1.2 History of public health development

Socio-hygienic elements and prescriptions are still found in the medicine of ancient socio-economic formations, but the isolation of social hygiene as a science is closely connected with the development of industrial production.

The period from the Renaissance to 1850 was the first stage in the modern development of public health (then this science was called "social hygiene"). During this period, serious studies were accumulated on the interdependence of the state of health of the working population, their living and working conditions.

The first systematic guide to social hygiene was Frank's multi-volume System einer vollstandingen medizinischen Polizei, written between 1779 and 1819.

The utopian socialist doctors who held leadership positions during the revolutions of 1848 and 1871 in France tried to scientifically justify public health measures, considering social medicine the key to the improvement of society.

The bourgeois revolution of 1848 was of great importance for the development of social medicine in Germany. One of the social hygienists of that time was Rudolf Virchow. He emphasized the close relationship between medicine and politics. His work "Mitteilungen uber Oberschlesien herrschende Typhus-Epidemie" is considered one of the classics in German social hygiene. Virchow was known as a democratic doctor and researcher.

It is believed that the term "social medicine" was first proposed by the French physician Jules Guerin. Guerin believed that social medicine included "medical police, environmental health, and forensic medicine".

Virchow's contemporary Neumann introduced the concept of "social medicine" into German literature. In his work Die offentliche Gesundshitspflege und das Eigentum, published in 1847, he convincingly proved the role of social factors in the development of public health.

At the end of the 19th century, the development of the main direction of public health to the present day was determined. This direction connects the development of public health with the general progress of scientific hygiene or, with biological and physical hygiene. The founder of this trend in Germany was M. von Pettenkofer. He included the section "Social Hygiene" in the manual on hygiene he published, considering it the subject of that sphere of life where the doctor meets with large groups of people. This direction gradually acquired a reformist character, since it could not offer radical social and therapeutic measures.

The founder of social hygiene as a science in Germany was A. Grotjan. In 1904, Grotjan wrote: “Hygiene must ... study in detail the influences of social relations, and the social environment in which people are born, live, work, enjoy, procreate and die. Thus, it becomes social hygiene, which appears next to physical and biological hygiene as its complement.

According to Grotjan, the subject of socio-hygienic science is the analysis of the conditions in which the relationship between man and the environment is carried out.

As a result of such studies, Grotjan came close to the second side of the subject of public health, that is, to the development of norms that regulate the relationship between a person and the social environment so that they strengthen his health and benefit him.

England in the 19th century also had major public health figures. E. Chadwick saw the main reason for the poor health of the people in their poverty. His work "The sanitary conditions of laboring populations", published in 1842, revealed the difficult living conditions of workers in England. J. Simon, being the chief physician of the English health service, conducted a series of studies of the main causes of death in the population. However, the first chair in social medicine was created in England only in 1943 by J. Ryle at Oxford.

The development of social hygiene in Russia was most facilitated by F.F. Erisman, P.I. Kurkin, Z.G. Frenkel, N.A. Semashko and Z.P. Solovyov.

Of the major Russian social hygienists, it should be noted G.A. Batkis, who was a well-known researcher and author of a number of theoretical works on social hygiene, who developed original statistical methods for studying the sanitary condition of the population and a number of methods for the work of medical institutions (a new system of active patronage of newborns, the method of anamnestic demographic studies, etc.).

1.3 Public health subject

The nature of the health care system in each country is determined by the position and development of public health as a scientific discipline. The specific content of any course in public health varies according to national conditions and needs, as well as the differentiation achieved by the various medical sciences.

The classic definition of the content of public health, mentioned in the discussion organized by WHO on the topic "Health Management as a Scientific Discipline": "... public health - relies on the" tripod "of social diagnosis, which are studied mainly by the methods of epidemiology, social pathology and social therapy based on cooperation between society and health professionals, as well as on administrative and medical-preventive measures, laws, regulations, etc. at central and local governments.

From the point of view of the general classification of sciences, public health is on the border between natural science and social sciences, that is, it uses the methods and achievements of both groups. From the point of view of the classification of medical sciences (about the nature, restoration and strengthening of human health, human groups and society), public health seeks to fill the gap between the two main groups of clinical (curative) and preventive (hygienic) sciences, which has developed as a result of the development of medicine. It plays a synthesizing role, developing unifying principles of thinking and research of both areas of medical science and practice.

Public health provides a general picture of the state and dynamics of the health and reproduction of the population and the factors that determine them, and hence the necessary measures follow. No clinical or hygienic discipline can give such a general picture. Public health as a science should organically combine a specific analysis of practical health problems with studies of the patterns of social development, with problems of the national economy and culture. Therefore, only within the framework of public health can a scientific organization and scientific planning of health care be created.

The state of human health is determined by the function of its physiological systems and organs, taking into account gender, age and psychological factors, and also depends on the impact of the external environment, including the social one, the latter being of primary importance. Thus, human health depends on the impact of a complex set of social and biological factors.

The problem of the relationship between the social and biological in human life is a fundamental methodological problem of modern medicine. One or another interpretation of natural phenomena and the essence of human health and disease, etiology, pathogenesis and other concepts in medicine depends on its solution. The socio-biological problem involves the allocation of three groups of patterns and their corresponding aspects of medical knowledge:

1) social patterns in terms of their impact on health, namely, on the incidence of people, on changes in demographic processes, on changes in the type of pathology in various social conditions;

2) general patterns for all living beings, including humans, manifested at the molecular biological, subcellular and cellular levels;

3) specific biological and mental (psychophysiological) patterns inherent only in man (higher nervous activity, etc.).

The last two regularities manifest themselves and change only through social conditions. Social patterns for a person as a member of society are leading in his development as a biological individual, contribute to his progress.

The methodological basis of public health as a science consists in the study and correct interpretation of the causes, relationships and interdependence between the state of health of the population and social relations, i.e. in the correct solution of the problem of the relationship between the social and the biological in society.

Social and hygienic factors affecting public health include working and living conditions of the population, housing conditions; the level of wages, the culture and upbringing of the population, nutrition, family relations, the quality and availability of medical care.

At the same time, climatic, geographical, hydrometeorological factors of the external environment also influence public health.

A significant part of these conditions can be changed by society itself, depending on its socio-political and economic structure, and their impact on the health of the population can be both negative and positive.

Therefore, from a socio-hygienic point of view, the health of the population can be characterized by the following basic data:

1) the state and dynamics of demographic processes: fertility, mortality, natural population growth and other indicators of natural movement;

2) the level and nature of the morbidity of the population, as well as disability;

3) the physical development of the population.

The study and comparison of these data in various socio-economic conditions allows not only to judge the level of public health of the population, but also to analyze the social conditions and causes that influence it.

In essence, all practical and theoretical activity in the field of medicine should have a social and hygienic orientation, since any medical science contains certain social and hygienic aspects. It is public health that provides the social and hygienic component of medical science and education, just as physiology substantiates their physiological direction, which is implemented in practice by many medical disciplines.

Public health and healthcare as an integrative science. The main sections, tasks, significance in the system of doctor's training.

The founders of domestic social medicine defined social medicine as the science of public health and healthcare. Its main task is to study the influence of medical and social factors, conditions and lifestyle on the health of various population groups, the development of evidence-based recommendations for the prevention and elimination of adverse social conditions and factors, as well as recreational activities to improve the health of the population. The main purpose of social medicine and health care management as a science and academic discipline is the assessment of criteria for public health and the quality of medical care, and their optimization.

Subject structure: 1) health history; 2) theoretical problems of public health; 3) the state of health and methods of its study; 4) organization of medical and social security and medical insurance; 5) organization of medical care to the population; 6) ensuring the sanitary and epidemiological welfare of the population; 7) economic and planning and organizational forms of improving healthcare, management, marketing and modeling of medical services; 8) international cooperation in the field of medicine and healthcare.

