Medical and social problems of demographic processes.
Features of demographic indicators in the different regions of the world, separate countries and in
One of the basic tasks of economic and social development of a country is pursuing an effective demographic policy, directed on the increasing of life-span, labour activity, saving and strengthening of health of population.
Demographic information is widely used for planning of the measures of a health care service, for the complex estimation of the state of health of population, drafting of the scientifically proved prognoses and purposeful organization of the medical care.
That is why among the medical indices of the population’s health the important part is acted by the demographic indices.
Demography is the science about the population (from “demos” – people, “grapho” – to describe), or the statistics of population.
The statistical study of population is conducted in two basic directions:
1. Description of population on the set time (its quantity, composition, features of settling apart and others like that) – the so called statistics of population;
2. Description of processes of change of quantity of population – a dynamics or the motion of population. The last one in the last turn divides into the mechanical motion of population ( the changes which take place under the act of migrations — migratory processes) and so called natural motion of population ( the changes, that take place as a result of birth-rate and death rate and characterize the processes of recreation of population).
The census of population is a basic information generator about a quantity and composition of population . It is large-scale statistical research, purpose of which is to set the exact information about a quantity and composition of population of one or other country. The program of census, that is the information about every citizen, is prepared preliminary. The census of population by the plenitude is a continuous research, and by the time of collection – simultaneous, because it is conducted on the certain, so called “critical date”.
In periods between the censuses the special count of quantity of population on the basis of previous censuses, materials about a birth-rate, death rate and migration on this territory is carried out.
In the world practice the censuses of population are carried out one time in 5-10 years. The first and unique in the Tsar’s
The method of medical and demographic researches
Medical-demographic information includes the information about a quantity, composition and recreation of population, the reasons of death, migration of population.
As it was marked above, the state censuses which are periodically conducted are the basic source of information about the quantity of population .
For the first time
In the year 2000 the population of planet attained to 6 milliards , from them 1 milliard lives in the developed countries of Europe, North America and in
In a post-war period 4 censuses of population were conducted in
The census is enumerated on the certain moment of time (for example, on 12 hour on January, 14). On this moment on the special census forms all habitants of country are brought. Thus, if the form is filled a bit later of the fixed date (the process of copying can last a few weeks), the forms are filled also on those ones, who have died after the fixed date.
The census of population by the plenitude is continuous research, and by the time of collection – оne-moment, because it is conducted on the certain, so called “critical date”.
The last census was conducted in 2001. The purpose of conducting of the first all-Ukrainian census of population was the receipt of objective information about the native changes, which took place during the last decade in social-economic life and the modes of independent Ukraine, creation of informative base of demographic and social-economic information both on a country on the whole and by all levels of its administrative-territorial mode in relation to the quantity of population, its national, linguistic, domestic composition, distribution by the age, sex, citizenship, level of education, sources of facilities of existence, professional belonging, position in employment, migratory activity and others like that. Basic features of modern censuses of population: generality, unity of the program, naming of registration on the certain moment of census.
The development of materials of census allows to get the exact information about the quantity of population on certain territories, their distributing for by the sex, age, nationality, domestic position, employment, education etc.
The special count of quantity of population on the basis of previous census, materials about a birth-rate, death rate and migration of population on this territory is produced in the intercensus years. These operations are carried out by the organs of statistical services by the special method.
Quantity and composition of population
From the data of UNO, the absolute annual increasing of population of the Earth makes an approximately 80 million, mainly, due to the countries which are developing. In the economically developed countries the rates of growth of quantity of population are the lowest – only 0,4 % per year.
For a long time the quantity of population of
In the first time for post-war period its diminishment which lasts to now was marked in 1993. For 1993-1998 the population of
The most perceptible diminishment of population takes place in
On the long-term demographic prognosis developed by the State CRI of information and design of economy of the National agency by the questions of information under the President of Ukraine, the quantity of the population of our country during the next years will continue to diminish and at the end of the year 2025 it will make 46,7 million, that is approximately on 3 million people less, thaow.
The information about a quantity and composition of population is used for the calculation of indices of health, at planning of network of treating-prophylactic and sanitary-prophylactic establishments, and also at planning of preparations and uses of medical shots.
