SOCIAL MEDICINE AND ORGANIZATION OF HEALTH PROTECTION AS SCIENCE. OBJECT, METHODS, VALUE FOR PRACTICE OF HEALTH PROTECTION
I. Definition
Social medicine and organization of health protection have no a final definition yet. That is explained of their relative youth. Less than one hundred years has passed from the time of subject describe and methods of research. That is a short period of time as compared with thousand years of medicine development on the whole. That is conditioned by great spaciousness of their interest, which includes health character of social people’s layers, of nations and humanity in general (such called, civic health). It also includes search for actions, which influence on this health, attempt to improve it by taking different measures, and first of all by organization of medical aid.
There were proposed the next definitions:
“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/.
“Social hygiene” studies social measures for hygienic perfections. /E.Yakovenko/.
As we see, in spite of some divergence, all of this definitions had the only joint feature, which is characterized by necessity to study the influence of social conditions (measures, activities) on the health, to study protection of humanity health and its separate layers.
New science acquired a wide development in many European countries, specifically in German. Hygiene and bacteriology, connected with the names of M.Petenkofer, R.Koch and others, achieved great success here at the end of the XIX century.
“Saving consolidation and increasing of people’s health” (A.Fisher) was determined as the subject of studying of the hygiene.
In its turn “civic medicine” was divided into two parts – physical and social.
“Physical hygiene” is the part of civic medicine that studies the influence of natural conditions of the surroundings upon sanitary condition of the people.
“Social hygiene” studied social (cultural) influence upon people’s health.
At the some time such concepts as “social pathology”, “social prophylaxis (hygiene)”, and “social therapy” appeared and were confirmed. The social pathology was implied as the science that studied the influence of social environment on beginning and coursing of disease. The social prophylaxis (hygiene) was implied as the science that occupied with disease prevention by using social measures. The social therapy (medicine) was implied as a science that tried to eliminate diseases with the help of social measures. The later concept (social medicine) was treated as a notion that unificated all of three above-named concepts.
Studying of reasons of disease’s spreading had begun long before realizing of social conditionality of the health. Since 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”.
Later on the diseases that were not caused by infectious agents but other reasons became of wide spread. But the conformity with a low of their spreading coincided mostly with infectious diseases, because in the first and in the second cases those reasons lay mostly in the social space. Epidemiology spread its methods concerning these diseases, which were interpreted as the most important mass noninfectious diseases.
In fact the parallel existence of different concepts and definitions of one science is going on since then.
On arising of the World Health Organization (WHO, 1948) search in this direction continued. New definitions on such concepts as “civic health protection”, “research into practice of health protection”, “social medicine”, “communal health protection” and “communal medicine” were given. The WHO conferencing gave the following definition to civic health protection” – this is the science and the 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 healthier the environment, to fight against infectious diseases, to learn people skills of individual hygiene, to organizate medical and nursling service for early diagnostics and preventive treatment of diseases.
The history of social medicine.
Many years ago people tried to make their health stronger by helping of the social measures. Those measures can be divided into 2 groups:
-measures, against the diseases;
-measures, to make the health stronger.
There are a lot of historical things, which played a big role in the health protection. One of them is Bible. In that book you can read that it is necessary to take a rest at the end of every week (10 commandments). And this commandment of Christian people is a tradition in different nations.
You can see a height level of health-improvement measures during Roman and Greek epoch. Their hygienic measures were directed to tempering of the organism and to making it clean. They had a lot of perfect reservoirs, pump-houses, bath-houses.
Big contributions into the development of social medicine were put by the father of medicine – Hippocrates. He told that the doctor must pay attention to the living conditions of the patient. He must know if the patients prefer to take a lot of food and drink or to work and physical training.
Learning the history of social medicine you can see the importance of social doctors, which have worked in the state-job. They appear, at first, in
First hospitals appeared at the 4th century. They were built near the monastery and sisters of Christ took care of the patients. That hospitals had their own specialization:
1.to treat people who had leprosy;
2.to treat all the rest patients.
First medical school appeared in
The main problem of social medicine were infectious diseases. Lots of measures were held to protect people because of leprosy. Doctors used an isolation against all the rest infectious diseases.
Famous scientist B.Ramaccini wrote a significant book “Thinking about the work diseases. In that book he described different kinds of diseases caused to different kinds of work. B.Ramaccini-the father of professional hygiene.
Big significance in the development of the social medicine played the finding of statistical analyses. In 1662 D.Grount wrote a work, where he described death-rate and birth-rate in
In 17th-18th centuries lots of acts, which regulated the doctor’s and pharmacist’s work were promulgated.
