The health of a population, The health of a population



Yüklə 1,39 Mb.
tarix15.07.2018
ölçüsü1,39 Mb.
#55789



The health of a population,

  • The health of a population,

  • its forming factors and conditions,

  • and creating the treatment and prophylactics methods aimed at public health improvement



The history of occurrence of our science is closely connected with the need of doctors to explain the reasons of health and illnesses of their patients and also to learn to control their health. From time immemorial man has been interested in trying to control disease. It is possible to give many examples from history of medicine confirming that many doctors connected occurrence of diseases with adverse conditions of a life of their patients.

  • The history of occurrence of our science is closely connected with the need of doctors to explain the reasons of health and illnesses of their patients and also to learn to control their health. From time immemorial man has been interested in trying to control disease. It is possible to give many examples from history of medicine confirming that many doctors connected occurrence of diseases with adverse conditions of a life of their patients.



Among many names in Hindu medicine, that of Susruta, the “Father of Indian surgery” stands out in prominence. He compiled the surgical knowledge of his time in his classic “Susruta Samhita” (it was compiled between 800 BC and 400 AD). Though this work is mainly devoted to surgery, it also includes medicine, pathology, anatomy, midwifery, ophthalmology, hygiene and bedside manners. Susruta taught attentive supervision over the patient: how he behaves, how he eats, how has a rest, how answers questions; that is what is the character of his behavior and the vital circumstances which have led to illness. For treatment Susruta recommended different diets, physical exercises, conditions change.

  • Among many names in Hindu medicine, that of Susruta, the “Father of Indian surgery” stands out in prominence. He compiled the surgical knowledge of his time in his classic “Susruta Samhita” (it was compiled between 800 BC and 400 AD). Though this work is mainly devoted to surgery, it also includes medicine, pathology, anatomy, midwifery, ophthalmology, hygiene and bedside manners. Susruta taught attentive supervision over the patient: how he behaves, how he eats, how has a rest, how answers questions; that is what is the character of his behavior and the vital circumstances which have led to illness. For treatment Susruta recommended different diets, physical exercises, conditions change.

















In the modern literature there is a considerable quantity of definitions of "health," however the basic one, adopted in all countries, is a definition of the World Health Organization (WHO). In the WHO Charter accepted in 1948 it is written: "Health is a condition of full physical, spiritual and social well-being, and not just absence of illnesses and physical defects."

  • In the modern literature there is a considerable quantity of definitions of "health," however the basic one, adopted in all countries, is a definition of the World Health Organization (WHO). In the WHO Charter accepted in 1948 it is written: "Health is a condition of full physical, spiritual and social well-being, and not just absence of illnesses and physical defects."



1. Health of a separate person – individual health;

  • 1. Health of a separate person – individual health;

  • 2. Health of social and ethnic groups – group health;

  • 3. Health of the population of administrative territory – regional health;

  • 4. Health of population, a society as a whole – public health.

  • Unlike the majority of medical and clinical disciplines dealing with a separate person, an individual and his health, public health and public health systems studies a state of health of all population of the country.



1. Demographic indices (death rate, birth rate, average life expectancy).

  • 1. Demographic indices (death rate, birth rate, average life expectancy).

  • 2. Morbidity rate.

  • 3. Disability rate.

  • 4. Indicators of physical development of the population.

  • The greater part of these indicators is of negative character; it concentrates doctors’ attention to pathological conditions and health definition through morbidity intensity.



1. A health index – a share of practically healthy population, which did not appeal for medical aid on account of diseases within a year;

  • 1. A health index – a share of practically healthy population, which did not appeal for medical aid on account of diseases within a year;

  • 2. Average duration of healthy life and others.



1st group – practically healthy people – the persons who do not have chronic diseases and functional deviations, seldom and short being ill with acute diseases;

  • 1st group – practically healthy people – the persons who do not have chronic diseases and functional deviations, seldom and short being ill with acute diseases;

  • 2nd group – risk group – persons who do not have chronic diseases, but have functional deviations in activity of various organs and systems, and also persons being frequently and prolonged ill with acute diseases;

  • 3rd group – chronic patients with a compensated form of disease and preserved functional abilities of the body;

  • 4th group – chronic patients with a sub compensated form of disease and with reduced functionality of the organism;

  • 5th group – chronic patients with a decompensate form of disease and invalids.



