Moscow Medical Academy named after. THEM. Sechenov

Department of Public Health and Healthcare with Economics Course

Guidelines

Population health and methods of studying it

IPart

Goal of the work: Based on an analysis of the health status of the population and the activities of health care institutions, be able to propose the main directions and measures to improve the organization and quality of medical and preventive care in the city of N.

To achieve this goal it is necessary:

1. Know the sequence of statistical research (its stages) and apply this knowledge when completing an independent fragment of coursework

2. Use the following summary indicators to assess and analyze the health status of the population based on the information in the course work:

Relative quantities (extensive, intensive, visibility and ratios)

Average values ​​(mode, median, arithmetic mean); variability indicators (limit, amplitude, sigma, coefficient of variation)

3. Be able to graphically represent various types of indicators

4. In order to identify factors on the results of health studies, use the following methods:

· Standardization;

· Correlations;

· Estimates of the reliability of the difference in research results (according to the “t” criterion).

5. In order to predict the results of the study, be able to use the method of “determining confidence limits”

Information block

The city of N. is an industrial center in the northeast of the European part of the country. It has a textile mill, a synthetic detergents plant, a powerful thermal power plant, and a large railway junction with a car repair plant. In recent years, due to a significant increase in the number of motor vehicles, the environmental situation has worsened: the content of harmful substances in the atmospheric air significantly exceeds the maximum permissible concentration, and the number of green spaces has decreased.

Due to higher levels of certain diseases, infant mortality and other public health problems in the city of N, the city health department and chief specialists decided to conduct an in-depth study of the factors affecting health indicators. It is necessary to organize a statistical study and present it for discussion: choose a topic, formulate the purpose and objectives of the study, draw up a collection program and a program for developing material (layouts of statistical tables).

There are 370 doctors of all specialties working in the city’s medical institutions; the bed capacity (hospital and maternity hospital) is 870 beds (Table 1)

Table 1. Provision of the population of the city of N. with doctors of all specialties and hospital beds (per 10,000 population).

Diagram 1.a. Provision of the population of the city of N with doctors of all specialties and hospital beds per 10,000 population

1. When comparing the supply of doctors in the region and the city of N, it can be noted that despite the fact that in the years under review the number of doctors in the city of N is increasing (although not steadily), there are currently more of them in the region.

2. In the city of N, there is a persistent negative trend in the provision of beds for the population of the city of N per 10,000 population.

The city health department, with the participation of expert specialists, conducted a study of the health status of the population. The results obtained are presented below.

The city of N. is home to 100,000 people, including 20,000 under the age of 15 years, 50,000 from 15 to 49 years old (including 23,000 women), 50 years and older – 30,000 people.

Diagram 1.b. Age structure of the city N

Conclusion: Based on the population structure over the past year, a regressive type of population demography is observed, since the total population aged 0 to 15 years is less than the total population over 50 years old.

In the year under study, 750 children were born alive in the city (in the previous year 780), all to women aged 15–49 years. 1,450 people died during the year, including 11 under the age of 1 year. Data on the dynamics of demographic indicators in the city during the study period from year 1 to year 5 of observation are presented in Table. 2.

Table 2. Dynamics of demographic indicators of the city of N. for 5 years and in comparison with the Russian Federation (per 1000)

Diagram 2.a. Birth and death rates for the population of the city N

Conclusion: 1. There is a persistent decline in birth rates in the city of N. By 2005, the birth rate became lower than the level in the Russian Federation. 2. At the beginning of the accounting period, the mortality rate in the city of N was lower than the mortality rate in the Russian Federation. Until 2004, this figure grew steadily, and by the end of the year it exceeded the level in the Russian Federation. However, in 2005, a trend towards improvement began to be observed, and again it was below the mortality rate for the Russian Federation.

Diagram 2.b. Natural population growth of the year

1. During the accounting period from 2001 to 2004, the natural population growth of the city of N has a persistent negative trend. And also at the beginning of the period (2001) a progressive type of population was observed. From 2002 to 2005, a regressive type of demographics of the population of the city of N. Since the indicator of natural population growth became with a “minus sign”, that is, more people die than are born.

2. Despite the fact that in 2005 there is still a negative trend in natural population growth, compared to 2004 there is a relatively positive trend in this indicator.

Diagram 2.c.

Conclusion: During the reference period, fertility in city N decreased.

Diagram 2.d. Infant mortality rates in the city of N for 2001-2005

Conclusion: During the accounting period, infant mortality in the city of N has decreased, but the mortality rate in the city of N is still higher than in the region, where traditionally the equipment and professionalism of maternity hospitals, as well as hospitals, are incomparably worse than in the city.

In recent years, the socio-economic situation in the city has worsened. Housing construction has stopped, the output of industrial enterprises has decreased, and the number of people employed in public production is decreasing. There has been an increase in the number of divorces and a decrease in the number of marriages. The number of children born to unmarried women has increased relatively (every fifth of them has not reached the age of 20).

Significant changes in age-specific fertility rates were found (Table 3).

Table 3. Dynamics of age-specific and total fertility in the city of N. (per 1000 women of fertile age and in absolute numbers and per 1000)

Diagram 3.a. Dynamics of total fertility in the city of N for 1995 and 2005

Conclusion: The total fertility rate has decreased greatly over the past 10 years. Conclusion: The total fertility rate has changed over the past 10 years - it has decreased, and the age distribution of fertility has changed:

1. In the age category of 15-19 years, despite the general decline in fertility, fertility is higher in 2005 compared to 1995. Based on the data that the number of children born to unmarried women has increased relatively (every fifth of them has not reached 20 years), the socio-economic situation in the city has worsened, housing construction has stopped - and the “queues” for social housing have not been eliminated, the population has been living for generations in conditions of m2 per person that do not meet sanitary and hygienic standards, the number of “unfavorable” families is growing. The number of “difficult” teenagers and crime is increasing. The latter is aggravated by growing unemployment due to a decrease in the number of people employed in public production, as well as an increase in prices for essential goods due to a reduction in the output of industrial enterprises and the forced import of these goods from other cities, regions, as well as from foreign countries.

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HEALTH AND METHODS OF ITS STUDY

Social and biological factors of health

Health and morbidity indicators are used in relation to specific groups of healthy and sick people. This obliges us to approach the assessment of a person’s lifestyle not only from biological, but also from medical and social positions. Social factors are determined by the socio-economic structure of society, the level of education, culture, industrial relations between people, traditions, customs, social attitudes in the family and personal characteristics. Most of these factors, together with the hygienic characteristics of life, are included in the general concept of “lifestyle,” the share of which influences health is more than 50% among all factors.

