Public health implications for healthcare professionals. History of the development of public health
(Brief history of development)
As you know, most disciplines and narrow specialties in medicine study various diseases, their symptoms and syndromes, various clinical manifestations of the course of diseases, their complications, methods of diagnosis and treatment of diseases and probable outcomes of the disease in the case of the use of modern methods of complex treatment known today. It is extremely rare to describe the basic methods of disease prevention, rehabilitation of people who have suffered a certain disease, sometimes severe, with complications and even with the release of sick people to disability.
Even less often in the medical literature, the term "recreation" is referred to, ie. a set of preventive, therapeutic and recreational measures aimed at maintaining the health of healthy people. Human health, its criteria, ways of preserving and strengthening in the difficult socio-economic conditions of our life - almost completely dropped out of the sphere of interests of modern medicine and healthcare in Russia. In this regard, before talking about public health, it is necessary to define the term "health", to identify the levels of its study in medical and social research and to determine the place of public health in this hierarchy.
So, the World Health Organization (WHO) back in 1948 formulated that "Health is a state of complete physical, spiritual and social well-being, and not only the absence of disease and physical defects." WHO has proclaimed the principle that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being." It is customary to distinguish 4 levels of health study:
1st level - health an individual person.
2nd level - health of small or ethnic groups - group health.
3rd level - public health, those. people living in a specific administrative-territorial unit (region, city, district, etc.).
4th level - public health- the health of society, the population of the country, the continent, the world, the population as a whole.
Public health and healthcare as an independent medical science studies the impact of social factors and environmental conditions on the health of the population in order to develop preventive measures to improve the health of the population and improve its medical care. Public health and health care is engaged in the study of a wide range of different medical aspects, sociological, economic, managerial, philosophical problems in the field of public health protection in a specific historical setting.
Taking into account the order of the Ministry of Health of the Russian Federation No. 83 of 03/01/2000 "On the improvement of teaching in medical and pharmaceutical universities of public health and health problems", as well as as a result of the initiative carried out at the initiative of the Moscow Medical Academy. IM Sechenov and with the support of the Ministry of Health of the Russian Federation of the seminar of heads of departments of the organizational profile of medical universities of Russia "Modern approaches, forms and methods of teaching" Public health and health care "(Moscow, 2000), the following definition of the concept of" public health "was developed, approved most of the seminar participants: "Public health is the most important economic and social potential of the country, due to the impact of various environmental factors and lifestyle of the population, which allows to ensure an optimal level of quality and safety of life."
In contrast to various clinical disciplines, public health studies the health status not of individual individuals, but of collectives, social groups and society as a whole in connection with the conditions and way of life. At the same time, living conditions, industrial relations, as a rule, are decisive for the state of human health, so scientific and technological progress, socio-economic revolutions and evolutionary periods, the cultural revolution bring the greatest benefits to society, but at the same time can have negative effects on its health. The greatest discoveries of our time in the field of physics, chemistry, biology, the urbanization of the population in the XX century, the rapid development of industry, in many countries, large volumes of construction, the chemicalization of agriculture, etc. often lead to significant violations in the field of ecology, which has a detrimental effect, first of all, on the health of the population, causes certain diseases, which sometimes become epidemiological in their prevalence.
Antagonistic contradictions between scientific and technological progress and the state of health of society in our country arise as a result of the government's underestimation of preventive measures. Consequently, one of the tasks of our science is to uncover such contradictions and develop recommendations for the prevention of negative phenomena and factors that negatively affect the health of society.
For the planned development of the national economy, information on the size of the population and the determination of its forecasts for the future are of great importance.
Public health identifies the patterns of population development, examining demographic processes, predicts the future, develops recommendations for state regulation of the population.
Thus, public health is characterized by the simultaneous, complex impact of social, behavioral, biological, geophysical and many other factors. Many of these factors can be identified as risk factors. What are disease risk factors?
Risk factors- potentially hazardous to health factors of a behavioral, biological, genetic, ecological, social nature, environment and work environment that increase the likelihood of developing diseases, their progression and unfavorable outcome.
Unlike the direct causes of diseases (bacteria, viruses, lack or excess of any trace elements, etc.), risk factors act indirectly, create an unfavorable background for the onset and further development of diseases.
When studying public health, the factors that determine it are usually grouped into the following groups:
1. Socio-economic factors(working conditions, living conditions, material well-being, level and quality of food, rest, etc.)
2. Socio-biological factors(age, gender, predisposition to hereditary diseases, etc.).
3. Environmental and climatic factors(pollution of the environment, average annual temperature, the presence of extreme natural and climatic factors, etc.).
4. Organizational or medical factors(provision of the population with medical care, quality of medical care, availability of medical and social assistance, etc.).
Academician of the Russian Academy of Medical Sciences Yu.P. Lisitsyn gives the following grouping and levels of influence that determine health risk factors (Table 1.1).
At the same time, the division of factors into certain groups is very arbitrary, since the population is exposed to the complex effects of many factors, in addition, factors affecting health interact with each other, change in time and space, which must be taken into account when carrying out complex medical and social research.
Table 1.1Grouping of health-related risk factors
Public health and healthcare as a science and teaching subject.Basic methods of public health and health science.
1 question. Public health and healthcare as a science and teaching subject.
Public health and health care as an independent medical science studies the impact of social conditions and environmental factors on the health of the population in order to develop preventive measures to improve its health and improve medical care.
