The history of the development of science public health and health care. Public health and healthcare

The subject of science.

Items:

1. Health of the population.

2. Health care.

1. Public health

2. Healthcare

3.Risk factors

4. The image and conditions of life.

II. Natural and climatic.

IV. Psycho-emotional.

The tasks of science:

Sections of science:

Research methods used in public health and healthcare

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

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

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

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

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

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

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

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

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

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

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

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

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

dynamic rows.

When studying the dynamics of a phenomenon, one resorts to the construction of a dynamic series.

dynamic series is a series of homogeneous statistical quantities , showing the change of a phenomenon in time and located in chronological order at certain intervals. Numbers , components of the dynamic series , are called levels.

row level- the size (value) of a particular phenomenon , achieved in a certain period or at a certain point in time. Series levels can be represented as absolute , relative or average values.

Dynamic series are divided into

a) simple(consisting of absolute values) - can be:

1) momentary- consists of values characterizing the phenomenon at a certain moment (statistical information, usually recorded at the beginning or end of a month, quarter, year)

2) interval - consists of numbers characterizing the phenomenon for a certain period of time (interval) - for a week, month, quarter, year (data on the number of births , deaths per year, number of infectious diseases per month). The peculiarity of the interval series is that , that its members can be summed up (in this case, the interval is enlarged), or split up.

b) complex(consisting of relative or average values).

Time series can be subjected to transformations, the purpose of which is to identify the features of the change in the process under study, as well as to achieve visibility.

Dynamic range indicators:

a) row levels are the values of the members of the series. The value of the first member of the series is called the initial (initial) level, the value of the last member of the series is the final level, the average value of all members of the series is called the average level.

b) absolute increase (decrease)- the value of the difference between the next and previous levels; the increase is expressed by numbers with a positive sign, the decrease - with a negative sign. The value of the increase or decrease reflects the changes in the levels of the dynamic series over a certain period of time.

in) rate of growth (decrease)- shows the ratio of each subsequent level to the previous level and is usually expressed as a percentage.

G ) rate of increase (loss)- the ratio of the absolute increase or decrease of each subsequent member of the series to the level of the previous one, expressed as a percentage. The growth rate can also be calculated using the formula: Growth rate - 100%

The absolute value of one percent increase (loss)- is obtained by dividing the absolute value of the increase or decrease by the rate of increase or decrease for the same period.

For a more visual expression of the increase or decrease in the series, you can transform it by calculating the visibility indicators, showing the ratio of each member of the series to one of them, taken as one hundred percent.

Sometimes the dynamics of the phenomenon under study is presented not as a continuously changing level, but as individual spasmodic changes. In this case, to identify the main trend in the development of the phenomenon under study, they resort to to equalize the dynamic range. In this case, the following methods can be used:

a) enlargement of the interval- summation of data for a number of adjacent periods. The result is results over longer periods of time. This smooths out random fluctuations and more clearly determines the nature of the dynamics of the phenomenon.

b) group average calculation- determination of the average value of each enlarged period. To do this, it is necessary to sum the adjacent levels of adjacent periods, and then divide the sum by the number of terms. This achieves greater clarity of changes over time.

in) moving average calculation- to some extent eliminates the influence of random fluctuations on the levels of the dynamic range and more noticeably reflects the trend of the phenomenon. When it is calculated, each level of the series is replaced by the average value from the given level and two neighboring ones. Most often, three terms of the series are summed up sequentially, but more can be taken.

G) graphic method- alignment by hand or with the help of a ruler, a compass of a graphic representation of the dynamics of the phenomenon under study.

e) least squares alignment- one of the most accurate ways to equalize the dynamic series. The method aims to eliminate the influence of temporarily acting causes , random factors and identify the main trend in the dynamics of the phenomenon, caused by the influence of only long-acting factors. Alignment is carried out along the line that is most appropriate to the nature of the dynamics of the phenomenon under study, if there is a main tendency to increase or decrease the frequency of the phenomenon. This line is usually a straight line. , which most accurately characterizes the main direction of changes, but there are other dependencies (quadratic, cubic, etc.). This method makes it possible to quantify the revealed trend, estimate the average rate of its development and calculate the predicted levels for the next year.

Primary incidence- a set of new, nowhere previously taken into account and for the first time in this calendar year diseases detected and registered among the population, calculated per 100 thousand population.

General morbidity- the totality of all diseases among the population, both first detected in a given calendar year and registered in previous years, for which patients reapplied in a given year.

Accumulated incidence - the totality of all primary diseases registered over a number of years (minimum 3 years).

Pathological affection- the totality of all pathological conditions (acute and chronic, premorbid conditions) identified during one-time examinations and preventive examinations.

traumatism

Medical and social significance:

1. Injuries and poisoning occupy the 2nd place in the structure of morbidity (in children - 4), their growth is observed. 30% of all outpatients and 50% of surgical patients in hospitals are treated for injuries.

