Development of the doctrine of public health and health care. History of the development of public health
public health and health care as a science and subject of teaching (definition, objectives, principles, methods).
The name of the discipline “Public Health and Health Care”, in contrast to the old established disciplines: therapy, surgery, hygiene, pediatrics, obstetrics and gynecology, etc., has undergone changes since the formation and development of the discipline. In the historical aspect, the following terms were used to refer to the subject: "Social hygiene", "Social hygiene and organization of health care", "Theory and organization of health care", "Medical sociology", "Sociology of medicine", "Public health", "Public health". Since 2000, the discipline has become known as "Public Health and Health".
This situation can be explained by the peculiarities of the subject itself, its structure, tasks, history, and most importantly, the place that it occupies in medicine, being an example of complexity, a combination of theory and practice of healing, prevention, social diagnostics, rehabilitation, sociology, social psychology and anthropology. , statistics, general hygiene, as well as a number of other sciences, disciplines and problems of natural science and human science.
This subject should be more in line with the development of the social policy of society and the state, social programs. And here, only through hygienic approaches, although they are very important, will not solve the problem of protecting, protecting and increasing public health and healthcare. We need decisions concerning all aspects of social policy in the field of health, decisions of a strategic nature. And discipline, more than anything else, is designed to help accomplish these tasks. It is essentially the science of the strategy and tactics of health care, since, based on public health research, it develops proposals for organizational, medical social character aimed at raising the level of public health and the quality of medical care. We are talking about science, about strategy also because the only goal of the healthcare strategy is to improve the level of health and medical care based on the rational use of forces, means and resources, material and other capabilities of society and the state and its healthcare system. But it is the development of proposals to achieve this goal that meets the purpose of the subject.
So, the subject, our science, discipline is studying the patterns of public health and healthcare in order to develop scientifically based proposals of a strategic and tactical nature to protect and improve the level of public health and the quality of medical care. social assistance. The subject is not limited to just one discipline - it extends to the whole of medicine, the whole business of health care. Indeed, it is difficult today to imagine therapists, pediatricians, surgeons, psychiatrists and other physicians who would not be involved in assessing the health of their patients, organizing medical care, prevention, medical examinations, examining quality, working capacity, etc. in their work, as part of their specialties, i.e. particular questions of our discipline. Our science, our subject, like others, can be divided into two sections - one focuses on solving predominantly general strategic problems of protecting and improving health, health care, the other - private, mainly tactical, specialized.
The rapid growth in the development of medical science has armed physicians with new, modern methods of diagnosing complex diseases and effective means of treatment. All this simultaneously requires the development of new organizational forms, conditions, and sometimes the creation of completely new, previously non-existent, medical institutions. There is a need to change the management system of medical institutions, the placement of medical personnel; there is a need to revise regulatory framework health care, expanding the autonomy of heads of medical institutions and the rights of a doctor. As a consequence of all that has been said, conditions are being created for revising the economic problems of healthcare, the introduction of intradepartmental cost 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 health care.
The unity of the theory and practice of domestic health care has found its expression in the unity of theoretical and practical tasks, methodical methods of public health and organization of health care.
Thus, the question of studying the effectiveness of the impact on the health of the population of all measures taken by the state, and the role of healthcare and individual medical institutions in this, i.e. this discipline reveals the significance of the entire socio-economic life of the country and determines ways to improve the medical care of the population.
Objectives of the subject Public health and health care:
study of the health status of the population and the impact of social conditions on it, development of methodology and methods for studying the health of the population;
theoretical substantiation of state policy in the field of healthcare, development and practical implementation of healthcare principles;
research and development for the practice of health care of organizational forms and methods of medical care for the population and management of health care that correspond to this policy;
critical analysis of theories in medicine and public health;
training and education of medical workers on a broad social and hygienic basis.
Statistical method is widely used in most studies: it allows you to objectively determine the level of the health status of the population, determine the efficiency and quality of the work of medical institutions.
historical method allows in the study to trace the state of the problem under study at different historical stages of the country's development.
economic method allows you to establish the impact of the economy on health care and health care on the economy of the state, to determine the most optimal ways to use public funds for the effective protection of public health. The issues of planning the financial activities of health authorities and medical institutions, the most rational use of funds, assessing the effectiveness of health care actions to improve the population and the impact of these actions on the economy - all this is the subject economic research in the field of healthcare.
experimental method includes setting up various experiments to find new, most rational forms and methods of work of medical institutions, 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 condition of outpatient care for the population and determine ways to improve it, then the statistical method studies the incidence of the population, the appeal to polyclinic institutions, historically analyzes its level in different periods, its dynamics. The proposed new forms in the work of the polyclinic are analyzed by the experimental method: their economic feasibility and efficiency are checked.
The study can use timing technique the actions of medical workers, the time spent by patients on receiving medical care, observation methods are often widely used, survey method (interview, questionnaire method) population or personnel.
As a subject of teaching Public health and healthcare primarily contributes to improving the quality of training of future specialists - doctors; the formation of their skills not only to be able to correctly diagnose and treat the patient, but also the ability to organize high level medical care, the ability to clearly organize their activities.
The structure of the subject so far is as follows:
Health history
Theoretical problems of public health and medicine. Conditions and way of life of the population: sanology (valeology); social and hygienic problems; general theories and concepts of medicine and public health.
