Factors affecting human health. What does prenosological diagnostics provide? The role of medical support

Health individual and society as a whole is determined by a number of factors that affect the human body, both positively and negatively. According to the conclusions of experts from the World Health Organization, four main groups of factors determining human health have been identified, each of which has a positive and bad influence, depending on application points:

• genetic inheritance;
• Medical support;
• Lifestyle;
• Environment.

The influence of each factor on human health is also determined by age, gender, individual characteristics of the organism.

Genetic factors that determine human health

A person's capabilities are largely determined by his genotype - a set of hereditary traits embedded in the individual DNA code long before birth. However, genotypic manifestations do not appear without certain favorable or negative conditions.

Critical terms of fetal development are due to violations of its gene apparatus during the laying of organs and body systems:

• 7 weeks pregnant: the cardiovascular system- manifested by the formation of heart defects;
• 12-14 weeks: Nervous system - improper formation of the neural tube leads to congenital pathology, most often as a result of neuroinfection - cerebral palsy, demyelinating diseases (multiple sclerosis, BASF);
• 14-17 weeks: musculoskeletal system - dysplasia hip joints, myotrophic processes.

In addition to genetic changes great importance have epigenetic mechanisms as factors determining human health after birth. In these cases, the fetus does not inherit the disease, but, being exposed to harmful effects, perceives them as the norm, which subsequently affects his health. The most common example of such a pathology is maternal hypertension. Increased blood pressure in the "mother-placenta-fetus" system contributes to the development vascular changes, preparing a person for living conditions with high blood pressure, that is, the development of hypertension.

hereditary diseases are divided into three groups:

• Gene and chromosomal abnormalities;
• Diseases associated with a violation of the synthesis of certain enzymes in conditions that require their increased production;
• hereditary predisposition.

Genetic and chromosomal abnormalities, such as phenylketonuria, hemophilia, Down syndrome, appear immediately after birth.

Fermentopathies, as factors that determine human health, begin to affect only in those cases when the body cannot cope with the increased load. This is how diseases associated with metabolic disorders begin to appear: diabetes mellitus, gout, neurosis.

Hereditary predisposition appears under the influence of environmental factors. Unfavorable environmental and social conditions contribute to the development of hypertension, gastric and duodenal ulcers, bronchial asthma and other psychogenic disorders.

Social factors of human health

Social conditions largely determine the health of people. An important place is occupied by the level of economic development in the country of residence. Sufficient money plays a dual role. On the one hand, all types of medical care are available to a rich person, on the other hand, health care is replaced by other things. Low-income people, oddly enough, are more likely to strengthen the immune system. Thus, the factors of human health do not depend on his financial situation.

The most important component healthy lifestyle life is the correct psychological attitude, aimed at a long life span. People who want to be healthy exclude factors that destroy human health, considering them incompatible with the norms. Regardless of place of residence, ethnicity, income level, everyone has the right to choose. Being isolated from the benefits of civilization, or using them, people are equally able to observe the elementary rules of personal hygiene. On the hazardous industries provided necessary measures personal safety, the observance of which leads to positive results.

The widely known concept of acceleration belongs to the social factors of human health. The child of the 21st century in terms of development is much superior to his peers of the 19th and early 20th centuries. The acceleration of development is directly related to the achievements of technological progress. The abundance of information encourages early development intelligence, skeleton and muscle mass. In this regard, in adolescents, there is a lag in the growth of blood vessels, which leads to early diseases.

Natural factors of human health

In addition to hereditary and constitutional features, environmental factors influence human health.

Natural effects on the body are divided into climatic and urban. The sun, air and water are far from the most important components of the environment. Energy impacts are of great importance: from the electromagnetic field of the earth to radiation.

People living in areas with a harsh climate have a greater margin of safety. However, the expenditure of vital energy in the struggle for survival among northerners is not comparable with those people who live in conditions where favorable natural factors of human health are combined, such as the action of a sea breeze, for example.

Environmental pollution due to the development of industry is capable of affecting at the gene level. And this action is almost never beneficial. Multiple factors that destroy human health contribute to the shortening of life, despite the fact that people try to lead a correct lifestyle. The impact of harmful substances in the environment today is the main problem for the health of residents of megacities.

Constitutional factors of human health

Under the constitution of a person is meant a feature of the physique, which determines the tendency to certain diseases. In medicine, these types of human constitution are divided:

The most favorable body type is normosthenic.

People of the asthenic type of constitution are more prone to infections, weakly resistant to stress, therefore they more often develop diseases associated with innervation disorders: peptic ulcer, bronchial asthma.

Persons of the hypersthenic type are more prone to the development of cardiovascular diseases and metabolic disorders.

According to the WHO, the main (50-55%) factor influencing a person's health is his lifestyle and living conditions. Therefore, the prevention of morbidity in the population is a task not only medical workers, but also government agencies that ensure the level and life expectancy of citizens.

On conditionhealth human influence various indicators. To keep good physical form and remain psycho-emotionally stable, you need to pay attention to the quality of your life in a multifactorial natural and social environment. What are the known factors affecting people's health and how to live a longer life, we learn from the article.

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Known Factors

Human health can be affected by various visible and invisible factors. Also known are ways to improve the physical, emotional, psychological state.

All factors affecting human health:

• genetics;
• medicine, healthcare;
• : climate, flora, landscape;
• Lifestyle;
• physical;
• biological;
• chemical.

Experts classify the above factors to the following types:

1. Social and economic;
2. Ecological - human communication with the outside world and constant indicators;
3. Hereditary - the presence of diseases, anomalies in the structure of the human body, inherited;
4. Medical - providing assistance to the population, the frequency and quality of examinations, disease prevention.

All four factors directly affect a person's well-being. Here side effects to consider: age, climatic conditions of the place of residence, individual indicators. However, the general average indicators of the influence of each factor separately on the population are determined:

• lifestyle — 55%;
• environment - 25%;
• genetics - 10%;
• medicine - 10%.

Harmful factors affecting human health:

• harmful addictions;
• incorrect distribution of working time;
• wrong diet;
• poor living conditions;
• poor environmental conditions;
• chemically polluted atmosphere;
• biological factors;
• lack of medical examination;
• genetic predisposition to disease.

Influence of genetic factors

On the general state health directly affectsheredity.

A person with genes inherited from his parents begins to adapt to the world.

This factor affects the physical and emotional state.

The gene is subject to natural selection.

It can make the owner more resistant to diseases and other aggressive factors, or, on the contrary, worsen the state of health.

Important! Each cell carries a large number of genes that control the processes of human development. A newborn baby has a set of genes from both parents. These traits are passed on to the next generation.

It has been proven that marriage between relatives increases the risk of diseases by fifty times, the mortality rate among such people is much higher. Genes are very sensitive to harmful influence environment, misbehavior of people, having bad habits.

When planning a child, future parents should prepare for conception several months in advance, providing all the conditions for the birth healthy baby. If this factor is foreseen, then it is possible to significantly reduce the risk of the influence of heredity on the unborn child and lay down a healthy gene code for him.

Influence of lifestyle

The impact of lifestyle on human health is enormous! A person who leads a healthy lifestyle feels full of energy, visits doctors less often and has clearly more advantages than those who do not follow their health and have bad habits.

Lifestyle has an impact into three environments:

• the closest environment of a person: friends, acquaintances, colleagues, family;
• an environment that includes people united by ethnicity, standard of living, place of residence;
• an environment that includes all people living in a particular country, who are united by social and economic relations, climatic conditions.

Each person has an impact not only on himself, but also on the people around him. The chosen way of life can be constructive or destructive.

Negative factors such as alcohol, smoking, drugs, can cause serious illness.

Also, lifestyle concerns not only physical, but also mental, mental aspects.

A lot is said about a person by what he is fond of, whether he goes in for sports, whether he follows his diet.

Attention! Scientists have found that bad habits are passed on through the parental line even after several generations. This means that any incorrect choice fraught with health loss in offspring.