2. Injuries and poisoning occupy the 5th place in the structure of morbidity, their growth is observed (in children - 6).

3. Injuries and poisonings are one of the main causes (3rd place) in the structure of morbidity with temporary disability.

4. Injuries and poisoning occupy the 3rd-4th place in the structure of total mortality, their growth is observed. It is the leading cause of death among people of working age.

5. They occupy the 3rd-4th place in the structure of disability, their growth is observed.

6. 70% of all injuries in men and 56% in women occur at working age.

7. Injuries and poisoning are more often recorded in men, especially in working age. At the age of 55 and more often in women (estrogen protection decreases).

8. Cause significant economic costs.

Medico-social conditionality:

Natural-climatic, biological, temporal factors are important in the occurrence of injuries (more on weekends, in the city - in winter, in the countryside - in summer). Alcohol - 40% causes death from herbs, 24% traffic injuries, 14% non-productive injuries.

Most injuries are caused by not so much an increase in trauma-risk environment how low the tolerance of the population to their effects (ie, low trauma-protection of the population). Low tolerance is due to lifestyle: national food, alcohol. It also affects the subsequent healing of wounds. Low tolerance is associated with insufficient medical literacy of the population.

50) Malignant neoplasms as a social and hygienic problem.

Malignant neoplasms as a medical and social problem. The main directions of prevention. Organization cancer care.

Malignant neoplasms as a medical and social problem:

1. Cancer is more common in older people.

2. Oncology is a hot spot in medicine.

3. In the structure of total mortality, oncology is 14%.

4. Medical and social significance: patients are long-term disabled, in a later period - disabled.

5. Every year, for every 10,000 employees, 78 people become disabled. In total mortality - 3rd place.

6. Late diagnosis, because Initially, malignant neoplasms are asymptomatic.

7. High costs for the diagnosis and treatment of oncology.

Organization of oncological care in the Republic of Belarus: the district doctor, if oncology is suspected, sends for a consultation to the surgeon. The surgeon sends the patient to an oncological dispensary (in Belarus - 11). There is also an institute of oncology and medical radiology, a children's onco-hematological center.

The main directions of prevention- as in BSC.

Health Economics.

Health economics- a branch of the science of economics that studies the place of healthcare in the national economy, developing methods rational use resources to ensure the protection of public health.

The Purpose of Health Economics- meeting the needs of the population in medical care.

Health economics subject- development of methods for the rational use of resources to achieve goals in protecting public health.

Health economics studies conditions and factors that ensure the maximum satisfaction of the needs of the population in goods and services necessary to maintain, strengthen, restore health, at minimal cost. Economists study the impact of public health on the economic development of the country, regions, production, etc., as well as the economic effect of medical and preventive care, prevention, diagnosis, treatment, rehabilitation, elimination of diseases, reducing disability and mortality, new methods, technologies, organizational events, programs, etc.

Health economics methods:

1) Analysis and synthesis. In the process of analysis, thinking goes from the general to the particular, i.e. the phenomenon under study is divided into its component parts and sides. Synthesis implies the integration of particular concepts, properties into the general in order to identify the most significant patterns.

2) Mathematical and statistical techniques and research tools - help to reveal the quantitative relationship of economic variables. Revealing the quantitative changes in processes, health economics explores the transition of quantity into a new quality. Mathematical and statistical analysis reveals real relations only when it is closely connected with the qualitative content of the analyzed subject.

3) The balance method is a set of methods of economic calculations. They are used to ensure a strictly defined quantitative relationship between any components, for example, between needs and the possibilities of satisfying them, between the revenue and expenditure parts of the budget, etc. The method of economic balances is based on the principle of equality of the values of resources and the possibilities of their use, taking into account the creation of reserves. The latter is very important, because Without reserves, in conditions of a sharp shortage of resources, one or another functional block of the health care system may fail, which is fraught with serious medical and social consequences.

4) Forecasting - represents the scientific prediction of the most likely changes in the state of the healthcare industry, the society's need for medical services, the production capabilities of medicine, the directions of technological progress in the industry, etc.

5) Household experiments - are one of the currently common methods. They are reasonable and necessary. The search for certain methods to improve the efficiency of the health care system on the example of several regions or individual medical institutions is of great practical importance.

Insurance form ZO.

Types of insurance: obligatory and voluntary medical insurance.

Sources of financing insurance medicine:

1) insurance premiums from enterprises and organizations

2) insurance premiums from citizens

3) state subsidies to insurance companies - to serve the uninsured

Public health and health care as a science and subject of teaching.

Public health and health care is a science and specific activities for the protection and promotion of public health, life extension through the mobilization of society's efforts and the implementation of appropriate organizational measures at various levels.

Public health is an area of scientific and practical activity that provides health care management as one of the largest social systems where medicine is one of the components along with economics, sociology, political sciences, and industry.