The quantity of population of
The correlation of urban and rural population of
The process of urbanization is most characteristic for such industrial regions of
For the process of urbanization, except for the growth of quantity of urban population, the growth of number of cities, change of the way of life, increasing of rate of life, concentration of forms of intercourse of people are characteristic. Urbanization has both positive and negative influence on a health of people, that has to be taken into account at planning and organization of giving of medical care to the population.
To the negative sides of urbanization are the contamination of atmosphere, hypodynamics, nerve-psychic overloads, which result in the growth of death rate of townspeople from the cardio-vascular diseases, malignant formations, traumas, to sharpening of sanitary-hygienic problems.
The sexual structure of population is caused foremost by a different level of death rate among men and women, what both biological and social factors influence on. From the data of the last census, in
In addition, in some regions on the sexual structure of population predominance of development of separate industries of industry can be designated.
Predominance of women is characteristic for many regions and world countries.
To the age structure of population of
The especially considerable decline of specific gravity of children in the recent years is observed among the urban population. By the age the population of
By the prognosis of Ministry of economy of Ukraine to 2025 year the particle of children in the structure of population will go down to 16,8 %, while the specific gravity of population in age 60 years and older will grow to 30 %.
The process of decrepitude of population, that is the growth of the quantity of population of senior age groups (60-65 years and older), is characteristic for the most economically developed countries. Eighteen from 20 countries of the world with the prevailing particle of people of senior age are in
Deepening of the process of decrepitude of population of
Among the urban population the particle of persons of retirement age during 90th has multiplied almost on 11 % and in the structure of population it makes 19,9 %, thus among women the specific particle of persons of senior age is almost 2 times higher, than among men.
However an especially unfavorable age structure has folded in rural area, where the level of decrepitude of population is considerably higher, than in towns, and the particle of population senior than 60 years makes 29,2 %, including the particle of men senior than the working age 18,8 %, women — 38,1 %.
The process of decrepitude of population pulls out the important problems before the system of organs and establishments of health protection:
• the increasing among the population of specific gravity of persons senior than 60 years brings it to the decline of indices of birth-rate and growth of general indices of death rate, that it is necessary to take into account at the analysis of demographic processes of population’s recreation;
•the growth of number of appeals of population of senior age groups for medical aid- ambulatory-policlinic and stationary, needs the special attention to the mentioned contingents from the services of primary medical –sanitary aid, also of the family medicine, and also the necessity of decision of such medical-social problems as caring of lonely, hospitalization of patients with the long-lasting chronic diseases and others like that.
Diminishment of particle of children in the structure of population, from one side, and the growth of particle of persons of senior age groups, from the other, results in the growth of the economic (demographic) loading on the working age. The index of the “demographic loading” is expected as the correlation of children and persons of retirement age to the quantity of the working population.
In
Analyzing the age structure of population, the particle of persons is determined in his structure 0-14, 15-49 and 50 years and senior. It enables to define the type of age structure of population, that lives on this or that territory.
At the progressive type of age structure the particle of children (0-14 years) exceeds the particle of population in age of 50 years and senior.
For the regressive type of age structure it is characteristically, that the particle of people of senior age prevails above the particle of persons of 0-14 years.
The type of age structure of population is considered stationary, if the particle of persons in the age of 0-14 years approximately equals to the particle of persons in the age of 50 years and senior.
For
Interesting data about the national composition of population of
The distribution of population of
Mechanical motion of population
There is the mechanical motion of population, or the migration – the moving of its groups as in a country, region, district – the internal migration, and the departure outside the state –the external migration: emigration (departure outside this country on the permanent residence) and immigration (entrance in this country on the permanent residence).
In the demography the migratory processes are distinguished by a territorial sign and by the duration.
By the territorial principle the migration is divided on: a) intergovernmental (within the limits of one continent, between the neighboring states); b) within the limits of one state.
By the duration the migration can be:
• permanent, when the migrants remains on a new place on the permanent residence or long time;
• seasonal (move from the short duration of time, often in communication with seasonal works);
• “pendulum” (daily departure of villagers on work, on studies in cities and returning in the evening to the permanent place of residence).
The composition of migrants depending on the direction of migration is distinguished also – in a city or rural locality. Most valuable is the migration in cities, industrial districts, that predetermines the process of urbanization.