In contrast to clinical disciplines, public health studies the state of health not of individual individuals, but of collectives, social groups and society as a whole in connection with the conditions and way of life. At the same time, living conditions, industrial relations, as a rule, are decisive.
Public health identifies the patterns of population development, studies demographic processes, predicts the future, develops recommendations for state regulation of the population.
Of leading importance in the study of this discipline is the question of the effectiveness of the impact on the health of the population of measures taken by the state, the role of health care, individual medical institutions in this.
Medicine is based on two basic concepts - "health" and "disease". In modern literature, there are a large number of definitions and approaches to the concept of "health".
WHO definition: « Health is a state of complete physical, mental and social well-being, and not only the absence of disease and physical defects ".
In medical and social research, when assessing health, it is advisable to distinguish four levels:
Level 1 - the health of an individual - individual health;
Level 2 - health of social and ethnic groups - group health;
Level 3 - the health of the population of the administrative territories - regional health;
Level 4 - the health of the population, society as a whole - public health.
According to WHO experts, in medical statistics, health at the individual level means the absence of identified disorders and diseases, and at the population level - the process of reducing the level of mortality, morbidity and disability, increasing the perceived level of health.
Human health can be considered in various aspects: socio-biological, socio-political, economic, moral and aesthetic, psychophysical, etc. Therefore, nowadays, terms are widely used that reflect only one facet of public health - "mental health", "reproductive health", "general somatic health", etc. Or - the health of a separate demographic or social group - "health of pregnant women", "health of children", etc.
Currently, there are very few indicators that would objectively reflect the quantity, quality and composition of public health. The search and development of integral indicators and indices for assessing the health of the population is underway. WHO believes that these indicators should have the following qualities:
1. Availability of data. It should be possible to obtain the required data without complex specialized research.
2. Comprehensiveness. The indicator should be derived from data covering the entire population for which it is intended.
3. Quality. National (or territorial) data should not change over time and space in such a way that the indicator has a significant impact.
4. Versatility. The indicator, if possible, should be a reflection of a group of factors that are identified and affect the level of health.
5. Computability. The indicator should be calculated as simple and inexpensive as possible.
6. Acceptability (interpretability). Acceptable methods should exist for calculating the indicator and its interpretation.
7. Reproducibility. When the health indicator is used by different professionals in different conditions and at different times, the results should be identical.
8. Specificity. The indicator should reflect changes only in those phenomena, which it serves as an expression.
9. Sensitivity. The health indicator should be sensitive to changes in the relevant phenomena.
10. Validity. The indicator should be a true expression of the factors that it is a measure of.
11. Representativeness: The indicator should be representative of the changes in health of the populations allocated for management purposes.
12. Hierarchy. The indicator should be constructed according to a single principle for different hierarchical levels, allocated in the studied population for the considered diseases, their stages and consequences.
13. Target consistency. The health indicator should adequately reflect the goals of maintaining and developing (improving) health and stimulate society to search for the most effective ways to achieve these goals.
In medical and social research for the quantitative assessment of group, regional and public health in Russia it is customary to use the following indicators: 1. Demographic indicators. 2. Morbidity. 3. Disability. 4. Physical development.
1. Deduction of the gross national product for health care.
2. Availability of primary medical and social care.
3. Coverage of the population with medical care.
4. The level of immunization of the population.
5. Extent of examination of pregnant women by qualified personnel.
6. Nutritional status of children.
7. Child mortality rate.
8. Average life expectancy.
9. Hygienic literacy of the population.
From the point of view of the general classification of sciences, public health is on the border between natural science and social sciences, that is, it uses the methods and achievements of both groups. In terms of the classification of medical sciences, public health seeks to bridge the gap between the clinical (curative) and preventive (hygiene) science groups. Public health provides a generalized picture of the state and dynamics of health and reproduction of the population and the factors that determine them.
The methodological basis of public health as a science consists in the study and correct interpretation of the causes and connections between the state of public health and social relations.
Social and hygienic factors affecting public health include: working and living conditions, living conditions; the level of wages, culture and upbringing, nutrition, family relations, the quality and availability of medical care.
Public health is also influenced by climatic-geographical, hydrometeorological factors of the external environment.
A significant part of these conditions can be changed by society itself, and their impact on the health of the population can be both negative and positive.
2 question. Public health practices.
1). Statistical method - the main method of the social sciences. It allows you to establish and objectively assess the ongoing changes in the state of health of the population and determine the effectiveness of the activities of health authorities and institutions, is widely used in medical research (hygienic, physiological, biochemical, clinical, etc.).
2). Expert judgment method serves as a complement to the statistical one. Its main task is to indirectly determine the correction factors, since public health uses quantitative measurements using statistics and epidemiological methods. This allows making forecasts based on previously formulated patterns, for example, forecasting fertility, population, mortality, etc.
3). Historical method is based on the study and analysis of public health and health care processes at various stages of history. This is a descriptive method.
4). Economic research method makes it possible to establish the impact of the economy on health care and health care on the economy. For this, methods are used that are used in economic sciences in the study and development of issues such as accounting, planning, financing, health care management, rational use of material resources, scientific organization of labor in health authorities and institutions.
5). Experimental method Is a method of searching for new, most rational forms and methods of work, creating models of medical care, introducing best practices, testing projects, hypotheses, creating experimental bases, medical centers, etc.
In public health, the experiment cannot be used often because of the administrative and legislative difficulties associated with it.