Methods of medical and social research: 1) historical; 2) dynamic observation and description; 3) sanitary-statistical; 4) medical and sociological analysis; 5) expert assessments; 6) system analysis and modeling; 7) organizational experiment; 8) planning and normative, etc.

Social medicine is the science of healthcare strategy and tactics. The objects of medical and social research are: 1) groups of persons, the population of the administrative territory; 2) individual institutions (polyclinics, hospitals, diagnostic centers, specialized services); 3) health authorities; 4) environmental objects; 5) general and specific risk factors for various diseases, etc.

Definition of the subject of public health and healthcare (V.O. Portugalov, F.F. Erisman, N.A. Semashko, N.A. Vinogradov, V.P. Kaznacheev, Yu.P. Lisitsyn).

In 1902 F.F. Erisman wrote: "There is no doubt that all the main factors of economic life strongly influence the state of public health and that often in these conditions lies the key to explaining the excessive morbidity and mortality of the population." This statement has not lost its significance even today. Experts from international organizations have repeatedly pointed out this fact. Thus, at the 52nd session of the World Health Organization, it was again emphasized that “all the main determinants of health are associated with socioeconomic factors ... The relationship between health status and employment, income level, social protection, housing conditions and education is clearly seen in all European states".

So, taking into account the biosocial essence of a person, Yu.P. Lisitsyn (1973) considers human health as a harmonious unity of biological and social qualities due to congenital and acquired mechanisms.

V.P. Kaznacheev (1974) defines human health as a process of maintaining and developing its biological, physiological and psychological capabilities, optimal social activity with a maximum life expectancy. At the same time, attention is drawn to the need to create such conditions and such hygienic systems that would ensure not only the preservation of human health, but also its development.

The main methods of the subject are public health and public health.

Methodology - a sequence of methods for collecting data on the phenomena under study.

Methodology - a set of techniques, methods, approaches to assessing the phenomena under study.

c) theoretical substantiation of the state policy in the field of health care and development of organizational principles of health care in the state.

d) development and practical implementation of organizational forms and methods of work of medical organizations and doctors of various specialties

e) training and education of medical workers as public doctors, doctors - organizers, organization of work in their specialty.

The object of the study of the OHS: society as a whole, a social group, a collective, as well as the health care system serving them.

OZZ subject:

1) the health of the population as a whole, collectives, social groups, depending on the influence of the social environment

2) a set of measures aimed at strengthening it: forms, methods, results of the work of the CA.

The main methods of SG research:

1) historical - you need to know the past in order to understand the present and foresee the future

2) statistical (sanitary-statistical) - allows a) to quantitatively measure the indicators of the health of the population and the activities of medical institutions; b) identify the impact of environmental factors on health; c) determine the effectiveness of therapeutic and recreational activities; e) to evaluate the dynamics of the CA indicators and forecast them; identify the necessary data for the development of new health care standards.

3) methods of experiment and modeling - research and development of the most rational organizational forms of work

4) the method of economic research - makes it possible to establish the influence of the economy on the SO and vice versa

5) method of expert assessments

6) the method of sociological research - identifying the attitude of the population to their health, the impact of working and living conditions on health

7) system analysis method

8) epidemiological method

9) medical geographical

Health study levels:

a) individual

b) group

c) regional

d) public

The main stages of the formation of the subject of public health and health care. History, foreign and domestic scientists. Sections of the subject public health and health care as an academic discipline.

Stages of health development

The development of health care in the Republic of Kazakhstan is historically connected with the development of medicine in Russia from the moment of accession in 1731 and in subsequent years until the end of the 19th century. And then the history of Soviet Kazakhstan and sovereign Kazakhstan since 1991

The training of medical personnel was carried out in medical-surgical schools (since 1786), and since 1798 - in the St. Petersburg and Moscow medical-surgical academies. In 1755, the first Moscow University in Russia with a medical faculty was established. An outstanding contribution to health care was made by M. V. Lomonosov, who in his work “The Word on the Reproduction and Preservation of the Russian People” gave a deep analysis of health care and proposed a number of specific measures to improve its organization. In the first half of the XIX century. the first scientific medical schools are formed: anatomical (P. A. Zagorsky), surgical (I. F. Bush, E. O. Mukhin, I. V. Buyalsky), therapeutic (M. Ya. Mudrov, I. E. Dyadkovsky) . N. I. Pirogov \

From the second half of the XIX century. In addition to state structures, public medicine was also involved in health protection issues: the Society for the Protection of Public Health (1878), through the organizational forms of public medicine (medical periodicals, medical societies, congresses, commissions), the first district medical care system in Russia was created (zemstvo doctors), and the beginning of the organization of sanitary affairs in St. Petersburg (1882) was laid. In the 70s of the 20th century, hygiene was formed as an independent discipline, the first scientific hygienic schools were created (A. P. Dobroslavin, F. F. Erisman) . For the first time in Russia (together with sanitary doctors A. V. Pogozhev and E. M. Dementiev), a comprehensive socio-hygienic study of factories and plants in the Moscow province (1879-1885) was carried out,

The first sanitary doctors I. I. Molleson, I. A. Dmitriev, G. I. Arkhangelsky, E. A. Osipov, N. I. Tezyakov, Z. G. Frenkel and others did a lot for the development of zemstvo and city sanitary organizations. I. I. Molleson, the first sanitary doctor in Russia, created the first medical and sanitary council - a collegial body designed to manage zemstvo medicine. He proposed a project for the organization of medical stations in the countryside, the position of a county sanitary doctor to study the sanitary condition of the population, working and living conditions, the causes of diseases and the fight against them. Organizer and leader of more than 20 provincial congresses of zemstvo doctors. I. I. Molleson emphasized: “Social medicine as a branch of knowledge and activity is broad and covers ... all activities that can improve the living conditions of the masses of the population.” E. A. Osipov is one of the founders of zemstvo medicine and sanitary statistics. For the first time in Russia, he introduced card registration of diseases. Created Zemstvo Moscow Provincial Sanitary Organization (1884). He developed the principle of operation of a medical section with a hospital-hospital, the functions of a rural doctor, as well as a program for the sanitary examination of the province. N. A. Semashko - theorist and organizer of health care, the first people's commissar of health care (1918-1930). Under his leadership, the principles of health care were developed - the state character, preventive orientation, free and generally accessible qualified medical care, the unity of science and practice, and broad public participation in addressing health issues. N. A. Semashko created a new science - social hygiene and became the first head of the department of social hygiene (1922). Created new types of health care - the protection of motherhood and infancy, sanatorium business. With his active participation, the State Scientific Institute of Public Health named after A.I. L. Pasteur, the system of higher medical education was rebuilt, institutes of physical culture were organized in Moscow and Leningrad. ZP Solovyov - theorist and organizer of civil and military health care, deputy people's commissar of health care, head of the Main Military Sanitary Directorate. In 1923 he organized the Department of Social Hygiene at the 2nd Moscow Medical Institute. He made a great contribution to the development of the preventive direction of health care, to the reform of medical education. ZG Frenkel is one of the founders of social hygiene in the country. Organizer and head of the Department of Social Hygiene of the 2nd Leningrad Medical Institute (1923-1949) ), a prominent specialist in communal hygiene, demography and gerontology, head of the Hygienic Society of Leningrad for 27 years. The period of the Great Patriotic War and the post-war years are associated with the development of military medicine, the restoration of the material base of health care and the active training of medical personnel. Since 1961, a number of legislative acts and resolutions of the Government of the Union have been adopted, aimed at developing the healthcare system. Public health protection has been proclaimed the most important social task. The material base of health care is being strengthened, specialization of medical care is being carried out, and the system of primary health care is being improved. In 1978, a WHO conference was held in Alma-Ata dedicated to the organization of primary health care for the population, at which there were 146 participating countries. The Magna Carta developed at this conference formed the basis of a new thinking about the health of peoples and divided the history of healthcare organization into before and after Almaty. The greatest merit in organizing and holding the conference, and in the development of healthcare in the Republic of Kazakhstan belongs to the first academician from medicine of Kazakhstan T.Sh.Sharmanov. Laureate of international prizes and awards, founder and director of the National Research Institute of Nutrition T.Sh.Sharmanov and today produces new medical knowledge and technologies.

