Social Medicine and Health Care Organization as a science

Friedrich Engels (1820-1895)Called attention to the health of the

working class

Rudolf Ludwig Karl Virchow (1821-1902)the “Father” of Social Medicine

Those measures can be divided into 2 groups:

• -measures against the diseases;

• -measures aimed at improving health.

“The physician is the natural attorney (advocate) for the poor.”

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.

Medicine is a social science,

and politics nothing but

medicine on a grand scale.

- R. Virchow, Die Medicinische Reform, 1848

“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 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.

Worsening inequality in the US

Source: Left Business Observer

Old Conceptual Model

HumanRights

Well-BeingHealth

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:

New Conceptual ModelFramework for Understanding

Human Rights

Health

Human Rights

Human Rights

Health

Health

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;

The Evolution of Epidemics

Virulence of the Causative Agent(M tuberculosis)

Population Susceptibility

Course of Epidemic

Reported TB Cases US, 1953-2002

10,000

20,000

50,000

70,000

100,000

Cas

esL

og

Sca

le

30,000

53 60 70 80 90

*Change in case definitionYear

00

*

*

Reported TB Cases US, 1983-2002

10000120001400016000180002000022000240002600028000

83 85 87 89 91 93 95 97 99 2001

Year

1981 1985 1989 1993 1997

No.

of

Cas

es

2002

*

* provisional

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.

Excess TB cases 1985-92

JAMA 1994; 272:536

•Infrastructuredeteriorated

•Epidemic HIV

•Immigration

•Institutionaltransmission

•MDR TB

• 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.

TB Morbidity US, 1997-2002

Year Cases Rate*1997 19,851 7.41998 18,361 6.81999 17,531 6.42000 16,377 5.82001 15,989 5.62002** 15,087 5.2

*Cases per 100,000 **Provisional

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.

TB Case Rates, US, 2002

< 3.5 (year 2000 target)

3.6 - 5.2

> 5.2 (national average)

D.C.

Rate: provisional cases per 100,000

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

Reported TB Cases by Race/Ethnicity, US, 2001

Hispanic(25%)

Black, non-Hispanic

(30%)

Asian/Pacific Islander(22%)

White, non-Hispanic(21%)

American Indian/ Alaska Native (1%)

• 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.

Number of TB Cases inUS-born vs. Foreign-born Persons,

US, 1992-2002*

0

5000

10000

15000

20000

US-born Foreign-born

No

. o

f C

ases

*2002 count is provisional

Statistical totality

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

Countries of Birth for Foreign-born Persons Reported with TB

US, 2002*

Mexico(25%)

Philippines(11%)

Vietnam(9%)India

(8%)China

(5%)

Haiti(3%)

S. Korea(3%)

OtherCountries

(36%)

*Provisional

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

22tn

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.

There are two levels of medical service organizations in our independent state:

• a) Ukrainian Public Health Service;

• b) private doctors.

The fundamental task of modern system of health

protection in Ukraineis saving and strengthening of population

health, improvement of medicare qualities, and development of concrete medical and prophylactic measures, forms and methods of work of the specialized services.

WHO (World Health Organization) determines health as the state of complete social, biological and psychological prosperity, when functions of all organs and systems are balanced with an environment, absence of diseases, sick states or physical defects.

The most essential among indices:

• demographic (birth-rate, death rate, average life duration);

• physical development (functional and biological development, harmoniousness);

• morbidity (general, hospitalized, infectious); disability (primary and constant);

• state (immunity, resistance of the systems, activity of enzymes, etc.).

Risk factors are divided into 4 large groups:

• 1) way of live (smoking, wrong food. Abuse of alcohol, harmful work, stresses, hypodynamia, using of drugs, incomplete family or family with many children, hyperurbanization) - 51-52%;

• 2) environment (air, water, meal, radiation level, electromagnetic fields) - 20-21%;

• 3) biological factors (heredity, constitution, sex, age) - 19-20%;

• 4) medical factors (inoculation against infections, medical inspections, quality of medical treatment) - 8-9%.

Groups of health • 1 group - healthy (0-1 case of acute respiratory illness

per year);• 2 group - practically healthy (persons with the factors

of risk; no more than 2-3 cases of acute respirator illness per year);

• 3 group - patients with the compensated state (persons with chronic illnesses without complications; 4 and more cases of acute respirator illnesses per year);

• 4 group - patients with the subcompensated state (persons with complications of chronic illnesses during a year);

• 5 group - patients with the decompensated state (chronic patients in stage of decompensation).

Weight of newborns, g. Number of newborns, n

2900 1

3000 2

3100 3

3200 3

3300 2

3400 1

Having worked out the general tendencies of main indices of population’s health the WHO defined the following criteria

which all countries are to aim at:

• 1. Availability of primary MSA;

• 2. The percentage of gross national product expended on the health protection, must be 7-8%; in our case it is 5% (more often 1-3%);

Age group Absolute number % from the general number

15 – 19 150 10,0

20 – 29 375 25,0

30 – 39 300 20,0

40 – 49 345 23.0

50 – 59 150 10.0

60 and senior 180 12.0

In total 1500 100.0

•3. Positive natural increase of population in all regions (now in many regions natural increase is negative);•4. Percent of children whose birth with weight 2500 grammas and less has to be no more than 3,5%;•5. The level of death rate of babies must not exceed 9 cases for 1000 born alive, and actually per year is within the limits of 12-15%;•6. Average life duration is not to be less than 75 years, and it actually is 67,8.

DiseaseStructure of

morbidity 

Structure of invalidity

 

Structure of the reasons of

death 

Index of relative intensity

Of invalidityreasons of

death

Traumas 12.0 8.0 30.0 0.35 2.0

Heart and vessel diseases 4.0

 27.0 19.0 6.76 4.75

Diseases of nervous system

6.0 8.0 - 1.33 -

Poisonings 0.3 - 0.4 - 13.3

Tuberculosis0.5 5.0 5.5 10.0 11.0

Other  74.2 52.0 41.5 0.7 0.56

Total100.0 100.0 100.0 - -

Data of demography is used in two basic directions:

• 1) Description of population for given time (quantity, composition, features) – this is statics of population;

• 2) Dynamics of population or its motion - it is description of population quantity change processes.

Natural motion of Ukraine population

Birth-Birth-raterate

Death Death raterate

Natural Natural increasincreas

ee 1990 1990 20020044 1990 1990 20020044 1990 1990 20020044

UkraineUkraine 12,712,7 9,09,0 12,112,1 116,06,0 0,60,6 -7,-7,00Ternopil Ternopil regionregion 14,214,2 9,9,99 12,812,8 114,44,4 1,41,4 --44,,55

General death General death rate index =rate index =

Number of died per year Number of died per year

* 1000* 1000

Average annual quantity Average annual quantity of populationof population

Average Average duration of duration of the casethe case of of temporary temporary disabilitydisability

==

Number of calendar days of Number of calendar days of temporary disabilitytemporary disability

×× 100 100Number of cases of Number of cases of temporary disabilitytemporary disability

Index of Index of morbidity morbidity structure structure withwith the the

temporary temporary loss of loss of

capacitycapacity

==

Number of cases (or Number of cases (or calendar days) of disability calendar days) of disability

for given diseasefor given disease×× 100 100Number of cases (days) at all Number of cases (days) at all

diseasesdiseases

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