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 its most general form 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 as a whole.

Public health events in the history of mankind began to be held with the advent of the state. They were modified 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 supporting structures of a medical and non-medical nature, whose activities 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 a systematic 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 (mental health) is a state characterized by a dynamic process of mental activity, which is characterized by the determinism of mental phenomena, the harmonious relationship between the reflection of the circumstances of reality and the attitude of the individual towards it, the adequacy of the body's reactions to social, psychological and physical (including biological) conditions of life, due to the ability of the individual to self-control behavior, plan and carry out his life path in the micro- and macro-social 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 of Soviet power, the main task of state health care has been the theoretical and practical development of preventive principles of health care. 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 influence of factors that can be combined into the following main groups:

- political(state social policy, 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(gender, age, heredity, nationality, constitution, type of nervous system, 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 (distresses), 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 activity typical of historically specific social relations; or a concept that characterizes the features of everyday life of people, determined 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, a special place is occupied by socially significant diseases, the list of which is established by the government in order to take additional or preferential measures of medical and social support: oncological and oncohematological diseases, diabetes, rheumatism, systemic lupus erythematosus, cerebral palsy, mental illness, myocardial infarction and others

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 with the active participation of 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.

Test questions:

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.

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 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 zone 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 indicate that more than 25% of patients daily visit general practitioners with respiratory diseases, 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 pulmonary 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 HIV patients were registered in 10 subjects of the Russian Federation: 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 (during 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 proportion 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 class "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).

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.

Factors:

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 of a 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.

1.2 Methods used in research and teaching of public health and health care.

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 evaluate 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 of 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. Issues of planning the financial activities of health authorities and medical institutions, the most rational use of funds, assessing the effectiveness of health care actions to improve the health of the population and the impact of these actions on the economy; one of these methods is called the budget method (method of budget estimates) and is widely used in research;

To study the influence of socio-economic factors on people's health, methods used in economic sciences are used. 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 the natural but also in the 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 the experimental method, great reliability is assigned to experimental zones and health centers, as well as to experimental programs on individual problems. Experimental zones and centers can be called "field laboratories" for conducting scientific research in the field of health. Depending on the goals and problems for which they are created, these models vary greatly in scope and organization, they 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.

1. 3 History of the formation of social medicine and healthcare organization, stages of formation and development.

1. Primitive society.

Folk medicine, folk hygiene. Collective → individual experience.

2. Antiquity.

State medicine: public positions (architers, aediles - dignity. controllers); legislative regulation, governing bodies.

Family, priestly, private forms.

3. Middle Ages.

Municipal medicine (magistrates)

State medicine - regulation and control of activities:

1140 – (Italy) decree on the admission to medical practice of persons who have been trained and passed state tests.

1241 – (Germany) decree establishing state control over the preparation of medicines and surgical practice.

Epidemics → sanitary laws (rules), sanitary authorities, sanitary measures.

1348 – (Venice) Sanitary Council (interdepartmental): with sanitary police functions.

1374 - (Italy) quarantine.

1426 – (Germany) Stadt physicists – city doctors.

1551 - (Moscow) Stoglavy Cathedral.

1617 - Apothecary order - state governing body.

1588 – Statute of the ON (medical issues from the legal side).

1571 – (Vilna) Medical Contubernia (partnership) – police supervision.

1621 - Mogilev, magistrate - established the position of an observer for those staying in the city.

Interest in the social problems of medicine originated in ancient times: they were dealt with by many outstanding scientists of antiquity - Hippocrates, Aristotle, Avicenna and others.

A deep trace in the emergence of a scientific worldview in Russia, including a socio-hygienic one, was laid by M.V. Lomonosov in a well-known letter to Count I.I. approach to public health and population problems.

M.V. Lomonosov in his letter showed not only the difficult sanitary conditions of the life of the people. He advocated a special study of population and public health, and also proposed measures to reduce the incidence and mortality of the population, increase the birth rate, improve medical care and health education.

The beginning of the socio-hygienic worldview in medicine was laid in the second half of the 18th century by clinicians of the medical faculty of Moscow University, later transformed into an independent higher medical educational institution (now the Moscow Medical Academy named after I.M. Sechenov). The greatest importance in this regard is the first Russian professor of the Medical Faculty of the University S.G. Zybelin, one of the most prominent founders of the remarkable Russian tradition of combining clinical activity with public hygiene. Professor S.G. Zybelin was the first in Russia to raise the issue of the influence of social factors on morbidity, fertility and mortality, he was the first to propose progressive for that time measures of a hygienic and social nature to combat morbidity.

