home Mortgage The study of the health status of the population. Methodical principles of studying the state of health of the population. Section III self-test questions

The study of the health status of the population. Methodical principles of studying the state of health of the population. Section III self-test questions

Basic research methods of public health and health care.

Public health and health care have their own methodology and research methods. Such methods are: statistical, historical, economic, experimental, timing research, sociological methods 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. Issues of planning the financial activities of health authorities and medical institutions, the most rational spending Money, 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 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 experimental method analyzes the proposed new forms in the work of polyclinics: their economic feasibility and efficiency are checked.

The study can use the methods of chronometric studies (chronometry of the work of medical workers, study and analysis of the time spent by patients on receiving medical care, etc.).

Often, sociological methods (interviewing method, questionnaire method) are widely used, which makes it possible to obtain a generalized opinion of a group of people about the object (process) of study.

The source of information is mainly the state reporting documentation of medical institutions, or for a deeper study, the collection of material can be carried out on specially designed maps, questionnaires, which include all questions to obtain the necessary information, according to the approved research program and tasks that placed before the researcher.

In the vast majority of socio-hygienic studies of group health, population health and public health in previous years, it was about the quantitative assessment of health. True, with the help of indicators, indices and coefficients, scientific studies have always tried to assess the quality of health, i.e. tried to characterize health as a parameter of the quality of life. The very term "quality of life" in the domestic scientific literature began to be used recently, only in the last 10-15 years. This is understandable, because only then can one speak of the "quality of life" of the population when in a country (as happened long ago in the developed countries of Europe, America, Japan and some other developed countries) the basic material and social benefits are available to the majority of the population.

According to 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 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).

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 a high level of medical care, the ability to clearly organize their activities.

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abstract

Modern methods for assessing the health of the population and their use for planning preventive measures

Introduction

AT contemporary literature There are more than a hundred definitions and approaches to the concept of "health". The approaches available in the literature to the definition of the concept of "health" often come down to the following formulations:

1) health is the absence of disease;

2) health and norm are identical concepts;

3) health as a unity of morphological, psycho-emotional and socio-economic components.

Common to these approaches is that health is understood as something opposite, different from illness, that is, the concept of "health" is still defined through the concept of "unhealthy" and depends on the prevalence of certain diseases, developmental defects, accidents, and the level of mortality. . Thus, until now, medicine and its theory remain at the mercy of pathology. There are very few such indices, indicators that would reflect the quality and quantity of proper health - personal and public.

When analyzing and assessing the risk to public health, it is necessary to use indicators that, on the one hand, would make it possible to quantify the state of health, and, on the other hand, confirm that changes in the state of health are reliably associated with the impact of a certain harmful factor.

The health of the population can be assessed at the individual and population level.

To assess individual health, indicators are used that take into account the level and degree of harmony of physical and mental development, reactivity and resistance to diseases, assessment of age-related changes, the presence of chronic diseases, indicators of disability due to diseases or injuries, etc.

To assess the state of health at the population level or for individual population groups, indicators are used that are based on data on morbidity and mortality, on health groups, on the time of maintaining health during a certain age period. Based on these indicators, the average life expectancy is calculated.

1. Mainpublic health and health research methods

public health population

Public health and health care have their own methodology and research methods. Such methods are: statistical, historical, economic, experimental, timing research, sociological methods and others.

2 . Statistic method

It 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.

It is customary to study public health statistics at three levels:

* the first level (group) - the health of small social or ethnic groups;

* the second level (regional) - the health of the population of individual administrative territories;

* the third level (population) - the health of the population as a whole.

The study of public health is carried out by medical statistics - one of the sections of biostatistics that studies the main patterns and trends in the health of the population, health care using the methods of mathematical statistics.

To assess public health, it is customary to use the following groups of indicators (indicators):

* indicators of medical and demographic processes;

* morbidity rates of the population;

* indicators of disability of the population;

* indicators of physical health of the population;

* indicators of social conditionality of public health;

* integral indicators of public health.

The analysis of these indicators in dynamics, their comparison with similar indicators of other countries serve as the basis for developing managerial decisions to optimize the performance of the healthcare system, maintain and improve the health of citizens.

In the work of a practical doctor, a doctor in a polyclinic, and especially a healthcare organizer, one often has to deal with the calculation of various indicators characterizing the health of the population, morbidity, fertility, mortality, various indicators of the work of medical personnel, etc.

Given that we have to deal with large numbers, it becomes clear the need to optimize the work of medical workers involved in these calculations (see Yu.I. Ivanov, O.N. Pogorelyuk Statistical processing of the results of biomedical research, M .: Medicine , 1990).

Interest Calculation

Most often, the doctor has to calculate the percentage of a particular phenomenon from the total population. Calculations are carried out according to the formula:

where K- required indicator a- the number of cases to be expressed as a percentage; b- the total number of cases taken as 100%.

ppm calculations

In the practice of a doctor - the organizer of health care, it is often necessary to calculate the number of certain signs from their total set in terms of 1000. Such indicators are expressed in ppm. The general formula for their calculations:

where K- calculated indicator; a- the number of phenomena occurring in a given environment; b- the total number of the environment.

Calculation of the coefficients of distribution of individual diseases or classes of diseases among the entire population or its individual groups

This figure is usually calculated per 10,000 population. Therefore, the calculation is carried out according to the formula:

where K- the desired indicator; a- number of cases; b- the average population.

Calculation of the annual mortality rate, taking into account the cause of death

This indicator is usually calculated per 100,000 population using the formula:

where K- annual mortality rate; a- the number of deaths from a given cause among the population of a given territory; b is the average annual population in the area.

The same formula is used to calculate the prevalence rate of rare diseases.

Calculation of the infant mortality rate

In cases of large differences in the birth rate in two adjacent years, the calculation of the infant mortality rate is carried out according to the formula:

where K- Child mortality rate; a- the number of deaths of children under the age of 1 year in a given year; b- the number of births in a given year; c- the number of births in the previous year.

However, the above formula is used very often, but it is not entirely accurate, since out of those who died this year, not necessarily 1/3 was born last year. Therefore, to take into account the exact ratio, it is more correct to use another formula, after simplification, which has the form:

where a- died children under the age of 1 year this year; b- of which were born in the last year; c- of which were born this year; d- total number of children born in the last year; e- total number of children born this year.

Calculation of the percentage of mortality in children in the first month of life in relation to all infant mortality

To find this indicator, the infant mortality rate is first calculated, then the mortality of children in the first month of life is calculated. Knowing the indicators, it is possible to calculate the percentage of infant mortality in the first month of life in relation to all infant mortality. After combining all these formulas, it turns out that the percentage of infant mortality in the first month of life in relation to all infant mortality can be found by the formula:

where K- the percentage of infant mortality in the first month of life in relation to all infant mortality; a- the number of deceased children under the age of 1 month; b- the number of births this year; c- the number of births in the previous year; d- the number of deaths of children under the age of 1 year.

Calculation of the perinatal mortality rate

The perinatal mortality rate is calculated by the formula:

where K- perinatal mortality rate; a- the number of stillborns; b- the number of deaths in the first week of life; c- the total number of births (alive and dead).