It is important that at the national level a positive outlook on . To change the situation, you need to understand what impact the following factors have on human health:

• inactivity, lack of physical activity of the population;
• glut of junk food and GMOs in products, which leads to obesity and disease;
• the active rhythm of life leads to stress, the nervous system suffers;
• bad habits: alcohol, smoking, sexual promiscuity.

Environmental influence

Influence of environmental factors for a healthy lifestyle is huge. Human intervention in the natural environment, even with good intentions, also has direct impact on the environment, and it subsequently affects the human body.

In addition to human impact on the ecological situation, the following environmental factors influence health:

• temperature;
• air humidity;
• vibration;
• radiation;
• wind gusts,;
• electromagnetic and sound vibrations.

For well-being and normal life influenced by weather conditions. They can cause pressure drops, exacerbate joint diseases, and lead to headaches.

If a person is healthy, then the change in weather conditions will pass without consequences. However, weather-sensitive people feel unwell.

AT recent times a person constantly experiences the influence of electromagnetic waves, radiation. It is emitted by all household appliances, telephones. Radiation affects not only the physical state of the body, but also destabilizes the psyche, changes the functioning of organs.

Important! The regular influence of electromagnetic waves adversely affects nervous system, immunity, thyroid gland, . For several decades, the number of oncological pathologies has increased.

Environmental factors include the influence of radiation. All living beings are exposed to background radiation. Radiation leads to a change in the genetic structure, slows down the regeneration processes, impairs the function of the digestive tract.

Socio-economic factors

The economic situation in the country, as a factor, is one of the decisive ones for the health of the population. This also includes medical care. Although now medicine is less and less focused on health, and more and more on the treatment of diseases. Currently, the structure of morbidity has changed: infections are ill in 10% of cases, and 40% of the incidence is due to mental disorders, alcoholism, and drug addiction.

Important! Of the majority of deaths, the most common causes are diseases such as: atherosclerosis, obesity, mental disorders, oncology.

Now medicine is aimed at treating these pathologies, and not at preventing the problem.

Chemical Factors

Chemical pollution of the planet- this is far from a fairy tale, but a reality in which we live constantly. Even in the womb, the fetus is at risk of getting chemical harm which affects health and quality of life.

Pollution of water bodies, increased radiation background - all this becomes the cause of huge amount diseases.

Chemical compounds penetrate through food, oxygen, and drink. Negative influence may have the following chemical factors:

• synthetic food additives, pesticides;
• household chemicals, hygiene products;
• medicines and biological additives;
• additives for the growth of animals, birds;
• building materials, paints;
• industrial waste;
• exhaust gases, etc.

Chemical elements especially dangerous due to the rapid accumulation in the body, and it is not so easy to remove them. As a result, the human body is prone to the manifestation of allergic reactions, various pathologies associated with nervous diseases, the liver and kidneys are affected. There is a risk of developing asthma.

Among the many facts about a person, I would like to note the following:

• The human skull is made up of twenty-nine bones;
• the body stops working when sneezing, including heart function;
• the nervous reaction has a speed of two hundred kilometers per hour;
• the child still in the womb at 3 months receives unique fingerprints;
• a woman's heart beats faster than a man's;
• right-handers live longer than left-handers;
• length of blood vessels in the body equals one hundred thousand km;
• there are about a hundred viruses that cause a runny nose;
• a smoker absorbs half a cup of tar in a year;
• after 60 people lose 50% taste buds, decreased sense of smell, vision;
• a tooth is the only part of a person that is not capable of self-healing.\

What affects our health

The main factors that affect the body

Conclusion

Harmful factors affecting human health can be reduced if you are attentive to your body, give up bad habits, improve your diet, and play sports. Healthy people can adapt in time to social, biological, chemical factors. Man is the only organism on the planet that has the ability to adapt the environment to suit itself. Be healthy!

To strengthen and maintain the health of healthy people, that is, to manage it, information is needed both about the conditions for the formation of health (the nature of the implementation of the gene pool, the state of the environment, lifestyle, etc.), and the final result of the processes of their reflection (specific indicators of the health status of the individual or population).

World Health Organization (WHO) experts in the 80s. 20th century determined the approximate ratio of various factors for ensuring the health of a modern person, highlighting four groups of such factors as the main ones. Based on this, in 1994, the Interdepartmental Commission of the Security Council of the Russian Federation for the protection of public health in the Federal concepts "Protection of public health" and "K healthy Russia"defined this ratio in relation to our country as follows:

genetic factors - 15-20%;

state of the environment - 20-25%;

medical support - 10-15%;

conditions and way of life of people - 50-55%.

Contribution amount individual factors of different nature on health indicators depends on age, gender and individual typological characteristics of a person. The content of each of the factors of ensuring health can be determined as follows (Table 11).

Let's take a closer look at each of these factors.

Table 11 - Factors affecting human health

Genetic factors

The ontogenetic development of daughter organisms is predetermined by the hereditary program that they inherit with parental chromosomes.

However, the chromosomes themselves and their structural elements - genes, can be exposed to harmful influences, and, most importantly, throughout the life of future parents. A girl is born into the world with a certain set of eggs, which, as they mature, are sequentially prepared for fertilization. That is, in the end, everything that happens to a girl, a girl, a woman during her life before conception, to one degree or another, affects the quality of chromosomes and genes. The life expectancy of a spermatozoon is much less than that of an egg, but their life span is also sufficient for the occurrence of disturbances in their genetic apparatus. Thus, it becomes clear the responsibility that future parents bear to their offspring throughout their entire life prior to conception.

Often, factors beyond their control, which include adverse environmental conditions, complex socio-economic processes, uncontrolled use of pharmacological preparations, etc., also affect. The result is mutations that lead to the occurrence of hereditary diseases or to the appearance of a hereditary predisposition to them.

In the inherited prerequisites for health, factors such as the type of morphofunctional constitution and the characteristics of nervous and mental processes, the degree of predisposition to certain diseases are especially important.

Life dominants and attitudes of a person are largely determined by the constitution of a person. Such genetically predetermined features include the dominant needs of a person, his abilities, interests, desires, predisposition to alcoholism and other bad habits, etc. Despite the significance of the influences of the environment and upbringing, the role of hereditary factors turns out to be decisive. This fully applies to various diseases.

This makes it clear the need to take into account the hereditary characteristics of a person in determining the optimal lifestyle for him, the choice of profession, partners in social contacts, treatment, the most suitable type loads, etc. Often, society makes demands on a person that conflict with the conditions necessary for the implementation of programs embedded in genes. As a result, many contradictions constantly arise and overcome in human ontogenesis between heredity and the environment, between various systems of the body, which determine its adaptation as complete system, etc. In particular, this is extremely important in choosing a profession, which is quite relevant for our country, since, for example, only about 3% of people employed in the national economy of the Russian Federation are satisfied with their chosen profession - apparently, Last but not least here is the discrepancy between the inherited typology and the nature of the professional activity performed.

Heredity and environment act as etiological factors and play a role in the pathogenesis of any human disease, however, the share of their participation in each disease is different, and the greater the share of one factor, the less the contribution of another. All forms of pathology from this point of view can be divided into four groups, between which there are no sharp boundaries.

The first group consists of actually hereditary diseases, in which the pathological gene plays an etiological role, the role of the environment is to modify only the manifestations of the disease. This group includes monogenic diseases (such as, for example, phenylketonuria, hemophilia), as well as chromosomal diseases. These diseases are transmitted from generation to generation through germ cells.

The second group is also hereditary diseases caused by a pathological mutation, but their manifestation requires a specific environmental impact. In some cases, the “manifesting” effect of the environment is very obvious, and with the disappearance of the effect of the environmental factor, clinical manifestations become less pronounced. These are the manifestations of HbS hemoglobin deficiency in its heterozygous carriers at a reduced partial pressure of oxygen. In other cases (for example, with gout), a long-term adverse effect of the environment is necessary for the manifestation of a pathological gene.

