Definition criteria, methods and principles for studying the health of the child population. Section III indicators for assessing the state of health of the population Dynamics of the study of disease and human health

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 generalized concept of "lifestyle", the share of the influence of which on health is more than 50% among all factors.

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

Prevention concept. Its main principles and types

Prevention is an integral part of medicine. The social-preventive direction in the protection and strengthening of the health of the people includes medical, sanitary-technical, hygienic and socio-economic measures. The creation of a system for preventing diseases and eliminating risk factors is the most important socio-economic and medical task of the state. Distinguish between 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 improvement, etc.). Primary prevention includes the state's socio-economic measures to improve the way of life, the environment, education, etc. Preventive activities are mandatory for all medical workers. It is no coincidence that polyclinics, 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, overstrain, adaptive breakdown) can lead to the onset, exacerbation or relapse of the disease. The most effective method of secondary prevention is clinical examination as a comprehensive method of early detection of diseases, dynamic observation, targeted treatment, and rational sequential improvement.

A number of experts propose the term "tertiary prevention" as a complex of measures for the rehabilitation of patients who have lost the ability to full-fledged life. Tertiary prevention aims at social (building confidence in one's own social suitability), labor (the ability to restore work skills), psychological (restoring the behavioral activity of an 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 medico-social factor of health

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

1) labor activity and working conditions;

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

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

4) socializing activities in the family (caring for children, elderly relatives); 5) family planning and family relationships;

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

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

The way of life is associated with such concepts as the 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).

The concept of medical activity and a healthy lifestyle

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

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

A healthy lifestyle is a hygienic behavior based on scientifically grounded sanitary and hygienic standards aimed at strengthening and maintaining health, enhancing 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, ecological illiteracy, physical inactivity, irrational, unbalanced diet, smoking, alcohol, drugs and toxic substances, strained relationships, unhealthy life, genetic risk, etc.). A healthy lifestyle is an important factor in health (it increases labor activity, creates physical and mental comfort, activates the position in life, the body's defenses, strengthens the general condition, reduces the incidence of diseases and exacerbations of chronic diseases).

The 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) the conscious creation of working conditions conducive to maintaining health and increasing efficiency;

2) active participation in cultural events, physical education and sports, rejection of passive forms of rest, training of mental abilities, auto-training, rejection of bad habits (alcohol, smoking), rational, balanced nutrition, adherence to personal hygiene rules, creation of normal conditions in family;

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

4) respect for 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 prescriptions, 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 healthy lifestyles is the responsibility of not only government bodies, but also every medical worker. At the same time, methods of oral, printed, visual (pictorial) and combined propaganda are used.

Oral propaganda is the most effective method. This is the most popular, economical, simple and organizationally accessible method. It includes the following means of propaganda: lectures, conversations, discussions, conferences, study circles, quizzes.

The method of print propaganda covers the general 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 means 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 effect on the auditory and visual analyzers.

Health as an indicator of the effectiveness of preventive medicine

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

Healthcare cannot pursue the goal of saving money on human health or saving on health. The economic justification of treatment and prophylactic measures, an analysis of the use of funds in health care are necessary to select the most optimal allocation options, to 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 disability, disability, premature death;

Reducing losses from reduced productivity of workers weakened by the disease;

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

Reducing the cost of additional training for workers who replace 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 (recreational activities, etc.) the incidence of workers decreased by 800 working days, then economic efficiency will be the saved value of those working days multiplied by the value of the output for each of the 800 days.

Definition of health. The main methods of studying it.

Health is a state that provides an optimal relationship between the body and the environment and contributes to the activation of all types of human life (labor, economic, household, recreational, sociological, family planning, medical and social, etc.). The World Health Organization defines health as "a state of complete physical, mental and social well-being, not just the absence of disease or physical defects." 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 for public health are:

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

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

Primary disability;

Physical development indicators;

Mental health indicators.