State of health of the population and methods of its study. Medical (sanitary) statistics.
Problems of social assistance. Social security and health insurance.
Organization of medical care to the population.
Economics, planning, healthcare financing.
Insurance medicine.
Health management. ACS in healthcare.
Health care abroad; activities of WHO and other international medical organizations.
At the beginning of the 20th century, the young doctor Alfred Grotjan began to publish a journal on social hygiene in 1903, in 1905 he founded a scientific society for social hygiene and medical statistics in Berlin, and in 1912 he achieved an associate professorship and in 1920 - the establishment of the department social hygiene in Berlin University.
Thus began the history of the subject and science of social hygiene, which gained independence and joined a number of other medical disciplines.
Following the department of A. Grotyan, similar divisions began to be created in Germany and other countries. Their leaders are A. Fisher, S. Neumann, F. Printing, E. Resle and others, as well as their predecessors and successors involved in public health and medical statistics (W. Farr, J. Graupt, J. Pringle, A Teleski, B. Hayes and others), went beyond the existing areas: hygiene, microbiology, bacteriology, occupational medicine, other disciplines and focused on social conditions and factors that determine the health of the population, on the development of proposals and requirements for the organization of state measures to protect the health of the population, primarily workers, to implement social and state policy, including effective medical (sanitary) legislation, health insurance, and social security.
In English-speaking countries, the subject is called public health or health care, preventive medicine, in French-speaking countries - social medicine, medical sociology, in the USA, earlier than in other countries, it began to be referred to as the sociology of medicine or the sociology of health. In Eastern European countries, our subject was called differently, most often as in the USSR - "organization of health care", "theory and organization of health care", "social hygiene", "social hygiene and organization of health care", etc. Recently, the term " medical sociology", "social medicine" (Romania, Yugoslavia, etc.).
In Russia, a major contribution to the development of social medicine was made by M. V. Lomonosov, N. I. Pirogov, S. P. Botkin, I. M. Sechenov, T. A. Zakharyin, D. S. Samoilovich, A. P. Dobroslavin , F. F. Erisman.
The formation and flourishing of social hygiene (as it was called until 1941) during the period of Soviet power is associated with the names of major figures in Soviet health care N. A. Semashko, Z. P. Solovyov. On their initiative, departments of social hygiene and healthcare organization began to be created at medical institutes. The first such department was created by N. A. Semashko in 1922 at the Medical Faculty of the First Moscow State University. In 1923, under the leadership of 3. P. Solovyov, a department was created at the II Moscow State University and under the leadership of A. F. Nikitin at the I Leningrad medical institute. Until 1929, such departments were organized in all medical institutes.
In 1923, the Institute of Social Hygiene of the People's Commissariat of Health of the RSFSR was organized, which became the scientific and organizational base for all departments of social hygiene and healthcare organization. Scientific social hygienists carry out important research for the study of sanitary and demographic processes in the country (A. M. Merkov, S. A. Tomilin, P. M. Kozlov, S. A. Novoselsky, L. S. Kaminsky), new methods for studying the health of the population are being developed (P. A . Kuvshinnikov, G. A. Batkis and others). In the 30s, G. A. Batkis published a textbook for the departments of social hygiene, according to which students of all medical institutes studied for many years.
During the Great Patriotic War the departments of social hygiene are renamed into the departments of "health organization". All the attention of the departments in these years was focused on the issues of medical and sanitary support of the front and the organization of medical care in the rear, the prevention of outbreaks infectious diseases. V post-war years the work of departments in connection with practical health care is being activated. Against the background of the intensification of the 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 evidence-based standards for health planning, studying the needs of the population in various types of medical care; Comprehensive studies are being widely developed to study the causes of the prevalence of various non-communicable diseases, in particular, cardiovascular pathology, malignant neoplasms, injuries, etc.
A great contribution to the development of science and teaching in these years was made by: 3. G. Frenkel, B. Ya. Smulevich, S. V. Kurashov, N. A. Vinogradov, A. F. Serenko, S. Ya. Freidlin, Yu. A. Dobrovolsky, Yu. P. Lisitsin and others.
In 1966, the Departments of Health Organization became known as the Departments of Social Hygiene and Health Organization, and in 1986, the Departments of Social Medicine and Health Organization.
At the present stage of development of our health care, when introducing a new economic mechanism into the management of medical institutions and in the transition to health insurance, a future doctor needs to master a significant amount of theoretical knowledge and practical organizational skills. Each doctor must be a good organizer of his business, be able to clearly organize the work of his subordinate medical personnel, know medical and labor legislation; master the elements of economics and management. An important role in the fulfillment of this task belongs to Public health and healthcare organization as a science and a subject of teaching in the higher medical school system.
(Brief history of development)
As you know, most disciplines and narrow specialties in medicine study various diseases, their symptoms and syndromes, various clinical manifestations of the course of diseases, their complications, methods for diagnosing and treating diseases, and probable outcomes of the disease in the case of using the currently known modern methods of complex treatment. It is extremely rare to describe the main methods of disease prevention, rehabilitation of people who have undergone a particular disease, sometimes severe, with complications, and even with sick people becoming disabled.
