics of behavior, manifestations of life activity, activity, image and style of thinking.
3. Standard of living - characterizes the size and structure of a person’s material needs (quantitative category).
4. Quality of life (QOL) is a multidimensional concept at its core, multifactorial and in a broad sense defined as the degree of possibility of realizing a person’s material and spiritual needs.
According to the definition of the Ministry of Health of the Russian Federation, quality of life is a category that includes a combination of life support conditions and health conditions that allow one to achieve physical, mental and social well-being and self-realization.
WHO definition (1999): Quality of life is the optimal state and degree of perception by individuals and the population as a whole of how their needs (physical, emotional, social, etc.) are met and opportunities are provided to achieve well-being and self-realization.
Public health and healthcare as a science and subject of teaching.Basic methods of public health and public health science.
1 question. Public health and healthcare as a science and subject of teaching.
Public health and healthcare as an independent medical science studies the impact of social conditions and environmental factors on the health of the population in order to develop preventive measures to improve its health and improve medical care.
Unlike clinical disciplines, public health studies the health status not of individuals, but of groups, social groups and society as a whole in connection with conditions and lifestyle. In this case, living conditions and production relations, as a rule, are decisive.
Public health identifies patterns of population development, studies demographic processes, forecasts the future, and develops recommendations for state regulation of population size.
Of leading importance in the study of this discipline is the question of the effectiveness of the impact on the health of the population of measures carried out by the state, the role of healthcare and individual medical institutions in this.
Medicine is based on two basic concepts - “health” and “disease”. In modern literature there are a large number of definitions and approaches to the concept of “health”.
WHO definition: « Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.".
In medical and social research, when assessing health, it is advisable to distinguish four levels:
Level 1 - individual health - individual health;
Level 2 - health of social and ethnic groups - group health;
Level 3 - health of the population of administrative territories – regional health;
Level 4 - health of the population, society as a whole – public health.
According to WHO experts, in medical statistics, health at the individual level is understood as the absence of identified disorders and diseases, and at the population level - the process of reducing mortality, morbidity and disability, and increasing the perceived level of health.
Human health can be considered in various aspects: socio-biological, socio-political, economic, moral-aesthetic, psychophysical, etc. Therefore, terms that reflect only one facet of population health are now widely used - “mental health”, “reproductive health”, “general somatic health”, etc. Or - the health of a separate demographic or social group - “pregnant health”, “children’s health”, etc.
Currently, there are very few indicators that would objectively reflect the quantity, quality and composition of public health. The search and development of integral indicators and indices for assessing the health of the population is underway. WHO believes that these indicators should have the following qualities:
1. Availability of data. It must be possible to obtain the required data without carrying out complex special studies.
2. Comprehensiveness of coverage: The indicator must be derived from data covering the entire population for which it is intended.
3. Quality. National (or territorial) data should not vary over time and space in such a way that the indicator is significantly affected.
4. Versatility. If possible, the indicator should reflect a group of factors that are identified and influence the level of health.
5. Computability. The indicator should be calculated in the simplest and least expensive way possible.
6. Acceptability (interpretability): There must be acceptable methods for calculating the indicator and its interpretation.
7. Reproducibility. When using a health indicator by different specialists in different conditions and at different times, the results should be identical.
8. Specificity. An indicator should reflect changes only in those phenomena that it serves as an expression.
9. Sensitivity. The health indicator must be sensitive to changes in relevant phenomena.
10. Validity. An indicator must be a true expression of the factors of which it is a measure.
11. Representativeness. The indicator must be representative in reflecting changes in the health of population groups identified for management purposes.
12. Hierarchy. The indicator must be constructed according to a single principle for different hierarchical levels allocated in the population being studied for the diseases taken into account, their stages and consequences.
13. Goal consistency. The health indicator must adequately reflect the goals of maintaining and developing (improving) health and stimulate society to find the most effective ways to achieve these goals.
In medical and social research, it is traditional to use the following indicators to quantify group, regional and public health in Russia: 1. Demographic indicators. 2. Morbidity. 3. Disability. 4. Physical development.
1. Deduction of gross national product for health care.
2. Availability of primary health care.
3. Coverage of the population with medical care.
4. Level of immunization of the population.
5. The extent to which pregnant women are examined by qualified personnel.
6. Nutritional status of children.
7. Infant mortality rate.
8. Average life expectancy.
9. Hygienic literacy of the population.
From the point of view of the general classification of sciences, public health is on the border between natural science and social sciences, that is, it uses the methods and achievements of both groups. From the point of view of the classification of medical sciences, public health seeks to fill the gap between the groups of clinical (therapeutic) and preventive (hygienic) sciences. Public health provides a general picture of the state and dynamics of health and reproduction of the population and the factors determining them.
The methodological basis of public health as a science is the study and correct interpretation of the causes and connections between the state of public health and social relations.
Social and hygienic factors influencing public health include: working and living conditions, living conditions; salary level, culture and upbringing, nutrition, family relationships, quality and availability of medical care.
Public health is also influenced by climatic-geographical and hydrometeorological factors of the external environment.
A significant part of these conditions can be changed by society itself, and their impact on the health of the population can be both negative and positive.
Question 2. Public health methods.
1). Statistical method - the main method of social sciences. It allows you to establish and objectively evaluate changes in the health status of the population and determine the effectiveness of health care bodies and institutions; it is widely used in medical scientific research (hygienic, physiological, biochemical, clinical, etc.).
2). Expert assessment method serves as a complement to the statistical one. Its main task is to determine correction factors indirectly, because public health uses quantitative measurements using statistics and epidemiological methods. This allows forecasts to be made based on pre-formulated patterns, for example, forecasts of fertility, population, mortality, etc.
3). Historical method is based on the study and analysis of public health and healthcare processes at various stages of history. This is a descriptive method.
4). Economic research method makes it possible to establish the impact of the economy on healthcare and healthcare on the economy. For this purpose, methods used in economic sciences are used in the study and development of such issues as accounting, planning, financing, healthcare management, rational use of material resources, scientific organization of labor in healthcare bodies and institutions.
5). Experimental method is a method of searching for new, most rational forms and methods of work, creating models of medical care, introducing best practices, testing projects, hypotheses, creating experimental bases, medical centers, etc.
In public health, the experiment cannot be used often because of the administrative and legislative difficulties associated with it.
6). Simulation method develops in the field of healthcare organization, and consists of creating organizational models for experimental testing. Depending on the goals and problems, models vary significantly in scope and organization, and can be temporary or permanent.
7). Observation and survey method – used to supplement and deepen data using special research. For example, to obtain more complete data on the morbidity of persons in certain professions, they use the results obtained during medical examinations. To identify the nature and degree of influence of social and hygienic conditions on morbidity or mortality, survey methods (interviews, questionnaires) of individuals, families or groups can be used under a special program.
8). Epidemiological method. An important place among epidemiological research methods is occupied by epidemiological analysis, which is a set of methods for studying the characteristics of the epidemic process in order to determine the reasons contributing to the spread of this phenomenon in a given territory and to develop practical recommendations for its optimization. From the point of view of public health methodology, epidemiology is applied medical statistics, which in this case acts as the main, largely specific, method.
The use of epidemiological methods on large populations allows us to distinguish various components of epidemiology: clinical epidemiology, environmental epidemiology, epidemiology of non-communicable diseases, epidemiology of infectious diseases, etc. In public health, there are epidemiology of public health indicators.