1.1. Name and purpose of science and academic discipline

The most common name for our discipline until recently has been "social hygiene and public health organization". However, the term "social hygiene" inaccurately and incompletely characterizes our subject, especially at the present time, when the health care of the country, as well as the entire national economy, the whole society, faces the problems of renewal, restructuring, and reform. Our subject should correspond to the development of the social policy of society and the state, social programs. Our discipline, more than others, is designed to help solve these problems. She is essentially is the science of healthcare strategy and tactics, because on the basis of public health research, it develops organizational, medical and social proposals aimed at raising the level of public health and the quality of medical care.

Our discipline studies patterns of public health and healthcare in order to develop evidence-based strategic and tactical proposals for the protection and improvement of public health and the organization of medical and social assistance. On the recommendation of the meeting of the heads of our departments (1999), a decision was made to rename the name of the discipline to “public health and healthcare”.

Unlike most medical and, above all, clinical disciplines that deal with an individual and his health, our subject studies the health and its protection (health care) of communities (populations), groups of people, population, i.e. it directly confronts social issues and processes and thus serves as a bridge between medicine and

social disciplines, especially sociology. He focuses his attention on social problems in medicine. ON THE. Semashko said that the main task of our science, our discipline is to deeply study the influence of the social environment on human health and develop effective measures to eliminate the harmful effects of the environment. However, not only the study and elimination of the harmful effects of the social environment is its task. Rather, it is more important to develop health-promoting factors with the maximum use of society's capabilities and resources. It is more correct to formulate the purpose of our subject something like this: the study of healing, as well as adverse effects social factors and conditions on the health of the population and its groups and the development of evidence-based recommendations for the elimination and prevention of the harmful effects of social conditions and factors on people's health in the interests of protecting and improving the level of public health. It is also accepted by the Great Medical Encyclopedia (BME. 3rd ed. - Vol. 25. - P. 60) and covers the main problems and tasks of the subject: healing, positive, as well as negative influence of social conditions and factors, public health and health care and improvement.

So our science is studying patterns of public health and healthcare.

To date, the following structure (main issues) of the subject of scientific research and teaching (academic discipline) has developed in our country:

Health history.

Theoretical problems of public health and medicine. Conditions and way of life of the population; sanology (valeology); social and hygienic problems; general theories and concepts of medicine and healthcare.

The state of health of the population and methods of its study. Medical (sanitary) statistics.

Problems of social assistance. Social security and health insurance.

Organization of medical care to the population.

Economics, planning, healthcare financing.

Insurance medicine.

Health management. ACS in healthcare.

Health care abroad; activities of WHO and other international medical organizations.

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The methodological base of the subject is distinguished by the breadth and variety of methods and methods, not only of its own, but taken from other sciences and branches of knowledge, mainly from sociology, mathematical statistics, epidemiology, social psychology, economic disciplines, management science, computer science and, of course, other medical sciences. It is no coincidence that our subject was formed at the intersection of medicine and social sciences. Usually 3-4 main methods are named (historical, expert, budgetary, statistical, etc.), but this is too general and inaccurate information.

Of course, our science, like any other, must study its history, use historical approach (method), the study of the past, its comparison with the present and prospects for the future.

Expert assessments are very widely used in studies of the quality and effectiveness of medical care, its planning, etc. it essential method and they cannot be neglected.

budget methodalso found wide application in our science, but it is only one of many statistical and mathematical techniques that are widely used in other branches of knowledge. Equally important are the methods of modern mathematical statistics, especially modeling, application of computer technology. Let's say more, statistics is the basis of our science, a section of which is medical or sanitary statistics, i.e. the use of general mathematical statistics on specific, medical objects.

Of paramount importance are sociological methods, used in medicine and healthcare. About them, as well as about other approaches, we will talk in detail when covering the topics and problems of our discipline. Here we note that sociological methods are based on questionnaires, interviews and surveys.

Not to mention the so-called systems approach and analysis as the basis of many, if not most, methods of scientific research, including mathematical, statistical, socio-

logical, etc. This method (even methodology) is especially successfully used in the study of social and biological systems (a set of interrelated parts, elements representing a new property, a new quality in comparison with the properties of individual components). Public health and health care are just complex, developing, dynamic systems that are closely related to other systems, industries, areas of knowledge of science and society.

The question of methods specific to our subject is debatable. Can talk about the method of organizational experiment: creation of institutions, forms of medical care in them or in certain territories in accordance with a given goal and evaluation of the effectiveness of this kind of organization using various, primarily statistical, methods. Strictly speaking, such an experiment is also applied in other industries; it is difficult to find any originality here. Talk about the specifics of planning methods, for example, the most important among them - normative, as well as about economic methods in our discipline. However, economic methods, like experimental ones, are also known in other sciences and industries.

This means that for our subject there are no specific methods, but there is an originality, specifics of research objects(sick people, healthcare facilities, medical personnel, etc.). Consequently, our science largely depends on the methodological and methodological base of other sciences and disciplines.

Thus, despite the fact that it is difficult to unambiguously name the methods of research and evaluation of public health and healthcare as its main categories that are purely specific to our discipline, we can consider a set of methodological techniques used on a basis specific to our discipline, a specific object. Research using a combination of these and other methods in accordance with scientific methodology (philosophical, sociological, technological and other provisions, concepts) is commonly called social hygienic research, and the named methods (both statistical up to mathematical modeling, and economic, budgetary, analytical, normative, methods of organizational experiment, sociological, psychological, historical and many others) used in the study and evaluation

public health and healthcare, - social and hygienic 1 .

Consequently, our discipline has its own subject, object of research and study (public health and healthcare) and a set of methods and approaches, which undoubtedly meets modern requirements and criteria for defining it as an independent science and subject of teaching.

1.2. From the history of the formation and development of science and academic discipline

The prerequisites, or rather, the reasons for the emergence of our science and academic discipline, lie in the need for a scientifically based explanation of the nature, health and disease not only of an individual, but also of the population: groups of people, their communities, i.e. public health, and the application of the knowledge gained in the study of health in its protection and improvement, the effective organization of medical care. The most important condition for the realization of this need was the successful study of the most common diseases of the population.

