Subject: public health and healthcare. Public health and healthcare as a science and subject of teaching

1.1. Name and purpose of science and academic discipline

Until recently, the most common name for our discipline was “social hygiene and health care organization.” However, the term “social hygiene” inaccurately and incompletely characterizes our subject, especially at the present time, when the country’s healthcare, as well as the entire national economy, and the entire society are faced with problems of renewal, restructuring, and reform. Our subject must correspond to the development of social policy of society and the state, social programs. Our discipline, more than others, is designed to help solve these problems. She is essentially is the science of health care strategy and tactics, since, based on public health research, it develops organizational, medical and social proposals aimed at raising the level of public health and the quality of medical care.

Our discipline studies patterns of public health and healthcare in order to develop scientifically based strategic and tactical proposals for protecting and improving the level of public health and organizing medical and social care. On the recommendation of a meeting of heads of our departments (1999), a decision was made to rename the name of the discipline to “public health and healthcare.”

Unlike most medical and, above all, clinical disciplines that deal with the individual and his health, our subject studies the health and its protection (health care) of communities (populations), groups of people, populations, i.e. it directly confronts social problems and processes and thus serves as a bridge between medicine and

social disciplines, primarily sociology. He focuses his attention on social problems in medicine. ON THE. Semashko said that the main task of our science, our discipline, is to deeply study the influence social environment on human health and develop effective measures to eliminate the harmful effects of the environment. However, its task is not only to study and eliminate the harmful influences of the social environment. Rather, it is more important to develop factors that favorably influence health while maximizing the use of society's capabilities and resources. It would be more correct to formulate the purpose of our subject something like this: the study of the health-improving as well as the adverse influence of social factors and conditions on the health of the population and its groups and the development of scientifically based recommendations for eliminating and preventing the influence of social conditions and factors harmful to people’s health in the interests of protecting and improving the level of social health. It was also accepted by the Great Medical Encyclopedia (BME. 3rd ed. - T. 25. - P. 60) and covers the main problems and objectives of the subject: health-improving, positive, as well as negative influence of social conditions and factors, public health and healthcare, their improvement.

So, our science studies patterns of public health and healthcare.

To date, the following structure (main problems) of the subject of scientific research and teaching (academic discipline) has developed in our country:

History of health care.

Theoretical problems of health care and medicine. Conditions and lifestyle of the population; sanology (valeology); social and hygienic problems; general theories and medical and healthcare concepts.

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.

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The methodological base of the subject is distinguished by the breadth and variety of techniques and methods, not only their own, but taken from other sciences and branches of knowledge, mainly from sociology, mathematical statistics, epidemiology, social psychology, economic disciplines, management science, computer science and, of course, other medical sciences. It is no coincidence that our subject was formed at the intersection of medicine and social sciences. Usually 3-4 main methods are named (historical, expert, budgetary, statistical, etc.), but this is too general and inaccurate information.

Of course, our science, like any other, must study its history, use historical approach (method), exploration of the past, its comparison with the present and prospects for the future.

Expert assessments are very widely used in studies of the quality and effectiveness of medical care, its planning, etc. This is the most important method and should not be neglected.

Budget methodalso found wide application in our science, but it is only one of many statistical and mathematical techniques that are widely used in other branches of knowledge. No less important are the methods of modern mathematical statistics, especially modeling, application of computer technology. Let's say more, statistics is the basis of our science, the section of which is medical or sanitary statistics, i.e. use of general mathematical statistics on specific medical objects.

Of utmost importance are sociological methods, used in medicine and healthcare. We will talk about them, as well as other approaches, in detail when covering the topics and problems of our discipline. Here we note that sociological methods are based on questionnaires, interviews and surveys.

It is impossible not to mention the so-called systematic approach and analysis as the basis of many, if not most, methods of scientific research, including mathematical, statistical, socio-

logical, etc. This method (even methodology) is especially successfully used in the study of social and biological systems(a set of interconnected parts, elements representing a new property, a new quality in comparison with the properties of individual components). Public health and healthcare are complex, developing, dynamic systems, closely related to other systems, industries, areas of knowledge of science and society.

The question of methods specific to our subject is controversial. Can talk about the method of organizational experiment: the creation of institutions, forms of medical care in them or in certain territories in accordance with a given goal and assessing the effectiveness of this type of organization using various, primarily statistical, methods. Strictly speaking, such an experiment is also used in other industries; it is difficult to find any originality here. They talk about specifics of planning methods, for example, the most important among them - normative, as well as about economic methods in our discipline. However, economic methods, like experimental ones, are also known in other sciences and industries.

This means that for our subject there are no specific methods, but there is originality, specifics of research objects(sick people, healthcare institutions, medical personnel, etc.). Consequently, our science largely depends on the methodological and methodological base of other sciences and disciplines.

Thus, despite the fact that it is difficult to unambiguously name methods of research and assessment of public health and healthcare as its main categories that are purely specific to our discipline, we can consider a complex methodological techniques, used on a basis specific to our discipline, a specific object. Research using a combination of these and other methods in accordance with scientific methodology (philosophical, sociological, technological and other provisions, concepts) is usually called social-hygienic research, and the named methods (and statistical up to mathematical modeling, and economic, budgetary, analytical, regulatory, methods of organizational experiment, sociological, psychological, historical and many others) used in the study and assessment

public health and healthcare, - social and hygienic 1.

Consequently, our discipline has its own subject, object of research and study (public health and healthcare) and a set of methods and approaches, which, undoubtedly, meets modern requirements and the criteria for defining it as an independent science and subject of teaching.

1.2. From the history of the formation and development of science and academic discipline

The prerequisites, or rather, the reasons for the emergence of our science and academic discipline, lie in the emergence of the need for a scientifically based explanation of the nature, health and diseases of not only an individual, but also the population: groups of people, their communities, i.e. public health, and the application of knowledge obtained from the study of health in its protection and improvement, and the effective organization of medical care. The most important condition for realizing this need was the successful study of the most common diseases of the population.

“For those wishing to become familiar with the methods of social and hygienic research in detail, we recommend that you refer to special manuals and monographs, primarily to the manual for doctors (which is also used by students): Manual on social hygiene and healthcare organization. In 2 volumes. / Edited by Yu.P. Lisitsyn - M.: Medicine, 1987. - T. 1. - P. 200-314.

certain diseases up to empirical vaccinations, quarantine and other fairly effective measures. However, without revealing the scientific basis, i.e. Without establishing the true causes of these diseases, one could not count on radical success in the fight against them. No seemingly indisputable, unshakable theories of the origin of these diseases, such as ideas about “miasmas”, “monads”, even “contagies”, not to mention cosmic and other forces, religious and similar ideas, were able to reveal their true causes until then , until the era of bacteriology came, when microorganisms that caused infectious diseases were discovered using a microscope, until this great discovery of the 19th century marked the beginning of the doctrine of immunity and, on its basis, vaccination and other effective steps in the treatment and prevention of mass infectious diseases.