The subject of science.

Science studies the patterns of public health and healthcare.

Items:

1. Health of the population.

2. Health care.

3. Factors affecting the health of the population.

4. Medical and socially significant pathology.

1. Public health- medical-demographic and social category, reflecting the physical, psychological, social well-being of people who carry out their livelihoods within the framework of the definition of social communities.

2. Healthcare is a system of socio-economic and medical measures aimed at maintaining and improving the health of each person and the population as a whole (BME, 3rd ed.)

3.Risk factors– potentially hazardous to health factors of behavioral, biological, genetic, environmental, social character, environmental and work environment, which increase the likelihood of developing diseases, their progression and unfavorable outcome.

I. Socio-economic factors.

1. The level of productive forces and the nature of production relations.

2. Organization of medical care.

3. Health legislation.

4. The image and conditions of life.

II. Natural and climatic.

III. Biological: sex, age, constitution, heredity.

IV. Psycho-emotional.

Health formula (in%): 50 - lifestyle, 20 - heredity, 20 - environment, 10 - health activities.

4. Socially significant diseases- diseases caused mainly by socio-economic conditions, causing damage to society and requiring social protection of a person.

The tasks of science:

1. Assessment and study of the health of the population, the dynamics of its development.

2. Evaluation and study of social and other conditions affecting health.

3. Development of methods and means of promoting health, preventing diseases and disabilities, as well as their rehabilitation.

4. Theoretical justification principles of development, assessment of the quality and effectiveness of health care.

5. Solving the problems of management, financing and economics of health care.

6. Legal regulation of healthcare.

7. Formation of social and hygienic mentality and thinking of medical workers.

Sections of science:

1. Sanitary statistics (public health).

2. Examination of incapacity for work.

3. Organization of medical care (health).

4. Management, planning, financing, healthcare economics.

The subject of science.

Science studies the patterns of public health and healthcare.

Items:

1. Health of the population.

2. Health care.

3. Factors affecting the health of the population.

4. Medical and socially significant pathology.

1. Public health- medical-demographic and social category, reflecting the physical, psychological, social well-being of people who carry out their livelihoods within the framework of the definition of social communities.

2. Healthcare is a system of socio-economic and medical measures aimed at maintaining and improving the health of each person and the population as a whole (BME, 3rd ed.)

3.Risk factors– factors of a behavioral, biological, genetic, environmental, social nature, environmental and working environment that are potentially hazardous to health, increasing the likelihood of developing diseases, their progression and unfavorable outcome.

Factors:

I. Socio-economic factors.

1. The level of productive forces and the nature of production relations.

2. Organization of medical care.

3. Health legislation.

4. The image and conditions of life.

II. Natural and climatic.

III. Biological: sex, age, constitution, heredity.

IV. Psycho-emotional.

Health formula (in%): 50 - lifestyle, 20 - heredity, 20 - environment, 10 - health activities.

4. Socially significant diseases- diseases caused mainly by socio-economic conditions, causing damage to society and requiring social protection of a person.

The tasks of science:

1. Assessment and study of the health of the population, the dynamics of its development.

2. Evaluation and study of social and other conditions affecting health.

3. Development of methods and means of promoting health, preventing diseases and disabilities, as well as their rehabilitation.

4. Theoretical substantiation of the principles of development, assessment of the quality and effectiveness of health care.

5. Solving the problems of management, financing and economics of health care.

6. Legal regulation of healthcare.

7. Formation of social and hygienic mentality and thinking of medical workers.

Sections of science:

1. Sanitary statistics (public health).

2. Examination of incapacity for work.

3. Organization of medical care (health).

4. Management, planning, financing, healthcare economics.

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

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

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

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

4) Method of economic research makes it possible to establish the impact of the economy on health care and, conversely, health care on the economy of society. The health care economy is an integral part of the country's economy. Healthcare in any country has a certain material and technical base, which includes hospitals, polyclinics, dispensaries, institutes, clinics, etc. Sources of health care financing, questions of the most effective use of these funds are being researched and analyzed. Issues of planning the financial activities of health authorities and medical institutions, the most rational use of funds, assessing the effectiveness of health care actions to improve the health of the population and the impact of these actions on the economy; one of these methods is called the budget method (method of budget estimates) and is widely used in research;

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

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

1. Primitive society.

Folk medicine, folk hygiene. Collective → individual experience.

2. Antiquity.

State Medicine: government positions (architers, ediles - dignity. controllers); legislative regulation, governing bodies.

Family, priestly, private forms.

3. Middle Ages.

Municipal medicine (magistrates)

State medicine - regulation and control of activities:

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

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

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

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

1374 - (Italy) quarantine.

1426 – (Germany) Stadt physicists – city doctors.

1551 - (Moscow) Stoglavy Cathedral.

1617 - Apothecary order - state governing body.

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

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

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

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

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

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

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

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

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

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

The current state of public health and healthcare.

