HEALTH CENTRES – NEW

PREVENTIVE STRUCTURE IN

PUBLIC HEALTH SERVICE OF THE

RUSSIAN FEDERATION

Nana GV Pogosova

Sergey A Boytsov

Irina D Sapunova

Yulia M Yufereva

Rafael G Oganov

More than 50 percent of deaths and disability from

heart disease and strokes, which together kill more

than 12 million people world-wide each year, can

be cut by a combination of simple, cost effective

national efforts and individual actions to reduce

major risk factors such as high blood pressure, high

cholesterol, obesity and smoking.

• It is very important that the First Global Ministerial

Conference on healthy lifestyle and non-

communicable diseases is held in Russia, which has

declared the human health a state priority, and is

implementing large-scale programs of healthcare

development emphasizing the reduction of mortality

from non-communicable diseases and the healthy

lifestyle.

• Since 2005, Russia has been implementing the Health

national project having among its key components the

development of primary healthcare institutions and

enhancement of prophylactic measures.

Since 2005 Priority National Project “Health” special attention to CVD

April 2008 Russia has signed the WHO Frame Convention

Against Smoking

June 2010 Not less than 80% of surface of 2 sides of

sigarettes pack– information about tobacco harm

Sept 2010 Vladimir Putin has signed the National

Antismoking Concept:

Ban on advertising of sigarettes in shops.

21% increase of taxes on sigarettes.

Ban on smoking in public places from 2015.

• From the last year, we have started shifting to the “physician – healthy man” interaction scheme by opening the special healthcare institutions called Health Centers.

• We have opened 502 Health Centers for adults and 193 pediatric and juvenile Health Centers.

• They focus on preventive and awareness raising efforts, examination of health people for risk factors and the development of individual recommendations as to the maintenance of healthy lifestyle.

• During their first year of operation, the Health Centers were visited by about 2.5 million people.

The aim was to increase citizens’ responsibility

towards their health, to motivate people to give up

unhealthy habits, including smoking and excessive

alcohol intake, and to obtain the risk factors goals.

In 2009-2010 in the Russian Federation was

developed a new preventive state health

service structure - health centers (HCs)

502 HCs for adults were opened

across the Russian Federation

Each HC, equipped equally, provides

preventive service for 200 thousands of

population on free of charge basis.

All health Centers have a identical equipment

HEALTH CENTERS

Basic characteristics of health on a free of charge basis:

● Weight, Hight, BMI

● Blood pressure

● Total Cholesterol

● Glucose

● Ancle-bracial index

● Spirometric parameters

● Smoking status

Ministry of Health and Social Development of the Russian Federation

HEALTH CENTERS

Basic characteristics of health on a free of charge basis:

● Carbon monooxide in the enhailed air (smokelyzer)

● Spyrometry

● Prophilaktic dental examination

● Ophthalmometry

● Bioimpedancemetry (percentage of water, muscle and

adipose tissue)

Ministry of Health and Social Development of the Russian Federation

Ishemia is shown

in red color

CARDIOVIZOR

rapid assessment of the

functional state of dispersion

mapping of the ECG signal

(sensitivity 90%, specificity

not less then 75%)

RAPID SCREENING

DOPPLER: handheld peripheral doppler

Vascular screening system with

automatic measurement of systolic

blood pressure and calculation of

ankle-brachial index to identify

persons with obstructive diseases of

the peripheral cardiovascular system.

Ankle-brachial index - 0,9 or less

(Circulation. 2004;110:3075-3080. The Edinburgh Artery

Study American Heart Association, Inc. Coronary Heart

Disease )

SPYROMETRY

(VC, FVC, FEV1, OFV1/VC, peak expiratory flow rate)

SMOKELAYZER:

Carbon monoxide in the exhaled air

Allows to control smoking cessation

Bioimpedancemetry

The percentage of

water, muscles and

adipose tissue

Express determination of total

cholesterol and blood glucose

Diagnostics of caries and

parodentium diseases

Education on tooth hygiene

Individual program on

prevention of dental diseases

Prophylactic dental examination

Assessment of refraction

(automatic

pneumorephractometer)

Assesment of the eye bottom

pressure

Ophthalmometry

Physicians of Health

Centers:

1. assess risk factors

2. assess of functional

and adaptive body

reserves

considering age

characteristics

3. estimate the total

risk of

cardiovascular

events

4. give

recommendations

on healthy lifestyle

5. Held education

programms

Based on the results of

the standard health

status study visitors of

HCs are given personal

recommendations on

lifestyle modification.

HCs provide educational

programs and

supervised exercise

training

EDUCATION

group training on:

Smoking cessation

Healthy diet

Weight reduction

Arterial hypertension

Training programms:

individual and group

training

Hypertension was diagnosed in 60 % (prevalence of

hypertension in population is about 40%)

In 2010-2011 more than 2,5 million

people have visited HCs

Less than 500 000 who came for a visit were considered to be healthy

68% of НСs visitors were owerweight,

58% had low level of physical activity,

45% - hypercholesterolemia,

20% - hyperglycemia. These data correspond with the results of previous

epidemiologic studies.

92 % of smokers who have visited HCs are willing to quit

smoking

24

First experiense of the Health Centers in Russia

• Health Centers are a new structure in the healthcare

system, which is developing a healthy lifestyle

among the population.

• Health Centers allow conducting individual primary

prevention among the population, especially for

those who do not apply for medical care to

healthcare institutions.

• Analysis of the health centers activity demonstrates

that they are visited by 70% of women.

Our aim now is to attract males of working age. In

this case there are mobile health centers for working

at enterprises and reaching remote areas.

First experiense of the Health Centers in Russia

• In some regions at the expense of regional budgets purchase

equipment for mobile health centers (Moskow, Samara, Novosibirsk,

Barnaul….

• Analysis of the health centers showed a high frequency of major risk

factors of chronic noninfectious diseases (70%).

• Assessment of risk for cardiovascular events and diabetes melitus

can identify individuals at high risk and start active prevention.

The algorithm of health status

study in CHs aimed to identify

risk factors of NCDs is highly

effective.

The methodology of risk factors

reduction need further improvement.

According to the opinion of Heads of Health Centers people are

pleased to visit our Centers. They want to know more about their

health and get recommendations..

Cardiovascular prevention in

Russia: time of hope and optimism

0,0

500,0

1000,0

1500,0

2000,0

2500,0

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Years

Thousands

Men Women Both sexes

TOTAL MORTALITY in the RUSSIAN FEDERATION

© Russian Federation Federal State Statistics Service 2011

67,9

61,8

74,2

67,5

64,8

65,365,4 65,7 65,3

65,366,6

58,559,059,1 58,8 58,9 58,960,4

61,4

72,0

72,372,372,0 72,4

72,3

73,2 73,9

50

60

70

80

2000 2001 2002 2003 2004 2005 2006 2007 2008

LIFE EXPECTANCY in the RUSSIN FEDERATION

years

Ministry of Health and Social Development of the Russian Federation, 2008

Women

Men + Women

Men

Thank you

for

Attention!