However, this circumstance alone was not enough to successfully combat mass diseases. Conditions were required for the implementation of effective measures on a mass scale, in relation to the entire population or its groups - social, professional, property, etc. Only the state, its bodies, institutions were able to organize and carry out such a struggle in practice on a national scale, using the achievements science, bacteriology and especially hygiene, which studies the effects on human health environment, sanitary and other preventive measures - prevention of mass infectious diseases, their treatment, as well as combating injuries and other mass casualties and damage. The attempts of individual, even very rich people and organizations could, as a rule, boil down to only charity and philanthropy. Thus, a certain, sufficiently strong government structure was required, capable of managing public health (mass diseases and injuries), based on scientific data.

Only capitalist society received the opportunity to organize the fight against mass diseases, the opportunity to create public health services using the achievements of science that reveal the nature of diseases, i.e. management - organized, targeted impact on public health. Another thing is to what extent the capitalist state

The donation used these opportunities, to whom and how organized medical care was provided, including sanitary, anti-epidemic, and preventive measures. The nature, volume of medical care, organization, and management are determined by the specific socio-economic and political interests of social strata and classes of society.

An important factor in the emergence of the need for science and practice of health care was public and especially revolutionary movement workers for social and political rights, among which the right to health protection has always been one of the first places. The government, making concessions to these demands, in its social policy must know how to manage medical care, how to most economically and effectively influence public health, if not the entire population, then some of its groups and strata.

Of course, not only the above-mentioned conditions and reasons gave rise to the need for the science of public health and healthcare management, as well as for the teaching of such a discipline in medical schools. Other factors can be mentioned. Among them is the development of the science of society - sociology, which widely uses philosophical concepts, economic teachings, psychological doctrines and, what is especially significant for our subject, statistics and statistical methods in relation to the assessment of health, demographic processes, and the activities of medical services.

Beginning in the first quarter of the century, the so-called Chartist movement of the English proletariat for its social rights resulted in mass protests by workers, especially during and after the revolutions in Europe in 1830, 1848 and subsequent years. In the middle and towards the end of the century, several European governments were forced to implement reforms and laws on social assistance for workers, including insurance and health care. State national services and public health management bodies were established, among them zemstvo and factory medicine in Russia. The works of political scientists and economists created widespread demographic and sociological doctrines, including the population concepts of T. Malthus, A.Zh. Gobineau, F. Galton and others. Statistics emerged as a science, the study

Following the footsteps of J. Bartillon and other outstanding scientists, classifications and nomenclatures of diseases, injuries, etc. were created.

The second half of the 19th century is the period of the emergence and development of materialist science about the laws of existence, nature and society, the creation of revolutionary social democratic and communist parties, including the RSDLP, populist and other social movements in Russia.

We should not forget about the progress of natural science during this period and especially about the role of evolutionary biology and Darwinism, which could not but affect the theory of our science.

During this period, under the influence of socio-economic changes and scientific and technological progress, patterns and trends in the development and formation of science and, above all, its differentiation, clearly emerged. In the second half of the 19th century, a whole “bouquet” of scientific disciplines was formed, including a number of medical ones: neuropathology, ophthalmology, pediatrics, otorhinolaryngology, pathological physiology, histology, human embryology, etc. Particular success was achieved in the physiology of nervous activity and its peak - higher nervous activity , the doctrine of nervousism - about the control of the vital functions of the body.

Among the new sciences and academic disciplines is experimental hygiene, which develops the doctrine of the influence of physical, chemical, and biological environmental factors on the body. However, some of its first representatives are not limited only to the study of natural factors - the person comes into their field of attention not only as a biological individual, but also as a social being, living in the human world, public relations that affect health and pathology. There is an interest in the study of social conditions, factors, processes in relation to human health and its reproduction. A prerequisite is created for the formation and research, so to speak, of the social, public side of hygiene. This is exactly how it is designated at the beginning of the 20th century. new science(discipline) about public health and healthcare.

Before the formation of our science (discipline), occasionally, in individual institutions, most often in higher educational institutions, in medical faculties of universities, thanks to the initiative of a number of scientific teachers of hygiene, microbiology, even physiology, clinical disciplines, who realized the importance of general

significant factors for health and the struggle for its protection and strengthening, not without difficulty and resistance on the part of representatives of the administration and official medicine, courses, training programs, laboratories on public hygiene, preventive medicine, public health, with medical statistics, sometimes political economy and other sections are created social and medical sciences. Although calls for the study and teaching of these (or similar) courses were heard earlier (for example, M.V. Lomonosov in his famous letter to Count I.I. Shuvalov about the reproduction and preservation of the Russian people; the first professors of the medical faculty of Moscow University S.G. Zabelin, F.F. Keresturi; I.P. Frank in his works on the so-called medical police and others at the end of the 18th - early XIX centuries pointed to the need to study public health and teach students the science of it), only in the second half of the 19th century were the first attempts to organize such courses made. So, at Kazan University in the 60s, prof. A.V. Petrov gave lectures to students on public health and public hygiene; in the 70s there prof. A.P. Peskov taught a course in medical geography and medical statistics, essentially public hygiene. Subsequently, similar courses were introduced at medical faculties of universities and other higher educational institutions in Moscow, St. Petersburg, Kyiv, Kharkov by professors A.I. Shingarev, A.V. Korczak-Chepurkovsky, S.N. Igumnov, L.A. Tarasevich, Z.Z. Frenkel, P.N. Diatroptov. The latter was even elected professor of the Department of Public Hygiene at the Higher Women's Courses in Moscow. However, these were only the first prototypes of special educational and scientific institutions in this subject. They were episodic, unstable, and usually included in other disciplines.

The history of our science as an independent discipline began in the first decades of the 20th century. First in Germany, and then in other countries, a discipline called social hygiene was formed.

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At the very beginning of the 20th century, the young doctor Alfred Grotjahn began publishing a journal on social hygiene in 1903, and in 1905 he founded a scientific society on social hygiene and medical care in Berlin.

statistics, and in 1912 he achieved an associate professorship and in 1920 the establishment of the Department of Social Hygiene at the University of Berlin.

This is how the history of the subject and science began social hygiene, gained independence and joined the ranks 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, etc., as well as their predecessors and followers involved in 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, other disciplines and focused their attention on social conditions and factors determining public health, on the development of proposals and requirements for state protection health of the population, primarily workers, for the implementation of social and government policies, including effective medical (sanitary) legislation, health insurance, social security. They embarked on the path of reform not only of hygiene itself with its technical, experimental-physiological, sanitary direction, but also of the entire matter of protecting public health and organizing medical care. It is impossible to deny the progressive significance of the founders of our subject abroad, especially since this focus continues to this day. Its modern representatives, such as R. Sand, W. Winslow, A. Parisot, L. Popper, C. Canaperia, as well as the creators and followers of the newest schools of social hygiene R. Dubos, K. Evang, P. Delors, H. Don , T. Person, E. Friendson, D. Mechanic, L. Bernard, M. Candau, H. Maller and others continued the line of identifying the social conditionality of public health, shared the positions of public health reforms, the primacy of state, government medicine. Their works, training courses, speeches and materials from national and international medical organizations contain serious observations, generalizations, studies of public health and social pathology using effective sociological, statistical, psychological, economic and other methods.

