Around the end of the 19th century, a trend toward an increase in life expectancy at birth emerged, developed, and is now stable. This trend has manifested itself especially clearly in developed countries of Europe, the USA, Japan and China. For example, according to the UN, on average in Europe from 1950 to 2005, life expectancy increased by more than eight years: from 65.6 to 73.7 years (see Table 1).

Table 1. Increase in average life expectancy at birth in Europe, 1950–2005.

Years	Life expectancy (both sexes)
1950-1955	65,6
1955-1960	68,1
1960-1965	69,6
1965-1970	70,6
1970-1975	71,0
1975-1980	71,5
1980-1985	72,0
1985-1990	73,1
1990-1995	72,6
1995-2000	73,2
2000-2005	73,7

Source: United Nations 2004 In connection with this, as well as in connection with a decrease in the birth rate in developed countries, in recent decades, many countries have faced a situation of “aging” (or graying) of the population: an increase in the proportion of older people (from 65 years of age and above) and related problems. Peter Peterson described this phenomenon as a “gray dawn” (Peterson 1999). Indeed, the average age (in years) of the population in Japan in 2000 was already 41.3, in Switzerland - 38.7, in Italy - 40.3. At the same time, in the same countries in 1960 this indicator was respectively: in Japan - 25.5, in Switzerland - 32.5, in Italy - 31.3 (United Nations 2004). Great Britain's demographic statistics are very indicative in this regard (See Diagram 1). There, in the 1850s, the proportion of the population over 65 was approximately 5%. This figure now exceeds 15% and continues to rise (Office for National Statistics 2003).

Chart 1. Older population of Great Britain 1901-2031.

Source: UK National Statistics 2005.

According to the UN, by 2025, approximately one in six people on Earth will be over 60 years old, amounting to more than one billion elderly and elderly people. The European adult population over 60 years of age will be 28% by 2025 (United Nations 2004). This trend is likely to continue. If in 2000-2005. life expectancy at birth in Japan, Sweden and Israel was 81.5, 80.1 and 79.2 years, respectively, then in 2045-2050. it will be, in accordance with forecasts, 88.0 84.6 and 83.5 years (United Nations 2004). The average age (in years) in 2050 in Japan will be 52.3, in Italy 52.5, in Switzerland 46.5. The “50 Club” in 2050 will include Austria (50.0) and Hong Kong (51.1). Spain will almost reach this level - 49.9 years (United Nations 2004). For Russia, this topic is also relevant. The population of Russia, by international standards, has been considered “old” since the 60s. Of course, one must keep in mind that in reality there is not only an increase in the proportion of the older population in the age structure of society, not only a gradual increase in life expectancy at birth life, but also another process, so far little noticed and practically unexplored by scientists: “population rejuvenation.” The population of developed countries, thanks to the development of medicine, maintains health and a youthful appearance longer, which leaves its mark on many processes of a psychological, cultural, socio-social nature, etc. We should also not forget that the real goal of gerontologists and all who deals with the issues of overcoming aging - not just increasing life expectancy, but extending life healthy life and youth. A great contribution to the “rejuvenation” of the population is made by the spread of many cosmetological techniques for maintaining a good appearance: plastic surgery, hardware and “pharmaceutical” cosmetology, etc. A whole direction in medicine has appeared: “anti-aging” (from the English. antiaging - “anti-aging”). Also, many diseases and conditions commonly associated with aging have themselves become “older.” So, on average, women now reach menopause later. If at the beginning of our century menopause and the climacteric syndrome accompanying it in some cases occurred in women at the age of 40, now most often - at 50-−52 years (Belova 2001). Hormone replacement therapy also contributes to the health and activity of women This “rejuvenation” of the population, as opposed to “graying,” often gives, as we will show below, new accents to a variety of processes. But in general, the increase in the average age of the population has far-reaching consequences and has a serious impact on the planning and implementation of social policy measures. UN Secretary-General Kofi Annan said at the Second World Assembly on Aging: “As more and more people move to cities, older people are losing traditional family support and social networks and are rapidly sliding towards marginalization... In many developed countries, the concept of a secure the cradle-to-grave existence is rapidly disappearing. The declining working population means that older people are even more at risk of being left without adequate pensions and health care. As the elderly population grows, these problems will increase many times over" (Annan 2002). He is echoed by Paul Hodge, an expert on age-related social policy at Harvard University: "Life expectancy will increase rapidly, and the strategy we are pursuing now will very soon will be unacceptable" (NEWSru 2006). Fortunately, it is the phenomenon of increasing health span during the aging period that can significantly make it easier for society to solve the problem of population aging. In addition to the phenomenon of “rejuvenation” of the population - and this will be specially noted in the section “Current state of technologies affecting life expectancy” - modern medicine has come close to the threshold beyond which we can expect a significant increase in life expectancy. Many famous scientists point to this. V. N. Anisimov, professor, president of the Gerontological Society of the Russian Academy of Sciences in the book “Evolution of Concepts in Gerontology” writes: “... if the current rate of progress in the study of the mechanisms of aging is maintained, then it is right to expect the receipt of critically important results in this area. It seems reasonable to hope that effective therapy for aging can be implemented already in the second quarter of the 21st century, and in its second half the emergence of methods that actually give a person “eternal youth”"(Anisimov, Soloviev 1999). There are other forecasts, slightly different in dates in both directions. However, the general direction of the trend is no longer in doubt among specialists. Moreover, in the field of counteracting aging, impressive results have already been achieved in animal experiments (Chistyakov 2006). In our research, we also proceed from the position that it is impossible not to notice and not to take into account both the “rejuvenation” of the population and the revolutionary state of gerontology in forecasting. So, the current trend, which will grow over time, poses economic, social, psychological, and moral problems to society. Already now, governments are forced to change pension policy, policy in the field of health insurance and services, develop education systems for people of the third age, respond to many challenges associated with this problem, while using various kinds of forecasts as a basis. But, let us note again: it is necessary to clearly understand that generally accepted indicators, for example, life expectancy, are an extrapolation of data from recent decades, which are characterized by the absence of fundamental breakthroughs in the field of medicine that could lead to any large-scale consequences, as was the case, for example, during the period of epidemiological transition .At the moment - and this has already been noticed by researchers (including Russian ones (Martynov 2001)) - there is reason to believe that we are living at the beginning of the biotechnological and gerontological revolution, and a simple extrapolation in relation to life expectancy and health of the population can be considered incorrect, in particular, seriously underestimating life expectancy at birth, especially for younger cohorts. This is one of the most serious dangers in forecasting: trying to extrapolate curves into the future without taking into account possible or even predicted by science(and sometimes even already existing!) qualitative, revolutionary changes in any industry that seriously affects the problem under study. It is impossible to predict the cost of developing new drugs without taking into account the rapidly developing computer modeling of humans at different levels: cells, biochemical interactions, various body systems, etc. The development of this area can seriously affect the cost of developing new drugs, as it will reduce testing costs and development time . Another interesting example: not so long ago it became clear that it is impossible to predict the structure of employment of the population without taking into account the development of information and communication technologies (Vaknin 2003: 88). It is also impossible to predict various indicators of public health without taking into account the future, projected development and influence of computer technologies, biotechnologies and already emerging nanomedicine. However, we consider it possible to rely in our research on official data, which, although they do not take into account the influence and prospects of the latest achievements of science and technology, correctly identify the current trend. However, I would like to note that we currently live in a developing NBIC-convergence, that is, increasing mutual influence and mutual acceleration of leading innovative technologies (nano- (N), bio- (B), information (I) and cognitive (C) science) (World Technology Evaluation Center 2004). In this regard, it would be wrong - given the currently very weak study of the issue of the impact of converging new technologies - to make forecasts for more than 20 years, maximum 30 years. Unfortunately, even recognized thinkers have not escaped this temptation. Thus, Umberto Eco recently put forward a forecast, which is based on the author’s conviction that in the coming centuries people will live on average 200 years (Eco 2006: 66-67). Based on this, the author makes very bold and, in our opinion, unjustified forecasts, such as, for example, the emergence of new diseases in the age range from 80 to 200 years, an increase in the age of majority, and, in connection with this, the transfer of the function of raising children to the state. As in many other forecasts, it does not take into account not only the already predicted influence of nanomedical technologies, new technologies of training and education, and emerging technologies for controlling cognitive processes. It is also misunderstood that as such a society where the average life expectancy is two hundred (or some other strictly defined number) years - such a society will not exist in the coming centuries, since it must be clearly understood that different age groups already have various life expectancy. For older people, it is approximately equal to the standards of the late twentieth century. For those in the middle age group, life expectancy can increase (depending on income) to one hundred and twenty years (counted from birth). The younger age group has a chance for a significantly longer life expectancy and even (which, as shown below, leading gerontologists tirelessly talk about) - for practically unlimited longevity. Unfortunately, this issue is extremely poorly studied, and quantitative research in this area is unknown. Therefore, in the study we have to rely on available data, information about technological advances and research logic. Based on this, we will consider what the prospects for increasing life expectancy are and what consequences this leads to now and what this process may lead to in the future.

2. Current state of technology affecting life expectancy

In our study, we will limit ourselves to considering exclusively medical and biomedical technologies that affect life expectancy, and will not consider social, political and other impacts, which include, in particular, the problems of alcohol and drug mortality, which have a noticeable impact on the decline in life expectancy in Russia and other Eastern European countries (Khalturina, Korotaev 2006). At the moment, we can say that the foundations for understanding the problem of aging have already been laid, many outstanding scientists are working on this important problem. Among the key figures are outstanding Russian scientists: Academician of the Russian Academy of Sciences V.P. Skulachev, professor V.N. Anisimov, scientists A.M. Olovnikov, V.B. Mamaev, as well as their foreign colleagues Richard Miller (University of Michigan), Jay Olshansky (University of Illinois), Aubrey de Gray (University of Cambridge), Bruce Ames and many others. Aubrey de Gray (University of Cambridge), an outstanding modern gerontologist, member of the Board of Directors American Association on Aging ( American Aging Association) and the International Association of Biomedical Gerontology ( International Association of Biomedical Gerontology) has already held conferences on engineering strategies for negligible aging (SENS), the results of which are difficult to overestimate. Funds allocated to the study of aging in developed countries are constantly growing. For example, from 1990 to 2000. Funds allocated to the National Institute on Aging (NIA) in the United States more than doubled: from 210 to 570 million dollars (Borner 2006). As indicated in the forecasts of the Institute of World Economy and International Relations of the Russian Academy of Sciences, “the trends in the rapid growth of fundamental and applied scientific research and developments aimed at solving a wide variety of health problems will intensify in the forecast period (2000−2015) in all developed countries” (Martynov 2001: 592).Accordingly, the number of discoveries and technological advances in the fields of medicine and biotechnology related to increasing life expectancy is growing. For example, it is necessary to note the rapid growth of advances in the field of cell culture of organs. Stem therapy already treats many previously incurable diseases and claims to be the main method of rejuvenation for the next 10-20 years (Maxon 2006). A huge number of organizations around the world are working on the problem of computer modeling of living organisms and humans in particular. Thus, work is underway on a project that aims to create a complete computer model of the bacterium Escherichia coli ( Escherichia coli), with an accuracy down to individual molecules ( International E. coli Alliance). There are a number of projects dealing with the study and “engineering analysis” of the human brain ( Human Cognome Project). Promoting IBM Blue Brain is a joint project between IBM and the Federal Polytechnic Institute of Lausanne, the goal of which is to create a digital model of the human brain ( Blue Brain Project 2007 ). NASA is also conducting work in this direction; there are a number of projects on human anatomical modeling (Potapov 2006). Solving the problem of human modeling will make it possible to solve both the issues of long-term consequences of the use of drugs, as well as almost any issues of medical and other interventions in the human body and its long-term effects. consequences. Russian science does not stand aside either. The most widespread attack on aging is being carried out by scientists led by the Institute of Physical and Chemical Biology named after. A. Belozersky under the leadership of Academician V.P. Skulachev. In many laboratories - both public and private - the properties of stem cells are being studied: not only their ability to enhance the regeneration of individual organs (impressive results have been achieved in this direction), but also the general rejuvenating effect . And although, it must be said, the attitude towards this young technique is ambiguous, nevertheless, society as a whole has quite easily resolved for itself the moral and ethical issues of using stem cells (which indicates the psychological readiness of people to increase their life span and youth). Treatment technologies and rejuvenation using stem cells are rapidly developing and expanding expansively. And although at the moment it is difficult to talk about any stable dynamics in prices for stem therapy services, in general, it is becoming more accessible. Indeed, is there something at the core of stem therapy that makes it fundamentally unsuitable for wide replication? In our opinion, it does not exist. The thesis about its individual orientation, about the need for an individual approach to each person, cannot be an obstacle to this, since we use a huge number of such individually oriented services: all medicine, almost all household services, etc. Also, this technology is based on a relatively simple (for modern society) technical base that can be easily replicated. Training practitioners is also not difficult. The medical infrastructure can easily cope with the widespread use of this technique. Taking into account all of the above, we can expect a large-scale dissemination of the stem cell rejuvenation technique (of course, if research in the coming years confirms optimistic forecasts) both on the basis of private initiative and with the support of the state, however, as seems not yet ready to realize the value of an individual human life and work to preserve it within more expanded limits than before. This issue is also widely considered in philosophical circles. First of all, I would like to note the contribution to understanding the problems of immortalism of the Russian philosopher, Doctor of Philosophy, Professor Igor Vladimirovich Vishev. Raising questions about the possibility of increasing life, Igor Vladimirovich has published over the past 15 years a large number of publications on issues of life, death and immortality, the most significant of which are the books “On the Path to Practical Immortality” (Vishev 2002) and “The Problem of Life, Death and Immortality” man in the history of Russian philosophical thought" (Vishev 2005). In the latter, the author convincingly shows that the question of the possibility and necessity of increasing a person’s lifespan was positively resolved by such thinkers as Nikolai Fedorov, Vladimir Solovyov, Nikolai Chernyshevsky. Also, Alexander Herzen found it possible to express the idea of ​​desirability and readiness to conquer death if the necessary conditions for this are present. The trend, gradually spreading in the societies of developed countries, can perhaps be expressed in the words of John Harris, professor of bioethics at the University of Manchester, who says that this the question must be viewed not as a fight against death, but as a fight for life. In a Reuters article dated March 26, 2006, “Happy 150th Anniversary!” Prospects for a New Era of Aging” quotes him as saying: “Saving a life is simply delaying death. If it is right and good to postpone death for a short period, then it is not clear why it would be less correct to postpone it for a long time? (Happy 2006). Since we are now living in the beginning of the biotechnological revolution, we generally believe that the already emerging advances in cell therapy, therapeutic cloning and other areas of modern gerontology and biotechnology will lead to higher life expectancy within a decade, which will lead to more obvious transformations of society than is seen from traditional positions. It should also be noted that the current position of older people in society has already fundamentally changed compared to traditional societies and will change even more in the near future, and these changes will not necessarily have the same effect character, which we will also try to show.