"Those who wish to get acquainted in detail with the methods of social and hygienic research, we recommend that you refer to special guidelines and monographs, primarily to the guide for doctors (which students also use): A Guide to Social Hygiene and Health Organization. In 2 volumes. / Edited by Yu.P. Lisitsyna - Moscow: Medicine, 1987. - T. 1.- S. 200-314.

diseases up to empirical vaccinations, quarantine and other fairly effective measures. However, without revealing scientific basis, i.e. without establishing the true causes of these diseases, it was impossible to count on cardinal success in the fight against them. No seemingly indisputable, unshakable theories of the origin of these diseases, such as ideas about "miasms", "monads", even "contagia", not to mention cosmic and other forces, religious and similar ideas, were not able to reveal their true causes until then. until the era of bacteriology came, when microorganism-causative agents of infectious diseases were discovered with the help of a microscope, until this great discovery of the 19th century laid the foundation for the doctrine of immunity and, based on it, vaccination and other effective steps in the treatment and prevention of mass infectious diseases.

However, this circumstance alone was not enough to successfully combat mass diseases. Conditions were required for the implementation of effective measures on a mass scale, in relation to the entire population or its groups - social, professional, property, etc. Only the state, its bodies, institutions were able to organize and implement such a fight in practice on a national scale, using the achievements science, bacteriology and especially hygiene, which studies the impact on human health of the environment, sanitary and other preventive measures - the prevention of mass infectious diseases, their treatment, as well as the fight against injuries and other massive injuries and injuries. The attempts of individual even very rich people and organizations could be reduced, as a rule, only to charity and philanthropy. Thus, a certain, sufficiently strong state structure was required, capable of managing public health (mass diseases and injuries), based on scientific data.

Only capitalist society got the possibility of an organized fight against mass diseases, the possibility of creating public health services using the achievements of science, which reveals the nature of diseases, i.e. management - an organized, directed impact on public health. Another thing is to what extent the capitalist state

The government used these opportunities, to whom and how organized medical care was provided, including sanitary, anti-epidemic, and preventive measures. The nature, volume of medical care, organization, management of it are determined by the specific socio-economic, political interests of the social strata and classes of society.

An important factor in the emergence of the need for the science and practice of health care was the public and especially the revolutionary movement of workers for social and political rights, among which the right to health care has always been put forward in one of the first places. The government, making concessions to these requirements, in its social policy should know how to manage medical care, how to most economically and effectively influence public health, if not the entire population, then some of its groups and strata.

Of course, not only the named conditions and reasons gave rise to the need for the science of public health management and health care, as well as for the teaching of such a discipline in medical schools. Other factors can also be mentioned. Among them is the development of the science of society - sociology, which widely uses philosophical concepts, economic doctrines, psychological doctrines and, which is especially significant for our subject, statistics and statistical methods in relation to the assessment of health, demographic processes, and the activities of medical services.

Started in the first quarter of the century, the so-called Chartist movement of the proletariat of England for their social rights resulted in mass actions of the working people, especially during and after the revolutions in Europe in 1830, in 1848 and in subsequent years. In the middle and towards the end of the century, the governments of a number of European countries were forced to implement reforms and pass laws on social assistance to workers, including insurance and health care. State national services and public health authorities were established, among them zemstvo and factory medicine in Russia. The works of political scientists and economists created widely used demographic and sociological doctrines, including the concept of population by T. Malthus, A.Zh. Gobineau, F. Galton and others. There was a formation of statistics as a science,

the studies of J. Bartillon and other prominent scientists created classifications and nomenclature of diseases, injuries, etc.

The second half of the 19th century is the period of the emergence and development of materialistic science about the laws of being, nature and society, the creation of revolutionary social democratic, communist parties, including the RSDLP, populist and other social movements in Russia.

We should not forget about the progress of natural science during this period, and especially about the role of evolutionary biology and Darwinism, which could not but affect the theory of our science.

During this period, under the influence of socio-economic changes and scientific and technological progress, patterns and trends in the development and formation of science and, above all, its differentiation, clearly manifested themselves. In the second half of the 19th century, a whole “bouquet” of scientific disciplines was formed, including a number of medical ones: neuropathology, ophthalmology, pediatrics, otorhinolaryngology, pathological physiology, histology, human embryology, etc. The physiology of nervous activity and its peak - higher nervous activity , the doctrine of nervism - the control of the vital functions of the organism.

Among the new sciences and academic disciplines is experimental hygiene, which develops the doctrine of the effect on the body of physical, chemical, biological factors external environment. However, some of its first representatives are not limited to the study natural factors- a person gets into the field of their attention not only as a biological individual, but also as a social being, living in the world of human, social relations that affect health and pathology. There is an interest in the study of social conditions, factors, processes in relation to human health and its reproduction. A prerequisite is being created for the formation and research, so to speak, of the social, public side of hygiene. This is how the new science (discipline) of public health and public health is designated at the beginning of the 20th century.

Before the formation of our science (discipline), occasionally, in separate institutions, most often in higher educational institutions, at the medical faculties of universities, thanks to the initiative of a number of scientists, teachers of hygiene, microbiology, even physiology, clinical disciplines, who realized the importance of general

factors for health and the struggle for its protection and strengthening, courses, curricula, laboratories in public hygiene, preventive medicine, public health, with medical statistics, sometimes political economy and other sections are created not without difficulty and resistance on the part of representatives of the administration and official medicine. social and medical sciences. Although calls for the study and teaching of these (or similar) courses were heard earlier (for example, M.V. Lomonosov in a famous letter to Count I.I. Shuvalov about the reproduction and preservation of the Russian people; the first professors of the medical faculty of Moscow University S.G. Zabelin, F.F. Keresturi, I.P. Frank in his writings on the so-called medical police and others at the end of the XVIII - early XIX centuries pointed to the need to study the health of the population, teaching students the science of it), only in the second half of the 19th century the first attempts were made to organize such courses. So, at Kazan University in the 60s, prof. A.V. Petrov gave lectures to students on public health and public hygiene; in the 1970s, Prof. A.P. Peskov taught a course in medical geography and medical statistics, essentially public hygiene. Subsequently, such courses were introduced at the medical faculties of universities and other higher educational institutions in Moscow, St. Petersburg, Kyiv, Kharkov by professors A.I. Shingarev, A.V. Korchak-Chepurkovsky, S.N. Igumnov, L.A. Tarasevich, Z.Z. Frenkel, P.N. Diatroptov. The latter was even elected a professor at the Department of Public Hygiene of the Higher Women's Courses in Moscow. However, these were only the first prototypes of special educational and scientific institutions on this subject. They were episodic, inconsistent, usually part of other disciplines.