At the same time, reformism was and remained their most significant feature. Moreover, it is even known that the theory and practice of social hygiene is used to “improve” and “correct” capitalist society itself and its institutions. For example, one of the leaders of social hygiene, Rene Sand, considered it as the key to resolving conflicts characteristic of bourgeois society. This trend is visible in the works and speeches of other representatives of our discipline, who, with the help of the concepts they formulated - social ecology, social maladaptation, psychoanalytic psychosomatics, etc., strive to reconcile, smooth out the social conflicts of modern society, and carry out “social therapy” and “social prevention”.

Despite the fact that our subject is currently recognized and considered one of the most important in the system of medical education and in medical and social research, its name, as noted, is not unified. Its name depends on its interpretation and identification of problems, the personal characteristics of its representatives, previous professional affiliation and other circumstances, mainly due to the youth of our science, which is still developing. One should also keep in mind the peculiarities of its history and well-known national traditions. In English-speaking countries it is more often 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 the sociology of medicine or the 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 has become more often used “medical sociology”, “social medicine” (Romania, Yugoslavia, etc.). Significant contributions to the development of the theory and methods of our science were made by such famous scientists as K. Winter (Germany), A. Buresh, Z. Stich (Czechoslovakia), P. Kolarov, E. Apostolov, N. Gogov (Bulgaria), E. Shtahelsky, M. Sokolska (Poland), etc.

In its “pure form,” except in a number of laboratories and departments, mainly in the USA, our subject is not often presented. Usually he

It is associated with such disciplines or problems, branches of science as medical statistics, epidemiology, especially the epidemiology of non-communicable diseases, general and private hygiene, history of medicine and healthcare, medical law, social insurance, economics, etc., even with “tropical diseases”. Thus, a large research center in our discipline was organized and traditionally exists at the London Institute of Tropical Medicine. Special research institutes on the problems of our science are called health institutes in Prague, Budapest; hygiene and health care - in Sofia and Bucharest; epidemiological studies - in France; national center of statistics - in the USA, etc. In the same way, scientific periodicals and scientific societies on our subject are called differently. The international journal “Health” was published in Bucharest, in the USA and England - “Public Health”, “Hospital”, “Lancet”, in France - “Review of Public Health”, etc. International medical organizations, and among them the largest - the World Health Organization (WHO), publish journals mainly devoted to our problems (World Health, International Health Forum, WHO Bulletin).

There are national and dozens of international scientific societies and associations that unite specialists in our subject, considering the problems of medical demography, health statistics and information, administration, economics and health planning, hospital care, etc. They also have corresponding names.

Our discipline is currently taught in the vast majority of medical schools in the world, although, as one would expect, not always in its “pure form,” i.e. in independent departments and courses; Sometimes teaching takes place in joint departments (blocks, centers, institutes, courses, etc.) with epidemiology, hygiene and other subjects. Independent departments are organized in some educational institutions in France, Great Britain, the USA and other countries. With all modifications of curricula and plans in our subject, they usually include a course in sociology, health statistics, epidemiology of non-epidemic diseases, computer science and computers, organization of work of medical institutions, management

(management), health insurance and some others. Since the 1920s, since the creation of the first departments and courses, textbooks, manuals and other aids on our subject have been published. In the modern period, the most respectable, fundamental ones, among them in the USA, France, Poland, Romania, Yugoslavia, etc., are published under the names “Social Medicine”, “Medical Sociology”, “Sociology of Medicine”.

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Social hygiene in the USSR, and this is exactly how it was literally from the first years Soviet power began to be called our subject, begins its history with the organization of the Museum of Social Hygiene in the difficult year of 1918 People's Commissariat healthcare of the RSFSR, the director of which was the famous hygienist prof. A.V. Molkov. The museum, and since 1920, the Institute of Social Hygiene, became the center of the formation of our discipline in new political conditions. Soviet social hygiene had to extract everything progressive from its predecessors - first of all, the public hygiene of Russia, those first institutions that were created before the revolution, the social hygiene of A. Grotjan, A. Fischer and its other representatives abroad.

An important condition for the development of social hygiene in the USSR was its organic connection with practice and the construction of a new society and state. This was facilitated by the fact that among the first social hygienists, theorists, scientists were the first organizers of the protection of public health and, above all, Nikolai Aleksandrovich Semashko - the first People's Commissar of Health, a Bolshevik doctor, comrade-in-arms and associate of V.I. Lenin, and his deputy - Zinovy Petrovich Solovyov - Bolshevik doctor, famous figure in social medicine. In 1922 N.A. Semashko with the support of Z.P. Solovyova, A.V. Molkova, L.N. Sysina, S.I. Kaplun and other authoritative scientists and figures of public hygiene organized the Department of Social Hygiene with a clinic of occupational diseases at the First Moscow University. At that time there was a single department for other higher medical educational institutions in Moscow (including II Moscow University). She was also involved in teaching issues of hygiene, epidemiology, etc. Subsequently, the Department of Social Hygiene gave a start to life to individual hygienic disciplines, the department

frames, courses, institutes - general and municipal hygiene (Prof. A.N. Sysin), professional hygiene (Prof. S.I. Kaplun), hygiene education, or school hygiene (A.V. Molkov), essentially, and the history of medicine (Prof. I.D. Strashun), etc. A year later, in February 1923, Z.P. Soloviev and his staff created the Department of Social Hygiene at the Medical Faculty of the Second Moscow University, formed on the basis of the former Higher Women's Courses. Since that time, departments of social hygiene began to be opened in other university centers and research laboratories and institutes were organized in our subject (social hygiene, social hygiene and sanitary statistics, etc.), headed by famous scientists and health care organizers Z. G. Frenkel (Leningrad), T.Ya. Tkachev (Voronezh), A.M. Dykhno (Smolensk), S.S. Kagan (Kyiv), M.G. Gurevich (Kharkov), M.I. Barsukov (Minsk), etc.

Already in 1922 the first training program on social hygiene, the first textbooks and teaching aids were soon published (Z.G. Frenkel, 1923; T.Ya. Tkachev, 1924; a group of authors edited by A.V. Molkov, 1927, etc.). In the 1920s they were translated into Russian scientific works And teaching aids A. Fischer, A. Grotjan and other foreign social hygienists. From 1922 to 1930, the scientific journal “Social Hygiene” was published, covering the problems of building Soviet healthcare, criticizing eugenics, Malthusianism, social Darwinism and other so-called bourgeois theories in population and healthcare, raising issues of scientific research and teaching of our subject, and also Marxist education of doctors and teaching of philosophy and other social disciplines. In the early years, the Soviet higher medical school did not have appropriate departments and courses, and their teaching was carried out by departments and institutes of social hygiene.

Now about the term “healthcare”, which until now we have used very rarely, preferring to talk about “public health”, “health protection”, etc. This is not accidental, since before the revolution this term was not in use. It became generally accepted only from the first years of Soviet power. On the one hand, it is the fruit of the then fashion for all kinds of abbreviations, combinations of words, abbreviations, word creation (“Mosselprom”, “Narkomzdrav”, “Mossovet”, etc.), since it comes from two words - “protection”

on”, “health”, and on the other hand, it reflected the desire for a brief, succinct designation of a new system of protection and improvement of public health. Social hygiene became the science of such a system and its management in order to raise the level and quality of public health, on the way of which there were serious difficulties, obstacles, and often dramatic events.