The first Russian professor who laid the foundation for the systematic teaching of the “medical police” was F.F. Keresturi, who made a bright act speech “On the “medical police” and its use in Russia”. The term “medical police” was first introduced in 1784 by the German scientist W.T. fight against quackery, education of the population. F.F. Keresturi repeatedly spoke about the benefits of a thorough knowledge and study of public health and medical care. With the establishment of zemstvo and factory medicine, demands for the organization of special studies of public health and its protection, the opening of special scientific and educational institutions came to the fore.

In his research, F.F. Erisman, E.A. Osipov, V.A. Levitsky, A.V. Pogozhev, A.I. Shengarev, P.I. Tezyakov, P.I. Kurkin, A. Fishev and other figures of zemstvo medicine and sanitary statistics laid the foundations for scientific analysis of public health and health problems. Moreover, at the end of the 19th and beginning of the 20th century, courses of lectures on public health and health were given in a number of educational institutions. However, until the early 20

century there were no special courses, departments, institutes specifically for social hygiene, there were no special periodicals.

The current state of public health and healthcare.

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 healthcare N.A. Semashko and Z.P. Solovyov.

The first department of social hygiene in our country was organized on the initiative of N.A. Semashko in 1922 at the medical faculty of the first Moscow University (the first ever department of social hygiene was opened in 1920 at the University of Berlin by Alfred Grotyan, the founder of the first journal on social hygiene (1903) and the scientific society on social hygiene and medical statistics (1905). It was a single, united department, whose employees taught social hygiene in all Moscow medical higher educational institutions, the department was headed by N.A. Semashko until the end of his life, until 1949. In 1923, under the leadership of Z.P. Solovyov, a department was created in the second Moscow University.

Among the first domestic textbooks and manuals on social hygiene appeared textbooks by T.Ya.Tkachev (1924) and Z.G.Frenkel (1923, 1926). In 1922-1930. a special journal "Social Hygiene" was published, which covered topical problems of Soviet health care, scientific research and teaching of social hygiene.

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 the departments of social hygiene, health and healthcare.

Important for the development of social hygiene was the discovery in 1924. in Moscow, the first clinic for social and occupational diseases, where clinicians, together with specialists in the field of social hygiene, studied the most important problems of social etiology, the role of professional, production factors in the occurrence of diseases, developed methods for diagnosing, treating and preventing social and occupational diseases.

In 1935 for the first time an independent department of statistics was created, headed by the famous scientist prof. P.A. Kuvshinnikov.

In 1936 a textbook by G.A. Batkis "Social Hygiene", which was reprinted many times and played a big positive role in the training of doctors in the field of social hygiene and healthcare organization.

In 1941, on the eve of 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.

A great contribution to the development of science and teaching in these years was made by: Z.G. Frenkel, B.Ya. Smulevich, S.V. Kurashov, N.A. Vinogradov, A.F. Serenko and others.

During the years of the post-war five-year plans (1946-1960), the tasks associated with the post-war development of the economy and health care in the country were reflected in the scientific and pedagogical activities of the departments of healthcare organization. A major comprehensive study was the work on the sanitary consequences of the war. In 1946 The Institute of Public Health Organization was founded in Moscow. Scientific sessions of the institute and various materials published for them had a great influence on the research activities of the departments. Mutual contact between departments and health authorities has intensified.

February 28, 1966 By order of the Minister of the USSR No. 132, the departments of health organization were reorganized into the departments of social hygiene and health organization with a change in the content of teaching programs. In social hygiene and healthcare organization, system analysis, methods of organizational experiment, expert assessments, methods of sociological research, mathematical

and logical modeling, methods of planning and economic research.

March 1991 At the All-Union Conference on the Teaching of Social Hygiene and Health Organization, it was recommended to rename the discipline into social medicine and health organization. The name of the departments was supposed to reflect a broader understanding of the subject of study, including a diverse range of problems in the protection of public health and the management of a demonopolized and decentralized healthcare system in the transition to a market economy.