The history of our science as an independent discipline began in the first decades of the 20th century. First in Germany, and then in other countries, a discipline called social hygiene was formed.

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At the very beginning of the 20th century, the young doctor Alfred Grotjan began to publish a journal on social hygiene in 1903, in 1905 he founded the scientific society for social hygiene and medical

statistics, and in 1912 he achieved an associate professorship and in 1920 - the establishment of a department of social hygiene at the University of Berlin.

Thus began the history of the subject and science social hygiene, gained independence and joined a number of other medical disciplines.

Following the department of A. Grotyan, similar divisions began to be created in Germany and other countries. Their leaders are A. Fisher, S. Neumann, F. Printing, E. Resle and others, as well as their predecessors and successors involved in public health and medical statistics (W. Farr, J. Graupt, J. Pringle, A Teleski, B. Hayes and others), went beyond the existing areas: hygiene, microbiology, bacteriology, professional medicine, other disciplines and focused on social conditions and factors that determine the health of the population, on the development of proposals and requirements for the state protection of the health of the population, primarily workers, on the implementation of social, public policy, including effective medical (sanitary) legislation, health insurance, social security. They embarked on the path of reforms not only of hygiene itself with its technical, experimental, physiological, and sanitary direction, but also of the whole matter of protecting public health and organizing medical care. It is impossible to deny the progressive significance of the founders of our subject abroad, especially since this orientation is preserved to this day. Its modern representatives, such as R. Zand, W. Winslow, A. Parisot, L. Popper, K. Kanaperia, as well as the creators and followers of the latest schools of social hygiene R. Dubos, K. Evang, P. Delors, H. Don , T. Person, E. Friendson, D. Mekhanik, L. Bernard, M. Kandau, H. Muller and others continued the line of identifying the social conditionality of public health, shared the positions of public health reforms, the primacy of state, government medicine. Their works, training courses, speeches and materials of national and international medical organizations contain observations, generalizations, and studies of public health and social pathology that deserve serious attention using effective sociological, statistical, psychological, economic and other methods.

At the same time, reformism was and remained their most essential feature. Moreover, even the use of the theory and practice of social hygiene for the "improvement", "correction" of capitalist society itself and its institutions is known. For example, one of the leaders of social hygiene, Rene Sand, considered it as the key to repaying the conflicts characteristic of bourgeois society. This trend is seen in the works and speeches of other representatives of our discipline, who, with the help of the concepts they have formulated - social ecology, social maladaptation, psychoanalytic psychosomatics, etc., seek to reconcile, smooth out the social conflicts of modern society, to carry out "social therapy" and "social prevention".

Despite the fact that by now our subject is recognized and considered one of the most important in the system of medical education and in medical and social research, its name, as noted, is not unified. Its name depends on its interpretation and identification of problems, the personal characteristics of its representatives, former professional affiliation and other circumstances, mainly due to the youth of our science, which is still being formed. One should also keep in mind the peculiarities of its history and well-known national traditions. AT English speaking countries it is more often called public health, or public health, preventive medicine, in the French-speaking - social medicine, medical sociology, in the United States earlier than in other countries, it began to be referred to as the sociology of medicine or the sociology of health. In Eastern European countries, our subject was called differently, most often as in the USSR - “organization of health care”, “theory and organization of health care”, “social hygiene”, “social hygiene and organization of health care”, etc. Recently, the term "medical sociology", "social medicine" (Romania, Yugoslavia, etc.). A significant contribution to the development of the theory and methods of our science was made by such famous scientists as K. Winter (Germany), A. Buresh, Z. Shtikh (Czechoslovakia), P. Kolarov, E. Apostolov, N. Gogov (Bulgaria), E. Shtahelsky, M. Sokolska (Poland) and others.

In "pure form", except for a number of laboratories and departments, mainly in the USA, our subject is not often presented. He usually

is combined with such disciplines or problems, sections of science as medical statistics, epidemiology, especially the epidemiology of non-communicable diseases, general and private hygiene, the history of medicine and health care, medical law, social insurance, economics, etc., even with "tropical diseases". Thus, a major research center in our discipline was organized and traditionally exists at the London Institute of Tropical Medicine. Special research institutes for the problems of our science are called public health institutes in Prague, Budapest; hygiene and health - in Sofia and Bucharest; epidemiological studies - in France; the national center of statistics - in the USA, etc. In the same way, scientific periodicals and scientific societies in our subject are called differently. In Bucharest, the international journal "Public Health" was published, in the USA and England - "Public Health", "Hospital", "Lancet", in France - "Public Health Review", etc. International medical organizations, and among them the largest - the World Health Organization (WHO) publish journals, mainly devoted to our problems ("Health of the World", "International Health Forum", "WHO Bulletin").

There are national and dozens of international scientific societies and associations that bring together specialists in our subject, considering the problems of medical demography, health statistics and information, administration, health economics and planning, hospital affairs, etc. They also have corresponding names.

Our discipline is currently taught in the vast majority of medical educational institutions world, although, as expected, not always in a "pure form", i.e. at independent departments and courses; sometimes teaching takes place in joint departments (blocks, centers, institutes, courses, etc.) with epidemiology, hygiene, and other subjects. Independent departments are organized in some educational institutions in France, Great Britain, the USA and other countries. With all the modifications of curricula and plans in our subject, they usually include a course in sociology, health statistics, epidemiology of non-epidemic diseases, informatics and computers, organization of work of medical institutions, management

(management), health insurance and some others. Since the 1920s, since the creation of the first departments and courses, textbooks, manuals and other manuals on our subject have been published. In the newest period, the most solid, fundamental ones, among them in the USA, France, Poland, Romania, Yugoslavia, etc., come out under the names “Social Medicine”, “Medical Sociology”, “Sociology of Medicine”.

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Social hygiene in the USSR, and this is how our subject began to be called literally from the first years of Soviet power, begins its history with the organization in the difficult 1918 of the Museum of Social Hygiene of the People's Commissariat of Health of the RSFSR, whose director was the famous hygienist prof. A.V. Molkov. The museum, and since 1920 - the Institute of Social Hygiene became the center of the formation of our discipline in the new political conditions. Soviet social hygiene had to extract everything progressive from its predecessors - first of all, public hygiene in Russia, those first institutions that were created before the revolution, social hygiene A. Grotyan, A. Fischer and its other representatives abroad.