Migrates, mainly, the masculine, young part of population, especially during the mass moves. It can be reflected on the demographic indicators (birth-rate, death rate), change of the structure of morbidity.
Mechanical motion of population matters very much for the sanitary state of country, because it can to help in the transference of infectious, the appearance and distribution of other diseases. That is why the account of migratory processes is an important condition for the estimation of the sanitary state of population, and exact information about it allows to provide the timely organization of medical care to the emigrants both on the way of the following and on arrival to the new place of residence.
Natural motion of population
More valuable for the estimation of health has the natural motion of population – its change of quantity as a result of co-operation of the basic demographic phenomena: birth-rate and death rate.
Natural motion or recreation of population shows, whether the existent levels of birth-rate and death rate provide the increase of population. A difference between the indices of birth-rate and death rate got the name natural increasing.
In order that the quantity of population did not diminish, a birth-rate has to be higher than the death rate, that is a positive natural increasing has to take place.
A natural increase in Ukraine to the year 1991 was just the same, but beginning with 1991 on the whole in Ukraine, and in rural area yet with 1979, the indices of death rate began to exceed the indices of birth-rate, that is the so called negative natural increase of population or depopulation was fixed..
In 1991 first for post-war years the curves of death rate and birth-rate intersected: the curve of death rate sharply went upwards, and birth-rate – crept downwards.
The negative natural increase of population in
• low birth-rate;
• high death rate;
• unfavorable age structure.
The Ukrainian demographers consider that the depopulation for a long time will become the determining sign of demographic development of
The indices of birth-rate, death rate, natural increase, average duration of life belong to the basic demographic indicators, and also one of age-old indices of death rate is the death rate of babies, that is children under the age of 1 year.
Birth-rate
The determination of the concept “birth-rate” is difficult enough.
As it is known, births end with the birth not only of active child, but abortions can take place, birth of dead featus. Thus, it is needed to distinguish such concepts as born alive and still-born.
Till the year
The transition in determination of born alive and still-born after the criteria of World organization of health protection took place in 1996 (WHO).
On all
• Born alive is the complete banishment or extraction of product of conception from the organism of mother regardless of term of pregnancy, which after such separation breathes or exposes other vital sparks, such as: palpitation, pulsation of umbilical cord or proper motions of arbitrary musculature regardless of the cut umbilical cord or not, whether a placenta was removed. Every product of such birth is considered born alive.
• Death of featus (stillborn featus) – is the death of product of conception to his complete banishment or exception from the organism of mother regardless of the duration of pregnancy: on it specifies the fact that after such separation a featus does not breathe or does not expose other vital sparks, such as: palpitation, pulsation of umbilical cord or proper motions of arbitrary musculature.
By the data of WHO was considered the criteria of born alive : the term of pregnancy 22 weeks and more, weight
Pursuant to the item 158 of Code of Ukraine about marriage and family (in future – Code), birth of child is subject to registration in the state organs of civil registration.
The application about the registration of birth of child must be handed in the organ of registry Office not later than three months from the day of birth of a child, and at birth of dead child – not later than three days (item 164 of the Code).
Registration is conducted at the producing of certificate of medical establishment about the birth of child – the “Medical birth certificate” (form № 103/0-95), which is given by all establishments of health protection during the extraction of mother from the permanent establishment, where births were adopted. In cases of births at home the medical birth certificate is given out by that establishment of health protection, the medical worker of which (doctor, medical assistant, midwife) adopted births.
In exceptional cases — at birth of child at home or in other town without presentation of medical care the registration of birth of child is conducted by the organs of civil registration. A fact and time of birth in such cases must be confirmed by the signatures of two witnesses, and also filling of the “Medical certificate about the stay of child under surveillance of medical establishment” (form №103-1/о-96). A certificate is given by the medical establishment, on an account of which the new-born is.
At multifeatus births the medical birth certificate is filled on every child separately.
All treating-prophylactic establishments of MOHC of Ukraine, regardless of presence or absence of maternity beds, journalize the account of new-born (f. № 152/0).
Registration of new-born in a magazine is conducted during the delivery to a mother of medical birth certificate for registration in the organs of registry Office only in cases of residence of mother (parents) in this region (city, district).