6). Modeling method develops in the field of healthcare organization, and consists in creating models of organization for experimental verification. Depending on the goals and problems, the models vary significantly in volume and organization, they can be temporary or permanent.
7). Observation and polling method - is used to supplement and deepen data using special studies. For example, to obtain more complete data on the incidence of persons in certain professions, they use the results obtained during medical examinations. To identify the nature and degree of influence of social and hygienic conditions on morbidity or mortality, survey methods (interviews, questionnaire method) of individuals, families or groups can be used according to a special program.
eight). Epidemiological method. An important place among epidemiological research methods is occupied by epidemiological analysis, which is a combination of methods for studying the characteristics of the epidemic process in order to determine the reasons that contribute to the spread of this phenomenon in a given territory, and to develop practical recommendations for its optimization. From the point of view of public health methodology, epidemiology is applied medical statistics, which in this case acts as the main, largely specific, method.
The use of epidemiological methods in large populations makes it possible to distinguish various components of epidemiology: clinical epidemiology, environmental epidemiology, epidemiology of non-communicable diseases, epidemiology of infectious diseases, etc. In public health, highlight epidemiology of public health indicators.
Page 1F KSMU 4 / 3-04 / 03
Karaganda State Medical University
Department of Social Medicine and Health OrganizationLECTURE
Topic: "Public health and health care as a science and subject of teaching"
Discipline "Public health and health care"
Specialty 5В110400 - "Preventive medicine"
Time -1 hour
Karaganda 2014
Approved at the meeting of the department
_________ 2014 Minutes No. ____
Head department, candidate of medical sciences, associate professor A.K. Sultanov
The topic is “Public health and healthcare as a science and teaching subject. Methods for the Study and Assessment of Public Health "
Lecture plan
Health levels
Risk factors, groups, concept
Public health and health research methodology and methods
Public health as a medical specialty and health science
Stages of health care development.
Relevance of the subject of public health
Even less often in the medical literature, the term "recreation" is referred to, ie. a complex of preventive, therapeutic and recreational measures aimed at maintaining the health of healthy people. Human health, its criteria, ways of preserving and strengthening in difficult socio-economic conditions almost completely dropped out of the sphere of interests of modern medicine and healthcare in Kazakhstan. In this regard, before talking about public health, it is necessary to define the term "health", to identify the place of public health in this hierarchy.
2. Health levels
Methodology and methods of research on public health and health care So, the World Health Organization (WHO) back in 1948. formulated that "health is a state of complete physical, spiritual and social well-being, and not only the absence of diseases and physical defects." WHO has proclaimed the principle that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being." It is customary to distinguish 4 levels of health study:
1st level - the health of the individual.
2nd level - health of small or ethnic groups - group health.
3rd level - public health, i.e. people living in a specific administrative-territorial unit (region, city, district, etc.).
4th level - public health - the health of society, the population of the country, the continent, the world, the population as a whole.
Public health and health care as an independent medical science studies the impact of social factors and environmental conditions on the health of the population in order to develop preventive services. Public health and health care is engaged in the study of a wide range of different medical aspects, sociological, economic, managerial, philosophical problems in the field of public health protection in a specific historical setting.
The following definition of the concept "Public health is the most important economic social potential of the country, due to the impact of various environmental factors and the lifestyle of the population, which allows to ensure the optimal level of quality and safety of life" was developed.
In contrast to various clinical disciplines, public health studies the state of health not of individual individuals, but of collectives, social groups and society as a whole in connection with the conditions and way of life. At the same time, living conditions, industrial relations, as a rule, are decisive for the state - economic revolutions and evolutionary periods, a cultural revolution bring the greatest benefits to society, but at the same time can have negative effects on its health. The greatest discoveries of our time in the field of physics, chemistry, biology, the urbanization of the population in the XX century, the rapid development of industry in many countries, large volumes of construction, the chemicalization of rural ecology, which has a detrimental effect, first of all, on the health of the population, causes certain diseases, which sometimes become epidemiological in their prevalence.
Antagonistic contradictions between scientific and technological progress and the state of health of society in our country arise as a result of the government's underestimation of preventive measures. Consequently, one of the tasks of our science is to uncover such contradictions and develop recommendations for the prevention of negative phenomena and factors that negatively affect the health of society.
For the planned development of the national economy, information on the size of the population and the determination of its forecasts for the future are of great importance. Public health reveals the patterns of population development, examining demographic processes, predicts the future, develops recommendations for state regulation of the population.
Thus, public health is characterized by the simultaneous complex impact of social, behavioral, biological, geophysical and other factors. Many of these factors can be identified as risk factors. What are disease risk factors?
3. Risk factors, groups, concept
- Potentially hazardous to health factors of a behavioral, biological, genetic, ecological, social nature, environment and work environment that increase the likelihood of developing diseases, their progression and unfavorable outcome.
Unlike the direct causes of diseases (bacteria, viruses, lack or excess of any trace elements, etc.), risk factors act indirectly, create an unfavorable background for the onset and further development of diseases.
When studying public health, the factors that determine it are usually grouped into the following groups:
Socio-economic factors(working conditions, living conditions, material well-being, level and quality of food, rest, etc.).
Socio-biological factors(age, gender, predisposition to hereditary diseases, etc.).
Environmental and climatic factors(pollution of the environment, average annual temperature, the presence of extreme natural and climatic factors, etc.).
Organizational or medical factors(provision of the population with medical care, quality of medical care, availability of medical and social assistance, etc.).