The third group is the vast majority of common diseases, especially diseases of mature and old age (hypertension, gastric ulcer, most malignant tumors, etc.). The main etiological factor in their occurrence is the adverse effects of the environment, however, the implementation of the effect of the factor depends on the individual genetically determined predisposition of the organism, and therefore these diseases are called multifactorial, or diseases with a hereditary predisposition.

It should be noted that different diseases with a hereditary predisposition are not the same in the relative role of heredity and environment. Among them, one could single out diseases with a weak, moderate and high degree of hereditary predisposition.

The fourth group of diseases is a relatively few forms of pathology, in the occurrence of which the environmental factor plays an exceptional role. Usually this is an extreme environmental factor, in relation to which the body has no means of protection (injuries, especially dangerous infections). Genetic factors in this case play a role in the course of the disease and influence its outcome.

Statistics show that in the structure of hereditary pathology, a predominant place belongs to diseases associated with the lifestyle and health of future parents and mothers during pregnancy.

Thus, there is no doubt about the significant role that hereditary factors play in ensuring human health. At the same time, in the vast majority of cases, taking these factors into account through the rationalization of a person's lifestyle can make his life healthy and long-lasting. And, on the contrary, the underestimation of the typological characteristics of a person leads to vulnerability and defenselessness before the action of adverse conditions and circumstances of life.

State of the environment

The biological characteristics of the body are the basis on which human health is based. In the formation of health, the role of genetic factors is important. However, the genetic program received by a person ensures its development under certain environmental conditions.

“An organism without an external environment that supports its existence is impossible” - in this thought I.M. Sechenov laid the inseparable unity of man and his environment.

Each organism is in a variety of mutual relationships with environmental factors, both abiotic (geophysical, geochemical) and biotic (living organisms of the same and other species).

Under environment It is customary to understand an integral system of interrelated natural and anthropogenic objects and phenomena in which work, life and recreation of people take place. This concept includes social, natural and artificially created physical, chemical and biological factors, that is, everything that directly or indirectly affects human life, health and activities.

Man, as a living system, is an integral part of the biosphere. The impact of man on the biosphere is associated not so much with his biological as with labor activity. It is known that technical systems have a chemical and physical impact on the biosphere through the following channels:

through the atmosphere (the use and release of various gases disrupts natural gas exchange);

through the hydrosphere (pollution chemicals and oil from rivers, seas and oceans);

through the lithosphere (use of minerals, soil pollution by industrial waste, etc.).

Obviously, the results of technical activity affect those parameters of the biosphere that provide the possibility of life on the planet. Human life, as well as human society as a whole, is impossible without the environment, without nature. Man as a living organism is characterized by the exchange of substances with the environment, which is the main condition for the existence of any living organism.

The human body is largely associated with the rest of the components of the biosphere - plants, insects, microorganisms, etc., that is, its complex organism enters the general circulation of substances and obeys its laws.

A continuous supply of atmospheric oxygen, drinking water, food is absolutely necessary for human existence and biological activity. Human body subject to daily and seasonal rhythms, responds to seasonal changes in ambient temperature, solar radiation intensity, etc.

At the same time, a person is a part of a special social environment - society. Man is not only a biological being, but also a social one. The obvious social basis for the existence of man as an element of the social structure is the leading, mediating his biological modes of existence and the administration of physiological functions.

The doctrine of the social essence of man shows that it is necessary to plan the creation of such social conditions its development, in which all its essential forces could unfold. In strategic terms, in optimizing living conditions and stabilizing human health, the most important thing is the development and introduction of a scientifically based general program for the development of biogeocenoses in an urbanized environment and the improvement of a democratic form of social structure.

Medical support

It is with this factor that most people link their hopes for health, but the share of responsibility of this factor turns out to be unexpectedly low. The Great Medical Encyclopedia gives the following definition of medicine: "Medicine is a system of scientific knowledge and practice, the purpose of which is to strengthen, prolong the life of people, prevent and treat human diseases."

With the development of civilization and the spread of diseases, medicine has become increasingly specialized in the treatment of diseases and less and less attention paid to health. The treatment itself often reduces the stock of health due to the side effects of drugs, that is, medical medicine does not always improve health.

In medical prevention of morbidity, three levels are distinguished:

first-level prevention is focused on the entire contingent of children and adults, its task is to improve their health throughout the entire life cycle. The basis of primary prevention is the experience of forming means of prevention, the development of recommendations for a healthy lifestyle, folk traditions and ways of maintaining health, etc.;

medical prevention of the second level is engaged in identifying indicators of the constitutional predisposition of people and risk factors for many diseases, predicting the risk of diseases based on a combination of hereditary characteristics, anamnesis of life and environmental factors. That is, this type of prevention is focused not on the treatment of specific diseases, but on their secondary prevention;

Level 3 prophylaxis, or disease prevention, aims to prevent disease recurrence in patients on a population scale.

The experience accumulated by medicine in the study of diseases, as well as the economic analysis of the costs of diagnosing and treating diseases, have convincingly demonstrated the relatively small social and economic effectiveness of disease prevention (prevention of III level) in improving the health of both children and adults.

It is obvious that the most effective should be primary and secondary prevention, which involves working with healthy or just starting to get sick people. However, in medicine, almost all efforts are focused on tertiary prevention. Primary prevention involves close cooperation between the doctor and the population. However, the healthcare system itself does not provide him with the necessary time for this, so the doctor does not meet with the population on prevention issues, and all contact with the patient is spent almost entirely on examination, examination and treatment. As for the hygienists who are closest to realizing the ideas of primary prevention, they are mainly concerned with the provision of a healthy environment, not human health.

The ideology of an individual approach to the issues of prevention and health promotion underlies the medical concept of universal medical examination. However, the technology for its implementation in practice turned out to be untenable for the following reasons:

it takes a lot of means to identify possible more diseases and their subsequent association in dispensary observation groups;

the dominant orientation is not on the prognosis (prediction of the future), but on the diagnosis (statement of the present);

leading activity belongs not to the population, but to physicians;

a narrowly medical approach to recovery without taking into account the diversity of the socio-psychological characteristics of the individual.

The valeological analysis of the causes of health requires a shift in the focus of attention from medical aspects to physiology, psychology, sociology, cultural studies, to the spiritual sphere, as well as specific modes and technologies of education, upbringing and physical training.

The dependence of human health on genetic and environmental factors makes it necessary to determine the place of the family, schools, state, sports organizations and health authorities in the implementation of one of the main tasks of social policy - the formation of a healthy lifestyle.

Conditions and lifestyle

Thus, it becomes clear that the diseases of modern man are caused, first of all, by his way of life and everyday behavior. Currently, a healthy lifestyle is considered as the basis for disease prevention. This is confirmed, for example, by the fact that in the United States, the reduction in infant mortality by 80% and the mortality of the entire population by 94%, the increase in life expectancy by 85% is associated not with the successes of medicine, but with the improvement of living and working conditions and the rationalization of the way the life of the population. At the same time, in our country, 78% of men and 52% of women unhealthy image life.

In defining the concept of a healthy lifestyle, it is necessary to take into account two main factors - the genetic nature of a given person and its compliance with specific living conditions.

A healthy lifestyle is a way of life that corresponds to the genetically determined typological characteristics of a given person, specific living conditions and is aimed at the formation, preservation and strengthening of health and the full performance by a person of his socio-biological functions.

In the above definition of a healthy lifestyle, the emphasis is on the individualization of the concept itself, that is, there should be as many healthy lifestyles as there are people. In determining a healthy lifestyle for each person, it is necessary to take into account both his typological features (type of higher nervous activity, morphofunctional type, the predominant mechanism of autonomic regulation, etc.), and age and gender and the social environment in which he lives (family position, profession, traditions, working conditions, material support, life, etc.). An important place in the initial assumptions should be occupied by the personality-motivational characteristics of a given person, his life guidelines, which in themselves can be a serious incentive to a healthy lifestyle and to the formation of its content and features.