Biological characteristics of a person (sex, age, heredity, constitution, temperament, adaptive capabilities, etc.) account for no more than 20% of the total impact of factors on health. Both social and biological factors influence a person in certain environmental conditions, the share of influence of which ranges from 18 to 22%. Only a small part (8-10%) of health indicators is determined by the level of activity of medical institutions and the efforts of medical workers. Therefore, human health is a harmonious unity of biological and social qualities determined by innate and acquired biological and social properties, and illness is a violation of this harmony.

Concept of prevention. Its basic principles and types

Prevention is an integral part of medicine. The social and preventive direction in protecting and strengthening the health of the people includes medical, sanitary, hygienic and socio-economic measures. Creating a system for preventing diseases and eliminating risk factors is the most important socio-economic and medical task of the state. There are individual and public prevention. Depending on the state of health, the presence of risk factors for the disease or severe pathology in a person, 3 types of prevention are considered.

Primary prevention is a system of measures to prevent the occurrence and impact of risk factors for the development of diseases (vaccination, rational work and rest, rational high-quality nutrition, physical activity, environmental health, etc.). Primary prevention includes socio-economic measures of the state to improve lifestyle, environment, education, etc. Preventive activities are mandatory for all medical workers. It is no coincidence that clinics, hospitals, dispensaries, and maternity hospitals are called medical and preventive institutions.

Secondary prevention is a set of measures to eliminate pronounced risk factors, which under certain conditions (decreased immune status, overexertion, adaptation failure) can lead to the onset, exacerbation or relapse of the disease. The most effective method of secondary prevention is medical examination as a comprehensive method of early detection of diseases, dynamic observation, targeted treatment, and rational consistent recovery.

A number of experts propose the term “tertiary prevention” as a set of measures for the rehabilitation of patients who have lost the ability to fully live. Tertiary prevention aims at social (building confidence in one’s own social suitability), labor (the possibility of restoring work skills), psychological (restoring the behavioral activity of the individual) and medical (restoring the functions of organs and systems) rehabilitation.

The most important component of all preventive measures is the formation of medical and social activity and attitudes towards a healthy lifestyle among the population.

Lifestyle as a medical and social factor of health

Lifestyle is a leading generalized factor that determines the main trends in health changes and is considered as a type of active human activity. The structure of the lifestyle with its medical and social characteristics includes: 1) work activity and working conditions; 2) economic and household activities (type of home, living space, living conditions, time spent on household activities, etc.); 3) recreational activities aimed at restoring physical strength and interacting with the environment; 4) socialization activities in the family (care for children, elderly relatives); 5) family planning and relationships between family members; 6) formation of behavioral characteristics and socio-psychological status; 7) medical and social activity (attitude to health, medicine, attitude towards a healthy lifestyle). Lifestyle is associated with such concepts as standard of living (structure of income per person), quality of life (measurable parameters characterizing the degree of material security of a person), lifestyle (psychological individual characteristics of behavior), way of life (national social order of life, everyday life, culture).

Concept of medical activity and healthy lifestyle

Medical activity refers to the activities of people in the field of protecting, improving individual and public health in certain socio-economic conditions. Medical (medical and social) activity includes: the presence of hygienic skills, implementation of medical recommendations, participation in improving lifestyle and the environment, the ability to provide first aid to oneself and relatives, use folk and traditional medicine, etc.

Increasing the level of medical activity and literacy of the population is the most important task of the local general practitioner and pediatrician (especially the family doctor). An important component of medical and social activity is the attitude towards a healthy lifestyle (HLS).

A healthy lifestyle is hygienic behavior based on scientifically proven sanitary and hygienic standards aimed at strengthening and maintaining health, activating the body's defenses, ensuring a high level of working capacity, and achieving active longevity.

Thus, healthy lifestyle can be considered as the basis for disease prevention. It is aimed at eliminating risk factors (low level of labor activity, dissatisfaction with work, passivity, psycho-emotional tension, low social activity and low cultural level, environmental illiteracy, physical inactivity, irrational, unbalanced nutrition, smoking, consumption of alcohol, narcotic and toxic substances, tense family relationships, unhealthy lifestyle, genetic risk, etc.). A healthy lifestyle is an important factor in health (increases work activity, creates physical and mental comfort, activates life position, the body’s defenses, strengthens general condition, reduces the frequency of diseases and exacerbations of chronic diseases).

Main directions and methods of promoting a healthy lifestyle

Formation of a healthy lifestyle is the creation of a system for overcoming risk factors in the form of active life activities of people aimed at preserving and strengthening health. A healthy lifestyle includes the following components:

1) conscious creation of working conditions conducive to maintaining health and increasing performance;

2) active participation in cultural events, physical education and sports, refusal of passive forms of rest, training of mental abilities, auto-training, giving up bad habits (drinking alcohol, smoking), rational, balanced nutrition, observing the rules of personal hygiene, creating normal conditions in family;

3) the formation of interpersonal relationships in work groups, families, attitudes towards the sick and disabled;

4) respect for the environment, nature, high culture of behavior at work, in public places and transport;

5) conscious participation in preventive measures carried out by medical institutions, compliance with medical orders, the ability to provide first aid, reading popular medical literature, etc.

In accordance with the orders of the Ministry of Health of the Russian Federation, promoting a healthy lifestyle is the responsibility of every medical worker. In this case, methods of oral, printed, visual (pictorial) and combined propaganda are used.

The method of oral propaganda is the most effective. This is the most popular, economical, simple and organizationally accessible method. It includes the following means of propaganda: lectures, conversations, discussions, conferences, club classes, quizzes.

The method of printed propaganda reaches wide sections of the population. It includes articles, health leaflets, memos, leaflets, wall newspapers, magazines, booklets, brochures, books, slogans.

The visual method is the most diverse in terms of the number of tools included in it. They can be divided into 2 groups: natural objects and visual means (volumetric and planar).

The combined method is a method of mass propaganda in which there is a simultaneous impact on the auditory and visual analyzers.

Structure of medical prevention centers. Their role in promoting a healthy lifestyle

Medical prevention centers are the scientific, methodological and coordination link in organizing the promotion of a healthy lifestyle in republics, regions, territories, cities and districts. They are under the authority of the health care committees of administrative territories. Main activities: consultations with residents of the region on health issues and disease prevention; formation of hygiene skills, competent hygienic behavior; combating unhealthy habits; overcoming health risk factors; preventive treatment; formation of a healthy lifestyle among the population.