Social and economic factors (material well-being, living conditions, working conditions, food quality, mutual relations in a family and others);

  • Social and economic factors (material well-being, living conditions, working conditions, food quality, mutual relations in a family and others);

  • Biological factors (sex, age, heredity, temperament etc.);

  • Ecological, natural and climatic factors (climate, weather, air condition, water, soil, level of solar radiation, etc.);

  • Medical and organizational factors (availability and quality of a medical and social help).

  • Conditions of a personal and collective life can be united and form a concept – a way of life.



The way of life includes set of features characterizing

  • The way of life includes set of features characterizing

  • activity of people at a factory and in a household,

  • political, cultural, physical, educational activity,

  • medical activity and others.



Regularly go in for physical training - 12 % of Russians

  • Regularly go in for physical training - 12 % of Russians

  • Abuse spirits – more than 30 million persons (21 %)

  • Regularly take drugs –nearly 2million people

  • Smokers - 45 % of the population

  • Formation of a healthy way of life in these conditions is the basic means of primary preventive maintenance and should become the basic purpose of social policy and major duty of all medical workers.



Nature-climatic factors.

  • Nature-climatic factors.

  • The sharp change of atmospheric processes leads to morbidity growth. So, for example, fluctuations of atmospheric pressure negatively influence cardiovascular system, and temperature drops lead to increase of respiratory diseases. . Shortage in water and soil of some microelements (iodine, fluorine and others) leads to occurrence of diseases endemic for this district.



Emissions of harmful substances into atmospheric air (thousand tons)

  • Emissions of harmful substances into atmospheric air (thousand tons)



Morbidity level in children during the first three years of life is highest, and then morbidity decreases. Morbidity level of boys during the first six years of life is essentially above the morbidity level of their contemporary-girls, at age of six years morbidity levels are leveled, and further morbidity of girls is always higher, than at boys.

  • Morbidity level in children during the first three years of life is highest, and then morbidity decreases. Morbidity level of boys during the first six years of life is essentially above the morbidity level of their contemporary-girls, at age of six years morbidity levels are leveled, and further morbidity of girls is always higher, than at boys.



Infectious diseases at children happen much more often, than at adults, but with age increase prevalence of illnesses of blood circulation system and death rate from them grow.

  • Infectious diseases at children happen much more often, than at adults, but with age increase prevalence of illnesses of blood circulation system and death rate from them grow.

  • Indices of morbidity and death rate from malignant growths increase with age, but at women they are considerably lower, than at men.



The person, entering into this world, receives health as gift of the nature, which he has inherited from ancestors. However the biological origin is never shown in the person in purely natural form. The man is a unique phenomenon of a society and the nature, representing a social and biological alloy. A problem of a parity of social and biological features in the person is a key to understanding of the nature and character of health of the person, its illnesses which needs to be considered as biosocial categories.

  • The person, entering into this world, receives health as gift of the nature, which he has inherited from ancestors. However the biological origin is never shown in the person in purely natural form. The man is a unique phenomenon of a society and the nature, representing a social and biological alloy. A problem of a parity of social and biological features in the person is a key to understanding of the nature and character of health of the person, its illnesses which needs to be considered as biosocial categories.



Payment of a total national product to public health services.

  • Payment of a total national product to public health services.

  • Availability of the primary medico-social help.

  • Coverage of the population with medical aid.

  • Level of immunization of the population.

  • Degree of survey of pregnant women by qualified personnel.

  • Condition of children’s diet.

  • Level of children's death rate.

  • Average duration of a forthcoming life.

  • Hygienic literacy of the population.



Social conditionality of health proves to be true by numerous medico-social researches. So, for example, while studying dependence between income average level per capita and average life expectancy worldwide it is easy to notice, that with income increase per capita average life expectancy increases also.

  • Social conditionality of health proves to be true by numerous medico-social researches. So, for example, while studying dependence between income average level per capita and average life expectancy worldwide it is easy to notice, that with income increase per capita average life expectancy increases also.



