1. Social Medicine and Health Care Organization as a science

3. Friedrich Engels (1820-1895) Called attention to the health of the working class

4. Rudolf Ludwig Karl Virchow (1821-1902) the “Father” of Social Medicine

5. Those measures can be divided into 2 groups: -measures against the diseases; -measures aimed at improving health.

6. “The physician is the natural attorney (advocate) for the poor.”

7. Before the beginning of the 20th century 3 ways of health protection were formed: with help of state measures(the promulgation of different medical and social work); with help of social measures; with help of medical insurance.

8. Medicine is a social science, and politics nothing but medicine on a grand scale. - R. Virchow, Die Medicinische Reform, 1848

9. “Social hygiene” studies interaction of social factors and human health including changing of need in medical aid with the purpose of making the rational economic system of civic health protection measures (K.Gargov, 1969).

11. Social medicine and organization of health protection is a science about social conformity with human health and the ways of its improvement by rational organization of health protection.

12. Worsening inequality in the US Source: Left Business Observer

13. Old Conceptual Model Human Rights Well- Being Health

14. The World Assembly of Health Protection (WAHP) in its resolution number 23.61 considers that the optimum development of health protection in any country needs making use of generalized experience of health protection development in all the countries of the world. The most effective principles marked by experience of different countries of building and development of national health protection system are the following:

15. New Conceptual Model Framework for Understanding Human Rights Health Human Rights Health

16.  Proclamation of the responsibility of state and society for health protection of the population, which is to be incarnate on the basis of carrying out the complex of economic and social measures which promote directly or collaterally to reach the highest health level of population by creating general national system of health protection services on the basis of the only national plan and local plans, and also by goal-directed and effective use of all resources, which society may apport on every stage of its development for requirements of health protection;

17. The Evolution of Epidemics Virulence of the Causative Agent (M tuberculosis) Population Susceptibility Course of Epidemic

18. Reported TB Cases US, 1953-2002 10,000 20,000 50,000 70,000 100,000 Cases Log Scale 30,000 5360708090 *Change in case definition Year 00 * *

19. Reported TB Cases US, 1983-2002 Year 19811985198919931997 No. of Cases 2002 * * provisional

20. The basic principles of the Public Health service: The determination of the Public Health service with the priority direction of the sasaity activities and government as the one of the basic factors of the surviving and Ukrainian nation development. The observance of the right and liberties of human and citizen according to the Public Health service and securing with the state guarantees. The human direction, securing with priority, common to all mankind treasures in classical, national, grope or individual interests, medical-social protection of the most vulnerable part of the population.

21. Excess TB cases 1985-92 JAMA 1994; 272:536 Infrastructure deteriorated Epidemic HIV Immigration Institutional transmission MDR TB

22. Of the citizens, democratism and opened to general use of the medical aid and other services in the Public Health service. Accordance to the task and social- economical level and cultural development of the sasaity, scientific explanation, material and technical and financial securing. Orientation to the modern health standards and medical aid. The unit of the old traditions and achievements in Public Health service.

24. TB Morbidity US, 1997-2002 Year Cases Rate* 199719,851 7.4 199818,361 6.8 199917,531 6.4 200016,377 5.8 200115,989 5.6 2002**15,087 5.2 *Cases per 100,000 **Provisional

25. Social medicine – is a science that studies social laws of peoples health and characterizes the ways of its improvement according to rational organization of public health services.

26. TB Case Rates, US, 2002 < 3.5 (year 2000 target) 3.6 - 5.2 > 5.2 (national average) D.C. Rate: provisional cases per 100,000

27. Health is a condition of complete social, mental and biological well-being, and not just the absence of diseases or physical defects

28. Reported TB Cases by Race/Ethnicity, US, 2001 Hispanic (25%) Black, non- Hispanic (30%) Asian/Pacific Islander (22%) White, non-Hispanic (21%) American Indian/ Alaska Native (1%)

29. 1. Historical, establishes historical regularities of development of public health and its protection; 2. Sociological, that allows studying social structure of a society and its influence on health; 3. Experimental, allows studying advantages (lacks) of organizational forms of medical service; 4. Expertise, which help quality and efficiency of medical service is studied; 5. Economical, that enable to determine economic efficiency of systems of medical service.

30. Number of TB Cases in US-born vs. Foreign-born Persons, US, 1992-2002* No. of Cases *2002 count is provisional

31. Statistical totality is the common number of units of supervision, taken in the set borders of space and time.

32. Countries of Birth for Foreign-born Persons Reported with TB US, 2002* Mexico (25%) Philippines (11%) Vietnam (9%) India (8%) China (5%) Haiti (3%) S. Korea (3%) Other Countries (36%) *Provisional

33. The ways of formation of the statistic integrity By the volume of observation continuous selective volume observation select ion accidental mechanic typological serial regional combinative By the time of observation By the type of observation flowing one-moment direct copying of the data By anamnesis questionnaire interrogatory

34. The stages of development of statistical material are following: control /logical and technical/; enciphering /code/ of registered signs by numbers, letters of alphabet; lay-out of cards on groups for the subaccount or groupment; report of material; deduction of statistical criteria /indexes/, their graphic image.

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

40. 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.

42. 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.

45. 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.).

47. 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) - 51-52%; 2) environment (air, water, meal, radiation level, electromagnetic fields) - 20-21%; 3) biological factors (heredity, constitution, sex, age) - 19-20%; 4) medical factors (inoculation against infections, medical inspections, quality of medical treatment) - 8- 9%.

50. 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).

51. Weight of newborns, g.Number of newborns, n 29001 30002 31003 32003 33002 34001

52. 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; 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%);

53. Age groupAbsolute number% from the general number 15 – 1915010,0 20 – 2937525,0 30 – 3930020,0 40 – 4934523.0 50 – 5915010.0 60 and senior18012.0 In total1500100.0

54. 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%; 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.

55. Disease Structure of morbidity Structure of invalidity Structure of the reasons of death Index of relative intensity Of invalidity reasons of death Traumas 12.08.030.00.352.0 Heart and vessel diseases 4.0 27.019.06.764.75 Diseases of nervous system 6.08.0-1.33- Poisonings 0.3-0.4-13.3 Tuberculosis 0.55.05.510.011.0 Other 74.252.041.50.70.56 Total 100.0 --

56. Data of demography is used in two basic directions: 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.

57. Polyclinic Number of visits Parameter of presentation = Polyclinic № 1 (100%) № 1850100,0 № 2920108,1 № 3990116,1 № 41200141,1 № 51290151,7

58. Natural motion of Ukraine population Birth-rate Death rate Natural increase 1990 200 4 1990 1990 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

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

60. 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

61. Thank you!