Medical prevention centers have rooms for: rational nutrition, physical education, mental hygiene and mental hygiene, household hygiene, prevention of unhealthy habits, marriage and family relations, genetics (marriage and family), vocational guidance, regulation (auto-training), etc. The centers coordinate the organizational and methodological activities of all medical institutions (polyclinics, dispensaries, SSES centers, etc.) on issues of promoting a healthy lifestyle, providing educational, methodological and information literature.

Health as an indicator of the effectiveness of medical and preventive activities

Any type of medical activity, a complex of health-improving, hygienic and preventive measures in individual teams and on administrative territory must be assessed from the point of view of their social, medical and economic effectiveness. The leading criterion for assessing effectiveness can only be health indicators over time (decrease in morbidity, mortality, disability, increase in the duration of working life, etc.). Efficiency is assessed as the ratio of the result obtained to the costs incurred.

In healthcare, the goal cannot be to save money on human health or to save money at the expense of health. Economic justification for treatment and preventive measures, analysis of the use of funds in healthcare are necessary to select the most optimal allocation options and achieve the best results in protecting public health. The main components of economic efficiency (or damage prevented) are as follows:

- increase in production by reducing the time lost by workers due to temporary incapacity, disability, and premature death;

-- reducing losses from decreased productivity of workers weakened by illness;

-- reduction of additional costs for health improvement and safety in areas with harmful and difficult working conditions;

-- reducing costs for additional training of workers replacing sick and disabled people;

-- reduction of costs for medical care in health care institutions due to a decrease in the number of patients;

-- reduction of costs for social insurance of temporary disability.

If, after vaccinations (health measures, etc.), the incidence of workers has decreased by 800 working days, then economic efficiency will be the saved cost of these working days, multiplied by the cost of output for each of the 800 days.

Definition of health. Basic methods of its study. Health groups

Health is a state that ensures an optimal relationship between the body and the environment and promotes the activation of all types of human life (labor, economic, household, recreational, socialization, family planning, medical and social, etc.). The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” There are other definitions, among which the health of an individual is considered as a dynamic state of preservation and development of his biological, physiological and mental functions, optimal working capacity and social activity with the longest and most active life.

The main criteria characterizing public health are:

-- medical and demographic (fertility, mortality, natural increase, infant mortality, frequency of premature births, life expectancy);

-- morbidity (general, infectious, with temporary disability, according to medical examinations, major non-epidemic diseases, hospitalized);

-- primary disability;

-- indicators of physical development;

-- mental health indicators.

All criteria are evaluated dynamically. An important criterion for assessing the health of the population should be considered the health index, that is, the proportion of those who were not sick at the time of the study (during the year, etc.). You can take into account the proportion of people with chronic forms of diseases, who are often and long-term ill, etc.

Information about the state of health (morbidity) can be obtained on the basis of medical examinations, the population’s seeking medical care, the results of special sample studies, data on the causes of death, etc.

When assessing health, the population is divided into health groups: Group 1 (healthy) - these are persons who have no complaints, a history of chronic diseases, functional abnormalities and organic changes; Group 2 (practically healthy) - persons who have chronic diseases in the stage of stable remission, functional changes in organs and systems that do not affect their activity and ability to work; Group 3 - patients with chronic diseases in the stage of compensation, subcompensation or decompensation.

Basic health indicators of the population of Russia. Their medical and social assessment

Medical and demographic indicators indicate a slowdown in population growth in Russia. In recent years, most cities in the country have experienced negative population growth (a decrease of about 6 per 1000 inhabitants). The process of reducing the birth rate to 8-10‰ is pronounced; the orientation towards a one-child family prevails. In St. Petersburg, the birth rate by 1996 was about 7 per 1000 inhabitants. In European countries the birth rate is also low, and in Southeast Asia it is more than 25 per 1000 inhabitants.

In Russia, mortality rates have increased to 15 per 1000 people (in St. Petersburg - about 17‰). Infant mortality is declining, but at an insufficient rate. In Russia and St. Petersburg, infant mortality is 1.5-2 times higher than in economically developed countries, and is about 15-17 per 1000 live births. Maternal mortality in St. Petersburg is 58.4 per 100,000 live births.

The average life expectancy does not increase, but rather decreases. In Russia by 1996 it was about 64 years, and there is a significant difference in this indicator for men (57 years) and women (71 years).

The incidence of temporary disability is about 70 cases and 1090 days per 100 workers. The number of registered infectious diseases (diphtheria, whooping cough, tick-borne encephalitis, salmonellosis) has increased. The incidence of sexually transmitted diseases, tuberculosis, and mental illnesses has increased. The number of suicides is growing. The rates of primary disability among the working-age population are increasing (65.2 per 10,000 workers).

The given population health indicators indicate that chronic non-communicable diseases are leading in the structure of morbidity and mortality of the population and depend primarily on risk factors and lifestyle.

Scheme for a comprehensive study of health and the factors that determine it

Analysis of the health status of the population or its individual groups should become mandatory in the work of a doctor. The main elements of a comprehensive analysis are: 1) collection of information about health status; 2) processing and analysis of health information; 3) putting forward a hypothesis about the connection between environmental factors and health status; 4) targeted study of environmental factors and in-depth study of health characteristics; 5) identification of quantitative relationships between environmental factors and health characteristics; 6) making decisions on improving the environment for primary disease prevention; 7) implementation of decisions made; 8) checking the effectiveness of decisions made.

The concept of morbidity, prevalence, pathological involvement. Sources and accounting characteristics when studying morbidity

health prevention biological morbidity

Morbidity is one of the criteria for assessing the health status of the population. Materials on the morbidity of the population in the practical activities of a doctor are necessary for: operational management of the work of healthcare institutions; assessing the effectiveness of ongoing medical and health measures, including medical examinations; assessing public health and identifying risk factors that help reduce morbidity; planning the scope of preventive examinations; determination of the contingent for dispensary observation, hospitalization, sanatorium-resort treatment, employment of a certain contingent of patients, etc.; current and future workforce planning, networks of various health services and departments; morbidity forecast.

The following indicators exist in morbidity statistics.

Morbidity is the totality of newly emerging diseases in a calendar year; is calculated as the ratio of the number of newly emerging diseases to the average population, multiplied by 1000.