All criteria are assessed over time. 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.). It is possible to take into account the proportion of people with chronic forms of diseases, often and long-term illnesses, etc.

Information about the state of health (morbidity) can be obtained on the basis of medical examinations carried out, the appeal of the population for medical care, the results of special selective studies, data on the causes of death, etc.

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

1st group (healthy) - these are persons who have no complaints, chronic diseases in history, functional deviations and organic changes;

2nd group (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;

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

HEALTH AND METHODS OF ITS STUDY

1. Social and biological factors of health.

2. The concept of prevention. Its basic principles and types.

3. Lifestyle as a medico-social factor of health. The concept of medical activity and a healthy lifestyle. The main directions and methods of promoting a healthy lifestyle. The structure of medical prevention centers. Their role in promoting healthy lifestyles.

4. Health as an indicator of the effectiveness of preventive medicine.

5. Definition of health. The main methods of studying it. Health groups. The main indicators of the health of the population of Russia.

6. The use of initial statistical indicators in assessing the physical development of the population.

7. Traumatism is a social and hygienic problem.

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

9.Medical and social aspects of the disability of the population. The structure and organization of the work of the expert commission. The procedure for processing documents for permanent disability.

1. Social and biological factors of health.

Health and morbidity indicators are used in relation to specific groups of healthy and sick people. This obliges 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 generalized concept of "lifestyle", the share of the influence of which on health is more than 50% among all factors.

The biological characteristics of a person (gender, age, heredity, constitution, temperament, adaptive capabilities, etc.) make up no more than 20% of the total impact of factors on health. Both social and biological factors affect a person in certain environmental conditions, the share of the influence of which ranges from 18 to 22%. Only a small part (810%) 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 due to innate and acquired biological and social properties,

and illness is a violation of this harmony.

2. The concept of prevention. Its basic principles and types.

Primary prevention includes the state's socio-economic measures to improve the way of life, the environment, education, etc. Preventive activities are mandatory for all medical workers. It is no coincidence that polyclinics, hospitals, dispensaries, and maternity hospitals are called medical and prophylactic institutions.

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

A number of experts suggest the term "tertiary prevention" as a set of measures for the rehabilitation of patients who have lost the ability to full-fledged life. 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 a person) 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.

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

The concept of medical activity and a healthy lifestyle.

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

A healthy lifestyle is a hygienic behavior based on scientifically grounded 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, psychoemotional tension, low social activity and low cultural level, ecological illiteracy, physical inactivity, irrational, unbalanced diet, smoking, alcohol, drugs and toxic substances, tense family relationships, unhealthy life, genetic risk, etc.). A healthy lifestyle is an important factor in health (it increases labor activity, creates physical and mental comfort, activates the life position, the body's defenses, strengthens the general condition, reduces the frequency of diseases and exacerbations of chronic diseases).

The main directions and methods of promoting a healthy lifestyle.

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

2) active participation in cultural events, physical education and sports, rejection of passive forms of recreation, training of mental abilities, auto-training, rejection of bad habits (alcohol, smoking), rational, balanced nutrition, adherence to the rules of personal hygiene, creation of normal conditions in family;

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

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

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

The method of print propaganda reaches a wide audience. 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 means 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 effect on the auditory and visual analyzers.

The structure of medical prevention centers. Their role in promoting healthy lifestyles.

Medical prevention centers are the scientific, methodological and coordinating link in organizing the promotion of a healthy lifestyle in the republics, regions, territories, cities and regions. They are under the authority of the territorial health committees. The main areas of activity: consultations of the residents of the region on health protection, disease prevention; the formation of hygienic skills, competent hygienic behavior; fighting unhealthy habits; overcoming health risk factors; preventive treatment; formation of a healthy lifestyle among the population.

In the centers of medical prevention, there are offices: rational nutrition, physical education, mental hygiene and mental health, household hygiene, prevention of harmful 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, centers of the State Sanitary and Epidemiological Service, etc.) on promoting a healthy lifestyle, providing educational, methodological and informational literature.