The development of social medicine was connected with an organization of people’s health protection. Working with this problem I.Frank wrote a work “The System of Perfect Medical Police” . the author worked with this question during all his life. He thought that the doctors were to learn the nature, the living conditions of their patients, different diseases and their causes, different social classes according to every geographical region.
C.Neiman in his work “The health protection and property’(1847)says: ”Medicine is a social science”. In
So, 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.
In 1946 “International collection of sanitary acts” was promulgated. In 1948 was founded that the “Health-is a state of social, physical and mental goodness and not only the absentee of different diseases and physical defects.
In 1976 “International act about economical, social and cultural rights of people”.
The aim of the 30th session of Universal Assembly was to amount the fixed level of health until 2000.
First scientist institutes, which learned the questions of social medicine appeared at the beginning of 20th century.
In the West-states height level of the development of social medicine. The heightest quantity of science researches was in the
The centers of communal medicine and organization of health protection, epidemiology, social health protection worked in
In
The main role in learning different problems of health protection in
In
In
The World Health Organization conference (1965) gave the follow definition to “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. And the efforts also are directed to develop civic institutes for ensuring every man the life conditions, which are necessary for saving the health; they are directed to organize all these prevalence’s that every citizen could use his right to have a long life.
This vast definition was made surer by the WHO committee of experts (1973), which noted that the definition of “civic health protection” includes problems that threaten human’s health and includes health condition on the whole, hygiene of the environment, health protection services and organization of medical-sanitary aid.
The international association of epidemiologists in collaboration with the WHO published the textbook on the teaching of the methods of epidemiology, in which the follow definition was given: studying the factor that cause frequency and spreading of diseases among people. By the way, it was marked that epidemiologic research have to direct the development of health services by establishment of disease spreading dimensions and the problems connected with it. This research must also reveal etiological factors, this will give an opportunity to fight purposefully against diseases; the research must work out the methods which definite the efficiency of measures conducting with the purpose of overcoming diseases and improvement social health.
Thus, we may suppose largely that the definition of “epidemiology” is analogous to the definition of “social hygiene”. The another conceptions of “organization of health protection” corresponded largely to the definition of “practice of health protection research”, which was adopted by the WHO. This definition was interpreted as use of scientific methods in research of planning and organization health services and their administrative management. Its wide purpose is to study and analyze the systems of giving medical aid and other health service for search of optimum organization, revelation of the ways and means to perfect the health service planning …
At the same time, the new interpretation to the definition of “social medicine” was given, which is occupied with conception of needs in services (disease realization, need in medical aid); it is occupied with satisfaction of this problem, with social participation in the programs of the fight against diseases, perception and accessibility of services.
Recently, the terms of “communal health protection”, “communal medicine” became of wide inculcation. The WHO gave them the following definitions.
“Communal health protection” includes the problems of influence upon human’s 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.
The widest interpretation of “communal medicine” was settled in
Numerous attempts were made to modernize this definition.
“Social hygiene” is a science on social conformity with a low of health and health protection (L.Lekaryev, 1969).
“Social hygiene” studies interaction of social factors and human’s 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” study 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 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’s health to promote the protection and increasing the level of civic health (Y. Lisicyn, 1987).
The second Allukrainian congress of social hygienists and organizers of health protection (1990) came to a decision to change somewhat the terminology, having approached it to international definition, such as “Social medicine and organization of health protection”. But it didn’t give the definition to a new conception.
Following aforesaid we give our definition: “Social medicine and organization of health protection” is a science that studies social conformity with a low of human’s health and substantiate the ways of its improvement by rational organization of health protection.
In the theory and especially in the practice of social medicine and organization of health protection the two conceptions are met as synonyms frequency, thought they are very different. They are “health protection” and “medical aid”. We give them the following definitions.
Health protection is a system of state, civic and individual measures and means that promote to become people healthy, to warn diseases and prevent of premature death, to ensure the active life and capacity for work.
Health protection is a conception that includes all complex of measures and means, which concern of human’s health, or it take into consideration all complex of the factors, which influences upon human’s health.
Medical aid is a system of special medical measured and means that promote to become people healthy, to warn diseases and prevent of premature death, to ensure the active life and capacity for work.
Medical aid is much narrow conception as compared with health protection, though the purpose of medical aid is the same as of health protection.
The incessant increasing of social health level gets a prevailing ideal of its life activity, subordinates all of other social interests. According to these social movements the demands for development level of social medicine and for organization of health protection as science increase. The main tasks of social medicine are:
-studying of the state of human’s health and processes of its reproduction;
-ensuring of thorough characteristic of movements(dynamics), which take place in indices of human’s health of the country in the whole and which take place in regional levels, social-economic, ecologic-geographic zones, settlements and separate collectives;
-scientific exposing 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;
-creating of different-term prognoses and plans of the development of health protection system with the purpose of carry-out goal-directed measures concerning maintaining the due level of human’s health.