The system of legislation on health protection in the Russian Federation.

The legislation of the Russian Federation on the protection of the health of citizens consists of the relevant provisions of the Constitution of the Russian Federation and the Constitutions (charters) of the constituent entities of the Russian Federation, these Fundamentals, other federal laws and federal regulatory legal acts, laws and other regulatory legal acts of the constituent entities of the Russian Federation.

These Fundamentals regulate the relations of citizens, public authorities and local governments, economic entities, entities of the state, municipal and private healthcare systems in the field of protecting the health of citizens.

The laws of the constituent entities of the Russian Federation, regulatory legal acts of local governments should not restrict the rights of citizens in the field of health protection established by these Fundamentals.

Health protection of citizens is a set of political, economic, legal, social, cultural, scientific, medical, sanitary-hygienic and anti-epidemic measures aimed at preserving and strengthening the physical and mental health of each person, maintaining his long-term active life, providing him with medical care in case of loss of health.

Citizens of the Russian Federation are guaranteed the right to health care in accordance with the Constitution of the Russian Federation, generally recognized principles and international norms and international treaties of the Russian Federation, Constitutions (charters) of the subjects of the Russian Federation.

Article 2. Basic principles of protecting the health of citizens

The main principles of protecting the health of citizens are:

1) observance of the rights of a person and a citizen in the field of health protection and provision of state guarantees related to these rights;

2) the priority of preventive measures in the field of protecting the health of citizens;

3) availability of medical and social assistance;

4) social protection of citizens in case of loss of health;

5) the responsibility of public authorities and local governments, enterprises, institutions and organizations, regardless of the form of ownership, officials for ensuring the rights of citizens in the field of health protection.

Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (2011), main provisions.

This Federal Law regulates relations arising in the field of protecting the health of citizens in the Russian Federation (hereinafter - in the field of health protection), and determines:

1) legal, organizational and economic foundations for protecting the health of citizens;

2) the rights and obligations of a person and a citizen, certain groups of the population in the field of health protection, guarantees for the implementation of these rights;

3) the powers and responsibilities of public authorities of the Russian Federation, public authorities of the constituent entities of the Russian Federation and local governments in the field of health care;

4) rights and obligations of medical organizations, other organizations, individual entrepreneurs in the implementation of activities in the field of health protection;

5) rights and obligations of medical workers and pharmaceutical workers.

See comments to Article 1 of this Federal Law

Article 2. Basic concepts used in this Federal Law

1) health - a state of physical, mental and social well-being of a person, in which there are no diseases, as well as disorders of the functions of organs and systems of the body;

2) protection of the health of citizens (hereinafter - health protection) - a system of measures of political, economic, legal, social, scientific, medical, including sanitary and anti-epidemic (preventive), nature, carried out by the state authorities of the Russian Federation, state authorities of the subjects of the Russian Federations, local governments, organizations, their officials and other persons, citizens in order to prevent diseases, preserve and strengthen the physical and mental health of each person, maintain his long-term active life, provide him with medical care;

3) medical assistance -

4) medical service -

5) medical intervention -

6) prevention - a set of measures aimed at maintaining and strengthening health and including the formation of a healthy lifestyle, prevention of the occurrence and (or) spread of diseases, their early detection, identification of the causes and conditions for their occurrence and development, as well as aimed at eliminating harmful the influence of environmental factors on human health;

7) diagnostics -

8) treatment -

9) patient -

10) medical activity -

11) medical organization -;

12) pharmaceutical organization -

13) medical worker -

14) pharmaceutical worker -

15) attending physician - a physician who is entrusted with the functions of organizing and directly providing medical care to a patient during the period of observation and treatment;

16) disease -

17) state -

18) underlying disease -

19) concomitant disease -

20) the severity of the disease or condition –

21) the quality of medical care -

Article 3. Legislation in the field of health protection

1. Legislation in the field of health care is based on the Constitution of the Russian Federation and consists of this Federal Law, other federal laws adopted in accordance with it

2. Norms on health protection contained in other federal laws, other regulatory legal acts of the Russian Federation

3. In case of inconsistency between the norms on health protection contained in other federal laws, other regulatory legal acts of the Russian Federation, laws and other regulatory legal acts of the subjects of the Russian Federation, the norms of this Federal Law, the norms of this Federal Law shall apply.

4. Local self-government bodies, within their competence, have the right to issue municipal legal acts containing norms on health protection in accordance with this Federal Law, other federal laws, other regulatory legal acts of the Russian Federation, laws and other regulatory legal acts of the constituent entities of the Russian Federation.

5. If an international treaty of the Russian Federation establishes rules other than those provided for by this Federal Law in the field of health protection, the rules of the international treaty shall apply.

Principles of health protection in the Russian Federation. The main ways of organizing health care.

Basic principles of health care in the Russian Federation:

1) The responsibility of society and the state for the protection and promotion of the health of the population, the creation of a public system that integrates the activities of institutions and organizations of all forms of ownership, all forms and structures, guaranteeing the protection and strengthening of the health of the population.

2) Providing by the state and society of all citizens with publicly available, qualified medical care, free of charge for its main types.

3) Preservation and development of social and preventive directions for the protection and strengthening of health care on the basis of sanitary and hygienic, anti-epidemic, social and individual measures, the formation of a healthy lifestyle, the protection and reproduction of healthy health - sanology (valeology).

4) Personal responsibility for your own health and the health of others.

5) Integration of health protection in a set of measures for protection, environmental protection, environmental policy, demographic policy, resource-saving, resource-protection policy.

6) Preservation and development of planning in accordance with the goals and objectives of the development of society and the state, health care strategies as a branch of the state and functions of society based on an interdisciplinary approach.

7) Integration of science and practice of healthcare. Use of scientific achievements in healthcare practice.

8) Development of amateur medical activity - participation of the population in health protection.

9) Protection and improvement of health as an international task, a global problem, a sphere of international cooperation.

10) Humanism of the medical profession, compliance with the norms and rules of medical ethics and medical deontology.

Federal Law “On Compulsory Medical Insurance in the Russian Federation” (2010), main provisions.

Article 1. Subject of regulation of this Federal Law

This Federal Law regulates relations arising in connection with the implementation of compulsory medical insurance, including determining the legal status of subjects of compulsory medical insurance and participants in compulsory medical insurance, the grounds for the emergence of their rights and obligations, guarantees for their implementation, relations and liability associated with the payment of insurance contributions to compulsory health insurance of the non-working population.

Article 2. Legal basis for compulsory health insurance

1. Legislation on compulsory health insurance is based on the Constitution of the Russian Federation and consists of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, Federal Law No. 165-FZ of July 16, 1999 "On the Fundamentals of Compulsory Social Insurance", this Federal Law, other federal laws, laws subjects of the Russian Federation. Relations related to compulsory health insurance are also regulated by other regulatory legal acts of the Russian Federation, other regulatory legal acts of the constituent entities of the Russian Federation.

2. If an international treaty of the Russian Federation establishes other rules than those provided for by this Federal Law, the rules of the international treaty of the Russian Federation shall apply.

3. For the purposes of the uniform application of this Federal Law, appropriate explanations may be issued, if necessary, in the manner established by the Government of the Russian Federation.