The formation and flourishing of social hygiene (as it was called until 1941) in the period Soviet power associated with the names of major figures in the Soviet health care N.A. Semashko and Z.P. Solovyov.

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

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

In 1923 The Institute of Social Hygiene of the People's Commissariat of Health of the RSFSR was organized, which became the scientific and organizational base for the departments of social hygiene, health and healthcare.

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

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

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

In 1941, on the eve of the Great Patriotic War, the departments of social hygiene were renamed the departments of “health organization”. All the attention of the departments in these years was focused on the issues of medical and sanitary support of the front and the organization of medical care in the rear, the prevention of outbreaks of infectious diseases.

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

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

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

and logical modeling, methods of planning and economic research.

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

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

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F KSMU 4/3-04/03

Karaganda State Medical University

Department of Social Medicine and Health Organization

LECTURE

Topic: "Public health and healthcare as a science and a subject of teaching"

Discipline "Public health and healthcare"

Specialty 5B110400 - "Medical and preventive work"

Time -1 hour

Karaganda 2014

Approved at the meeting of the department

_____ 2014 Minutes No.

Head department, candidate of medical sciences, associate professor A.K. Sultanov

Topic “Public health and healthcare as a science and subject of teaching. Methods for studying and evaluating public health”

Objective: To introduce students to the subject of public health in its historical development. Show the relevance and possibilities of public health in the system of medicine and health care not only in the Republic of Kazakhstan, but also, in foreign countries

Lecture plan

Health levels
Risk factors, groups, concept
Methodology and methods of public health and health research
Public health like medical specialty and public health science
Stages of healthcare development.

Relevance of the subject public health

As you know, most disciplines and narrow specialties in medicine study various diseases, their symptoms, various clinical manifestations of the course of diseases, their complications, methods for diagnosing and treating diseases, and probable outcomes of the disease in the case of using modern methods of complex treatment. It is extremely rare to describe the main methods of disease prevention, rehabilitation of people who have undergone a particular disease, sometimes severe, with complications, and even with sick people becoming disabled.

Even less often in the medical literature, the term "recreation" is used, i.e. a complex of preventive, therapeutic and health-improving measures aimed at maintaining the health of healthy people. People's health, its criteria, ways of preserving and strengthening in difficult socio-economic conditions have almost completely fallen out of the sphere of interests of modern medicine and health care in Kazakhstan. In this regard, before talking about public health, it is necessary to define the term "health", to identify the place of public health in this hierarchy.

2. Health levels

Methodology and methods of public health and health research So, the World Health Organization (WHO) back in 1948. stated that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. WHO has proclaimed the principle that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”. It is customary to distinguish 4 levels of health study:

Level 1 - the health of an individual.

2nd level - health of small or ethnic groups - group health.

Level 3 - health of the population, i.e. people living in a specific administrative-territorial unit (region, city, district, etc.).

Level 4 - public health - the health of society, the population of the country, continent, world, the population as a whole.

Public health and health care as an independent medical science studies the impact of social factors and environmental conditions on the health of the population in order to develop preventive services. Public health and health care is engaged in the study of a wide range of different medical aspects, sociological, economic, managerial, philosophical problems in the field of public health in a specific historical setting.

The following definition of the concept “Public health is the most important economic and social potential of the country, due to the impact various factors environment and lifestyle of the population, allowing to ensure the optimal level of quality and safety of life.

Unlike various clinical disciplines, public health studies the state of health not of individual individuals, but of collectives, social groups and society as a whole in connection with the conditions and lifestyle. At the same time, living conditions, production relations, as a rule, are decisive for the state - economic revolutions and evolutionary periods, cultural revolution bring the greatest benefits to society, but at the same time can have negative impacts on its health. Greatest discoveries modernity in the field of physics, chemistry, biology, urbanization of the population in the 20th century, the rapid development of industry in many countries, large volumes of construction, chemicalization of rural ecology, which has a detrimental effect, first of all, on the health of the population, causes certain diseases, which sometimes in their prevalence acquire an epidemiological character.

Antagonistic tensions between scientific and technological progress and the state of public health in our country arise as a result of underestimation of preventive measures by the state. Consequently, one of the tasks of our science is to reveal such contradictions and develop recommendations for the prevention of negative phenomena and factors that adversely affect the health of society.

For the planned development of the national economy, information on the size of the population and the determination of its forecasts for the future are of great importance. Public health reveals the patterns of population development by examining demographic processes, predicts the future, and develops recommendations for state regulation of the population.

Thus, public health is characterized by the simultaneous complex impact of social, behavioral, biological, geophysical and other factors. Many of these factors can be defined as risk factors. What are risk factors for diseases?

3. Risk factors, groups, concept

– factors of a behavioral, biological, genetic, environmental, social nature, environmental and industrial environment that are potentially hazardous to health, increasing the likelihood of developing diseases, their progression and adverse outcomes.

