Improvement approaches to regional socio-economic policy in public health in Russia Shibalkov Ivan Petrovich assistant of economics department Tomsk 2017

Problem Statement and Purpose of the Study 2) expanding the approach to understanding the population health 1) demographic situation in Russia: regional differentiation, population aging, high mortality ecology health care 20% Death rate (the number of deaths per 1000) 10% 50% lifestyle choices 20% genetics Population of Russia over the age of 60 years, % Russia USA Canada India China Brazil World Bank, 2015 Russian Federal State Statistics Service The purpose of the study is to investigate socio-economic factors of the state of population health in the regions of Russia and to develop conceptual bases of socio-economic policy aimed at the formation of public health (increasing life expectancy) with considering regional differentiation. 2

The Health Determinants SES Education Occupation Income Controlled determinants of health are largely determined by the socio-economic status of the individual (SES) quality of the physical environment quality of housing overcrowding noise level intensity of social interaction models of social interaction trust level relative deprivation access to health services choice between public and private medicine relationship with a doctor social networks of alternative counseling on health issues physical culture diet alcohol, tobacco HEALTH Environment Health Behavior Access to health care Degree of controllability high mean Genetic factors Inequality in SES leads to a significant Inequalities in health 3 low

from infectious and parasitic diseases Improvement approaches to regional socio-economic policy in public health in Russia The significant differentiation of socio-economic characteristics of Russian regions indicates considerable regional differences in the initial conditions of demographic development Distribution of Russian regions by the level of deviation of the death rate per 1000 from the average Russian indicator value deviation: more than 30% deviation: from 10% to 30% deviation: less than 30% from infectious and parasitic diseases from external causes 2011 2015 2011 2015 4

Improvement approaches to regional socio-economic policy in public health in Russia We proposed and tested a methodology for assessing the impact of socio-economic parameters of regions on the state of population health (on the basis of factor and cluster analysis). Steps to assess the impact of socio-economic parameters of the regions on the state of population health: 1. the formation of the indicators system; 2. factor analysis of indicators (principal component analysis) and economic interpretation of factors; 3. typology of the investigated objects on the basis of cluster analysis and economic interpretation of the obtained groups, with considering the results of factor analysis; 4. regression and variance analysis of trend dynamics of indicators, calculation of the coefficient of determination to establish the strength of the relationship between the indicators. 5

6 Improvement approaches to regional socio-economic policy in public health in Russia Based on socio-economic and historical-geographical characteristics, clusters isolated through statistical analysis were combined into 4 groups: 1. Relatively prosperous regions of Central Russia, the Volga region, the North-West, as well as the industrialized regions of the Ural, Siberia, and the Far East, characterized by medium or high standard of living and life expectancy. 2. Relatively problematic regions of various districts of the country, which are at the same stage of the epidemiological transition as the regions of the first group, but have some developmental lag - a lower standard of living. 3. Republics of the North Caucasus are regions with unique natural and climatic conditions of life, characterized by high life expectancy despite the low living standards of the population. 4. Hard problematic regions of Siberia, the Far East and other regions, lags far behind in its development of the national average, characterized by low life expectancy and low standard of living, but also the apparent incompleteness of the epidemiological transition. For each of these groups there are some recommendations on socio-economic policies aimed at increasing the average life expectancy with considering the demographic situation from the position of the epidemiological transition theory and successful experience in managing public health. 6

increase the average age of death from various causes Improvement approaches to regional socio-economic policy in public health in Russia 1st group (25 regions) So-called avoidable mortality methodology is recommended: it’s an opportunity to reduce the loss of population from causes that are susceptible to influence by health institutions. The most effective strategy for the improvement of public health for these regions is to concentrate efforts on reducing preventable losses through: medico-social prevention and rehabilitation, the introduction of high-tech methods of treatment, the revitalization of lifestyle activities. Moscow, Saint Petersburg, Nizhny Novgorod Oblast, Tomsk Oblast, Sverdlovsk Oblast etc. closest to the end of the epidemiological transition   a large proportion of deaths occur in causes strongly associated with age  overmortality of men of working age increase the average age of death from various causes 7

definition and elimination of “bottlenecks” in development Improvement approaches to regional socio-economic policy in public health in Russia 2nd group (33 regions) Ivanovo Oblast, Ryazan Oblast, Kaliningrad Oblast, Krasnodar Krai, Altai Krai etc. closest to the end of the epidemiological transition   have some lag in development - a lower standard of living more thorough analysis of the mortality structure factor analysis of the living standards of the population application of best practices of neighboring regions having similar resource and economic potential definition and elimination of “bottlenecks” in development unresolved problems of socio-economic development hamper the success of measures taken to increase life expectancy 8

3rd group (5 regions) 9 Republics of the North Caucasus Improvement approaches to regional socio-economic policy in public health in Russia 3rd group (5 regions) Republics of the North Caucasus unique natural and climatic conditions of life   low mortality, high fertility   high life expectancy, despite the low living standards of the population   phenomenon of group longevity The organization of safe working and resting conditions, the creation of a social environment with the opportunity to choose and achieve decent living conditions Improving the quality of life Alignment of municipalities in terms of level and quality of life Raising the cultural level of the population Development of health, education, physical culture and sports Prevention of risky, aggressive behavior, programs to develop social skills Investments in human capital are very promising. achievement of the life expectancy level of developed countries integrated development of socio-economic system 9

the mortality structure Improvement approaches to regional socio-economic policy in public health in Russia 4th group (20 regions) Jewish Autonomous Oblast, Tuva Republic, Altai Republic, Kurgan Oblast, Kemerovo Oblast etc. did not complete the epidemiological transition   high mortality from external causes and infectious diseases Point measures to reduce traumatic mortality, especially at working age: organization of safe working conditions, rest, movement creating a social environment with the opportunity to choose and achieve decent living conditions strengthening the police and judiciary measures for the formation of vital behavior among the population antialcohol policy using the Haddon matrix Poverty reduction and inequality Complex social and economic development of the territory and the development of a competent socio-demographic policy with measurable results. bringing the mortality structure to normal 10

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