3. Social consequences of increasing life expectancy and forecasts

What changes in society that are directly related to the increase in life expectancy in recent decades do we already know about? Which ones are we just starting to guess about? What border situations related to this may arise, and which ones will be smoothed out? What can the dramatic increase in life expectancy expected by many scientists bring in the next 20-30 years? In our article we will try to answer these questions. First of all, I would like to list the processes and phenomena we have identified that are most closely related to the process of increasing life expectancy. This:

changes in the structure of social stratification of society; changes in retirement age and pension policy; development of retraining, training for adults and older people (lifelong education); conflict between the new reality and traditional ideas about age and the “age schedule”; erosion of age stratification and the beginning of the formation of an ageless society ;possible decline in the popularity of radical movements; changes in family life associated with increased life expectancy; possible overpopulation.

Let's look at them in more detail.

3.1. Changes in the structure of social stratification of society

We are considering those changes in the social stratification of society that are already taking place (and, perhaps, will manifest themselves) precisely due to increased life expectancy. We do not consider the dependence of increases in life expectancy and health on such variables as gender, racial characteristics, or various environmental influences, although it is clear that, in general, health is determined by the interaction of social, psychological and biological factors. We also neglect the influence of geographic location, since it does not play a decisive role when considering the trend of interest to us. First of all, I would like to note that at this stage of research in this area there is no clear answer to the question of whether there will be social stratification as life expectancy at birth increases life to grow or shrink. At the same time, no one has yet put forward any convincing arguments in defense of the position that social tension increases as life expectancy increases. In addition, the unequal distribution of income in the world (the 400 richest people in America had a wealth of $328 billion in 1993, which is more than the gross national income of a billion people living in India, Bangladesh, Sri Lanka and Nepal in 1991 ( Inozemtsev 2001: 12-138)) is critical and does not consider the prospects for increasing life expectancy. It must be said that researchers have already obtained some data on the dependence of mortality on belonging to social classes. For example, people with higher education in the UK already live on average seven years longer than unskilled workers.

Diagram 2. Mortality in Great Britain in 1976-1989. men aged 15 to 64 years. Distribution by cause of death and social class in 1971

Sources: Data from Population Trends, 80. 1995. From Sociology Review, 9.2. Nov.1999. P. 3. Crown copyright.

In Russia, there are even more significant differences in the mortality rate between persons engaged in mental and physical labor, as well as very strong differences associated with educational level (Andreev, Kvasha, Kharkova 2005: 227-228; Andreev, Kharkova, Shkolnikov 2005: 68- 81; Khalturina, Korotaev 2006: 39–42, 86).Recently, a number of publications have appeared (Sukhikh 2005; Ashursky 2005), where, mainly on the basis of similar facts, without taking into account the reasons influencing this dependence and trends in change influencing factors, rather gloomy forecasts of social storms are given that will supposedly break out with the further development of life extension technologies. We do not agree with such conclusions, since we believe it is necessary to take into account trends affecting the existing problem: We believe that in any forecasts regarding the topic under consideration, it is necessary to keep in mind that differences in the health of different social classes are influenced by such (and changing depending on time the degree of its importance) factors such as: the degree of accessibility of modern, including currently expensive methods of treatment; government programs for the development of social medicine; a traditional way of life for a certain stratum; programs to combat smoking, alcohol abuse, drug abuse (which are more common in less affluent and less educated sections of society); level of education, and recently - the emergence with the development of the Internet - accessible education through the Internet. For such forecasts, factors that influence differences in the health of different classes are also of great importance, such as the gradual disappearance of unskilled labor - one of the most stable trends in the development of post-industrial society; an increase in the social activity of older people, etc. Also - and this is extremely important - there is a constant decrease in the cost and improvement of the quality of medical services, including those that were previously available only to the wealthiest layers. Against this background, scenarios for the “revolutionary” resolution of possible social conflicts based on different life expectancies at birth do not look convincing. Already now, as we showed above, different age cohorts have significantly different life expectancies (counting from the moment of birth). Already, it varies significantly in different countries. And at the same time, we do not observe “wars of mortals against immortals.” In conclusion of our brief review, I would like to say that modern society has significant potential for leveling out any social imbalances. In this case, this could be, for example, the expansion of free and subsidized services in the medical and social sphere. The main importance in matters of social stratification will be political decisions and the will of governments: the adoption of various accessibility programs, programs to combat poverty and inequality in various areas, etc. In general, we want to say that we see no reason why the existing mechanism smoothing out social differences would not work given the increasing influence of the factor of increasing life expectancy on social stratification.

3.2. Changes in retirement age and pension policy

It is a common belief that as the number of older people continues to increase, so will the need for certain social services and health care systems. Increasing life expectancy means that pensions will have to be paid for more years than now. In Italy, for example, people retire on average at 57 years old. “This leads to excessive costs and a loss of skills and knowledge that could sink our economy,” the Libero newspaper said. There are already proposals that the retirement age should be gradually raised to 60 years by 2010 and then to 62 years (Arie, Aris 2003). “Pension associations have recently warned that the current pension scheme cannot continue indefinitely. They called for an increase in the minimum retirement age for both women (from the current 60 to 65 years) and men (from 65 to 70 years), in order to compensate for increased life expectancy” (Giddens 2005).

Chart 3. Government spending on pensions and health care in seven countries in 1995 and projected for 2030.

One can argue with the assertion that as life expectancy increases, pensions will have to be paid longer. It is based on the assumption that the dependence of the incidence rate on age will have approximately the current character, maybe only slightly “stretched” (not shifted!) by the end of life for the corresponding number of years. This can be questioned. For example, S. Jay Olshansky, a famous American biogerontologist and biodemographer, and his colleagues proposed an idea known as the “Longevity Dividend.” They argue that what is optimal from an economic point of view is not the study and treatment of individual diseases, but the development of methods to slow down and treat aging. Later and shorter old age (the so-called “mortality compression” concept) will significantly reduce society’s costs of treating the elderly and increase their contribution to the economy. The costs of such an approach will be about 1 percent of total medical expenses (in the USA), but will bring economic returns 1-2 orders of magnitude greater (Olshansky, Perry, Miller, Butler 2006). But in any case, the most natural thing in a situation of increasing life expectancy and the expected improvement in the health of the population will be a change in pension policy. The first step is already being taken - increasing the retirement age. The second step will need to be taken, no matter how unpopular it may seem now: the establishment of pensions for health reasons, starting from a certain age. Or no age at all. The development of a unified standard for determining biological age can help here. There are other approaches to developing pension policy in the future (Grey 2007). Speaking about the long-term prospect of a radical extension of life, we can say: if the population’s health is ideal, pensions may not be needed at all.

3.3. Development of retraining, training for adults and older people ( Lifelong Education)

According to British company estimates iSociety Among those in the UK over 65, only 20% are PC users (Web Planet 2002). As computerization advances, the proportion of older PC users will increase and, accordingly, the opportunities for this cohort to find work and study will increase. Kofi Annan, in his speech at the Second World Assembly on Aging, said: “We must recognize that as people become more educated , live longer and enjoy better health, older people can and do make more meaningful contributions to society than ever before. By promoting their active participation in society and its development, we can ensure that their invaluable talents and experience are put to good use. Older people who are able and willing to work should be able to do so; and every person should have the opportunity to learn throughout his life.” In many countries, so-called third-age universities are already developing, and systems lifelong education generally. Very indicative against this background is the appearance in Japan in 2005 of the “Brain Training for the Elderly” program for game consoles Nintendo(Membrana 2006).

3.4. The conflict between the new reality and traditional ideas about age and the “age schedule” in various ethnic cultures ( Lifelong Education)

This is a very serious moment, which is already leading to various kinds of borderline situations. Issues of marriage, having children, work, relationships between different age groups - literally all aspects of life are currently being rethought by societies that are faced with an increase in life expectancy, and, of course, the emergence of new realities brings to life various borderline situations. Thus, gerontological violence is a phenomenon that occurs among all social groups, regardless of income level, education, position in society; unfortunately, it is present both at home (in individual families) and in social and medical treatment institutions. It is this problem that is now widely covered in the press and studied by researchers. Even a conditional typology of facts of violence has been developed - physical, emotional-psychological, financial-economic, neglect, sexual-gerontological and violence associated with drug abuse. Each of the older people is, to one degree or another, influenced by traditional views expressed by relatives, The media, neighbors, etc. Also, the cultural orientations of older people, formed in the first half of the 20th century, differ from the cultural orientations of people born in the post-industrial era of high technology (second half of the 20th century). This is expressed in work and work ethics, family, religious, patriotic orientations. This conflict will be erased as age stratification weakens (we write about this in section 5 “Weakening age stratification”), as third-age universities develop and are introduced into public consciousness ideas about older people as a real active force, which will naturally happen more and more as healing and rejuvenation technologies develop. However, in each country, the development of the activity of the elderly population follows its own path, and what suits one culture and system, cannot always be transferred unchanged to another cultural environment. One can only note this trend and study the most successful experience to adapt it to the specific needs of society. It should also be noted that the conflict between the new reality and traditional ideas about age and the “age schedule” is not the first conflict of this kind in the history of mankind. For example, the prestigious age was not always the same - all periods of human life, under certain conditions, were such. And the moment of changing the affiliation of prestige was, of course, to one degree or another a conflict of the indicated type. But now, despite widespread stereotypes about the happiest time in youth, we can safely say that any time in life, including old age, can be prestigious. And such an approach must be widely cultivated in society; power structures must proceed from it when determining social policy in relation to older people. It should also be noted that, unfortunately, in modern society, focused on youth culture, negative stereotypes of old age have developed, which negatively affect not only the elderly and elderly people themselves, but also the culture of society as a whole. Stereotypes of old age are determined by a set of simplified generalizations about people of the third age, which allows them to be perceived as stereotyped and unfounded. As a result, in many countries, including Russia, the so-called ageism The term “ageism” was originally coined by British researcher R. Butler in the early 1960s (Butler 1980). It has been defined as a process of stereotyping and discrimination directed against older people simply because they are older, similar to racism and sexism. This negative attitude towards older generations, which affects the quality of life of the elderly and elderly people themselves, limits the possibilities of their participation in the political, economic, social and cultural life of society, where the third age can manifest and express itself, use the talents and knowledge accumulated over the years. Ageism exists in all modern, and therefore rapidly developing, societies. Apparently, this is due to the fact that relations between generations have never been of a harmonious and idyllic nature. V.V. Bocharov notes that “in traditional societies, the attitude towards the elderly varied from touching care to the most cruel treatment, even murder” (Bocharov 2000). He argues in detail that, contrary to the established opinion about the harmony of relations between generations in the traditional Russian community, they were characterized by quite strong tension, and sometimes turned into outright conflict (Bocharov 2000: 169-184). Fear and rejection of old age permeate modern Russian society. One of the important directions of the state’s socio-pedagogical and socio-cultural activities on overcoming the influence of ageism, as well as increasing life expectancy and improving the quality of life in old age, is the formation of a social system that will allow older people generations to fully and actively participate in public life. To practically solve these issues, not only logical, statistical analysis and laboratory research are needed, but, above all, a theoretical basis and scientific understanding of the phenomenon of old age itself, the study of the mechanisms of aging and the development on this basis of ways to change stereotypes simplified perception of people of the third age, development of methods and means of maintaining the health of older people, increasing life expectancy, maintaining an active lifestyle in old age. The possibility of socio-cultural activity in the third age is one of the main ways to improve the quality of life of people of the third age and overcome negative trends in relation to old age. This can be greatly facilitated by the implementation of the principle of socio-cultural activation of the individual, the main postulate of which is to provide varied opportunities for active socio-cultural activities of elderly and elderly people. Societies faced with the problem of “graying” of the population are forced to promote a more active integration of elderly and elderly people into the economic, political, social and cultural life of society, to develop and stimulate programs and activities aimed at providing social guarantees for older people, to develop programs for training qualified specialists for services whose activities are related to meeting the needs and interests of third-age persons. As life expectancy continues to increase, these tasks become increasingly urgent.

