Medical and social problems of health and methodology of its study. Strategies of health care.

Medical and social Medical and social problems of health and problems of health and methodology of its methodology of its study. Strategies of study. Strategies of health carehealth care

There are two levels of medical There are two levels of medical service organizations in our service organizations in our

independent state:independent state:

a) Ukrainian Public Health a) Ukrainian Public Health Service; Service;

b) private doctors. b) private doctors.

The fundamental task of The fundamental task of modern system of health modern system of health

protection in Ukraineprotection in Ukraineis saving and strengthening of is saving and strengthening of

population health, improvement of population health, improvement of medicare qualities, and development of medicare qualities, and development of concrete medical and prophylactic concrete medical and prophylactic measures, forms and methods of work measures, forms and methods of work of the specialized services.of the specialized services.

WHO (World Health Organization) WHO (World Health Organization) determines healthdetermines health as as the state of the state of complete social, biological and complete social, biological and psychological prosperity, when psychological prosperity, when functions of all organs and functions of all organs and systems are balanced with an systems are balanced with an environment, absence of diseases, environment, absence of diseases, sick states or physical defectssick states or physical defects..

The most essential among The most essential among indices:indices:

demographic (birth-rate, death rate, demographic (birth-rate, death rate, average life duration);average life duration);physical development (functional and physical development (functional and biological development, biological development, harmoniousness);harmoniousness);morbidity (general, hospitalized, morbidity (general, hospitalized, infectious); disability (primary and infectious); disability (primary and constant);constant);state (immunity, resistance of the state (immunity, resistance of the systems, activity of enzymes, etc.).systems, activity of enzymes, etc.).

Risk factors are divided Risk factors are divided into 4 large groups:into 4 large groups:

1) way of live (smoking, wrong food. Abuse of 1) way of live (smoking, wrong food. Abuse of alcohol, harmful work, stresses, hypodynamia, alcohol, harmful work, stresses, hypodynamia, using of drugs, incomplete family or family with using of drugs, incomplete family or family with many children, hyperurbanization) - 51-52%;many children, hyperurbanization) - 51-52%;

2) environment (air, water, meal, radiation 2) environment (air, water, meal, radiation level, electromagnetic fields) - 20-21%;level, electromagnetic fields) - 20-21%;

3) biological factors (heredity, constitution, sex, 3) biological factors (heredity, constitution, sex, age) - 19-20%;age) - 19-20%;

4) medical factors (inoculation against 4) medical factors (inoculation against infections, medical inspections, quality of infections, medical inspections, quality of medical treatment) - 8-9%.medical treatment) - 8-9%.

Groups of healthGroups of health 1 group - healthy (0-1 case of acute respiratory 1 group - healthy (0-1 case of acute respiratory

illness per year);illness per year); 2 group - practically healthy (persons with the 2 group - practically healthy (persons with the

factors of risk; no more than 2-3 cases of acute factors of risk; no more than 2-3 cases of acute respirator illness per year);respirator illness per year);

3 group - patients with the compensated state 3 group - patients with the compensated state (persons with chronic illnesses without (persons with chronic illnesses without complications; 4 and more cases of acute complications; 4 and more cases of acute respirator illnesses per year);respirator illnesses per year);

4 group - patients with the subcompensated 4 group - patients with the subcompensated state (persons with complications of chronic state (persons with complications of chronic illnesses during a year);illnesses during a year);

5 group - patients with the decompensated state 5 group - patients with the decompensated state (chronic patients in stage of decompensation).(chronic patients in stage of decompensation).