The formation of a healthy lifestyle is based on a number of key provisions:

An active carrier of a healthy lifestyle is a specific person as a subject and object of his life and social status.

In the implementation of a healthy lifestyle, a person acts in the unity of his biological and social principles.

The formation of a healthy lifestyle is based on a person's personal motivational attitude to the realization of his social, physical, intellectual and mental capabilities and abilities.

A healthy lifestyle is the most effective means and method of ensuring health, primary prevention of disease and meeting the vital need for health.

Quite often, unfortunately, the possibility of maintaining and strengthening health through the use of some remedy with miraculous properties (motor activity of one kind or another, nutritional supplements, psycho-training, body cleansing, etc.) is considered and proposed. Obviously, the desire to achieve health at the expense of any one means is fundamentally wrong, since any of the proposed "panacea" is not able to cover the whole variety of functional systems that form the human body, and the relationship of man himself with nature - all that ultimately determines the harmony of his life and health.

According to E. N. Weiner, the structure of a healthy lifestyle should include the following factors: optimal motor mode, rational nutrition, rational mode of life, psychophysiological regulation, psychosexual and sexual culture, immunity training and hardening, the absence of bad habits and valeological education.

The new paradigm of health is clearly and constructively defined by Academician N. M. Amosov: “To become healthy, you need your own efforts, constant and significant. Nothing can replace them."

A healthy lifestyle as a system consists of three main interrelated and interchangeable elements, three cultures: a culture of food, a culture of movement and a culture of emotions.

Food culture. In a healthy lifestyle, nutrition is decisive, system-forming, as it has a positive effect on motor activity and emotional stability. With proper nutrition, food best matches the natural technologies for the assimilation of nutrients developed during evolution.

Movement culture. The health effect of aerobic physical exercises(walking, jogging, swimming, skiing, gardening, etc.) natural conditions. They include sun and air baths, cleansing and hardening water procedures.

The culture of emotions. Negative emotions (envy, anger, fear, etc.) have tremendous destructive power, positive emotions (laughter, joy, gratitude, etc.) preserve health and contribute to success.

The formation of a healthy lifestyle is an extremely long process and can last a lifetime. Feedback from the changes that occur in the body as a result of following a healthy lifestyle does not work immediately, the positive effect of switching to a rational lifestyle is sometimes delayed for years. Therefore, unfortunately, quite often people only “try” the transition itself, but, having not received a quick result, they return to their previous way of life. There is nothing surprising. Since a healthy lifestyle involves the rejection of many pleasant living conditions that have become habitual (overeating, comfort, alcohol, etc.) and, conversely, constant and regular heavy loads for a person who is not adapted to them and strict regulation of lifestyle. In the first period of the transition to a healthy lifestyle, it is especially important to support a person in his desire, provide the necessary consultations, point out positive changes in his state of health, in functional indicators, etc.

At present, there is a paradox: with an absolutely positive attitude towards the factors of a healthy lifestyle, especially in relation to nutrition and motor mode, in reality only 10% -15% of the respondents use them. This is not due to the lack of valeological literacy, but due to the low activity of the individual, behavioral passivity.

Thus, a healthy lifestyle should be purposefully and constantly formed during a person's life, and not depend on circumstances and life situations.

The effectiveness of a healthy lifestyle for a given person can be determined by a number of biosocial criteria, including:

assessment of morphofunctional indicators of health: level physical development, the level of physical fitness, the level of human adaptive capabilities;

assessment of the state of immunity: the number of colds and infectious diseases during a certain period;

assessment of adaptation to the socio-economic conditions of life (taking into account the effectiveness professional activity, successful activity and its "physiological value" and psychophysiological features); activity in the performance of family and household duties; breadth and manifestations of social and personal interests;

assessment of the level of valeological literacy, including the degree of formation of the attitude towards a healthy lifestyle (psychological aspect); level of valeological knowledge (pedagogical aspect); the level of assimilation of practical knowledge and skills related to the maintenance and promotion of health (medical-physiological and psychological-pedagogical aspects); the ability to independently build an individual program of health and a healthy lifestyle.

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Today, environmental problems have arisen on our planet, food cannot give the body all the necessary nutrients, it contains many harmful components, many have weakened immunity, sick children are born - a natural result of a breakdown in communication with the outside world.

The factors that affect the health of each person can be listed:

1. Nutrition;

3. Lifestyle;

4. Heredity;

5. Medicine;

The World Health Organization claims that the environment affects human health by 20%, heredity - by 10%, medicine is also only 10%.

Prevention. Medical prevention. Kinds.

PREVENTION - a complex of state, social. And medical measures aimed at preserving and strengthening the health of citizens, raising a healthy young generation, and increasing working longevity.

MED.PROPHYLAXIKA - a set of measures aimed at eliminating the causes and conditions that give rise to the disease.

1. Primary (radical) is aimed at eliminating the causes of the disease by improving working and living conditions. Primary prevention includes socio-economic measures of the state to improve the lifestyle, environment, education, etc. Preventive activities are mandatory for all medical workers. It is no coincidence that polyclinics, hospitals, dispensaries, maternity hospitals are called medical and preventive institutions.

2. Secondary to be carried out among apparently healthy citizens in order to determine premorbid conditions in people with increased risk disease development. It is aimed at increasing the body's resistance (treatment-prophylactic nutrition, personal protective equipment. The most effective method of secondary prevention is medical examination as complex method early detection of diseases, dynamic monitoring, targeted treatment, rational consistent recovery.

3. Tertiary (rehabilitation) is aimed at preventing complications, relapses of already developed diseases, the transition of diseases to chronic form. The creation of a system for preventing diseases and eliminating risk factors is the most important socio-economic and medical task states. Allocate individual and social prevention. Tertiary prevention aims at social (the formation of confidence in one's own social suitability), labor (the possibility of restoring labor skills), psychological (restoration of the behavioral activity of the individual) and medical (restoration of the functions of organs and systems) rehabilitation.

Prevention (other Greek prophylaktikos - protective)- complex various kinds measures aimed at preventing a phenomenon and/or eliminating risk factors.

Preventive measures are the most important component of the healthcare system, aimed at creating medical and social activity among the population and motivation for a healthy lifestyle.

Types of prevention

Depending on the state of health, the presence of risk factors for the disease or severe pathology, three types of prevention can be considered.

Primary prevention- a system of measures to prevent the occurrence and impact of risk factors for the development of diseases (vaccination, rational mode work and rest, rational quality nutrition, physical activity, environmental protection, etc.). A number of primary prevention activities can be carried out nationwide.

Secondary prevention- a set of measures aimed at eliminating pronounced risk factors that, under certain conditions (stress, weakened immunity, excessive loads on any other functional systems of the body) can lead to the onset, exacerbation and recurrence of the disease. The most effective method of secondary prevention is prophylactic medical examination as a complex method of early detection of diseases, dynamic monitoring, targeted treatment, rational consistent recovery.

Some experts suggest the term tertiary prevention as a set of measures for the rehabilitation of patients who have lost the possibility of a full life. Tertiary prevention is aimed at social (formation of confidence in one's own social suitability), labor (the possibility of restoring work skills), psychological (restoration of behavioral activity) and medical (restoration of the functions of organs and body systems) rehabilitation.

Environmental and health factors. risk factor. Definition, classification.

Under the environment, modern medical science understands the totality of everything that surrounds a person in everyday life and directly or indirectly affects his health and the conditions of this life. In the broad sense of the term "Environment" (OS), it includes our entire planet and space in which it is located. In a narrower sense, the OS is only the biosphere, i.e. the natural shell of the Earth, in which all living organisms inhabiting it are concentrated. The main components of the natural environment are soil (lithosphere), solar radiation and other cosmic factors, air (atmosphere) and water (hydrosphere) shells. Their initial physical and chemical properties, the nature and level of pollution form the ecological conditions of human life and activity.