In accordance with the decisions of the Collegium of the Ministry of Health of the Russian Federation "On the role of the departments of social hygiene, organization, management and economics of health care in the training and advanced training of specialists in the industry" (April 1999), the All-Russian Conference of Heads of Departments of Social Medicine and Health Organization (Moscow, December 1997) and the All-Russian Scientific and Practical Conference “Actual Issues of Teaching Social Medicine. The work of departments with health authorities "(Anapa, October 1999) and on the basis of the order of the Ministry of Health of the Russian Federation of 01.03.2000. 83 “On Improving the Teaching of Public Health and Health Problems in Medical and Pharmaceutical Universities”, the discipline received a new name - “public health and healthcare”, as the most appropriate for the conditions of healthcare reform and the priority of public health problems in the context of radical socio-economic transformations in Russia.

1. Public health as a science and subject of teaching

1.1 Basic concepts and social conditioning of public health

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. Public health deals with the study of a wide range of medical, sociological, economic, managerial, philosophical problems in specific historical conditions.

Unlike various clinical disciplines, public health studies the state of health not of individuals, but of human groups, social groups and society as a whole in connection with the conditions and lifestyle. At the same time, living conditions, industrial relations, as a rule, are decisive for the state of people's health. For example, socio-economic transformations, scientific and technological progress, can bring certain benefits to society, but at the same time can have a negative impact on its health.

Discoveries in the field of physics, chemistry, biology, urbanization, the rapid development of industry in many countries, large volumes of construction, chemicalization of agriculture, etc. often lead to serious violations in the field of ecology, which has a detrimental effect, first of all, on human health. Therefore, one of the tasks of public health is the development of recommendations for the prevention of negative phenomena that adversely affect the health of society.

For the planned development of the economy of any country, information about the size, age and sex structure of the population, and determining its forecasts for the future is of great importance. 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 all activities carried out by the state, and the role of health care, individual medical institutions in this.

According to accepted concepts, medicine is a system of scientific knowledge and practical activities, the goals of which are to strengthen and preserve health, prolong life of people, prevent and treat human diseases. Thus, medicine is based on two basic concepts - “health” and “disease”. These two concepts, while fundamental, are also the most difficult to define.

In modern literature, there are a large number of definitions and approaches to the concept of "health".

The starting point for the medical and social interpretation of health is the definition adopted by the World Health Organization (WHO): "Health is a state of complete physical, spiritual and social well-being, and not just the absence of disease and physical defects" .

This definition is reflected in the WHO Constitution (1948). WHO has proclaimed the principle that "... the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being."

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

the first level - the health of the individual - individual health;

the second level - the health of social and ethnic groups - group health;

the third level - the health of the population of administrative territories - regional health;

the fourth level - the health of the population, society as a whole - public health.

Characteristics of group, regional, public health in statics and dynamics are considered as an integral state of health of all individuals taken together. At the same time, it should be understood that this is not just a sum of data, but the sum of interrelated quantitative and qualitative indicators.

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, as well as increasing the perceived level of health.

Public health, according to WHO, should be considered as a resource of national security, a means that allows people to live a prosperous, productive and quality life. All people should have access to the resources they need to be healthy.

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

Although the use of these terms narrows the understanding of the classical definition of "public health", they can be used in practice.

To assess individual health, a number of very conditional indicators are used: health resources, health potential and health balance.

Health resources - These are the morphofunctional and psychological capabilities of the body to change the balance of health in a positive direction. The increase in health resources is ensured by all measures of a healthy lifestyle (nutrition, physical activity, etc.).

Health potential - it is a combination of the individual's abilities to adequately respond to the impact of external factors. The adequacy of reactions is determined by the state of compensatory-adaptive systems (nervous, endocrine, etc.) and the mechanism of mental self-regulation (psychological protection, etc.).

Health balance - a pronounced state of balance between the health potential and the factors acting on it.

Currently, there are very few indicators that would objectively reflect the quantity, quality and composition of public health. The search and development of integral indicators and indices for assessing the health of the population is being carried out all over the world. This is due to a number of reasons.

First, correctly collected and well-analyzed statistical data on health serve as the basis for state and regional planning of recreational activities, the development of organizational forms and methods of work of health authorities and institutions, as well as for monitoring the effectiveness of their activities to preserve and improve the health of the population.

Secondly, high requirements are imposed on integral indicators and indices of public health. 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 possible way, the calculation should not be expensive.

6. Acceptability (interpretability). The indicator must be acceptable, and there must 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. Some form of independent and external proof of this fact must be created.

