Social medicine. I

From hygiene to beauty Now that your feet are well-groomed and healthy, you can think about how to decorate them. The first option is to go to the salon. Today, the choice of pedicure options in beauty salons is huge. You can get a classic pedicure or

Rules of sanitation and hygiene The causative agent of an infectious disease from a patient enters the body of a healthy person directly through the mouth or nose (airborne transmission), from care items or through touch (contact).

Attitude to one's own social role The sense of one's own role in society and the task that a person must perform are among the most essential elements in the formation of personality. They can also turn out to be pathogenic moments - causing greater

In the social work system, social medicine, which is closely related to the medical direction of social work, is currently becoming increasingly important.

The science of the patterns of development of social health and healthcare. Social medicine (public hygiene) is at the intersection of various sciences - medicine, hygiene, etc. Hygiene (from the Greek healthy) is a science that studies the influence of various environmental factors (including industrial ones) on human health, its performance, duration life.

Social hygiene (medicine) studies the impact of social conditions on the health of the population, as well as the influence of sociological and economic factors on people's health. Social medicine, in contrast to medicine as a science, studies the health not of individual people, but the health of certain social groups of the population, the health of society as a whole in connection with living conditions. N. A. Semashko said: “Social hygiene is the science of the health of society, the social problems of medicine... the main task of social hygiene is to deeply study the influence of the social environment on human health and develop effective measures to eliminate the harmful influences of the environment "

Until recently, the concept of “social hygiene” was synonymous with the concept of “social medicine”. There were several other names: “social hygiene and health care organization”, “medical sociology”, “preventive medicine”, “public health”, etc.

Social medicine is directly related to social processes in society, medicine and healthcare; it occupies an intermediate position between sociology and medicine. Therefore, social medicine studies social problems in medicine and medical problems in other sciences.

The main direction in social medicine is the study of social relations in society that are associated with human life and lifestyle; social factors influencing health. This determines the development of measures to protect public health and improve the level of public health.

Social medicine studies problems of public health, organization, forms and methods of medical and social assistance to the population, the social and economic role of health care in society, the theory and history of public health, organizational and managerial foundations and principles of economics for planning and financing of medical and social assistance to the population.

Object medical direction of social work are people who are socially maladjusted, usually suffering from some chronic disease, having physical disabilities or socially significant illnesses.

The clients of a social work specialist are most often the disabled and the elderly, who, in addition to social services, also need medical services, but these services are special and differ from the assistance provided by practical healthcare workers. As a rule, it is the clients of social work specialists who need social and medical assistance.

By studying the influence of social factors and conditions on the health of the population and its individual groups, social medicine substantiates recommendations for eliminating and preventing the harmful effects of social conditions and factors on people’s health, i.e. social health measures are based on the scientific achievements of social medicine.

Methods, which are used in social medicine, are very diverse: sociological (based on questionnaires and interviews), expert (to study the quality and effectiveness of medical care), the method of mathematical statistics (including the modeling method), the method of organizational experiment (creation of institutions with new forms of medical care in certain territories), etc.

Brief historical sketch of social medicine

The foundations of social medicine (public hygiene) arose as long ago as personal hygiene.

The rudiments of hygienic skills appeared in primitive man: home arrangement, cooking, providing primitive mutual assistance, burying the dead, etc. As primitive society developed, knowledge about natural phenomena, diseases, and measures to provide assistance accumulated. Gradually, a circle of people with medical and hygienic knowledge emerged: shamans, sorcerers, healers, etc., who were engaged in treatment through spells, witchcraft, and the use of traditional medicine. During the period of matriarchy, care for the health of the family passed to women, who used natural remedies of animal and plant origin, various medical procedures, obstetrics, etc. for medical purposes.

With the formation of tribal unions, their rulers also paid attention to the health of their fellow tribesmen: they took sanitary measures to protect against epidemics (purely empirically), promoted the training of doctors, etc.

Archaeological finds indicate that in the states of the Ancient World (Egypt, Mesopotamia, Babylon, India, China), schools for doctors were used not only to provide purely medical care, but also to provide assistance to the poor, for sanitary supervision of the condition of markets, wells, water supply, etc. Attempts were made by the state to regulate the activities of doctors: hygienic requirements were contained in legislative acts and religious books (especially there are many of them in the Talmud and the Koran). One of the oldest legislative acts of the past is considered to be a basalt pillar with the texts of the laws of King Hammurabi (XVIII century BC) inscribed on it. Among others, on this pillar there are laws on rewarding and punishing doctors for the results of treatment. It should be noted that when assessing medical care, the financial situation of patients was taken into account: for the same medical care, a rich patient paid several times more than a poor one. Conversely, in the case of unsuccessful treatment of a rich patient, the doctor’s punishment was more severe - in case of unsuccessful treatment, a monetary fine was levied on the slave and the doctor, and in case of unsuccessful treatment, the rich man’s hand was cut off.