Even less often in the medical literature, the term "recreation" is used, i.e. a complex of preventive, therapeutic and health-improving measures aimed at maintaining the health of healthy people. People's health, its criteria, ways of preserving and strengthening in the difficult socio-economic conditions of our life - have almost completely fallen out of the sphere of interests of modern medicine and health care 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, the World Health Organization (WHO) back in 1948 formulated that "health is a state of complete physical, spiritual and social well-being, and not just the absence of disease and physical defects." WHO proclaimed the principle that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”. It is customary to distinguish 4 levels of health study:
Level 1 - the health of an individual.
2nd level - health of small or ethnic groups - group health.
3rd level - health of the population, i.e. 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, continent, world, the population as a whole.
Public health and healthcare as an independent medical science studies the impact of social factors and environmental conditions on public health in order to develop preventive measures to improve the health of the population and improve its medical care. Public health and health care is engaged in the study of a wide range of different medical aspects, sociological, economic, managerial, 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 dated March 1, 2000 “On improving the teaching of public health and healthcare problems in medical and pharmaceutical universities”, as well as as a result of the MMA named after MMA. I.M. Sechenov and with the support of the Ministry of Health of the Russian Federation a seminar for heads of organizational profile departments medical schools 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, due to the impact various environmental factors and lifestyle of the population, which allows to ensure the optimal level of quality and safety of life.
Unlike various clinical disciplines, public health studies the health status not of individual individuals, but of collectives, social groups and society as a whole in connection with the conditions and lifestyle. At the same time, living conditions, production relations, as a rule, are decisive for the state of human 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 can provide negative impacts on his health. The greatest discoveries of our time in the field of physics, chemistry, biology, the urbanization of the population in the 20th century, the rapid development of industry in many countries, large volumes of construction, chemicalization Agriculture and others 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 acquire an epidemiological character due to their prevalence.
Antagonistic contradictions between scientific and technological progress and the state of public health in our country arise as a result of 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 adversely affect the health of society.
For planned development National economy Of great importance is information about the size of the population, determining its forecasts for the future.
Public health reveals patterns of population development by examining demographic processes, predicts the future, and develops recommendations for state regulation of the population.
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 defined as risk factors. What are risk factors for diseases?
Risk factors are factors of a behavioral, biological, genetic, ecological, social nature, environment and work environment that are potentially hazardous to health, increasing the likelihood of developing diseases, their progression and adverse outcomes.
Unlike the immediate causes of diseases (bacteria, viruses, lack or excess of any trace elements, etc.), risk factors act indirectly, create 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, housing conditions, material well-being, level and quality of food, rest, etc.)
2. Socio-biological factors (age, gender, predisposition to hereditary diseases, etc.).
3. Ecological and natural and climatic factors (environment pollution, average annual temperature, the presence of extreme natural and climatic factors, etc.).
4. Organizational or medical factors (security of the population medical care, the quality of medical care, the availability of medical and social assistance, etc.).
Yu.P. Lisitsyn, Academician of the Russian Academy of Medical Sciences, 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 conditional, since the population is exposed to the complex effects of many factors, in addition, the factors affecting health interact with each other, change in time and space, which must be taken into account when conducting complex medical and social research.
Table 1.1 Grouping of health risk factors*
Sphere of influence of factors on health Groups of risk factors Share (in %) of risk factors
Lifestyle Smoking, alcohol consumption, unbalanced diet Stressful situations (distresses) Harmful working conditions Physical inactivity Poor material and living conditions Drug consumption, drug 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 Pollution with carcinogens and other harmful substances air " Pollution with carcinogens and other harmful substances of water Pollution of soil Abrupt shifts atmospheric phenomena Increased heliocosmic, radiation, magnetic and other radiations 17-20
Health care Inefficiency of preventive measures Poor quality of medical care Untimely medical care 8-10
* Social Hygiene (Medicine) and Health Organization: Textbook / Ed. Yu.P. Lisitsina. - Kazan, 1998. - S. 52.
The second part of the science of public health and healthcare includes the development of evidence-based, the most optimal methods of healthcare management, new forms and methods of work of various medical institutions, ways to improve the quality of medical care, substantiates optimal solutions to economic and managerial problems in healthcare.
The rapid growth in the development of medical science has armed physicians with new, modern methods of diagnosing complex diseases and effective means of treatment. All this simultaneously requires the development of new organizational forms and conditions for the activities of physicians, 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, the placement of medical personnel; there is a need to revise the regulatory framework for healthcare, to expand the autonomy of the heads of medical institutions and the rights of the doctor.
As a consequence of all that has been said, conditions are being created for reviewing options for a more optimal solution to the economic problems of healthcare, introducing elements of intradepartmental cost accounting, economic incentives for high-quality work of medical personnel, etc.
These problems determine the place and importance of science in the further improvement of domestic health care.
The unity of the theory and practice of domestic health care has found its expression in the unity of theoretical and practical tasks, methodological techniques of domestic public health and health care.
Thus, the leading importance in science is the question of studying the effectiveness of the impact on the health of the population of all activities carried out by the state and the role of healthcare and individual medical institutions in this, both with state and non-state forms of ownership, i.e. the subject reveals the significance of the entire diversity of the socio-economic life of the country and determines ways to improve the medical care of the population.