At the same time, the division of factors into certain groups is very arbitrary, since the population is exposed to the complex effects of many factors, in addition, factors affecting health interact with each other, change in time and space, which must be taken into account when carrying out complex medical social research.
The second part of the science of public health and health care includes the development of scientifically based, most optimal methods of health care management, new forms and methods of work of various medical institutions, ways to improve the quality of medical care, substantiates optimal solutions to economic and managerial problems in health care.
The rapid growth in the development of medical science has armed doctors with new, modern methods of diagnosing complex diseases, effective treatments. All this simultaneously requires the development of new organizational forms and conditions for the activities of physicians, health care facilities, and sometimes - the creation of completely new, previously non-existent medical institutions. There is a need to change the management system of medical institutions, the placement of medical personnel; there is a need to revise the regulatory framework for health care, expand the independence of the heads of medical institutions and the rights of a doctor.
As a consequence of all that has been said, conditions are being created for revising options for a more optimal solution to the economic problems of health care, introducing elements of intradepartmental cost accounting, economic incentives for high-quality work of medical personnel, etc.
These problems determine the place and significance of science in the further improvement of domestic health care.
The unity of the theory and practice of national health care found its expression in the unity of theoretical and practical tasks, methodological techniques of national public health and health care.
Thus, the question of studying the effectiveness of the impact on the health of the population of all measures taken by the state and the role of health care and individual medical institutions in this, both with state and non-state forms of ownership, is of leading importance in science, i.e. the subject reveals the significance of the entire diversity of the country's socio-economic life and determines the ways of improving medical services for the population.
4. Methodology and methods of research of public health and health care Public health and health care have their own methodology and research methods. These methods are: statistical, historical, economic, experimental, time studies, sociological methods, etc.
Statistical method is widely used in most studies: it allows to objectively determine the level of the population's health, as well as the efficiency and quality of the work of medical and preventive institutions.
Historical method allows in the study to trace the state of the problem under study at different historical stages of the country's development.
Economic method makes it possible to establish the influence of the economy on health care and health care on the economy of the state, to determine the most optimal ways to use public funds for effective protection of public health. The issues of planning the financial activities of health care authorities and medical institutions, the most rational spending of funds, the assessment of the effectiveness of health care actions to improve the health of the population and the impact of these actions on the country's economy - all this is the subject of economic research in the field of health care.
Experimental method include the setting of various experiments to find new, most rational forms and methods of work of medical institutions, individual health services.
It should be noted that in most studies, a complex technique is mainly used with the use of most of these methods. So, if the task is to study the level and state of outpatient care to the population and determine the ways of its improvement, then the statistical method is used to study the incidence of the population, the appealability to polyclinic institutions, its level in different periods and its dynamics are historically analyzed. The proposed new forms in the work of polyclinics are analyzed using an experimental method: their economic feasibility and efficiency are checked.
The research can use methods timing studies(timing of the work of medical personnel, study and analysis of the time spent by patients to receive medical care, etc.).
Sociological methods (interviewing methods, questionnaire method) are often used, which makes it possible to obtain a generalized opinion of a group of people about the object (process) of study.
The source of information is mainly the state reporting documentation of treatment-and-prophylactic medical institutions; for a deeper study, the collection of material can be carried out on specially designed maps, questionnaires, which include all questions to obtain the necessary information in accordance with the approved research program and tasks that are assigned to the researcher. For this purpose, the researcher can, using a special program, enter the necessary data into the computer from the primary registration documents.
In the overwhelming majority of socio-hygienic studies of group health, population health and public health in previous years, it was about a quantitative assessment of health. True, with the help of indicators, indices and coefficients, they have always tried to assess the quality of life in scientific research. The term “quality of life” itself has been used in Russian scientific literature in the last 10-15 years. This is understandable, only then we can talk about the "quality of life" of the population when in the country (as happened long ago in the developed countries of Europe, America, Japan and some others), the main material and social benefits are available to the majority of the population.
As defined by WHO (1999), the quality of life- the optimal state and degree of perception by individuals and the population as a whole of how their needs (physical, emotional, social, etc.) are met and opportunities are provided to achieve well-being and self-realization.
In our country, the quality of life is most often understood as a category that includes a combination of living conditions and health conditions that allow achieving physical, mental, social well-being and self-realization.
Despite the absence of the generally accepted in the world concept of "quality of health" as the most important component of "quality of life", attempts are being made to give a comprehensive assessment of public health (quantitative and qualitative).
Basic theoretical and organizational principles
The concept of "health care" means activities to preserve, improve, ensure and enhance the health of various groups of the population. The main legislative acts enshrine the human right to health protection and promotion. Optimization of the health care system is the most important part of the socio-economic policy of the state. Health care is viewed as a state system with the unity of goals, interaction and continuity of services (therapeutic and prophylactic), universal availability of qualified medical care, and a real humanistic orientation.
The priority structural element of the health care system is the preventive activity of medical workers, the development of medical and social activity and attitudes towards a healthy lifestyle among various groups of the population.
The main direction in the development and improvement of healthcare at the present stage is the protection of mothers and children, the creation of optimal socio-economic, legal and medico-social conditions for strengthening the health of women and children, family planning, and solving medico-demographic problems.
The state nature of health care provides funding, training and improvement of personnel. The activities of bodies and institutions are carried out on the basis of state legislation and regulatory documents. The principle of the unity of medical science and practice is implemented in the form of joint activities and the introduction of scientific developments in health care institutions.