In ancient Greek city-states, the activities of doctors were also regulated. The laws of Lycurgus (Sparta) talk about the regulation of the work of doctors: for example, special officials-ephors had to select healthy babies and kill the sick. These officials also strictly enforced the hygiene rules established in Sparta during the training of warriors. The ancient Greeks also contributed to the understanding of a healthy lifestyle and its importance for health. Thus, Hippocrates wrote a treatise “On Airs, Waters and Places”, in which he describes the influence of natural conditions, customs and traditions on health and illness.

The laws of Ancient Rome (Laws of 12 tables) provided for sanitary measures: prohibition of the use of water from a contaminated source, control of food products in markets, compliance with burial rules, compliance with requirements for the construction of public baths, etc. (all this was monitored by special officials - aediles). Cities were required to hire and maintain so-called “folk doctors,” whose responsibilities included protecting public health. There was also a clearly organized medical service in the Roman army, and doctors of cohorts, legions, and military hospitals not only treated the wounded and sick, but also monitored the sanitary condition of the army, i.e., they performed duties to protect the health of soldiers. Roman water pipes and baths still testify to the high hygienic culture of antiquity. Ancient temples also served as places of treatment. In Ancient Greece, hospitals at temples were called ascleipeons in honor of the god of healing, Asclepius. The names of the children of Asclepius - Hygeia, Panacea - became household names (hygiene means healthy, panacea is a non-existent cure for all diseases). The position of a doctor in the ancient world was honorable. “One skillful healer is worth many brave warriors,” says the great Homer in the Iliad. Julius Caesar granted Roman citizenship to anyone who studied medicine. Epidemics and wars posed a difficult problem for ancient states. The fight against infectious diseases has contributed to the development of ideas about the connection between living conditions and health. In Byzantium, “folk doctors” were also hired and maintained in cities until the 8th-9th centuries, and then hospitals for the poor began to be opened there.

In the Middle Ages, due to the widespread spread of infectious diseases, anti-epidemic measures were developed and legislated: isolation of patients, quarantine, burning of things and homes of sick people, prohibition of burying the dead within city limits, supervision of water sources, establishment of leper colonies, etc. But legislative acts of that time were of a local nature, that is, medical work until the 16th century. was governed and regulated not by the central government, but only by local secular and religious authorities. This was largely due to the historical conditions of that time, in particular to the feudal fragmentation of the warring principalities. This led to the fact that during epidemics the measures taken were ineffective due to their fragmentation. A significant role in the development of social medicine was played by the views of the early utopian socialists (Thomas More, Tommaso Campanella, etc.), who in their works, outlining ideas about an ideal society, paid great attention to the breast regime, hygiene, healthy lifestyle, nutrition, etc. d.

The further development of social and hygienic views is associated with the emergence of occupational diseases during the emergence of manufactories. It was then that doctors drew attention to the connection between the nature of work and the characteristics of occupational diseases (primarily among miners and metallurgists).

The founder of the doctrine of occupational diseases was the Italian professor of clinical medicine Bernardino Ramazzini, who in 1700 created the work “On the Diseases of Craftsmen,” in which he described the working conditions and corresponding diseases of workers in various professions.

For the first time, the issue of public health was addressed in law - the Declaration of the Rights of Man and the Citizen, adopted by the Constituent Assembly of France during the French Revolution. Population health was considered as . This approach to healthcare dictated the reforms that were prepared by the commission under the leadership of the famous figure of the French Revolution, a doctor by training. Cabanis (Marat and Robespierre were also doctors). This commission also prepared reforms in medical education, making it accessible to ordinary people. According to this reform, medical schools in Paris, Montpellier and other cities were transformed into health schools, in which departments of hygiene were opened (one of them was even called the department of social hygiene).

Gradually, conditions were created for the organization of national health systems and services. The first reform affecting medical institutions of the entire state was carried out in France in 1822, when the Higher Medical Council was established under the Ministry of the Interior, and corresponding committees and commissions were established in the provinces. This structure of medical management became the prototype of similar services in other European countries: in England, under the influence of a social movement to preserve the workforce, the General Department of Public Health was established in 1848 and the “Public Health Law” was adopted, sanitary councils were organized, etc. The impetus for the emergence of a social movement was the activity of sanitary inspectors: Ashley, Chadwick, Simon (their works were referred to in their works by K. Marx and F. Engels), who showed the difficult working conditions of workers.