Calculation of postneonatal mortality rates

Under postneonatal mortality understand the mortality of children over the age of 1 month to 1 year and calculate it by the formula:

where K- the desired indicator; a- the number of children who died at the age of 28 days to 1 year; b- the number of children born; c- the number of deaths in the first 28 days of life.

Calculation of the mortality rate for children older than 1 year

This indicator is usually calculated by the formula:

where K- the desired indicator; a- the total number of deaths; b- the number of deaths under the age of 1 year; c- total population; d is the total number of births.

Calculation of the average annual load for 1hwork of the local pediatrician

where K- indicator of annual load for 1 hour; a- total number of visits to local pediatricians; b- number of local pediatricians; c- number of working days per year; d- Number of hours worked per day.

Calculation of the total percentage of errors in determining the due date

The frequency of errors in determining the timing of childbirth, the timeliness of the provision of prenatal leave is determined by the formula:

where K- the percentage of errors in determining the term of childbirth; a- the number of women who gave birth 15 days or more earlier than the period established by the consultation; b- the number of women who gave birth later than the established date by 15 days or more; c- the number of women who gave birth and had prenatal leave.

Calculation of the rate of termination of pregnancy by childbirth

This indicator is calculated by the formula:

where K- the studied indicator; a- the number of women whose pregnancy ended in childbirth; b- the number of women whose pregnancy ended in abortion.

Calculation of the rate of complications in childbirth

This indicator is calculated by the formula:

where K- indicator of the frequency of complications in childbirth in percent; a- number of puerperas who had complications in childbirth; b- the number of delivered births; c- the number of admitted women who gave birth outside the maternity ward.

Calculation of the needs of the population in outpatient care

where K- need for polyclinic care (number of visits to a doctor per 1000 population); a- morbidity (contact rate per 1000 population); b- the coefficient of repetition of visits for medical purposes per one disease in this specialty; c- the number of dispensary visits due to morbidity; d- number of preventive maintenance visits.

Calculation of the population's need for inpatient care

This indicator in general and for individual specialties is calculated by the formula:

where K- the required number of average annual beds per 1000 population; a- the level of negotiability per 1000 population; b- the percentage of hospitalization or the percentage of selection for a bed from among those who applied; c- the average duration of the patient's stay in bed; d- average annual bed occupancy.

Calculation of the coefficient of natural increase of the population

This indicator is calculated by the formula:

where K- coefficient of natural increase of the population; a- the number of births; b- the number of deaths; c is the average annual population.

3 . Istoric method

Allows in the study to trace the state of the problem under study at different historical stages of the country's development. It is necessary to know the past in order to understand the present and foresee the future. In accordance with past experience, measures are being developed to prevent the rise in the incidence or prevent it.

4 . Ekonomic 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 country's economy - all this is the subject of economic research in the field of health care.

5 . Memethod of expert assessments

It is used to study the quality and effectiveness of medical care, its planning, etc. The assessment of the quality level of medical services is carried out by producers and consumers. Manufacturers can focus on the best domestic and world analogues, the requirements of international and national standards. Raising the level of the CMP means the embodiment in it of new and previously unrealized achievements of medical science and practice.

Each new technology embodies the currently available medical and scientific and technical knowledge. Of course, medical and scientific and technical knowledge is not always amenable to direct quantitative measurement. Therefore, new technologies of medical care have a relative assessment based on comparison with the reference (standard). In other words, the technical level of manufacturing a heart valve prosthesis is revealed by comparing the evaluated product with the best, in terms of technical capabilities, the world level. From this point of view, it is necessary to distinguish between the technical and technical and economic levels of the product of the medical industry.

6 . Memethod of sociological research

Allows you to identify the attitude of the population to their health, the impact of working and living conditions on the health of the population, etc.

Modern methods of sociological research make it possible to study the processes of formation of public opinion about medical and social phenomena and thereby obtain information not only in the form of subjective assessments of the measures being taken, but also in the form of objective medical and sociological indicators of the functioning of the municipal health care system. To improve the quality of medical care, satisfaction of the population with the work of the entire system of urban healthcare, harmonization of interaction between the subjects of the system of compulsory health insurance it is necessary to obtain the opinions of representatives of these subjects. Therefore, the problem of public assessment of ongoing activities in the urban healthcare system on the basis of ongoing monitoring of public opinion becomes relevant. The study of public opinion in the healthcare of a large industrial city as a system of logically consistent methodological and organizational and technological procedures requires highly professional work of specialists. Therefore, the primary task of the organizers of such studies is the creation of research structures, which will necessarily include healthcare organizers and sociologists of medicine. This will improve the efficiency and predict the development of the territorial health care system, obtain the necessary data for making managerial decisions, as well as have professional knowledge about the capabilities of the system of medical and sociological research and monitoring and about further experience in their application.

7. Ekexperimental method

It includes setting up various experiments to find new, most rational forms and methods of work of medical institutions, individual health services.

The study can use the methods of chronometric research (chronometry of the work of medical workers, the study and analysis of the time spent by patients on receiving medical care, etc.).

This method can be shared with others, for example:

1. Mesystem analysis method- a scientific method of cognition, which is a sequence of actions to establish structural relationships between the variables or constant elements of the system under study. It is based on a set of general scientific, experimental, natural science, statistical, and mathematical methods.

2. Epideological method- a specific set of techniques and methods designed to study the causes of the occurrence and spread of any pathological conditions in a population of people (includes observation, examination, historical and geographical description, comparison, experiment, statistical and logical analysis).

3. Medico-geographical method- a method of medical geography, which consists in collecting, systematizing and summarizing information about the natural, economic, geographical and health conditions of a particular territory and the impact of these conditions on the health of the population.

Effective forms of recreational work are unified comprehensive plans. They (for individual facilities or for the administrative territory) are aimed at carrying out complex measures by forces not only of medical workers (medical and hygienic profile), but also specialists of technical, administrative, trade union, financial, legal and other departments and departments.

Based on an analysis of the medical-demographic, epidemic and environmental situation, an assessment of the sanitary condition and health of various groups of the population and the level of technical support, measures are planned with indication of deadlines and responsible persons.

The compilation of comprehensive plans is organized by specialist doctors (the head of the health committee and the chief state sanitary doctor of the territory), approved by their heads of the territory administration. After approval, the plan takes the form of a document binding on all performers. At individual production facilities, comprehensive plans are drawn up by the chief doctors of the medical and sanitary units, shop therapists, and sanitary doctors for occupational health. They are approved by the director of the facility.

Conclusion

Literature

1. Ayvazyan S.A. Analysis of synthetic categories of quality of life of the population of the constituent entities of the Russian Federation: their measurement, dynamics, main trends // Level of life of the population of regions of Russia. - 2002. - No. 11.

2. National welfare: tendencies and prospects / ed. N.M. Rimashevskaya, L.A. Onikov. - M.: Nauka, 1991. - 255 p. 41. Novikov G.N. Theories of international relations: tutorial. - Irkutsk: IGU Publishing House, 1996. - 298 p.