The indicators of public health include: medical and demographic, indicators of the incidence and spread of diseases (morbidity), disability and physical development of the population.

Medical and demographic, in turn, are divided into indicators of the natural movement of the population (birth rate, mortality, natural population growth, average life expectancy, marriage rate, fertility, etc.) and indicators of mechanical movement of the population (population migration: emigration, immigration) ...

Vital indicators - and - are calculated based on the registration of each birth and death in the civil registry offices (Civil Registry Office). Birth and death are registered on special forms "Birth certificate", "Death certificate", which, in turn, are drawn up on the basis of a birth certificate and a medical death certificate.

Fertility rate (rate) - the number of births per year per 1000 people.

The average birth rate is 20-30 children per 1000 people.

The indicator (coefficient) of general mortality is the number of deaths per year per 1000 people.

The average mortality rate is 13-16 deaths per 1000 people. If mortality in old age is a consequence of the physiological process of aging, then mortality in children, primarily under the age of one year (infant), is a pathological phenomenon. Therefore, infant mortality is an indicator of social ill-being, ill-health of the population.

The mortality rates during the 1st year of life are also uneven: the highest mortality occurs in the 1st month of life, and in the 1st month - in the 1st week. Therefore, special attention is paid to the following indicators of infant mortality (per 1000 people):

The term "perinatal mortality" means mortality "around" childbirth. There are antanatal mortality (before childbirth), intrapartum mortality (during childbirth), postnatal mortality (after childbirth), neonatal (within 1 month of life) and early neonatal (within 1 week of life) mortality.

Antanatal and intrapartum mortality accounts for stillbirth.

The main causes of perinatal mortality are birth trauma, congenital malformation, asphyxia, etc. The following factors affect the level of perinatal mortality: socio-biological (age of the mother, her condition during pregnancy, history of abortion, number of previous births, etc.) socio-economic (working conditions of a pregnant woman, financial situation, marital status, level and quality medical care pregnant and newborns).

Studies have shown that child mortality is influenced by the following groups of factors: socio-economic and the lifestyle they determine, health policy, health care for women and children, specific methods of combating child mortality arising from honey and co-social causes.

The most important indicator of public health is infant mortality - mortality of children under 1 year of age, calculated per 1000 live births in one year. She defines most infant mortality affects all demographics. The low infant mortality rate is 5-15 children per 1000 people. population, average - 16-30, high - 30-60 and more.

Natural population growth - the difference between the birth rate and the death rate of the population per 1000 people. population.

Currently, in European countries, there is a decrease in natural population growth due to a decrease in the birth rate.

Average life expectancy - the number of years that a given generation of births will have to live on average or the number of peers of a certain age, assuming that throughout their life the mortality rate will be the same as in the year of calculation. As follows from the definition, this indicator is calculated according to age-related mortality data using special mortality tables and statistical calculation methods. At present, the high rate is considered to be 65-75 years and more, the average 50-65 years and the low 40-50 years.

Population aging indicator is the proportion of persons 60 years and older. A high level of aging of the population is considered if this age category is 20% of the population or more, moderate aging - 5-10%, low - 3-5%.

Indicators of the mechanical movement of the population. Mechanical movement of the population - movement (migration) of certain groups of people from one region to another or outside the country. Unfortunately, in recent years, within the borders of the homeland, due to socio-economic instability, interethnic conflicts, migration processes have taken on a spontaneous character, have become more widespread.

The mechanical movement of the population has a great impact on the sanitary state of society. Due to the movement of significant masses of people, the possibility of spreading infections is created. Migrants are one of the main objects of social work.