The most important theoretical problems of health care include: the social conditioning of public health, disease as a biosocial phenomenon, the main categories of health care (public health, material and economic base, personnel, etc.), forms and ways of developing health care under various socio-economic conditions and dr.
The World Health Organization has identified 4 categories of generalized indicators that characterize the state of health in the country: 1) indicators related to health policy; 2) social and economic indicators; 3) indicators of the provision of medical and social assistance; 4) indicators of the health status of the population.
The founders of Russian social medicine defined social medicine as the science of public health and health care. Its main task is to study the influence of medical and social factors, conditions and lifestyles on the health of various population groups, develop scientifically based recommendations for the prevention and elimination of unfavorable social conditions and factors, as well as recreational activities to improve the health of the population. The main purpose of social medicine and health care management as a science and academic discipline is to assess the criteria of public health and the quality of medical care, and their optimization.
The structure of the subject: 1) history of health care; 2) theoretical problems of health care; 3) the state of health and methods of its study; 4) the organization of medical and social security and health insurance; 5) organization of medical care for the population; 6) ensuring the sanitary and epidemiological well-being of the population; 7) economic and planning-organizational forms of improving health care, management, marketing and modeling of medical services; 8) international cooperation in the field of medicine and health care.
Methods of medical and social research: 1) historical;
2) dynamic observation and description; 3) sanitary and statistical; 4) medical and sociological analysis; 5) expert assessments; 6) system analysis and modeling; 7) organizational experiment; 8) planning and regulatory, etc.
Social medicine is the science of health strategy and tactics. The objects of medical and social research are:
1) groups of persons, the population of the administrative territory; 2) separate institutions (polyclinics, hospitals, diagnostic centers, specialized services); 3) health authorities; 4) objects of the environment; 5) general and specific risk factors for various diseases, etc.
Stages of health care development
The training of medical personnel was carried out in medical and surgical schools (since 1786), and since 1798 - in the St. Petersburg and Moscow medical and surgical academies. In 1755, the first in Russia Moscow University with a medical faculty was created.
An outstanding contribution to health protection was made by M. V. Lomonosov, who in his work "The Lay of Reproduction and Preservation of the Russian People" gave a deep analysis of public health and proposed a number of specific measures to improve its organization.
In the first half of the 19th century. the first scientific medical schools are formed: anatomical (P.A.Zagorsky), surgical
(I. F. Bush, E. O. Mukhin, I. V. Buyalsky), therapeutic
(M. Ya.Mudrov, I.E.Dyadkovsky). N.I. Pirogov \
From the second half of the XIX century. in addition to state structures, public medicine was also involved in health protection: the society for the protection of public health (1878),
through the organizational forms of public medicine (medical periodicals, medical societies, congresses, commissions), the first district system for the provision of medical care in Russia (zemstvo doctors) was created, and the beginning of the organization of sanitary work in St. Petersburg (1882),
In the 70s of the 20th century, hygiene was formed as an independent discipline, the first scientific hygienic schools were created (A.P. Dobroslavin, F.F. Erisman).
For the first time in Russia (together with sanitary doctors A.V. Pogozhev and E.M.Dementyev), a comprehensive social and hygienic study of factories and plants in the Moscow province was carried out (1879-1885),
The first sanitary doctors I.I.Molleson, I.A.Dmitriev, G.I. Arkhangelsky, E.A.Osipov, N.I.
I.I.Molleson - the first sanitary doctor in Russia, created the first medical and sanitary council - a collegial body called upon to lead zemstvo medicine. He proposed a project for the organization of medical sites in the countryside, the position of a district sanitary doctor to study the sanitary state of the population, working and living conditions, the causes of diseases and the fight against them. Organizer and leader of more than 20 provincial congresses of zemstvo doctors. II Molleson emphasized: "Social medicine as a branch of knowledge and activity is wide and covers ... all measures that can improve the living conditions of the masses of the population."
EA Osipov is one of the founders of zemstvo medicine and sanitary statistics. For the first time in Russia, he introduced a card registration of diseases. Created the Zemsky Moscow Provincial Sanitary Organization (1884). He developed the principle of the operation of the medical department with a hospital-hospital, the functions of a village doctor, as well as a program of sanitary examination of the province.
N. A. Semashko - theorist and organizer of health care, the first People's Commissar of Health (1918-1930). Under his leadership, the principles of health care were developed - a state nature, a preventive focus, free and affordable qualified medical care, the unity of science and practice, and broad public participation in solving health issues. N. A. Semashko created a new science - social hygiene and became the first head of the department of social hygiene (1922). He created new types of health care - protection of mothers and babies, sanatorium and resort business. With his active participation, the State Scientific Institute of Public Health named after V.I. L. Pasteur, the system of higher medical education was rebuilt, institutes of physical culture were organized in Moscow and Leningrad.
ZP Soloviev - theorist and organizer of civil and military health care, deputy people's commissar of health care, head of the Main Military Sanitary Directorate. In 1923 he organized the Department of Social Hygiene at the 2nd Moscow Medical Institute. He made a great contribution to the development of the preventive direction of health care, to the reform of medical education.
ZG Frenkel is one of the founders of social hygiene in the country. Organizer and head of the department of social hygiene of the 2nd Leningrad Medical Institute (1923-1949), a prominent specialist in communal hygiene, demography and gerontology, head of the Hygienic Society of Leningrad for 27 years.