Public health and health care have their own methodology and research methods. Such methods are: statistical, historical, economic, experimental, timing studies, sociological methods other.
The statistical method is widely used in most studies: it allows you to objectively determine the level of the health status of the population, determine the efficiency and quality of the work of medical institutions.
The historical method allows us to trace the state of the problem under study at different historical stages of the country's development.
The economic method allows you to establish the impact of the economy on health care and health care on the economy of the state, to determine the most optimal ways to use public funds for the effective protection of public health. The issues of planning the financial activities of health authorities and medical institutions, the most rational use of funds, assessing the effectiveness of health care actions to improve the health of the population and the impact of these actions on the country's economy - all this is the subject of economic research in the field of health care.
The experimental method includes the setting up of various experiments to find new, most rational forms and methods of work of medical institutions, 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 condition of outpatient care for the population and determine ways to improve it, then the statistical method studies the incidence of the population, the appeal to polyclinic institutions, historically analyzes its level in different periods, its dynamics. The experimental method analyzes the proposed new forms in the work of polyclinics: their economic feasibility and efficiency are checked.
The study can use the methods of chronometric studies (chronometry of the work of medical workers, study and analysis of the time spent by patients on 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 the state reporting documentation of medical institutions, or for a deeper study, the collection of material can be carried out on specially designed maps, questionnaires, which include all questions to obtain the necessary information, according to the approved research program and tasks that placed before the researcher. For this purpose, a PC can also be used, when the researcher, using a special program, enters the necessary data into the computer from the primary registration documents.
In the vast majority of socio-hygienic studies of group health, population health and public health in previous years, it was about the quantitative assessment of health. True, with the help of indicators, indices and coefficients, scientific studies have always tried to assess the quality of health, i.e. tried to characterize health as a parameter of the quality of life. The very term "quality of life" in the domestic scientific literature began to be applied recently, only in the last 10-15 years. This is understandable, because only then can one speak of the "quality of life" of the population when in a country (as happened long ago in the developed countries of Europe, America, Japan and some other developed countries) the 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 for achieving well-being and self-realization.
In our country, the quality of life is most often understood as a category that includes a combination of life support conditions and health conditions that allow achieving physical, mental, social well-being and self-realization.
Despite the absence of the concept of "quality of health" generally accepted in the world 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; the formation of their skills not only to be able to correctly diagnose and treat the patient, but also the ability to organize a high level of medical care, the ability to clearly organize their activities.
The social problems of medicine were of interest to prominent scientists of antiquity - such as Hippocrates, Avicenna, Aristotle, Vesalius and others. In Russia, 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 social movement 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 assistance, in the context of the approaching series of revolutions and wars of the early 20th century and other factors, the foundations of science and academic discipline on public health and healthcare. Thus, at Kazan University in the 60s of the 19th century, Professor A.V. Petrov gave lectures to students on public health and social hygiene. V late XIX century at the medical faculties of many universities in Russia (St. Petersburg, Moscow, Kiev, Kharkov, etc.) public hygiene courses were taught, as well as courses in medical geography and medical statistics. However, these courses were episodic, often part of other disciplines. Only in 1920 in Germany at the University of Berlin was formed the world's first department of social hygiene. This department was headed by its founder, the German social hygienist professor Alfred Grotjan. Thus began the history of an independent subject and the science of social hygiene. Following the department of A. Grotyan, similar departments began to be organized at other universities in Germany and other European countries. Their leaders (A. Fisher, S. Neumann, F. Printing, E. Resle and others) directed the research work of the departments to develop urgent problems of public health and medical statistics.
The formation and flourishing of social hygiene (as science was called in Russia until 1941) during the period of Soviet power is associated with the names of major figures in Soviet health care N.A. Semashko, 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 on medical faculty I Moscow State University. In 1923, under the leadership of Z.P. Soloviev, 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 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 healthcare organization. Social hygienists carry out 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 and others), new methods for studying the health of the population are being developed (P.A. Kuvshinnikov, G.A. Batkis and others). 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 organization". All the attention of the departments in these years was focused on the issues of medical and sanitary support of the front and the organization of medical care in the rear, the prevention of outbreaks of infectious diseases. In the post-war years, the work of the departments to strengthen communication with practical health care was activated. Against the background of the strengthening of the 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 science-based health care planning, studying the needs of the population in various types of medical care; Comprehensive studies are 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 the departments of public health and health care.
At the present stage of development of domestic healthcare, with the introduction of new economic mechanisms for managing and financing healthcare, new legal relationships in the healthcare system, and with the transition to health insurance, a future doctor needs to master a significant amount of theoretical knowledge and practical organizational skills. Each doctor must be a good organizer of his business, be able to clearly organize the work of his subordinate medical personnel, 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 health care, which represent both science and the subject of teaching in the higher medical school system.
The subject of science.
Items:
1. Health of the population.
2. Health care.
1. Public health
2. Healthcare
3.Risk factors
4. The image and conditions of life.
II. Natural and climatic.
IV. Psycho-emotional.
The tasks of science:
Sections of science:
Research methods used in public health and healthcare
Public health, like other scientific disciplines, has its own research methods.