The formation of social hygiene met resistance from conservative professors, a number of former members of the Society of Russian Doctors in memory of N.I. Pirogov. The tendency to combine hygiene and sociology provoked opposition; Social hygiene and its representatives were often opposed by members of various societies, including those who took one-sided mechanistic or even vitalistic positions, some members of the societies “Marxist doctors”, “materialist doctors”, representatives of the so-called Russian Eugenics Society, etc. However, especially Medical science and, along with it, social hygiene suffered heavy damage as a result of the repressions of the late 20s and 30s during the period of Stalin’s personality cult. Our discipline, like all the science, due to the top-secrecy regime, was deprived of information. It got to the point that even statistical information generally accepted throughout the world on demographic processes - mortality, population composition, morbidity, fertility, etc. was closed. This situation continued in subsequent years. For example, information about child mortality and its structure, infectious, mental morbidity, injuries, even the number of doctors in specialties, etc. was closed. Without knowledge of these and other demographic and medical statistical data, it is difficult to imagine research into public health and healthcare problems, i.e. e. successful development of social hygiene. At this time (late 20s - early 30s), the institutes of social hygiene that existed in almost all the republics were disbanded and closed. An attack began from above on formal genetics and experimental biology, led by such remarkable scientists as professors N.K. Koltsov and N.I. Vavilov.

Yet our science survived and moved forward. Widely known manuals, textbooks, and monographs were created, including on sanitary statistics (P.I. Kurkin, S.A. Tomilin, S.A. Novoselsky, P.I. Kuvshinnikov, G.A. Bat-

Kis, B.Ya. Smulevich, V.V. Paevsky, A.M. Merkov, A.Ya. Boyarsky, etc.), developed and improved methods of social-hygienic, medical-demographic, epidemiological studies, on the basis of which, using a sampling method on predominantly regional and local materials, important results were obtained on trends, changes in public health, used in improving the organization medical assistance to the population.

However, this applied, normative side of social hygiene was recognized by the governing authorities as insufficient, especially during the period of accelerated collectivization and industrialization, requiring immediate organizational decisions. In 1941, on the eve of the Great Patriotic War, the Department of Social Hygiene, by order of the People's Commissar of Health G.A. Miterev were renamed departments of healthcare organization. This decision narrowed the theoretical basis of the subject, limited research into social problems of health care, which was already in a constrained state, squeezed by official restrictions and prohibitions, harmed the teaching process and the education of students, and diminished the prestige of our science, which was increasingly becoming a servant of the health care administration. Such conclusions arise when analyzing the discussion on the topic “Organization of health care or social hygiene,” which took place on the pages of the journal “Soviet Health Care” (the main printed organ of our discipline) immediately after the end of the war. Supporters of retaining the name “health care organization” were most afraid of the “bourgeoisification” of our subject, turning it into a semblance of “reformist”, “apologetic” social hygiene in the West. It should not be forgotten that at that time, on orders from above, a campaign was carried out to combat cosmopolitanism, eradicate bourgeois trends, to prove and preach everywhere the priorities of domestic and Soviet science. A number of famous scientists, including the medical historian Acad. USSR Academy of Medical Sciences I.D. Strashun were accused of cosmopolitanism and removed from their posts. Soon, as we know, the persecution of “Mendelian-Morganists”, geneticists who did not share the “only correct” principles of “Michurin biology”, “agrobiology” of Acad. T.D. Lysenko. During the 1948 VASKhNIL session, at which T.D.’s opponents were “defeated.” Ly-

Senko, followed by the infamous “Pavlovian Session” (1951) of two academies - the Academy of Medical Sciences created in 1944 and the USSR Academy of Sciences, dedicated to the teachings of I.P. Pavlova. Having paid tribute to the outstanding merits of the great Russian physiologist, the founder of the doctrine of higher nervous activity, the session, in essence, made dogmatic decisions, raising the teaching of I.P. to the absolute. Pavlova, discarding any alternative to this teaching and thereby striking a blow at other progressive trends in physiology and, in general, the sciences of the animal world, man, and even Pavlov’s teaching itself. The research of “non-Pavlovian” schools began to be ignored, their representatives lost their jobs, were sometimes persecuted, and even the most prominent followers and direct students of I.P. who creatively developed Pavlovian heritage. Pavlova, such as academicians L.A. Orbeli, I.S. Beritashvili, A.D. Speransky, were discredited in every possible way. After these events, the “discoveries” of O.B. were announced. Lepeshinskaya and M.G. Bashyan, who tried to prove the “dialectical-materialistic” direct transformation in laboratory conditions of extracellular matter into cells, of nonliving matter immediately into living matter. Such “experiments” were picked up by the Lysenkoites, received the support of the apostle of Michurin biology himself, and were approved from above. Militant dogmatism did not stop there: what was ahead was the exposure of the bourgeois “pseudoscience” of cybernetics; resolutions were passed on the magazines “Zvezda”, “Leningrad” and other official acts accusing them of cosmopolitanism, apoliticality, lack of spirituality, isolation from the people, kowtowing to the West, not only ideological, but also political mistakes, miscalculations and even crimes with all that entails hence the consequences up to the repression of a number of outstanding writers, composers, artists and other figures of art, culture, and science. In 1953, after trials the end of the 30s and the repression of the “killer doctors”, the “Doctors’ Plot” broke out, and a number of brilliant clinicians, among whom were Professors S.M. Vovsi, V.N. Vinogradov and others, subjected to unfounded political accusations, were arrested and convicted. Only the death of I.V. Stalin saved them from reprisals.

We talk about these dramatic events here because they had the most detrimental effect on the development of medical science and health care and their prestige, and therefore on such

combat, socially significant discipline, like ours, and its fate, forcing it to be an obedient executor of command and administrative decisions, pushing it to dogmatic, often far from genuine science, voluntaristic, insufficiently tested and balanced recommendations and conclusions. For example, with light hand Some dogmatic social scientists believed that since under socialism there can be no class contradictions, it means that public health does not depend on social conditions and factors. This statement, which was based on an unacceptable mixture of class and social, emasculated science at its roots, making it only in words a science about the social problems of medicine and health care. Dogmatic discussions in the early 50s about the basis and superstructure echoed in our discipline with useless, abstract disputes about the place in the system of social relations of medical science and healthcare itself (what is the “base” and what is the “superstructure”). One can also recall the hasty, insufficiently scientifically substantiated, voluntaristic decisions of this time on the widespread unification of hospitals and clinics and many others, such as the decision on immediate, within a year, general medical examination, etc. We are no longer talking about the disparagement of foreign science, including social hygiene, the denigration of its representatives and the completely unfounded, harmful for its fate in our country, discarding and non-recognition of many useful facts, generalizations, and methods. Consider, for example, the sweeping criticism of medical sociology, sociology of health, social biology and other areas, schools and concepts of foreign social hygienists.

The discussion “Social hygiene or health care organization” on the pages of medical journals, ending, showed that life requires, despite all the obstacles and objections, the restoration of a healthy and creative core of social hygiene.