3. Shitova Yu.Yu. Socio-economic analysis in the SPSS package / Yu.Yu. Shitova, Yu.A. Shitov. - Saransk: Publishing House of the Mordovian State. unta, 2010. - 60

4. Avaliani S.L. Theoretical and methodological foundations of hygienic assessment of the real load of the impact of environmental chemical factors on the body: Abstract of the thesis. diss. MD - M., 1995.

5. Beaglehole R., Bonita R., Kjellstrom T. Fundamentals of epidemiology. - Geneva, WHO. 1994.

6. Kiselev A.V. Health risk assessment in the system of hygienic monitoring. - St. Petersburg: Medical Academy of Postgraduate Education, 2001. - 36 p.

7. Lisitsin Yu.P., Sakhno A.V. Human health is a social value. - M.: Thought, 1989. -89 p.

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Population health indicators include: medical and demographic, indicators of morbidity and spread of diseases (morbidity), disability and physical development population.

Medical and demographic, in turn, are divided into indicators of the natural movement of the population (birth rate, mortality, natural population growth, average life expectancy, marriage, fertility, etc.) and indicators of the mechanical movement of the population (population migration: emigration, immigration) .

The vital statistics - and - are calculated on the basis of the registration of each birth and death in the civil registry offices (ZAGS). Birth and death are registered on special forms "Birth Certificate", "Death Certificate", which, in turn, are drawn up on the basis of a Birth Certificate and a Medical Death Certificate.

Indicator (coefficient) of fertility- the number of births per year per 1000 people.

The average birth rate is 20-30 children per 1000 people.

The indicator (coefficient) of general mortality is the number of deaths per year per 1000 people.

The average mortality rate is 13-16 deaths per 1000 people. If mortality in old age is a consequence of the physiological process of aging, then the mortality of children, primarily under the age of one year (infant), is a pathological phenomenon. Therefore, infant mortality is an indicator of social ill-being, the ill-being of the population's health.

Mortality levels during the 1st year of life are also uneven: the highest mortality occurs in the 1st month of life, and in the 1st month - in the 1st week. Therefore, special attention is paid to the following indicators of infant mortality (per 1000 people):

The term "perinatal mortality" refers to mortality "around" childbirth. There are antenatal mortality (before childbirth), intranatal mortality (during childbirth), postnatal mortality (after childbirth), neonatal (during the 1st month of life) and early neonatal (during the 1st week of life) mortality.

Antanatal and intranatal mortality are stillbirths.

The main causes of perinatal mortality are birth trauma, congenital anomalies, asphyxia, etc. The following factors influence the level of perinatal mortality: socio-biological (age of the mother, her condition during pregnancy, a history of abortions, the number of previous births, etc.); etc.), socio-economic (working conditions of a pregnant woman, financial situation, marital status, level and quality of medical care for pregnant women and newborns).

Studies have shown that child mortality is influenced by the following groups of factors: socio-economic and the way of life determined by them, health policy, health care for women and children, specific methods of combating child mortality arising from medical and co-social causes.

The most important indicator of public health is infant mortality - mortality of children under the age of 1 year, calculated per 1000 live births in one year. It determines the majority of child mortality and affects all demographic indicators. The low infant mortality rate is 5-15 children per 1000 people. population, average - 16-30, high - 30-60 and more.

Natural population growth - the difference between the birth rate and the death rate of the population per 1000 people. population.

Currently, in Europe, there is a decrease in natural population growth due to a decrease in the birth rate.

Average life expectancy- the number of years that, on average, a given generation of births or the number of peers of a certain age will have to live, assuming that throughout their life the mortality rate will be the same as in the year of calculation. As follows from the definition, this indicator is calculated according to age-related mortality using special mortality tables and statistical calculation methods. Currently, a high indicator is considered to be 65-75 years of age or more, an average of 50-65 years and a low of 40-50 years.

Population aging indicator is the proportion of persons 60 years of age and older. A high level of aging of the population is considered if this age category is 20% of the population or more, moderate aging - 5-10%, low - 3-5%.

Indicators of the mechanical movement of the population. The mechanical movement of the population is the movement (migration) of certain groups of people from one region to another or outside the country. Unfortunately, in recent years within the homeland, due to socio-economic instability, interethnic conflicts, migration processes have taken on a spontaneous character and become more widespread.

The mechanical movement of the population has a great influence on the sanitary condition of society. Due to the movement of large masses of people, the possibility of spreading infections is created. Migrants are one of the main objects of social work.

Morbidity rates. Morbidity is of paramount importance in studying the state of health of the population. Morbidity is studied on the basis of the analysis of medical documentation of outpatient and inpatient and inpatient institutions: disability certificates; cards of patients who left the hospital; statistical coupons for registration of updated diagnoses; emergency notifications of infectious diseases; death certificates, etc. The study of morbidity also includes a quantitative (morbidity rate), qualitative (morbidity structure) and individual (multiplicity of diseases transferred per goal) assessment.

Distinguish: morbidity itself- a new disease in a given year; the prevalence of the disease (morbidity) - diseases that have reappeared in a given year and have passed from the previous year at the moment.

The incidence of the population shows the level, frequency, prevalence of all diseases taken together and each separately among the population as a whole and its individual groups by age, sex, profession, etc.

There are methods for studying morbidity according to the data of negotiability, according to medical examinations and causes of death. Morbidity rates are determined by the corresponding figure per 1000, 10,000 or 100,000 people. population. The types of morbidity are as follows: general morbidity, morbidity with temporary disability, infectious morbidity, etc.

Currently, the structure of mortality and morbidity is being transformed: if in the past the most common diseases were infectious (they were the main cause of death of the population), now non-infectious, i.e. chronically occurring diseases - cardiovascular, oncological, neuropsychiatric , endocrine, injury. This is due to the achievements of medicine in the fight against mass infectious diseases: vaccination, measures for the protection of labor and the environment (elimination of natural foci of malaria, plague, etc.), health education, etc.

Currently, among the causes of death in the first place are cardiovascular diseases, then oncological diseases and, finally, injuries. In our country, cardiovascular disease ranks first among the causes of disability.

A change in the nature of morbidity is facilitated by a rapid change in lifestyle, leading to a violation of human adaptation in the environment. A theory of diseases of civilization arose. Chronic non-epidemic diseases arise because civilization (in particular, urbanization) leads to a rapid increase in the pace of life, pulls a person out of his usual living conditions, to which he has adapted for many generations, and a person remains defenseless against the pace and rhythms of modern life. As a result, the biological rhythms of a person, his ability to adapt, cease to correspond to social rhythms, i.e. modern diseases, such as cardiovascular diseases, are considered by supporters of the theory of diseases of civilization as an expression of inability to live in the environment.

One of the most important tasks of a social work specialist is to improve medical and social adaptation, in other words, the activities of social work specialists should indirectly help reduce the incidence of chronic non-epidemic diseases.

disability indicators. Disability is a health disorder with a persistent disorder of body functions due to diseases, birth defects, and the consequences of injuries that lead to disability. Disability indicators are identified by registering the data of medical and social expertise.