Weight of newborns, g. Number of newborns, n

2900 1

3000 2

3100 3

3200 3

3300 2

3400 1

Having worked out the general tendencies Having worked out the general tendencies of main indices of population’s health the of main indices of population’s health the WHO defined the following criteria which all WHO defined the following criteria which all countries are to aim at:countries are to aim at:

1. Availability of primary MSA;1. Availability of primary MSA;

2. The percentage of gross national 2. The percentage of gross national product expended on the health product expended on the health protection, must be 7-8%; in our protection, must be 7-8%; in our case it is 5% (more often 1-3%);case it is 5% (more often 1-3%);

Age group Absolute number % from the general number

15 – 19 150 10,0

20 – 29 375 25,0

30 – 39 300 20,0

40 – 49 345 23.0

50 – 59 150 10.0

60 and senior 180 12.0

In total 1500 100.0

3. Positive natural increase of 3. Positive natural increase of population in all regions (now in many population in all regions (now in many regions natural increase is negative);regions natural increase is negative);4. Percent of children whose birth 4. Percent of children whose birth with weight 2500 grammas and less with weight 2500 grammas and less has to be no more than 3,5%;has to be no more than 3,5%;5. The level of death rate of babies 5. The level of death rate of babies must not exceed 9 cases for 1000 must not exceed 9 cases for 1000 born alive, and actually per year is born alive, and actually per year is within the limits of 12-15%;within the limits of 12-15%;6. Average life duration is not to be 6. Average life duration is not to be less than 75 years, and it actually is less than 75 years, and it actually is 67,8.67,8.

DiseaseStructure of

morbidity 

Structure of invalidity

Structure of the reasons of

death 

Index of relative intensity

Of invalidity reasons of death

Traumas 12.0 8.0 30.0 0.35 2.0Heart and vessel diseases 4.0

  27.0 19.0 6.76 4.75

Diseases of nervous system

6.0 8.0 - 1.33 -

Poisonings 0.3 - 0.4 - 13.3Tuberculosis

0.5 5.0 5.5 10.0 11.0

Other  74.2 52.0 41.5 0.7 0.56

Total100.0 100.0 100.0 - -

Data of demography is Data of demography is used in two basic used in two basic

directions:directions: 1) Description of population for given 1) Description of population for given

time (quantity, composition, features) time (quantity, composition, features) – this is statics of population;– this is statics of population;

2) Dynamics of population or its 2) Dynamics of population or its motion - it is description of motion - it is description of population quantity change population quantity change processes. processes.

The motion of The motion of population can be:population can be:

- - mechanical (migrations, mechanical (migrations, migratory processes);migratory processes);

- natural (changes which take - natural (changes which take place as a result of birth-rate and place as a result of birth-rate and death rate and characterize the death rate and characterize the population recreation processes).population recreation processes).

NaturalNatural motion of motion of Ukraine populationUkraine population

Birth-Birth-raterate

Death Death raterate

Natural Natural increasincreas

ee 1990 1990 20020044 1990 1990 20020044 1990 1990 20020044

UkraineUkraine 12,712,7 9,09,0 12,112,1 116,06,0 0,60,6 -7,-7,00Ternopil Ternopil regionregion 14,214,2 9,9,99 12,812,8 114,44,4 1,41,4 --44,,55

It enables to define the type of It enables to define the type of population age structure:population age structure:

-- Progressive - 0-14 year-olds Progressive - 0-14 year-olds prevail over 50 year-olds and prevail over 50 year-olds and senior;senior;

-- Regressive - 0-14 year-olds are Regressive - 0-14 year-olds are less than 50 year-olds and senior;less than 50 year-olds and senior;

-- Stationary - 0-14 year-olds = Stationary - 0-14 year-olds = 50 year-olds and senior.50 year-olds and senior.

General index of birth-rateGeneral index of birth-rate(frequency of birth-rate)(frequency of birth-rate)

Number of born alive during a year ---------------------------------------------- * 1000Average annual quantity of population

Some social physicians bring in Some social physicians bring in the index: the index:

►gross-coefficient of birth-rategross-coefficient of birth-rate – total – total number of girls born by woman during number of girls born by woman during genital period (15-49); genital period (15-49);

►netto-coeficcient of birth-ratenetto-coeficcient of birth-rate - ordinary - ordinary number of girls born by woman during number of girls born by woman during genital period (15-49) except those, genital period (15-49) except those, which do not live so long to beginning which do not live so long to beginning of genital age.of genital age.