1) Statistical method as the main method of the social sciences is widely used in the field of public health. It allows you to establish and objectively assess the ongoing changes in the state of health of the population and determine the effectiveness of the activities of health authorities and institutions. In addition, it is widely used in medical research (hygienic, physiological, biochemical, clinical, etc.).
2) Method expert assessments serves as an addition to the statistical one, the main task of which is to determine indirectly certain correction factors.
Public health uses quantitative measures, applying statistics and epidemiological methods. This makes it possible to make predictions based on previously formulated regularities, for example, it is quite possible to predict future birth rates, population size, mortality, deaths from cancer, etc.
3) Historical method is based on the study and analysis of the processes of public health and healthcare at various stages of human history. The historical method is a descriptive, descriptive method.
4) Method of economic research makes it possible to establish the impact of the economy on health care and, conversely, health care on the economy of society. The health care economy is an integral part of the country's economy. Healthcare in any country has a certain material and technical base, which includes hospitals, polyclinics, dispensaries, institutes, clinics, etc. Sources of health care financing, questions of the most effective use of these funds are being researched and analyzed.
To study the influence of socio-economic factors on people's health, methods used in economic sciences. These methods find direct application in the study and development of such health issues as accounting, planning, financing, health management, rational use of material resources, scientific organization of labor in health authorities 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.
The experiment can be carried out not only in natural, but also in social sciences. In public health, the experiment may not be used often because of the administrative and legislative difficulties associated with it.
In the field of healthcare organization, a modeling method is being developed, which consists in creating organization models for experimental verification. In connection with experimental method great reliability is assigned to experimental zones and health centers, as well as to pilot programs on individual problems. Experimental zones and centers can be called "field laboratories" for conducting scientific research in the field of healthcare. Depending on the goals and problems for which they are created, these models vary greatly in scope and organization, are temporary or permanent.
6) Method of observation and questioning. To replenish and deepen these data, special studies can be undertaken. For example, to obtain more in-depth data on the incidence of persons of certain professions, the results obtained during medical examinations of this contingent are used. To identify the nature and degree of influence of social and hygienic conditions on morbidity, mortality and physical development, survey methods (interview, questionnaire method) of individuals, families or groups of people according to a special program can be used.
The survey method (interview) can provide valuable information on a variety of issues: economic, social, demographic, etc.
7) Epidemiological method. An important place among epidemiological research methods is occupied by epidemiological analysis. Epidemiological analysis 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.
dynamic rows.
When studying the dynamics of a phenomenon, one resorts to the construction of a dynamic series.
dynamic series is a series of homogeneous statistical quantities , showing the change of a phenomenon in time and located in chronological order at certain intervals. Numbers , components of the dynamic series , are called levels.
row level- the size (value) of a particular phenomenon , achieved in a certain period or at a certain point in time. Series levels can be represented as absolute , relative or average values.
Dynamic series are divided into
a) simple(consisting of absolute values) - can be:
1) momentary- consists of values characterizing the phenomenon at a certain moment (statistical information, usually recorded at the beginning or end of a month, quarter, year)
2) interval - consists of numbers characterizing the phenomenon for a certain period of time (interval) - for a week, month, quarter, year (data on the number of births , deaths per year, number of infectious diseases per month). The peculiarity of the interval series is that , that its members can be summed up (in this case, the interval is enlarged), or split up.
b) complex(consisting of relative or average values).
Dynamic series can be subjected to transformations, the purpose of which is to identify the features of the change in the process under study, as well as to achieve clarity.
Dynamic range indicators:
a) row levels are the values of the members of the series. The value of the first member of the series is called the initial (initial) level, the value of the last member of the series is the final level, the average value of all members of the series is called the average level.
b) absolute increase (decrease)- the value of the difference between the next and previous levels; the increase is expressed by numbers with a positive sign, the decrease - with a negative sign. The value of the increase or decrease reflects the changes in the levels of the dynamic series over a certain period of time.
v) rate of growth (decrease)- shows the ratio of each subsequent level to the previous level and is usually expressed as a percentage.
G ) rate of increase (loss)- the ratio of the absolute increase or decrease of each subsequent member of the series to the level of the previous one, expressed as a percentage. The growth rate can also be calculated using the formula: Growth rate - 100%
The absolute value of one percent increase (loss)- is obtained by dividing the absolute value of the increase or decrease by the rate of increase or decrease for the same period.
For a more visual expression of the increase or decrease in the series, you can transform it by calculating the visibility indicators, showing the ratio of each member of the series to one of them, taken as one hundred percent.
Sometimes the dynamics of the phenomenon under study is presented not as a continuously changing level, but as individual spasmodic changes. In this case, to identify the main trend in the development of the phenomenon under study, they resort to to equalize the dynamic range. In this case, the following methods can be used:
a) enlargement of the interval- summation of data for a number of adjacent periods. The result is results over longer periods of time. This smooths out random fluctuations and more clearly determines the nature of the dynamics of the phenomenon.
b) group average calculation- determination of the average value of each enlarged period. To do this, it is necessary to sum the adjacent levels of adjacent periods, and then divide the sum by the number of terms. This achieves greater clarity of changes over time.
v) moving average calculation- to some extent eliminates the influence of random fluctuations on the levels of the dynamic range and more noticeably reflects the trend of the phenomenon. When it is calculated, each level of the series is replaced by the average value from the given level and two neighboring ones. Most often, three terms of the series are summed up sequentially, but more can be taken.