Indicators of physical development. Physical development - an indicator of the growth and formation of the body - depends not only on heredity, but also on social conditions. The level of physical development of the examined is determined by anthropometric and physiometric measurements of height, body weight, chest circumference, muscle strength, fat deposits, lung capacity. Based on the data obtained, the standards of physical development are set for each age and sex group. The standards serve for an individual assessment of physical development, which is carried out at medical examinations.

The level of physical development is closely related to climatic and geographical conditions and various ethnic groups.

Why are local standards created? Mass repeated medical observations from year to year make it possible to judge changes in the level of physical development, and, consequently, changes in the health of the population.

The accelerated pace of physical development is called acceleration. Acceleration is observed already in the period of intrauterine development of the fetus. In the future, there is an acceleration in the growth rate of body weight, early puberty, early ossification of the skeleton. Acceleration leaves its mark on the development of the body in the future, on the manifestation of diseases at an older age. There is an assumption that acceleration increases the likelihood of developing cardiovascular diseases, diabetes, etc.

Examination of physical development is carried out for newborns; children of the 1st year of life monthly; children of early preschool age annually; before going to school students of the “declared” classes of the school (3rd, 6th, 8th grades).

The problem of studying the phenomenon of health is important not only for medicine, but also for humanity as a whole. So far, only one of its definitions has been given, which was proposed by WHO experts (see Chapter 1). It exists, but even this formulation is not entirely accurate in the system “man and his health - environment”. It is no coincidence that when considering this problem, it is stated that it is very difficult to define the concept of "health of the population (human)". This is true, but there are also encouraging successes.

Analyzing the currently existing definitions of health, we can conclude that in a certain sense they can be grouped according to semantic features.

In terms of definitions, first of all, the philosophical content of the concept of “health” is revealed, which was formulated by K. Marx: “Disease is a life constrained in its freedom”, implying that health in this case should be understood as the absence of disease. The second kind of definitions to some extent details the above definition. This includes the WHO wording mentioned above, which states not only the absence of disease, but also the presence of "...complete physical, mental and social well-being ...".

Both aspects of the phenomenon of health in the general philosophical, methodological terms, apparently, are fair and have the right to exist, but the question arises - how to use them in practice? After all, the conceptual apparatus in both cases does not lend itself to a quantitative assessment accessible to the doctor. And this already contradicts the very essence of hygienic science, which, as already emphasized, has the status of evidence, i.e. quantitative discipline. Therefore, with particular care,

consider another methodological approach in determining the phenomenon of health.

The essence of the third group of definitions of health is that its supporters consider this concept either as process(“health is a process ...”, or as condition("health is a state...").

Without going into details and inconsistency in the interpretation of the concepts “process” and “state” by different authors, we note that both phenomena (process, state) are amenable to both qualitative (in the most general form: progress or regression) and quantitative ( more or less) analysis. And from this point of view, this approach should be considered more acceptable. Thus, it becomes possible to apply certain qualitative and quantitative criteria in relation to the system "man (people) - environment" in specific conditions.

But in relation to a person, his health needs a clear definition: life is a “process”, and health is a “state”. Only on the basis of such an understanding of such a complex biosocial being as a person, one can further move along the path of studying human health (population) as a criterion of social and hygienic well-being. At the same time, it is necessary to keep in mind other concepts (definitions) necessary for progress in this direction.

General biological health (norm) - the interval within which the quantitative fluctuations of all physiological systems of the body do not go beyond the optimal (normal) level of self-regulation.

Population health is a conditional statistical concept that characterizes the state of demographic indicators, physical development, the frequency of premorbid, morbid indicators and disability of a certain population group.

Individual health is the state of the body in which it is able to fully perform its social and biological functions.

Population - a set of people living in a certain territory and capable of self-restoration of their numbers.

The actual population is the number of all persons who were in the given settlement at the critical moment of the census, including those temporarily residing and excluding those temporarily absent.

Permanent population - persons permanently residing in a given settlement, including those temporarily absent and excluding temporary residents.

Legal population - persons included in the lists of residents of a given territory, regardless of their permanent place of residence and stay at the time of the census.

Estimated actual population - persons present in the territory at the time of the census.

A population is a part of the population within a specific territory, identified according to the most characteristic socio-economic, environmental and other factors for its life, demographic and ethnic characteristics, lifestyle, value orientations, traditions, etc., uniting it as a single whole with the inherent her group-wide processes of formation of the level of health.

Cohort - part of the population, united by a single date of occurrence of a certain event (birth, arrival in a given region or residence in a certain zone (place), beginning of employment, marriage, military service, etc.).

Medical (morbidity and frequency of individual premorbid conditions, general and child mortality, physical development and disability);

Social well-being (demographic situation, sanitary and hygienic indicators of environmental factors, lifestyle, level of medical care, social and hygienic indicators);

Mental well-being (incidence of mental illness, frequency of neurological conditions and psychopathy, psychological microclimate).

Analyzing the criteria for assessing population health, we will once again make sure that the definition of the WHO health phenomenon cannot be applied to an individual. In addition, it is not applicable to children, young men, which is its significant drawback.

Most of these indicators are medical, reflecting not the actual level of health, but the prevalence of diseases (morbidity, disability, mortality), i.e. indicators of morbidity (“illness”). It is assumed that the higher they are, the lower the level of health of the corresponding population group, i.e. and in this case, the path to assessing health goes through "ill health", which does not apply to new approaches.

It should be noted that WHO has attempted to more subtly and in detail outline the criteria for social well-being, which include:

1. Percentage of the gross national product used for health care.

2. Availability of primary health care.

3. Coverage of the population with safe water supply.

4. Percentage of people immunized against infectious diseases that are especially common among the population of developing countries (diphtheria, whooping cough, tetanus, measles, poliomyelitis, tuberculosis).

5. The percentage of women being served by qualified personnel during pregnancy and childbirth.

6. Percentage of children born underweight (less than

7. Average life expectancy.

8. Level of literacy of the population.

It is easy to see that this, like other approaches, also gravitates more towards a "theoretical" assessment of health, far from quantitative. Therefore, in practice, the already mentioned medical indicators are most often used, reflecting morbidity, mortality, etc.

The sources of information in this case are:

1. Official reports of healthcare facilities, health authorities, social security, registry offices, state statistics authorities.

2. Specially organized registration of morbidity and mortality in health facilities - prospective studies.

3. Retrospective information for the study period.

4. Data from medical examinations.

5. Data from clinical, laboratory and other studies.

6. Results of medical and social research.

7. Results of mathematical modeling and forecasting. In general, the integral assessment of the health status of the population

is carried out in the following algorithm (Fig. 3.4).

From fig. 3.4 it can be seen that before achieving the desired result - "Indicators of the health status of the population", it is necessary to perform many intermediate evaluation actions (qualitative and quantitative analyzes, distribution into health groups, determination of health indices, etc.).

Rice. 3.4. Integral assessment of population health (Goncharuk E.I. et al., 1999)

But an even more difficult task lies ahead at the stage of linking (pairing) indicators of the health status of the population and environmental factors (Fig. 3.5).