3.5. Erosion of age stratification and the formation of an ageless society

Many researchers argue that advanced technologies, as they are successfully introduced into life, become source stratification of generations; that the generation gap and dramatic the consequences of modernization have become the common fate of society in developed countries around the world. Key importance when considering this topic is given to the social and cultural aspects of information as a global problem of our time. Intergenerational problems in the context of scientific and technological progress are considered in the works of A. I. Rakitov, I. V. Bestuzhev-Lada, L. N. Gumilev, A. V. Lisovsky, V. V. Radaev, O. I. Shkaratan, D. A. Ivanova.In recent decades, during the heyday of information and communication technologies, it is true that the younger cohorts at that time have mastered the emerging technology to a greater extent. This intergenerational gap is still observed today. But since the late 90s of the 20th century, the second “super-technological” revolution began, conventionally called biotechnological, which carries the potential to smooth out this borderline situation. This can be facilitated by an increase in life expectancy associated with improved health of older people, which will lead and is already leading to the widespread dissemination of various forms of education for the elderly and their mastery of new technologies on a larger scale. Secondly, the spread began freelancing(from English freelancer- mercenary), remote ways of working, which can encourage older people to work remotely using a computer and, accordingly, master new opportunities. Taking into account the above, we believe that thanks to favorable revolutionary global changes, the essence of which is the use of information technology and the expansion of civil rights society, as well as the future widespread dissemination of new methods of treatment and prevention of aging, we can build the partnerships necessary to create a society of people of all ages. Speaking about age stratification, it is worth noting that during initial contact people build their relationships, in particular, on determining whether the contactee belongs to any age group, based on determining this affiliation with the help of visual and other information and using established stereotypes. Nowadays it is possible (and even more so, perhaps in the future) to increasingly observe people who do not correspond to the stereotypes that have developed in the past. These are people who look good in old age, play sports, engage in work or activities previously considered youthful. Situations are increasingly encountered where a person’s biological age is significantly less than his actual age. Accordingly, such people have different patterns of behavior, different claims and opportunities than are still usual for the age group of their actual age. Accordingly, age gradually ceases to play a determining role in interpersonal communication; moreover, some disorientation in connection with these processes is possible among part of the population. Society is becoming more and more ageless.This leads to such phenomena as changes in the structure of employment (taking over jobs that were traditionally given to young people); strengthening “meritocracy” (discrimination based on ability), weakening age discrimination in general (and, accordingly, reducing age benefits). Of course, age stratification is not limited to demographic processes and division of labor, but also has a socio-economic and organizational aspect. The very concept of “stratification” presupposes a certain hierarchy in the distribution of authority or power (Psychology of age-related crises 2000). All these aspects will also undergo corresponding changes.

3.6. Possible decline in popularity of radical movements

Practice shows that radically minded people are more common among young people. For example, J. Goldstone (Goldstone 1991) associates political instability in Europe in modern times with a high proportion of young cohorts in society. As life expectancy increases, we can, we think, expect a general decrease in radicalism as the proportion of radically minded people in the population (which, however, it will not necessarily lead to a significant reduction in the risks of extremism and terrorism). Manifestations of radicalism are directly related to age-related crises. In human development, critical transitions are natural, accompanied, as a rule, by hormonal changes in the body and corresponding changes in behavior. Typical examples of such transitions are periods of puberty (“transitional age”, often accompanied in pack animals by leaving the pack and increasing search activity), periods of premenopause and menopause in women. Naturally, as the percentage of older people increases, fewer and fewer people will be in the “age of radicalism.” Accordingly, we have the right to expect a decrease in youth radicalization. It is currently unknown whether people in the older age group will experience new periods of crisis associated, for example, with a change in life scenarios.

3.7. Changes in family structure associated with increased life expectancy

In this area of ​​human relationships, we can expect the following changes: an increase in divorces, a change in attitudes towards older people (in particular, this will be influenced by a decrease in the number of elderly people living with children); Bigam marriages, which are typical for older age groups, are likely to become more common. The proportion of marriages with a large age difference between the bride and groom will also increase. All these processes are already visible. Today in the UK, every fourth woman is married to a man who is 15 or more years older than her. In Russia, every year there are also more and more unions in which the man is significantly older than his partner (15 years or more). In Moscow, 60 thousand marriages take place annually, of which approximately 11–11.5 thousand per year - with a difference of 15 or more years in favor of the man. 20 years ago this figure was 10 times less (Arguments and Facts 2005). With the development of rejuvenation technologies, obviously, the number of unions with a large age difference in favor of women will increase. Also today, many marriages that were previously broken by death are ending in divorce. Experts call this “retired husband fatigue syndrome.” One elderly Japanese woman says: “Not only did I wait on him when he came home from work, but now he will hang around the house all the time. I can’t stand this anymore.” There are also more radical forecasts. Thus, Umberto Eco, for example, predicts a dramatic increase in “abandoned” children due to the infantilization of the population and a possible increase in the age of majority (Eco 2006: 66-67). In our opinion, this forecast is not convincing, since the author connects the determination of the age of majority solely with the accumulation of competitive knowledge. In reality, determining (establishing) the age of majority is a task that depends on many biological, social and cultural factors. For our part, we can also point out the possible increase in incestuous unions and the devaluation of the institution of family prestige, since with a decrease in the birth rate, the main function of the family is reproduction of the population will lose its significance. In general, I would like to say that whatever the forecasts, it is obvious that serious changes will occur in this area, the trend towards which is already visible.

3.8. Overpopulation?

Speaking about the prospects for increasing life expectancy, one cannot help but pay attention to a frequently asked question: will the Earth be threatened with overpopulation if people begin to live longer, and even more so if, as some gerontologists predict, a radical increase in life expectancy is achieved? Obvious The answer, which follows from the existing demographic situation of developed countries, is: “No. The demographic situation in the most developed countries tends to stabilize by reducing the birth rate.” Taking into account the current trends, we can say that this issue will become relevant beyond the time frame (20-maximum 30 years) that we set for ourselves in our study. Considering the long-term prospects, researchers associate the solution to this problem, in particular:

• with the development of new, still inaccessible territories (Siberia, deserts, the bottom and surface of seas and oceans);
• with the construction of city houses;
• with the exploration of other planets and outer space;
• with a reasonable demographic policy;
• with the control of instincts, which will become possible as we further understand the work of the brain (i.e., with the development of the cognitive revolution) and improve methods of working with it (Grey 2007).

There is no doubt that humanity will be able to solve this problem, while at the same time not depriving people of their right to life.

Conclusion

In connection with the intensification of NBIC convergence, humanity will face amazing metamorphoses, which are still difficult to predict. It is the duty of humanities scholars to keep a close eye on the latest technological trends and carefully analyze their possible consequences. I would also like to draw attention once again to the fact that in modern post-industrial society, any forecasts that do not take into account the growing technological revolutions are doomed to be mere monuments of the recent past and present.

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INTRODUCTION

Demography belongs to the family of population humanities. In addition to demography, this includes history, sociology, psychology and ethnography. Let us define the object of study of each of them.

Demography deals with the study of problems of population reproduction, a statistical description of its condition (population size, distribution by sex and age, marital status, etc.) and demographic processes (fertility, mortality, marriage, displacement) occurring with the population.

Demography has its own clearly defined research field. Moreover, it serves as the basis for the development of such sciences as sociology, psychology, ethnography. There is probably no need to prove that there is a close connection between the processes occurring in the population and the development of society as a whole. It is obvious, for example, that the type of socialization of a person depends on the time of his birth, and the behavior of members of a social group is largely determined by the age of its members. So a group of students will behave completely differently than a group of pensioners. The same can be said about psychology. For ethnography, it is extremely important to study the demographic behavior of peoples; it is enough to recall the problem of the extinction of small peoples of the North, etc.

In addition, demographic knowledge is used in numerous interdisciplinary studies. So, the economy is concerned about:

· structure of the economically active population,

· availability of labor resources and the related problem of labor markets and unemployment.

· the problem of pension provision.

· social security, migration and refugees.

Thus, demography includes two components - its most fundamental part is demographic analysis itself and applied demography, which is part of the structure of interdisciplinary research focused on understanding the economic and social causes of ongoing demographic processes.

The subject of demography is population reproduction. It comes down to three most important forms of population movement. This:

· natural population movement. It includes such facts of a person's biography as birth, transition from one age group to another, marriage, birth of children or parenthood, divorce, widowhood and death;

· mechanical movement of population or migration. This includes the entirety of human movement across the territory, both temporary and permanent relocations;

· social movement or social and professional mobility. For demography, the reproduction and replacement of social structures, changes in such characteristics of the population as the level of education and professional composition are important.

In my work I will take a closer look at the problem of mortality and life expectancy, what are the factors and causes of death. I will also consider the economic aspects of the struggle to reduce mortality and improve public health.

1. THE CONCEPT OF MORTALITY. FACTS AND CAUSES OF DEATH. MORTALITY AND POPULATION HEALTH

1.1 Mortality concept

Mortality is the most important demographic process after fertility. The study of mortality has as its subject the impact that death has on the population, its size and structure.

In demography, mortality is the process of extinction of a generation and is considered as a mass statistical process, consisting of many single deaths that occur at different ages and, in their totality, determine the order of extinction of a real or conditional generation.

Death is the primary vital event for which the vital statistics system collects and combines data. Death statistics, as well as mortality analysis in general, are necessary both for the purposes of demographic research (a purely cognitive aspect) and for practice, primarily for health authorities and social policy.

Mortality is the frequency of deaths in a social environment.

The most important and priority areas for using death and mortality statistics are: analysis of the existing demographic situation and trends in its change; meeting the administrative and research needs of health services in connection with the development and implementation of public health programs and the evaluation of their effectiveness; determining policies and actions in areas other than health care; meeting the needs for information about changes in the population in connection with various professional and commercial activities (demographics).

Mortality is a massive process of ending individual lives that occurs in a population. Along with fertility, mortality forms the natural movement (reproduction) of the population.

Mortality data are needed both to analyze past population trends and to develop population projections. The latter, as is known, are used in almost all areas of activity: for planning the development of housing services, the education system, health care, for the implementation of social protection programs, for the production of goods and services for various groups of the population.

Mortality statistics are necessary in the analysis of morbidity at both the national and regional levels. Health authorities use mortality statistics to monitor and improve their activities.

In the early 1990s, socio-economic processes in society were accompanied by unfavorable changes in the demographic situation in Russia: a decrease in the previously low birth rate, an increase in mortality and, since 1992, an increasing natural population decline, which is not compensated by migration growth. The permanent population of the Russian Federation as of October 1, 2001 numbered 144.2 million people. In 1991, its average annual value was 148.6 million people.