However, it was impossible to discard the valuable things that our discipline had accumulated and achieved by studying normative, applied issues, problems of organization, management, and, in a broad sense, management in healthcare. Employees of the Institute of Health Organization named after. ON THE. Semashko, created on the initiative of this outstanding scientist and theorist in 1946, including me (Yu.P. Lisitsyn), it was proposed to restore the previous

the name “social hygiene” and leave a new one - “health care organization”. This decision reconciled supporters of the two points of view and removed the notorious “or” (social hygiene or health care organization). In 1966, USSR Minister of Health B.V. Petrovsky signed an order to transform the departments and the Institute. ON THE. Semashko to the departments and the Institute of Social Hygiene and Health Organization.

After the order of the Minister of Health, our discipline received an additional impetus for development. Gradually the classification of secrecy was removed from statistical information. A lot of scientific research began to be carried out on public health and new forms of organizing medical care. Textbooks and manuals on our discipline were published, which became famous abroad (textbook by G.A. Batkis and L.G. Lekarev, lectures by S.Ya. Freidlin, Yu.P. Lisitsyn, manuals by E. Belitskaya, group authors edited by Yu.P. Lisitsyn and others). This was initially facilitated by perestroika, which began in 1985, glasnost, the fall of the Iron Curtain, and the development of international cooperation. With the help of scientific research, ways to overcome the extensive development of healthcare have been outlined. The transition to new economic relations necessitated health care reform and the introduction of a health insurance mechanism. In the 90s, first in Moscow (II MOLGMI, now RGMU, I MMI, now I.M. Sechenov Moscow Medical Academy), departments of insurance medicine, economics and health care management were organized, and the first textbooks on these sections of our subject were published. Institute named after V.A. Semashko was refocused on research into economics and healthcare management and became known as the All-Russian Scientific Research Institute of Social Hygiene, Economics and Healthcare Management. In 1991, a new research center in our discipline was organized - NPO "Sotsgigeconominform" of the Ministry of Health.

However, the beginning of the restructuring of the economy and all structures of the state and society, the collapse of the USSR had a negative impact on the provision of budgetary funds for healthcare and especially medical science and medical education. The “residual principle of financing” has worsened, the number of publications, scientific research and research institutes has decreased, scientific prestige and scientific knowledge have been damaged.

The potential of many institutions, including medical ones, was weakened by ties with scientists from the former Soviet republics, and the activities of scientific societies were undermined.

Our discipline (like others) is going through a difficult period in its history. In difficult material conditions, attempts are being made to preserve scientific and personnel potential, to continue scientific research and teaching of the subject, and to preserve its information base. In 1999, as noted, it was decided to rename our discipline “public health and public health” in accordance with two main components it and taking into account its purpose and history of development.

IN last years, especially after the message of the President of the Russian Federation, who drew attention to the demographic crisis in Russia, which threatens the socio-economic development and national security of the country, measures are being taken to implement national projects, including a project to improve health levels. On May 10, 2006, the President of the Russian Federation noted the need to solve three problems: “The first is to reduce mortality. The second is an effective demographic policy. And thirdly, increasing the birth rate.” For implementation national project additional funds were released. They will improve the availability of medical care and its quality, improve the working conditions of healthcare workers, and raise the prestige of the medical profession.

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 health care as 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. The legislative framework 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 national 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.

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, geographical location locality) - 17-20%;

Level of development of healthcare facilities (providing the population with medicines, quality and timeliness of medical care, development of material and technical base, carrying out preventive measures) - 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 behavior, manifestations of life, 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.

Target: Students should have a general understanding of the discipline “Public Health and Healthcare”, know the basic concepts, sections, and methods. Students should be aware of the social determination of public health.

Healthcare in the most general view is a complex social dynamic, functional, open and adaptive system that society at each stage of its development creates and uses to implement a set of measures aimed at protecting and improving the health of each person and the entire society as a whole.

Public health measures in human history began to be carried out with the advent of the state. They changed depending on changes in socio-economic formations, changes in the method of production and production relations, and the state system.

Public health system is a system of scientific and practical measures and structures of a medical and non-medical nature that support them, the activities of which are aimed at implementing the concept of protecting and promoting public health, preventing diseases and injuries, increasing the duration of active life and working capacity by combining the efforts of society.

The subject of public health is the study of the influence of social living conditions on the health and medical care of the population. Methodological basis public health is systems approach to the definition and study of public health.

It should be noted that definitions and assessments of health have changed throughout the history of health care. Currently, we have to admit that there is no generally accepted unified interpretation of the concept of health. The literature devoted to various aspects of health contains many definitions of this category, based on various approaches and criteria.

Health, according to the WHO Constitution (1948), is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.

As follows from the definition, the health characteristic combines three components: physical(biological), mental(spiritual) and social health.

Physical health is a condition characterized by the level of physical development, physical capabilities and adaptive abilities of individuals, groups of people and society as a whole, ensuring the achievement of quality of life, well-being of society and ensuring the preservation and strengthening of public health.

Mental health is a state characterized by a dynamic process of mental activity, which is characterized by the determinism of mental phenomena, a harmonious relationship between the reflection of the circumstances of reality and the individual’s attitude towards it, the adequacy of the body’s reactions to social, psychological and physical (including biological) conditions of life, thanks to the individual’s ability to self-control behavior, plan and implement his life path in micro- and macrosocial environments.

Social health – measure social adaptation of a person, determined by his place and role in society.

When we talk about health, we mean a harmonious combination of all three components. The consequence of a violation of one of them is disharmony and, ultimately, disease.

According to WHO definition, disease(illness) is a life disrupted in its course by damage to the structure and functions of the body under the influence of external and internal factors. The disease occurs as a result of exposure to external and internal environmental factors that exceed the adaptive-compensatory (adaptation) capabilities of the body.

There are several levels of health:

individual health- human health;

group health– a set of characteristics of the health of persons united according to any criterion: family, work collectives, students, etc.;

regional health– a set of health characteristics of people living in a certain territory);

public health– a medical and social resource and potential of society that contributes to ensuring national security.

WHO recognizes that the enjoyment of the highest attainable standard of health is a fundamental right of every person. All people should have access to the resources they need to stay healthy.

At the XXX session of the World Health Assembly (1977), the most important social goal was proclaimed: “Achievement by the year 2000 by all the inhabitants of the earth of a level of health that will allow them to lead a socially and economically productive lifestyle.” The WHO policy “Health for all” is aimed at solving this problem.

Later, the document “Health 21: a policy framework for achieving health for all in the European Region” was adopted (1999). The “Health for All in the 21st Century” strategy is implemented differently in each country depending on social and economic characteristics, health status and mortality rates of the population, status and level of development of healthcare systems.

The history of public health in Soviet Kazakhstan reflects the main stages of the development of state socialism in the USSR. Since the establishment of Soviet power, the main task public health The theoretical and practical development of preventive principles of health care was carried out. The focus was also on providing the population with free, publicly available medical care. During the Great Patriotic War all attention was focused on issues of medical and sanitary support for the front and the deployment of rear hospitals. IN post-war years tasks related to the restoration of the national economy and the elimination of sanitary consequences were reflected. In subsequent years, scientific and practical interests corresponded to the ideology of socialist construction, among which the most ambitious were measures for general medical examination of the population.