11. Representativeness. The indicator should be representative when reflecting changes in the health of certain age-sex and other population groups 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. There should be the possibility of its unified convolution and development by constituent components.

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 medical and social research for the quantitative assessment of group, regional and public health in our country, it is traditionally customary to use the following indicators:

1. Demographic indicators.

2. Morbidity.

3. Disability.

4. Physical development.

Currently, many researchers are trying to give a comprehensive assessment of public health (quantitative and qualitative) and even develop special indicators for its assessment.

For example, American scientists, studying the health status of American Indians, derived an index that is a linear function of mortality and includes the number of days spent on outpatient and inpatient care. Then, this index was modified to assess the impact of diseases on different population groups.

There is another approach that has been widely developed among American researchers - the model health status index. The modern approach to the integral assessment of the health of the population is often associated with this model. The goals of creating this model were both to develop generalized indices of morbidity - mortality of the population, and to develop quantitative methods for measuring the effectiveness of various programs in the field of public health.

The basis of the concept of the health status index model is the representation of an individual's health as a continuously changing set of so-called instant health in the form of a certain value that takes values ​​from optimal well-being to maximum illness (death). This interval is divided into an ordered set of health states - movement along the interval; population health is the distribution of points characterizing people's health over this interval.

One of the most popular is the index proposed by the World Bank for Development experts in a 1993 report to assess the effectiveness of investments in health care. In Russian translation, it sounds like "Global Burden of Disease (GBD)" and quantifies the population loss in active life due to disease. The unit used to measure GBD is disability-adjusted life year (DALY). The GBD indicator takes into account losses due to premature death, which is defined as the difference between actual age at death, life expectancy at that age, and years of healthy life lost due to disability.

The GBD calculation allows assessing the importance of various diseases, substantiating health care priorities, and comparing the effectiveness of medical interventions in terms of spending per year of life without diseases.

However, the lack of the necessary statistics to fill the models with actual data does not allow for regular calculations of the indices. Problems in determining the quantity and quality of public health are partly related to the fact that in medicine one cannot talk about health and illness in general, but one should talk about the health and illness of people. And this obliges us to approach a person not only as a biological, animal organism, but as a biosocial being.

The health of a modern person is the result of the natural evolution of the Homo sapiens species, in which social factors have a gradually increasing influence. Their role for 10,000 years of development of civilization has increased in all respects. A person receives health, in a certain sense, as a gift of nature, he inherited from his animal ancestors the natural basis, the program of behavior in this world. However, in the process of socialization, the level of health changes either in one direction or the other, the laws of nature manifest themselves in a special form peculiar only to man.

The biological never manifests itself in a person in a purely natural form - it is always mediated by the social. The problem of the relationship between social and biological in a person is the key to understanding the nature and nature of his health, his illnesses, which should be interpreted as biosocial categories.

Human health and disease, in comparison with animals, is a new, socially mediated quality.

WHO documents have repeatedly indicated that people's health is a social quality, and therefore, for assessing public health, WHO recommends the following indicators:

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.

Public health is due to the complex impact of social, behavioral and biological factors. If we are talking about the social conditionality of health, then the paramount in its significance, and sometimes the decisive impact on it, of social risk factors is implied.

The social conditionality of health is confirmed by numerous medical and social studies. For example, it has been proven that preterm birth occurs 4 times more often in unmarried women than in married women; the incidence of pneumonia in children in incomplete families is 4 times higher than in complete families. The incidence of lung cancer is affected by smoking, environment, place of residence, etc.

Unlike the immediate causes of diseases (viruses, bacteria, etc.), risk factors act indirectly, disrupt the stability of regulatory mechanisms, and create an unfavorable background for the onset and development of diseases. Thus, for the development of a pathological process, in addition to the risk factor, the action of a specific causal factor is also required.

Under the influence of a complex of factors, the magnitude of public health indicators changes and sometimes quite significantly, both in space and in time; have their epidemiology.

In modern literature, under the concept "epidemiology" most often they understand the science that studies the patterns of occurrence and spread of pathological processes in order to develop measures for the prevention and optimal treatment of diseases. Epidemiology studies the influence of a complex of various factors on the formation of health, the prevalence of various diseases (infectious and non-infectious) and physiological states of a person.