Physical factors: solar radiation and other physical effects of cosmic origin (galactic, moon, interplanetary magnetic field, etc.), temperature, humidity, air speed and pressure, temperature of enclosing surfaces (radiation temperature from building structures, soil, equipment, etc.), noise, vibration, ionizing radiation, illumination, electromagnetic waves, etc. Starting from certain levels of intensity, they can cause disturbances: mutagenic effects, radiation, altitude and vibration diseases, heat stroke, etc.

Chemical Factors: natural and artificial origin chemical elements and compounds (pollutants) that are part of air, water, soil, food products, building materials, clothing, footwear, various household and interior items, household electrical appliances, industrial equipment, etc.

Biological factors: harmless and harmful microorganisms, viruses, worms, fungi, various animals and plants and their metabolic products. Physical, chemical, and, to a certain extent, biological factors can be both natural and artificial (anthropogenic-technogenic) origin, more often a combination of these factors affects a person. It should be borne in mind that in addition to the listed material factors, a person is also significantly influenced by informational and psychological factors - the impact of the spoken and printed word, auditory and visual perceptions. Almost all diseases are the result of the interaction of the environment and the internal environment of a person. As a result of exposure to an inadequate factor, a new ext. Factor (mutations).

Changes in the state of health under the influence of anthropogenic factors:

1) an increase in the incidence and a change in its structure:

Allergic diseases

Malignant tumors

Diseases of the blood.

2) chronicity of the disease

3) decline immunobiological reactivity organism (nutrition, social factors)

4) decrease in reproductive function

5) increased mutation in the human population (chromosomal abnormalities)

6) decrease in intellectual potential

7) the appearance of previously unknown diseases (chronic fatigue syndrome).

Risk factor - Factors that do not play an etiological role, but increase the likelihood of a disease, for example, a constitutional predisposition in psychogenic reactions, alcoholism in relation to metalluetic psychoses. Risk factors are assessed by comparing the risk of those who are exposed to a potential risk factor with those who are not.

Assessment of the risk of adverse effects in accordance with international recommendations.

Health risk assessment:

1) the process of establishing the likelihood of development and the severity of adverse effects on human health, due to the impact of environmental factors.

2) scientific assessment toxic properties the chemical and the conditions of its exposure to humans, aimed at establishing the likelihood that exposed people will be affected, as well as characterizing the nature of the effects that they may experience;

3) identification of danger, its reality, assessment of exposure, intensity of the factor, frequency, duration of action in the past, present and future, risk notification, risk management (development of methods to prevent or reduce risk).

Risk assessment consists of the following stages: hazard identification, exposure-response assessment, exposure assessment, risk characterization. Assessment of the comparative significance of risks is the stage of risk characterization, which involves determining the comparative significance of identified hazards and calculated risks to public health. Risk assessment aims to identify the levels and causes of risk and provide individuals with the most complete and objective information necessary for making effective management decisions.

Human health risk assessment is a quantitative and/or qualitative characteristic harmful effects developing or capable of developing as a result of existing or possible impact environmental factors on a specific group of people under specific, regionally determined exposure conditions. The results of the risk assessment are advisory in nature and are used to justify and make decisions on risk management.

Risk assessment is generally carried out in accordance with the following steps:

1. Hazard identification (assessment of the risk to human health of the studied substances, compilation of a list of priority chemical compounds);

2. Evaluation of the "exposure-response" relationship (establishing quantitative relationships between exposure levels, frequency and severity of adverse effects, selection of indicators for subsequent risk assessment);

3. Evaluation of the exposure (impact) of chemicals on humans, taking into account the influencing media, the duration of exposure, the characteristics of the exposed population groups and the routes of entry of chemicals into the body;

4. Risk characterization: analysis of all data obtained, calculation of risks for the population and its individual subgroups, comparison of risks with acceptable (acceptable) levels, comparative assessment of risks according to their degree of significance, establishment of medical priorities and those risks that should be prevented or reduced to acceptable level.

High - not acceptable for production conditions and the population. It is necessary to implement measures to eliminate or reduce the risk. Medium - acceptable for production conditions; Short - acceptable risk(the level at which, as a rule, hygienic standards are set for the population. Minimal - the desired (target) risk value during health and environmental activities does not require any corrective actions aimed at reducing the risk.

Modern methodology comparative assessment Risk Management provides for a parallel consideration of health risks, environmental risks due to ecosystem disruption and harmful effects on aquatic and terrestrial organisms (except humans), risks of reduced quality and deterioration of living conditions. Risk analysis - the process of obtaining the information needed to prevent negative consequences for public health, consisting of three components: risk assessment, risk management, risk communication.

Comprehensive hygienic assessment. Research methods used in gig.diagnostics.

it comprehensive study natural, social environment and health status, followed by the identification of the regular dependence of health on the quality of the environment. Includes: study of the intensity, duration, frequency of the impact of factors on individual person and a group of people diagnostics of the state of health of individuals, groups of people, especially hypersensitive (teenagers, children); establishing the contribution of factors to the violation of the health status of an individual, groups of people, hypersensitive groups of people.

METHODS:

2. Physical. - instrumental, when using instruments to study physical parameters (temperature, humidity, radiation, air ionization)

4. Biol. - bacteriological and helminthological (the presence of eggs in the soil, vegetables, etc.) the number of bacteria in the reservoir does not exceed hundreds per 1 ml.

5. Epidemiological - when studying morbidity rates, it is associated with sanitary-statistical, which uses official data reports. The latter studies the total impact of social, economic, natural. Health conditions.

6. Clinical studies in dozonological diagnostics, in the study of professional diseases, the development of adequate methods of profiling and treatment.

Prenosological diagnostics. The medical methods of researches used at a gigabyte. diagnostics.

This is an assessment of the functional state of the body and its adaptive capabilities in a period when there are still no obvious signs of disease.

GOAL: early detection of primorbid conditions in the form of: tension of adaptation mechanisms, unsatisfactory or failure of adaptation; development and implementation of adequate methods of disease profiling.

ASSESSMENT OF ADAPTATION SYSTEMS INCLUDES Key words: immunological status, state of enzymatic systems, antioxidant systems, psychol. Testing, FLOOR, regulatory mechanisms CCC. In practically healthy people, the following is revealed: 40% tension of adaptation, 25% unsatisfactory, 9% breakdown.

What does prenosological diagnostics provide?

1. Early detection developing disease before the onset of clinical symptoms (latent forms of the course).

2. Identification of critical conditions that can lead to exacerbation of existing diseases.

3. Select the system or organ that requires priority intervention.

4. Indicates the system with the greatest degree of damage.

5. Evaluation of violations of vitamin and microelement balance and targeted prescription of biocorrectors.

6. Tracking the effectiveness of any wellness procedures and the dynamics of the state of health.

Contraindications to the use of prenosological diagnostics:

1. Acute infectious diseases with febrile syndrome.

2. Traumatic amputation of the phalanges of the fingers.

3. Congenital malformations of the limbs.

4. Age less than 4 years.

5. Severe hearing and speech disorders.

6. Violations of consciousness.

METHODS:

1. Sanitary description of environmental objects, living and working conditions, the nature of nutrition and the pathology associated with all this.

2. Physical. - instrumental, when using instruments to study physical parameters (temperature, humidity, radiation, air ionization)

3. Chem. - in the form of a qualitative and quantitative analysis for the study of products and the state of air, water, soil, the determination of pesticides, metals, gases, etc., cat. can harm.

4. Biol. - bacteriological and helminthologist (the presence of eggs in the soil, vegetables, etc.). The number of bacteria in the reservoir does not exceed hundreds per 1 ml.

5. Epidemiological - in the study of incidence rates, it is associated with sanitary-statistical, cat. uses official reporting data. The latter studies the total impact of social, economic, natural. Health conditions.

6. Clinical research - in dozonological diagnostics, in the study of professional diseases, the development of adequate methods of profiling and treatment.