Morbidity is the prevalence of reported diseases, both new and pre-existing, at initial presentation in a calendar year; statistically expressed as the ratio of the number of all diseases in the population per year to the average population, multiplied by 1000.

Pathological lesions are a set of diseases and pathological conditions identified by doctors through active medical examinations of the population; statistically expressed as the ratio of the number of currently existing diseases to the average population, multiplied by 1000. These are mainly chronic diseases, but currently existing acute diseases can also be taken into account. In practical healthcare, this term can be used to define the results of medical examinations of the population. It is calculated as the ratio of the number of diseases identified during a medical examination to the number of persons examined, multiplied by 1000.

Depending on the purpose of the study, various statistical materials and accounting documents are used (medical records, emergency notices, certificates of incapacity for work, cards of those leaving the hospital, medical death certificates, other special forms and questionnaires). When studying the morbidity and mortality of the population, they use the “International Statistical Classification of Diseases and Related Health Problems” (10th revision, 1995, WHO), which includes 21 classes of diseases, which are divided into a block of headings, terms and diagnostic formulations.

General morbidity. Main criteria and indicators. Their medical and social assessment

The general morbidity rate of the population is studied based on data from all initial requests for medical care in treatment and preventive institutions. The main accounting document in outpatient clinics is a medical card. The unit of observation when studying general morbidity is the patient’s initial visit in the current calendar year regarding this disease. When studying general morbidity, general and special indicators are calculated.

The overall morbidity rate is determined by the number of initial visits for medical care to medical institutions in a given year per 1000 or 10,000 inhabitants. The overall indicator is the ratio of the number of cases per year to the total population.

The number of requests for medical help for diseases in St. Petersburg has currently decreased significantly and is: the general morbidity rate of the adult population is about 900 calls per 1000, and the primary morbidity rate is about 500 calls per 1000 residents. Morbidity rate among children: general - 1800, primary - 1500 visits per 1000 children.

The incidence of infectious diseases is studied by recording each infectious disease or suspicion of it. The accounting document is an emergency notification of an infectious disease. An emergency notification is drawn up for each infectious disease or suspected disease and sent within 12 hours to the SSES center. An emergency notification prior to departure is recorded in the infectious disease journal (Form No. 060). Based on the entries in this journal, a report is compiled on the dynamics of infectious diseases for each month, quarter, half-year and year.

The analysis of infectious morbidity is carried out using general and special indicators. The general infectious morbidity rate is the number of infectious diseases registered per 10,000 inhabitants per year, divided by the population size. Special indicators - age and gender, depending on profession, work experience, etc.

The structure of infectious morbidity is calculated (in %) - the proportion of infectious diseases among the total number of registered diseases, the mortality rate is estimated (the number of deaths per 10,000 registered patients), etc.

In an in-depth study of infectious diseases, seasonality, sources of infection, the effectiveness of preventive vaccinations, etc. are analyzed, which enables doctors to develop measures to combat infectious diseases.

The incidence of the most important non-epidemic diseases (tuberculosis, sexually transmitted diseases, neoplasms, trichophytosis, etc.), registered for the first time in a given year, is calculated per 10,000 inhabitants (level, structure). The unit of observation when studying non-epidemic morbidity is each patient diagnosed with one of these diseases for the first time in his life. Diseases are recorded in dispensaries.

Morbidity with temporary disability. Accounting and reporting documentation and evaluation of indicators. Frequency of diseases. Health Index

Morbidity with temporary disability (TL) occupies a special place in morbidity statistics due to its high economic importance. Morbidity with VUT is one of the types of morbidity according to appealability, and is a priority characteristic of the health status of workers. The morbidity rate with VUT characterizes the prevalence of those cases of morbidity among workers that resulted in absenteeism from work.

The unit of observation when studying morbidity with VUT is each case of temporary disability due to illness or injury in a given year. The accounting document is a certificate of incapacity for work, which is not only a medical statistical document, but also a legal document certifying temporary release from work, and a financial one, on the basis of which benefits are paid from social insurance funds. In addition to passport data (last name, first name, patronymic, gender, age), the certificate of incapacity for work contains information about the sick person’s place of work, diagnosis and duration of treatment.

The assessment of morbidity with VUT is carried out both according to the generally accepted method based on reports of temporary disability (form No. 16-VN), and according to an in-depth method using the police method. According to the generally accepted methodology, based on data from form No. 16-VN, a number of indicators can be calculated: 1) the number of cases of temporary disability per 100 workers: calculated as the ratio of the number of cases of diseases (injuries) to the average number of workers, multiplied by 100 (on average about 80- -100 cases per 100 workers); 2) the number of days of illness per 100 workers: the ratio of days of illness (injuries) to the number of workers, multiplied by 100 (about 800-1200 per 100 workers); 3) the average duration of one case of PVUT (the ratio of the total number of days of disability to the number of cases of disability) is about 10 days.

When analyzing the VUT, the structure of temporary disability in cases and days is determined (the first place is diseases of acute respiratory infections, then diseases of the nervous system and sensory organs, hypertension, diseases of the musculoskeletal system, skin infections, diseases of the digestive system, etc.) . All morbidity indicators are assessed by nosological forms (in cases and days per 100 workers) and in dynamics over a number of years. In an in-depth method for studying morbidity with VUT using the police method, a personal, or personal, card is filled out for each worker. The unit of observation in this technique is the worker. When registering morbidity by police, the following are assessed: health index; frequency of diseases (1, 2, 3 times); the proportion of people who are often sick (4 times or more a year) and those who are sick for a long time (more than 40 days).

Based on health groups, workers can be divided into 5 main groups: 1) healthy (who did not have a single case of disability in the year); 2) practically healthy (those who had 1-2 cases of disability per year due to acute forms of disease); 3) who had 3 or more cases of disability per year due to acute forms of disease; 4) having chronic diseases, but no cases of loss of ability to work; 5) having chronic diseases and cases of loss of ability to work due to these diseases.

Hospital morbidity rates

The morbidity rate of hospitalized patients is a count of persons treated in a hospital during the year. Information on hospitalized morbidity makes it possible to judge the timeliness of hospitalization, the duration and outcome of treatment, the coincidence or divergence of diagnoses, the volume of medical care provided, etc. Data on hospitalized morbidity are taken into account when planning bed capacity and determining the need for various types of inpatient care. The unit of observation when studying hospitalized morbidity is each hospitalization. The registration statistical form is the card of those leaving the hospital.

The overall hospitalization rate is about 150 cases per 1,000 people. In the structure of hospitalized patients, the main share is made up of patients with diseases of the circulatory system, digestive system, chronic respiratory diseases, and patients with injuries.