Article 3. Basic concepts used in this Federal Law

For the purposes of this Federal Law, the following basic concepts are used:

1) compulsory medical insurance - a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, in the event of an insured event, guarantees of free provision of medical care to the insured person at the expense of compulsory medical insurance within the territorial program of compulsory medical insurance and in the cases established by this Federal Law within the framework of the basic program of compulsory medical insurance;

2) the object of compulsory medical insurance

3) insurance risk

4) insured event

5) insurance coverage for compulsory health insurance

6) insurance premiums for compulsory health insurance - mandatory payments that are paid by insurers, have an impersonal nature and the purpose of which is to ensure the rights of the insured person to receive insurance coverage;

7) the insured person

8) basic program of compulsory medical insurance

9) territorial program of compulsory medical insurance - an integral part of the territorial program of state guarantees of free provision of medical care to citizens, which determines the rights of insured persons to free provision of medical care to them on the territory of a constituent entity of the Russian Federation and meets the uniform requirements of the basic program of compulsory medical insurance.

Article 4. Basic principles for the implementation of compulsory medical insurance

The main principles for the implementation of compulsory health insurance are:

1) ensuring, at the expense of the funds of compulsory medical insurance, guarantees of free provision of medical care to the insured person in the event of an insured event within the framework of the territorial program of compulsory medical insurance and the basic program of compulsory medical insurance (hereinafter also referred to as the compulsory medical insurance program);

2) stability of the financial system of compulsory medical insurance, ensured on the basis of the equivalence of insurance coverage to the means of compulsory medical insurance;

3) obligatory payment by insurers of insurance premiums for compulsory medical insurance in the amounts established by federal laws;

4) state guarantee of observance of the rights of insured persons to fulfill obligations under compulsory health insurance within the framework of the basic program of compulsory health insurance, regardless of the financial situation of the insurer;

5) creation of conditions for ensuring the availability and quality of medical care provided within the framework of compulsory health insurance programs;

6) parity of representation of subjects of compulsory health insurance and participants of compulsory health insurance in the management bodies of compulsory health insurance.

National project "Health". Main priorities.

The National Project "Health" is a program to improve the quality of medical care, announced by the President of the Russian Federation V.V. Putin, which started on January 1, 2006 as part of the implementation of four national projects.

Project goals[edit | edit wiki text]

Improving the health of citizens

Increasing the availability and quality of medical care

Development of primary health care

The revival of the preventive direction in health care

Providing the population with high-tech medical care

Department of Public Health and Health

Course work

by discipline: Public health and healthcare

Introduction

A sharp drop in the living standards of most Russian citizens during the years of reforms, instability in society, a decrease in the level of socially guaranteed medical care, growing unemployment, an increase in mental and emotional stress associated with a radical reform of all aspects of society, affected the health indicators of the Russian population. Almost 70% of the Russian population lives in a state of prolonged psycho-emotional and social stress, which depletes the adaptive and compensatory mechanisms that maintain people's health.

The sharp increase in the incidence of the population is primarily due to the changed living conditions. Studies show that the health of a nation is only 15% dependent on the state of the healthcare system, 20% is determined by genetic factors, 25% by ecology, and 55% by socio-economic conditions and lifestyle.

The unfavorable environmental situation has a sharp negative impact on the health of the population of Russia. About 40 million people live in cities where the concentration of harmful substances is 5-10 times higher than the maximum allowable. Only half of the country's inhabitants use water for drinking purposes that meets the requirements of the state standard. A high level of chemical and bacterial contamination of drinking water has a direct impact on the incidence of the population in many regions of the country, leading to outbreaks of intestinal infections, viral hepatitis A. When presenting a question on the topic, attention should be paid to and characterized:

1) the structure of morbidity;

2) methods for studying morbidity;

3) incidence rates in recent years

Incidence- a medical-statistical indicator that determines the totality of diseases first registered in a calendar year among the population living in a particular territory. It is one of the criteria for assessing the population.

Morbidity structure

Structure is the distribution of frequency indicators (intensity) among different population groups.

The heterogeneity of a population is characterized not only by the fact that each of its representatives has some features that distinguish it from others, but also by the fact that, for a number of reasons, it is possible to unite a certain number of people into groups.

One group includes persons who have the same type or more or less similar indicators either in biological or social, or sometimes natural factors. For example, the population is divided into children and adults, since there is a fundamental difference between these groups in a number of indicators, while at the same time, a number of characteristics uniting them are noted within the groups.

So, children, due to the lack of immunity or its insufficiency, suffer from so-called childhood infections (rubella, chickenpox, etc.), adults are more likely to suffer from malignant neoplasms and cardiovascular diseases. Livestock workers, unlike other populations, constitute a group of people who are at great risk of suffering from zoonotic infections, etc.

Morbidity assessment, taking into account a well-thought-out structural distribution, is of great importance for selecting the most vulnerable groups of the population, the so-called risk groups, and implementing generally accepted priority measures in the fight against morbidity in the most affected group; in addition, at the analytical stage, the assessment of the structural distribution of morbidity is of decisive diagnostic importance, since it becomes possible to conduct comparative studies.

It must be borne in mind that there is a standard scale of structural differentiation, based on the accumulated experience of anti-epidemic work, which is mandatory in all territories (administrative units), - without this, it is impossible to compare, compare different populations of the country (living in different regions, in cities and villages, in places with different social, ecological and natural characteristics).

But along with this, taking into account the specific characteristics of the population, it is possible (necessary) to divide into some groups specific to this population that reflect their particular characteristics. So, for example, the founder of population analytical studies, J. Snow, in order to clarify and prove the role of water in the spread of cholera, divided the population of London according to the principle of providing water by two different water companies, which differed in the place where water was taken from the River Thames upstream of the city and downstream at the place of drains . After the accident at the Chernobyl nuclear power plant, the population that found itself in the area of ​​the radioactive cloud was differentiated according to the radiation dose and the degree of radioactive contamination of their places of residence.

Epidemiologists studying cardiovascular pathology, phthisiatricians, obstetricians dealing with the problem of neonatal infant mortality, etc. have their own system of structural division of the population.

Morbidity study methods 1. Solid 2. Selective Solid- acceptable for operational purposes . Selective- used to identify the relationship between morbidity and environmental factors. The sampling method was used during the census years. An example of it is the study of morbidity in a separate area. The choice of method for studying the incidence of the population in a particular territory or its individual groups is determined by the purpose and objectives of the study. Indicative information about the levels, structure and dynamics of morbidity can be obtained from the reports of medical institutions and reports from the central administration using the continuous method. Identification of patterns, morbidity, relationships is possible only with a selective method by copying passport and medical data from primary accounting documents onto a statistical card. When assessing the level, structure and dynamics of the incidence of the population and its individual groups, it is recommended to compare with the indicators for the Russian Federation, city, district, region. The unit of observation in the study of general morbidity is the initial appeal of the patient in the current calendar year about the disease.

Incidence rates in recent years

Morbidity of the population by main classes of diseases in 2002 - 2009
(registered patients with a diagnosis established for the first time in their lives)
(Data of the Ministry of Health and Social Development of Russia, Rosstat calculation)
	Total, thousand people
All diseases
neoplasms
diseases of the nervous system
diseases of the circulatory system
respiratory diseases
diseases of the digestive system
diseases of the genitourinary system
complications of pregnancy, childbirth and the postpartum period
Per 1000 population
All diseases
neoplasms
diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism
diseases of the endocrine system, eating disorders and metabolic disorders
diseases of the nervous system
diseases of the eye and its adnexa
diseases of the ear and mastoid process
diseases of the circulatory system
respiratory diseases
diseases of the digestive system
diseases of the skin and subcutaneous tissue
diseases of the musculoskeletal system and connective tissue
diseases of the genitourinary system
complications of pregnancy, childbirth and the postpartum period 1)
congenital anomalies (malformations), deformities and chromosomal abnormalities
injuries, poisoning and some other consequences of external causes
1) Per 1000 women aged 15-49.