At the same time, it is important to take into account one important circumstance: to model the relationships in the “environment-health” system and determine its quantitative characteristics (without this it is impossible to predict the situation), mathematical and statistical analysis is used, in which generalized health indices are used as “operational units”. They give an idea of the level of health of the population, integrating a number of indicators. In this regard, rather stringent requirements are applied to them, which the WHO formulated back in 1971:

Availability of data for index calculation;

Completeness of coverage of the population;

Reliability (data should not change in time and space);

Computability;

Acceptability of the method of calculation and evaluation;

Reproducibility;

Specificity;

Sensitivity (to relevant changes);

Validity (a measure of the true expression of factors);

Representativeness;

Hierarchy;

Target viability (adequate reflection of the goal of improving health).

Shown in Fig. 3.5 the algorithm for solving the problem of studying relationships in the system “human (population) - environment” shows how complex and multifaceted this task is. It can only be done by specialized scientific (research institutes) or practical bodies and institutions accredited in this field.

The end result of such studies is to determine the level (indicative level) of the health of the population. As an example, an assessment of the named levels according to certain criteria is given (Table 3.4).

Table 3.4. Approximate assessment of the level of public health

Health level	Morbidity by referrals per 1000 population	Morbidity with temporary disability per 1000 employees
primary	general
city	village	city	village	cases	days
Very low
Short
Average
High
Very tall

Note: 1 - disability per 1000 population; 2 - child (infant) mortality, %; 3 - total mortality,%.

One of the final stages of an epidemiological study of public health is a quantitative assessment of the relationship between the severity of environmental factors and the level of health.

Rice. 3.5. Identification and assessment of the relationship between environmental factors and public health

For this, they usually math modeling, i.e. using special methods, mathematical models are built that reflect the dependence of the level of public health on the studied factors. In the process of such an analysis, the degree of influence of each of the studied factors on the level of public health is established.

One of the ways to make a conclusion about the degree of influence of each factor is to use the criterion of correlation and regression analysis - determination coefficient.

The advantage of this criterion is that it characterizes the relative role of each specific environmental factor in influencing the level of health. This makes it possible to rank the factors according to the degree of their harmfulness and to develop prevention programs taking into account the priority of their action.

The epidemiological study of the state of health of the population ends with the development of preventive recommendations and their implementation in practice, followed by an assessment of the effectiveness of implementation.

From the materials discussed above, it can be seen that for research in the "environment - health of the population" system, numerous evaluation actions are required, which can only be carried out by large scientific or practical organizations or their complex. For smaller studies, more simplified approaches, such as cohort studies, can be applied.

In this case, the algorithm may be as follows - it is necessary to decide in the directions of the study of the state of health (Fig. 3.6).

Rice. 3.6. Main directions of health research

Having decided on the directions of research, they conduct a purposeful study of the indicators of the state of health presented in Fig. 3.7. The interest lies in the fact that here it is possible to use both individual and collective and even population approaches.

As for the comparison of the obtained indicators, indices, etc. with environmental factors, it is carried out in accordance with the settings discussed above.

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The concept of health, its assessment, social conditioning*

In modern literature, there are more than a hundred definitions and approaches to the concept of "health". The approaches available in the literature to the definition of the concept of "health" often come down to the following formulations:

1) health is the absence of disease;

2) health and norm are identical concepts;

3) health as a unity of morphological, psycho-emotional and socio-economic components.

At present, along with the long-standing theory of pathology, a new theory is being developed, the theory of health - sanology - valeology (Yu.P. Lisitsyn).

To assess individual health, a number of very conditional indicators are used (Yu.P. Lisitsyn, N.M. Amosov, etc.). Among the many indicators and definitions, the following can be distinguished:

Health resources are the morpho-functional 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, exercise, rest, etc.).

Health potential is a combination of an 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.).

The balance of health is a pronounced state of balance between the health potential and the factors acting on it.

Human health can be considered in various aspects: socio-biological, socio-political, economic, moral-aesthetic, psycho-physiological and others. The main prerequisites for this are that one cannot define health and illness in general, but one should speak about the health and illness of people. And this obliges us to approach a person not only as a biological, animal organism, but as a biosocial being. The health of modern man is the result of the natural evolution of the species Homo sapiens, in which social factors are gradually gaining more and more influence. Their role throughout
* A number of concepts, definitions, classifications are presented in Chapter I of the textbook in order to rationalize the subject and science of public health and healthcare in the system of medical sciences and the modern structure of the healthcare system.

period of development of civilization has increased in all respects. A person receives health, in a certain sense, as a gift of nature. However, in the process of socialization, the level of health changes either in one direction or in the other, the laws of nature manifest themselves in a special form peculiar only to man. The biological in man is always mediated by the social. The problem of the relationship between social and biological in a person is the basis for understanding the nature and nature of his health, his illnesses, which should be interpreted as biosocial categories.

The starting point for the medical and social interpretation of health is the definition adopted by the World Health Organization and presented by us in the first chapter of the textbook: "Health is a state of complete physical, spiritual and social well-being, and not just the absence of diseases and physical defects." WHO documents have repeatedly stated that people's health is a social quality. In this connection, WHO recommends the following indicators for assessing public health:

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, including children's nutrition.

7. Child mortality rate.

8. Average life expectancy.

9. Hygienic literacy of the population.

However, in medical and social studies of group health, population health and public health, it is traditionally customary to use the following indicators or groups of indicators:

1. Medical and demographic indicators.

2. Morbidity rates.

3. Indicators of disability.

4. Indicators of the physical development of the population.

When we talk about the social conditionality of health, we mean the paramount in its significance, and sometimes the decisive influence on it of social risk factors, i.e. factors, the impact of which leads to a violation of compensatory-adaptive mechanisms and thereby contributes to the development of pathology (see Chapter 1).

4.2. Demographics

The word demography comes from the Greek words demos - people and grapho - to write, depict. Thus, demography is the science of population. The range of demographic problems includes the study of the territorial distribution of the population, trends and processes occurring in the population in connection with the socio-economic conditions of life, life, traditions, environmental, medical, legal and other factors. The population (population) is understood as a set of people united by a community of residence within a particular country or part of its territory (region, territory, district, city), a group of countries, the whole world. One of the most important characteristics of the population is its state of health.

At the junction of general demography (mainly economic) and social medicine, an adjacent scientific field emerged - medical demography. Renowned scientist, specialist in the field of medical demography prof. M.S. Bedny wrote (1984) that “Medical demography is a science that studies the numerous connections of the human population (population) with social and natural factors that influence the most important qualitative aspect of reproduction - the state of health of the population and trends in its changes.”

The statistical study of the population is carried out in two main directions:

1. Population statics.

2. Population dynamics.

Population statics, that is, the size of the population at a certain (critical) point in time. The composition of the population is studied according to a number of basic features: gender, age, social groups, profession and occupation, marital status, nationality, language, cultural level, literacy, education, place of residence, geographical distribution and population density.