An important condition for the formation of social hygiene in the USSR was its organic connection with practice, the construction of a new society and state. This was facilitated by the fact that among the first social hygienists, theorists, scientists were the first organizers of the health of the people and, above all, Nikolai Aleksandrovich Semashko - the first people's commissar of health, a Bolshevik doctor, an associate and associate of V.I. Lenin, and his deputy - Zinovy ​​​​Petrovich Soloviev - Bolshevik doctor, a well-known figure in public medicine. In 1922 N.A. Semashko with the support of Z.P. Solovieva, A.V. Molkova, L.N. Sysina, S.I. Kaplun and other authoritative scientists and figures of public hygiene, organized a department of social hygiene with a clinic of occupational diseases at the First Moscow University. Then there was a single department for other higher medical educational institutions in Moscow (including the II Moscow University). She also taught questions of hygiene, epidemiology, etc. Subsequently, the Department of Social Hygiene gave a start to the life of individual hygiene disciplines, departments

frames, courses, institutes - general and communal hygiene (prof. A.N. Sysin), professional hygiene (prof. S.I. Kaplun), hygiene of education, or school hygiene (A.V. Molkov), in essence , and the history of medicine (Prof. I.D. Strashun), etc. A year later, in February 1923, Z.P. Solovyov and his staff created a department of social hygiene at the medical faculty of II Moscow University, formed on the basis of the former Higher Women's Courses. Since that time, departments of social hygiene began to open in other university centers and research laboratories and institutes were organized in our subject (social hygiene, social hygiene and sanitary statistics, etc.), headed by well-known scientists and public health organizers Z. G. Frenkel (Leningrad), T.Ya. Tkachev (Voronezh), A.M. Dykhno (Smolensk), S.S. Kagan (Kyiv), M.G. Gurevich (Kharkov), M.I. Barsukov (Minsk), etc.

Already in 1922, the first training program on social hygiene, the first textbooks and teaching aids were soon published (Z.G. Frenkel, 1923; T.Ya. Tkachev, 1924; a team of authors edited by A.V. Molkov, 1927, etc.). In the 1920s, the scientific works and textbooks of A. Fischer, A. Grotyan and other foreign social hygienists were published in Russian translation. From 1922 to 1930 was published Science Magazine"Social Hygiene", which covered the problems of building Soviet health care, criticized eugenics, Malthusianism, social Darwinism and other so-called bourgeois theories in population and health care, raised issues of scientific research and teaching of our subject, as well as the Marxist education of doctors and the teaching of philosophy and others social disciplines. In the first years in the Soviet higher medical school there were no corresponding departments and courses, and departments and institutes of social hygiene were engaged in their teaching.

Now about the term "health", which until now we have used very rarely, preferring to talk about "public health", "health protection", etc. This is not accidental, since before the revolution, this term was not in circulation. It became generally accepted only from the first years of Soviet power. On the one hand, it is the fruit of the then fashion for all kinds of abbreviations, word combinations, abbreviations, word creation (“Mosselprom”, “Narkomzdrav”, “Mossovet”, etc.), since it comes from two words - “protection

on”, “health”, and on the other hand, it reflected the desire for a brief, capacious designation of a new system of protection, improving the health of the population. The science of such a system and its management in order to raise the level and quality of public health became social hygiene, on the way of which there were serious difficulties, obstacles, often dramatic events.

The formation of social hygiene met with resistance from conservative professors, a number of former members Society of Russian doctors in memory of N.I. Pirogov. The tendency to connect with hygiene, sociology provoked opposition; social hygiene and its representatives were often opposed by members of various societies, including those standing on one-sided mechanistic or even vitalistic positions, some members of the societies "Doctors-Marxists", "Doctors-Materialists", representatives of the so-called Russian Eugenic Society, etc. However, especially Medical science and, along with it, social hygiene suffered heavy damage as a result of the repressions of the late 1920s and 1930s during the period of Stalin's personality cult. Our discipline, like all science, has been deprived of information due to the regime of top secrecy. Things got to the point that even statistical data on demographic processes generally accepted throughout the world - mortality, population composition, morbidity, fertility, etc. were closed. This situation continued in subsequent years. For example, data on child mortality and its structure, infectious, mental morbidity, injuries, even on the number of doctors by specialty, etc. were closed. Without knowledge of these and other demographic and medical statistics, it is difficult to imagine a study of public health and health problems, because e. successful development of social hygiene. At this time (the end of the 1920s - the beginning of the 1930s), the institutes of social hygiene, which existed in almost all republics, were disbanded and closed. An attack from above began on formal genetics, experimental biology, led by such remarkable scientists as professors N.K. Koltsov and N.I. Vavilov.

Yet our science survived and advanced. Guides, textbooks, monographs, including those on sanitary statistics, which gained wide popularity were created (P.I. Kurkin, S.A. Tomilin, S.A. Novoselsky, P.I. Kuvshinnikov, G.A. Bat-

kitty, B.Ya. Smulevich, V.V. Paevsky, A.M. Merkov, A.Ya. Boyarsky and others), developed and improved the methods of socio-hygienic, medical-demographic, epidemiological studies, on the basis of which, using a sampling method on mainly regional and local materials, important results were obtained on trends, changes in public health, used in improving the organization medical care to the population.

However, this applied, normative side of social hygiene was recognized by the governing authorities as insufficient, especially during the period of spurring collectivization and industrialization, which required immediate organizational decisions. In 1941, on the eve of the Great Patriotic War, the Department of Social Hygiene, by order of the People's Commissar of Health G.A. Miterev were renamed the departments of healthcare organization. This decision narrowed the theoretical base of the subject, limited the study of social problems of health care, which is already squeezed, squeezed by official restrictions and prohibitions, harmed the teaching process and education of students, belittled the prestige of our science, which is increasingly becoming a servant of the health administration. Such conclusions come to mind when analyzing the discussion on the topic "Organization of health care or social hygiene", which took place on the pages of the journal "Soviet Health" (the main publication of our discipline) immediately after the end of the war. The proponents of retaining the name "health organization" feared most of all the "bourgeoisization" of our subject, turning it into a kind of "reformist", "apologetic" social hygiene in the West. It should not be forgotten that at that time, on orders from above, a campaign was carried out to combat cosmopolitanism, to eradicate bourgeois trends, to prove and preach everywhere and everywhere the priorities of domestic and Soviet science. A number of well-known scientists and among them the historian of medicine acad. USSR Academy of Medical Sciences I.D. Strashun were accused of cosmopolitanism and removed from their posts. Soon, as is known, the persecution of the “Mendelists-Morganists”, geneticists who did not share the “only correct” principles of “Michurin biology”, “agrobiology” of Acad. T.D. Lysenko. During the session of VASKhNIL in 1948, at which the opponents of T.D. Ly-