7. Method gig. experiment - will investigate the influence of various factors on humans and experimental animals.

8. Laboratory modeling-experimental establishment of maximum allowable concentrations and levels (MAC, MPC), indicative safe exposure levels (OBUV) and other indicators, cat. called gig. standards.

9. To modern. Physical-chemical methods include: spectrometric, radiometric, dosimetric, luminescent analysis, etc.

Social gig monitoring. Information subsystems of monitoring.

1. Social and hygienic monitoring is a system of organizational, sanitary and epidemiological, medical, social, scientific, technical, methodological and other measures aimed at organizing monitoring of the state of sanitary and epidemic welfare of the population, its assessment and forecasting of changes to establish, prevent, eliminate or reduce the factors of the harmful effects of the environment on human health.

2. Social and hygienic monitoring is carried out at the republican, regional and local levels by sanitary and epidemiological institutions

3. The main purpose of social and hygienic monitoring is to identify levels of risk for, based on systems for monitoring the state of health and the environment.

4. When conducting social and hygienic monitoring, the following are provided:

Organization of monitoring of the sanitary and epidemic well-being of the population;

Identification and risk assessment of the impact of environmental factors on human health and the implementation of targeted, scientific, technical and regional programs on issues of ensuring sanitary and epidemic well-being and protecting public health, preventing diseases and improving the human environment;

Obtaining and processing information from state and industry surveillance systems, assessing and forecasting changes in the state of health of the population, the surrounding natural, industrial and social environment, socio-economic development;

Identification of cause-and-effect relationships between the state of health and the human environment, the causes and conditions for changes in the sanitary and epidemic well-being of the population;

Preparation of proposals for the organization of activities aimed at preventing, eliminating or reducing the factors of the harmful effects of the environment on human health;

Development of forecasts of changes in the state of health of the population in connection with changes in the human environment;

Transfer of information to users of social and hygienic monitoring and its distribution among interested bodies, enterprises, institutions and organizations, as well as citizens;

The organization, provision and maintenance of the republican system of social and hygienic monitoring is carried out by Republican Center hygiene and epidemiology. Scientific and methodological support and support of social and hygienic monitoring in the republic is carried out by the Belarusian Scientific Research Sanitary and Hygienic Institute.

INFORMATION FUND of social gig monitoring consists of data blocks characterizing:

Public health;

The state of the environment;

Indicators of socio-economic development of the republic, regions and cities.

Infor-th sources for social gig. monitoring are:

Databases for monitoring the state of health and physical development of the population;

Behind providing a dignity. - epidemic. well-being of the population and the natural environment;

Databases for monitoring natural and climatic factors, sources of anthropogenic impact on the environment, radiation safety, as well as the quality of atmospheric air, surface and ground waters, soil;

Databases for monitoring the indicators of socio-economic development in the republic, regions and cities;

Organ databases executive power, institutions and organizations, as well as international organizations.

The software and technological support provides for, while maintaining the existing functionality formation, use, updating, updating and presentation of all types of indicators included in the databases of social and hygienic monitoring. The exchange of data from the information fund of social and hygienic monitoring between the bodies, institutions and organizations authorized to conduct this monitoring is carried out free of charge through established communication channels, and with other users - on a contractual basis.

The users of the data of the information fund of socio-hygienic monitoring may be authorities state power republics and localities, enterprises, institutions and organizations, regardless of their subordination and form of ownership, public associations, as well as citizens. Users are prohibited from transferring data from the information fund of social and hygienic monitoring to third parties on a commercial basis. Information subsystems are information about the results of the annual state sanitary supervision, data from the state environmentalist. monitoring, the results of automated control of the radiation situation.

The main factors affecting the health of the population: lifestyle, environmental and socio-economic situation, biological factors (heredity), government policy in the field of public health (Fig. 2.26).

It is difficult to determine the share of influence of each of these factors, since all of them are interconnected and are largely modified by the policy in the field of public health, which is implemented through the health care system. According to the definition in the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens of the Russian Federation”, public health protection is a system of political measures. economic, legal, social, scientific, medical, including sanitary and anti-epidemic (preventive) nature, aimed at preventing diseases, preserving and strengthening the physical and mental health each person, maintaining his active long-term life, providing him with medical care. Health authorities (ministries) have been established to implement health protection programs.

According to this definition, and in line with WHO (2000) recommendations, the goal of ministries of health is to improve the health of the population. Their activities cover the provision of medical care to the sick, the implementation of public health programs for the prevention of diseases and the coordination

nation of interdepartmental programs to increase the commitment of the population to a healthy lifestyle. In developed countries, the term "public" (public health) means that the activities of the public health service are aimed at society as a whole, and not at its individual members. In the Russian Federation, this activity is carried out by the sanitary and epidemiological service of Rospotrebnadzor, federal and regional bodies healthcare management.

Such a broad interpretation of the responsibility of the Ministry of Health also determines a higher degree of influence of its activities on the health of the population. With a complex effect on the health of the population of sanitary and epidemiological measures, health education, preventive immunization and treatment serious illnesses antibiotics impact the health care system will be 70-80%. Some experts indicate an impact of 10-15%, meaning only medical care for the sick in a fairly well-funded health care system.

In countries with developed market economies, where sufficient funds are allocated for health care and the population is provided with an almost complete set of all possible medical services, an additional increase in system funding will lead to a relatively small effect compared to countries where there are growth reserves in this direction. In the Russian Federation, increased funding and improved efficiency of the health care system will have a greater impact on improving health than in the EU countries.

LIFESTYLE

WHO estimates the impact of lifestyle on health is 2-2.5 times higher than other factors. By modifying a person's lifestyle and reducing the influence of risk factors, more than 80% of cases of diseases of the cardiovascular system and type II diabetes mellitus, about 40% of cases of malignant neoplasms can be prevented.

Analysis of epidemiological data reveals the impact various reasons on morbidity and mortality of the population, to identify risk factors. The presence of a risk factor indicates increased likelihood development of this or that unfavorable event, and its value - about the level of this probability. The presence of a risk factor in a particular person may not lead to illness or death, but the magnitude of the risk factor can determine its impact on the health of the country's population as a whole.

WHO data on the frequency of 10 major risk factors in the structure of total mortality (2 million 406 thousand deaths) and the number of years of life with disability (39.41 million years) in Russia in 2002 are given in Table. 2.12. The number of years of life with disability is a general indicator of the health of the population, taking into account mortality, morbidity and the degree of disability. It is calculated for a country as the sum of years of life with disability due to premature death from all causes in all age groups, disability and temporary disability. These years are calculated by frequency and duration various kinds disability multiplied by a factor (specific gravity) that takes into account the degree of disability compared to the loss of life.

Four risk factors - high blood pressure and cholesterol levels, smoking and excessive alcohol consumption - together account for 87.5% of total mortality in the country and 58.5% of the share of life years with disability. At the same time, in 1st place in terms of the impact on the number of years of life with loss of labor

ability is worth alcohol abuse - 16.5%. According to expert opinion, over the past 6 years, relative indicators have changed little.

Alcohol abuse. This is a major public health problem, the cause of the catastrophically high mortality rate (especially for men) in Russia. Premature mortality is about 0.5 million people a year.

The main consequences of alcohol abuse in Russia:

Supermortality, reduced life expectancy, loss of health, reduced birth rate, deterioration in heredity and children's health;

Degradation of the social and spiritual and moral environment, breakup of families;

The economic losses from the destruction of human potential are many times higher than the income from the production and circulation of alcohol.

Alcohol abuse increases the likelihood of death from cardiovascular disease (CHD, high blood pressure, hemorrhagic stroke, arrhythmias, cardiomyopathy), accidents, injuries, and sudden cardiac arrest.

According to the Federal State Statistics Service, in 2010, 1.95 million people, or 1.4% of the country's population, were registered with medical institutions for alcoholism and alcoholic psychosis.