1. Current trends in the incidence of the population of Russia

The level of general morbidity, per 1000 of the population of the corresponding age, tends to increase over the past years. An increase in morbidity rates is observed in almost all classes of diseases. The structure of morbidity in adults: 1st place - diseases of the circulatory system; respiratory diseases (in adolescents - 42.6%, in children - 58.6%); 2nd place in adults - diseases of the respiratory system (15.9%), in adolescents - injuries and poisoning (6.5%), in children - diseases of the genitourinary system - (5%); 3rd place - in adults - diseases of the genitourinary system, in adolescents - diseases of the eye (6.7%), in children - injuries (4.1%).

Prevention and treatment of diseases of the circulatory system is currently one of the priority health problems. This is due to the significant losses that these diseases cause in connection with mortality and disability. Cardiovascular diseases cause a high level of mortality and disability of the population. The share of diseases of the cardiovascular system in the structure of causes of total mortality accounts for more than half (55%) of all deaths, disability (48.4%), temporary disability (11.6%). About 7.2 million people suffering from arterial hypertension are currently registered in the Russian Federation, of which 2.5 million patients have complications in the form of coronary heart disease and 2.1 million patients in the form of cerebrovascular diseases. However, according to experts, arterial hypertension affects 25-30% of the population, i.e. more than 40 million people.

Every year, about 500 thousand patients are registered for the first time, in which arterial hypertension is the leading or concomitant disease; 26.5% of patients under dispensary observation for diseases of the circulatory system suffer from this disease. Of particular concern is the high prevalence of arterial hypertension in people of young and working age. The unfavorable situation is aggravated by the insufficient work of health authorities and institutions to reduce the prevalence of arterial hypertension. Late diagnosis and ineffective treatment lead to the development of severe forms of arterial hypertension and related cardiovascular diseases, requiring specialized cardiac care.

A significant increase in prices for imported medical equipment and many vital drugs have made them difficult to access for medical institutions and the general population. The level of sanitary-educational work among the population is very low. There is practically no promotion of a healthy lifestyle in the media, there is no information about the harmful effects of risk factors for cardiovascular diseases and methods for their correction. Insufficient awareness of the population about the causes, early manifestations and consequences of arterial hypertension leads to the lack of motivation in most people to maintain and improve their health, including the control of blood pressure.

There is no system for monitoring and evaluating risk factors for arterial hypertension and mortality from its complications. A similar pattern persists in acute myocardial infarction. In the structure of general morbidity, diseases of the circulatory system took first place. Almost 1.5 times increased the incidence of arterial hypertension. There is also a slight increase in the incidence of angina pectoris. Several categories of diseases determine the neurological morbidity of the population. These primarily include vascular diseases of the brain, diseases of the peripheral nervous system, traumatic brain injury. Vascular diseases of the brain, due to their significant prevalence and severe consequences, occupy one of the first places in the structure of general mortality of the population. According to statistics, the frequency of these diseases is 80.6 per 1000 population. Mortality in the acute stage of diseases is 20.8%. The mortality rate from cerebrovascular diseases is one of the highest in the world, and there is no downward trend. At the same time, in many economically developed countries of the world, over the past 15-20 years, there has been a steady decline in mortality from cerebrovascular diseases. Among the most important reasons for this phenomenon, experts attribute successes in the active detection and treatment of arterial hypertension on a national scale, and favorable changes in the lifestyle and nutrition of the population of these countries carried out at the state level.

2. Growth of diseases of the circulatory system per 1000 population

In Russia, the last 25 years have been characterized by the rapid spread of infectious, allergic diseases of the respiratory system, environmentally caused lung diseases, which is reflected in the original WHO documents. According to experts, the 21st century will become the century of pulmonary pathology due to dramatic changes in the environment, and this group of diseases will share the first places with the pathology of the cardiovascular system and neoplasms. Studies carried out in Russia show that more than 25% of patients visit general practitioners every day, with diseases of the respiratory system, mainly of the upper section. The prevalence of respiratory tract pathology is global in nature and occupies one of the leading places in the structure of morbidity by classes and groups of diseases.

The incidence of respiratory organs due to the vastness of the territory of the Russian Federation depends on the geographical location of the subject of the Federation. According to environmental monitoring in 282 cities of Russia, the average annual concentrations of dust, ammonia, hydrogen fluoride, nitrogen dioxide, soot and other technical substances exceed the maximum allowable concentrations by 2-3 times. With an increase in the concentration of several studied pollutants, the level of increase in the risk of disease on average increases by 18-20% for respiratory diseases and by 6-22% for malignant tumors.

Among lung diseases, chronic bronchitis and emphysema occupy an important place, while the growth trend of this pathology attracts attention, although disturbed by fluctuations associated with influenza epidemics. Probably, this trend can be explained by an increase in the proportion of older people in the population, the number of smokers.

The level of diseases of the endocrine system and eating disorders has sharply increased.

An acute medical and social problem that requires radical measures from the state to organize modern diagnostic and therapeutic care is diabetes mellitus. In recent years, the number of patients with diabetes mellitus in the Russian Federation has increased dramatically. The Register showed that the prevalence of insulin-dependent diabetes mellitus among the child population is 0.7, the incidence is 0.1 per 1000 child population; among the adolescent population 1.2 and 1.0 per 1000; among the adult population - 2.2 and 0.1 per 1000.

4. Diseases of the endocrine system, eating disorders and metabolic disorders per 1000 population

The indicators of the epidemic situation in tuberculosis remain tense. In the Russian Federation, there is an unfavorable situation in terms of the incidence of tuberculosis among the population. Taking into account the significant number of sources of tuberculosis infection among the population, the increase in the number of infected people, the spread of drug-resistant forms of tuberculosis, the state of the material base of the TB service, the social problems of society, as well as the impact of economic instability on the standard of living of the population and on the financing of anti-TB programs, an increase is predicted in the coming years. tuberculosis morbidity and mortality rates. The value and rate of growth of these indicators will depend on the timeliness and effectiveness of ongoing anti-tuberculosis activities at all levels.

In 2008, 120,021 cases of newly diagnosed active tuberculosis were registered (in 2007 - 117,738 cases). The incidence rate of tuberculosis was 84.45 per 100 thousand of the population (in 2007 - 82.8 per 100 thousand) and 2.5 times higher than the incidence rate before its growth in 1989 (33.0 per 100 thousand . population). The incidence of tuberculosis in the rural population is higher - 90.84 per 100 thousand rural residents.

In 2008, 3155 children under the age of 14 fell ill with active newly diagnosed tuberculosis (3372 children in 2007); the incidence rate of the child population on average in the country amounted to 15.13 per 100 thousand of this age group (2007 - 16.01). Among children under the age of one year, the incidence was 6.92 per 100 thousand of this age group, in children 1-2 years old - 13.34 per 100 thousand, 3-6 years old - 21.5.

The incidence is high among adolescents 15-17 years old. The national average tuberculosis incidence rate in this age group was 33.85 per 100,000 in 2008 (33.5 in 2007). According to preliminary data from the Tuberculosis Monitoring Center, the death rate from tuberculosis in 2008 was 16.6 per 100,000 population (2007 - 18.4, 2006 - 20.0).

The prevalence (morbidity) of all forms of tuberculosis is almost 2.1 times higher than the incidence rate. The death rate from tuberculosis has been declining over the past five years. Indicators characterizing the organization of detection and dispensary observation of patients with tuberculosis have stabilized. The decline in the effectiveness of treatment of patients with tuberculosis has stopped. The highest incidence of tuberculosis in 2009 took place in Primorsky Krai, the Republic of Tyva and the Jewish Autonomous Region (2.8-2.3 times higher than the average for Russia), the Republic of Buryatia, Omsk, Kemerovo, Amur Regions, Khabarovsk Territory, Irkutsk Region and Altai Territory ( 2.0-1.6 times higher). Malignant neoplasms remain one of the most difficult problems in medicine and public health.