Population dynamics, that is, the movement and change in the population. A change in the population may occur due to its mechanical movement - under the influence of migration processes. In addition, the size of the population is changing as a result of natural movement - fertility and mortality. The natural movement of the population is characterized by a number of statistical indicators. The main indicators of the natural movement of the population are: the birth rate, mortality, natural population growth. In all countries of the world, infant mortality rates (mortality of children under 1 year of age) are separately identified and analyzed. In addition, the main indicators of natural movement are supplemented by clarifying indicators: fertility, maternal mortality, perinatal mortality, the structure of mortality by cause, etc.

4.2.1. Population statics

The main, most reliable source of information about the size of the population are the censuses regularly conducted in our country.

One of the earliest known attempts at population counting was carried out in China in 238 BC. Similar information about Palestine is repeatedly found in the Old Testament. The first census that met the scientific principles of counting the population (one-day and by name) was carried out in Belgium in 1846.

In Russia, non-economic accounting of the population was mainly carried out (by “houses”, by “yards”, by “plows”) for the purpose of rational taxation. From 1718 to 1860, ten "revisions" took place in Russia, "how many male souls in each village."

The first general census of the population of Russia was carried out in 1897.

During the 20th century, 8 general censuses took place in our country: in 1920, 1926, 1937, 1939, 1959, 1970 and 1989.

The next general population census in Russia is scheduled for 2002.

Along with a complete population count conducted during the census period, selective socio-demographic surveys are carried out, which make it possible to trace changes in the composition of the country's population in the inter-census period, to obtain the necessary data for long-term planning of economic and social development.

Sample socio-demographic surveys are conducted on a broad program and are a valuable source of information for studying the health status of the population and planning various health services.

The current estimate of the population in the years between censuses is made on the basis of the results of the last population census, to which the numbers of births and arrivals in the territory are added annually, and the numbers of deaths and departures from the territory are subtracted. At the same time, changes in the population as a result of administrative-territorial transformations are also taken into account. Current population estimates are updated based on the results of the next census.

Data on the total population are usually given according to the present population, and information characterizing the age and sex composition is given according to the resident population. In addition, the average population is calculated.

The actual population includes persons who are at the time of the census in the given territory, including temporary residents. The permanent population includes persons permanently residing in a given territory, including those temporarily absent. The average annual population is calculated as the arithmetic average of the population at the beginning and end of the corresponding year based on the results of current estimates and is used in calculating population replacement indicators.

Based on the calculation of the proportion of persons aged 0-14, 15-49, 50 years and older, the age type of the population is determined. According to the age composition, progressive, regressive and stationary types of the population are distinguished.

A progressive population is one in which the proportion of children aged 0-14 exceeds the proportion of the population aged 50 and over.

Stationary is the type in which the proportion of children is equal to the proportion of persons aged 50 years and older. The progressive type of population ensures a further increase in the population, the regressive type threatens the nation with extinction.

However, the age of 50 for most countries is the age of the working-age population, and it is hardly advisable to take it as a basis for determining the type of age composition. Therefore, many scientists propose to determine the level of demographic "old age" of the population by the proportion of people aged 60 years and older. It is believed that if there are more than 12% of people aged 60 years and older among the population, then this is a demographically old type of population.

Indicators characterizing population statics are of great importance in practical public health.

They are needed for:

Calculation of indicators of the natural movement of the population;

Planning of the entire health system;

Calculation of the need for outpatient and inpatient care, both general and specialized;

Determination of the required amount of funds allocated by the budget for health care;

Calculation of quantitative indicators characterizing the activities of health authorities and institutions;

Organization of anti-epidemic work, etc.

Not to mention the entire health care system, each outpatient clinic must have a clear idea of the size and composition of the population in the area of its operation. The size, age and sex composition of the population underlies the organization of the district service, the analysis of its activities, and in recent years - as part of the organization of general medical practice in our country.

4.2.2. Mechanical population movement

The mechanical movement of the population occurs as a result of migration processes characteristic of the entire history of mankind. The word migration comes from the Latin migratio (migro - I pass, I move). Thus, the migration of the population is the movement of people, usually associated with a change of residence. Migration is divided into: irrevocable, that is, with a permanent change of permanent place of residence; temporary - resettlement for a sufficiently long, but limited period; seasonal - movement during certain periods of the year; pendulum - regular trips to the place of work or study outside their locality. In addition, there is a distinction between external migration, that is, migration outside one's own country, and internal - movement within the country. External includes emigration - the departure of citizens from their country to another for permanent residence or a long period of time and immigration - the entry of citizens from another country into this one. Internal migration includes inter-district resettlement, as well as the resettlement of residents in the countryside to the city, as an important part of the urbanization process.

Urbanization (from the Latin urbs - city) is the process of increasing the role of cities in the development of society. The main social significance of urbanization is the special "urban relations", covering the population, its way of life, culture, distribution of productive forces, and settlement. The prerequisites for urbanization are the growth of industry in cities, the development of their cultural and political functions. Urbanization is characterized by an influx into cities rural population and the increasing pendulum movement of the population from the villages of the environment and the nearest small towns to large cities (for work, etc.).

To assess migration processes, a number of indicators are calculated. The most commonly used are: the number of arrivals per 1000 population, the number of departures per 1000 population, migration gain, migration efficiency coefficient. These indicators are calculated as follows:

Number of people who entered (departed) Number of arrivals = to the administrative territory (departed) per 1000 Average annual population Migration growth = Number of arrivals-Number of departures.

Migration growth can be calculated both in absolute and relative terms.

Coefficient = Migration gain _ efficiency Sum of arrivals and departures

The study of migration processes is important for practical healthcare authorities, namely:

The process of urbanization changes the ecological situation, requires a revision of the planned standards of medical care, changes in the network of medical institutions, changes the structure of morbidity and mortality of the population, affects the epidemic situation in the region, leads to changes in the birth rate;

Pendulum migration increases the number of contacts that contribute to the spread of infectious diseases, leads to an increase in stressful situations, injuries;

Seasonal migration leads to an uneven seasonal load on health care facilities, affects the health of the population;

The health indicators of migrants differ significantly from those of the indigenous population.

4.2.3. Vital movement of the population

Of greatest importance to medical workers are indicators of the natural movement of the population, including the birth rate.

4.2.3.1. The birth rate of the population

Fertility is the process of renewal of new generations, which is based on biological factors that affect the body's ability to reproduce offspring. Speaking about the birth rate in human society, it should be remembered that in this case it is determined not only by biological, but also by socio-economic processes, living conditions, life, traditions, religious attitudes and other factors.

To determine the intensity of the birth process, fertility rates are usually used. The total fertility rate is calculated using the formula:

Total number of live births per year ^ Average annual population

The total fertility rate does not give an exhaustive idea of the intensity of the process; it is suitable for an approximate characterization of the phenomenon.

More accurate fertility characteristics are obtained by calculating a special indicator - the fertility rate. When calculating the total fertility rate, in contrast to the birth rate, the denominator is not the total population, but the number of women aged 15-49 years.

This age interval is called the generative or fertile period of a woman.