The period of the Great Patriotic War and the post-war years are associated with the development of military medicine, the restoration of the material base of health care and the active training of medical personnel.
Since 1961, a number of legislative acts and resolutions of the Union Government have been adopted, aimed at the development of the health care system. The most important social task is the protection of public health. The material base of health care is being strengthened, medical care is being specialized, and the system of primary health care is being improved. In 1978, in Alma-Ata, a WHO conference was held on the organization of primary health care for the population, which was attended by 146 countries. The Magna Carta, developed at this conference, formed the basis for a new thinking about the health of peoples and divided the history of healthcare organization into before and after AlmaAta. The greatest merit in organizing and holding the conference, and in the development of healthcare in the Republic of Kazakhstan belongs to the first academician from medicine of Kazakhstan T.Sh. Shamanov. Lauret of international prizes and awards, founder and director of the National Research Institute of Nutrition, T.Sh. Sharmanov, is still producing new medical knowledge and technologies.
Famous scientists S.V. Kurashev, G.A. Batkis, S. Ya.Freidlin, E. Ya.Belitskaya and others contributed to the development of social hygiene during these years. as: Yu.P. Lisitsyn, O. P. Shchepin, I. N. Denisov, Kucherenko, I. V. Lebedeva, V. A. Minyaev, A. M. Moskvichev, IDR, in Russia, and in Kazakhstan O. Zhuzzhanov. A.A. Akanov, T.I. Slazhneva and others.
In recent years, priority health problems are such as the protection of mothers and children, the establishment of state sanitary supervision and environmental protection, medical support in a new economic mechanism, a market economy and health insurance, the introduction of the principles of family medicine, improving the training of medical personnel.
Illustrative material:
Slides:
Table layouts.
Literature:
1.Yu.P. Lisitsin, NV Polunina "Public health and health care" M: Medicine, 2002, pp. 353-357.
2. Actual problems of social medicine and health management. // In collection: Selected lectures (edited by M.K. Kulzhanov, MD). - Almaty, 1994 .-- 175 p.
3. Yuriev V.K., Kutsenko G.I. Public health and healthcare. - St. Petersburg, Petropolis. - 2000 .-- 914 p.
Literature
Additional:
1.Reshetnikov A.V., Shapovalova O.A. Health as a subject of study in the sociology of medicine: a textbook. - M., 2008 .-- 64 p.
Medic V.A. A guide to statistics in medicine and biology. 3 volumes Medic V.A., Tokmachev M.S., Fishman B.B., Komarov Yu.M. - Publisher: M .: Medicine, 2006 .-- 352
Akanov A.A., Devyatko N.V., Kulzhanov M.K. Public health in Kazakhstan: concept, problems and prospects. - Almaty, - 2001-100s.
In Kazakh language
main:
Bigalieva R.K., Ismailov Sh.M. Social medicine and health care management: Textbook (in Kazakh). - Almaty, 2001.- 371 p.
Control questions
Give the concept of "health", "public health"
2. How many health levels are there?
What are risk factors?
What is the specific weight of lifestyle factors on health?
5. What is the share of health factors on health?
6. Basic methods of public health
What does public health study?
Basic methods of studying public health?
What are the main structures of the subject?
Healthcare system in the Republic of Kazakhstan
Pathways of health care
The current state of healthcare in the Republic of Kazakhstan
Public health sector
Non-governmental healthcare sector.
State program for the development of healthcare in the Republic of Kazakhstan
Page 1
The subject of science.
Science studies the patterns of public health and health care.
Items:
1. Public health.
2. Healthcare.
3. Factors affecting public health.
4. Medical and socially significant pathology.
1. Public health- medical-demographic and social category, reflecting the physical, psychological, social well-being of people who carry out their life activities within the framework of the definition of social communities.
2. Healthcare Is a system of socio-economic and medical measures aimed at preserving and improving the level of health of each person and the population as a whole (BME, 3rd ed.)
3.Risk factors- Potentially hazardous to health factors of a behavioral, biological, genetic, ecological, social nature, environment and work environment, increasing the likelihood of developing diseases, their progression and unfavorable outcome.
Factors:
I. Socio-economic factors.
1. The level of productive forces and the nature of production relations.
2. Organization of medical care.
3. Legislation on health care.
4. Lifestyle and living conditions.
II. Natural and climatic.
III. Biological: gender, age, constitution, heredity.
IV. Psycho-emotional.
Health formula (in%): 50 - lifestyle, 20 - heredity, 20 - environment, 10 - health activity.
4. Socially significant diseases- diseases caused mainly by socio-economic conditions, causing damage to society and requiring social protection of a person.
Science tasks:
1. Assessment and study of the health of the population, the dynamics of its development.
2. Assessment and study of social and other conditions affecting health.
3. Development of methods and ways of health promotion, prevention of diseases and disabilities, as well as their rehabilitation.
4. Theoretical substantiation of the principles of development, assessment of the quality and effectiveness of health care.
5. Solving problems of management, financing and economics of health care.
6. Legal regulation of health care.
7. Formation of social and hygienic mentality and thinking of medical workers.
Sections of science:
1. Sanitary statistics (public health).
2. Examination of incapacity for work.
3. Organization of medical care (health care).
4. Management, planning, financing, health economics.
1. 2 Methods used in research and teaching in public health and health care.
Public health, like other scientific disciplines, has its own research methods.