5. Growth of neoplasms per 1000 population

According to official statistics, every fifth inhabitant of Russia falls ill during the life of one of the forms of malignant tumors. In 2006, the incidence of malignant neoplasms continued to grow. In 2006, the incidence was 418.5 per 100 thousand. population against 382.6 per 100 thousand in 2002. At the same time, some indicators of the state of oncological care are deteriorating: low detection rate during preventive examinations -11.8% in 2005, the proportion of actively detected tumors of visual localizations is decreasing; morphological verification of the diagnosis was 80.7% in 2006; remains higher than the Russian such indicator as mortality in the 1st year from the date of diagnosis - 33.2 in 2005; mortality from malignant neoplasms in 2006 was 232.8 per 100 thousand. population (in 2002 - 220.8 per 100 thousand). The structure of morbidity is dominated by skin cancer (12.9%); cancer of the trachea, bronchi, lungs (11.9%); stomach cancer (10.7%); breast cancer (10.4%). With a relatively favorable situation in the country as a whole, in a number of subjects of the Russian Federation in 2009. remained significant incidence of syphilis. Thus, in the Republic of Tyva it was 6.8 times higher than the national average.

High rates of syphilis incidence were observed in the Jewish Autonomous Region, the Republic of Khakassia, the Amur Region and the Trans-Baikal Territory (3.2-2.7 times higher), the Republic of Altai, the Irkutsk Region, the Republic of Buryatia, Kemerovo and Sakhalin Regions (2.4-2.7 times higher). 1.9 times higher). In 2008, 611,634 cases of sexually transmitted infections (STIs) were registered, which amounted to 403.5 per 100,000 population. In the structure of STI incidence, syphilis accounted for 13.9%, gonococcal infection - 13.1%. The predominant part, as in previous years, was trichomoniasis (38.9%) and chlamydial infection (20.8%), the smallest - viral STIs (genital herpes - 5.3%, anogenital warts - 8.0%). Relative to 1997, the number of STI patients decreased by 3.2 times.

Over the past three years, in Russia as a whole, there has been a decrease in the number of patients with STIs, including syphilis - by 8.7%, gonococcal infection - by 12.0%, chlamydial infection - by 8.4%%, trichomoniasis - by 16.5% %, genital herpes - by 3.0%, anogenital warts - an increase of 2.0%. The incidence of syphilis in Russia was not stable and changed over the years. The most intensive growth of morbidity rates was noted in the early 1990s. of the 20th century, the level of which during this period was more than twice as high as the pre-war level. The maximum incidence rates were noted in 1997 (277.3 per 100,000 population).

In 2009 13,995 people were registered with a disease caused by the human immunodeficiency virus (HIV), and 34,992 people with asymptomatic infectious status caused by the human immunodeficiency virus (HIV), including children aged 0-17 years - 399 people and 703 people, respectively. More than half (60.0%) of all identified patients with HIV infection were registered in 10 regions of the Russian Federation: in St. Petersburg, Chelyabinsk, Nizhny Novgorod, Ulyanovsk regions, Primorsky Krai, Rostov, Omsk, Sverdlovsk, Irkutsk regions and Perm Krai.

The average Russian prevalence rate of alcoholism (including alcoholic psychosis - AP) in 2005 was 1650.1 patients per 100,000 population, or about 1.7% of its total population. The dynamics of this indicator over the past 5 years has been stable: the average annual increase of the indicator was 0.4%, the total increase over the past 5 years was 2.0% (Fig. 1). The prevalence of alcoholic psychoses (AP) had a more pronounced upward trend, increasing by an average of 4.5% per year. Over the past 5 years, it has increased from 75.1 patients per 100,000 population in 2000 to 93.6 in 2005, or by 24.7%.

"Leader" in the prevalence of alcoholism in 2005 was the Magadan region - 5409.2 patients per 100,000 population, or 5.4% of its total population. High rates were noted in the Sakhalin region - 4433.0, Chukotka Autonomous Okrug - 3930.4, Novgorod - 2971.6, Ivanovo regions - 3157.4, Republic of Karelia - 2922.1, Kamchatka - 2850.8, Nizhny Novgorod - 2545.5 , Lipetsk - 2585.3, Bryansk - 2615.8, Kostroma regions - 2508.1. The prevalence of alcoholism is especially high (over 5% of the population) in the Koryak (5633.6) and Nenets - (5258.1) autonomous districts. The lowest rates were noted in Ingushetia - 15.8 patients per 100,000 population (104 times lower than the national average) and Dagestan - 363.3 per 100,000 population. The highest incidence of alcoholism in 2005 was observed in the Chukotka Autonomous Okrug - 846 per 100,000 population, or 0.8% of the total population of this district. High rates were recorded in Magadan - 575.9, Sakhalin - 615.9, Irkutsk - 322.7, Bryansk - 242.5, Perm - 240.7, Novgorod - 242.3, Ivanovo - 249.4 regions, as well as in republics - Karelia - 239.2, Yakutia - 303.6, Komi - 249.5. High rates were noted in most autonomous districts: Taimyr, Komi-Permyatsky, Evenki, Koryaksky, Nenets.

On the territory of the Russian Federation in 2009. compared to 2008 The epidemiological situation was characterized by a certain increase in the incidence of a number of infectious diseases among the population, including: acute intestinal infections, certain socially significant diseases, whooping cough, acute respiratory viral infections.

In December 2009 2 cases of measles were registered, no cases of diphtheria were registered (for the same month in 2008 - 3 cases of diphtheria, no cases of measles were registered). Compared to the corresponding month of 2008 9.7% more patients with the disease caused by the human immunodeficiency virus were detected, 1.6 times more - with acute infections of the upper respiratory tract, 76.3 times more - with influenza.

Among those infected with infectious diseases in 2009. children aged 0-17 years were: hepatitis A - 48.6%, mumps - 56.4%, acute intestinal infections - 66.1%, infectious meningitis - 73.1%, rubella - 76.8%, whooping cough - 97.1%.

There is a deterioration in maternal and especially children's health. A strict correlation is known between a decrease in the health of women, especially pregnant women, and an increase in the probability of giving birth to already sick children. More than a third of pregnant women (35.8%) suffered from anemia and almost a third (31.3%) of children were born already sick.

The most common complications of pregnancy are: maternal and fetal anemia, fetal underdevelopment, ectopic pregnancy, toxicosis of pregnant women, abortion, various pathological conditions of the placenta, hemolytic disease of the fetus and newborn.

It should be noted that in most cases, competent monitoring of pregnancy and the provision of timely assistance to a pregnant woman can either prevent the development of complications or significantly alleviate their course.

7. Complications of pregnancy, childbirth and the postpartum period per 1000 women aged 15-49 years.

Attendance to psychologists during the crisis increased by 20 percent. Over 70% of the population of the Russian Federation lives in a state of prolonged psycho-emotional and social stress, causing an increase in depression, reactive psychoses, severe neurosis and psychosomatic disorders, a number of internal diseases, mental breakdowns, alcoholism and drug addiction, antisocial outbreaks in individuals, which increases the risk of inadequate mass destructive reactions. and explosions among the population. The number of patients with schizophrenia in Russia exceeds 500 thousand people, in Moscow there are 60 thousand of them. At the same time, 60% of such people (300 thousand) are disabled, their illness is accompanied by severe hallucinations and delusions. With the development of world civilization, the stresses that a person experiences are intensifying, and it becomes more difficult to cope with them, psychiatrists say. The human brain does not keep up with rapidly changing technologies - it develops more slowly. In addition, the risks of emergencies have recently increased all over the world, the aging of humanity as a whole is taking place, and in old age the appearance of mental disorders is possible 5-7 times more often than at a young age. In the occurrence of schizophrenia, the leading role is assigned to the genetic factor, but under negative social conditions, stress, the risk of this disease increases. Psychiatrists say that there are more schizophrenics in cities than in villages and villages. All these negative factors, according to psychiatrists, can lead to an increase in all mental disorders, including schizophrenia, in less than 20 years.