Summarizing the above reasoning, we can formulate the concept "public health epidemiology", or "social epidemiology": - this is a section of the discipline "public health and health care", which studies the patterns of distribution of public health indicators in time, in space, among various groups of the population in connection with the influence of conditions and lifestyle, environmental factors.

The goal of public health epidemiology (social epidemiology) is the development of political, economic, medical, social and organizational measures aimed at improving public health indicators. In the future, when using this term, we will put it precisely this meaning.

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 physicians who held leadership positions during the revolutions of 1848 and 1871 in France tried to scientifically justify public health measures, regarding social medicine as the key to the health 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 closer to the second side of the subject of public health, that is, to the development of norms that regulate the relationship between a person and the social environment so that they strengthen his health and benefit him.

England 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 determining them, and the necessary measures follow from this. 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 is to study and correctly interpret 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; level of wages, culture and education of the population, nutrition, family relations, quality and accessibility 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.

1.4 Public health practices

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.).

Method of 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.

2). 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.

3). 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 are used. 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.

4). 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 the natural but also in the 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 the experimental method, great reliability is assigned to experimental zones and health centers, as well as to experimental programs on individual problems. Experimental zones and centers can be called "field laboratories" for conducting scientific research in the field of health. Depending on the goals and problems for which they are created, these models vary greatly in scope and organization, are temporary or permanent.

5. 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.

6. 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.

The use of epidemiological methods in different areas of health care 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.

Clinical epidemiology is the basis of evidence-based medicine, which allows, using strictly scientific methods, based on the study of the clinical course of the disease in similar cases, to make a prognosis for each individual patient. The goal of clinical epidemiology is to develop and apply methods of clinical observation that make it possible to draw objective conclusions, avoiding the influence of previously made mistakes.

The epidemiology of noncommunicable diseases studies the causes and frequency of occurrence of noncommunicable diseases with the aim of developing measures to prevent and reduce the prevalence of these diseases.

The epidemiology of infectious diseases studies the patterns of the epidemic process, the causes of the emergence and spread of infectious diseases in order to develop measures to combat these diseases, their prevention and elimination.

Speaking of public health, the epidemiology of public health indicators is singled out.

To study various problems in the field of public health, it is necessary to use all these research methods. They can be used not only independently, but also in various combinations, due to which consistency and evidence of the results of social and hygienic research can be achieved.

The main goal of public health is to create a rational public health service with high efficiency. Therefore, for her research related to the improvement of the work of health authorities and institutions, the scientific organization of the work of medical personnel, etc., is of particular importance. The topics of such studies can be: assessment of the nature and volume of the population's needs for medical care; study of the influence of various factors that determine these needs; assessment of the effectiveness of the existing health care system; development of ways and means of its improvement; making forecasts for providing the population with medical care.

2. Fundamentals of medical statistics

2.1 Statistics. Subject and methods of research. medical statistics

The word "statistics" comes from the Latin word "status" - state, position. For the first time this word was used in the middle of the 18th century by the German scientist Achenwal when describing the state of the state (German Statistik, from Italian stato - state).

Statistics:

1) a type of practical activity aimed at collecting, processing, analyzing and publishing statistical information characterizing the quantitative patterns of society (economy, culture, politics, etc.).

2) the branch of knowledge (and its corresponding academic disciplines), which sets out the general issues of collecting, measuring and analyzing mass quantitative data.

Statistics as a science includes sections Keywords: general theory of statistics, economic statistics, sectoral statistics, etc.

The general theory of statistics sets out the general principles and methods of statistical science.

Economic statistics studies the national economy as a whole with the help of statistical methods.

Branch statisticians use statistical methods to study various sectors of the national economy (sectors of statistics: industrial, trade, judicial, demographic, medical, etc.)

Like every science, statistics has its own subject of study- mass phenomena and processes of social life, their research methods- statistical, mathematical, develops systems and subsystems of indicators, which reflect the size and quality ratios of social phenomena.

Statistics studies the quantitative levels and correlations of social life in close connection with their qualitative side. Mathematics also studies the quantitative side of the phenomena of the surrounding world, but abstractly, without connection with the quality of these bodies and phenomena.

Statistics arose on the basis of mathematics, and is widely used mathematical methods. This is a selective research method based on the mathematical theory of probability and the law of large numbers, various methods for processing variational and dynamic series, measuring correlations between phenomena, etc.

Statistics develops and special methodology for the study and processing of materials Key words: mass statistical observations, method of groupings, averages, indices, method of graphic images.