1) Statistical method as the main method of social sciences is widely used in the field of public health. It allows you to establish and objectively assess the ongoing changes in the health status of the population and to determine the effectiveness of the activities of health authorities and institutions. In addition, it is widely used in medical research (hygienic, physiological, biochemical, clinical, etc.).
2) The method of expert assessments serves as a supplement to the statistical one, the main task of which is to indirectly determine certain correction factors.
Public health uses quantitative measurements using statistics and epidemiological methods. This makes it possible to make forecasts based on previously formulated patterns, for example, it is quite possible to predict future fertility, population, mortality, mortality from cancer, etc.
3) Historical method is based on the study and analysis of public health and health care processes at various stages of human history. The historical method is a descriptive, descriptive method.
4) Method of economic research makes it possible to establish the influence of the economy on health care and, conversely, health care on the economy of society. The health care economy is an integral part of the country's economy. Health care in any country has a certain material and technical base, which includes hospitals, clinics, dispensaries, institutes, clinics, etc. The sources of health care financing, issues of the most effective use of these funds are investigated and analyzed. Questions of planning financial activities of health care authorities and medical institutions, the most rational spending of funds, assessment of the effectiveness of health care actions to improve the health of the population and the impact of these actions on the economy; one of these methods is called the budgetary method (the method of budget estimates) and has found wide application in research;
Methods used in economic sciences are used to study the influence of socio-economic factors on human health. These methods find direct application in the study and development of such health issues as accounting, planning, financing, health management, rational use of material resources, scientific organization of labor in health authorities and institutions.
5) Experimental method Is a method of searching for new, most rational forms and methods of work, creating models of medical care, introducing best practices, testing projects, hypotheses, creating experimental bases, medical centers, etc.
The experiment can be carried out not only in natural, but also in social sciences. In public health, the experiment may not be used often because of the administrative and legislative difficulties associated with it.
In the field of healthcare organization, a modeling method is being developed, which consists in creating models of the organization for experimental verification. In connection with the experimental method, great reliability is assigned to experimental zones and health centers, as well as to experimental programs on individual problems. Experimental sites and centers can be called “field laboratories” for health research. Depending on the goals and problems for which they were created, these models vary considerably in scope and organization, they can be temporary or permanent.
6) Method of observation and interrogation. To supplement and deepen this data, special studies can be undertaken. For example, to obtain more in-depth data on the incidence of people in certain professions, they use the results obtained during medical examinations of this contingent. To identify the nature and degree of influence of social and hygienic conditions on morbidity, mortality and physical development, survey methods (interviews, questionnaire method) of individuals, families or groups of people can be used according to a special program.
Using the survey (interview) method, you can get valuable information on a variety of issues: economic, social, demographic, etc.
7) Epidemiological method. Epidemiological analysis occupies an important place among epidemiological research methods. Epidemiological analysis is a set of methods for studying the characteristics of the epidemic process in order to find out the reasons that contribute to the spread of this phenomenon in a given territory, and to develop practical recommendations for its optimization. From the point of view of public health methodology, epidemiology is applied medical statistics, which in this case acts as the main, largely specific, method.
1. 3 The history of the formation of social medicine and the organization of health care, the stages of formation and development.
1. Primitive society.
Traditional medicine, folk hygiene. Collective → individual experience.
2. Antiquity.
State medicine: government positions (archiyaters, aediles - dignitaries. Controllers); legislative regulation, governing bodies.
Family, priestly, private forms.
3. Middle Ages.
Municipal medicine (magistrates)
Public medicine - regulation and control of activities:
1140g. - (Italy) decree on the admission to medical practice of persons who have undergone training and passed state tests.
1241 - (Germany) decree establishing state control over drug preparation and surgical practice.
Epidemics → sanitary laws (rules), sanitary authorities, sanitary measures.
1348g. - (Venice) Sanitary Council (interdepartmental): with sanitary police functions.
1374 - (Italy) quarantine.
1426 - (Germany) stadt-physicists - city doctors.
1551 - (Moscow) Stoglavy Cathedral.
1617 - Pharmaceutical order - state governing body.
1588 - Statute of the ON (medical issues from the legal side).
1571 - (Vilna) Medical contubernia (partnership) - police supervision.
1621 - Mogilev, magistrate - established the position of an observer for those staying in the city.
Interest in the social problems of medicine originated in ancient times: many outstanding scientists of antiquity were engaged in them - Hippocrates, Aristotle, Avicenna and others.
MV Lomonosov laid a deep mark in the birth of the scientific worldview in Russia, including the social and hygienic one, in his famous letter to Count II Shuvalov "On the reproduction and preservation of the Russian people" (1761), in which he demonstrated the social and hygienic approach to public health and population problems.
MV Lomonosov in his letter showed not only the difficult sanitary conditions of the people. He spoke in favor of a special study of population and public health, and also proposed measures to reduce the morbidity and mortality of the population, increase the birth rate, improve medical care and health education.
The beginning of the socio-hygienic worldview in medicine was laid in the second half of the 18th century by clinical scientists of the Medical Faculty of Moscow University, which was later transformed into an independent higher medical educational institution (now the IM Sechenov Moscow Medical Academy). The greatest significance in this respect is represented by the first Russian professor of the medical faculty of the university S.G. Zybelin, one of the most prominent founders of the remarkable Russian tradition of combining clinical activity with social and hygienic activity. Professor S.G. Zybelin was the first in Russia to raise the issue of the influence of social factors on the incidence, birth rate and mortality of the population; for the first time, he proposed progressive measures of a hygienic and social nature to combat morbidity for that time.