According to Rospotrebnadzor, real per capita alcohol consumption, taking into account the turnover of alcohol-containing products, including perfumery and cosmetics, goods household chemicals and others, in Russia is about 18 liters pure alcohol per person per year. According to medical statistics, 2.8 million Russians are involved in severe, painful drunkenness - 2% of the country's population. In 2011, according to the country's chief narcologist, adult alcohol consumption fell to 15 liters of pure alcohol per capita per year (see Figure 2.27), 1.6 times higher than the OECD average. Perhaps this is due to some government measures aimed at reducing alcohol consumption, or to inaccurate statistics on illegal alcohol trafficking.

According to Rospotrebnadzor, in 1990-2006. Alcohol consumption per capita increased by 2.5 times, mainly due to the increase in beer consumption. Every day in the Russian Federation drink alcoholic beverages (including beer) 33% of boys and 20% of girls, about 70% of men and 47% of women.

In most Organization for Economic Co-operation and Development (OECD) countries, in particular the United States, alcohol consumption is lower, although still high, but does not lead to abnormally high mortality (Fig. 2.27). The reason is that different types alcoholic beverages have different effects on health, while important factor risk - the strength of the most popular drink in the country. Since 1990, the consumption of strong alcoholic beverages in the Russian Federation has not decreased in absolute terms, although their share in the structure of consumption has decreased to 15% due to a sharp increase in beer consumption. In most EU countries, the main alcoholic beverages are wine and beer. This difference, along with the massive spread of smoking, is the main reason for the high mortality of men of working age in Russia (see also section 2.2).

Smoking. According to the Center for Preventive Medicine of the Ministry of Health of Russia, 220,000 people a year in the country die from smoking-related diseases. It causes the growth of BSC, leads to chronic diseases lungs and many cancers. Smoking is the cause of death from lung cancer - 90%, from AOD - 75%, from heart disease - 25%. Approximately 25% of smokers die prematurely, smoking reduces life expectancy by an average of 10-15 years (data from Rospotrebnadzor). Smoking is associated with 40% of the mortality of Russian men from CSD. higher mortality smoking men leads to a 1.5-fold decrease in the proportion of men over the age of 55.

In 1990-2009 the sale of cigarettes increased 1.6 times - from 246 to 400 billion pieces per year, or from 5 to 8 pieces per capita per day. In 1990-1995 there was a slight decrease in cigarette consumption (by 20%), but already in 1995-2005. it doubled - from 1.4 to 2.8 thousand units per capita per year, and it has remained at this level for the last 5 years.

In Russia, 63% of men and 30% of women, 40% of boys and 7% of girls smoke. The share of smokers among the adult population in Russia is one of the highest in the world and is 2 times higher than in the US and EU countries - 25% (Fig. 2.28).

Smoking is a preventable cause of disease. In many countries of the world (USA, EU countries) there are national anti-smoking programs. Their implementation makes it possible to reduce the prevalence of smoking and related mortality by 1.5-2 times (WHO, 2005). It is very important that in 2008 Russia finally ratified the Framework Convention on Smoking Control, which has already been signed by 172 out of 192 UN member countries today. Also adopted in the strictest version of the Federal Law "On the protection of public health from the consequences of tobacco consumption", proposed by the Government of the Russian Federation (dated February 23, 2013 No. 15-FZ).

drug use(see also section 2.2). Every year, tens of thousands of Russians die from drugs. In June 2009, the head of the State Drug Control Service said that 30 thousand people die every year from drugs, and cited horrifying facts:

There are 2-2.5 million drug addicts in Russia, mostly aged 18-39;

The average age of a dying drug addict is 28;

Every year, the army of Russian drug addicts is replenished by 80 thousand recruits;

In terms of the number of drug addicts, Russia is ahead of the EU states by an average of 5-8 times, in terms of the consumption of hard drugs it ranks one of the first places in the world.

Among intravenous drug users, the risk of death is 20 times higher than in the general population. Such drug addiction is associated with an increase in teenage mortality in Russia.

High blood pressure. AH is the main cause of death and the second most important cause of morbidity (in terms of years of life with disability) in Russia. Patients with uncontrolled hypertension have a 3-4 times higher risk of stroke and myocardial infarction. In Russia, about 34-46% of men and 32-46% of women (depending on the region) suffer from hypertension. However, these data do not reflect a reliable picture, its real prevalence is higher.

High cholesterol. Approximately 60% of adult Russians have cholesterol levels above the recommended level, and it is so high that it requires medical intervention about 20% of people. Reducing the level of cholesterol in the blood by only 1% can reduce the risk of coronary artery disease in the population by 2.5%.

Improper diet and sedentary lifestyle. The documents adopted by the WHO General Assembly indicate that about 1/3 of all CSD is due to malnutrition. If you reduce the consumption of vegetables and fruits, the mortality from CSD will increase by 28%. Despite the fact that in the Russian Federation in 1995-2007. consumption of fruits and vegetables per capita has increased by 27%, it is still significantly less than in Italy and France, which have the lowest death rates from CSD in Europe.

Improved nutrition also contributes to a reduction in mortality from cancer by 30-40%. In the nutrition of the country's population, there is a shortage of certain microelements and essential acids (iodine, iron, etc.), which can be easily compensated by enriching food products with these elements. Unfortunately, there are no such programs in the country.

sedentary image life exacerbates this problem. Moderate but regular exercise improves physical and mental health, and reduces the chance of CSD, colon cancer, diabetes, and high blood pressure. Studies in 2002 indicate a low level of physical activity in 73-81% of men and 73-86% of women in Russia.

Obesity and overweight. Adults with overweight body or obese prone increased risk premature death and disability. Life expectancy in people with severe obesity is reduced by 5-20 years. In total, 1.06 million obese people, or 0.7% of the population, are registered in Russia, but the real prevalence of obesity and overweight is higher. According to the Research Institute of Nutrition of the Russian Academy of Medical Sciences (2009), in the Russian Federation, the number of overweight residents aged 25-64 years, depending on the region, is 47-54% of men and 42-60% of women; obesity - in 15-20% of them.

Sugar diabetes. About 3.3 million citizens suffering from diabetes are officially registered in Russia, about 50% of them are in the most active working age - 40-59 years. According to the control and epidemiological studies conducted by the Endocrinological Research Center of the Russian Academy of Medical Sciences in various regions of Russia, the true number of patients with diabetes is 3-4 times higher than the officially registered and is about 9-10 million people (7.1% of the total population of Russia). According to the WHO database, the overall incidence of diabetes mellitus (number of cases per 100 thousand population) in Russia in 2011 was 2363.2, while in the "new countries" of the EU it is 5.3 times less (428.0 cases per 100 thousand population). According to Rosstat, the death rate from diabetes (number of deaths per 100,000 population) in Russia in 2011 was 6.2 cases (1% of all deaths).

Not detected in time, and, accordingly, untreated diabetes mellitus entails the threat of the development of severe chronic vascular complications: retinopathy, leading to total loss vision; nephropathy requiring lifelong renal replacement therapy with hemodialysis and the inevitable kidney transplant; damage to the vessels of the lower extremities with the development of gangrene and subsequent amputation of the extremities; damage to the main vessels of the heart and brain, leading to the development of myocardial infarction and stroke. By the time the patient first visits a doctor, about 40% of patients already have irreversible vascular lesions, which indicates insufficient detection of diabetes mellitus and its adequate treatment.