At the meeting held in Almaty in 1978 International conference The WHO/UNICEF socialist healthcare system (model of N.A. Semashko) received worldwide recognition, and the adopted Alma-Ata Declaration was proclaimed the Magna Carta of healthcare of the 20th century.

With the acquisition of sovereignty and the formation of market relations public health in Kazakhstan has undergone a number of fundamental changes. Modern period can be defined as a stage of accelerated modernization of the healthcare system, including the transition to modern principles and standards in the organization of the healthcare sector.

One of the most important tasks of public health is to identify the nature of the complex influence of environmental factors (natural and social) on the health of the population, to search for patterns and trends in the formation of public health, taking into account socio-economic conditions.

The formation of public health is determined by the complex influence of factors that can be combined into the following main groups:

- political(state social policy, health care policy, state regulation of the health care system, legal acts in the field of health care, etc.);

- socio-economic(GDP per capita, financing of the healthcare system, working and living conditions, nutrition, organization of the healthcare system, lifestyle, etc.);

- natural-climatic, environmental(condition and pollution of the environment);

- biological(gender, age, heredity, nationality, constitution, type nervous system and etc.).

In the 20th century, the social conditioning of health was recognized, which is enshrined in the Charter of the World Health Organization. This definition of health overcomes the limitations of approaches that contrast social and biological components human organization.

The ratio of social and biological factors in relation to various diseases is not the same, but still the leading role is given to the social component: conditions and factors.

Social conditions – this is a form of manifestation of production relations, a method of social production, a socio-economic system and the political structure of society.

Social factors – this is a manifestation of social conditions for a particular person: working and rest conditions, housing, food, education, upbringing, etc.

Among the most significant achievements of public health, first of all, medical, social and epidemiological studies should be noted, based on the results of which groups of factors (risk factors) and their contribution to the health of the population were established:

conditions and lifestyle– 49-53%, on average 50% of the total influence (smoking, alcohol abuse, unbalanced diet, stressful situations (distress), harmful working conditions, physical inactivity, poor material and living conditions, drug use, medication abuse, family fragility, loneliness, low cultural and educational level, urbanization, etc.);

- genetic factors– 18-22%, on average 20% (predisposition to hereditary diseases

- environment– 17-20%, on average 20% (climate, pollution of air, water, soil by harmful substances; increased heliocosmic, radiation, magnetic and other radiation);

- healthcare– 8-10%, on average 10% (ineffectiveness of preventive measures, low quality of medical care, untimely medical care).

The results of the largest ever WHO research project(2002) identified 10 leading risk factors that determine levels of morbidity and mortality in populations at the global level: malnutrition; smoking; arterial hypertension; unsatisfactory state of water supply, sanitation, as well as personal and household hygiene; physical inactivity; occupational hazards; unsafe sex; alcohol abuse; air pollution.

Thus, the leading role of social factors in the formation of public health is mediated through conditions and lifestyle.

Modern researchers in the scientific knowledge of the problems of health formation are not limited to the medical and social framework and are increasingly considering lifestyle from a broad perspective. public positions, using philosophical and sociological interpretations:

Lifestyle– forms of individual and group life activity, typical for historically specific social relations; or concept characterizing features Everyday life people determined by a given socio-economic formation.

In general, lifestyle summarizes four categories:

- standard of living– an economic category that characterizes the degree of satisfaction of the material and cultural needs of people and can be expressed quantitatively (size of the gross national product, real income of the population, availability and provision of medical care, length of the working day, etc.);

- the quality of life– a sociological category that characterizes the qualitative side of satisfying the material and cultural needs of people through comparison with the level or standard of living (satisfaction with work, quality of food, medical care, etc.);

- life style– a socio-psychological category that characterizes a certain type of behavior of an individual or group of people, which captures consistently reproducible traits, manners, habits, tastes, and inclinations;

- way of life - a socio-economic category that characterizes the system of industrial relations in a socio-political formation.

Despite significant differences in conceptual approaches to assessment and lifestyle criteria, the role of social factors in shaping population health is recognized throughout international health care.

There are social groups whose lifestyle is most predisposed to various diseases, the so-called risk groups:

- demographic: children, old people, single people, widows, widowers, migrants, refugees, displaced persons;

- professional risk: working in hazardous production conditions (heavy engineering, chemical, metallurgical industries, transport, etc.);

- functional, pathological state: pregnant women; premature babies born with low birth weight; persons with genetic risk, with congenital anomalies, defects; disabled children;

- low material standard of living, poverty, misery: the poor, the underprivileged, the unemployed, the underemployed, the “homeless.”

- persons with deviant behavior, the presence of psychopathic, socio-psychological and other conflicts: alcoholics, drug addicts, substance abusers, prostitutes, persons with sexual perversions, persons with mental health and behavioral deformations (neuropathy, psychopathy, etc.), religious and other sectarians with mental and physical disabilities.

Among all diseases, a special place is occupied by socially significant diseases, the list of which is established by the government in order to take additional or preferential measures of medical and social support: oncological and oncohematological diseases, diabetes, rheumatism, systemic lupus erythematosus, cerebral palsy, mental illness, myocardial infarction and etc.

Recognition of the social determination of health justifies the need to consider health problems from a broad social positions, as well as the fact that ensuring health goes beyond the competence and responsibility of purely healthcare authorities and organizations. Preserving and promoting health is the joint responsibility of the state, employer and citizen, which is implemented through intersectoral cooperation with the active participation of the population itself.

Illustrative material: 20 slides in Row Point software.

Literature:

1.Akanov A.A., Devyatko V.N., Kulzhanov M.K. Public health in Kazakhstan: concept, problems and prospects. – Almaty, 2001. – 100 p.

2. Kamaliev M.A., Bigalieva R.K., Khabieva T.Kh. History of traditional medicine and public health of Kazakhstan. – Almaty, 2004. – 173 p.

3. Lisitsyn Yu.P. Public health and healthcare: Textbook. – 2nd ed., revised. and additional – GEOTAR-Media, 2007. – 512 p.

4. Tulchinsky T.K., Varavikova E.A. The New Public Health: An Introduction to modern science. – Jerusalem, 1999. – 1049 p.

5. Yuryev V.K., Kutsenko G.I. Public health and healthcare. – St. Petersburg, 2000. – 914 p.

Control questions:

1.Define public health and healthcare

2.List the components of health.

3.Indicate your health levels.

4.Name the main sections of the discipline.

5.List the main methods of discipline.

6.What factors influence public health?

7.What contribution do risk factors make to health?

8.What is the social conditioning of health?

9. Define lifestyle and its categories.

10.List the social groups at risk of diseases.

(Brief history of development)

As is known, most disciplines and subspecialties in medicine study various diseases, their symptoms and syndromes, various clinical manifestations of the course of diseases, their complications, methods of diagnosis and treatment of diseases and the probable outcomes of the disease in the case of using modern methods of complex treatment known today. It is extremely rare that the basic methods of disease prevention and rehabilitation of people who have suffered from one or another disease, sometimes severe, with complications and even resulting in disability, are described.