If at the turn of the 80–90s the overall mortality rate of the population was at the average European level (10.7‰), then in 1999 it significantly exceeded the level of all developed countries in Europe (14.7‰).

The increase in the overall mortality rate is mainly due (according to data, by two thirds) to its increase in working age (men 16-59 years old, women 16-54 years old). From 1990 to 1999, the number of deaths in working age men increased by 41.4%, women - by 43.3%. (In 1994, compared to 1990, these figures were even higher: 76 and 56%, respectively.) Moreover, a new trend was an increase in mortality at young ages. Mortality increased most of all in the age groups 20-29 years, 30-39, 40-49 years (in 1995 compared to 1990 - by 61, 75 and 73%, respectively). Among all deceased persons, a quarter of them (24.8%) in 1990 and 27.1% in 1999 were of working age, including 41% in men in 1990 and 42 in 1999. The mortality rate of working-age men is 4 times higher than that of women. If the current mortality rate at these ages continues to persist in Russia, a little more than half (54%) of the current generation of 16-year-old boys will live to be 60 years old. The mortality rate for men of working age is now almost the same as in 1896-1897: the probability of surviving to 60 years for 16-year-old men was about 56% in 50 provinces of European Russia. It is estimated that the life expectancy of men who live to be 20 years old in modern Russia is the same as it was 100 years ago.

In table 1. and in Fig. 1 shows the dynamics of the natural movement of the country’s population for the period from 1950 to 1999.

In the first post-war decade, after a period of high fertility (“baby boom”), in the next three decades there was a decline, especially significant in the years 1960-1969, when the small generation born during the Great Patriotic War entered the childbearing period. The number of births was 7.1 million. (-25%) less than in the previous decade. A less significant decline in the birth rate was noted in 1970-1979. After a slight rise in 1980-1989. There was a huge (almost 38%) previously unprecedented decline in the birth rate in 1990-1999, amounting to 8.9 million people compared to the previous decade.

After a decrease in mortality in 1960-1969. compared to the previous decade by almost 1 million people. (-9 %), in all subsequent decades there was an increase in mortality compared to the previous decade: for 1970-1979. by 3.2 million people (+33%), 1980-1989 – by 2.7 million people. (+21 %) and for 1990-1999. – by 4.4 million people. (+29%). A feature of the last decade was that for the first time in the second half of the twentieth century, natural growth was replaced by a decline, amounting to more than 5.4 million people over 10 years, which cumulatively included a large decrease in the birth rate (38%) and a significant increase in mortality (28 %).

In developed European countries, as a result of a decrease in the birth rate (although its level remains higher than in Russia), natural population growth has also decreased, however, a decrease in mortality rates in these countries makes it possible to maintain natural growth or keep depopulation parameters at an insignificant level. In Fig. 1, between the points of the fertility and mortality curves, one can see how the potential for natural growth decreased, which in 1992 turned into a depopulation regime, called in foreign literature for its graphic clarity the “Russian cross” of depopulation. Annual natural population decline in 1999 and 2000 exceeded the previous “peak” figure noted in 1994: 930 and 960 thousand people. compared to 893, and per 1000 people. population -6.4 and -6.7 compared to -6.1 people. The unfavorable demographic processes that have begun continue today: natural decline increased in 2001 (the first half of the year) – to 6.9‰. After a short period of decline in the number of deaths and the overall mortality rate from 15.7‰ in 1994 to 13.6 in 1998, the increase in mortality resumed in 1999. In 2000, the total mortality rate of the population increased to 2.2 million people. or by 3.4% per year, amounting to 15.4‰. In mid-2001, the crude mortality rate exceeded its 1994 peak of 15.9 compared to 15.7 (Table 2). In 2001, the indicators under consideration continue to deteriorate.

In the country as a whole, the number of deaths exceeds the number of births by almost 2 times. In 43 regions this excess is from 2 to 4 times.

The significant increase in mortality in Russia in the 90s is not associated with a parallel process of population aging. The average age of the Russian population in the second half of the twentieth century was lower than in any region of Europe and Japan and only slightly lower than in North America. A comparison of the overall dynamics of mortality of men and women with the dynamics of the proportion of people aged 60 years and older for the period from 1960 to 1999 shows that from 1960 to 1975 these indicators changed in parallel (Fig. 2).

From 1975 to 1985, the increase in the number of deaths of both men and women significantly outpaced the increase in the proportion of people over 60 years of age. In 1984, the death toll reached its highest level in previous years: 1.65 million people. (810 thousand men and 841 thousand women), which was probably one of the reasons for the anti-alcohol campaign. During this action, the number of deaths fell in 1986 to 696 thousand men and 802 thousand women - the lowest values ​​​​for a decade - and remained at levels below 1984 until 1990.

Since 1991, the annual number of deaths of both men and women began to grow, significantly exceeding the dynamics of the proportion of people over 60 years of age. The absolute number of deaths in each year for the period 1991-1999. exceeded the figures of the 80s. The “peak” of mortality in the last decade occurred in 1994. This year, compared to 1984 (which had the highest mortality rate in the 80s), the number of deaths in men increased by 52%, in women by 28%, and in 1999. compared to 1984, indicators for men increased by 37%, women - by 21%.

In the regions of the country, the highest overall mortality rate is observed where the proportion of older people is highest (Figure 3). In the “peak” year of 1994, the largest increase in mortality compared to 1990 was in the Northern region (63%), in Eastern Siberia and the Far East (55%), in the Kaliningrad region (51%); the smallest is in the North Caucasus and Central Black Earth regions (25%). In 1999, the greatest dynamics of mortality were characteristic of the same regions where there was the greatest increase in 1994. The smallest increase was observed in St. Petersburg, Moscow, the North Caucasus and Central Black Earth regions.

Decrease in the total number of deaths in 1995-1998. compared to 1993-1994 contributed to the hypothesis that the jump in mortality in 1993-1994. - just a distant echo of the anti-alcohol campaign of 1985-1987, which later gave rise (8-10 years later!) to a period of “double mortality” as a result of the implementation of the delayed deaths of the perestroika years. From the point of view of medical demography, testing this hypothesis requires a specific analysis of statistics on causes of death and mortality dynamics by age groups. At the same time, it must immediately be emphasized that the main cause of high mortality in working age was and remains accidents, poisoning and injuries. It is obvious that deaths that did not take place for this reason during the anti-alcohol campaign cannot be considered fatally postponed for the future.

If we consider the dynamics of demographic indicators of countries with different levels of socio-economic development for the period since 1950, then against the background of the global trend of decreasing overall mortality of the population, the dynamics of indicators in Russia (as well as in a number of countries in Eastern Europe) looks anomalous.

During the second half of the 20th century, the global average overall mortality rate decreased from 20 to 10‰, including in the least developed countries - from 28 to 15‰; in the group of the most developed countries, mortality remained at the level of 9-10‰. In Russia in the 50-70s, the overall mortality rate was the lowest among the groups of countries under consideration (8.4‰) (Fig. 4a).

Until the mid-80s, its level did not exceed the average for the countries of Northern and Western Europe. In the 90s, mortality in Russia exceeded the level of these countries (except for Eastern Europe), reaching an average of 1990-1999. 13.6‰. (Fig. 4b). According to the UN forecast (medium option), mortality in Russia in the first half of this century will be the highest among the world regions under consideration (Fig. 4).

1.2 Factors and causes of death

For a long time now, two classes of causes of death have had a decisive influence on changes in life expectancy: accidents, poisoning and injuries (hereinafter, for brevity, “accidents”) and diseases of the circulatory system (Table 3). In the last hesitation and expected continuation telnosti life men - its rise in the mid-90s and subsequent fall - the main role belonged to accidents, but in 2003-2004. An unexpectedly large negative contribution was made by the increase in mortality from diseases of the circulatory system. Such growth was also observed in women, in whom diseases of the circulatory system have always been the most important factor unfavorable speaker

Table 3 - Contribution of the main classes of causes of death to changes in life expectancy in Russia, 1980-2004, in years

Infectious diseases and illnesses respiratory organs: long-term progress

In 1965, mortality from infectious diseases was significantly higher in Russia than, for example, in France, especially among men - for them the difference was twofold. Subsequently, it steadily declined, but since the decline occurred in both countries, the gap between them remained. In both countries, the favorable trend has been reversed in recent years: in France, since 1987, there has been slow growth caused by AIDS, in Russia in 2002-2003. marked sharp under e m, due to changes in living conditions.

In Russia, the evolution of mortality from infectious diseases is determined mainly by mortality from tuberculosis. This disease predominates in the class of infectious diseases: in different years it accounted for from 70 to 90% of all deaths from infectious diseases in men and from 40 to 70%, respectively, in women. The significant increase in mortality of both sexes from this disease since 1992 is an alarming indicator; it indicates a significant expansion of the corresponding risk group.

Mortality rates from respiratory diseases have also generally declined over the past 30 years. True, the decline in lu is relatively slow and became more pronounced only in the 80s. Favorable changes are clearly observed for acute respiratory diseases of infectious etiology, such as influenza and pneumonia. The situation with chronic diseases, for example, chronic bronchitis or asthma, is less stable.

Neoplasms: unreliable advantage Russia

Mortality from malignant neoplasms in Russia over the past 30 years has been lower than in a number of other Western countries, although this is not always the case for certain tumor diseases. In particular, in Russia the situation with cancer of the respiratory organs is worse - it is the leading cause of death among neoplasms in men in both countries, which is closely related to the prevalence of smoking.

For most tumor diseases, the situation in Russia is worsening. Unfavorable evolution is characteristic, in particular, for those diseases that were relatively favorable in terms of mortality in the mid-60s, for example, for intestinal and rectal cancer in both sexes, for neoplasms of the upper respiratory tract and prostate cancer in men, breast cancer glands in women. The increase in mortality from these diseases fits into the dynamics of the transition to a structure of tumor pathology reminiscent of the modern Western one. The current situation portends a further increase in mortality from neoplasms in Russia

External straight

Mortality from external causes - accidents lu teas, poisonings, injuries and violent causes changed especially unpredictably in Russia and was the cause of most short-term fluctuations in overall mortality.

In the evolution of mortality from external causes over the past 30 years, four periods can be distinguished: continuous growth until the end of the 70s, then relative stabilization until 1985, a sharp decrease in 1985-1986, and a new increase , which began in 1988 and intensified in 2002-2003. Mortality from this class of causes in Russia this year cha with twice as high, I eat in 1965. The trends and changes are the same for men and women.

In Russia, especially among men, violent mortality not associated with accidents is very high. Since 1965, the male mortality rate from suicide has been 50% higher than the mortality rate from suicide in France, and the mortality rate from homicide in Russia has been 10 times higher than the French rate. For women the gap is not so great, although the differences are also unfavorable for Russia. Deaths from violent causes for both men and women are growing in both countries, but in France much more slowly than in Russia.

The gradual increase in male suicide mortality in Russia was interrupted in 1985, when there was a sharp decrease. In 2003, after the new meaning l significant increase, the 1984 level was again reached. In the evolution of female suicide mortality, the decline in 1985, as well as the increase in recent years, was less pronounced. But what is particularly impressive is the change in homicide mortality. IN trends There are two large jumps in mortality from this cause. The first occurred between 1965 and 1981. and led to a doubling of mortality for both sexes. The second, which began in 1987, increased male mortality in six years from murders by 5, and female murders by 3 times. In 2003, the standardized mortality rate from homicide in Russia was already 34 times higher than in France. In parallel, there is a rapid increase in accidental deaths without specifying their accidental or intentional nature. This leads us to assume that mortality from murders in Russia is not fully reflected in statistics, and some murders are registered under the heading of deaths of an unidentified nature.

1.3 Mortality and public health

Population health is a characteristic of the health status of members of a social community, measured by a set of socio-demographic indicators: fertility, mortality, average life expectancy, morbidity, level of physical development.

In the field of improving health and increasing life expectancy of the population, the following priorities have been identified:

· strengthening the health of children and adolescents, primarily through improving preventive measures to reduce injuries and poisonings, smoking, alcoholism and drug addiction, developing physical education, recreation and health improvement;

· maintaining the reproductive health of the population by improving preventive, therapeutic and diagnostic care;

· improving the health of the population of working age, primarily through preventive measures to reduce injuries and poisonings, as well as early detection of diseases of the circulatory system, neoplasms and infectious diseases;

· maintaining the health of older people, for whom the prevention of cardiovascular, oncological, endocrine and infectious diseases is most important.