General death General death rate index =rate index =

Number of died per year Number of died per year * 1000* 1000

Average annual quantity Average annual quantity of populationof population

Age- death rateAge- death rate

Number of died in certain age per Number of died in certain age per yearyear * 1000* 1000

------------------------------------------------------------------------------------------Average amount of inhabitants of Average amount of inhabitants of

the same age group per yearthe same age group per year

Death rate of babiesDeath rate of babies

Number of children that were born Number of children that were born alive and died during 1st year of alive and died during 1st year of

life * 1000life * 1000 ------------------------------------------------------------------------------------------total number of children that were total number of children that were

born alive per yearborn alive per year

Still born childrenStill born children

Number of children that were born Number of children that were born dead in age dead in age of 22 weeks during of 22 weeks during

yearyear * 1000* 1000 ------------------------------------------------------------------------------------------

total number of children older total number of children older than 22 weeks that were born than 22 weeks that were born

alive and deadalive and dead

Early neonatal death rateEarly neonatal death rate

Number of children that were born Number of children that were born alive and died during the 1st alive and died during the 1st

week (0-6 days)week (0-6 days) * 1000* 1000 ------------------------------------------------------------------------------------------total number of children that were total number of children that were

born alive per yearborn alive per year

Perinatal death ratePerinatal death rate

(Number of children that were (Number of children that were born dead + Number of children born dead + Number of children that died during 7 days )that died during 7 days ) * 1000* 1000

------------------------------------------------------------------------------------------Number of children that were born Number of children that were born

alive and deadalive and dead

Neonatal death rateNeonatal death rate

Number of children, that died Number of children, that died during the first 18 days of lifeduring the first 18 days of life * *

10001000 ------------------------------------------------------------------------------------------Number of children born alive in a Number of children born alive in a

current yearcurrent year

Postneonatal death ratePostneonatal death rate

Number of children, that died in the Number of children, that died in the age of 29 days-12 monthsage of 29 days-12 months * 1000* 1000

------------------------------------------------------------------------------------------Number of children, that were born Number of children, that were born

alive in current year - number of alive in current year - number of children that died during the first children that died during the first

month of lifemonth of life

The following methods are used at the The following methods are used at the study of population morbidity:study of population morbidity:

the analysis of appeals to the medical institutions for the medical help; short description on the basis of results of medical reviews of separate groups of population; analysis of reasons of death; results of questioning of population; special selective researches.

morbidity based on data of morbidity based on data of appeals for medical help:appeals for medical help:

general morbidity, general morbidity, infectious morbidity, infectious morbidity, morbidity from the most important morbidity from the most important

unepidemic diseases, unepidemic diseases, hospital or hospitalized morbidity,hospital or hospitalized morbidity, morbidity with the temporary loss of morbidity with the temporary loss of

capacity.capacity.

General morbidityGeneral morbidity

Amount of all illnesses, traumas in Amount of all illnesses, traumas in the definite yearthe definite year * 1000* 1000

------------------------------------------------------------------------------------------Average quantity of populationAverage quantity of population

Primary morbidityPrimary morbidity

Amount of illnesses, which are Amount of illnesses, which are registered for the first time registered for the first time

during the yearduring the year * 1000* 1000 ----------------------------------------------------------------------------------Average quantity of population Average quantity of population

during a yearduring a year

Morbidity accordingMorbidity according appeal dataappeal data

Amount of illnesses and Amount of illnesses and traumas, which are registered traumas, which are registered

at the appeal during a yearat the appeal during a year ----------------------------------------------------------------------------------Average quantity of populationAverage quantity of population

- - frequency of diseases exposure frequency of diseases exposure (correlation of their number to the quantity (correlation of their number to the quantity of population of the given territory, of population of the given territory, increased on a 100000 population);increased on a 100000 population);