8. Diseases of the nervous system

Analysis of federal reports for 2005-2008. on the composition of patients discharged from the hospital showed that, on average, the share of injuries, poisonings and some other consequences of external causes ranges from 7.7% to 8.1% in the total structure of hospital morbidity. In addition, on average, the proportion of undifferentiated diagnoses in the structure of this class of diseases ranges from 58.8% to 63.2% over this period. This does not mean that diseases are not clinically identified. The very structure of the reporting form does not allow to recognize which nosological forms cannot be subjected to statistical analysis. According to federal statistical reporting, fractures were the cause of hospitalization for this class of diseases in dynamics from 24.2% to 27.1% with a noticeable decrease in this indicator in 2008.

Poisonings occupy the second position, and their share ranges from 7.8% to 9.8% with a noticeable decrease in this indicator in 2008. The share of thermal and chemical burns in dynamics ranges from 4.2% to 4.8% of hospitalizations. It should be noted that hospital mortality from diseases in the category "Injury, poisoning and some other consequences of external causes" has a dynamic tendency to decrease annually. This decrease in mortality in the Russian Federation is not significant and currently amounts to 0.1% annually.

9. Injuries, poisoning and some other consequences of external causes

Conclusion

Summing up the consideration of the incidence of the population of Russia, it is necessary to note the deterioration in the quality of public health. This deterioration is expressed in an increase in the number of such severe chronic diseases as hypertension, coronary heart disease, angina pectoris, myocardial infarction, oncological pathology, and diseases of the genitourinary system. One of the most serious reasons for the current situation is the aging of the population and the burden of difficult events of the recent and distant past, causing many, especially the elderly, periodically occurring emotional stress. The result of these complex events is an increase in diseases of the elderly and senile age. The same is true for the increase in disability.

To reduce the incidence of diseases, as well as mortality from them, due to exposure to polluted atmospheric air, first of all, it is necessary to take measures to reduce emissions from vehicles and power plants.

The development of the national project "Health" had a significant impact on the demographic situation in the country. In two years, the birth rate increased by 11%, while the death rate of the population decreased by 9%. However, the negative trends in Russia's population decline will continue for the time being, and it will take many more years to overcome this demographic trend. Thus, modern pathology testifies to the many manifestations and forms of morbidity in the population, which can lead to a decrease in labor and intellectual potential, to significant restrictions on the biological and social functions of certain groups of the population, including their participation in improving the socio-economic situation in the country. A more active orientation of the entire medical care service to these new manifestations in the nature of the morbidity of the population is needed. In order to ensure sustainable socio-economic development of the Russian Federation, one of the priorities of state policy should be to preserve and strengthen the health of the population through the formation of a healthy lifestyle and increasing the availability and quality of medical care.

References

1. Trauma. Russian encyclopedia of labor protection.

2. International classifier of diseases ICD-10. Electronic version.

3. Website of the Federal State Statistics Service

4. Health of the population of Russia and the activities of health care institutions in 2001: Statistical materials. M.: Ministry of Health of the Russian Federation, 2002.

5. Medvedev S.Yu., Perelman M.I. Tuberculosis in Russia. "Tuberculosis and vaccine prevention", No. 1 January-February 2002

6. Application of methods of statistical analysis for the study of public health and health care, ed. Corresponding Member RAMS prof. V.Z. Kucherenko. GEOTAR-Medicine. 2006

7. Lisitsyn Yu.P. Public health and health care: Textbook for students of medical universities - M .: GEOTAR - Media, 2007.

eight. . Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens. - M., 1993 (additional 2005).

Public health and health care as a science and subject of teaching.Basic methods of the science of public health and health care.

1 question. Public health and health care as a science and subject of teaching.

Public health and healthcare as an independent medical science studies the impact of social conditions and environmental factors on the health of the population in order to develop preventive measures for its improvement and improvement of medical care.

Unlike clinical disciplines, public health studies the state of health not of individuals, but of collectives, social groups and society as a whole in connection with the conditions and lifestyle. At the same time, living conditions and production relations, as a rule, are decisive.

Public health reveals the patterns of population development, examines demographic processes, predicts the future, and develops recommendations for state regulation of the population.

The leading importance in the study of this discipline is the question of the effectiveness of the impact on the health of the population of the activities carried out by the state, the role of health care, individual medical institutions in this.

Medicine is based on two basic concepts - "health" and "disease". In modern literature, there are a large number of definitions and approaches to the concept of "health".

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

In medical and social studies, when assessing health, it is advisable to distinguish four levels:

Level 1 - the health of an individual - individual health;

Level 2 - health of social and ethnic groups - group health;

Level 3 - health of the population of administrative territories - regional health;

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

According to WHO experts, in medical statistics, health at the individual level is understood as the absence of identified disorders and diseases, and at the population level - the process of reducing mortality, morbidity and disability, increasing the perceived level of health.

Human health can be considered in various aspects: socio-biological, socio-political, economic, moral and aesthetic, psychophysical, etc. Therefore, terms are now widely used that reflect only one facet of the population's health - "mental health", "reproductive health", "general somatic health", etc. Or - the health of a separate demographic or social group - "health of pregnant women", "health of children", etc.

Currently, there are very few indicators that would objectively reflect the quantity, quality and composition of public health. A search and development of integral indicators and indices for assessing the health of the population is underway. WHO believes that these indicators should have the following qualities:

1. Availability of data. It should be possible to obtain the required data without complex special studies.

2. Completeness. The indicator should be derived from data covering the entire population for which it is intended.

3. Quality. National (or territorial) data should not change over time and space in such a way that the indicator is significantly affected.

4. Versatility. The indicator, if possible, should be a reflection of a group of factors that are identified and affect the level of health.

5. Computability. The indicator should be calculated in the simplest and least expensive way possible.

6. Acceptability (interpretability). There should be acceptable methods for calculating the indicator and its interpretation.

7. Reproducibility. When using the health indicator by different specialists in different conditions and at different times, the results should be identical.

8. Specificity. An indicator should reflect changes only in those phenomena, the expression of which it serves.

9. Sensitivity. The indicator of health should be sensitive to changes in relevant phenomena.

10. Validity. An indicator must be a true expression of the factors it measures.

11. Representativeness. The indicator should be representative in reflecting changes in the health of populations identified for management purposes.

12. Hierarchy. The indicator should be constructed according to a single principle for different hierarchical levels allocated in the studied population for the considered diseases, their stages and consequences.

13. Target viability. The health indicator should adequately reflect the goals of maintaining and developing (improving) health and encourage society to find the most effective ways to achieve these goals.

In medico-social research for the quantitative assessment of group, regional and public health in Russia, it is traditionally customary to use the following indicators: 1. Demographic indicators. 2. Morbidity. 3. Disability. 4. Physical development.

1. Deduction of the gross national product for health care.

2. Availability of primary medical and social assistance.

3. Coverage of the population with medical care.

4. The level of immunization of the population.

5. The degree of examination of pregnant women by qualified personnel.

6. Nutritional status of children.

7. Child mortality rate.

8. Average life expectancy.

9. Hygienic literacy of the population.

From the point of view of the general classification of sciences, public health is on the border between natural science and social sciences, that is, it uses the methods and achievements of both groups. From the point of view of the classification of medical sciences, public health seeks to fill the gap between the groups of clinical (curative) and preventive (hygienic) sciences. Public health provides a general picture of the state and dynamics of the health and reproduction of the population and the factors that determine them.

The methodological basis of public health as a science is the study and correct interpretation of the causes and relationships between the state of health of the population and social relations.