In 1784 in Germany, for the first time, V. T. Pay introduced the term “medical police,” including in this concept monitoring the health of the population, supervision of hospitals and pharmacies, preventing epidemics, educating the population, etc. The idea of ​​“medical police” in was further developed by the progressive Hungarian doctor Z. P. Husti. Along with the “medical police,” an important role in the development of social hygiene was played by medical-topographical descriptions, which became widespread in the late 18th and early 19th centuries and were widespread in many countries.

Particular influence on the development of social medicine in the 19th century. were influenced by the views of J. Giersna, one of the utopian socialists, who formulated the concept of social medicine as the unification of medicine and social activities.

In the 60s XIX century International agreements on measures to combat infectious diseases were created. In 1861, the first International Quarantine Council was established in Alexandria, which was one of the first measures to protect public health of an international nature.

In Germany in the 80-90s. XIX century Social insurance laws were adopted, which provided for funding from three sources: enterprise profits, workers' contributions, and state budget funds.

In America, the development of social and hygienic ideas was delayed, which is associated with the influx of emigrants. The development of social and hygienic ideas in America was facilitated by the establishment in 1839 of the American Statistical Association. In 1851, New Orleans physician J. C. Simone, based on statistical data, made the first attempt to determine the cost of illness and death in his city and to reduce this cost by improving the living conditions of the poor.

By the end of the 19th century. public hygiene (social medicine) was formed as a science that studies the influence of socio-economic factors on the health of various population groups. In many countries, including Russia, scientific societies began to be created on public health issues, as specialists in the field of social medicine appeared, engaged in both practice and scientific research. Thus, in 1905, the Society of Social Hygiene and Medical Statistics was established in Germany, which dealt with issues of protecting children's health, combating tuberculosis and alcoholism, etc.

At the beginning of the 20th century. social hygiene finally took shape as a subject of teaching in higher medical educational institutions. The first courses on social hygiene were organized at the Universities of Vienna (1909) and Munich (1912). During the first quarter of the 20th century. Academies of social hygiene were opened in several cities in Germany. One of the founders of social hygiene was Alfred Grotjahn, a “socialist doctor,” as he called himself. It was he who, in 1902, began to give a course of lectures on the topic “Social Medicine” at the University of Berlin. In his book “Social Pathology” he wrote: “... the task of social hygiene is to study all aspects of social life and the social environment from the point of view of their influence on the human body and, based on this study, to search for activities that ... should not have always only of a purely medical nature, but can often cover the area of ​​social policy or even general politics.” The works of A. Grotjan and his associates became widespread in other countries. Since 1919, social hygiene courses were opened in higher schools in France, and the first Institute of Hygiene and Social Medicine in France was organized. In Belgium in the 1930s. social medicine was included in the training of health care managers, and social hygiene was included in the training of students of higher medical schools. In Italy, guidelines have been published on social medicine. The ideas of social medicine became widespread in Great Britain, when during the Second World War the first departments of social medicine were organized (in Oxford, Edinburgh, Manchester and other cities), as well as the Institute of Social Medicine. In the USA, the first scientific works on the connection between diseases and the socio-economic conditions of people's lives appeared in 1911. The outstanding American hygienist G. Sigerist, in his scientific works, argued that medicine should change towards the merging of curative and preventive care, that the doctor of the new generation should become social doctor

Recently, in Western countries there has been a tendency to divide social medicine as a science and a subject of teaching into two disciplines: social medicine(trains public health specialists who develop measures to protect and restore public health) and healthcare management(trains specialists in the field of management of health authorities and institutions).

The history of domestic medicine repeats the main stages in the development of social medicine in the world.

For many centuries, the main role in social assistance was given to the church. Thus, the Kiev prince Vladimir in 999 ordered the clergy to engage in public charity. The monasteries maintained hospitals, almshouses, and orphanages. The assistance provided by the monasteries was free. This continued for almost five centuries (scribal books indicate the existence of almshouses in almost all monasteries and many churches).

The idea of ​​​​developing state assistance to the disadvantaged was first expressed by Ivan the Terrible at the Council of the Stoglavy (1551), when he argued that every city should have not only hospitals, but also almshouses and shelters.

In 1620, the Pharmacy Order was established - the highest administrative body, which was in charge of medical and pharmacy matters. In fact, there was a separation of medicine from religion, although for a long time medicine bore the stamp of religiosity: the first Russian doctors, graduates of Moscow University, had medical and spiritual education.