In the literature, as a rule, no distinction is made between mathematical and statistical methods used in statistics.

The main task of statistics, like any other science, is to establish the patterns of the studied phenomena.

One of the branches of statistics is medical statistics, which studies the quantitative side of mass phenomena and processes in medicine.

health statistics studies the health of society as a whole and its individual groups, establishes the dependence of health on various factors of the social environment.

health statistics analyzes data on medical institutions, their activities, evaluates the effectiveness of various organizational measures for the prevention and treatment of diseases.

The requirements for statistical data can be formulated in the following provisions:

1) reliability and accuracy of materials;

2) completeness, understood as the coverage of all objects of observation for the entire period under study, and the receipt of all information on each object in accordance with the established program;

3) comparability and comparability achieved in the process of observation by the unity of the program and nomenclatures and in the process of processing and analyzing data - by using unified methodological techniques and indicators;

4) urgency and timeliness of receipt, processing and presentation of statistical materials.

The object of any statistical study is aggregate- a group or set of relatively homogeneous elements, i.e. units taken together within specific boundaries of time and space and possessing signs of similarity and difference

The purpose of studying any statistical population is the identification of common properties, general patterns of various phenomena, since these properties cannot be detected in the analysis of individual phenomena.

The statistical population consists of units of observation. Unit of observation- each primary element of the statistical population, endowed with signs of similarity. For example: a resident of the city of N., who was born in a given year, got the flu, etc.

Signs of similarity serve as the basis for combining units of observation into a population. The volume of the statistical population is the total number of observation units.

accounting signs- signs by which units of observation are distinguished in the statistical population.

Signs of similarity serve as the basis for combining units into a set, signs of difference, called accounting signs, are the subject of their special analysis

In my own way the nature of accounting signs can be:

- qualitative (they are also called attributive): they are expressed verbally and have a definitive character (for example, gender, profession);

- quantitative, expressed by a number (for example, age).

According to their role in the aggregate, accounting signs are divided:

- factorial, which affect the change in the signs that depend on them;

- effective, which depend on factorial.

Distinguish two types of statistics:

– general, consisting of all units of observation that can be attributed to it, depending on the purpose of the study;

– selective- part of the general population, selected by a special sampling method.

Each statistic depending on the purpose of the study, can be considered as general and as selective. The sample must be representative in quantity and quality of the general population.

Representativeness- the representativeness of the sample in relation to the general population.

Representativeness quantitative– a sufficient number of observation units of the sample population (calculated using a special formula).

Representativeness is qualitative- correspondence (uniformity) of the signs characterizing the units of observation of the sample population in relation to the general one. In other words, the sample population should be as close as possible to the general population in terms of quality.

Representativeness is achieved by a correctly conducted selection of observation units, in which any unit of the entire population as a whole would have an equal opportunity to get into the sample population.

The sampling method is used in cases where it is necessary to conduct an in-depth study, while saving effort, money, and time. The selective method, when applied correctly, gives fairly accurate results suitable for their use in practical and scientific purposes.

There are a number of methods for selecting units for a sample population, of which the following methods are most commonly used: random, mechanical, typological, serial, cohort.

Random selection is characterized by the fact that all units of the general population have an equal opportunity to get into the sample (by lot, according to a table of random numbers).

Mechanical selection is characterized by the fact that a mechanically selected, for example, every fifth (20%) or every tenth (10%) unit of observation is taken from the entire (general) population.

Typological selection (typical sampling) allows you to select units of observation from typical groups of the entire population. To do this, first, within the general population, all units are grouped according to some characteristic into typical groups (for example, by age). From each such group, a selection is made (randomly or mechanically).

Serial selection is similar to typological selection, i.e. first, within the general population, all units are grouped according to some characteristic into typical groups (for example, by age), and then, in contrast to typological selection, several groups (series) are taken as a whole.

The cohort selection method is characterized by the fact that all units of the population selected for the study are united by a common feature for them (for example, year of birth, year of registration of marriage). This selection method is often used in demographic studies. The observation time, in this case, should be at least 5 years.

Stages of statistical research. Statistical research is built on the basis of certain scientifically generalized principles, rules and techniques developed in the course of many years of practice, which together constitute the statistical methodology.

Statistical work in healthcare practice and special medical research consists of four successive stages, which in turn fall into a number of static operations:

1st stage - drawing up a plan and program of research (preparatory work). Definition of the purpose and objectives of the study.