The American scientists have determined that the state of health in many respects depends on the marital status. Both at married men and women a death rate is essentially lower, than at unmarried and especially dissolved

  • The American scientists have determined that the state of health in many respects depends on the marital status. Both at married men and women a death rate is essentially lower, than at unmarried and especially dissolved



The factors defining health of the population, co-operate with each other, have regional features, and vary in time. At complex medico-social research the most possible number of factors is taken into consideration, their interrelation and force of influence of each of them. Scientists of our country managed to calculate, that such major index of health as morbidity is caused to 50 % by conditions and a way of life, to 20-25 % by condition (pollution) of an environment, to 20 % by genetic factors and to 10-15 % by public health services condition. For other indices of health above resulted rates can be others; however the leading part of conditions and a way of life remains invariable.

  • The factors defining health of the population, co-operate with each other, have regional features, and vary in time. At complex medico-social research the most possible number of factors is taken into consideration, their interrelation and force of influence of each of them. Scientists of our country managed to calculate, that such major index of health as morbidity is caused to 50 % by conditions and a way of life, to 20-25 % by condition (pollution) of an environment, to 20 % by genetic factors and to 10-15 % by public health services condition. For other indices of health above resulted rates can be others; however the leading part of conditions and a way of life remains invariable.







For many diseases, the disease “agent” is still unidentified, e.g. coronary heart disease, cancer, peptic ulcer, mental illness, etc. Where the diseases agent is not firmly established, the aetiology is generally discussed in terms of “risk factors”.

  • For many diseases, the disease “agent” is still unidentified, e.g. coronary heart disease, cancer, peptic ulcer, mental illness, etc. Where the diseases agent is not firmly established, the aetiology is generally discussed in terms of “risk factors”.

  • The term “risk factors” is used by different authors with at least 2 meanings:

  • an attribute or exposure that is significantly associated with the development of a disease,

  • a determinant that can be modified by intervention, thereby reducing the possibility of occurrence of disease or other specified outcomes.



Rick factors are often suggestive, but absolute proof of cause and effect between a risk factor and disease is usually lacking. That is, the presence of a risk factor does not imply that the disease will occur, and in its absence, the disease will not occur. The important thing about risk factors is that they are observable or identifiable prior to the event they predict. It is also recognized that combination of risk factors in the same individual may by purely additive or synergistic (multiplicative). For example, smoking and occupational exposure (shoe, leather, rubber, dye and chemical industries) were found to have an additive effect as risk factors for bladder cancer. On the other hand, smoking found to be synergistic with other risk factors such as hypotension and high blood cholesterol. That is, the effects are more than additive.

  • Rick factors are often suggestive, but absolute proof of cause and effect between a risk factor and disease is usually lacking. That is, the presence of a risk factor does not imply that the disease will occur, and in its absence, the disease will not occur. The important thing about risk factors is that they are observable or identifiable prior to the event they predict. It is also recognized that combination of risk factors in the same individual may by purely additive or synergistic (multiplicative). For example, smoking and occupational exposure (shoe, leather, rubber, dye and chemical industries) were found to have an additive effect as risk factors for bladder cancer. On the other hand, smoking found to be synergistic with other risk factors such as hypotension and high blood cholesterol. That is, the effects are more than additive.

  • Risk factors may be truly causative (e.g., smoking for lung cancer); they may be merely contributory to the undesired outcome (e.g., lack of physical exercise is a risk factor for coronary heart disease), or they may be predictive only in a statistical sense (e.g., illiteracy for perinatal mortality).



Some risk factors can be modified; others cannot be modified. The modifiable factors include smoking, physical activity, diet. They are amenable to intervention and are useful in the care of the individual. The unmodifiable or immutable risk factors such as age, sex, race, family history and genetic factors are not subject to change. They act more as signals in alerting health professionals and other personnel to the possible outcome.

  • Some risk factors can be modified; others cannot be modified. The modifiable factors include smoking, physical activity, diet. They are amenable to intervention and are useful in the care of the individual. The unmodifiable or immutable risk factors such as age, sex, race, family history and genetic factors are not subject to change. They act more as signals in alerting health professionals and other personnel to the possible outcome.