Morbidity detected actively during periodic and mass medical examinations

Morbidity detected during preventive medical examinations is called pathological involvement. Periodic and mass medical examinations make it possible to identify previously unknown chronic diseases for which the population does not actively seek medical attention. Cases of initial (hidden) manifestations of certain diseases must be taken into account. The advantage of the method of active medical examinations is also the clarification of the diagnosis of certain chronic diseases and pathological abnormalities.

The main accounting document when studying this type of morbidity is the “List of persons subject to targeted medical examination.” Analysis of the study of morbidity based on medical examination data is carried out according to the frequency of diseases detected during preventive examinations (the ratio of the number of detected diseases to the number of examined ones, multiplied by 1000). During this analysis, the structure of the identified pathology is calculated and the health index is determined.

When choosing a primary diagnosis, one should be guided by the “International Classification of Diseases and Related Health Problems” (10th revision, 1995). When diagnosing and coding morbidity, preference should be given to: 1) the underlying disease rather than the complication; 2) more severe and fatal disease; 3) infectious rather than non-infectious diseases; 4) acute form of the disease, not chronic; 5) a specific disease associated with certain working and living conditions.

Structure of causes of death. Sources of information, main indicators and risk factors for population mortality and mortality in various diseases

The source of information on morbidity and causes of death is a medical death certificate. It must indicate the immediate cause of death and the disease that caused or contributed to the immediate cause of death, that is, the underlying disease. In addition, all concomitant diseases that the patient had are indicated.

In the registry office, on the basis of a medical death certificate, a “Death Certificate” is drawn up. These acts are sent monthly to the regional statistical office, where reports are compiled and the causes of mortality are analyzed.

Studies of the frequency of diseases that contributed to the death allow us to study the mortality rate for various diseases (the number of deaths among 100 cases). When analyzing morbidity based on data on causes of death, general and special indicators are used: general indicators - the number of deaths during the reporting year per 1000 inhabitants; special indicators: a) mortality rate depending on the disease - the number of deaths from a particular disease per 1000 inhabitants; b) mortality rate depending on gender (age, profession, etc.) - the number of deaths per year of persons of a certain gender (age, profession, etc.) per 1000 inhabitants of this group; c) an indicator of the structure of causes of mortality - the percentage ratio of the number of deaths from certain diseases to the total number of deaths.

In the structure of general mortality of the population, diseases of the circulatory system occupy the first place. The main risk factors for mortality and lethality in these diseases are physical inactivity, especially in a large city, excess body weight, bad habits (smoking and drinking alcohol, stressful situations, etc.). In second place are oncological diseases, which are caused by exposure to risk factors such as environmental pollution with harmful chemical compounds, radiation, smoking, etc. Third place in the structure of overall mortality is occupied by injuries and chronic nonspecific lung diseases.

Use of initial statistical indicators in assessing the physical development of the population

Currently, physical development is considered as one of the main indicators of the health of an individual and the population as a whole. Physical development is understood as a complex of morphological and functional properties of the body, characterizing mass, density, body shape, etc. Physical development is characterized by the following parameters: anthropometric (body weight, body length, etc.); physiometric (pulse rate, respiration rate, vital capacity, blood pressure indicators); somatoscopic (physique, turgor, shape of legs, chest, etc.).

Anthropometric measurements in health care practice, due to their information content, simplicity and accessibility, are mandatory from birth to adulthood. Data from anthropometric studies are subjected to variation-statistical processing with the compilation of variation series, regression equations, etc. The data obtained are analyzed using the sigma assessment method, according to special tables of physical development (regression scale), according to the increase in indicators in different age periods. This approach to assessing physical development involves identifying children who correspond to the norm. The proportion of children with deviations from the norm is determined.

There are 5 somatic types: 1) slow type of growth and development; 2) delayed type of development; 3) average type of growth and development; 4) accelerated type of development; 5) accelerated type of growth and development. This typology is based on the connection between morphological status and the degree of puberty. The technique involves assessing the child’s physical development by comparing the achieved values ​​with the standard ones. The rates of age-related development of children are assessed.

When studying the physical development of children and adolescents, the method of assessing height, weight, and chest circumference using a regression scale is widely used. The individual values ​​of individual characteristics are varied: for example, in people of the same height, body weight and chest circumference can fluctuate within the widest range. The measure of diversity of individual indicators is characterized by the regression sigma, which is used in calculating the regression coefficient (the ratio of the body weight sigma to the body length sigma, multiplied by the correlation coefficient). Knowing the regression coefficient, using the regression equation and regression sigma, you can build a regression scale. Physical development standards are based on this principle of calculation, which make it possible to compare the height of each child with his body weight, chest circumference, sitting height, etc.

Using regression in research, we can judge by changes in the size of a feature per unit value about changes in the size of another feature that is interconnected with it.

Diseases of the circulatory system as a social and hygienic problem

Diseases of the circulatory system occupy second place in the structure of general morbidity (about 16%) and first place among the causes of death (the mortality rate is more than 980 cases per 100,000 inhabitants). The increase in mortality rates from these diseases occurs against the background of an increase in the overall mortality rate of the population. It has been established that the number of patients with this pathology increases especially rapidly among men aged 40-50 years. Cardiovascular diseases today occupy first place among the causes of disability in our country. At the same time, 4% of men receive group I disability, 60% receive group II disability. For women, these figures are slightly lower. Among the causes of disability, coronary and hypertension diseases, vascular lesions of the brain, and rheumatism prevail.

With age, there is an increase in the incidence of cardiovascular diseases (except rheumatism). Women have higher incidence rates (except for myocardial infarction) than men. The increase in mortality rates from cardiovascular diseases is due to factors such as the aging of the population, improved diagnostics, and a more precise formulation of the causes of death.

Of the large number of risk factors for coronary heart disease, two main groups have been identified: 1) socio-cultural risk factors; 2) “internal” risk factors. Group 1 includes: consumption of high-calorie foods rich in saturated fats and cholesterol, smoking, sedentary (inactive) lifestyle, nervous stress; to the 2nd group - arterial hypertension, hypercholesterolemia, impaired tolerance to carbohydrates, obesity (excess body weight), heredity. The degree of influence of each of these factors and their combinations is different.

Depending on the nature of the disease and the patient’s condition, doctors outline a number of treatment and preventive measures: drug treatment, inpatient treatment, physiotherapy, exercise therapy, sanatorium-resort treatment, etc. There are cardiology departments, dispensaries, centers, research institutes, rehabilitation hospitals .