Drawing up a plan and monitoring program:

– determination of the object of observation;

– establishment of the unit of observation;

– determination of accounting features;

- drawing up or choosing the form of an accounting document;

– determination of the type and method of statistical observation.

Compilation of the program of the summary of materials:

– establishment of grouping principles;

– selection of grouping features;

- determination of the necessary combinations of features;

– drawing up layouts of statistical tables.

Drawing up an organizational plan for the study:

- determination of the place, time and subject of observation,

- summaries and processing of materials.

Elements of statistical tables:

1. The name of the table (clear, short), which defines its content.

2. Statistical subject - as a rule, this is the main feature of the phenomenon under study. It is usually located along the horizontal rows of the table.

3. Statistical predicate - a sign that characterizes the subject. It is located in the vertical columns of the table.

4. Final columns and rows - complete the design of the table.

Types of statistical tables

1. Simple called a table in which only the quantitative characteristics of the subject are presented (Table 2.1)

Table 2.1. The number of beds in hospitals in the city of N. as of 01.01.

Simple tables are easy to compile, but their information is not very suitable for analysis, so they are used mainly for statistical reporting (information about the network and activities of medical institutions, etc.).

2. Group a table is called in which the connection of the subject with only one of the signs of the predicate is presented (Table 2.2).

Table 2.2. Distribution of patients by sex and age treated in various departments of the hospital in the city of N. in 2002

Branch name				Age groups (years)				Total
			Both sexes				Total
Therapeutic
Surgical
Gynecological
Total

The group table can contain an unlimited number of signs in the predicate (no more than 24 are recommended, since it is not convenient to work with such tables), but they can only be combined with the subject in pairs:

– hospital and treated by sex,

- hospital and treated by age.

3. Combination a table is called, the data of which characterize the connection of the subject with a combination of features of the predicate (Table 2.3).

Table 2.3. Distribution of patients treated in hospital No. 4 of the city of A., by nosological forms, sex and age for 1997–2002.

Nosological forms

Age (in years)

Total

up to 30

31 – 40

41 – 50

over 50

Pneumonia

M

F

OP

M

F

OP

M

F

OP

M

F

OP

M

F

OP

Bronchitis

Tracheitis

Flu

SARS

Total

Combination tables are used to conduct a detailed study of the relationships between individual features of a phenomenon, or between several homogeneous phenomena that differ in only one feature.

2nd stage– statistical observation (registration). Briefing. Providing registration forms. Collection of material. Registration quality control.

3rd stage– statistical summary and grouping of materials. Counting and logical verification of materials. Marking (encryption) of materials according to grouping characteristics. Counting totals and filling tables. Counting processing and analysis of materials:

– calculation of relative values ​​(statistical coefficients), calculation of average values;

- compiling time series;

- statistical assessment of the reliability of sample indicators and testing of hypotheses;

– construction of graphic images;

- measuring the relationship between phenomena (correlation);

– attraction of comparative data.

Stage 4– analysis, conclusions, suggestions, implementation of research results into practice.

Statistical research is not necessarily a scientific work; in the daily practice of healthcare institutions, all of the above steps are carried out. Thus, the practice of filling out accounting documents corresponds to the stage of statistical observation; preparation of periodic reports - the stage of statistical summary and grouping of materials; the analysis stage consists in the text part of the reports, in the preparation of explanatory notes and business reviews that give a scientific and medical interpretation and explanation of digital data. In this case, the first stage of statistical research corresponds to the development of a system of accounting and reporting of health care institutions.

2.2 Relative values

A derived value is an indicator obtained as a result of converting an absolute value based on its comparison with another absolute value. It is expressed as a ratio or difference of absolute values. The main types of derived values ​​used in biomedical statistics are relative values ​​(statistical coefficients) and average values.

Absolute values ​​characterize, for example, the size of the population, the number of births, isolated cases of certain infectious diseases, and their chronological fluctuations. They are necessary for organizational and planning constructions in healthcare (for example, planning the required number of beds), as well as for calculating derived values.

However, in the vast majority of cases, the series of absolute numbers are not suitable for comparison, identifying relationships and patterns, qualitative features of the processes under study. Therefore, relative values ​​are calculated, the types of which depend on what is being compared:

- a phenomenon with the environment from which it occurs;

- constituent elements of the same phenomenon;

- independent phenomena compared with each other.