Peter I made a great contribution to the formation of measures of public charity in a certain system. The decrees of Peter I covered almost all problems of public charity. The types of assistance provided varied depending on the needs. In 1712, Peter 1 demanded the widespread establishment of hospitals for “the crippled and the most elderly, who do not have the opportunity to earn food through labor,” and charged city magistrates with the responsibility of preventing poverty. Under Peter I, a whole network of social institutions was created: strait houses, spinning houses, etc.

The initiatives of Peter I were continued by Catherine II. Thus, in 1775, a state system of public charity was founded. By a legislative act called “Institutions for the Administration of the Provinces of the All-Russian Empire,” special administrative bodies were created in each self-governing territory - orders of public charity, which were entrusted with public education, healthcare, and public charity. The orders required “care and supervision of the establishment and solid foundation of public schools... orphanages... hospitals or clinics... almshouses for the male and female poor, crippled...”.

A great contribution to the development of social and hygienic views was made by M. V. Lomonosov in his famous letter “On the Preservation and Reproduction of the Russian People” (1761), in which an attempt was made to approach the problems of public health and population from a social and hygienic position. In the same letter, Lomonosov proposed measures to reduce morbidity and mortality of the population, increase the birth rate, improve medical care and health education.

The first professor of the medical faculty of Moscow University, S. G. Zybelin, also made a great contribution to the formation and development of social medicine. For the first time in Russia, he raised the question of the influence of social factors on morbidity, fertility and mortality of the population.

In the dissertation of a student of the Moscow Hospital School, I.L. Danilevsky, “On the Best Medical Management,” an idea was expressed that is still relevant today: the need to use schools as the most important stage of health education. In his work, the author proposed teaching the basics of health preservation at school. In the same work, I.L. Danilevsky argued that the eradication of the causes of diseases does not depend on doctors, but on government authorities.

I.L. Danilevsky’s ideas about the state’s responsibility for protecting the health of the population corresponded to the idea of ​​“medical police” proposed by I.P. Frank in his work “System of Complete Medical Care.”

Professor of the Medical Faculty of Moscow University E. O. Mukhin proposed that the “medical police” develop administrative measures against influences harmful to health.

I. Yu. Veltsin in his book “Outline of Medical Improvement, or On the Means Dependent on the Government to Preserve Public Health” (1795) said that through the “medical police” the state should take care of the health of the population in order to strengthen the power of the state. This was the subject of N. N. Rozhdestvensky’s dissertation “Discussions on government measures to preserve the life and health of the people” (1830), K. Geling’s work “The experience of civil medical care applied to the laws of the Russian Empire” (1842), etc.

Outstanding Russian doctors M. Ya. Mudrov and E. T. Belopolsky made a great contribution to the formation of military hygiene as a section of medical care.

From the end of the 18th century. In Russia, teaching the basics of medical care began together with forensic medicine. In 1775, professor of medicine F. F. Keresturn gave an assembly speech “On the medical police and its use in Russia.” At the beginning of the 19th century. The “medical police” course was introduced at the St. Petersburg Medical-Surgical Academy. In 1845, it was proposed to allocate general state medicine to a special department, which would consist of two courses: national hygiene and national medicine (1st year), medical law and forensic medicine (2nd year).

In Russia, along with the “medical police,” medical and toiographic descriptions played a role in the development of social and hygienic views, which in the 19th-20th centuries. were compiled based on the results of numerous expeditions of the Academy of Sciences. Senate, Free Economic Society. As a rule, these descriptions were carried out using specially designed questionnaires, which provided information about the sanitary condition of the population, morbidity, the causes of diseases and their treatment, etc.

Since 1797, the compilation of these descriptions became the responsibility of county doctors and inspectors of medical boards. Consequently, from the beginning of the 19th century. In Russia, a study was conducted on the sanitary condition of the population.

In 1820, G. L. Attenhofer’s monograph “Medical and topographical description of St. Petersburg, the main and capital city of the Russian Empire” was published. This monograph provides mortality tables with rates per 1000 people. In 1832, the work of economist-statistician V.P. Androsov, “Statistical Note on Moscow,” was published, which presented a social and hygienic analysis of population health indicators.

Therefore, we can conclude that in the second quarter of the 19th century. sanitary statistics, moving from descriptions to analysis, became the basis of social and hygienic research, i.e. by this time the foundations of social medicine had been laid in Russia: many works of scientists emphasized the dependence of public health on socio-economic factors.

The further formation of social medicine (hygiene) was facilitated by the zemstvo reform of 1864. According to the main provisions of this reform, the zemstvo was entrusted with care of “people's health.” The world's first system of medical care for the population, operating on a local basis, appeared. The centers for providing free medical care in rural areas were the rural medical district, the zemstvo hospital, an outpatient clinic, paramedic and obstetric stations, sanitary doctors, the district and provincial sanitary council, etc. The activities of the zemstvo doctors had a clearly social and hygienic direction. This is stated in the work of the outstanding figure of zemstvo medicine, I. I. Molleson, “Zemstvo Medicine”: “... the cause of all ailments is crop failure, housing, air, etc.”