Senko, followed by the infamous "Pavlovian session" (1951) of two academies - the Academy of Medical Sciences established in 1944 and the Academy of Sciences of the USSR, dedicated to the teachings of I.P. Pavlova. Having paid tribute to the outstanding merits of the great Russian physiologist, the founder of the doctrine of higher nervous activity, the session, in essence, made dogmatic decisions, elevating the teachings of I.P. Pavlov, rejecting any alternative to this teaching and thereby dealing a blow to other progressive areas in physiology and the sciences of the animal world in general, about man, and even to Pavlov's teaching itself. The studies of the "non-Pavlovian" schools began to be ignored, their representatives lost their jobs, were sometimes persecuted, and the most prominent followers and direct students of I.P. Pavlov, such as Academicians L.A. Orbeli, I.S. Beritashvili, A.D. Speransky, were discredited in every possible way. After these events, the "discoveries" of O.B. Lepeshinskaya and M.G. Bashyan, who tried to prove "dialectical-materialistic" direct transformations in laboratory conditions of extracellular matter into cells, inanimate matter immediately into living matter. Such "experiments" were picked up by the Lysenkoites, received the support of the apostle of Michurin biology himself, and were approved from above. Militant dogmatism did not stop there: ahead was the exposure of the bourgeois "pseudo-science" of cybernetics; decisions were made on the magazines Zvezda, Leningrad and other official acts accusing them of cosmopolitanism, apoliticality, lack of spirituality, separation from the people, cringing before the West, not only of ideological, but also of political mistakes, miscalculations and even crimes with all the consequences hence the consequences up to the repressions of a number of prominent writers, composers, artists and other figures of art, culture and science. In 1953, after the trials of the late 1930s and the repressions of the "killer doctors", the "doctors' case" broke out, and a number of brilliant clinicians, among whom were professors S.M. Vovsi, V.N. Vinogradov and others, subjected to unfounded political accusations, were arrested and convicted. Only the death of I.V. Stalin saved them from reprisals.

We are talking about these dramatic events here because they had the most detrimental effect on the development medical science and health care and their prestige, therefore, on such

military, socially significant discipline, like ours, and its fate, forcing it to be an obedient executor of command and administrative decisions, pushing it to dogmatic, often far from true science, voluntaristic, insufficiently tested and balanced recommendations and conclusions. For example, with the light hand of some dogmatic social scientists, it was believed that since there can be no class contradictions under socialism, it means that public health does not depend on social conditions and factors. This statement, which proceeded from the unacceptable mixing of class and social, emasculated science at the root, making it only in words a science of the social problems of medicine and health care. The dogmatic discussions in the early 1950s about the basis and the superstructure resounded in our discipline as useless, abstract disputes about the place in the system of social relations of medical science and health care itself (what is the "base" and what is the "superstructure"). One can also recall the hasty, insufficiently scientifically substantiated, voluntaristic decisions of this time on the universal unification of hospitals and polyclinics, and many others, such as the decision on immediate, within a year, general medical examination, etc. We are no longer talking about the treatment of foreign science, including social hygiene, the denigration of its representatives and the completely unfounded, harmful to its fate in our country, rejection, non-recognition of many useful facts, generalizations, methods. What is worth, for example, the indiscriminate criticism of medical sociology, sociology of health, social biology and other areas, schools and concepts of foreign social hygienists.

The discussion "Social Hygiene or the Organization of Health Care" in the pages of medical journals, ending, showed that life requires, despite all obstacles and objections, the restoration of a healthy and creative core of social hygiene.

However, it was impossible to discard the valuable things that our discipline has accumulated and achieved by studying normative, applied issues, problems of organization, management, in a broad sense - management in health care. Employees of the Institute of Health Organization. ON THE. Semashko, created on the initiative of this outstanding scientist and theorist in 1946, including myself (Yu.P. Lisitsyn), it was proposed to restore the former

the name "social hygiene" and leave the new one - "health organization". Such a decision reconciled the supporters of two points of view, removed the notorious “or” (social hygiene or healthcare organization). In 1966, the Minister of Health of the USSR B.V. Petrovsky signed an order on the transformation of the departments and the Institute. ON THE. Semashko to the departments and the Institute of Social Hygiene and Health Organization.

After the order of the Minister of Health, our discipline received an additional impetus for development. Gradually, the secrecy stamp was removed from statistical information. A lot of scientific research on the health of the population, new forms of organization of medical care began to be carried out. Textbooks and manuals on our discipline were published, which became famous abroad (textbook by G.A. Batkis and L.G. Lekarev, lectures by S.Ya. Freidlin, Yu.P. Lisitsyn, manuals by E. Belitskaya, group authors under the editorship of Yu.P. Lisitsyn and others). This was first facilitated by perestroika, begun in 1985, glasnost, the fall of the Iron Curtain, and the development of international cooperation. With the help of scientific research, ways were outlined to overcome the extensive development of health care. Transition to new economic relations caused the need for health care reform, the introduction of a medical insurance mechanism. In the 90s, first in Moscow (II MOLGMI, now RSMU, I MMI, now MMA named after I.M. Sechenov), the departments of insurance medicine, economics and healthcare management were organized, the first textbooks on these sections of our subject were published. Institute. V.A. Semashko was refocused on research in economics and healthcare management, became known as the All-Russian Research Institute of Social Hygiene, Economics and Health Management. In 1991, a new research center for our discipline was organized - NPO Sotsgigeeconominform of the Ministry of Health.

However, the beginning of the restructuring of the economy and all structures of the state and society, the collapse of the USSR had a negative impact on the provision of public health funds, and especially medical science and medical education. The “residual principle of financing” has worsened, the number of publications, scientific studies and research institutes has decreased, scientific prestige and scientific research have been damaged.

The potential of many institutions, including medical ones, weakened ties with scientists from the former Soviet republics, and the activities of scientific societies were undermined.

Our discipline (like others) is going through a difficult period in its history. In difficult material conditions, attempts are being made to preserve the scientific and personnel potential, continue Scientific research and teaching the subject, to maintain its information base. In 1999, as noted, it was decided to rename our discipline "public health and health" in accordance with its two main components and taking into account its purpose and history of development.