There are the following types of relative values:

– Intensive coefficients (relative frequency values).

– Extensive coefficients (relative values ​​of distribution or structure).

– Coefficients (relative values) of the ratio.

– Coefficients (relative values) visibility.

Intensive coefficients- characterize the strength, frequency (degree of intensity, level) of the distribution of the phenomenon in the environment in which it occurs, with which it is directly related.

Phenomenon

Intensive indicator = - · 100 (1000; 10000… etc.)

Calculation of intensive measures produced in the following way. For example: the population of the N-th region in 2003 amounted to 1318.6 thousand people. During the year, 22.944 thousand people died. To calculate the mortality rate, it is necessary to compose and solve the following proportion:

1.318.600 – 22.944 22.944 · 1000

1000 - X X \u003d - \u003d 17.4 ‰.

Conclusion: the death rate in 2003 was 17.4 per 1,000 population.

It should be remembered that when calculating intensive coefficients, we are always dealing with two independent, qualitatively different aggregates, one of which characterizes the environment, and the second characterizes the phenomenon (population and number of births; number of sick people and number of deaths). It cannot be considered that the patients were “divided into the recovered and the dead”, the dead are a new (in this case, irreversible) phenomenon, an independent set.

Examples of applying intensive coefficients:

- determination of the level, frequency, prevalence of a particular phenomenon;

– comparing a number of different populations in terms of the degree of frequency of a particular phenomenon (for example, comparing birth rates in different countries, comparing mortality rates in different age groups);

- identification of the dynamics of changes in the frequency of the phenomenon in the observed population (for example, changes in the prevalence of infectious diseases in the country's population over several years).

Ratio coefficients- characterize the numerical ratio of two, not directly related, independent sets, compared only logically, according to their content. The technique for calculating ratio indicators is similar to the technique for calculating intensive indicators:

Phenomenon A

Ratio indicator = - · one; 100 (1000; 10000 etc.)

Phenomenon B

Ratio coefficients usually indicate the numerical ratio of two phenomena that are not directly related to each other.

Calculation of ratio indicators produced in the following way. For example: the number of children in the N-th region in 2004 was 211.480 people. The number of pediatricians in the region in 2004 was 471.

To calculate the provision of the child population with pediatricians, it is necessary to draw up and solve the following proportion:

211.489 – 471 471 · 10.000

10.000 - X X \u003d - \u003d 22.3

Conclusion: the provision of the pediatric population with pediatricians was 22.3 per 10,000 children.

Extensive coefficients can characterize the structure of fertility (the distribution of those born by sex, height, weight); the structure of mortality (distribution of the dead by age, sex and causes of death); structure of morbidity (distribution of patients according to nosological forms); composition of the population by sex, age and social groups, etc.

Calculation of extensive coefficients produced in the following way. For example: in 2003, the population of the N-th region was 1318.6 thousand people, including men - 605.3 thousand people. If we take the entire population of the N-th region as 100%, then the proportion of men will be:

1.318.600 – 100% 605.300 · 100

605.300 – Х Х = – = 45.9%

Conclusion: the proportion of the male population of the N-th region in 2003 was 45.9%

A characteristic feature of extensive coefficients is their interconnectedness, which causes a certain automaticity of shifts, since their sum is always 100%. For example, when studying the structure of morbidity, the proportion of a particular disease may increase in the following cases:

1) with its true growth, i.e. with an increase in the intensive indicator;

2) at the same level, if the number of other diseases decreased during this period;

3) with a decrease in the level of this disease, if the decrease in the number of other diseases occurred at a faster pace.

Extensive coefficients give an idea of ​​the proportion of a particular disease (or class of diseases) only in a given population group and only for a certain period.

Visibility ratios- are used for the purpose of more visual and accessible comparison of series of absolute, relative or average values. They represent a technique for converting digital indicators.

This coefficient is obtained by converting a number of quantities with respect to one of them - basic(any, not necessarily primary). This base value is taken as 1; 100; 1000, etc., and the remaining values ​​​​of the series, using the usual proportion, are recalculated in relation to it (Table 2.4).

Table 2.4. Birth rate in Russia for 1997 and 2000 (per 1000 us.)

The visibility coefficients can be used to demonstrate the trends of dynamic shifts and changes in the process under study (increasing or decreasing).