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

There are two levels of medical service organizations in our independent state:  a) Ukrainian Public Health Service;  b) private doctors.

The fundamental task of modern system of health protection in Ukraine is saving and strengthening of population health, improvement of medicare qualities, and development of concrete medical and prophylactic measures, forms and methods of work of the specialized services.

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

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

Risk factors are divided into 4 large groups: 1) way of live (smoking, wrong food. Abuse of alcohol, harmful work, stresses, hypodynamia, using of drugs, incomplete family or family with many children, hyperurbanization) %; 1) way of live (smoking, wrong food. Abuse of alcohol, harmful work, stresses, hypodynamia, using of drugs, incomplete family or family with many children, hyperurbanization) %; 2) environment (air, water, meal, radiation level, electromagnetic fields) %; 2) environment (air, water, meal, radiation level, electromagnetic fields) %; 3) biological factors (heredity, constitution, sex, age) %; 3) biological factors (heredity, constitution, sex, age) %; 4) medical factors (inoculation against infections, medical inspections, quality of medical treatment) - 8-9%. 4) medical factors (inoculation against infections, medical inspections, quality of medical treatment) - 8-9%.

Groups of health  1 group - healthy (0-1 case of acute respiratory illness per year);  2 group - practically healthy (persons with the factors of risk; no more than 2-3 cases of acute respirator illness per year);  3 group - patients with the compensated state (persons with chronic illnesses without complications; 4 and more cases of acute respirator illnesses per year);  4 group - patients with the subcompensated state (persons with complications of chronic illnesses during a year);  5 group - patients with the decompensated state (chronic patients in stage of decompensation).

Weight of newborns, g.Number of newborns, n

Having worked out the general tendencies of main indices of population’s health the WHO defined the following criteria which all countries are to aim at: 1. Availability of primary MSA; 1. Availability of primary MSA; 2. The percentage of gross national product expended on the health protection, must be 7-8%; in our case it is 5% (more often 1-3%); 2. The percentage of gross national product expended on the health protection, must be 7-8%; in our case it is 5% (more often 1-3%);

Age groupAbsolute number% from the general number 15 – ,0 20 – ,0 30 – ,0 40 – – and senior In total

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

Disease Structure of morbidity Structure of invalidity Structure of the reasons of death Index of relative intensity Of invalidity reasons of death Traumas Heart and vessel diseases Diseases of nervous system Poisonings Tuberculosis Other Total

Data of demography is used in two basic directions: 1) Description of population for given time (quantity, composition, features) – this is statics of population; 1) Description of population for given time (quantity, composition, features) – this is statics of population; 2) Dynamics of population or its motion - it is description of population quantity change processes. 2) Dynamics of population or its motion - it is description of population quantity change processes.

Polyclinic Number of visits Parameter of presentation = Polyclinic № 1 (100%) № ,0 № ,1 № ,1 № ,1 № ,7

The motion of population can be: - mechanical (migrations, migratory processes); - mechanical (migrations, migratory processes); - natural (changes which take place as a result of birth-rate and death rate and characterize the population recreation processes). - natural (changes which take place as a result of birth-rate and death rate and characterize the population recreation processes).

Natural motion of Ukraine population Birth-rate Death rate Natural increase Ukraine 12,79,012,1 16,0 0,6 -7,0 Ternopil region 14,2 9,9 12,8 14,4 1,4 -4,5-4,5-4,5-4,5

It enables to define the type of population age structure: It enables to define the type of population age structure: -Progressive year-olds prevail over 50 year-olds and senior; -Progressive year-olds prevail over 50 year-olds and senior; -Regressive year-olds are less than 50 year-olds and senior; -Regressive year-olds are less than 50 year-olds and senior; -Stationary year-olds = 50 year-olds and senior. -Stationary year-olds = 50 year-olds and senior.

General index of birth-rate (frequency of birth-rate) Number of born alive during a year * 1000 Average annual quantity of population

Some social physicians bring in the index: ► gross-coefficient of birth-rate – total number of girls born by woman during genital period (15-49); ► netto-coeficcient of birth-rate - ordinary number of girls born by woman during genital period (15-49) except those, which do not live so long to beginning of genital age.