The number of births before and after this age interval is insignificant and can be neglected. In addition, the birth rate is specified by age-specific indicators of fertility, for which the entire generative period of women is conventionally divided into separate intervals (15-19, 20-24, 30-34, 35-39, 40-44, 45-49 years). The total fertility rate is calculated using the following formula:

Total number of births per year of life 1000

Average annual number of women aged 15-49

Age-specific fertility rates are calculated using the formula: Number of live births in women of the corresponding age ^qqq Average annual number of women of the corresponding age

The birth rate is the most important, and not only demographic, but also a medical and social criterion of the viability and reproduction of the population.

According to the legislation, within a month from the date of birth, all children must be registered with the registry office at the place of birth of the children or the place of residence of the parents (Table 2.1 and Figure 4.2).
Table 2.1
Year 1940 1960 1970 1980 1990 2000
Birth rate %o 31.2 24.0 17.0 15.9 13.4 8.7

4.2.3.2. Mortality of the population To assess the social, demographic and medical well-being of a particular territory, it is necessary to take into account not only birth rates, but also mortality rates. The interaction between birth and death rates, the replacement of some generations by others ensures the continuous reproduction of the population.
Dynamics of the birth rate in Russia from 1940 to 2000
14,0
i n about 12.0
S O) 10.0
8,0
h 6.0
He<я 4,0
<я X 2,0
from 0

1990 1992 1994 1996 1998 2000

Rice. 4.2. Dynamics of the birth rate of the Russian population in the last decade of the 20th century (in %o).

The first rough estimate of mortality can be given on the basis of the total mortality rate, which is calculated as follows:

Overall ratio Total number of deaths per year

mortality Average annual population

However, the overall mortality rate is hardly suitable for any comparison, since its value largely depends on the characteristics of the age composition of the population. Thus, the increase in the general mortality rate, noted in recent years in some economically developed countries, does not so much indicate an actual increase in mortality as it reflects the growth in the proportion of elderly people in the structure of the population.

Much more accurate are the mortality rates of certain age and sex groups of the population, which are calculated as follows:

Number of persons of a given sex, Mortality of persons of a given deceased at a given age per year of age and given sex Average annual number of persons

given age and gender

Specifics in calculations and analysis are indicators of infant mortality, perinatal and maternal mortality (see below). The age structure of the population has almost no effect on the age-sex mortality rates.

Important in the struggle to reduce mortality and improve the health of the population are mortality rates from certain diseases and the structure of causes of death.

Number of deaths Mortality = from this disease per year 1000

from this disease Average annual

population

The source of information on the causes of death in Russia is the entries in the "Medical death certificates" or "Paramedic death certificates" filled out by a doctor (paramedic).

In accordance with the legislation, death is subject to registration in the state civil registry offices (ZAGS) at the place of residence of the deceased or at the place of death on the basis of the conclusion of a medical institution no later than 3 days from the moment of death or the discovery of a corpse.

To ensure the registration of mortality approved "Medical death certificate" - f. No. 106 / y-84 and "Paramedic's certificate of death" - f. No. 106-1 / y-84.

"Medical Death Certificate" is issued by all health care institutions that employ at least 2 doctors. In rural areas, where there is only one doctor in a healthcare institution, in case of his absence (vacation, illness, etc.), as well as in institutions where there is no doctor, the paramedic issues a “Paramedic death certificate”. Paramedics are prohibited from issuing a "Medical Death Certificate". Table 4.2 and Figure 4.3 show the dynamics of the mortality rate of the Russian population in the second half of the 20th century.

Dynamics of the mortality rate in Russia %0
Table 4.2
Year 1940 1970 1980 1990 2000
Mortality rate %0 17.4 8.4 11.0 11.2 15.3

4.2.3.3. Natural population growth Natural population growth is the most common measure of population growth. Natural increase can be expressed by the absolute number of deaths for a certain period of time (usually a year). In addition, the coefficient of natural population growth can be calculated as the difference between birth and death rates.
Rate of natural population growth
Number of births-number of deaths Average annual population
1000
Natural population growth itself does not always reflect the graphic situation in society, since the same growth rates can be obtained with different birth and death rates. Therefore, natural population growth must be assessed only in relation to birth and death rates.
17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 I 0
-I-

2000s
1996
1990
1992
1994
1998
Rice. 4.3. Dynamics of the mortality rate of the population of Russia from 1990 to 2000 (%o).

High natural increase can be considered as a favorable demographic phenomenon only with low mortality. High growth with high mortality characterizes the unfavorable situation with the reproduction of the population, despite the relatively high birth rate.

The low growth with high mortality also points to an unfavorable demographic situation.

A negative natural increase in all cases indicates a clear trouble in society. Such a demographic situation is usually characteristic of a period of war, economic crises, and other upheavals. Negative natural increase is commonly called unnatural population decline. Table 4.3 presents the indicators of natural increase (decrease) of the population of Russia from 1970 to 2000.
Table 4.3
years
1970 1980 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Index (%o)
+8,6 +4,9 +2,2 +0,7 -1,3 -5,1 -6,1 -5,7 -5,3 -5,2 -4,8 -6,4 -6,7

4.2.3.4. Average life expectancy One of the indicators used to assess public health is the average life expectancy, which is a more objective indicator than the general mortality rate and the rate of natural population growth.

The average life expectancy should be understood as the hypothetical number of years that a given generation of births or the number of peers of a certain age will have to live, provided that throughout their life the mortality rate in each age group will be the same as it was in that year for which calculation was made. This indicator characterizes the viability of the population as a whole, it does not depend on the characteristics of the age structure of the population and is suitable for analysis in dynamics and comparison of data for different countries. The average life expectancy indicator should not be confused with the average age of the deceased or the average age of the population.

The average life expectancy indicator is calculated on the basis of age-specific mortality rates by constructing mortality (or survival) tables, the construction methodology of which has been known since the 18th century. Tables of mortality (survival) are calculated by an indirect method and show, as it were, the order of successive extinction of a hypothetical population of persons born at the same time. The dynamics of the indicator of the average life expectancy in Russia at the end of the 20th century is presented in Table 4.4.
Dynamics of the indicator of natural increase (decrease) of the population of Russia from 1970 to 2000 (%o)

Table 4.4
Dynamics of life expectancy at birth in Russia (number of years)
Years Total Men Women
1980 67,6 61,5 73,1
1990 69,2 63,8 74,3
1995 64,6 57,6 71,2
2000 65,3 59,0 72,2

4.2.3.5. maternal mortality

Maternal mortality refers to demographic indicators that refine the crude mortality rate. Due to its low level, it does not have a noticeable impact on the demographic situation, but it fully reflects the state of the system of maternal and child health care in the region.

The World Health Organization defines maternal mortality as conditioned pregnancy, regardless of duration and location, the death of a woman during pregnancy or within 42 days after its termination from any cause associated with pregnancy, aggravated by it or its management, but not from an accident or an accidental cause."

Maternal deaths are divided into two groups:

1. Death directly related to obstetric causes, i.e. death as a result of obstetric complications of the pregnancy condition (i.e. pregnancy, childbirth and the postpartum period), as well as as a result of interventions, omissions, improper treatment or a chain of events following any of these causes.

