Social medicine Social medicine as science and as science and

article of article of teachingteaching

•“Civic medicine” studies laws of distribution of diseases among people’s layers and searches for causes of this distribution /commission of the Pirogov association/.

•“Civic medicine” studies experience, principles and forms of organization of medical aid, its connection and interaction with civic life and with local authorities. /A.Shyngarov/

•“Social medicine” studies state action mainly in field of disease prophylactic /commission/.

•“Social medicine and civic medicine” study laws of health protection of people /V.Kanel/.

Studying of reasons of disease’s spreading had begun long before realizing of social conditionality of the health. For a long time infectious diseases with typical for them mass epidemic spreading were the main problem so the science, which studied that, was named “epidemiology”.

The WHO conferencing gave the following definition to civic health protection” – this is the science and the art of preventing diseases, prolongation of life and strengthening of mental and physical health and capacity for work by means of organization of social efforts directed at making the environment healthier, fight against infectious diseases, train people’s skills of individual hygiene, organize medical and nursing service for early diagnostics and preventive treatment of diseases.

Those measures can be divided into 2 groups:

• -measures against the diseases;

• -measures aimed at improving health.

Before the beginning of the 20th century 3 ways of health protection

were formed:

• with help of state measures(the promulgation of different medical and social work);

• with help of social measures;

• with help of medical insurance.

“Civic health protection”

– this is a science and art of prevention from diseases, prolongation of life and strengthening of mental and physical health and capacity for work by organization of social efforts, which are directed to make the environment healthier, to fight against infectious diseases, to study people skills of individual hygiene, to organize medical and nursery service for early diagnostics and preventive treatment for diseases.

Communal health protection

includes the problems of influence upon human health, determination of its composition, the environment hygiene, health protection services and administrative management of medical-sanitary aid services. But in some countries “communal health protection” is used as a synonym of “environment hygiene”; in other countries it personifies medical-sanitary aid out of hospital or medical-sanitary work among people.

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

Social hygiene and organization of health protection studies the sanitative and negative influence of social factors upon people’s health and their separate layers, and work out scientific substantiated recommendations for realization of measures concerning liquidation and prevention of unhealthy influence of social factors on human health to promote the protection and increasing the level of civic health (Y. Lisicyn, 1987).

Social medicine and organization of health protection

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

The main tasks of social medicine

• study of the state of human health and processes of its reproduction;

• ensuring of thorough characteristic of movements (dynamics), which take place in indices of human health of the country on the whole and which take place in regional levels, social-economic, ecologic-geographic zones, settlements and separate collectives;

• scientific exposition of conditions and factors which reduce to positive and negative divergence

• in the state of health of different social, age-sexual and other population groups

• elaboration of the directions of population’s sanitation and determination of principles of health protection system, its theoretical and organizing bases;

• -analysis of health service organ’s activity and establishments, creating their rational structures and scientific substantiation of the most expedient forms of work organization, reformation and restructurization;

• creation of different-term prognoses and plans of the development of health protection system with the purpose of carrying out goal-directed measures concerning maintaining the due level of human health.

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

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

Organization of rational training of national specialists of all levels of health protection as the basis for successful work of any health protection system and realization by all medical specialists of their high social responsibility to society;

• To ensure all population of the country the highest possible level of qualified, generally accessible prophylactic and medical aid, which is given without financial or other restrictions by creating suitable network of medical, prophylactic and rehabilitation establishments;

• Wide use achievement of world medical science and practice of health protection in every country with the purpose of ensuring conditions for getting maximum effectiveness of all taken measures in health protection sphere;

• Sanitary education of citizens and drawing into participation in conducting of all programmers of health protection of wide sphere of population are the argument of personal and collective responsibility of all members of society for health protection of people.

The basic principles of the Public Health service:

• The determination of the Public Health service with the priority direction of the sasaity activities and government as the one of the basic factors of the surviving and Ukrainian nation development.

• The observance of the right and liberties of human and citizen according to the Public Health service and securing with the state guarantees.

• The human direction, securing with priority, common to all mankind treasures in classical, national, grope or individual interests, medical-social protection of the most vulnerable part of the population.

• Of the citizens, democratism and opened to general use of the medical aid and other services in the Public Health service.

• Accordance to the task and social-economical level and cultural development of the sasaity, scientific explanation, material and technical and financial securing.

• Orientation to the modern health standards and medical aid.

• The unit of the old traditions and achievements in Public Health service.