The first Russian professor who laid the foundation for the systematic teaching of "medical police" was F.F. Keresturi, who delivered a vivid speech "On the" medical police "and its use in Russia." The term "medical police" was first introduced in 1784 by the German scientist VT Rau, who included in the competence of the "medical police" the organization of treatment of patients, monitoring the health of the population, regulating medical education, monitoring hospitals and pharmacies, preventing epidemics, the fight against quackery, education of the population. F.F. Keresturi has repeatedly spoken about the benefits of sound knowledge and study of public health and medical care. With the establishment of zemstvo and factory medicine, the requirements for the organization of special studies of public health and its protection, the opening of special scientific and educational institutions came to the fore.
In his research F.F. Erisman, E.A. Osipov, V.A. Levitsky, A.V. Pogozhev and A.I. Shengarev, P.I. Tezyakov, P.I. Kurkin, A. Fishev and other leaders of zemstvo medicine and sanitary statistics laid the foundations for the scientific analysis of public health and health care problems. Moreover, in the late 19th and early 20th centuries, courses of lectures on public health and health were delivered in a number of educational institutions. However, until the beginning of 20
century there were no special courses, departments, institutes specifically on social hygiene, there were no special periodicals.
The current state of public health and health care.
The formation and flourishing of social hygiene (as it was called until 1941) during the period of Soviet power are associated with the names of prominent figures in Soviet health care N.A. Semashko and Z.P. Solovyov.
The first department of social hygiene in our country was organized on the initiative of N.A. Semashko in 1922 at the Faculty of Medicine of the first Moscow University (the first in history department of social hygiene was opened in 1920 at the University of Berlin by Alfred Grotian, the founder of the first journal on social hygiene (1903) and the scientific society for social hygiene and medical statistics (1905). It was a single, united department, whose staff taught social hygiene in all Moscow medical higher educational institutions, N.A.Semashko headed the department until the end of his life, until 1949. In 1923, under the leadership of ZP Soloviev, a department was created in the second Moscow University.
Among the first domestic textbooks and guidelines on social hygiene, there appeared textbooks by T.Ya. Tkachev (1924) and Z.G. Frenkel '(1923, 1926). In 1922-1930. a special journal "Social Hygiene" was published, which covered urgent problems of Soviet health care, scientific research and teaching social hygiene.
In 1923. was organized by the Institute of Social Hygiene of the People's Commissariat of Health of the RSFSR, which became the scientific and organizational base for the departments of social hygiene, health and health.
The discovery in 1924 was important for the development of social hygiene. in Moscow, the first clinic for social and occupational diseases, where clinicians, together with specialists in the field of social hygiene, studied the most important problems of social etiology, the role of occupational and industrial factors in the occurrence of diseases, developed methods of diagnosis, treatment and prevention of social and occupational diseases.
In 1935. for the first time, an independent department of statistics was created, the head of which was the famous scientist prof. P.A. Kuvshinnikov.
In 1936. a textbook by G.A. Batkis "Social Hygiene", which was reprinted many times and played a great positive role in the training of doctors in the field of social hygiene and healthcare organization.
In 1941, on the eve of the Great Patriotic War, the departments of social hygiene were renamed into the departments of "healthcare organization". All the attention of the departments during these years was focused on the issues of medical and sanitary support of the front and the organization of medical assistance in the rear, the prevention of outbreaks of infectious diseases.
A great contribution to the development of science and teaching during these years was made by: Z.G. Frenkel, B. Ya. Smulevich, S.V. Kurashov, N.A. Vinogradov, A.F. Serenko and others.
In the years of the post-war five-year plans (1946-1960), the scientific and pedagogical activities of the departments of healthcare organization reflected the tasks associated with the post-war development of the economy and healthcare in the country. A large complex study was the work devoted to the sanitary consequences of war. In 1946. the Institute of Public Health Organization was established in Moscow. The scientific sessions of the Institute and various materials published to them had a great influence on the research activities of the departments. Mutual contact between departments and public health authorities has increased.
02/28/1966 By order of the Minister of the USSR No. 132, the departments of healthcare organization were reorganized into departments of social hygiene and healthcare organization with a change in the content of teaching programs. In social hygiene and health care organizations, system analysis, methods of organizational experiment, expert assessments, methods of sociological research, mathematical
and logical modeling, planning methods and economic research.
In March 1991. at the All-Union meeting on the teaching of social hygiene and the organization of health care, it was recommended to rename the discipline to social medicine and the organization of health care. The name of the departments was supposed to reflect a broader understanding of the subject of study, including a diverse range of problems in protecting public health and managing a demonopolized and decentralized health care system in the transition to a market economy.
In accordance with the decisions of the Board of the Ministry of Health of the Russian Federation "On the role of the departments of social hygiene, organization, management and economics of healthcare in the training and advanced training of specialists in the industry" (April 1999), the All-Russian conference of heads of departments of social medicine and organization of healthcare (Moscow, December 1997) and the All-Russian Scientific and Practical Conference “Topical Issues of Teaching Social Medicine. Departments' work with health authorities "(Anapa, October 1999) and on the basis of the order of the Ministry of Health of the Russian Federation of 03/01/2000. № 83 "On improving teaching in medical and pharmaceutical universities of public health and health care" the discipline received a new name - "public health and health care", as the most appropriate to the conditions of health care reform and the priority of public health problems in the context of radical socio-economic transformations in Russia.