Malignant neoplasms as a social and hygienic problem

Since the 40s and 50s, the second place in the structure of causes of mortality in economically developed countries has been occupied by malignant neoplasms. In Russia, the highest incidence of malignant neoplasms among women was noted in St. Petersburg (197.7 per 10,000 inhabitants). For men, this figure is higher - 282 per 10,000 inhabitants. The overall cancer incidence rate in St. Petersburg is 285 per 10,000 inhabitants. Every day in St. Petersburg, on average, 50 people get cancer and about 40 people die. The mortality rate from neoplasms is about 280 cases per 100,000 inhabitants.

The increase in the number of neoplasms occurs not so much due to improved diagnosis of these diseases and an increase in the number of elderly and old people in whom malignant tumors develop more often, but as a result of a true increase in morbidity and mortality, especially from lung cancer and blood cancer.

Mortality rates in the age groups of men and women differ significantly. Thus, for the group of 25-34 years of age, mortality is slightly higher in men, in the group of 35 years old - in women, and at the age of 55-64 years, significantly more men die. In general, the mortality rate among men exceeds that among women. In different age groups of men and women, there are also differences in the localization of malignant neoplasms: at the age of 25-40 years, genital cancer predominates in women, and lung cancer and stomach cancer predominate in men.

Mortality from respiratory cancer has increased rapidly over the past 25-30 years, and primarily in men of older age groups.

Dispensary registration of patients with malignant neoplasms under the supervision of an oncologist makes it possible to judge their total number, since these patients are under the supervision of oncological institutions for life.

Special indicators of the work of oncology dispensaries, offices and departments include: 1) the volume and effectiveness of mass and individual preventive examinations of the population, carried out for the purpose of early detection of malignant neoplasms and precancerous conditions; 2) the proportion of patients with advanced forms of cancer among newly diagnosed patients with malignant neoplasms; 3) awareness of the population about the early signs of cancer and other tumors, their curability if they seek medical help in a timely manner (questionnaire method, etc.); 4) long-term results of treatment.

Injuries are a social and hygienic problem

The third place among the causes of mortality in most economically developed countries is occupied by accidents and injuries, the number of which is growing every year. The share of injuries and poisonings in the structure of general morbidity among residents of St. Petersburg is about 12%. The proportion of injuries is also high among adolescents - 8%. Among the adult population, this figure is 121 cases per 1000 inhabitants.

The share of mortality from accidents has now increased by 8-10%. Mortality has increased especially rapidly in the last 20-25 years (1.5-2 times). Accidents are the main cause of death for children, adolescents and young people. In developed countries, mortality from them ranks first among men in the age groups from 1 to 44 years. The “epidemic” of injuries continues, with hundreds of thousands of people becoming victims every year; to these we must add cases of murders and rapes, the number of which is increasing every year. The increase in transport injuries in recent years is alarming, accounting for 30-40% of all accidents. A large number of deaths are associated with occupational and household injuries, especially falls (at home, at work). The number of injuries among athletes has increased.

Overpopulation of cities, pollution of the external environment, acceleration of the general rhythm of life, an increase in the number of vehicles and an increase in the speed of their movement, the spread of new technological processes in production and agriculture, the widespread use of technology in everyday life - all this determines the level of injuries.

Injuries are an important social and hygienic problem, its solution is inextricably linked with improving the health of the population, reducing the level of temporary disability, disability, mortality, and increasing the average life expectancy. Injuries cause enormous economic damage to the country's national economy.

Medical and social analysis of injuries is carried out taking into account: 1) the circumstances of accidents (industrial, domestic, pedestrian traffic, vehicle damage, sports, murder, suicide, etc.); 2) age and gender characteristics, profession; 3) the nature of the injuries (bruise, fracture, wound); 4) localization of injuries; 5) places of medical care; 6) consequences of injuries (without loss of ability to work, disability, death). The causes of injuries include technical, organizational, sanitary and hygienic, and individual behavioral.

Alcoholism, smoking and drug addiction as a medical and social problem

Alcoholism is one of the most dangerous risk factors for the development of various diseases. Alcoholism is considered as a medical and social problem that affects health indicators, morbidity and mortality. The level of general morbidity among alcohol abusers is 1.5 times higher, mainly due to diseases of the circulatory system, digestive organs, poisoning and injuries. In the structure of general morbidity after respiratory diseases among drinkers, injuries are occupied.

In the country, the rate of alcoholic psychosis is 10.5 cases per 100,000, and the prevalence of alcoholism is 115.3 cases per 100,000 inhabitants.

The mortality rate among regular drinkers is 3 times higher than among non-drinkers. In the structure of mortality, the first place is occupied by injuries and poisonings, the second by diseases of the circulatory system, and the third by oncological diseases. Alcohol abuse reduces average life expectancy by 20 years.

Smoking is one of the risk factors for developing serious diseases. The medical and social significance of smoking is manifested in public health indicators. It is the cause of malignant neoplasms of the trachea, bronchi, lungs, larynx, esophagus, and oral cavity. Smoking is associated with 90% of lung cancer. Smokers are more likely to develop cardiovascular diseases, obstructive bronchitis and emphysema. Thus, myocardial infarction occurs 3 times more often in smokers than in non-smokers. This bad habit causes many functional disorders: memory disorders, attention disorders, delayed growth and sexual development in adolescents, infertility, and decreased performance. The death rate among smokers is 70% higher than among non-smokers. Smoking leads to premature death and shortens life expectancy by 8-15 years.

Drug addiction and substance abuse are a medical and social problem; they affect the level of morbidity and mortality. There is a high risk of HIV infection in this population group.

The use of demographic indicators in the work of a doctor. Population statics and dynamics

Sanitary and demographic indicators are the most important criteria for assessing the health of the population. Information on the population size is necessary for health authorities to develop plans for health-improving measures, determine the number, capacity and location of a network of treatment and preventive institutions, and to plan the training of medical personnel.

Demography as a science studies the numerical composition of the population, the distribution of the population by gender, age, social and professional groups, the distribution and movement of the population in the territory, the causes and consequences of changes in the composition of the population, the relationship between socio-economic factors and these changes. It is the oldest branch of sanitary statistics. Demographic statistics indicators are widely used in:

-- assessment of population health (fertility, mortality, average life expectancy, final reproduction indicators);

-- assessment of the patterns of reproduction that shape the structure of the population;

-- planning, placement and forecasting of the health workforce network based on the size and structure of the population;

-- assessing the effectiveness of planning and forecasting medical and social activities.