AT last years, especially after the message of the President of the Russian Federation, who drew attention to the demographic crisis in Russia, which threatens socio-economic development and national security countries, measures are being taken to implement national projects, including the health improvement project. On May 10, 2006, the President of the Russian Federation noted the need to solve three tasks: “The first is to reduce mortality. The second is an effective demographic policy. And the third is to increase the birth rate.” Additional funds were allocated for the implementation of the national project. They will increase the availability of medical care and its quality, improve the working conditions of healthcare workers, and raise the prestige of the medical profession.

1. Public health as a science and subject of teaching

1.1 Basic concepts and social conditioning of public health

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

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

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

For the planned development of the economy of any country, information about the size, age and sex structure of the population, and determining its forecasts for the future is of great importance. Public health reveals the patterns of population development, examines demographic processes, predicts the future, and develops recommendations for state regulation of the population.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Secondly, high requirements are imposed on integral indicators and indices of public health. WHO believes that these indicators should have the following qualities:

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

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

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

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

5. Computability. The indicator should be calculated in the simplest possible way, the calculation should not be expensive.

6. Acceptability (interpretability). The indicator must be acceptable, and there must be acceptable methods for calculating the indicator and its interpretation.

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

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

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

10. Validity. An indicator must be a true expression of the factors it measures. Some form of independent and external proof of this fact must be created.

11. Representativeness. The indicator should be representative when reflecting changes in the health of certain age-sex and other population groups identified for management purposes.

12. Hierarchy. The indicator should be constructed according to a single principle for different hierarchical levels allocated in the studied population for the considered diseases, their stages and consequences. There should be the possibility of its unified convolution and development by constituent components.

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

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

1. Demographic indicators.

2. Morbidity.

3. Disability.

4. Physical development.

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

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

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

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

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

The GBD calculation makes it possible to assess the significance of various diseases, justify health care priorities, and compare the effectiveness of medical interventions in terms of spending per year of life without diseases.

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

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

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

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

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

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

2. Availability of primary medical and social assistance.

3. Coverage of the population with medical care.

4. The level of immunization of the population.

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

6. Nutritional status of children.

7. Child mortality rate.

8. Average life expectancy.

9. Hygienic literacy of the population.

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

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

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

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

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

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

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

1.2 History of public health development

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1.3 Public health subject

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3) the physical development of the population.

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

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

1.4 Public health practices

Public health, like other scientific disciplines, has its own research methods.

1) Statistical method as the main method of the social sciences is widely used in the field of public health. It allows you to establish and objectively assess the ongoing changes in the state of health of the population and determine the effectiveness of the activities of health authorities and institutions. In addition, it is widely used in medical research (hygienic, physiological, biochemical, clinical, etc.).

Method of expert assessments serves as an addition to the statistical one, the main task of which is to determine indirectly certain correction factors.

Public health uses quantitative measures, applying statistics and epidemiological methods. This makes it possible to make predictions based on previously formulated regularities, for example, it is quite possible to predict future birth rates, population size, mortality, deaths from cancer, etc.

2). historical method is based on the study and analysis of the processes of public health and healthcare at various stages of human history. The historical method is a descriptive, descriptive method.

3). Method of economic research makes it possible to establish the impact of the economy on health care and, conversely, health care on the economy of society. The health care economy is an integral part of the country's economy. Healthcare in any country has a certain material and technical base, which includes hospitals, polyclinics, dispensaries, institutes, clinics, etc. Sources of health care financing, questions of the most effective use of these funds are being researched and analyzed.

To study the influence of socio-economic factors on people's health, methods used in economic sciences are used. These methods find direct application in the study and development of such health issues as accounting, planning, financing, health management, rational use of material resources, scientific organization labor in health authorities and institutions.

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

The experiment can be carried out not only in the natural but also in the social sciences. In public health, the experiment may not be used often because of the administrative and legislative difficulties associated with it.

In the field of healthcare organization, a modeling method is being developed, which consists in creating organization models for experimental verification. In connection with the experimental method, great reliability is assigned to the experimental zones and health centers, as well as to experimental programs on individual problems. Experimental zones and centers can be called "field laboratories" for conducting scientific research in the field of health. Depending on the goals and problems for which they are created, these models vary greatly in scope and organization, are temporary or permanent.

5. Method of observation and questioning. To replenish and deepen these data, special studies can be undertaken. For example, to obtain more in-depth data on the incidence of persons of certain professions, the results obtained during medical examinations of this contingent are used. To identify the nature and degree of influence of social and hygienic conditions on morbidity, mortality and physical development survey methods (interview, questionnaire method) of individuals, families or groups of people under a special program can be used.

The survey method (interview) can provide valuable information on a variety of issues: economic, social, demographic, etc.

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

The use of epidemiological methods in different areas of health care on large populations makes it possible to distinguish various components of epidemiology: clinical epidemiology, environmental epidemiology, epidemiology of noncommunicable diseases, epidemiology of infectious diseases, etc.

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

The epidemiology of noncommunicable diseases studies the causes and incidence of noncommunicable diseases in order to develop measures to prevent and reduce the prevalence of these diseases.

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

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

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

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

2. Fundamentals of medical statistics

2.1 Statistics. Subject and methods of research. medical statistics

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

Statistics:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1) reliability and accuracy of materials;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

- effective, which depend on factorial.

Distinguish two types of statistics:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Drawing up a plan and monitoring program:

– determination of the object of observation;

– establishment of the unit of observation;

– determination of accounting features;

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

– determination of the type and method of statistical observation.

Compilation of the program of the summary of materials:

– establishment of grouping principles;

– selection of grouping features;

- determination of the necessary combinations of features;

– drawing up layouts of statistical tables.

Drawing up an organizational plan for the study:

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

- summaries and processing of materials.

Elements of statistical tables:

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

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

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

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

Types of statistical tables

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

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

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

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

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

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

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

– hospital and treated by sex,

- hospital and treated by age.

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

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

Nosological forms

Age (in years)

Total

up to 30

31 – 40

41 – 50

over 50

Pneumonia

M

AND

OP

M

AND

OP

M

AND

OP

M

AND

OP

M

AND

OP

Bronchitis

Tracheitis

Flu

SARS

Total

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

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

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

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

- compiling time series;

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

– construction of graphic images;

- measuring the relationship between phenomena (correlation);

– attraction of comparative data.

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

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

2.2 Relative values

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

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

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

- a phenomenon with the environment from which it occurs;

- constituent elements of the same phenomenon;

- independent phenomena compared with each other.