Fulfilling tasks, which include the sphere of scientific and practical interests of social medicine and organization of health protection, is connected as with department as with interdepartmental correlations, which need permanent scientific elaboration and creating the most prolific theoretical principles.
The World Assembly of Health Protection (WAHP) in its resolutioumber 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. Among them the most effective and checked by the experience of different countries principles of building and development of national health protection system are the following principles:
· 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 making use of all strength and resources, which society may apport on every stage of its development for requirements of health protection;
· Organization of rational training national specialists of all levels of health protection as the basis for successful work of any health protection system and realization of all medical specialists their high social responsibility to society;
· Health protection development, in first turn on the basis of wide carrying out the measures, which are directed to the development of social and individual prophylactic, foreseeing fundamental connecting medical and prophylactic work in all medical and sanitary establishments and services, foreseeing also protection of women and children health, which are the future of every country and whole humanity, and establishment the effective control of sanitary state of environment as the source of health and life of modern and future generations;
· 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 the 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 above-mentioned principles were determined and used by most of all countries of the world for development of the people’s health examination and activity of establishments and organs of health protection.
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 Ukrainiaation 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.
So the positions of our government coincide, with progressive sights world thought about health sasaity.
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.
Social medicine lays between biological and social sciences which are involved in studying the essence of health and diseases of a person.
Basic features that differ social medicine from fundamental and clinical disciplines that occupy a prevailing part of teaching at the high and secondary medical schools are the following:
1. The subject of its interest are health and diseases of groups of people – collectives, populations, society as a whole, not the separate person, in other words not health or disease of an individual, but the public’s one.
2. Considering the occurrence, pathogenesis and clinics of separate diseases all of them are equivalent between themselves. In fact it is impossible to imagine the physician who has well learnt etiology, pathogenesis and clinic of hyper, tonic disease but who is poorly acquainted with the same questions dealing with stomach ulcer.
From the positions of social medicine diseases are not equivalent, because at a certain historical stage they influence public health differently. So, 50-60 years ago most people were dying from epidemic diseases and tuberculosis, now – from so-called chronic degenerate diseases (of heart and vessels, malignant formations, chronic diseases of lungs, etc.).
3. Fundamental and clinical sciences consider the health and diseases to be a biological phenomenon, social medicine – the social one.
An individual is a complex biopsychosociological system. It can be viewed under three corners of sight: as a biological organism, as a personality (the carrier of consciousness) and as a carrier of social quality.
Therefore, there is a clear definition of health by World Health Organization (WHO): «Health is a condition of complete social, mental and biological well-being and not just the absence of diseases or physical defects».
There is a natural question concerning the influence of separate factors on health. This question is still poorly studied.
It is proved, that 25 % of person’s health depends on biological factors, 15 % – on environmental conditions and 60 % on social factors. Among social factors 10 % occupies the system of medical services, the one that appeared quite a long time ago and gradually developed into a powerful social factor of health protection.
Social medicine as the science and a subject of teaching uses different methods.
Among them it is necessary to name the following ones:
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 helps quality and efficiency of medical service is studied;
5.Economical, that enables to determine economic efficiency of systems of medical service.
The basic concepts of medical statistics are:
A statistical aggregate is the commoumber of units of supervision, taken in the set borders of space and time.
A general statistical aggregate is an aggregate, which includes all units of supervision. For example, all morbidity on the earth.
A selective statistical aggregate is an aggregate, which includes the certain part of units of supervision, but this part is able to represent all general aggregate.
Unit of supervision is every special case of the phenomenon, that is studied, that it is every primary element of aggregate, which belongs to the account (for example, every case of disease, birth, deaths, hospitalizations and others like that). Such registration elements of aggregate divide into attributive (expressed verbally) and quantitative (expressed by a number).
Indexes of population’s health:
The І group is morbidity and traumatism
The 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 development
The V group is assignment of population in health 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 – 1 %
Group properties of statistical totality:
1. Distribution of characteristic (criterion – relative sizes);
2. Average level of index (criterions – Mo-mean, Me-median, arithmetical mean);
3. Variety of characteristic (criterions – lim– limit, am – amplitude, σ – average deviation);
4. Representation (criterions – mM – mistake of average sizes, m% – mistake of relative sizes);
5. Mutual connection between characteristics (criterion – rxy – coefficient of connection.