G) graphic method- alignment by hand or with the help of a ruler, a compass of a graphic representation of the dynamics of the phenomenon under study.
e) least squares alignment- one of the most accurate ways to equalize the dynamic series. The method aims to eliminate the influence of temporarily acting causes , random factors and identify the main trend in the dynamics of the phenomenon, caused by the influence of only long-acting factors. Alignment is carried out along the line that best corresponds to the nature of the dynamics of the phenomenon under study, if there is a main tendency to increase or decrease the frequency of the phenomenon. This line is usually a straight line. , which most accurately characterizes the main direction of changes, but there are other dependencies (quadratic, cubic, etc.). This method allows you to quantify the identified trend, assess the average rate of its development and calculate the predicted levels for the next year.
Primary incidence- the totality of new, nowhere previously recorded and for the first time in a given calendar year, diseases detected and registered among the population, calculated per 100 thousand population.
General morbidity- the totality of all diseases among the population, both first detected in a given calendar year and registered in previous years, for which patients reapplied in a given year.
Accumulated incidence - the totality of all primary diseases registered over a number of years (minimum 3 years).
Pathological affection- the totality of all pathological conditions (acute and chronic, premorbid conditions) identified during one-time examinations and preventive examinations.
traumatism
Medical and social significance:
1. Injuries and poisoning occupy the 2nd place in the structure of morbidity (in children - 4), their growth is observed. 30% of all outpatients and 50% of surgical patients in hospitals are treated for injuries.
2. Injuries and poisoning occupy the 5th place in the structure of morbidity, their growth is observed (in children - 6).
3. Injuries and poisonings are one of the main causes (3rd place) in the structure of morbidity with temporary disability.
4. Injuries and poisoning occupy the 3rd-4th place in the structure of total mortality, their growth is observed. It is the leading cause of death among people of working age.
5. They occupy the 3rd-4th place in the structure of disability, their growth is observed.
6. 70% of all injuries in men and 56% in women occur at working age.
7. Injuries and poisoning are more often recorded in men, especially in working age. At the age of 55 and more often in women (estrogen protection decreases).
8. Cause significant economic costs.
Medico-social conditionality:
Natural-climatic, biological, temporal factors are important in the occurrence of injuries (more on weekends, in the city - in winter, in the countryside - in summer). Alcohol - 40% causes death from herbs, 24% traffic injuries, 14% non-productive injuries.
Most injuries are caused by not so much an increase in the trauma-hazard of the environment, but the low tolerance of the population to their effects (ie, low trauma-protection of the population). Low tolerance is due to lifestyle: national food, alcohol. It also affects the subsequent healing of wounds. Low tolerance is associated with insufficient medical literacy of the population.
50) Malignant neoplasms as a social and hygienic problem.
Malignant neoplasms as a medical and social problem. The main directions of prevention. Organization of cancer care.
Malignant neoplasms as a medical and social problem:
1. Cancer is more common in older people.
2. Oncology is a hot spot in medicine.
3. In the structure of total mortality, oncology is 14%.
4. Medical and social significance: patients are long-term disabled, in a later period - disabled.
5. Every year, for every 10,000 employees, 78 people become disabled. In total mortality - 3rd place.
6. Late diagnosis, because Initially, malignant neoplasms are asymptomatic.
7. High costs for the diagnosis and treatment of oncology.
Organization of oncological care in the Republic of Belarus: the district doctor, if oncology is suspected, sends for a consultation to the surgeon. The surgeon sends the patient to an oncological dispensary (in Belarus - 11). There is also an institute of oncology and medical radiology, a children's onco-hematological center.
The main directions of prevention- as in BSC.
Health Economics.
Health economics- a branch of the science of economics that studies the place of health care in the national economy, developing methods for the rational use of resources to ensure the protection of public health.
The Purpose of Health Economics- meeting the needs of the population in medical care.
Health economics subject- development of methods for the rational use of resources to achieve goals in protecting public health.
Health economics studies conditions and factors that ensure the maximum satisfaction of the needs of the population in goods and services necessary to maintain, strengthen, restore health, at minimal cost. Economists study the impact of public health on the economic development of the country, regions, production, etc., as well as the economic effect of medical and preventive care, prevention, diagnosis, treatment, rehabilitation, elimination of diseases, reducing disability and mortality, new methods, technologies, organizational events, programs, etc.
Health economics methods:
1) Analysis and synthesis. In the process of analysis, thinking goes from the general to the particular, i.e. the phenomenon under study is divided into its component parts and sides. Synthesis implies the integration of particular concepts, properties into the general in order to identify the most significant patterns.
2) Mathematical and statistical techniques and research tools - help to reveal the quantitative relationship of economic variables. Revealing the quantitative changes in processes, health economics explores the transition of quantity into a new quality. Mathematical and statistical analysis reveals real relationships only when it is closely connected with the qualitative content of the analyzed subject.