In carrying out preventive work, it is necessary to coordinate the actions of executive authorities at all levels with public, charitable and religious organizations, and also to provide for the active participation of the population itself.

It is necessary to revive the system of mass sanitary and hygienic education and training of citizens.

The most important task is to introduce life-saving behavior into practice and develop a healthy lifestyle among all categories of the population. In this regard, it is necessary to intensify efforts to organize and conduct propaganda work, including through the media, aimed at promoting a healthy lifestyle, which involves the development of physical education, recreation and tourism institutions, leisure centers (especially for children, adolescents and young people) . Support should be provided for charitable events and initiatives aimed at improving public health. These individual initiatives and charitable actions can become an important reserve in the fight against factors of premature and preventable mortality. It is necessary to develop mechanisms to support such initiatives.

Particular attention should be paid to reducing alcohol consumption and taking measures aimed at mitigating the consequences of drunkenness and alcoholism, while a combination of measures from the field of fiscal policy, administrative restrictions, and information influences can lead to the desired effect. The system of measures should include strict quality control of alcoholic products and a pricing policy that encourages the transition to the consumption of less harmful types of alcoholic beverages. Pricing policy should, on the one hand, prevent the population from reorienting toward homemade or illegal alcoholic products, but, at the same time, limit alcohol consumption.

For these purposes, it is also necessary to introduce rules prohibiting the sale of alcohol to highly intoxicated persons and minors, and a ban on the sale of strong alcoholic beverages in crowded places.

As part of measures to improve the mental health of the population, it is necessary to take measures to prevent and prevent suicide, which may include the creation of new and support for existing helplines, improving the working methods of psychiatrists, medical psychologists, psychotherapists, and social workers.

In the field of protecting and promoting the health of citizens, the attention of government authorities of the Russian Federation will be increased to improving the organization and development of state and non-state forms of providing medical care to the population, and the implementation of federal programs.

The problem of ensuring access to medical care for patients with serious illnesses who require examination and treatment using expensive technologies, primarily in federal medical institutions, requires a solution.

It is necessary to ensure the further development and strengthening of consulting and diagnostic services of regional, regional and republican health care institutions, to restore the work of visiting teams of clinics in order to ensure access to medical care for residents of rural areas and remote areas, to develop a network of rehabilitation (restoration) departments of central district and regional hospitals, and also a network of hospitals and medical and social care departments in rural areas.

The primary task is to strengthen the role of primary health care, structural and economic transformations of the outpatient clinic, rational use of hospital beds (reducing the volume of expensive inpatient care while increasing the volume of day hospital services).

Health and social protection authorities must implement comprehensive measures for the further development of psychiatric and drug treatment services for the population, vaccine prevention, and the fight against HIV infection, tuberculosis, and sexually transmitted diseases.

It is necessary to strengthen government support for measures aimed at prevention, early detection of diseases, development and implementation of modern technologies in diagnostic and treatment processes.

In order to reduce complications and mortality from malignant neoplasms, the development and implementation of screening programs for the prevention and early detection of cancer is required.

Particular attention should be paid to the prevention and treatment of infertility, in connection with which it is planned to develop appropriate programs aimed at ensuring early diagnosis and treatment of reproductive health disorders.

In order to prevent the pathology of pregnancy and childbirth and preserve the health of newborns, family health passports should be introduced, and opportunities should be provided to improve the quality of nutrition for pregnant women and improve their health in sanatorium and resort institutions.

An important area is the development and implementation of progressive organizational and perinatal technologies that help improve the quality of medical care for pregnant women and newborns, the development of perinatal centers; development and implementation of effective medical technologies for diagnosis, treatment and rehabilitation of reproductive disorders; development and implementation of reproductive health standards; carrying out measures to prevent unwanted pregnancy, abortion and sexually transmitted infections.

Particular attention should be paid to protecting the reproductive health of adolescents, creating and developing new approaches to their hygienic and moral education.

Due to the widespread prevalence of alcoholism, drug addiction, substance abuse, and sexually transmitted infections among children and adolescents, it is necessary to provide for the creation of new structural units such as departments (offices) of medical and social care in outpatient clinics and educational institutions.

In order to prevent the risk of violation of the reproductive health of workers, a set of measures must be implemented, providing for the certification of workplaces to identify and eliminate the impact of adverse factors on the health of workers, and carry out certification work on labor protection. It is necessary to provide in legislation for the responsibility of employers and other officials for concealing information about the health risks of workers in harmful and difficult conditions.

In addition, government authorities should develop a system of principles for the economic interest of employers in improving working conditions and labor protection, providing for the development of insurance against industrial injuries.

Providing a barrier-free living environment for people with disabilities requires further development of the rehabilitation industry aimed at creating opportunities to maximize the potential of people with disabilities.

In order to carry out medical and social rehabilitation of categories of the population who, due to life circumstances, have found themselves in difficult living conditions, it is necessary to provide for the development of new forms of medical and social services for citizens released from prison, as well as homeless people sent to social service institutions from reception centers -distributors of internal affairs bodies. It is necessary to provide for the development of a network of Night Stay Homes, which provide socio-psychological and legal assistance to citizens who find themselves in difficult life situations and who do not have a place to live or work.

Active measures must be taken to develop and improve rehabilitation assistance, the development of sanatorium and resort organizations and health institutions of the social protection system, healthcare, and education.

To improve the quality and accessibility of medical care for the rural population, it is essential to strengthen the material and technical base of treatment and diagnostic complexes operating in rural areas. One of the primary tasks for health authorities of the constituent entities of the Russian Federation is the further development of mobile forms of diagnostic, treatment and advisory assistance.

Taking into account the peculiarities of protecting the health of indigenous peoples of the North, special attention should be paid to improving the organization of medical care in the northern territories.

2. INDICATORS OF THE LEVEL AND STRUCTURE OF MORTALITY

All main factors are combined into four groups: 1) the standard of living of the people; 2) effectiveness of health services; 3) sanitary culture of society; 4) ecological environment.

1. Standard of living of the people. The standard of living is the main factor in improving the health of the population, because it is it that creates the conditions (space) for the development of all other factors for the growth of general and sanitary culture, health care, improvement of the environment, etc. Poverty does not contribute to this in any way. The vast majority of our population is poor by modern (“Western”) standards of living. Soviet social statistics for measuring living standards are absolutely unsuitable, false and were almost completely classified. However, based on many fragmentary data, it is still possible to get some idea that the standard of living in our country has been extremely low for decades, on the verge of just the simple reproduction of a person’s personality and his labor force, or even lower. The development of the individual occurred largely due to the refusal of the most necessary things, including rest, the acquisition of effective medicines and paid healthcare services, quality nutrition, etc.

One of the most advanced comprehensive indicators by which the level and quality of life is assessed at the international level is the so-called “human development index” (or “human development index”), which is the arithmetic average of the gross domestic product per capita population, level of education of the population and average life expectancy. As for per capita gross domestic product, this indicator can give an incorrect impression of the standard of living if the items of its expenses are not disclosed.

2. Healthcare efficiency. The development of our healthcare throughout the years of Soviet power was characterized mainly by the number of doctors and hospital beds, as well as their distribution by specialty and purpose. The relatively low level and unfavorable dynamics of life expectancy indicate the ineffectiveness of healthcare. By 1990, most economically developed countries spent more than 8% of gross domestic product on health care. In Russia at this time they were only 3.3%.

An integral part of the problem of low healthcare financing is the very low wages of those employed in this industry. Only those employed in education, culture and the arts have lower wages than in healthcare.

No less important than the financial support of healthcare is its relationship with the patient. The organization of our healthcare is impersonal in nature, that is, the doctor in the treatment process does not take into account the individuality of the patient, the characteristics of his personality, and treats him as an inanimate organism. In the post-transition period, when dramatic changes occur in the structure of mortality by causes of death, when chronic, largely individualized diseases begin to predominate, medicine, or rather, healthcare, must also change towards greater consideration of the patient’s character and the characteristics of his unique fate. A longer-term, more personal relationship between doctor and patient is required. The system of compulsory health insurance introduced in our country several years ago, it would seem, could well provide the possibility of such a choice, and at the same time an objective assessment of medical qualifications. But this system does not perform such a function. It is a bureaucratic procedure.

3. Sanitary culture. One of the most important social consequences of changes in the structure of mortality by causes of death is the growing importance of sanitary culture as one of the most important factors in maintaining health and increasing life expectancy of the population.

The communist regime, despite its outwardly truly wonderful slogans, turned out to be inhumane and inhumane towards the majority of the people. Dedication and self-denial were required from people in order to implement the idea, giving up today's life in the name of life for future generations. The results were low product quality, high injuries and equipment breakdowns, loss of life and loss of health.

Low culture of alcohol consumption, mass smoking, including widespread among women and adolescents, a huge number of induced abortions instead of modern means of contraception, propaganda of violence and cruelty by the media - all these are the most important factors that destroy the health of the nation and do not contribute to the growth of average life expectancy ( as well as strengthening the family and increasing the birth rate).

4. Environmental quality. The main problems are a consequence of the hypertrophied military economy of the Soviet state, in which little attention was paid to environmental issues (as well as to healthcare, the standard of living of the people and all other vital aspects). According to the air pollution monitoring network in the cities of the Russian Federation, which has been operating for about three decades, air pollution from industrial waste is observed in almost all the largest industrial cities of Russia (only the degree of pollution differs, which, however, everywhere exceeds the maximum permissible concentrations - MAC). Concentrations of harmful substances in the atmosphere exceed permissible limits by 5 times in 150 cities of Russia, and by 10 times in 86 cities. According to environmentalists, about half of the Russian population continues to use water for drinking that does not meet hygienic requirements for a wide range of water quality indicators. Almost all bodies of water near cities are contaminated to one degree or another with industrial waste in concentrations that are dangerous to human life and health. Only 68% of rural residents of Russia (47% of populated areas) still use centralized water supply.

3. BASIC METHODS FOR CONSTRUCTING MORTALITY TABLES

3.1 Construction of a complete mortality table

The construction of mortality tables is, in principle, a simple, but rather labor-intensive computational procedure. It includes several stages:

calculation of the values ​​of the initial indicator for all ages based on mortality statistics (distribution of deaths by age);

if necessary, processing this series of values ​​to eliminate distortions caused by age accumulation;

interpolation of a range of values ​​to eliminate possible omissions or extrapolation to calculate values ​​for the oldest ages;

calculation of other functions of the mortality table.

The main methodological problem in constructing mortality tables, as already mentioned, is associated with the transition from real age-specific mortality rates to tabulated probabilities of dying at a given age, i.e. from tx* to qx.

Methods for constructing mortality tables occupy a large place in demography. We can repeat what has already been said above that the history of demography largely coincides with the history of the development and improvement of these methods.

Modern mortality tables are calculated using the so-called. indirect, or demographic, method. The demographic method is so named because it is based on data on age-specific mortality, as well as on the age-sex structure of the population obtained during censuses and current records. This method is called indirect to contrast it with the so-called. the direct method, or, in other words, the R. Beck method, based on the direct calculation of mortality table indicators in a situation where the distribution of deaths into elementary aggregates of the Lexis grid is known.

The initial indicator here is the age-specific mortality rate, which is equated to the table mortality rate (dx/Lx) and on the basis of which all functions of the mortality table are determined, starting, of course, with the probability of dying at the age of x years. The demographic method makes it possible to construct mortality tables that most adequately reflect its level. At the same time, the value of the final indicators is not affected by fluctuations in the numbers of births and deaths in the years preceding the calculation.

The problem associated with the transition from age-specific mortality rates to the probabilities of death at the age interval (x, x + n) years is that the former, as is known, are calculated in relation to the total number of person-years lived by the population at this age interval , or to its approximation, i.e. average annual population. The latter are calculated in relation to the population size at the beginning of the age interval. To construct a mortality table, it is necessary to establish the relationship between them, i.e. between tx and qx. In other words, you need to move from the thk qx6.

Let Nx be the number of people living to age x years in the real population. Of this number, Dx will not live to see the next age x+1 years.

At the same time, the age-specific mortality rate is equal to the ratio of Dx to the number of person-years lived Nx during the interval (x, x + 1). This number of person-years, in turn, is equal to the sum of two terms:

The first term is (Nx - Dx, i.e. the number of person-years lived in this age interval by those who lived to age (x, x + 1).

The second term is the number of person-years lived in this age interval by those who did not live to age (x, x + 1), i.e. died at this age interval. This number is equal to a"x-Dx.

The last expression is a familiar formula for calculating the age-specific mortality rate.