The socio-hygienic factors affecting public health include: working and living conditions, housing conditions; wages, culture and upbringing, nutrition, family relations, quality and accessibility of medical care.

Public health is also influenced by climatic, geographical, hydrometeorological factors of the external environment.

A significant part of these conditions can be changed by society itself, and their impact on the health of the population can be both negative and positive.

2 question. public health methods.

one). Statistical method - the basic method of the social sciences. It allows you to establish and objectively evaluate the ongoing changes in the state of health of the population and determine the effectiveness of the activities of health authorities and institutions, it is widely used in medical research (hygienic, physiological, biochemical, clinical, etc.).

2). Method of expert assessments serves as a complement to the statistical one. Its main task is to indirectly determine the correction factors, because public health uses quantitative measurements, applying statistics and epidemiological methods. This allows you to make forecasts based on previously formulated regularities, for example, forecasts of fertility, population, mortality, etc.

3). historical method is based on the study and analysis of the processes of public health and healthcare at various stages of history. This is a descriptive method.

4). Method of economic research makes it possible to establish the impact of the economy on health care and health care on the economy. For this, methods are used that are used in economic sciences in the study and development of such issues as accounting, planning, financing, healthcare management, rational use of material resources, scientific organization of labor in healthcare bodies and institutions.

5). experimental method is a method of searching for new, most rational forms and methods of work, creating models of medical care, introducing best practices, testing projects, hypotheses, creating experimental bases, medical centers, etc.

In public health, the experiment cannot be used frequently because of the administrative and legislative difficulties associated with it.

6). Modeling method develops in the field of healthcare organization, and consists in creating organization models for experimental verification. Depending on the goals and problems, the models vary considerably in scope and organization, they are temporary or permanent.

7). Method of observation and interrogation - used to supplement and deepen the data, with the help of special studies. For example, to obtain more complete data on the incidence of persons of certain professions, they use the results obtained during medical examinations. To identify the nature and extent of the influence of socio-hygienic conditions on morbidity or mortality, survey methods (interview, questionnaire method) of individuals, families or groups under a special program can be used.

eight). epidemiological method. An important place among epidemiological research methods is occupied by epidemiological analysis, which is a set of methods for studying the characteristics of the epidemic process in order to find out the reasons that contribute to the spread of this phenomenon in a given territory and develop practical recommendations for its optimization. From the point of view of public health methodology, epidemiology is applied medical statistics, which in this case acts as the main, largely specific, method.

The use of epidemiological methods on large populations makes it possible to distinguish various components of epidemiology: clinical epidemiology, environmental epidemiology, epidemiology of noncommunicable diseases, epidemiology of infectious diseases, etc. In public health, allocate epidemiology of public health indicators.

STATE BUDGET EDUCATIONAL INSTITUTION

HIGHER PROFESSIONAL EDUCATION

“KRASNOYARSK STATE MEDICAL UNIVERSITY named after Professor V.F. Voyno-Yasenetsky"

MINISTRIES 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 the CMC meeting

Protocol number …………….

"___" ____________ 2015

Chairman of the CMC Nursing

………………Cheremisina A.A.

Compiled by:

………… Korman Ya.V.

Krasnoyarsk 2015

Lecture 1

Subject. 1.1. Public health and health care as a scientific discipline

Lecture plan:

1. Public health and health care as a scientific discipline about the laws 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 policy. Legislative base of the industry. Health problems in the most important socio-political, state documents (Constitution of the Russian Federation, Legislative acts, decisions, resolutions, etc.).

3. Health care as a system of measures to preserve, strengthen and restore the health of the population. The main directions of health care reform.

Information block:

Public health and health care as a scientific discipline about the laws of public health, the impact of social conditions and environmental factors, lifestyle on health, ways to protect and improve it. Correlation between social and biological in medicine. Basic theoretical concepts of medicine and health care.

The role of the discipline "Public Health and Health Care" in the practice of a dentist, health authorities and institutions, in planning, management, and organization of work in health care. The main methods of studying the discipline: statistical, historical, experimental, sociological, economic and mathematical, modeling, method of expert assessments, epidemiological, etc.

The emergence and development of social hygiene and the organization of health care (public medicine) in foreign countries and in Russia.

Problems of social policy in the country. Fundamentals of domestic health policy. Legislative base of the industry. Health problems in the most important socio-political, state documents (Constitution of the Russian Federation, Legislative acts, decisions, resolutions, etc.). Health care as a system of measures to preserve, strengthen and restore the health of the population. The main directions of health care reform.

Theoretical aspects of medical ethics and medical deontology. Ethical and deontological traditions of Russian medicine. Bioethics in the work of a dentist: the procedure for applying new methods of prevention, diagnosis and treatment, conducting biomedical research, etc.

Health as an object of 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 affiliation).

Health of the population by belonging to an administrative-territorial unit (population of a city, village, district).

Public health - the health of society, the population as a whole (state, global scale).

1. Definition of the concept - the health of the individual.

The constitution of the World Health Organization (WHO) includes the definition of health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

For practical use, we will use the definition of health as a human condition that has physical, psychological and social parameters, each of which can be represented as a continuum with positive and negative poles.

The positive pole (good health) is characterized by the ability to withstand the effects of adverse factors, and the negative pole (poor health) is characterized by morbidity and mortality.

Individual health is assessed according to subjective (well-being, self-esteem) and objective (deviation from the norm, severe heredity, genetic risk, reserve capacity, 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 ill for a year or rarely go to the doctor without losing their ability to work);

group 2 - practically healthy individuals with functional and some morphological changes or rarely sick 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 condition);

Group 5 - patients with exacerbation of long-term diseases (subcompensated condition).

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 the potential of society that contributes to ensuring national security.

Population health is a medical, demographic and social category that reflects the physical, mental, social well-being of people who carry out their life activities within certain social communities.

The basis for assessing the state of public health is accounting and analysis of:

The number of cases of diseases, injuries and poisonings detected for the first time or exacerbated cases of chronic pathology;

The number of disabled people for the first time established and all registered;

Number of deaths;

Data of physical development.

3. Factors that determine the health of the population.

Risk factors are behavioral, biological, genetic, environmental, social, environmental and occupational factors that are potentially hazardous to health and increase the likelihood of developing diseases, their progression and poor outcome.

Unlike the immediate causes of the onset and development of diseases, risk factors create an unfavorable background, i.e. contribute to the onset and development of the disease. However, it should be noted that these categories are closely related to each other.

Yu.P. Lisitsin (1989) determined that the influence of factors determining health correlates in the following proportion:

Lifestyle accounts for 50-55%;

On internal hereditary biological factors (predisposition to hereditary diseases) - 18-22%;

On environmental factors (pollution of air, water, soil with carcinogenic and other harmful substances, a sharp change in atmospheric phenomena, radiation, geographical location) - 17-20%;

The level of development of the WA (providing the population with medicines, the quality and timeliness of medical care, the development of the material and technical base, the implementation of preventive measures) is 8-12 percent.

3.1. Lifestyle is the main factor that determines health.

The way of life is qualified as a system of the most essential, typical characteristics of the mode 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 the productive forces and production relations.

Lifestyle summarizes and includes four categories: economic - "standard of living", sociological - "quality of life", socio-psychological - "lifestyle" and socio-economic - "way of life".

1. The way of life is the conditions in which people live (social and cultural life, life, work).

2. Lifestyle - individual characteristics of 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. The quality of life (QOL) concept is multidimensional in its basis, multifactorial and in a broad sense is defined as the degree of the possibility of realizing the material and spiritual needs of a person.
According to the definition of the Ministry of Health of the Russian Federation, the quality of life is a category that includes a combination of life support conditions and health status, allowing to achieve physical, mental and social well-being and self-realization.
Definition by 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 for well-being and self-fulfillment are provided.