Incidence rates. The incidence has critical importance in the study of the state of health of the population. The morbidity is studied on the basis of the analysis of medical records of outpatient and polyclinic and inpatient institutions: certificates of incapacity for work; cards of patients who left the hospital; statistical coupons for registration of specified diagnoses; emergency notifications about infectious diseases; death certificates, etc. The study of morbidity also includes quantitative (incidence rate), qualitative (morbidity structure) and individual (frequency of diseases transferred per year) assessment.

Distinguish: actual morbidity - newly emerged disease in a given year; the prevalence of the disease (soreness) - diseases that have reappeared in a given year and have passed from the previous year to the present.

The incidence of the population shows the level, frequency, prevalence of all diseases taken together and each separately among the population as a whole and its separate groups by age, sex, profession, etc.

There are methods for studying morbidity according to the data of appealability, according to the data of medical examinations and the causes of death. The incidence rates are determined by the corresponding figure per 1000, 10,000 or 100,000 people. population. The types of morbidity are as follows: general morbidity, morbidity with temporary disability, infectious morbidity, etc.

At present, the structure of mortality and morbidity is being transformed: if in the past, the most common diseases were infectious (they were the main cause of death of the population), now non-infectious diseases prevail, that is, chronic diseases - cardiovascular, oncological, neuropsychiatric diseases. , endocrine, trauma. This is due to the achievements of medicine in the fight against mass infectious diseases: vaccination, measures to protect labor and the environment (elimination of natural foci of malaria, plague, etc.), health education, etc.

Currently, among the causes of death in the first place are cardiovascular diseases, then cancer and, finally, injury. In our country, cardiovascular diseases rank first among the causes of disability.

A change in the nature of morbidity is facilitated by a rapid change in lifestyle, leading to a violation of human adaptation to the environment. The theory of civilization diseases emerged. Chronic non-epidemic diseases arise because civilization (in particular, urbanization) leads to a rapid increase in the pace of life, pulls a person out of his usual living conditions, to which he has adapted for many generations, and a person remains defenseless against the pace and rhythms of modern life. As a result, the biological rhythms of a person, his ability to adapt cease to correspond to social rhythms, that is, modern diseases, such as cardiovascular, are considered by the supporters of the theory of civilization diseases as an expression of inability to the environment of existence.

One of the most important tasks of a social work specialist is to improve medical and social adaptation, in other words, indirectly, the activities of social work specialists should help reduce the incidence of chronic non-epidemic diseases.

Disability indicators. Disability is a health disorder with a persistent disorder of the body's functions, caused by diseases, birth defects, the consequences of trauma, leading to limitation of life. Disability indicators are identified by registering data from medical and social expertise.

Indicators of physical development. Physical development - an indicator of the growth and formation of an organism - depends not only on heredity, but also on social conditions. The level of physical development of the surveyed is revealed by anthropometric and physiometric measurements of height, body weight, chest circumference, muscle strength, fat deposits, vital capacity of the lungs. Based on the data obtained, standards of physical development are established for each age-sex group. The standards serve for an individual assessment of physical development, which is carried out during medical examinations.

The level of physical development is closely related to climatic and geographical conditions and different ethnic groups.

why local standards are created. Massive from year to year repeated medical observations make it possible to judge changes in the level of physical development, and, consequently, changes in the health of the population.

The accelerated pace of physical development is called acceleration. Acceleration is observed already during the period of intrauterine development of the fetus. In the future, there is an acceleration in the growth rate of body weight, early puberty, early ossification of the skeleton. Acceleration leaves its mark on the development of the body in the future, on the manifestation of diseases at an older age. There is an assumption that acceleration increases the likelihood of developing cardiovascular diseases, diabetes mellitus, etc.

Physical development assessment is carried out for newborns; children of the 1st year of life monthly; children of early preschool age annually; before entering school; students of "decreed" classes of the school (3, 6, 8th grades).

Moscow Medical Academy. THEM. Sechenov

Department of Public Health and Health Care with a Course in Economics

Methodical instructions

Public health and methods of its study

I part

Objective:Based on the 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 N.