Let's solve the equation

Рх = (NX -Dx) + a"x Dx

relative to Nx:

Let's substitute this expression into the above formula for qx.

If the numerator and denominator of this expression are divided by Px, we obtain the desired basic relationship between qx and mx:

The values ​​of a0 a1... vary from country to country depending on the mortality rate. For developing countries where mortality is high, a0 is usually taken as 0.3, a1 as 0.4 and 0.5 for all others. Where mortality is low, the best value for a0 is 0.1. In general, the selected value is not critical, with the exception of a0. Moreover, there is an alternative way to determine q0 without using the above formula. We are talking about simply equating q0 to the infant mortality rate. Newell S. Methods and Models in Demography. London. 1988. P. 69.

The above equation is fundamental to the construction of modern life tables. Knowing all qx and choosing the root of the mortality table l0, you can, using the above relationships between them, construct all other functions of the mortality tables.

3.2 Construction of a short mortality table

The idea and method of constructing a short life table are similar to those just discussed for full life tables. The only difference is the length of the age interval. The length of a typical age interval (xi,xi+l) in short tables is equal to ni = xi+1- xi, i.e. exceeds 1 year. Most often it is 5 years. The essential element here is the average proportion of that interval lived by those who died in that age interval.

This share, denoted ai, is a generalization of the share a"x of the last year of life discussed above. Determining this share is a separate task that can be solved in different ways. One of the possible solutions is given in the box on this page. In general, fortunately, for With the exception of the youngest ages, the choice of ai is not critical for the construction of summary life tables. It is usually conventionally accepted that a0 = 0.1 for countries with low mortality and 0.3 for countries with high mortality. All other values ​​of this parameter are taken equal 0.4 for all other age intervals7.

At the same time, as shown by Chin Long Chan8, the value of ai does not depend on the specific values ​​of the mortality rate per year for which the short mortality table is calculated, but is determined only by the trend of changes in the probability of death within the age interval (xi, xi + l) and can be calculated based on data on one-year probabilities of death. The availability of special computer programs for constructing mortality tables makes the calculation of this parameter a trivial task.

The task of constructing all functions of the mortality table according to age-specific mortality rates jn (x), which are considered equal to the table ones, is very important in practice. To solve it, you need to solve a special equation 1(x+n) - 1(x) - = -nm(x)nLp which is called the main equation of the mortality table. There are various methods for solving this equation. I'll point out the simplest one.

The formula for the probability of dying at an age interval of (xj, xi+1) years is similar to the formula for complete mortality tables.

This formula is constructed under the assumption that within the age interval (x + n) the probability of death is either constant or varies linearly (in the age intervals 0-1 year and 1-4 years). If the linearity hypothesis is not accepted, then the alternative formula of Gompertz (1825) and Farr (1864) is used, in which the linearity hypothesis is replaced by the hypothesis of an exponential change in the probability of death over the age interval (x + n) years. Accordingly, nqx = 1 - nрх.

For the age interval 0 - 1 year, as an alternative, q0 is sometimes simply equated to the infant mortality rate.

All other functions of the short mortality table are calculated based on the calculated ai, qi and the root of the table l0.

The numbers of people dying (di) at an age interval of (xi, xi+l) years from those surviving to the exact age of xi+1 years are calculated using the formulas:

di = l iqi; or li+1 = li - di, where i=0, 1, 2, 3,..., w - 1.

The number of person-years lived in the age interval (xi, xi+l) years, or the number of people living in this interval, when accepting the linearity hypothesis is equal to: Li = ni(li - di) + ai ni di, where i = 0.1, 2, 3,..., w - 1. If the exponential hypothesis is accepted, then an alternative formula is used for the age interval 0 - 1 year.

And for the age range 1 - 4 years:

4 l1 = 1.704 li + 2.533 l5 -237 l10.

Using the example of data on age-specific mortality of men in Russia in 1997, we will show the procedure for calculating a short mortality table for the male population. We will accept the linearity hypothesis, as well as the values ​​of the parameter ai, equal to its values ​​​​according to the mortality table for the entire population of the USA in 1960, since the then level Mortality rate in this country is quite close to its current level in Russia. The average life expectancy for both sexes in 1960 in the United States was approximately 70 years, and the infant mortality rate was 26.8%o9.

In Russia, the average life expectancy for both sexes in 1997 was approximately 67 years, and the infant mortality rate was 17.2%.

Let's calculate a short life table using the following step-by-step procedure.

Step 1. Calculate the length of the age interval (xi, xi+1). For the interval 0-1 year it is equal to 1 year; for the interval 1-4 years it is equal to 4 years; for all others - 5 years. We conditionally accept the same value (5 years) for the last open interval of 85 years and older. Although knowing the exact age of death at the oldest ages allows us to more accurately estimate its length. However, for the procedure described, the length of the open interval does not play any role.

Step 2. We convert the values ​​of age-specific mortality rates from ppm to relative fractions of a unit.

Step 3. Taking into account the value of the parameter ai, we determine qi - the probability of dying at the age interval (xi, xi+l). In this case, for the interval 0-1 year we take the value q0 equal to the infant mortality rate.

Step 4. Using an iterative process, we calculate the number of deaths (di) at the age interval (xi, xi+l) and the number of survivors (li) to the exact age x years. In this case, we take l0 equal to 10,000 (taking into account the accuracy of age-specific mortality rates); d0= lOq0 and 11= l0 - d0. The entire procedure is then repeated for each age interval (xi, xi+l), except for the last open interval of 85 years and older. On this interval, the probability of death is equal to one, so d18 = l18.

Step 5. Using the above formulas, we calculate the number of people living (Li) at the age interval (xi, xi+1). For the last open age interval of 85 years and older, this value is equal to: L18 = l18/m18, where m18 is the age-specific mortality rate for this age interval.

Step 6. We calculate the total number of person-years that will live until the beginning of the age interval (xi, xi+1) years (until the exact age of x years). This value is equal to the sum of all Li from i to w (in this case up to 18).

Step 7. Dividing Lina by li, we obtain the average expected life expectancy for those who have lived to the beginning of the age interval (xi,xi+1) years (up to the exact age of x years), ei. The construction of a short mortality table is completed.

The penultimate column of the table shows official data on the value of ei, published in the Demographic Yearbook of the Russian Federation 98, and the last column shows the difference between the values ​​of this indicator calculated by us and the official ones. As you can see, they are close to each other, although our calculation showed slightly higher than official values ​​of average life expectancy for ages from 0 to 59 years. For older ages, on the contrary, the calculated values ​​are less than the official ones. There cannot be a complete match, since official data are calculated from complete mortality tables.

In modern conditions, the calculation of mortality tables, both short and full, has become significantly simplified and has become much less labor-intensive than before. Special software packages and spreadsheets have been developed that allow the entire procedure for calculating mortality tables to be reduced to simply entering its age-specific coefficients and some other parameters. An example of such packages is Mort-Pak, an example of spreadsheets is LTPOPDTH and LTMXQXAD from the PAS1 kit.

4. STANDARDIZATION OF MORTALITY RATES

The value of overall mortality rates, being free from the influence of absolute population size, nevertheless depends on structural factors, i.e. on the ratio of the male and female population, urban and rural population, married and unmarried, etc. One of the most powerful factors influencing the value of general coefficients is the age structure of the population. What has been said here applies to general coefficients for other demographic processes.

The influence of structural factors on the value of the overall coefficients can be illustrated by the following hypothetical example, which considers three countries with equal populations but different age structures. In countries A and B, the same age-specific mortality rates are considered. However, country A has an overall mortality rate that is more than one and a half times that of country B. This is a direct result of country A having a higher proportion of children aged 0-4 years. This group is characterized by increased values ​​of age-specific mortality rates (especially in the 0-year group).

On the other hand, countries B and C have the same overall mortality rates, but significantly different age-specific rates. Country C has a much higher proportion of the population at older ages (where one would expect higher mortality rates). However, in this country the age-specific mortality rate for older ages is half that of countries A and B. Due to this, country C, although it has an older population, has an overall mortality rate the same as country B.

It is clear that it is impossible to directly compare data on overall mortality rates in these fictitious countries. And in general, the effect of structural factors is one of the reasons that makes data on demographic indicators of different territories or different periods practically incomparable (if, over time, significant changes have occurred in various population structures).

Therefore, it is necessary to use various methods to eliminate the distorting influence of structural factors, primarily age structure. One of these methods is the use of special and partial coefficients, which are not affected by structural factors or are influenced to a much lesser extent.

Another way to eliminate the influence of structural factors is to standardize demographic coefficients. The standardization method was proposed and first applied in mortality analysis by the English statistician and demographer W. Farr (W. Farr, 1807-1883).

The use of standardization is based precisely on the decomposition of general coefficients into factors expressing, on the one hand, the intensity of the demographic process, and on the other, the number or proportion of the corresponding subpopulation in the entire population.

General coefficients are weighted sums of particular or special coefficients. In this case, partial or special coefficients characterize the intensity of the process (or, what is the same, the corresponding average behavior), and the weights, which are the numbers or shares of the corresponding subpopulations, characterize the structural factor.

The essence of standardization is that the real overall coefficients are compared with the indicators of some conditional population, which is obtained if the following is done.

The intensity of the demographic process in a certain population (real or artificially constructed) or its structure is taken as a standard*. Then, for each of the populations being compared, a standardized overall coefficient is calculated, which shows what the overall coefficients of the process under consideration would be in a given population if the intensity of this process in it or its structure were the same as in the standard population. At the same time, depending on what exactly is taken as a standard (intensity or structure), various standardization methods are used.

The most widespread are direct standardization, indirect and inverse, which we now consider. Let us show the essence of these methods using the example of standardization of general mortality rates.

Standardization methods

With direct standardization, age-specific mortality rates of the real population are reweighted by the age structure of the standard. This gives the number of deaths that would occur in the actual population if its age structure were the same as the age structure of the standard. Dividing this number by the number of deaths in the standard population gives the direct standardization index. If the crude mortality rate of the standard is multiplied by this index, we obtain the standardized crude mortality rate, which shows what the crude mortality rate would be in the real population if its age structure were the same as the age structure of the standard.

Hence CMRcmаm = CMR0-Ipr, where CMRcman is the standardized crude mortality rate; CMR0 is the overall mortality rate of the standard.

Direct standardization can be used if the age-specific mortality rates of the real populations being compared and the age structure of the standard are known. In this case, either the age structure of any real population or an artificially constructed one can be taken as a standard age structure.

With direct standardization, there is a danger that both the standardization index and the standardized coefficient will be influenced by the age-specific coefficient, the weight of which is small in the real population and, on the contrary, large in the standard population. Indirect standardization allows you to avoid this danger.

In the case of indirect standardization, the exact opposite is done: the age-specific mortality rates of the standard are reweighted by the age structure of the real population. This yields the number of deaths that would occur in the real population if its age-specific mortality were the same as the age-specific mortality of the standard population. By dividing the number of deaths in the actual population by their expected number, an indirect standardization index is obtained. If the overall mortality rate of the standard is multiplied by this index, we obtain the standardized overall mortality rate, which shows what the overall mortality rate would be in the real population if the age-specific mortality rates in it were the same as in the standard population.

All of the above can be expressed in the form of the following formula:

where 1 kosv is the index of indirect standardization; Px1 - age structure of the real population, expressed in absolute values ​​or shares; th0 - age-specific mortality rates in a standard population and th1 - age-specific mortality rates in a given population.

Hence CMR cman - CMR0 - 1 cos, where CMR cman is the standardized crude mortality rate; CMR0 is the general mortality standard ratio.

It is advisable to use indirect standardization if the age structures of the real population and the standard and the age-specific intensities of demographic processes in the standard population are known.

Indirect standardization has wide application in the analysis of mortality, for which it was, in fact, developed. However, in the last half century, the method of indirect standardization has been actively used in the study of fertility. The scope of its application here is the analysis of the comparative role of the demographic structure (age, marriage, etc.) and the behavior of individuals in shaping the birth rate, which was discussed in the previous chapter. In particular, it is indirect standardization that underlies E. Cole’s fertility indices and the so-called model. hypothetical minimum natural birth rate V.A. Borisova.