3) The balance method is a set of methods of economic calculations. They are used to ensure a strictly defined quantitative relationship between any components, for example, between needs and the possibilities of satisfying them, between the revenue and expenditure parts of the budget, etc. The method of economic balances is based on the principle of equality of the values of resources and the possibilities of their use, taking into account the creation of reserves. The latter is very important, because Without reserves, in conditions of a sharp shortage of resources, one or another functional block of the health care system may fail, which is fraught with serious medical and social consequences.
4) Forecasting - represents the scientific prediction of the most likely changes in the state of the healthcare industry, the society's need for medical services, the production capabilities of medicine, directions technical progress industries, etc.
5) Household experiments - are one of the currently common methods. They are reasonable and necessary. The search for certain methods to improve the efficiency of the health care system on the example of several regions or individual medical institutions is of great practical importance.
Insurance form ZO.
Types of insurance: obligatory and voluntary medical insurance.
Sources of financing insurance medicine:
1) insurance premiums from enterprises and organizations
2) insurance premiums from citizens
3) state subsidies to insurance companies - to serve the uninsured
Public health and health care as a science and subject of teaching.
Public health and health care is a science and specific activities for the protection and promotion of public health, life extension through the mobilization of society's efforts and the implementation of appropriate organizational measures at various levels.
Public health is an area of scientific and practical activity that provides health care management as one of the largest social systems where medicine is one of the components along with economics, sociology, political sciences, industry.
The subject of science.
Science studies the patterns of public health and healthcare.
Items:
1. Health of the population.
2. Health care.
3. Factors affecting the health of the population.
4. Medical and socially significant pathology.
1. Public health- medical-demographic and social category, reflecting the physical, psychological, social well-being of people who carry out their livelihoods within the framework of the definition of social communities.
2. Healthcare is a system of socio-economic and medical measures aimed at maintaining and improving the health of each person and the population as a whole (BME, 3rd ed.)
3.Risk factors– factors of a behavioral, biological, genetic, environmental, social nature, environmental and working environment that are potentially hazardous to health, increasing the likelihood of developing diseases, their progression and unfavorable outcome.
I. Socio-economic factors.
1. The level of productive forces and the nature of production relations.
2. Organization of medical care.
3. Health legislation.
4. The image and conditions of life.
II. Natural and climatic.
III. Biological: sex, age, constitution, heredity.
IV. Psycho-emotional.
Health formula (in%): 50 - lifestyle, 20 - heredity, 20 - environment, 10 - health activities.
4. Socially significant diseases- diseases caused mainly by socio-economic conditions, causing damage to society and requiring social protection person.
The tasks of science:
1. Assessment and study of the health of the population, the dynamics of its development.
2. Evaluation and study of social and other conditions affecting health.
3. Development of methods and means of promoting health, preventing diseases and disabilities, as well as their rehabilitation.
4. Theoretical substantiation of the principles of development, assessment of the quality and effectiveness of health care.
5. Solving the problems of management, financing and economics of health care.
6. Legal regulation of healthcare.
7. Formation of social and hygienic mentality and thinking of medical workers.
Sections of science:
1. Sanitary statistics (public health).
2. Examination of incapacity for work.
3. Organization of medical care (health).
4. Management, planning, financing, healthcare economics.
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 area) 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 indicator of health by different specialists in different conditions and in 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. A 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.
Target: Students should have a general understanding of the discipline "Public health and healthcare", know the basic concepts, sections, methods. Students should be aware of the social determinants of public health.
Health care in the most general view is a complex social dynamic, functional, open and adaptive system that society creates and uses at each stage of its development to implement a set of measures aimed at protecting and improving the health of each person and the whole society.
Public health events in the history of mankind began to be held with the advent of the state. They changed depending on the change in socio-economic formations, changes in the mode of production and production relations, and the state system.
Public health (public health system) is a system of scientific and practical measures and medical and non-medical structures that provide them, the activities of which are aimed at implementing the concept of protecting and strengthening the health of the population, preventing diseases and injuries, increasing active life expectancy and working capacity by combining the efforts of society.
The subject of public health is the study of the influence of social conditions of life on the health and medical care of the population. The methodological basis of 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 state the absence of a generally accepted unified interpretation of the concept of health. The literature on 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, three components are combined in the health profile: physical(biological), mental(spiritual) and social health.
Physical health is a state 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 the quality of life, the well-being of society and ensuring the preservation and strengthening of public health.
Mental health is a state characterized by a dynamic process mental activity, which is characterized by the determinism of mental phenomena, the harmonic relationship between the reflection of the circumstances of reality and the attitude of the individual to it, the adequacy of the body's reactions to social, psychological and physical (including biological) conditions of life, thanks to the ability of the individual to self-control behavior, plan and implement his life path in the micro- and macrosocial environment.
Social health is a measure of a person's social adaptation, determined by his place and role in society.
When we talk about the state of health, we mean the harmonious combination of all three components. The consequence of violation of one of them is disharmony and, ultimately, disease.
According to the WHO, disease(illness) is a life disturbed 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 factors of the external and internal environment that exceed the adaptive-compensatory (adaptive) capabilities of the body.
There are several levels of health:
individual health- human health;
group health- a set of characteristics of the health of individuals, united by any sign: family, work collectives, students, etc.;
regional health- a set of characteristics of the health of people living in a certain area);
public health- a medical and social resource and the potential of society, contributing to national security.