To achieve this goal, you must:

1. Know the sequence of conducting a statistical study (its stages) and apply this knowledge when performing an independent fragment of the course work

2. Use the following summary indicators for assessing and analyzing the state of health of the population according to information in term paper:

Relative values \u200b\u200b(extensive, intense, visibility and ratio)

Average values \u200b\u200b(mode, median, arithmetic mean); variability indicators (limit, amplitude, sigma, coefficient of variation)

3. Be able to graphically represent different types of indicators

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

· Standardization;

· Correlations;

· Evaluation of the reliability of the difference in research results (according to the "t" criterion).

5. In order to predict research results, be able to apply the method of "determining confidence limits"

Information block

The city of N. is an industrial center in the north-east of the European part of the country. It has a textile mill, a synthetic detergents, a powerful thermal power plant, a large railway junction with a car repair plant. In recent years, due to a significant increase in the number of road transport, the ecological situation has worsened: the content of harmful substances in the atmospheric air significantly exceeds the MPC, the number of green spaces has decreased.

In connection with the higher levels of certain diseases, infant mortality and other public health problems in the city of N, the city health department, 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 goal and objectives of the study, draw up a collection program and a program for the development of material (layouts of statistical tables).

There are 370 doctors of all specialties in the city's medical and preventive 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 provision of doctors in the region and city 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 dynamics of 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 state of health of the population. The results are presented below.

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

Diagram 1.b. Age structure of the city H

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

In the year under study, 750 children were born alive in the city (in the previous year 780), all of them were women aged 15 - 49 years. In a year, 1450 people died, including 11 under the age of 1 year. Data on the dynamics of demographic indicators in the city for the studied period from 1 year of observation, 5 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)

Indicators	Previous years (period)				Studied year *	Assessment of the level of indicators of the studied year **	RF levels
Indicators	2001	2002	2003	2004	2005		RF levels
Fertility	13,8	11,6	8,4	8,1	7,5	10,6
Mortality	12,1	13,7	15,6	16,3	14,5	15,9
Natural growth	1,7	-2,1	- 7,2	- 8,2	-7	-	-5,3
Fertility	55,5	45,0	36,4	35.4	32,6	-	-34
Infant mortality	18,0	17,0	15,9	14,2	-	12,4

Diagram 2.a. Fertility and mortality rates of the city population N

Conclusion: 1. There is a steady decline in the birth rate in the city of N. By 2005, the birth rate became lower than in the RF. 2. At the beginning of the reference period, the death rate in the city of N was lower than the death rate in the Russian Federation. Until 2004, this indicator grew steadily, and by the end of the year exceeded the level in the Russian Federation. However, in 2005, a tendency towards improvement began to be observed, and again it turned out to be below the mortality rate in the Russian Federation.

Diagram 2.b. Natural population growth of the year

1. During the reference period from 2001 to 2004, the natural growth of the population of the city of N has a persistent negative trend. And also at the beginning of the period (2001) there was a progressive type of population. From 2002 to 2005, the regressive type of demography of the population of the city of N. Since the indicator of natural population growth has become a "minus" sign, that is, more dies than are born.

2. Despite the fact that in 2005 there is still a negative trend in the indicators of natural population growth, in comparison with 2004 there is a relatively positive trend in this indicator.

Diagram 2.c.

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

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

Conclusion: During the reference period, infant mortality in the city of N decreased, however, the mortality 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. The construction of housing has ceased, the output of industrial enterprises has decreased, and there is a decrease in the number of people employed in social production. An increase in the number of divorces and a decrease in the number of marriages were noted. The number of children born to unmarried women has relatively increased (one in five of them has not reached the age of 20).