2. Death indirectly related to obstetric causes, i.e. death as a result of a pre-existing disease or a disease that occurred during pregnancy, not due to a direct obstetric cause, but aggravated by the physiological effects of pregnancy.

This indicator allows you to evaluate all losses of pregnant women (from abortions, ectopic pregnancy, obstetric and extragenital pathology during the entire gestation period), women in labor, puerperas within 42 days after the end of pregnancy.

The indicator should be calculated at the level of the city, region, territory, republic. In the institution where the death occurred, a detailed analysis of each death should be carried out from the standpoint of its preventability.

In accordance with the International Classification of Diseases, the maternal mortality rate should be calculated per 1000 live births. However, WHO, taking into account the small number of deaths in developed countries and, accordingly, the insignificant value of the indicator when calculated per 1000 live births, in statistical terms gives calculations per 100,000 live births.

Calculation of the maternal mortality rate:

Number of dead pregnant women (since the beginning of pregnancy), women in labor, puerperas within 42 days Maternal = after termination of pregnancy _ 00000

mortality Number of live births

When assessing the dynamics of maternal mortality, one should take into account the statistical features of the indicator with a small number of births and deaths. For example, in countries with low fertility, one death can change an indicator that may not always be correctly assessed. In order to avoid errors in the analysis of the dynamics of maternal mortality in these cases, statistical methods should be used (in particular, the alignment of the dynamic series using the moving average method). This method allows, to some extent, to eliminate the influence of random fluctuations on the level of the dynamic series and helps to identify the main trend reflected by it.

Important for the analysis of maternal mortality is the analysis of its structure.

The structure of causes of maternal mortality is calculated as follows:

Proportion (share) of pregnant women, Number of women, dead women in childbirth and puerperas, who died from _ from a given cause of a given cause, in the total number Total number of women who died (in %) who died from all causes

Indicators of the structure of causes of maternal death determine the role and significance of each disease in the total set of causes, i.e. allow you to establish the place of a particular cause of death among all deceased women.

Along with determining the structure of mortality, it is very important to calculate the intensive mortality rate from individual causes.

The calculation of the frequency of death from individual causes is made as follows:

Number of women who died Maternal death- = from bleeding 10000

haemorrhage rate Number of live births

To improve the quality of maternal mortality statistics and to introduce alternative data collection methods for pregnancy-related or pregnancy-related deaths, and to improve the recording of deaths directly attributable to obstetric causes if death occurs later than 42 days after delivery, the World Health Assembly introduced additional concepts - "late maternal mortality" and "pregnancy-related death".

Late maternal mortality refers to the death of a woman from a direct obstetric cause or a cause indirectly related to it, occurring more than 42 days after birth, but less than a year after birth. Pregnancy-related death is defined as the death of a woman during pregnancy or within 42 days of childbirth, regardless of the cause of death.

Registration and recording of maternal mortality is carried out in accordance with the same rules as for general mortality. Table 4.5 presents the dynamics of maternal mortality in Russia.

Table 4.5
Years 1980 1985 1990 1995 2000
Maternal mortality rate %o 68.0 54.0 47.4 53.3 39.7

4.2.3.6. Child mortality

A correct and timely analysis of child mortality makes it possible to develop a number of specific measures to reduce the incidence and mortality of children, evaluate the effectiveness of previous measures, and to a large extent characterize the work of local health authorities in protecting motherhood and childhood.

In the statistics of child mortality, it is customary to single out a number of indicators:

1. Infant mortality (mortality of children in the first year of life), which includes:

a) early neonatal mortality (mortality in the first 168 hours of life);

b) late neonatal mortality (mortality at 2, 3, 4 weeks of life);

c) neonatal mortality (mortality in the first 4 weeks of life);

d) postneonatal mortality (mortality from 29 days of life to 1 year).

2. Mortality of children under the age of 5 years.

3. Mortality of children aged 1 to 15 years. The total, general indicator of infant mortality is the total annual. There are a number of different ways to determine it. The simplest of them is the calculation method according to the following formula:

The number of children who died during the year in the 1st year of life ^

Number of live births in a given calendar year

However, among the children who died during the year under the age of 1 year, there are those born both in the previous calendar year and in the current one, and it is theoretically incorrect to correlate the dead only with those born in the given calendar year. The application of this method is possible only if the number of births in the reporting and last year is the same.

It has been calculated that among the children who died under the age of J. in a given calendar year, approximately 1/3 was born in the previous year. Therefore, now in practical healthcare to calculate the infant mortality rate, the WHO-recommended Rats formula is used: h

The number of children who died during the year in the 1st year of life ^

2/3 of live births in this calendar year + 1/3 of live births in the previous year

The dynamics of the infant mortality rate in Russia is presented in Table 4.6.
Dynamics of maternal mortality in Russia per 100,000 live births

Table 4.6

Dynamics of the infant mortality rate in Russia (%o)
Years 1980 1985 1990 1995 2000
Infant mortality rate 22.1 20.7 17.4 18.1 15.3

The indicator of infant mortality is specified by indicators of neonatal, early neonatal, late neonatal, postneonatal mortality.

Neonatal mortality is calculated using the formula:
1000

Number of children who die in the first four weeks of life Number of live births

Postneonatal mortality is calculated as: The number of children who died between 29 days and 1 year of age

Number of live births - Number of deaths in the first four weeks of life
1000
Early neonatal mortality is calculated:

Number of children who died at age 0-6 days (168 hours) Number of live births

Late neonatal mortality is calculated: The number of children who died at 2, 3, 4 weeks of life

Number of live births
1000
In addition to infant mortality rates, it is customary in international practice to calculate the mortality rate for children under 5 years of age (CDR). This indicator is calculated using the following formula:
Under-5 mortality rate
Number of children under 5 _dyed per year__ 1000

Number of live births
The mortality rate of children under 5 years of age was chosen by UNICEF as a special, most important indicator of the situation of children in various states, as a kind of indicator of the well-being of the child population.

To assess the health status of the child population, the mortality rate of children older than one year is important:

Number of children under the age of 1 Mortality of children aged _ under 15 who died during the year from 1 to 15 years Average annual number of children

aged 1 to 15 years

Recording the mortality of children, starting from the second week of life, is based on the analysis of "Medical death certificates".
1000

4.2.3.7. Perinatal mortality Since 1963, the term "perinatal period" has been introduced into the country's health statistics and healthcare practice.

The World Health Assembly defined the perinatal period as the period that begins with the 22nd completed week (154th day) of fetal life (at this time, normal body weight is 500 g) and ends 7 completed days (168 hours) after birth.

The perinatal period includes three periods: antenatal (from the 22nd week of pregnancy to childbirth), intranatal (the period of childbirth), postnatal (the first 168 hours of life). In terms of terminology, the postpathic ^ period corresponds to the early neonatal period. Each period has its own mortality rate. The perinatal mortality rate is calculated using the formula:

Number of stillborns + Number of perinatal deaths in the first 168 hours of life Q00 mortality Number of live births and stillbirths

Antenatal mortality and intrapartum mortality add up to stillbirth. Stillbirth is calculated by the formula.

The study of the health status of the population. Methodical principles of studying the state of health of the population. Section III self-test questions

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