The activities of zemstvo doctors were actively supported by scientific medical societies - Kazan, Moscow, etc. One of the figures of the Kazan Society of Doctors, A. V. Petrov, was the author of the term “social medicine”. In the 70s XX century A.V. Petrov defined the tasks of public medicine: “...doctors are called upon to serve the whole society, it is required to cure public diseases, raise the level of public health, and improve public welfare.” At the 4th Congress of Naturalists and Doctors in 1873, a new department of the section of scientific medicine was opened - statistical and hygienic. At this time, the morbidity of the population and the health of workers at industrial enterprises are being studied in depth (research by Erisman, Dobroslavin, etc.). The results of these studies laid the foundation for public hygiene (social medicine) as a science. Domestic hygienists practiced a social approach to public health, linking the tasks of hygiene with public health and public health, i.e., in contrast to the sanitary-technical orientation of the West, they gave hygiene a social orientation. Thus, F. F. Erisman argued: “Deprive hygiene of a social orientation and you ... turn it into a corpse.”

Professor of Moscow University F.F. Erisman in 1884 headed the department of hygiene he created at the Faculty of Medicine. It was Erisman who substantiated the social and hygienic orientation of the work of a sanitary doctor: a sanitary doctor should help eliminate unfavorable living conditions. F. F. Erisman proved the need to create industrial and sanitary legislation in the interests of protecting the health of workers.

By the end of the 19th century. Along with the health of industrial and agricultural workers, the attention of domestic doctors was attracted by mortality, especially child mortality. This problem was studied by many zemstvo and sanitary doctors. A “household map” was developed for family-based social and hygienic research. These studies made it possible to establish the dependence of health on economic conditions.

Active development of social hygiene in Russia in the second half of the 19th century. became possible thanks to the development of methods for collecting material and analyzing this material (“Schemes for constructing zemstvo sanitary statistics” by P. I. Kurkin or “Household maps” by A. I. Shingarev).

Social hygiene, which is emerging in Russia as a science, has become the subject of teaching. As early as 1865, a course on social hygiene was taught at Kiev University. In 1906, an independent course “Fundamentals of Social Hygiene and Public Medicine” was introduced in Kyiv. Since 1908, the course “Social hygiene and public medicine” was taught in St. Petersburg.

Thus, at the beginning of the 20th century. In Russia, the foundations of social hygiene as a science were formed and its foundations were laid as a subject of teaching.

Since 1920, the Institute of Social Hygiene has become the center of social hygiene in Russia. The first People's Commissar of Health N.A. Semashko was a social hygienist, his deputy Z. P. Solovyov was a well-known figure in social medicine.

In 1922, with the participation of N.A. Semashko, the Department of Social Hygiene with a Clinic of Occupational Diseases was organized at the First Moscow University. A year later, similar departments were organized in other universities. Since 1922, the first textbooks and teaching aids on social hygiene (medicine) began to be published, and the scientific works of foreign social hygienists were translated into Russian. From 1922 to 1930, the journal “Social Hygiene” was published.

Repressions and exiles of the 1930s. caused serious damage to the development of social hygiene, since social hygiene was deprived at that time of the most necessary thing - information, since statistical research was closed. Despite this, through the efforts of domestic hygienist scientists, social hygiene as a science moved forward, as evidenced by social-hygienic, medical-demographic and epidemiological studies. On the eve of the Great Patriotic War, the departments of social hygiene were renamed the departments of health care organization, which limited the range of problems of the subject. In 1946, the Institute of Social Hygiene and Health Organization named after N. A. Semashko was created, and in 1966 it was transformed into the All-Union Research Institute of Social Hygiene and Health Organization (now the Research Institute of Social Hygiene, Economics and Health Management named after N. A. Semashko RAMS). This institute conducts comprehensive studies to study general morbidity (according to admission data), morbidity with temporary disability, hospitalization and attendance at clinics by the population. These studies make it possible to develop standards for treatment and preventive care for the population as a whole or for specific groups.

During the years of perestroika, political and socio-economic reforms, the direction of social hygiene changed somewhat. Management issues in the new economic conditions, economic and financial problems, medical insurance, legal regulation of the activities of medical workers, protection of patients' rights, etc. come to the fore (Appendix 1).