Significant changes were found in the indicators of age-specific fertility (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)

Indicators Age	10 years ago, per 1000 women, respectively. age	Study year
		Number of women	Live births
		Number of women	Abs.	Per 1000 women age
1	2	3	4	5
Total 15-49	45,0	23 000	750	30,6
15 –19	24,5	3 500	90	25,7
20 - 24	110,0	3 600	320	8,8
25 – 29	75,0	3 500	205	58,6
30 - 34	50,1	3 400	86	25,3
35 – 39	18,2	3 200	35	10,9
40 – 44	5,0	3 000	9	3,0
45 - 49	2,6	2 800	5	1,8

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

Conclusion: the overall fertility rate has decreased significantly 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 group 15-19, despite a 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 that do not meet sanitary and hygienic standards m2 per person, the number of “not prosperous” families is growing. The number of “difficult” teenagers and criminality is increasing. The latter is aggravated by growing unemployment due to a decrease in the number of people employed in social production, as well as an increase in prices for essential goods due to a decrease in the output of industrial enterprises and the forced import of these goods from other cities, regions, as well as from foreign countries.

Basic research methods of public health and health care.

Public health and health care have their own methodology and research methods. These methods are: statistical, historical, economic, experimental, time studies, sociological methods and others.

Statistical method is widely used in most studies: it allows you to objectively determine the level of the population's health, to determine the effectiveness and quality of the work of medical institutions.

Historical methodallows in the study to trace the state of the problem under study at different historical stages of the country's development.

Economic method allows you to establish the impact of the economy on health care and health care on the economy of the state, to determine the most optimal ways of using public funds for effective protection of public health. Planning issues financial activities health authorities and medical institutions, the most rational spending money, assessment of the effectiveness of health care actions to improve the health of the population and the impact of these actions on the country's economy - all this is the subject of economic research in the field of health care.

Experimental method includes setting up various experiments to find new, most rational forms and methods of work of medical institutions, individual health services.

It should be noted that the majority of studies predominantly use a complex technique using most of these methods. So, if the task is to study the level and state of ambulatory-polyclinic care for the population and determine the ways of its improvement, then the statistical method is used to study the incidence of the population, the appealability to polyclinic institutions, its level is historically analyzed in different periods, its dynamics. The proposed new forms in the work of polyclinics are analyzed experimentally: their economic feasibility and efficiency are checked.

The study can use the methods of timing studies (chronometry of the work of medical workers, study and analysis of the time spent by patients on receiving medical care, etc.).

Sociological methods (interviewing method, questionnaire method) are often widely used, which allows obtaining a generalized opinion of a group of people about the object (process) of study.

The source of information is mainly the state reporting documentation of medical and preventive medical institutions, or for a deeper study, the collection of material can be carried out on specially developed cards, questionnaires, which include all questions to obtain the necessary information, according to the approved research program and tasks that put before the researcher.

In the vast majority of socio-hygienic studies of group health, population health and public health in previous years it was a quantitative assessment of health. True, with the help of indicators, indices and coefficients, scientific research has always tried to assess the quality of health, i.e. tried to characterize health as a parameter of the quality of life. The very term "quality of life" in the domestic scientific literature began to be used recently, only in the last 10-15 years. This is understandable, because only then can we talk about the "quality of life" of the population when in the country (as it happened a long time ago in the developed countries of Europe, America, Japan and some other developed countries) the main material social benefits are available to the majority of the population.

According to the WHO (1999), quality of life is the optimal state and degree of perception by individuals and the population as a whole of how their needs (physical, emotional, social, etc.) are met and opportunities are provided to achieve well-being and self-realization.

In our country, the quality of life is most often understood as a category that includes a combination of living conditions and health conditions that allow achieving physical, mental, social well-being and self-realization.

Despite the absence of the generally accepted in the world concept of "quality of health" as the most important component of "quality of life", attempts are being made to give a comprehensive assessment of public health (quantitative and qualitative).

As a teaching subject, public health and health care primarily contributes to the improvement of the quality of training of future specialists - doctors; shaping their skills not only to be able to correctly diagnose and treat a patient, but also to organize a high level of medical care, the ability to clearly organize their activities.