The term “recreation” is even less commonly used in medical literature, i.e. a set of preventive, therapeutic and health measures aimed at preserving the health of healthy people. People's health, its criteria, ways to preserve and strengthen it in the difficult socio-economic conditions of our lives have almost completely fallen out of the sphere of interests of modern medicine and healthcare in Russia. In this regard, before talking about public health, it is necessary to define the term “health”, identify the levels of its study in medical and social research and determine the place of public health in this hierarchy.

So, World organization of Health (WHO) formulated back in 1948 that “health is a state of complete physical, spiritual and social well-being, and not merely the absence of disease or infirmity.” WHO has proclaimed the principle that “the enjoyment of the highest attainable standard of health is a fundamental right of every person.” It is customary to distinguish 4 levels of health study:

Level 1 - health an individual person.

Level 2 - health of small or ethnic groups - group health.

3rd level - population health, those. people living in a specific administrative-territorial unit (region, city, district, etc.).

4th level - public health- the health of society, the population of the country, the continent, the world, and the population as a whole.

Public health and healthcare as an independent medical science studies the impact of social factors and environmental conditions on the health of the population in order to develop preventive measures to improve the health of the population and improve their medical care. Public health and healthcare studies a wide range of different medical aspects, sociological, economic, managerial, and philosophical problems in the field of public health in a specific historical setting.

Taking into account the order of the Ministry of Health of the Russian Federation No. 83 of 03/01/2000 “On improving the teaching of public health and healthcare issues in medical and pharmaceutical universities,” as well as as a result of the work carried out on the initiative of the MMA named after. I.M. Sechenov and with the support of the Ministry of Health of the Russian Federation a seminar of heads of departments of organizational profile medical universities Russia “Modern approaches, forms and methods of teaching “Public health and healthcare” (Moscow, 2000) developed the following definition of the concept of “public health”, approved by the majority of seminar participants: “Public health is the most important economic and social potential of the country, determined by the influence of various environmental factors and the lifestyle of the population, allowing to ensure an optimal level of quality and safety of life.”

Unlike various clinical disciplines, public health studies the health status not of individual individuals, but of groups, social groups and society as a whole in connection with conditions and lifestyle. At the same time, living conditions and production relations, as a rule, are decisive for the state of people’s health, so scientific and technological progress, socio-economic revolutions and evolutionary periods, the cultural revolution bring the greatest benefits to society, but at the same time they can have negative impacts on his health. Greatest discoveries modernity in the field of physics, chemistry, biology, urbanization of the population in the 20th century, rapid development of industry in many countries, large volumes of construction, chemicalization of agriculture, etc. often lead to significant violations in the field of ecology, which has a detrimental effect, first of all, on health population, causes certain diseases, which sometimes become epidemiological in nature.

Antagonistic contradictions between scientific and technological progress and the state of public health in our country arise due to the state’s underestimation of preventive measures. Consequently, one of the tasks of our science is to reveal such contradictions and develop recommendations for the prevention of negative phenomena and factors that negatively affect the health of society.

For the systematic development of the national economy great value has information about the population, determining its forecasts for the future.

Public health identifies patterns of population development, studying demographic processes, predicts the future, and develops recommendations for state regulation of population size.

Thus, public health is characterized by the simultaneous, complex impact of social, behavioral, biological, geophysical and many other factors. Many of these factors can be identified as risk factors. What are disease risk factors?

Risk factors- potentially hazardous to health factors of a behavioral, biological, genetic, environmental, social nature, environmental and industrial environment, increasing the likelihood of developing diseases, their progression and unfavorable outcome.

Unlike the direct causes of diseases (bacteria, viruses, deficiency or excess of any microelements, etc.), risk factors act indirectly, creating an unfavorable background for the occurrence and further development diseases.

When studying public health, the factors that determine it are usually combined into the following groups:

1. Socio-economic factors(working conditions, living conditions, material well-being, level and quality of nutrition, recreation, etc.)

2. Socio-biological factors(age, gender, predisposition to hereditary diseases, etc.).

3. Environmental and climatic factors(habitat pollution, average annual temperature, the presence of extreme natural and climatic factors, etc.).

4. Organizational or medical factors(provision of the population with medical care, quality of medical care, availability of medical and social care, etc.).

Academician of the Russian Academy of Medical Sciences Yu.P. Lisitsyn gives the following grouping and levels of influence of risk factors that determine health (Table 1.1).

Table 1.1Grouping of health-related risk factors

(Brief history of development)

So, the World Health Organization (WHO) formulated back in 1948 that “health is a state of complete physical, spiritual and social well-being, and not merely the absence of disease or infirmity.” WHO proclaimed the principle that “the enjoyment of the highest attainable standard of health is a fundamental right of every person.” It is customary to distinguish 4 levels of health study:

Level 1 - individual health.

Level 2 - health of small or ethnic groups - group health.

Level 3 - public health, i.e. people living in a specific administrative-territorial unit (region, city, district, etc.).

Level 4 - public health - the health of society, the population of the country, continent, world, population as a whole.

Taking into account the order of the Ministry of Health of the Russian Federation No. 83 of 03/01/2000 “On improving the teaching of public health and healthcare issues in medical and pharmaceutical universities,” as well as as a result of the work carried out on the initiative of the MMA named after. I.M. Sechenov and with the support of the Ministry of Health of the Russian Federation of the seminar of heads of departments of organizational profile of medical universities in Russia “Modern approaches, forms and methods of teaching “Public health and healthcare” (Moscow, 2000) the following definition of the concept of “public health” was developed, approved by the majority of the seminar participants: “Public health is the most important economic and social potential of the country, determined by the influence of various environmental factors and the lifestyle of the population, allowing to ensure an optimal level of quality and safety of life.”

Unlike various clinical disciplines, public health studies the health status not of individual individuals, but of groups, social groups and society as a whole in connection with conditions and lifestyle. At the same time, living conditions and production relations, as a rule, are decisive for the state of people’s health, since scientific and technological progress, socio-economic revolutions and evolutionary periods, the cultural revolution bring the greatest benefits to society, but at the same time they can have a negative impact on its health. The greatest discoveries of our time in the field of physics, chemistry, biology, urbanization of the population in the 20th century, rapid development of industry in many countries, large volumes of construction, chemicalization of agriculture, etc. often lead to significant violations in the field of ecology, which has a detrimental effect, first of all, on the health of the population, causes certain diseases, which sometimes become epidemiological in nature.

For the planned development of the national economy, information on the population size and the determination of its forecasts for the future are of great importance.

Public health identifies patterns of population development, studying demographic processes, predicts the future, and develops recommendations for state regulation of population size.

When studying public health, the factors that determine it are usually combined into the following groups:

1. Socio-economic factors (working conditions, living conditions, material well-being, level and quality of nutrition, rest, etc.)

2. Socio-biological factors (age, gender, predisposition to hereditary diseases, etc.).

3. Environmental and natural-climatic factors (pollution of the environment, average annual temperature, the presence of extreme natural-climatic factors, etc.).

4. Organizational or medical factors (provision of the population with medical care, quality of medical care, availability of medical and social care, etc.).

Academician of the Russian Academy of Medical Sciences Yu.P. Lisitsyn gives the following grouping and levels of influence of risk factors that determine health (Table 1.1).