Ultimately, without knowledge of the quantitative and qualitative composition of the population, it is impossible to conduct a deep statistical analysis of the state of its health, the activities of medical institutions, and clearly plan their work.

Data on population statics and dynamics are widely used in healthcare. Statics characterizes the population at any given moment (its number, composition, settlement patterns, employment, etc.).

Population dynamics are divided into mechanical and natural movement. Mechanical movement refers to the process of population migration. Depending on the duration, migration is divided into permanent and seasonal. When studying the state of health of the population and other social and hygienic studies in certain regions of the country, it is useful to take into account the length of residence in a given area, to study the state of health, the process of acclimatization and the quality of medical and preventive services for migrants. Accounting for the mechanical movement of the population is carried out by administrative bodies.

Natural population movement is a set of demographic phenomena such as fertility, mortality, natural population growth, infant mortality, data on marriages, divorces, and average life expectancy, which are registered in medical institutions and civil registry offices. Vital statistics are based on mandatory registration of births, deaths, marriages, and divorces using special documents.

Age and sex structure of the population. Using this data in a doctor’s work

Age and sex composition is important for characterizing the health status and reproduction of the population. The predominance of certain age and sex groups in the population structure determines the level of mortality, birth rate, causes of death, the proportion of people of working and disabled age, and the average life expectancy. The type of age structure of the population is determined by the ratio of the number of children under 14 years of age to the population aged 50 years and older. The prevalence of persons under 14 years of age in the age structure of the population indicates a progressive type of population structure. The decrease in the proportion of the young population and the predominance of older age groups characterize a regressive structure. The equal ratio between the number of persons under 14 years of age and the number of persons over 50 years of age, with the proportion of the population aged 15-49 years up to 50%, indicates a stationary type of population structure.

Analysis of the age-sex structure of the population of a particular region allows us to anticipate changes in the natural movement of the population, as well as use these patterns in planning (economic and social development, provision of medical personnel, etc.) of various health services. In Russia, as in other economically developed countries, there is a tendency towards an aging population, a decrease in the birth rate, an increase in overall mortality rates, an increase in the number of divorces, and a decrease in the number of children in the family.

Methodology for conducting a population census. Main indicators of the Russian population census, their medical and social assessment

A population census is a special scientifically organized state statistical operation for recording and analyzing data on the population, its composition and distribution over the territory. The census is characterized by the following features.

1. Periodicity (in most countries, censuses are conducted every 10 years, in economically developed countries - every 5 years).

2. Universality (covering the entire population).

3. Unity of methodology (presence of a unified census program in the form of a census form).

4. Simultaneity (the population is taken into account at a certain moment, when the population leads the most sedentary lifestyle).

5. Collection of information by survey with the help of census takers without mandatory confirmation by documents.

6. Centralized method of data processing.

Population census data is necessary for long-term population calculations, for planning the development of sectors of the national economy, including healthcare, for assessing the sanitary condition of the population and calculating various health indicators. The sanitary and epidemiological service uses census data to assess the sanitary and epidemiological state of the area, to develop forecasts of the epidemic situation, etc.

Population censuses have shown that in economically developed countries there is a constant trend of population increase - on average about 1% per year, in developing countries - up to 2%. In most countries of the world, older women and men under the age of 32 predominate.

In Russia, over the past decade, the population has decreased annually and by 1996 amounted to about 147 million people. The natural increase rate (the difference between the birth rate and the death rate) is negative (-6 per 1000 inhabitants). There is an aging population. Thus, the share of the population of older age groups in St. Petersburg is about 23%. The share of the child population is decreasing (up to 20%).

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Social and biological factors of health

Health and morbidity indicators are used in relation to specific groups of healthy and sick people. This obliges us to approach the assessment of a person’s lifestyle not only from biological, but also from medical and social positions. Social factors are determined by the socio-economic structure of society, the level of education, culture, industrial relations between people, traditions, customs, social attitudes in the family and personal characteristics. Most of these factors, together with the hygienic characteristics of life, are included in the general concept of “lifestyle”, the share of which influences health is more than 50% among all factors.

Biological characteristics of a person (sex, age, heredity, constitution, temperament, adaptive capabilities, etc.) account for no more than 20% of the total impact of factors on health. Both social and biological factors influence a person in certain environmental conditions, the share of influence of which ranges from 18 to 22%. Only a small part (8-10%) of health indicators is determined by the level of activity of medical institutions and the efforts of medical workers. Therefore, human health is a harmonious unity of biological and social qualities determined by innate and acquired biological and social properties, and disease is a violation of this harmony.

Concept of prevention. Its basic principles and types

Prevention is an integral part of medicine. The social and preventive direction in protecting and strengthening the health of the people includes medical, sanitary, hygienic and socio-economic measures. Creating a system for preventing diseases and eliminating risk factors is the most important socio-economic and medical task of the state. There are individual and public prevention. Depending on the state of health, the presence of risk factors for the disease or severe pathology in a person, 3 types of prevention are considered.

Primary prevention is a system of measures to prevent the occurrence and impact of risk factors for the development of diseases (vaccination, rational work and rest regime, rational high-quality nutrition, physical activity, environmental health, etc.). Primary prevention includes socio-economic measures of the state to improve lifestyle, environment, education, etc. Preventive activities are mandatory for all medical workers. It is no coincidence that clinics, hospitals, dispensaries, and maternity hospitals are called medical and preventive institutions.

Secondary prevention is a set of measures to eliminate pronounced risk factors, which under certain conditions (decreased immune status, overexertion, adaptation failure) can lead to the onset, exacerbation or relapse of the disease. The most effective method of secondary prevention is medical examination as a comprehensive method of early detection of diseases, dynamic observation, targeted treatment, and rational consistent recovery.

A number of experts propose the term “tertiary prevention” as a set of measures for the rehabilitation of patients who have lost the ability to fully live. Tertiary prevention aims at social (building confidence in one’s own social suitability), labor (the possibility of restoring work skills), psychological (restoring the behavioral activity of the individual) and medical (restoring the functions of organs and systems) rehabilitation.

The most important component of all preventive measures is the formation of medical and social activity and attitudes towards a healthy lifestyle among the population.