- seasonality (data about the number of - seasonality (data about the number of diseases on months are undertaken as a diseases on months are undertaken as a basis indices of seasonal vibrations - this basis indices of seasonal vibrations - this correlation of data for a month to average correlation of data for a month to average annual);annual);

For the analysis of For the analysis of infectious morbidity such infectious morbidity such indices are used:indices are used:

- - frequency of hospitalization and frequency of hospitalization and plenitude of its scope (in the first plenitude of its scope (in the first case – this correlation of number of case – this correlation of number of hospitalized to the quantity of hospitalized to the quantity of population, in the second to the population, in the second to the number of the exposed diseases, in number of the exposed diseases, in percents);percents);

- frequency of diseases according to - frequency of diseases according to the age, sex, and profession the age, sex, and profession (correlation of number diseases in (correlation of number diseases in the proper group to the quantity of the proper group to the quantity of population of the given group);population of the given group);

- the number of exposured bacillus - the number of exposured bacillus carriers for every 1000 examined carriers for every 1000 examined persons.persons.

Morbidity on the most important Morbidity on the most important unepidemic diseases, which are unepidemic diseases, which are

subject to the special consideration subject to the special consideration are the following:are the following:

- malignant new formations;- malignant new formations;- psychical illnesses;- psychical illnesses;- venereal illnesses;- venereal illnesses;- active tuberculosis;- active tuberculosis;- heavy mycosis.- heavy mycosis.

Morbidity of Morbidity of the the

hospitalizedhospitalized==

number of all number of all hospitalizedhospitalized

×× 10001000Quantity of populationQuantity of population

There are such indices of There are such indices of the hospitalized the hospitalized morbidity:morbidity: 1) the level of hospitalization by age, 1) the level of hospitalization by age,

sex, residence (attitude of number of sex, residence (attitude of number of the hospitalized patients of the given the hospitalized patients of the given group to the quantity of population of group to the quantity of population of this group);this group);

2) the structure of hospitalization 2) the structure of hospitalization (specific quantity of every disease (specific quantity of every disease among the common amount of the among the common amount of the hospitalized patients);hospitalized patients);

3) the average duration of medical 3) the average duration of medical treatment (relation of number of treatment (relation of number of the bed-days conducted by the bed-days conducted by patients in permanent institution, patients in permanent institution, to the number of drop-out to the number of drop-out patients); this index is worth of patients); this index is worth of linking to the age of patients, their linking to the age of patients, their diagnoses, the results of medical diagnoses, the results of medical treatment and of analyzing treatment and of analyzing separately for left from permanent separately for left from permanent institution and deceased patients.institution and deceased patients.

Morbidity Morbidity with thewith the

temporary temporary disabilitydisability

==

Number of diseases and Number of diseases and traumas of working traumas of working

persons during a yearpersons during a year ××

100100total number of working total number of working persons during a yearpersons during a year

Index of Index of calendar calendar days of days of

temporary temporary disability for disability for

every 100 every 100 workingworking personspersons

==

Absolute number of Absolute number of calendar days ofcalendar days of

temporary disabilitytemporary disability ××

100100Average quantity of Average quantity of workersworkers

Average Average duration of duration of the casethe case of of temporary temporary disabilitydisability

==

Number of calendar days of Number of calendar days of temporary disabilitytemporary disability

×× 100 100Number of cases of Number of cases of temporary disabilitytemporary disability

Index of Index of morbidity morbidity structure structure withwith the the

temporary temporary loss of loss of

capacitycapacity

==

Number of cases (or Number of cases (or calendar days) of disability calendar days) of disability

for given diseasefor given disease×× 100 100Number of cases (days) at all Number of cases (days) at all

diseasesdiseases

DisabilityDisability

A year number of patients that lost theA year number of patients that lost the capacity forever * 10000 (or 1000)capacity forever * 10000 (or 1000)

General quantity of working peopleGeneral quantity of working people

Thank you!Thank you!