The question arose about whether the names of the departments corresponded to the new socio-economic conditions. By the decision of the All-Union Meeting of Heads of Departments (Ryazan, March 1991), it was recommended to rename the departments of social hygiene into the departments of social medicine and health care organization, i.e., a broader understanding of the subject was reflected, including a wide range of problems in protecting public health and managing a decentralized system healthcare in the context of transition to a market economy.

Currently, one of the main tasks is the training of social hygienists and health care organizers (health care managers). Not only a training system for healthcare managers has been created, but also for nursing managers (nurses with higher medical education).

Consequently, social medicine and healthcare organization at the turn of the XX-XXI centuries. is again in a state of development when the content of the subject is improved, which may entail clarification or change of its name.

At 16, listening to the conversations of experienced women who, at 37, no one needs with children, I wanted to ask: do you need you for yourself? But in those years it was not customary to ask adults questions.

When I was a young lady, women at 40 seemed to me dull and boring old women. They seemed like that to themselves: youth was gone, old age did not come, the alarming timelessness was colored by loud divorces - yet another unfaithful husband ran to a young woman. The young women wore short skirts and bright lipstick, laughed wildly and did not know how to cook. The ex-husbands cooked - ineptly and poorly. Ex-wives pursed their lips and mournfully shared the sad “Who needs me, at 37, with children.”

The cult of youth, to whom everything is allowed, is still thriving. It’s just that youth today is not a calendar concept, but a purely visual one. Do you look 40/30? Well done! And they’ll get you a job, and they’ll settle down with your personal life, and they’ll make friends with such people more willingly and more actively (especially on social networks, where friendship is expressed in a stingy like, and being beautiful is much easier than in reality), and they’ll hate you more intensely, and you’ll look in the mirror nicer.

Being young and beautiful today is like brushing your teeth. A question of social hygiene.

People are greeted by their clothes and escorted by their minds, says popular wisdom. My experience says that they also escort you based on your clothes; no one’s mind has given up. As well as a broad soul, and a subtle mental organization, and a deep inner world (try to imagine a kind of cadaver in three-dimensional space).

Of course, reader, this is not about you. You don’t look at the external, but pierce the inner essence. Wisdom speaks in you! And a little self-deception.

Because they communicate with a cheerful, cheerful and nice person much more willingly than with a very smart, but boring, boring and ugly person.

I, as an ugly and boring bore, have known this since childhood. Even the “I’ll let you write it off” option does not guarantee people’s love. Especially after graduation.

C-grade slobs, jokers and bon vivants suddenly make rapid careers, overtaking arrogant excellent students. C students know how to make an impression, and this impression does half the work for them in the matter of self-promotion.

Excellent students go to “How to Succeed” trainings. They (us) are taught the skill of keeping silent in time when once again you want to talk about Plutarch.

The services of stylists are no less in demand than the services of life coaches. Forgive me, reader, for the anglicism, but there is no way to translate this concept into Russian. Russian is the language of harsh survivalists, we have the word “felt boots” and a fairy tale about porridge from an ax.

Stylists teach you to wear felt boots with force. Fashionable felt boots are decorated with embroidery, lace and rhinestones.

Nutritionists teach how to cook porridge correctly: for at least 20 minutes, instant oatmeal is equivalent to a bun, rinse the ax in filtered water.

Helping professions are becoming increasingly important. There is a huge demand for attractiveness in society.

Sometimes this demand goes beyond all boundaries and turns into fascism. Women torture themselves with diets because after size 50 there is no life. There are no clothes in stores either. It is impossible to find shoes that fit a full foot.

Slender women accuse fat women of laziness and lack of will.

The young trample on the egos of the aged.

The athletic ones inspect the loose ones with disgust.

Women in leopard print leggings basically despise everyone.

At a cosmetics store, my face is carefully examined by a consultant. Silent. He examines again. I understand that we probably need to think through the repertoire of the funeral orchestra.

“Well,” says the consultant, “a dense tone won’t work with your wrinkles. You need fluid, concealer, highlighter, misty powder, paint over green bruises under the eyes with pink, blue bruises with yellow, remove pigmentation with peelings.”

“These are freckles,” I say.

“Grhm,” the consultant smiles skeptically. She was trained not to argue with women under 40. “You also need a base for the shadows, otherwise the shadows will collect in the folds of the eyelid, this is normal at your age, don’t worry. And contouring. The shape of the face decides everything!”

The list of makeup products for creating a naturally youthful look was a couple of sheets, for a total of 50 thousand. This is if you save money.

If you save money, then a cosmetologist is cheaper. “Beauty injections,” as punitive cosmetology is often called, can prolong youth for a long time. It is not accepted in society to admit to cosmetic procedures.