Reverse standardization method, otherwise called the expected population method, is used when there is no data on the age structure of a given population, but there is data on its total size and the number of demographic events in it (a case not uncommon in many developing countries where population censuses have begun to be conducted only recently). And also, of course, the age-specific mortality rates of the standard are known. Knowing this, it is possible to restore the conditional average size of all age groups of the real population, provided that the real population has the same age-specific mortality rates as the standard population. To do this, you simply divide the known number of deaths by the standard age-specific mortality rate:

where fxs is the conditional size of the group at age x years; Dx - real number of deaths and fxs - age-specific mortality rates of the standard. Then, by summing up all Fxs, it is possible to restore the total population that should have been if the real population had the same age-specific mortality rates as the standard population. And then, dividing this conditional number by the real one, we get the reverse standardization index:

The denominator of this expression is the real average population, the numerator is its hypothetical (<ожидаемая>) the number that, with standard age-specific mortality rates, would produce the actual number of deaths at each age.

By multiplying the inverse standardization index by the overall mortality standard coefficient, we obtain the standardized overall mortality rate, the value of the overall mortality rate for the real population that would occur if its age-specific mortality rates were the same as those in the standard population.

Concluding this paragraph, it is necessary to emphasize the following. When using standardized mortality rates, we must remember that they do not have independent meaning, since they depend on the chosen standard. Therefore, their scope of application is limited only to the comparison of different populations with each other, and then only on the condition that standardization is carried out using the same method and using the same standard. In this case, it is necessary to select as a standard a population (real or artificially constructed), whose demographic structure (age first of all) is close to the age structures of the populations being compared, although different from them.

5. ECONOMIC ASPECTS OF THE STRUGGLE TO REDUCE MORTALITY AND IMPROVE POPULATION HEALTH IN RUSSIA

In the early 90s, Russia entered a period of acute demographic crisis. The population of the RSFSR during the collapse of the USSR was 149 million people. Since mid-1991, mortality in Russia for the first time in the last century exceeded the birth rate (birth rate 0.93%, death rate 1.5%, the difference between them is minus 0.57%). This is no longer a natural increase, but a “decline” of the population.

In Russia, maternal mortality is 10 times higher than in Europe, and child mortality is 2.5 times higher. And these losses continue.

Today Russia loses 1 million people every year. A year - and there is no population of the Kursk region, a year - and there is no population of the Khabarovsk Territory. The situation is especially catastrophic in the so-called “Russian” territories and regions. Theoretically, it has become possible to calculate the day when the lid of the last coffin will close on the last Russian.

There are many reasons for the demographic crisis in Russia, among them are:

1) reduction in life expectancy The average life expectancy in today's Russia is 57.7 years for men and 71.2 years for women. Let's compare: for the USA, Canada, France, Germany and other developed countries of the world, these indicators are equal, respectively: 73-74 years and 79-80 years. And for Japan, the champion in longevity, 75.90 and 81.6 years. So, our men today live on average 16 years less, and women 8 years less, than in the West. The gap between the life spans of opposite sexes is especially alarming, more than 13 years. This does not exist, and has never happened anywhere. The New York Times writes that Russia became the first industrialized country to experience such a sharp decline in population in conditions where there was no

2) Declining birth rate. In 1993, the birth rate fell by 15% compared to the previous year and reached 9.0 births per thousand people.

We are now seeing a downward trend in the number of children in a family. According to Goskomstat, the majority of Russians today consider it most acceptable to have one child.

Until now, the birth rate of children in rural areas is significantly higher than the birth rate in large cities, despite the fact that the socio-economic situation has led to the uncontrollability of the urbanization process in many countries, including Russia. The percentage of urban population in individual countries is: Australia –75; USA – 80; Germany – 90. In addition to large millionaire cities, urban agglomerations or merged cities are growing rapidly.

According to 1999 data, the mortality rate was 16.6 deaths per 1000 people.

Let’s compare: in the USA – 9.0 people, despite the fact that life expectancy there is 72 years, in Russia it is only 57.7 years.

3) Increase in the number of abortions. Abortion is one of the main reasons for low birth rates and negative natural population growth. The number of abortions per thousand women of childbearing age in Russia is 83. What about in the West: Germany - 5.1; Austria – 7.7; France – 13.8. This list can be continued, but it does not change the essence; among the countries of Western Europe, we remain the undisputed leaders in the number of abortions, and our lead over the rest is simply amazing. Such a huge number of abortions in our country is connected, first of all, with the economic situation in today's Russia. For several years now, our country has been in a socio-economic crisis, which is the reason for such a demographic phenomenon as abortion. Most abortions are performed by women aged 16 to 25 years, because... this social stratum is in the most unfavorable financial situation.

4) Increase in child mortality.

The statistics on infant mortality in Russia are frightening. This figure is 18.6; those. 18-19 deaths under one year of age per 1000 live births. Let's compare: in the USA, 5 newborns out of 1000 die, in Canada and Japan - 7, in the most developed countries of Western Europe - from 6 to 8. In modern Russia, infant mortality is almost 3 times higher than in the civilized world.

5) Increase in suicides. The population of Russia, although to a small extent, is influenced by the suicide rate. A sharp increase in the number of suicides since 1992. to 1995 is explained by the crisis development of the country's economy and the fall in production, as well as a sharp deterioration in the socio-economic condition of Russia. Note that Russia is in the top ten countries with the highest suicide rate.

Also appalling is the percentage of criminal crimes, in particular murders, in terms of the number of which we are already approaching the United States, which is the clear leader in this area. The murders affect not so much the demographic state of Russia as the social one.

6) Migration. We all know about such a phenomenon as migration - population movement.

Large population movements were observed during the war years and in the early post-war years. Thus, in 1941-1942, 25 million people were evacuated from areas threatened by occupation.

In 1968-1969, 13.9 million people changed their permanent place of residence, and 72% of migrants were of working age.

Now the flow of population movement has become migration from rural to urban areas.

The total volume of population movements to a new place of residence is quite large. In recent years, the process of intellectual emigration, or, as it is also called, “brain drain,” has acquired such proportions in Russia that it threatens the existence and development of entire areas of science, causing many negative social and economic consequences for Russian society. In the 90s, 110-120 thousand scientists, doctors, engineers, and musicians emigrate from Russia every year.

In recent years, about 100-120 thousand people leave annually. There are, of course, much more people who want it, but the recipient countries are holding back and prolonging their influx over time. However, it must be taken into account that the share of people with higher education among those traveling through this channel is almost 20 times higher than in Russia as a whole. The emigration of scientists and highly qualified specialists has another qualitative aspect: as a rule, the most talented and active people of working age emigrate. Russia lost at least 0.6 million specialists in 2000-2004. There is a kind of export of intelligence, which is why the average level of intelligence in the country is decreasing.

7) Economic instability

9) Diseases

10) Drug addiction and alcoholism

11) Lack of systematic demographic policy

20 years ago, the latest resolutions were adopted aimed at increasing the birth rate and improving the education of the younger generation. Commitment to the spirit and goals of the Cairo Conference was evidenced (at the session of the UN General Assembly on Population Problems in New York in July 1999) not only in the speech of Deputy Prime Minister V.I. Matvienko, but also in the national report submitted to this session by Russia. All six national priorities of the demographic policy of the Russian Federation include family planning:

1. Improving reproductive health.

2. Promotion of a healthy lifestyle.

3. Moral encouragement for responsible childbirth.

4. Reducing maternal mortality.

5. Providing targeted support for low-income families with children and certain categories of the population in need of special social protection.

6. Promoting the adaptation of migrants.

True, among these priorities there is not a word about increasing the birth rate.

In President Putin's program message to the Federal Assembly, a thesis was voiced about the seriousness and even catastrophic nature of the demographic situation in the country.

The “Concept of Russia’s demographic policy until 2015” was recently published; it was developed under the leadership of one of our leading demographers, L. Rybakovsky. The government approved basically the concept of demographic policy until 2015. True, at a briefing after the end of the cabinet meeting, it was much easier for Minister of Labor and Social Development Alexander Pochinok to talk about the difficult demographic situation in today's Russia than to provide specific data on ways to solve it.

Now in the country there are 1.1 children per family, while 2.5 are needed for simple population reproduction. Against the background of low birth rates, there is an increase in mortality from alcoholism, accidents and poor quality of medical services. The decline in the working-age population by 2015 will amount to 7.4 million people. The Ministry of Labor, the main developer of the concept, proposes to correct the situation through various measures to stimulate the birth rate (housing loans for young families), reduce the number of injuries at work, etc. Another tool for solving the problem could be a well-thought-out migration policy, which involves tightening the procedure for providing Russian citizenship. However, it is quite clear that the problem cannot be solved by any special demographic policy. Both the state of medicine and the number of children that the average Russian family can afford directly depend on the general economic situation in the country. According to Alexander Pochinok, Russia’s next budgets need to include higher rates of wage growth in the public sector. In general, it will not be easy to find money to implement the demographic concept. The entire range of measures requires 450 billion rubles, and all social expenses in 2004 amounted to 270 billion rubles. There is a huge distance between concept and policy.

Achievements current his level I'm west s country n (expected life expectancy for men 72-75 years, women -78-81 years) and in 10-20 years.

Priorities in the areas of health and mortality need clarification. Of course, among them remains the fight against cardiovascular diseases, especially coronary heart disease and cerebrovascular accidents, which are one of the main causes of excess deaths in people under 70 years of age, because, as world experience shows, they may well be pushed back to later ages. But a place must be found and clearly designated to combat morbidity, disability and mortality from external causes - accidents, poisonings, injuries and causes of a violent nature, especially among men, for whom the excess mortality caused by these causes is even higher than from diseases of the system blood circulation Priority should also include measures aimed at combating out-of-control infectious diseases, such as tuberculosis or syphilis, as well as AIDS. In terms of mortality, the impact of these diseases is still small, but their impact on public health and their ability to spread rapidly require urgent and decisive action. The main priorities should include the development and implementation of a set of measures to dramatically improve the health and preserve the lives of newborn children.

LITERATURE

1. Population of Russia. 1999. Seventh annual demographic report // M., 2000.

2. Demographic catastrophe in Russia: causes, coping mechanism. - M., 2003.

3. Population statistics with basic demography: Textbook / G.S. Kildishev. - M., 1990.

4. Evolution of women’s mortality from injuries and poisoning in some regions of Russia during the period of economic reforms / Semenova V.G., Varavikova E.A., Gavrilova N.S., Evdokushkina G.N., Gavrilov L.A. // Disease prevention and health promotion. - M., 2002. No. 3.

5. Features of the formation of territorial differences in population mortality / Virganskaya I.M., Dmitriev V.I. // Therapeutic archive. 1992. No. 2.

6. Possible reasons for fluctuations in life expectancy in Russia in the 90s. /Andreev E.M. // Questions of statistics. 2002 No. 11.

7. Biryukov V.A. Male hypermortality. Vishnevsky A.G. Mortality. Demographic encyclopedic dictionary. M.: Soviet Encyclopedia, 1985.

8. http://www.gks.ru

The duration and quality of life, determined beyond the main reproductive age to a large extent by the rate of aging, characterize each organism personally, separately from others and, thus, are purely individual characteristics. That is why research in the field of gerontology has long been characterized by organism-centrism, with concentration in recent decades on the study of the age process at suborganism levels - macromolecular, subcellular, cellular, cell-population (tissue systems).

At the same time, the dependence of the individual characteristics of a particular ontogenesis, which are a consequence of the genetic constitution and the conditions in which development and life activity takes place, requires expanding the area of ​​interest of gerontologists with access to supraorganism levels - population and ecosystem. The need for such an exit is obvious, first of all, due to the presence of risk factors.

Indeed, the probability of being a carrier of a risk factor for accelerated aging of a genetic nature is determined by the characteristics of the gene pool of the parent population.

The likelihood of phenotypic realization of genotypic risk factors, which varies from population to population, often depends on the ethnic, sociocultural, religious attitudes and traditions of individual groups of people, which even today have a significant influence, in particular, on the selection of marriage pairs (consanguineous marriages, religious, economic , educational qualifications). The source of exogenous risk factors is the environment, conditions in the population's distribution area, and for humans - a way of life, often historically associated with the climatic and geographical characteristics of habitats.

The scope of studying the biological aspects of aging has expanded and currently includes the entire range of manifestations of life built into the age-related process - from macromolecular to ecosystem and biosphere.

It is obvious that access to supra-organismal levels creates new guidelines, primarily for preventive practical gerontology, and stimulates the involvement of non-medical specialists in solving specific issues. Despite the expansion of the sphere of scientific and practical interests of gerontology, the primacy of the organism in studies of aging and life expectancy, especially biomedical ones, remains fully preserved.