• Preventive character, and composite. Social ecological and medical approach to the Public Health service.

• The unit state guarantees with demonopolization and connecting of the enterprises and competition.

• Decentralization of the state department, development of the autocracy of the institutions and Public health service staff independence, based on low and contract.

Social medicine

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

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

• 1. Historical, establishes historical regularities of development of public health and its protection;

• 2. Sociological, that allows studying social structure of a society and its influence on health;

• 3. Experimental, allows studying advantages (lacks) of organizational forms of medical service;

• 4. Expertise, which help quality and efficiency of medical service is studied;

• 5. Economical, that enable to determine economic efficiency of systems of medical service.

Statistical totality

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

Unit of supervisionis every special case of the phenomenon, that is studied, that it is every primary element of totality, which belongs to the account (for example, every case of disease, birth, deaths, hospitalizations and others like that). Such registration elements of totality divide into attributive (expressed verbally) and quantitative (expressed by a number).

• A general statistical totality is an totality, which includes all units of supervision. For example, all morbidity on the earth.

• A selective statistical totality is an totality, which includes the certain part of units of supervision, but this part is able to represent all general totality.

Indexes of population’s health

The І group is morbidity and traumatismThe ІІ group is demographic indicators

(birth-rate, death rate, natural increase, death rate of babies, average life duration )

The ІІІ group is disability (primary and general)

The IV group is physical developmentThe V group is assignment of population

in health groups

Нealth groups• 1 group are healthy – 20 %• 2 group are practically healthy – 40 %• 3 group – chronic patients in the

compensation phase – 35 %• 4 group – chronic patients in the

subcompensation phase – 4 %• 5 group – chronic patients in the

decompensation phase – 35 %

Group properties of statistical totality:

• Distribution of characteristic (criterion – relative sizes);

• Average level of index (criterions – Mo-mode, Me-median, arithmetical mean);

• Variety of characteristic (criterions – lim- limit, am – amplitude, σ – average quadratic deviation, Cv – coefficient of variation );

• Representation (criterions – mM – mistake (error) of average values, m% - mistake of relative values);

• Correlation between occurrences and features (criterion – rxy - coefficient of correlation).

The stages of statistic investigation

• 1st stage – composition of the program and plan of investigation

• 2nd stage – collection of material

• 3ed stage – working up of material

• 4th stage – analysis of material, conclusions, proposals

• 5th stage – putting into practice

The program of statistical research shows the basic directions of research and information, which it is necessary to collect.

The programs are official (medical statistical forms of document) and special (which are folded by a researcher).

The program of statistic investigation consists of the program of material collection, the elaboration program and the program of analysis.

The collection program is the program of statistic observation, the form with the list of signs, that have to be registered (registration’ signs) with an indication on whom it will be filled in, that is with a determination of the unit of observation.

There are the official programs of material collection to study the health and activity of medical establishments, and special ones, composed by the investigater.

The material elaboration program is the composition of models of tables.

Types of tables

• simple (that give the material bringing together only by one sign);

• group (that give the material bringing together only by two sign);

• combinational (connection of three or more signs).

The plan of statistic investigation consists of:

• 1) the determination of the object of investigation; • 2) the place of investigation; • 3) the time of investigation; • 4) the volume of investigation; • 5) the method of material elaboration (manual, with the

help of ECM); • 6) the terms of the carrying out of the work; • 7) executors; • 8) composition of the instructions of the methods of

work;• 9) carrying out of the seminar for the executors.

The ways of formation of the object of investigation:

• by the scope of observation are continuous or selective;

• by the time of observation – flowing or one-moment;

• by the way of obtaining the information – direct observation, copying, filling in a form.

• Complete or continuous research covers all observation units.

• Selective research covers a representative part of the supervision units, which enables to evaluate phenomenon in whole.

The ways of formationof the statistic integrity

By the volume of observation

continuous

selective

volume

observation

selection

accidental

mechanic

typological

serial

regionalcombinative

By the time of observation

By the type of observation

flowing

one-moment

direct

copying of the data

By anamnesis

questionnaire

interrogatory

2

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2

2

pqtn

The stages of development of statistical material are following:

• control /logical and technical/;

• enciphering /code/ of registered signs by numbers, letters of alphabet;

• lay-out of cards on groups for the subaccount or groupment;

• report of material;

• deduction of statistical criteria /indexes/, their graphic image.

Thank you!Thank you!