Unlike immediate causes diseases (bacteria, viruses, lack or excess of any trace elements, etc.) risk factors act indirectly, create an unfavorable background for the onset and further development of diseases.

When studying public health, the factors that determine it are usually combined into the following groups:

Socio-economic factors(working conditions, living conditions, material well-being, level and quality of food, rest, etc.).
Socio-biological factors(age, gender, predisposition to hereditary diseases, etc.).
Ecological and natural-climatic factors(environment pollution, average annual temperature, the presence of extreme natural and climatic factors, etc.).
Organizational or medical factors(security of the population with medical care, quality of medical care, availability of medical and social assistance, etc.).

Academician of the Russian Academy of Medical Sciences Yu.P. Lisitsyn gives the following grouping and levels of influence of risk factors causing health (Table 1.1.).

At the same time, the division of factors into certain groups is very conditional, since the population is exposed to the complex effect of many factors, in addition, the factors affecting health interact with each other, change in time and space, which must be taken into account when conducting complex medical social research.

The second part of the science of public health and healthcare includes the development of evidence-based, the most optimal methods of healthcare management, new forms and methods of work of various medical institutions, ways to improve the quality of medical care, substantiates optimal solutions to economic and managerial problems in healthcare.

Explosive Development Growth medical science armed doctors with new ones, modern methods diagnosis of complex diseases, effective means treatment. All this simultaneously requires the development of new organizational forms and conditions for the activities of physicians, healthcare facilities, and sometimes the creation of completely new, previously non-existent medical institutions. There is a need to change the management system of medical institutions, the placement of medical personnel; there is a need to revise the regulatory framework for health care, expand the independence of the heads of medical institutions and the rights of the doctor.

As a consequence of all that has been said, conditions are being created for reviewing options for a more optimal solution to the economic problems of healthcare, introducing elements of intradepartmental cost accounting, economic incentives for high-quality work of medical personnel, etc.

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

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

Thus, the question of studying the effectiveness of the impact on the health of the population of all activities carried out by the state and the role of health care and individual medical institutions in this, both with state and non-state forms of ownership, is of leading importance in science, i.e. the subject reveals the significance of the entire diversity of the socio-economic life of the country and determines ways to improve the medical care of the population.

4. Methodology and methods of public health and health research Public health and health care have their own methodology and research methods. Such methods are: statistical, historical, economic, experimental, timing studies, sociological methods, etc.

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

historical method allows in the study to trace the state of the problem under study at different historical stages of the country's development.

economic method makes it possible 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 of using public funds for the effective protection of public health. The issues of planning the financial activities of health authorities and medical institutions, the most rational use of funds, assessing the effectiveness of health care actions to improve the health of the population and the impact of these actions on the country's economy - all this is the subject of economic research in the field of health care.

experimental method include 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 are studied, its level in different periods, its dynamics. The experimental method analyzes the proposed new forms in the work of polyclinics: their economic feasibility and efficiency are checked.

Methods may be used in the study timing studies(chronometry of the work of medical personnel, study and analysis of the time spent by patients on receiving medical care, etc.).

Sociological methods are often used (interviewing methods, questionnaire method), which allows you to get a generalized opinion of a group of people about the object (process) of study.

The source of information is mainly the state reporting documentation of medical institutions; for a deeper study, the collection of material can be carried out on specially designed maps, questionnaires, which include all questions for obtaining necessary information according to the approved research program and tasks assigned to the researcher. For this purpose, the researcher can, using a special program, enter the necessary data into the computer from the primary registration documents.

In the vast majority of socio-hygienic studies of group health, population health and public health in previous years, it was about quantification health. True, with the help of indicators, indices and coefficients, scientific studies have always tried to assess the quality of life. The very term "quality of life" in the domestic scientific literature has been used in the last 10-15 years. This is understandable, only then can we talk about the “quality of life” of the population, when in the country (as happened long ago in the developed countries of Europe, America, Japan and some others) the main material and social benefits are available to the majority of the population.

As defined by WHO (1999), the quality of life- the optimal state and degree of perception by individuals and the population as a whole of how their needs (physical, emotional, social, etc.) are met and opportunities are provided for achieving well-being and self-realization.

In our country, the quality of life is most often understood as a category that includes a combination of life support conditions and health conditions that allow achieving physical, mental, social well-being and self-realization.

Despite the absence of the concept of "quality of health" generally accepted in the world as the most important component of "quality of life", attempts are being made to give a comprehensive assessment of public health (quantitative and qualitative).

Basic theoretical and organizational principles

Basic theoretical and organizational principles

The concept of "health care" means activities to preserve, improve, ensure and promote the health of various groups of the population. The main legislative acts enshrine the human right to the protection and promotion of health. Optimization of the healthcare system is an essential part of the socio-economic policy of the state. Health care is considered as a state system with unity of goals, interaction and continuity of services (therapeutic and preventive), universal accessibility of qualified medical care, and a real humanistic orientation.