Beauty injections are a special type of fraud: it’s time, woman, to think about grandchildren, but you are still eager to join the closed club of those laughing loudly. We’ve lived and had enough, it’s time to give up our place to a young, unfamiliar tribe. Peers are also despised. Carry your years with dignity! For them, a good-looking woman is worse than any young woman. He works in contrast, rides into heaven on someone else’s hump. And in general, the king is not real!

Someone else's appearance concerns both the young, slender and beautiful, and representatives of the other camp. There are no indifferent people. Everyone blames everyone, filled with a sense of righteous indignation.

Righteous indignation is generally a very nice feeling: you can express rage, and it seems like it’s not gossip or condemnation, but a fight for a just cause. There is a reason to unite with like-minded people, hold hands, sing hymns, shout slogans. Burn another witch at the stake of cyberbullying (and sometimes not cyber).

At 16, listening to the conversations of experienced women who, at 37, no one needs with children, I wanted to ask: do you need you for yourself? But in those years it was not customary to ask adults questions.

Now I’m 37 myself, I’m an adult matron with children. And I have a question. All the same.

Do we need ourselves? Or is our value measured by appraisers at the gender auction? As much as a stranger (or auntie) says, will they write?

Then go and guess whether such a lot is needed, not needed, and if needed, then who needs it. When will this someone come and take responsibility, because how long can you endure, really? Isn't it time to start losing weight? Or smear your face with highlighter? Spending your beautiful moment, and then another and another, until there are too many moments - for what?

Current problems studied by modern social hygiene:

Study of the theoretical and organizational foundations of healthcare

Studying the influence of social conditions and lifestyle on public health

Development of criteria for assessing public health

Development of scientific forecasts in the field of public health protection

Research on population issues and their links to public health

Study of urbanization processes study of human ecology

Study of the social, economic and medical significance of healthcare as a social system and the development of rational ways for its development

Study of the legal and ethical foundations of health care

Studying the needs of the population for medical care and its options in outpatient clinics and hospitals

Development of sanitary and epidemiological aspects of health care

Development of socio-economic and medical prevention measures

Development of a set of programs to reduce and eliminate the most common and severe diseases (tuberculosis, diabetes, AIDS)

Development of issues of planning and management of treatment and preventive care for the population.

Development of problems of health care economics and its financing

Development of activities to promote and implement a healthy lifestyle, hygiene training and education

Development of measures and actions in case of natural disasters and other extreme situations

Health“is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO).

3health– individual and social value of the highest rank; it cannot be replaced or supplanted by any other value or interest without significant damage to the fullness of the individual’s existence.

Health deficit imposes serious restrictions on the possibilities of individual and social functioning.

Population health is assessed by a set of demographic indicators: birth rate, morbidity, average life expectancy, level of physical development, mortality. The level of physical development and functional capabilities of the human body are displayed in digital indicators - health indices.

The main factors influencing the health of the nation:

Working conditions, nature and level of remuneration, work and rest schedule;

The level of employment-unemployment ratio, potential and actual threat of loss of job and social status;

Occupational hazards, i.e. exposure to harmful agents associated with the technology and/or organization of this type of activity;

Level and quality of food;

Living conditions;

Features of lifestyle;

Bad habits (or addictions: alcohol, drugs, food, etc.);

State of the environment;

Level and quality of healthcare development and sanitary condition of the territory.

Social hygiene and healthcare organization as a science and subject of teaching. ON THE. Semashko and Z.P. Soloviev - organizers of the first departments of social hygiene in Russia.

Social hygiene and health care organization is the science of public health and healthcare, and the social problems of medicine. Its main tasks are studying the patterns of influence of socio-economic conditions, factors and lifestyles of people on the health of the population, as well as its individual groups and theoretical justification for an effective system of state and public measures, ways and methods aimed at eliminating the influence of harmful environmental factors, ensuring a high level of health for all members of society, increasing the period of their active creative longevity.

In our country social hygiene scientifically substantiates public health policies. She plays a leading role in scientific substantiation preventive areas of medicine. Important sections are development of scientific foundations medical examination population as a method of activity of medical institutions, as well as analysis and evaluation techniques activities of these institutions. The development of scientific foundations of economics, planning and forecasting of healthcare, forms and methods of healthcare management is becoming increasingly important. Organizational issues have a large share in the overall complex of preventive measures. sanitary and epidemiological service, which performs the function of “protecting the health of the healthy”, as well as hygienic education of the population, the formation of a healthy lifestyle.

Nikolai Alexandrovich Semashko– doctor, Soviet party and statesman, one of the organizers of the healthcare system in the USSR,

In 1921-1949, Semashko was a professor, head of the department of social hygiene of the medical faculty of Moscow University (from 1930 - the 1st Moscow Medical Institute).