At the same time, the division of factors into certain groups is very arbitrary, since the population is exposed to the complex influence of many factors, in addition, factors influencing health interact with each other, change in time and space, which must be taken into account when carrying out complex medical and social research.
Table 1.1 Grouping of health-related risk factors*
Sphere of influence of factors on health Groups of risk factors Share (in%) of risk factors
Lifestyle Smoking, drinking alcohol, unbalanced diet Stressful situations (distress) Harmful working conditions Physical inactivity Poor material and living conditions Drug consumption, medication abuse Fragility of families, loneliness Low cultural and educational level High level of urbanization 49-53
Genetics, human biology Predisposition to hereditary diseases Predisposition to so-called degenerative diseases (hereditary predisposition to diseases) 18-22
External environment Air pollution by carcinogens and other harmful substances "Water pollution by carcinogens and other harmful substances Soil pollution Sudden changes in atmospheric phenomena Increased heliocosmic, radiation, magnetic and other radiation 17-20
Healthcare Ineffectiveness of preventive measures Low quality of medical care Lack of timeliness of medical care 8-10
* Social hygiene (medicine) and healthcare organization: Educational manual / Ed. Yu.P. Lisitsina. - Kazan, 1998. - P. 52.

The second part of the science of public health and healthcare includes the development of science-based, most optimal methods of healthcare management, new forms and methods of operation of various medical institutions, ways to improve the quality of medical care, and substantiates optimal solutions to economic and managerial problems in healthcare.

The rapid growth of medical science has armed doctors with new, modern methods diagnostics of complex diseases, effective means of treatment. All this simultaneously requires the development of new organizational forms and conditions for the activities of doctors, health care facilities, 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 options for a more optimal solution to the economic problems of healthcare, introducing elements of 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 domestic public health and healthcare.

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 health care and individual medical institutions in this, both with state and non-state forms of ownership, i.e. the subject reveals the significance of the entire diversity of the country’s socio-economic life and determines ways to improve medical care for the population.

Public health and healthcare have their own methodology and research methods. Such methods are: statistical, historical, economic, experimental, timing research, sociological methods and others.

The 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.

The historical method allows the study to trace the state of the problem being studied at different historical stages development of the country.

The economic method allows us to establish the influence of the economy on healthcare and healthcare on the state’s economy, and determine the most optimal ways to use public funds to effectively protect the health of the population. Planning issues financial activities health authorities and medical institutions, the most rational use Money, assessment of the effectiveness of health care actions to improve the health of the population and the impact of these actions on the country's economy - all this constitutes the subject of economic research in the field of health care.

The 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 historically analyzed. The proposed new forms in the work of polyclinics are analyzed using the experimental method: their economic feasibility and effectiveness are checked.

The study may use timing research methods (chronometry of the work of medical workers, study and analysis of the time spent by patients receiving medical care, etc.).

Often sociological methods (interviewing method, questionnaire method) are widely used, which makes it possible to obtain a generalized opinion of a group of people about the object (process) of study.

The source of information is mainly state reporting documentation of treatment and preventive medical institutions, or for a more in-depth study, the collection of material can be carried out on specially designed cards, questionnaires, which include all the questions to obtain the necessary information, according to the approved research program and tasks that presented to the researcher. A personal computer can also be used for this purpose, when the researcher, using a special program, enters the necessary data into the computer from the primary registration documents.

The vast majority of socio-hygienic studies of group health, population health and public health in previous years dealt with the quantitative assessment of health. True, with the help of indicators, indices and coefficients there is always scientific research tried to assess the quality of health, i.e. tried to characterize health as a parameter of quality of life. The term “quality of life” itself began to be used in the domestic scientific literature recently, only in the last 10-15 years. This is understandable, because only then can we talk about the “quality of life” of the population when in a country (as has long happened in the developed countries of Europe, America, Japan and some other developed countries) basic material and social benefits are available to the majority of the population.

According to WHO (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.

In our country, quality of life most often means a category that includes a combination of life support conditions and health conditions that allow one to achieve physical, mental, social well-being and self-realization.

Despite the absence of a globally accepted concept of “quality of health” as the most important component of “quality of life,” attempts are being made to give a comprehensive assessment of public health (quantitative and qualitative).

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.

Social problems of medicine interested outstanding scientists of antiquity - such as Hippocrates, Avicenna, Aristotle, Vesalius and others. 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.

It was in Russia in the second half of the 19th century, under the influence of the social movement of the advanced intelligentsia, representatives of zemstvo and factory medicine, famous medical scientists, as well as under the influence of the growing dissatisfaction of the majority of the country's population with the level of medical and social care, in the context of an approaching series of revolutions and wars the beginning of the 20th century and other factors, the foundations of the science and academic discipline of public health and healthcare began to form for the first time. Thus, at Kazan University in the 60s of the 19th century, Professor A.V. Petrov lectured students on public health and social hygiene. At the end of the 19th century, the medical faculties of many Russian universities (St. Petersburg, Moscow, Kyiv, Kharkov, etc.) taught courses in public hygiene, as well as courses in medical geography and medical statistics. However, these courses were sporadic and were often part of other disciplines. Only in 1920 in Germany, at the University of Berlin, the world's first department of social hygiene was established. This department was headed by its founder, the German scientist social hygienist Professor Alfred Grotjan. Thus began the history of the independent subject and science of social hygiene. Following the department of A. Grotjahn, similar departments began to be organized at other universities in Germany and other European countries. Their leaders (A. Fischer, S. Neumann, F. Prinzing, E. Resle, etc.) directed the research work of the departments to develop current problems of public health and medical statistics.

The formation and flourishing of social hygiene (as the science was called in Russia until 1941) during the period of Soviet power are associated with the names of major figures in Soviet health care N.A. Semashko and Z.P. Solovyov. On their initiative, departments of social hygiene 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 Professor A.F. Nikitin - at the I Leningrad Medical Institute. Until 1929, such departments were organized in all medical institutes.

In 1923 it was opened State Institute social hygiene of the People's Commissariat of Health of the RSFSR, which became the scientific and organizational base for all departments of social hygiene and health care organization. Scientists social hygienists conduct important research on the study of sanitary and demographic processes in Russia in the first half of the 20th century (A.M. Merkov, S.A. Tomilin, P.M. Kozlov, S.A. Novoselsky, L.S. .Kaminsky, etc.), new methods for studying population health are being developed (P.A. Kuvshinnikov, G.A. Batkis, etc.). In the 30s, G.A. Batkis published a textbook for the departments of social hygiene of all medical institutes.

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 to strengthen connections with practical healthcare was 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 health care planning, studying the population's needs 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 the second half of the 20th century in Russia was made by: Z.G. Frenkel, B.Ya. Smulevich, S.V. Kurashov, N.A. Vinogradov, A.F. Serenko, S.Ya. Freidlin, Yu.A. Dobrovolsky, Yu.PLisitsin, O.P. Shchepin and others.

In 2000, the departments were renamed into departments of public health and healthcare.

On modern stage development of domestic healthcare with the introduction of new economic mechanisms for managing and financing healthcare, new legal relationships in the healthcare system, and the transition to health insurance from the future doctor requires the assimilation of a significant amount 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 the departments of public health and healthcare, which represent both science and the subject of teaching in the higher medical school system.