The priority structural element of the healthcare system is the preventive activity of medical workers, the development of medical and social activity and attitudes towards healthy lifestyle life among different populations.
The main direction in the development and improvement of health care in present stage- protection of motherhood and childhood, creation of optimal socio-economic, legal and medical and social conditions for improving the health of women and children, family planning, solving medical and demographic problems.
The state nature of health care provides funding, training and improvement of personnel. The activities of bodies and institutions are carried out on the basis of state legislation and legal documents. The principle of the unity of medical science and practice is implemented in the form of joint activities and the introduction of scientific developments in healthcare institutions.
Among the most important theoretical problems health care include: social conditionality of public health, disease as a biosocial phenomenon, main categories of health care (public health, material and economic base, personnel, etc.), forms and ways of development of health care under various socio-economic conditions, etc.
The World Health Organization defines 4 categories of generalized indicators that characterize the state of healthcare in the country: 1) indicators related to health policy; 2) social and economic indicators; 3) indicators of provision with medical and social assistance; 4) indicators of the health status of the population.

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 management as a science and academic discipline- assessment of criteria for public health and quality of medical care, 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, 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.

Public health as a medical specialty and the science of public health

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: 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 XIX in. 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 system of medical care in Russia (zemstvo doctors) was created, and the beginning of the organization of sanitary affairs in St. Petersburg (1882),
In the 70s of the 20th century, hygiene was formed as an independent discipline, the first scientific hygienic schools were created (A.P. Dobroslavin, F.F. Erisman).
For the first time in Russia (together with sanitary doctors A. V. Pogozhev and E. M. 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 of 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 public health them. L. Pasteur, the system of higher medical education was rebuilt, institutes of physical culture were organized in Moscow and Leningrad.
Z. P. Solovyov - theorist and organizer of civil and military health care, deputy People's Commissar 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. 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 well-known scientists S. V. Kurashev, G. A. Batkis, S. Ya. Freidlin, E. Ya. Belitskaya and others contributed to the formation of social hygiene in these years. as: Yu. P. Lisitsyn, O. P. Shchepin, I. N. Denisov, Kucherenko, I. V. Lebedeva, V. A. Minyaev, A. M. Moskvichev, etc., in Russia, and in Kazakhstan O. Zhuzzanov. A.A. Akanov, T.I. Slazhneva and others.

AT last years priority health problems are such as the protection of motherhood and childhood, the formation of state sanitary supervision and environmental protection, medical support in the new economic mechanism, market economy and health insurance, the introduction of the principles of family medicine, improving the training of medical personnel

Illustrative material:
Slides:

Table layouts.

Literature:

1.Yu.P. Lisitsin, N.V. Polunina "Public health and healthcare" M: Medicine, 2002, pp. 353-357.

2 .Actual problems social medicine and health management. // In: Selected lectures (edited by MD Kulzhanov M.K.). - Almaty, 1994. - 175 p.

3. Yuryev V.K., Kutsenko G.I. Public health and healthcare. - St. Petersburg, Petropolis. - 2000. - 914 p.

Literature

Additional:

1. Reshetnikov A.V., Shapovalova O.A. Health as a subject of study in the sociology of medicine: tutorial. - M., 2008. - 64 p.
Medic V.A. Guide to statistics in medicine and biology. 3 volumes Medik V.A., Tokmachev M.S., Fishman B.B., Komarov Yu.M. - Publisher: M.: Medicine, 2006. - 352
Akanov A.A., Devyatko N.V., Kulzhanov M.K. Public health in Kazakhstan: concept, problems and prospects. - Almaty, - 2001-100s.

On the Kazakh language

main:

Bigaliyeva R.K., Ismailov Sh.M. Social Medicine and Health Management: Textbook (in Kazakh). - Almaty, 2001.- 371 p.

test questions

Give the concept of "health", "public health"
2. How many health levels are there?
What are risk factors?
What specific gravity lifestyle factors on health?
5. What is the share of health care factors in health?
6. Basic public health practices
What does the subject of public health study?
The main methods of studying public health?
What are the main structures of the subject?
The healthcare system in the Republic of Kazakhstan
Ways of becoming health care
The current state of healthcare in the Republic of Kazakhstan
public health sector
Non-state health sector.
State program for the development of healthcare in the Republic of Kazakhstan

Page 1

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 Health Care”, in contrast to the old established disciplines: therapy, surgery, hygiene, pediatrics, obstetrics and gynecology, etc., has undergone changes since the formation and development of the discipline. In the historical aspect, the following terms were used to refer to the subject: "Social hygiene", "Social hygiene and organization of health care", "Theory and organization of health care", "Medical sociology", "Sociology of medicine", "Public health", "Public health". Since 2000, the discipline has become known as "Public Health and Health".