WHO recognizes that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being. All people should have access to the resources they need to be healthy.
At the XXX session of the World Health Assembly (1977), the most important social task was proclaimed: "Achievement by the year 2000 by all inhabitants of the earth of such 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" (1999) was adopted. The strategy of "Health for All in the 21st century" is implemented differently in each country, depending on the social and economic characteristics, health status and mortality rates of the population, the status and level of development of health systems.
The history of public health in Soviet Kazakhstan reflects the main stages in the development of state socialism in the USSR. Since the establishment Soviet power The main task of public health was the theoretical and practical development of preventive principles of public health. The focus was also on providing the population with free public health care. During the Great Patriotic War, all attention was focused on the issues of medical and sanitary support for the front and the deployment of rear hospitals. In the postwar years, the tasks associated with 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 the general medical examination of the population.
At the WHO/UNICEF International Conference held in Alma-Ata in 1978, the socialist health care system (model N.A. Semashko) received worldwide recognition, and the adopted Alma-Ata Declaration was proclaimed the Great Charter of Health 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. The 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 healthcare organization.
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, the search for patterns and trends in the formation of public health, taking into account socio-economic conditions.
The formation of public health is due to the complex impact of factors that can be combined into the following main groups:
- political(state social politics, health 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, ecological(state and pollution of the environment);
- biological(sex, age, heredity, nationality, constitution, type nervous system and etc.).
In the 20th century, the social conditionality 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 oppose the social and biological components of human organization.
The ratio of social and biological factors in relation to various diseases is not the same, but still the leading role is assigned to the social component: conditions and factors.
Social Conditions - it 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, it should be noted medico-social and epidemiological studies, the results of which have established groups of factors (risk factors) and their contribution to the health of the population:
conditions and lifestyle– 49-53%, on average 50% of the total impact (smoking, alcohol abuse, unbalanced diet, stressful situations(distress), harmful working conditions, physical inactivity, poor material and living conditions, drug use, drug abuse, fragility of families, 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 with harmful substances; increased heliocosmic, radiation, magnetic and other radiation);
- healthcare- 8-10%, on average 10% (ineffectiveness of preventive measures, poor quality of medical care, untimely medical care).
The results of the largest research project in the history of WHO (2002) identified 10 leading risk factors that determine levels of morbidity and mortality in the population at the global level: malnutrition; smoking; arterial hypertension; unsatisfactory state of water supply, sanitation, as well as personal and household hygiene; hypodynamia; professional hazards; unsafe sex; alcohol abuse; air pollution.
Thus, the leading role of social factors in the formation of public health is mediated through the 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 the way of life from a broad social standpoint, using philosophical and sociological interpretations:
Lifestyle- forms of individual and group life, typical for historically specific social relations; or a concept that characterizes the features Everyday life people defined by a given socio-economic formation.
In general, the 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 quantified (the size of the gross national product, real incomes of the population, accessibility and provision of medical care, working hours, etc.);
- the quality of life- a sociological category that characterizes the qualitative side of meeting the material and cultural needs of people by comparing it with the level or standard of living (satisfaction with work, food quality, medical care, etc.);
- life style- a socio-psychological category that characterizes a certain type of behavior of an individual or a group of people, fixing consistently reproducible features, manners, habits, tastes, inclinations;
- way of life - a socio-economic category that characterizes the system of production relations in a socio-political formation.
Despite significant differences in conceptual approaches to assessment and lifestyle criteria, the role of social factors in shaping the health of the population is recognized by all international health care.
Allocate social groups whose lifestyle is most predisposed to various diseases, make up the so-called risk groups:
- demographic: children, old people, singles, widows, widowers, migrants, refugees, displaced persons;
- professional risk: working in the conditions of industries harmful to health (heavy engineering, chemical, metallurgical industry, transport, etc.);
- functional, pathological condition: pregnant women; premature babies born with low body weight; persons at genetic risk, with congenital anomalies, defects; disabled children;
- low material standard of living, poverty, poverty: the poor, the underprivileged, the unemployed, the part-time workers, the "homeless".
- persons with deviant behavior, the presence of psychopathic, socio-psychological and other collisions: alcoholics, drug addicts, drug addicts, prostitutes, people with sexual perversions, people with mental health and behavioral deformities (neuropathies, psychopathy, etc.), religious and other sectarians with mental and physical disabilities.
Among all diseases special place occupy 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, etc.
Recognition of the social determination of health justifies the need to consider health problems from broad social positions, as well as the fact that ensuring health goes beyond the competence and responsibility of purely health authorities and organizations. The preservation and promotion of health is the joint and several responsibility of the state, the employer and the citizen, which is implemented through intersectoral cooperation in active participation the population itself.
Illustrative material: 20 slides in the program "Rower Point".
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 folk medicine and public health of Kazakhstan. - Almaty, 2004. - 173 p.
3. Lisitsyn Yu.P. Public health and health care: 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.
1. Define public health and healthcare
2. List the components of health.
3.Specify health levels.
4. Name the main sections of the discipline.
5. List the main methods of discipline.
6. What factors affect the health of the population?
7. What is the contribution of risk factors to the formation of health?
8. What is the social conditionality of health?
9. Define the lifestyle and its categories.
10. List the social risk groups for diseases.