There are the following types of relative values:

– Intensive coefficients (relative frequency values).

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

– Coefficients (relative values) of the ratio.

– Coefficients (relative values) visibility.

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

Phenomenon

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

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

1.318.600 – 22.944 22.944 · 1000

1000 - X X \u003d - \u003d 17.4 ‰.

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

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

Examples of applying intensive coefficients:

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

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

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

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

Phenomenon A

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

Phenomenon B

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

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

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

211.489 – 471 471 · 10.000

10.000 - X X \u003d - \u003d 22.3

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

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

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

1.318.600 – 100% 605.300 · 100

605.300 – Х Х = – = 45.9%

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

OZZ subject:

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

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

The main methods of SG research:

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

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

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

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

5) method of expert assessments

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

7) system analysis method

8) epidemiological method

9) medical geographical

Health study levels:

a) individual

b) group

c) regional

d) public

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

Stages of health development

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

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

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

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

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

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

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

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

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

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

Article 2. Basic principles of protecting the health of citizens

The main principles of protecting the health of citizens are:

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

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

3) availability of medical and social assistance;

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

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

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

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

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

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

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

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

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

See comments to Article 1 of this Federal Law

Article 2. Basic concepts used in this Federal Law

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

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

3) medical assistance -

4) medical service -

5) medical intervention -

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

7) diagnostics -

8) treatment -

9) patient -

10) medical activity -

11) medical organization -;

12) pharmaceutical organization -

13) medical worker -

14) pharmaceutical worker -

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

16) disease -

17) state -

18) underlying disease -

19) concomitant disease -

20) the severity of the disease or condition –

21) the quality of medical care -

Article 3. Legislation in the field of health protection

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

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

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

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

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

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

Basic principles of health care in the Russian Federation:

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

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

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

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

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

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

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

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

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

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

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

Article 1. Subject of regulation of this Federal Law

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

Article 2. Legal basis for compulsory health insurance

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

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

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

Article 3. Basic concepts used in this Federal Law

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

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

2) the object of compulsory medical insurance

3) insurance risk

4) insured event

5) insurance coverage for compulsory health insurance

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

7) the insured person

8) basic program of compulsory medical insurance

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

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

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

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

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

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

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

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

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

National project "Health". Main priorities.

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

Project goals[edit | edit wiki text]

Improving the health of citizens

Increasing the availability and quality of medical care

Development of primary health care

The revival of the preventive direction in health care

Providing the population with high-tech medical care

Lecture 1

Public health and health care as a science and subject of teaching (definition, objectives, principles, methods).
The name of the discipline "Public health and healthcare" in different from the old established disciplines: therapy, surgery, hygiene, pediatrics, obstetrics and gynecology, etc. since the formation and development of the discipline has undergone changes. In the historical aspect, the following terms were used to refer to the subject: "Social hygiene", "Social hygiene and organization of health care", "Theory and organization of health care", "Medical sociology", "Sociology of medicine", "Public health", "Public health". Since 2000, the discipline has become known as "Public Health and Health".

This situation can be explained by the peculiarities of the subject itself, its structure, tasks, history, and most importantly, the place that it occupies in medicine, being an example of complexity, a combination of theory and practice of healing, prevention, social diagnostics, rehabilitation, sociology, social psychology and anthropology. , statistics, general hygiene, as well as a number of other sciences, disciplines and problems of natural science and human science.

This item must more in line with development social policy of society and the state, social programs. And here, only through hygienic approaches, although they are very important, will not solve the problem of protecting, protecting and increasing public health and healthcare. We need decisions concerning all aspects of social policy in the field of health, decisions of a strategic nature. And discipline, more than anything else, is designed to help accomplish these tasks. It is essentially a science of the strategy and tactics of health care, since, on the basis of public health research, it develops proposals of an organizational, medical and social nature aimed at raising the level of public health and the quality of medical care. We're talking about science about the strategy also because that the only goal of the healthcare strategy is to improve the level of health and medical care based on the rational use of forces, means and resources, material and other capabilities of society and the state and its healthcare system. But it is the development of proposals to achieve this goal that meets the purpose of the subject.

So, the subject, our science, discipline is studying the patterns of public health and healthcare in order to develop scientifically based proposals of a strategic and tactical nature to protect and improve the level of public health and the quality of medical and social care. The subject is not limited to just one discipline - it extends to the whole of medicine, the whole business of health care. Indeed, it is difficult today to imagine therapists, pediatricians, surgeons, psychiatrists and other physicians who would not be involved in assessing the health of their patients, organizing medical care, prevention, medical examinations, examining quality, working capacity, etc. in their work, in within their specialty, i.e. particular questions of our discipline. Our science, our subject, like others, can be divided into two sections - one focuses on solving predominantly general strategic problems of protecting and improving health, health care, the other - private, mainly tactical, specialized.

The rapid growth in the development of medical science has armed doctors with new, modern methods for diagnosing complex diseases, effective means treatment. All this simultaneously requires the development of new organizational forms conditions, and sometimes the creation of completely new, previously non-existent, medical institutions. There is a need to change the management system of medical institutions, the placement of medical personnel; there is a need to revise the regulatory framework for healthcare, to expand the autonomy of the heads of medical institutions and the rights of the doctor. As a consequence of all that has been said, conditions are being created for revising economic health problems, the introduction of intradepartmental cost accounting, economic incentives for the quality work of medical personnel, etc.

These problems determine the place and importance of science in the further improvement of domestic health care.

The unity of the theory and practice of domestic health care has found its expression in unity of theoretical and practical tasks, methodical methods of public health and organization of health care.

Thus, the question of studying the effectiveness of the impact on the health of the population of all measures taken by the state, and the role of healthcare and individual medical institutions in this, i.e. this discipline reveals the significance of the entire socio-economic life of the country and determines ways to improve the medical care of the population.

Objectives of the subject Public health and health care:

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  study of the health status of the population and the impact of social conditions on it, the development methodology and methods of studying health population;
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  theoretical substantiation of state policy in the field of healthcare, development and practical implementation of healthcare principles;
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  research and development for the practice of health care of organizational forms and methods of medical care for the population and management of health care that correspond to this policy;
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  critical analysis of theories in medicine and public health;
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  training and education of medical workers on a broad social and hygienic basis.

Public health and healthcare organization has its own methodology and research methods. Such methods are: statistical, historical, economic, experimental, chronometric and method of questioning or interviewing and others.