From 11.7.1918 to 25.1.1930 People's Commissar of Health of the Council of People's Commissars of the RSFSR.

From 1930 to 1936, Semashko worked at the All-Russian Central Executive Committee, holding the positions of member of the Presidium, chairman of the Children's Commission (she was entrusted with the fight against homelessness, management of treatment and preventive work in children's health institutions). In 1945-1949 - director of the Institute of School Hygiene of the Academy of Pedagogical Sciences of the RSFSR and at the same time (1947-1949) - the Institute of Health Organization and History of Medicine of the USSR Academy of Medical Sciences (since 1965, the All-Russian Research Institute of Social Hygiene and Health Organization named after Semashko). Initiator of the creation of the Central Medical Library (1918), the House of Scientists (1922) in Moscow. In 1927-1936, editor-in-chief of the Great Medical Encyclopedia. The first chairman of the Supreme Council for Physical Culture and Sports (since 1923), chairman of the All-Union Hygienic Society (1940-1949). Delegate to the 10th, 12th-16th Congresses of the All-Union Communist Party (Bolsheviks).

Zinoviy Petrovich Solovyov - doctor, one of the organizers of Soviet healthcare, Deputy People's Commissar of Healthcare of the RSFSR. In 1920-28 he headed the military sanitary service of the Red Army and the Executive Committee of the Russian Red Cross Society. On his initiative and with his active participation, the pioneer camp-sanatorium Artek and a number of children's health institutions were created in Crimea.

The leading representatives of the Russian intelligentsia in the mid-19th century - the revolutionary democrats - attached great importance to hygiene issues.

Formation of prerequisites for the emergence and development of social hygiene as a science and subject of teaching. The history of its development.

Need scientific substantiation of health and disease at the individual and, most importantly, at the group and population levels served as a prerequisite the emergence of social hygiene and health care organization. The practical embodiment of this need is the study and disclosure of the causes of the most common diseases of the population, identifying the social conditionality of health.

In the second half of the 19th century in Russia Hygiene developed simultaneously with Germany. The conditions that contributed to this were basically the same as in other capitalist countries : the economic development of the country, which entered the capitalist socio-economic formation in the middle of the 19th century, the growth of industry, the increase in population in cities, the successes of natural science, the use of which made it possible to give hygienic factors an accurate expression, to study them quantitatively and qualitatively using the methods of the natural sciences. The high incidence of infectious diseases and mortality from them in Russia raised the question of improving public life in terms of hygiene and preventing these diseases. The social movement in Russia and the growth of revolutionary upsurge after the defeat in the Crimean War, the difficult sanitary and living conditions of the Russian peasantry, which determined the beginning of the revolutionary-democratic period of the Russian liberation movement, gave a special color to the development of hygiene in Russia in the second half of the 19th century and determined special original features in the activities of the majority of domestic hygienists, which sharply distinguished them from the hygienists of Western European countries.

In the second half of the 19th century, in Russia, Medical faculties of a number of universities began to create educational programs and courses for the study of public health. At Kazan University, for example, in the 60s. prof. A.V. Petrov gave lectures on public health. There in the 70s. prof. A.P. Peskov gave a course of lectures on medical geography and medical statistics. Subsequently, public health courses were introduced at the medical faculties of universities in Moscow, St. Petersburg, Kyiv, etc.

In the post-revolutionary period, the history of social hygiene in Russia dates back to the organization of the Museum of Social Hygiene in Moscow in 1918. In 1920, the museum was reorganized into a research institute for social hygiene and health care organization. Currently it is the leading center of social and hygienic science in the CIS.

From a historical perspective The roots of the term and definition of “social hygiene” are important. First in Russian literature term was used by a Russian social hygienist IN. Portugalov in the work "Issues of Public Hygiene".

Official emergence of social hygiene date back to the first decade of the 20th century and are associated with the name of a German doctor A. Grotjana. In 1903 he organized a journal of social hygiene, in 1905 he founded a scientific society of the same name, in 1920 he headed the first department of social hygiene in the history of medical education at the University of Berlin. Similar departments soon began to be organized in other university centers.

Tasks of social hygiene and health care organization as a science and subject of teaching. History of the Department of Social Hygiene of the Tyumen Medical Academy.

Social hygiene deals development scientifically based methods of prevention and elimination harmful influences of social factors and environmental conditions on health.

The objectives of social hygiene are:

1) study of the health status of the population and its individual groups in connection with the influence of environmental conditions;

2) development of principles of clinical examination and prevention of social diseases;

3) establishing a connection between the morbidity of the population and working conditions;

4) organization and conduct of recreational activities.