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

This subject should be more in line with the development social policy 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 are talking about science, about strategy also because the only goal of the healthcare strategy is to improve the level of health and medical care based on the rational use of forces, means and resources, material and other capabilities of society and the state and its healthcare system. But it is the development of proposals to achieve this goal that meets the purpose of the subject.

So, the subject, our science, discipline is studying the patterns of public health and healthcare in order to develop scientifically based proposals of a strategic and tactical nature to protect and improve the level of public health and the quality of medical 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, as part of their specialties, i.e. particular questions of our discipline. Our science, our subject, like others, can be divided into two sections - one focuses on solving predominantly general strategic problems of protecting and improving health, health care, the other - private, mainly tactical, specialized.

The rapid growth in the development of medical science has armed physicians with new, modern methods of diagnosing complex diseases and effective means of treatment. All this simultaneously requires the development of new organizational forms, conditions, and sometimes the creation of completely new, previously non-existent, medical institutions. There is a need to change the management system of medical institutions, the placement of medical personnel; there is a need to revise 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 the economic problems of healthcare, the introduction of intradepartmental cost accounting, economic incentives for the quality work of medical personnel, etc.

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

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

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

Objectives of the subject Public health and health care:

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

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 in the study to trace the state of the problem under study at different historical stages of the country's development.

economic method allows you to establish the impact of the economy on health care and health care on the economy of the state, to determine the most optimal ways to use public funds for the effective protection of public health. The issues of planning the financial activities of health authorities and medical institutions, the most rational use of funds, assessing the effectiveness of health care actions to improve the 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 the statistical method studies the incidence of the population, the appeal to polyclinic institutions, historically analyzes its level in different periods, its dynamics. The proposed new forms in the work of the polyclinic are analyzed by the experimental method: their economic feasibility and efficiency are checked.

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

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

The structure of the subject so far is as follows:

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

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 a scientific society for social hygiene and medical statistics in Berlin, and in 1912 he achieved an associate professorship and in 1920 - the establishment of the department social hygiene 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, 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 organization of state measures to protect the health of the population, primarily workers, to implement social, state policy, including effective medical (sanitary) legislation, health insurance, social security.

AT English speaking countries the subject is called public health or health care, preventive medicine, in the French-speaking - 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.).

In Russia, a major contribution to the development of social medicine was made by M. V. Lomonosov, N. I. Pirogov, S. P. Botkin, I. M. Sechenov, T. A. Zakharyin, D. S. Samoylovich, 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 are conducting 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), new methods are being developed studying the health of the population (P. A. Kuvshinnikov, G. A. Batkis, etc.). In the 1930s, 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 intensification of the development of theoretical problems of health care, sociological and demographic research, research in the field of health care organization is expanding and deepening, aimed at developing evidence-based standards for health planning, studying the needs of the population in various types of medical care; Comprehensive studies are being widely developed to study the causes of the prevalence of various non-communicable diseases, in particular, cardiovascular pathology, malignant neoplasms, injuries, etc.

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

In 1966, the Departments of Health Organization became known as the Departments of Social Hygiene and Health Organization, and in 1986, the Departments of Social Medicine and Health Organization.

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

STATE BUDGET EDUCATIONAL INSTITUTION

HIGHER PROFESSIONAL EDUCATION

“KRASNOYARSK STATE MEDICAL UNIVERSITY named after Professor V.F. Voyno-Yasenetsky"

MINISTRIES OF HEALTH OF THE RUSSIAN FEDERATION

College of Pharmacy

Specialty 060501 Nursing

Qualification Nurse

TO THEORETICAL LESSONS

In the discipline "Public health and healthcare"

Agreed at the CMC meeting

Protocol number …………….

"___" ____________ 2015

Chairman of the CMC Nursing

………………Cheremisina A.A.

Compiled by:

………… Korman Ya.V.

Krasnoyarsk 2015

Lecture 1

Topic. 1.1. Public health and health care as a scientific discipline

Lecture plan:

1. Public health and healthcare as a scientific discipline about the patterns of public health, the impact of social conditions and environmental factors, lifestyle on health, ways to protect and improve it.

2. Problems of social policy in the country. Fundamentals of domestic health policy. The legislative framework industries. Health problems in the most important socio-political, state documents (Constitution of the Russian Federation, Legislative acts, decisions, resolutions, etc.).

3. Health care as a system of measures to preserve, strengthen and restore the health of the population. The main directions of health care reform.

Information block:

Public health and health care as a scientific discipline about the laws of public health, the impact of social conditions and environmental factors, lifestyle on health, ways to protect and improve it. Correlation between social and biological in medicine. Basic theoretical concepts of medicine and health care.

The role of the discipline "Public Health and Health Care" in the practice of a dentist, health authorities and institutions, in planning, management, and organization of work in health care. The main methods of studying the discipline: statistical, historical, experimental, sociological, economic and mathematical, modeling, method of expert assessments, epidemiological, etc.