  • Risk factors may characterize the individual, the family, the group, the community or the environment. For example, some of the individual risk factors including age, sex, smoking, etc. But there are also collective community risks – for example, from the presence of malaria, from substandard housing or a poor water supply or poor health care services. The degree of risk in these cases is indirectly an expression of need. Therefore it is stated that a risk factor is a proxy for need – indicating the need for promotive and preventive health services.



Epidemiological methods (e.g., case control and cohort studies) are needed to identify risk factors and estimate the degree of risk. These studies are carried out in population groups among whom certain diseases occur much more frequently than other groups. By such comparative studies, epidemiologists have been able to identify smoking as a risk for lung cancer; high serum cholesterol and high blood pressure as risk factors for coronary disease. The detection of risk factors should be considered a prelude to prevention. For each risk factor ascertained, the question has to be asked whether it can be reduced in a cost-effective way and whether its reduction will prevent or delay the unwanted outcome. Since the detection procedure usually involves whole population, it bears some similarity to presymptomatic screening for disease.

  • Epidemiological methods (e.g., case control and cohort studies) are needed to identify risk factors and estimate the degree of risk. These studies are carried out in population groups among whom certain diseases occur much more frequently than other groups. By such comparative studies, epidemiologists have been able to identify smoking as a risk for lung cancer; high serum cholesterol and high blood pressure as risk factors for coronary disease. The detection of risk factors should be considered a prelude to prevention. For each risk factor ascertained, the question has to be asked whether it can be reduced in a cost-effective way and whether its reduction will prevent or delay the unwanted outcome. Since the detection procedure usually involves whole population, it bears some similarity to presymptomatic screening for disease.



Another approach developed and promoted by WHO is to identify precisely the “risk groups” (e.g. at-risk mothers, at-risk infants, at-risk families, chronically ill, elderly) in the population by certain defined criteria and direct appropriate action to them first. This is known as the “risk approach”. It has been summed up as “something for all, but more for those in need – in proportion to the need”. In essence, the risk approach is a managerial devise for increasing the efficiency of health care services within the limits of resources. WHO has been using the risk approach in MCH services for sometime.

  • Another approach developed and promoted by WHO is to identify precisely the “risk groups” (e.g. at-risk mothers, at-risk infants, at-risk families, chronically ill, elderly) in the population by certain defined criteria and direct appropriate action to them first. This is known as the “risk approach”. It has been summed up as “something for all, but more for those in need – in proportion to the need”. In essence, the risk approach is a managerial devise for increasing the efficiency of health care services within the limits of resources. WHO has been using the risk approach in MCH services for sometime.



1. Biological situation:

  • 1. Biological situation:

  • - Age group, e.g., infants (low birth weight), elderly

  • - Sex, e.g., females in the reproductive age period

  • - Physiological state, e.g., pregnancy, high blood pressure

  • - genetic factors, e.g., family history of genetic disorders

  • - other health conditions (disease, physical functioning, unhealthy behaviour)

  • 2. Physical situation:

  • - rural, urban slums

  • - living conditions, overcrowding

  • - environment: water supply, proximity to industries

  • 3. Socio-cultural and cultural situation:

  • - social class

  • - ethnic and cultural group

  • - family disruption, education, housing

  • - customs, habits and behavior

  • - access to health services

  • - lifestyles and attitudes



Modern epidemiology is concerned with the identification of risk factors and high-risk groups in the population. Since resources are scarce, identification of those at risk is imperative. It helps to define priorities and points to those most in need of attention.

  • Modern epidemiology is concerned with the identification of risk factors and high-risk groups in the population. Since resources are scarce, identification of those at risk is imperative. It helps to define priorities and points to those most in need of attention.

  • The knowledge of risk factors and risk groups can be used to prevent disease in so far as we are able to remove or minimize the risk.



Yüklə 1,39 Mb.

Dostları ilə paylaş:




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©genderi.org 2024
rəhbərliyinə müraciət

    Ana səhifə