Statistical Method is widely used in most studies: it allows you to objectively determine the level of the health status of the population, determine the efficiency and quality of the work of medical institutions.

historical method allows the study to track the state of the studied problems at different historical stages development of the country.

economic method allows you to establish the impact of the economy on health care and health care on the economy of the state, to determine the most optimal ways to use public funds for the effective protection of public health. The issues of planning the financial activities of health authorities and medical institutions, the most rational use of funds, assessing the effectiveness of health care actions to improve the health of the population and the impact of these actions on the economy - all this is the subject of economic research in the field of health care.

experimental method includes setting up various experiments to find new, most rational forms and methods of work of medical institutions, individual health services. It should be noted that most studies predominantly use a complex methodology using most of these methods. So, if the task is to study the level and condition of outpatient care for the population and determine ways to improve it, then statistical method the morbidity of the population, the appeal to polyclinic institutions, historically its level is analyzed in different periods, its dynamics. The proposed new forms in the work of the polyclinic are analyzed by the experimental method: their economic feasibility and efficiency are checked.

The study can use timing technique actions of medical workers, the time spent by patients on receiving medical care, are often widely used observation methods , survey method (interview, questionnaire method) population or personnel.

As a subject of teaching Public health and healthcare primarily contributes to improving the quality of training of future specialists - doctors; the formation of their skills not only to be able to correctly diagnose and treat the patient, but also the ability to organize high level medical care, the ability to clearly organize their activities.

The structure of the subject so far is as follows:

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  Health history
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  Theoretical problems of public health and medicine. Conditions and way of life of the population: sanology (valeology); social and hygienic problems; general theories and concepts of medicine and public health.
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  The health status of the population and methods of studying it. Medical (sanitary) statistics.
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  Problems of social assistance. Social security and health insurance.
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  Organization of medical care to the population.
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  Economics, planning, healthcare financing.
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  Insurance medicine.
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  Health management. ACS in healthcare.
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  Health care abroad; activities of WHO and other international medical organizations.

The history of the formation of the discipline.

At the beginning of the 20th century, the young doctor Alfred Grotjan began to publish a journal on social hygiene in 1903, in 1905 he founded in Berlin Scientific Society for social hygiene and medical statistics, and in 1912 he achieved an associate professorship and in 1920 - the establishment of a department of social hygiene at the University of Berlin.

Thus began the history of the subject and science of social hygiene, which gained independence and joined a number of other medical disciplines.

Following the department of A. Grotyan, similar divisions began to be created in Germany and other countries. Their leaders are A. Fisher, S. Neumann, F. Printing, E. Resle and others, as well as their predecessors and successors involved in public health and medical statistics (W. Farr, J. Graupt, J. Pringle, A Teleski, B. Hayes and others), went beyond the existing areas: hygiene, microbiology, bacteriology, occupational medicine, other disciplines and focused on social conditions and factors that determine the health of the population, on the development of proposals and requirements for organization of state events for protection of the health of the population, primarily workers, for the implementation of social and state policy, including effective medical (sanitary) legislation, health insurance, and social security.

In English-speaking countries, the subject is called public health or health care, preventive medicine, in French-speaking countries - social medicine, medical sociology, in the USA, earlier than in other countries, it began to be referred to as the sociology of medicine or the sociology of health. In Eastern European countries, our subject was called differently, most often as in the USSR - "organization of health care", "theory and organization of health care", "social hygiene", "social hygiene and organization of health care", etc. recent times began to use the term "medical sociology", "social medicine" (Romania, Yugoslavia, etc.).

AT Russia in the development of social medicine, a major contribution was made by M. V. Lomonosov, N. I. Pirogov, S. P. Botkin, I. M. Sechenov, T. A. Zakharyin, D. S. Samoilovich, A. P. Dobroslavin, F. F. Erisman.

The formation and flourishing of social hygiene (as it was called until 1941) during the period of Soviet power is associated with the names of major figures in Soviet health care N. A. Semashko, Z. P. Solovyov. On their initiative, departments of social hygiene and healthcare organization began to be created in medical institutes. The first such department was created by N. A. Semashko in 1922 at the Medical Faculty of the First Moscow State University. In 1923, under the leadership of 3. P. Solovyov, a department was created at the II Moscow State University and under the leadership of A. F. Nikitin at the I Leningrad Medical Institute. Until 1929, such departments were organized in all medical institutes.

In 1923, the Institute of Social Hygiene of the People's Commissariat of Health of the RSFSR was organized, which became the scientific and organizational base for all departments of social hygiene and healthcare organization. Social hygienists carry out important research on the study of sanitary and demographic processes in the country (A. M. Merkov, S. A. Tomilin, P. M. Kozlov, S. A. Novoselsky, L. S. Kaminsky), develop new methods of studying the health of the population(P. A. Kuvshinnikov, G. A. Batkis and others). In the 30s, G. A. Batkis published a textbook for the departments of social hygiene, according to which students of all medical institutes studied for many years.

During the Great Patriotic War, the departments of social hygiene were renamed the departments of "health organization". All the attention of the departments in these years was focused on the issues of medical and sanitary support of the front and the organization of medical care in the rear, the prevention of outbreaks of infectious diseases. In the post-war years, the work of departments in connection with practical health care was activated. Against the background of the strengthening of the development of theoretical problems of health care, sociological and demographic research, research in the field of health care organization is expanding and deepening, aimed at developing evidence-based standards for health care planning, studying the needs of the population in various types medical care; Comprehensive studies are being widely developed to study the causes of the prevalence of various non-communicable diseases, in particular, cardiovascular pathology, malignant neoplasms, injuries, etc.

A great contribution to the development of science and teaching in these years was made by: 3. G. Frenkel, B. Ya. Smulevich, S. V. Kurashov, N. A. Vinogradov, A. F. Serenko, S. Ya. Freidlin, Yu. A. Dobrovolsky, Yu. P. Lisitsin and others.

In 1966, departments health care organizations were named departments of social hygiene and healthcare organization and in 1986 departments of social medicine and healthcare organization.

At the present stage of development of our health care, when introducing a new economic mechanism into the management of medical institutions and in the transition to health insurance, a future doctor needs to master a significant amount of theoretical knowledge and practical skills. organizational skills. Each doctor must be a good organizer of his business, be able to clearly organize the work of his subordinate medical personnel, know medical and labor legislation; master the elements of economics and management. An important role in the fulfillment of this task belongs to Public health and healthcare organization as a science and a subject of teaching in the higher medical school system.