Viability, which depends, among other things, on the effectiveness of anti-bioaging mechanisms, characterizes a single individual or individual personally. It is at the level of the organism that the integration of the action of the entire set of factors affecting aging and survival occurs: genetic, environmental, for humans - socio-ecological, relating to any level of organization of living systems and life in general. In methodological terms, the presence of population and ecosystem aspects in the problem of aging, along with organismal, ontogenetic, requires the unification of two traditional, but little connected in the recent past directions - medical-biological and statistical-demographic.

In accordance with the above, aging should be perceived as a universal (obligatory in living nature, but manifesting itself in the most typical form in the world of multicellular organisms) biological phenomenon, which is systemic in nature, incorporating natural, destructive and disintegrative changes in structures, functions, progressive with age. biorhythms, information, energy and material flows that organize and constitute the essence of life processes.

In nature, among other structures and systems, the presence of which reflects the multi-level nature of the hierarchical structure of life, in the context of gerontological problems the central place is given to the body.

As a matter of fact, it is he who ages, realizing and accumulating the above changes in his individual development. In this regard, three circumstances are perceived as important. Firstly, the organism is a spatially delimited integral, self-governing, self-regulating, self-sustaining structure due to self-renewal. The noted focuses attention on the genetic and endogenous metabolic prerequisites for aging and life expectancy. Secondly, an organism cannot exist without constant interaction and equilibrium with factors external to it - changing environmental conditions, which is associated with the presence of environmental prerequisites for aging and lifespan.

The role of environmental prerequisites increases many times due to the presence of a third circumstance. Essential aspects of the life activity of an organism, as well as its interaction with the living environment, depend on inclusion in a single material-energy field of the planet and solar system and are subject to a fairly strict time scheme, which is manifested in the rhythmicity and mutual consistency of physiological parameters, behavioral reactions, and other important biological in relation to events in populations and ecosystems.

Thus, in order for the strategy of active and targeted intervention in the age-related process in order to prevent the development of its negative component in the form of senile manifestations to count on success, the corresponding programs, in their essence and the breadth of scientific and practical coverage of the problem, must have a pronounced multi-level and interdisciplinary nature. The ultimate goal is to project onto the body the operating factors that differ at the points of application of medical-biological and social technologies, to achieve health improvement, delay and reversal of aging, increase the duration and quality of life of individual real-life people. The health, quality and future duration of individual life of an elderly person are determined not only by age-related changes, but also by specific pathology. This obvious circumstance also necessitates the need for this strategy to take into account specific geriatric objectives.

The current state of gerontology as a scientific and practical discipline allows us to make some predictions. They usually characterize an indicator such as life expectancy, in relation to which aging acts as a limiting, to a certain extent, regulating factor. The methods of influencing the body to achieve the predicted values ​​of life expectancy differ depending on whether we are talking about average, species or maximum individual life expectancy. It is assumed that by optimizing socially controlled parameters of the environment and lifestyle, the problem of increasing only the average life expectancy is solved, and to values ​​of 70-80 years (according to another opinion, thanks to socio-economic measures, by 2040 the average life expectancy can reach 90 years).

Due to a number of theoretical premises that are experimentally confirmed, it is assumed that with a high standard of living and medical care, the given figures can increase by about 10 years if, by developing adaptations to high altitudes, cold, and hypoxia, a high content of mitochondria in cells is maintained. Further growth of the indicator under consideration is also possible, but only after ways are found to increase the vector life expectancy, which is associated with the acquisition of control over the aging process.

By changing some aspects of the lifestyle (diet, physical activity, anti-slag measures), using certain classes of pharmacological agents (biostimulants, geroprotectors), it is possible, according to a number of authors, to raise the bar for individual life expectancy by 10-20%, i.e. the maximum calendar age of the “average” person is up to 130-140 years, compared with the currently registered 120-130 years in exceptional cases. The prospect of increasing species lifespan (and, apparently, individual lifespan) is associated with fundamental changes in either the structure of ontogenesis or the biological potential of antibioaging mechanisms.

In particular, species life expectancy values ​​demonstrate a clear correlation with the age of sexual maturity and the development of the most important anti-bioaging factors: DNA damage repair, antioxidant systems, and stem cells. Thus, by keeping rat pups on a low-calorie diet, which results in a selective prolongation of the prepubertal period of postnatal development, it is possible to increase the life expectancy of animals by 2 times. On the other hand, chimpanzees and humans, which are extremely close to each other in terms of their assortment of structural genes, differ in their maximum recorded individual life expectancy by more than two times.

The same order of differences (25 and 40 units/mg of tissue protein) characterizes the two named representatives of the primate order in the activity of superoxide dismutase, the key enzyme of the antioxidant system. At the same time, the duration of the prepubertal period is the same: puberty is reached at the age of 12-13 years. It is assumed that by implementing a set of measures that result in changing the rate of aging, increasing the effectiveness of anti-bioaging factors, optimizing conditions, lifestyle and medical care, one can hypothetically expect an increase in the individual life expectancy of people to 200-300 years. However, the goal sometimes formulated by gerontologists falls into the category of unattainable: “To live forever while remaining young.” To do this it would be necessary to stop the process of individual development.

Contents: Human life expectancy Life expectancy in Russia Is health a problem or an asset for Russians? Average human life expectancy Aging Why aging occurs Reasons for the shorter life expectancy of men compared to women Factors that determine the development of age-related diseases Prevention and treatment of infectious diseases Mortality in Russia Epidemiological transition: the main causes of death Fertility Authors of the presentation

Life expectancy of a person The life expectancy of a person is determined not only by his biological and hereditary characteristics, but also by social conditions (life, work, rest, nutrition). Some people are known to live to be 110 years or more. “Records” of life expectancy are found in various countries and parts of the world and characterize its species (biological) limit. Average life expectancy is a variable value: it indicates the efforts of society aimed at preventing mortality and improving the health of the population. In economically developed countries, the average life expectancy has now reached 70 years.

Life expectancy in Russia In Russia, the average life expectancy is only years, for men – years, and for women – 73.1 years. This is even lower than that of such fraternal peoples as Indians and Ukrainians!

Aging Aging in biology is the process of gradual disruption and loss of important functions of the body or its parts, in particular the ability to reproduce and regenerate. As a result of aging, the body becomes less adapted to environmental conditions and reduces and loses its ability to fight off predators and resist disease and injury. The science that studies aging is called gerontology. The term "aging" can be used to describe the social effects of human aging, as well as to describe the breakdown of non-living systems (metal aging)

Why does aging occur? The hypothesis that formed the basis of the genetic approach was proposed by Peter Medawar in 1952 and is now known as the “mutation accumulation theory.” The mead maker noticed that animals in nature very rarely live to an age when aging becomes noticeable. According to his idea, alleles that emerge late in life and that arise from mutations in germ cells are subject to fairly weak evolutionary pressure, even if traits such as survival and reproduction suffer as a result. Thus, these mutations can accumulate in the genome over many generations. However, any individual that has managed to avoid death for a long time experiences their effects, which manifests itself as aging.

Reasons for the shorter life expectancy of men compared to women The difference in life expectancy arose as a result of sexual selection. Females and males play different roles in the reproductive process. In general, females do more child rearing than males, but they may leave fewer offspring. The role of males is to attract and retain the attention of females. Males are doomed to fierce competition for female attention, and for this they have to pay a high price. In the wild, this means that males have less advantageous physiology and riskier behavior. For example, the body's resources are spent on creating a spectacular appearance (for example, a peacock's tail) or on physical struggle with rivals. The immune system of men is somewhat weaker than the immune system of women. The male body is less suited to digest fat. Smoking, overeating, risky driving, and violence all contribute to the difference in life expectancy between men and women. "Now that mortality from disease is decreasing, behavioral causes are becoming more important," says Kruger. Socioeconomic factors also influence the difference in mortality. Men who occupy a low social position are at greater risk of dying than their advantaged peers. In women, this effect is not so pronounced. Scientists believe that this may be partly due to the riskier behavior of men who occupy a low social position or do not have a regular partner.

Factors determining the development of so-called age-dependent diseases We consider genetic predisposition to be one of the most important factors and recognize the role of environmental influences. Exposure to microorganisms is another leading factor in the etiopathogenesis of age-dependent diseases. Currently, the possibilities of influencing genetic predisposition are minimal or non-existent. At the same time, we can influence the microbial factor. Impact on microbial factor increase in life expectancy Age-related diseases Genetic predisposition Impact of microorganisms Other factors of external and internal environment

Mortality in Russia: (thousands of people) 2002 year year year year year year Mortality rate among Russian men and women of working age is significantly higher than the European average. However, infant mortality in Russia is only slightly higher than the European average

Epidemiological transition: main causes of death 1900-2004 Leading causes of death% of total deaths Leading causes of death% of total deaths 1. Pneumonia (all forms) and influenza 11.7 Heart disease 27.2 2. Tuberculosis (all forms) 11.3 Malignant neoplasms 23.1 3. Diarrhea, enteritis, gastrointestinal ulcers 8.3 Cerebrovascular diseases 6.3 4. Heart diseases 7.9 Chronic obstructive respiratory diseases (COPD) 5.1 5. Cerebrovascular diseases 6.2 All injuries 4.7 6. Nephritis (all forms) 5.6 Diabetes mellitus 3.1 7. All injuries 4.2 Alzheimer's disease 2.8 8. Malignant neoplasms 3.72 Pneumonia and influenza 2.5 9. Frailty 2.9 Nephritis, nephrotic syndrome and nephrosis 1.8 10. Diphtheria 2.3 Septicemia 1.4

Birth rate: 8 thousand people, 0 thousand people, 3 thousand people, 5 thousand people, 4 thousand people, 6 thousand people, 1 thousand people, 5 thousand people The birth rate in Russia does not reach the level required for simple population reproduction. The total fertility rate is 1.4, while for simple population reproduction without population growth, a total fertility rate of 2.112.15 is required.

MOSCOW, September 29 - RIA Novosti. There are no objective reasons for the rapid increase in life expectancy of Russians, even with a favorable socio-economic situation in the country, gerontologist Elena Tereshina told RIA Novosti.

Earlier, Izvestia reported that Rosstat increased the life expectancy of pensioners in the Russian Federation. According to service forecasts, Russians who retired last year could live an average of 78.4 years.

“There are no objective reasons for life expectancy to increase so quickly,” Tereshina said.

“I don’t believe it. Even in a very favorable socio-economic situation,” she added.

According to the gerontologist, based on her practice, the average life expectancy, in particular, for men in Russia is no more than 65 years. Most often, Russians die from heart attacks and heart failure.

“My personal opinion is that if recently the average life expectancy for men was 60.5 years, do you think that in seven years it is possible to reach 72? This is impossible. No country has achieved (such indicators) even in a very good economic situation.” “, the expert emphasized.

Survey

According to a VTsIOM survey, Russians most often fear illness and poor health in old age (34%), small pensions and lack of money (33%), loneliness (20%) and death (11%). At the same time, almost three-quarters of Russians (73%) are not afraid of old age; the share of such answers is high in all social groups. A quarter of respondents (25%) reported fear of old age; such answers were most often given by people with less than a secondary education (38%) and poor financial situation (32%), as well as young people (31% among 18-24 year olds).

According to VTsIOM, the majority of Russians (62%) see advantages in their old age. This answer was given by more than half of the respondents in all groups, regardless of gender, age and financial status. They find advantages in communication with family and friends, the availability of free time, the opportunity to do what they love, as well as extensive life experience. At the same time, a third of respondents (33%) do not see any advantages in old age; Muscovites and St. Petersburg residents (41%) and low-income citizens (44%) do not notice them more often.

The opinions of respondents about the age at which old age begins are divided: 27% believe that in the period from 60 to 64 years, 19% - from 55 to 59 years, 17% - in 50 - 54 years. Respondents in the oldest age group, 60+, believe that old age comes either at 60 - 64 years (25%) or at 70 - 74 years (19%). At the same time, respondents said that an active and healthy lifestyle helps them stay young longer (26% each), a favorite interesting job (17%), material well-being (15%), good health (13%), loved ones (11%) , proper nutrition (10%). Lack of work, purpose in life, and participation in public life are mentioned much less frequently.

According to VTsIOM, those who have lived an interesting life feel better in old age - today every second respondent (54%) thinks so; according to 37%, those who have savings feel better. We can say that ideas about a prosperous old age have changed dramatically over the past 10-20 years. In 1998 and 2009, 68% and 53%, respectively, thought that those with savings would have a better old age, while only 32% and 39%, respectively, said they had an interesting life.

The VTsIOM-Sputnik survey was conducted on September 25-26, 2017. Russians over the age of 18 took part in the survey. 1.2 thousand respondents took part in the survey. For this sample, the maximum error with a probability of 95% does not exceed 3.5%.