General death rate index = Number of died per year * 1000 Average annual quantity of population

Age- death rate Number of died in certain age per year * Average amount of inhabitants of the same age group per year

Death rate of babies Number of children that were born alive and died during 1st year of life * total number of children that were born alive per year

Still born children Number of children that were born dead in age of 22 weeks during year * total number of children older than 22 weeks that were born alive and dead

Early neonatal death rate Number of children that were born alive and died during the 1st week (0-6 days) * total number of children that were born alive per year

Perinatal death rate (Number of children that were born dead + Number of children that died during 7 days ) * Number of children that were born alive and dead

Neonatal death rate Number of children, that died during the first 18 days of life * Number of children born alive in a current year

Postneonatal death rate Number of children, that died in the age of 29 days-12 months * Number of children, that were born alive in current year - number of children that died during the first month of life

The following methods are used at the 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 appeals for medical help: general morbidity, general morbidity, infectious morbidity, infectious morbidity, morbidity from the most important unepidemic diseases, morbidity from the most important unepidemic diseases, hospital or hospitalized morbidity, hospital or hospitalized morbidity, morbidity with the temporary loss of capacity. morbidity with the temporary loss of capacity.

General morbidity Amount of all illnesses, traumas in the definite year * Average quantity of population

Primary morbidity Amount of illnesses, which are registered for the first time during the year * Average quantity of population during a year

Morbidity according appeal data Amount of illnesses and traumas, which are registered at the appeal during a year Average quantity of population

- frequency of diseases exposure (correlation of their number to the quantity of population of the given territory, increased on a population); - frequency of diseases exposure (correlation of their number to the quantity of population of the given territory, increased on a population); - seasonality (data about the number of diseases on months are undertaken as a basis indices of seasonal vibrations - this correlation of data for a month to average annual); - seasonality (data about the number of diseases on months are undertaken as a basis indices of seasonal vibrations - this correlation of data for a month to average annual); For the analysis of infectious morbidity such indices are used:

- frequency of hospitalization and plenitude of its scope (in the first case – this correlation of number of hospitalized to the quantity of population, in the second to the number of the exposed diseases, in percents); - frequency of hospitalization and plenitude of its scope (in the first case – this correlation of number of hospitalized to the quantity of population, in the second to the number of the exposed diseases, in percents); - frequency of diseases according to the age, sex, and profession (correlation of number diseases in the proper group to the quantity of population of the given group); - frequency of diseases according to the age, sex, and profession (correlation of number diseases in the proper group to the quantity of population of the given group); - the number of exposured bacillus carriers for every 1000 examined persons. - the number of exposured bacillus carriers for every 1000 examined persons.

Morbidity on the most important unepidemic diseases, which are subject to the special consideration 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 the hospitalized = number of all hospitalized × 1000 Quantity of population

There are such indices of the hospitalized morbidity: 1) the level of hospitalization by age, sex, residence (attitude of number of the hospitalized patients of the given group to the quantity of population of this group); 1) the level of hospitalization by age, sex, residence (attitude of number of the hospitalized patients of the given group to the quantity of population of this group); 2) the structure of hospitalization (specific quantity of every disease among the common amount of the hospitalized patients); 2) the structure of hospitalization (specific quantity of every disease among the common amount of the hospitalized patients);

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

Morbidity with the temporary disability = Number of diseases and traumas of working persons during a year × 100 total number of working persons during a year Index of calendar days of temporary disability for every 100 working persons = Absolute number of calendar days of temporary disability × 100 Average quantity of workers

Average duration of the case of temporary disability = Number of calendar days of temporary disability × 100 Number of cases of temporary disability Index of morbidity structure with the temporary loss of capacity = Number of cases (or calendar days) of disability for given disease × 100 Number of cases (days) at all diseases

Disability A year number of patients that lost the capacity forever * (or 1000) General quantity of working people General quantity of working people

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