Lifestyle as a medical and social factor of health

Lifestyle is a leading generalized factor that determines the main trends in health changes and is considered as a type of active human activity. The structure of the lifestyle with its medical and social characteristics includes:

1) labor activity and working conditions;

2) economic and household activities (type of home, living space, living conditions, time spent on household activities, etc.);

3) recreational activities aimed at restoring physical strength and interacting with the environment;

4) socialization activities in the family (care for children, elderly relatives); 5) family planning and relationships between family members;

6) formation of behavioral characteristics and socio-psychological status;

7) medical and social activity (attitude to health, medicine, attitude towards a healthy lifestyle).

Lifestyle is associated with such concepts as standard of living (structure of income per person), quality of life (measurable parameters characterizing the degree of material security of a person), lifestyle (psychological individual characteristics of behavior), way of life (national social order of life, everyday life, culture).

Concept of medical activity and healthy lifestyle

Medical activity refers to the activities of people in the field of protecting, improving individual and public health in certain socio-economic conditions. Medical (medical and social) activity includes: the presence of hygienic skills, implementation of medical recommendations, participation in improving lifestyle and the environment, the ability to provide first aid to oneself and relatives, use folk and traditional medicine, etc.

Increasing the level of medical activity and literacy of the population is the most important task of the local general practitioner and pediatrician (especially the family doctor). An important component of medical and social activity is the attitude towards a healthy lifestyle (HLS).

A healthy lifestyle is hygienic behavior based on scientifically proven sanitary and hygienic standards aimed at strengthening and maintaining health, activating the body's defenses, ensuring a high level of working capacity, and achieving active longevity.

Thus, healthy lifestyle can be considered as the basis for disease prevention. It is aimed at eliminating risk factors (low level of labor activity, dissatisfaction with work, passivity, psycho-emotional tension, low social activity and low cultural level, environmental illiteracy, physical inactivity, irrational, unbalanced nutrition, smoking, consumption of alcohol, narcotic and toxic substances, tense family relationships, unhealthy lifestyle, genetic risk, etc.). A healthy lifestyle is an important factor in health (increases work activity, creates physical and mental comfort, activates life position, the body’s defenses, strengthens general condition, reduces the frequency of diseases and exacerbations of chronic diseases).

Formation of a healthy lifestyle is the creation of a system for overcoming risk factors in the form of active life of people aimed at maintaining and strengthening health. A healthy lifestyle includes the following components:

1) conscious creation of working conditions conducive to maintaining health and increasing performance;

2) active participation in cultural events, physical education and sports, refusal of passive forms of rest, training of mental abilities, auto-training, giving up bad habits (drinking alcohol, smoking), rational, balanced nutrition, observing the rules of personal hygiene, creating normal conditions in family;

3) the formation of interpersonal relationships in work groups, families, attitudes towards the sick and disabled;

4) respect for the environment, nature, high culture of behavior at work, in public places and transport;

5) conscious participation in preventive measures carried out by medical institutions, compliance with medical orders, the ability to provide first aid, reading popular medical literature, etc.

In accordance with the orders of the Ministry of Health of the Russian Federation, promoting a healthy lifestyle is the responsibility of not only government bodies, but also every medical worker. In this case, methods of oral, printed, visual (pictorial) and combined propaganda are used.

The method of oral propaganda is the most effective. This is the most popular, economical, simple and organizationally accessible method. It includes the following means of propaganda: lectures, conversations, discussions, conferences, club classes, quizzes.

The method of printed propaganda reaches wide sections of the population. It includes articles, health leaflets, memos, leaflets, wall newspapers, magazines, booklets, brochures, books, slogans.

The visual method is the most diverse in terms of the number of tools included in it. They can be divided into 2 groups: natural objects and visual means (volumetric and planar).

The combined method is a method of mass propaganda in which there is a simultaneous impact on the auditory and visual analyzers.

Health as an indicator of the effectiveness of medical and preventive activities

Any type of medical activity, a complex of health-improving, hygienic and preventive measures in individual teams and on administrative territory must be assessed from the point of view of their social, medical and economic effectiveness. The leading criterion for assessing effectiveness can only be health indicators over time (decrease in morbidity, mortality, disability, increase in the duration of working life, etc.). Efficiency is assessed as the ratio of the result obtained to the costs incurred.

In healthcare, the goal cannot be to save money on human health or to save money at the expense of health. Economic justification for treatment and preventive measures, analysis of the use of funds in healthcare are necessary to select the most optimal allocation options and achieve the best results in protecting public health. The main components of economic efficiency (or damage prevented) are as follows:

Increase in production by reducing the time lost by workers due to temporary incapacity, disability, and premature death;

Reducing losses from decreased productivity of workers weakened by illness;

Reducing additional costs for health improvement and safety in areas with harmful and difficult working conditions;

Reducing the cost of additional training for workers replacing sick and disabled people;

Reducing the cost of medical care in healthcare institutions due to a decrease in the number of patients;

Reducing the cost of social insurance for temporary disability.

If, after vaccinations (health measures, etc.), the incidence of workers has decreased by 800 working days, then economic efficiency will be the saved cost of these working days, multiplied by the cost of output for each of the 800 days.

Definition of health. Basic methods of its study.

Health is a state that ensures an optimal relationship between the body and the environment and promotes the activation of all types of human life (labor, economic, household, recreational, socialization, family planning, medical and social, etc.). The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” There are other definitions, among which the health of an individual is considered as a dynamic state of preservation and development of his biological, physiological and mental functions, optimal working capacity and social activity with the longest and most active life.

The main criteria characterizing public health are:

Medical and demographic (fertility, mortality, natural increase, infant mortality, frequency of premature births, life expectancy);

Morbidity (general, infectious, with temporary disability, according to medical examinations, major non-epidemic diseases, hospitalized);

Primary disability;

Indicators of physical development;

Mental health indicators.

All criteria are evaluated dynamically. An important criterion for assessing the health of the population should be considered the health index, that is, the proportion of those who were not sick at the time of the study (during the year, etc.). You can take into account the proportion of people with chronic forms of diseases, who are often and long-term ill, etc.

Information about the state of health (morbidity) can be obtained on the basis of medical examinations, the population’s seeking medical care, the results of special sample studies, data on the causes of death, etc.

When assessing health, the population is divided into health groups:

Group 1 (healthy) - these are persons who do not have complaints, a history of chronic diseases, functional abnormalities and organic changes;

Group 2 (practically healthy) - persons who have chronic diseases in the stage of stable remission, functional changes in organs and systems that do not affect their activity and ability to work;

Group 3 - patients with chronic diseases in the stage of compensation, subcompensation or decompensation.