ENVIRONMENTAL FACTORS AND WORKING CONDITIONS IN THE PRODUCTION

In Russia, due to the reduction in industrial production, the main environmental indicators (pollution of the atmosphere and water bodies by industrial waste, sanitary drinking water) in 1990-2007. improved somewhat. However, a significant part of the population of industrial cities still live in unfavorable environmental conditions. In 2010, Roshydromet determined a list of 94 cities with the most unfavorable environmental situation associated with the release of more than 1000 tons of pollutants into the atmosphere from industrial enterprises. From this list, 12 most "dirty" Russian cities can be distinguished in terms of the level of emissions of pollutants into the atmosphere by industrial enterprises (more than 100 thousand tons). This is primarily Norilsk with a population of 176 thousand people - 1924 thousand tons, then in decreasing order: Cherepovets (315 thousand people) - 333 thousand tons, Novokuznetsk (549 thousand people) - 301 thousand tons, Lipetsk ( 511 thousand people) - 299 thousand tons, Magnitogorsk (410 thousand people) - 232 thousand tons, Angarsk (241 thousand people) - 207 thousand tons, Omsk (1 million 154 thousand people) - 198 thousand. tons, Krasnoyarsk (1 million 186 thousand people) - 149 thousand tons Ufa (1 million 82 thousand people) - 134 thousand tons, Chelyabinsk (1 million 143 thousand people) -

118 thousand tons. Bratsk (244 thousand people) - 116 thousand tons. Nizhny Tagil (361 thousand people) - 114 thousand tons. For comparison, in the megacities of Moscow (11.8 million people) and St. Petersburg ( 5 million people), the level of emissions was 63 and 57 thousand tons, respectively. In terms of soil pollution with chemicals (sarin, dioxins, etc.), the most polluted city in the world is Dzerzhinsk, Nizhny Novgorod Region.

A number of cities in Russia with the most unfavorable environmental situation in 1992, 2000 and 2010 is shown in Fig. . 2.29.

Another factor affecting the deterioration of the health of the working population is employment in industries with working conditions that do not meet hygienic standards. According to Rosstat (2010), in 1990-2007. the share of such workers increased by 1.3-2 times in industrial production(depending on the type of production) and 3.8 times among transport workers. In 2007, every 3rd worker in the extractive industry and transport and every 4th worker in the energy production and manufacturing industry were in conditions that did not meet sanitary and hygienic standards. An analysis of the causes of morbidity in the Russian Federation shows that 40% of diseases of the working-age population are directly or indirectly associated with unsatisfactory working conditions (see Section 2.3).

WELFARE OF THE STATE AND INCOME OF THE POPULATION

The change in the economic system and the corresponding sharp deterioration in the socio-economic conditions in the country had a negative impact on health

population. In 1990-1995 gross domestic product(GDP) of the country and the income of the population fell sharply, and most citizens of the Russian Federation had difficulty adapting to market conditions. Since 1995, the economic situation in the country began to gradually improve, and since 1999, a steady growth of the economy has been noted. At the same time, health care expenditures in comparable prices fell from 1990 until 1999 and reached the 1990 level only in 2006.

Dynamics of change (growth/decline) of GDP and government spending on health care in constant prices (1991 is taken as 100%) is shown in fig. 2.30. State expenditures of the Russian Federation in 1991-2000 obtained from calculations. made by the Institute for the Economy in Transition in 2007. Rosstat data 2000-2004. are obtained by adding up the expenditures of the budget system of the Russian Federation (expenditures of the federal budget and the consolidated budgets of the constituent entities of the Russian Federation) and the expenditures of the territorial compulsory medical insurance funds (TFOMS) and Federal Fund compulsory health insurance (FOMS; minus subventions in TFOMS to avoid double counting). Since 2005, in the data of Rosstat, the expenditures of the budgetary system include the expenditures of off-budget funds, therefore, direct data from Rosstat are taken.

To improve the accuracy of calculations, the deflator index has been refined: relative changes in GDP as a percentage of previous year at constant prices - the most accurate description of changes in GDP minus inflation. To obtain the exact value of the deflator index, the value of GDP at current prices for two adjacent years was divided by the change in GDP at constant prices. The resulting index is used to obtain health care expenditures at constant prices.

Only by 2005 did the level of healthcare financing in the Russian Federation exceed the level of 1991 in comparable prices, and in total this growth for the period from 1991 to 2011 amounted to 26.8% in 1991 prices.

spending on health care at constant prices (1991 - 100%) shows that in the period 2005-2007. health care costs were 15% higher than the value of GDP. However, as early as 2008, health care expenditures declined compared to 2007, and in subsequent years (2009-2010) they stopped growing.

It should be noted that in the Russian Federation there is a high degree of inequality in the distribution of national income between various groups population. International experts also pay attention to this. In the words of the Nobel laureate in economics Joseph Stiglitz (2001), “in terms of inequality, Russia is comparable to the worst Latin American societies in the world that inherited a semi-feudal system.” The existing flat scale of taxation and tax evasion for the wealthiest categories of the population do not allow generating sufficient funds in the budget of the Russian Federation. including funds for the solidarity health care system.

Distribution of incomes between various groups of the population of the Russian Federation is presented on fig. 2.31. The total income of the population of the Russian Federation is 21 trillion rubles a year. For analysis, the population of the country is divided into 10 groups of equal size (or 10% decile groups) in ascending order of their monetary value.

income. The tenth (richest) decile group officially accounts for 30.6% of income, while the poorest - 1.9%. The ratio between the incomes of the richest and poorest groups - the decile coefficient - in the Russian Federation is 16. In the Scandinavian countries it is 3-4, in the EU - 5-6, in South Africa - 10, in Latin America - 12. Citizens of the first two groups make up 20% of the population of the Russian Federation, and all of them live below or near the subsistence level.

To analyze the income of the richest decile group, its population is divided by 100 equal parts, or centile groups (1% each). The poorest of the rich - the 91st group - has about 2% of the official income of the entire population. The richest of the rich (or 1% of the country's population) - the 100th group - has, taking into account undeclared incomes, 50-100% of the official income of the rest of the country's population. And almost all of this income is "shadow" for official statistics and tax authorities and is received in foreign currency. Unrecorded incomes of super-rich citizens are calculated on the basis of Rosgosstrakh data, which indicates that 0.4% of families (200 thousand families) have annual incomes of more than 30 million rubles, and 0.2% of families (100 thousand families) own 70% of the national wealth .

In the Russian Federation, for a fair distribution of national wealth among the population, including filling the solidarity healthcare system, it is necessary to revise the flat scale of the income taxation system (13% for all incomes) and strengthen state control over tax evasion, as is customary in developed countries. For example, in the EU and the USA there is a progressive scale of taxation of the population, and the rich give a larger share (50-60%) of their income than the poor, and any tax evasion is tightly controlled and punished by the state.

Dynamics of per capita money incomes of the population of Russia (columns in Fig. 2.32) and average consumer prices for essential goods: bread (including bakery products from wheat flour first class) and medical services(initial appointment with a specialist doctor and a blood test, until 2000, a urine test was also included) from 1993 to 2010 is shown in fig. 2.32. For a more accurate comparison, a common unit of measure was adopted, taking into account its growth - the dollar,

valued at parity purchasing power($PPP) - the number of units of currency required to purchase a standard set of goods and services that can be purchased with one currency unit of the base country (US dollar). According to Rosstat, in 1993 - 0.14 rubles / US dollar; 1996 - 2.21: 1997 -2.53; 1998 - 2.83; 1999 - 5.29; 2000 - 7.15: 2001 - 8.19; 2002 - 9.27; 2003 - 10.41; 2004 - 11.89; 2005 - 12.74; 2006 - 12.63; 2007 - 13.97; 2008 - 14.34; 2009 - 14.49; 2010 - 15.98.

From fig. Figure 2.32 shows that prices for medical services rose sharply compared to the dynamics of household incomes in the period from 1993 to 1998. Then their growth, until 2007, coincides with the dynamics of growth in household incomes, and since 2008 it has outstripped them.

Thus, we can conclude that among the factors that influenced the deterioration of the health of the population of the Russian Federation in 1990-2011, an unhealthy lifestyle (high prevalence of alcoholism, smoking and drug addiction), poor working conditions at work played a predominant role. The main reason for this situation is the lack of public policy aimed at improving public health. An active state policy (including restrictive and prohibitive measures) aimed at improving a healthy lifestyle will lead to a significant improvement in public health in a short time (an example is the anti-alcohol campaign in the Russian Federation, see Fig. 2.5).