The emergence and development of social hygiene and the organization of health care (public medicine) in foreign countries and in Russia.

Problems of social policy in the country. Fundamentals of domestic health policy. Legislative base of the industry. Health problems in the most important socio-political, state documents (Constitution of the Russian Federation, Legislative acts, decisions, resolutions, etc.). Health care as a system of measures to preserve, strengthen and restore the health of the population. The main directions of health care reform.

Theoretical aspects medical ethics and medical deontology. Ethical and deontological traditions of Russian medicine. Bioethics in the work of a dentist: the procedure for applying new methods of prevention, diagnosis and treatment, conducting biomedical research, etc.

Health as an object of health service.

Health levels:

1. The health of an individual is individual.

2. The health of groups of people is collective.

Health of small groups (social, ethnic, professional affiliation).

Health of the population by belonging to an administrative-territorial unit (population of a city, village, district).

Public health - the health of society, the population as a whole (state, global scale).

1. Definition of the concept - the health of the individual.

The constitution of the World Health Organization (WHO) includes the definition of health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

For practical use, we will use the definition of health as a human condition that has physical, psychological and social parameters, each of which can be represented as a continuum with positive and negative poles.

The positive pole (good health) is characterized by the ability to withstand adverse factors, and the negative pole (poor health) is characterized by morbidity and mortality.

Individual health is assessed by subjective (well-being, self-esteem) and objective (deviation from the norm, severe heredity, genetic risk, reserve capacity, physical and mental condition) criteria.

In a comprehensive assessment of individual health, the population is divided into health groups:

group 1 - healthy individuals (who have not been ill for a year or rarely go to the doctor without losing their ability to work);

group 2 - practically healthy individuals with functional and some morphological changes or rarely sick during the year (isolated cases of acute diseases);

group 3 - patients with frequent acute diseases (more than 4 cases and 40 days of disability per year);

group 4 - patients with long-term chronic diseases (compensated condition);

Group 5 - patients with exacerbation of long-term diseases (subcompensated condition).

2. Definition of the concept - public health.

Definitions given by the Ministry of Health of the Russian Federation:

Public health is a medical and social resource and the potential of society that contributes to ensuring national security.

Public health is a medical, demographic and social category that reflects the physical, mental, social well-being of people who carry out their life activities within certain social communities.

The basis for assessing the state of public health is accounting and analysis of:

The number of cases of diseases, injuries and poisonings detected for the first time or exacerbated cases of chronic pathology;

The number of disabled people for the first time established and all registered;

Number of deaths;

Data of physical development.

3. Factors that determine the health of the population.

Risk factors are behavioral, biological, genetic, environmental, social, environmental and occupational factors that are potentially hazardous to health and increase the likelihood of developing diseases, their progression and poor outcome.

Unlike the immediate causes of the onset and development of diseases, risk factors create an unfavorable background, i.e. contribute to the onset and development of the disease. However, it should be noted that these categories are closely related to each other.

Yu.P. Lisitsin (1989) determined that the influence of factors determining health correlates in the following proportion:

Lifestyle accounts for 50-55%;

On internal hereditary biological factors (predisposition to hereditary diseases) - 18-22%;

On environmental factors (pollution of air, water, soil with carcinogenic and other harmful substances, a sharp change in atmospheric phenomena, radiation, geographical location) - 17-20%;

The level of development of the MA (providing the population with medicines, the quality and timeliness of medical care, the development logistical bases, carrying out preventive measures) - 8-12 percent.

3.1. Lifestyle is the main factor that determines health.

The way of life is qualified as a system of the most essential, typical characteristics of the mode of activity or activity of people, in the unity of its quantitative and qualitative aspects, which are a reflection of the level of development of the productive forces and production relations.

Lifestyle summarizes and includes four categories: economic - "standard of living", sociological - "quality of life", socio-psychological - "lifestyle" and socio-economic - "way of life".

1. The way of life is the conditions in which people live (social and cultural life, life, work).

2. Lifestyle - individual characteristics of behavior, manifestations of life, activity, image and style of thinking.

3. Standard of living - characterizes the size and structure of a person's material needs (quantitative category).

4. The quality of life (QOL) concept is multidimensional in its basis, multifactorial and in a broad sense is defined as the degree of the possibility of realizing the material and spiritual needs of a person.
According to the definition of the Ministry of Health of the Russian Federation, the quality of life is a category that includes a combination of life support conditions and health conditions that allow achieving physical, mental and social well-being and self-realization.
Definition by WHO (1999): Quality of life is the optimal state and degree of perception by individuals and the population as a whole of how their needs (physical, emotional, social, etc.) are met and opportunities for well-being and self-fulfillment are provided.

Karaganda State Medical University

Time -1 hour

Approved at the meeting of the department

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Objectives of the subject Public health and health care:

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