In a magazine, as well as in the medical birth certificate, is necessarily noted, if a child was born from one of parents, which suffered from the consequences of failure on CAES on the basis of certification of a victim.
The organs of recording of acts of the civil state pass the information about the number of born alive for a current year in territorial statistical establishments, where the calculation of the proper indices of birth-rate is.
A birth-rate, as well as other demographic phenomena, is determined by statistical indices.
The general index of birth-rate settles accounts foremost. As well as most indices of natural increase, it is determined by the number of born in a calculation on a 1000 population:
But the process of recreation of population can be described more precisely, if to expect a birth-rate not among all population, but only among the women of fertile age (15-49 years). This index is named the special index of birth-rate (fertility, fecundity) and it is settled thus:
Except for the above-mentioned such special indices are used:
• the total index of recreation of population – the number of the children born by a woman during the fertile period of her life (15-49 years);
• the brutto-coefficient of recreation – the number of the girls born by a woman in age of 15-49 years;
• the netto-coefficient, or the cleared index of recreation- the amount of the girls born in the middle by one woman for all reproductive period of her life, that attained age, which a woman at their birth was in.
If the netto-coefficient is 1, brutto-coefficient – 1,2, total coefficient – 2,2, then the process of recreation of population is defined as stationary, indices which exceed the indicated levels are determined the extended recreation and the indices below the indicated level are the narrowed recreation.
Death rate
One of major demographic indicators of public health is a death rate which characterizes the health of population from the point of view of distribution of the most heavy pathology.
The death records are conducted by the organs of civil registration (REGISTRY OFFICE) after the last place of residence deceased, after the place of offensive of death, exposure of dead body or after a burial-place.
Attestation of death is conducted on the statement of relatives of deceased, his neighbours, workers of life-expluatational organizations and other persons or according to the news of administration of medical establishment, where death followed.
The statement about the registration must be done not later than three days from the day of death or exposure of dead body, and if it is impossible receipt of certificate of medical establishment or conclusion of the forensic expertise or public prosecutor – not later than five.
The foundation for the registration is given out by the medical establishment “Medical certificate about death” (form № 106/о-95) or “Assistant medical certificate about death” (form № 106-1/о-95), decision of court about the establishment of fact of death or announcement of citizen deceased, and also report from the places of imprisonment.
All establishments of health protection, which give out the “Medical certificate about death” or “Assistant medical certificate about death” journalize account of deceased (f. № 151/о). An account is conducted parallelly with the delivery of foregoing documents which certify death, only in the cases when the last place of residence of deceased was a district given (city).
Monthly the information from the organs of registry Office about the deceased is brought in these magazines, on which the “Medical certificate about death” or “Assistant medical certificate about death” is given out in establishments of health protection outside this district (cities) or in the department of treating-prophylactic establishments.
The magazines of account of deceased on the whole on a district or city at the beginning of year new after current are passed in the regional centers of medical statistics for the automated treatment and analysis of death rate. The databases of regional deceased are passed to the informational –analytic center of medical statistics of MOHC of Ukraine for creation of a similar state base.
Registration of birth of dead child must be done not later than three days from the moment of births.
In cases of death of child in the period of 0-6 days the “Medical birth certificate” of child is filled -form № 103/0-95 and the “Medical certificate about perinatal death” – form № 106-2/0-95. The last document is filled also in cases of birth of dead child.
All treating-prophylactic establishments of MOHC of Ukraine, which fill the “Medical certificate about perinatal death”, journalize account of perinatal death rate (f. № 153/о). A record in a magazine is done parallelly with filling of foregoing certificate.
Correction of number of cases of perinatal death after a record in the magazine of f.№ 153/о is monthly conducted with the number of the cases incorporated in the organs of registry Office.
Responsibility for the report in the organs of civil registration about a birth of dead child, about birth and death of child, which died on the first week of life, is laid:
• on the main doctor (leader) of establishment of health protection, where a mother during births was, where the new-born died;
• on establishment, the doctors of which gave medical help at births at home;
• on the leader of forensic expertise- in the case of the establishment of fact of death of child out of hospital establishment ( in the street, at home and other).
Departments of registry Office, in the turn, pass the information about the quantity of deceased on this territory in the proper organs of statistics, which carry out the calculation of general and special indices of death rate.
The general index of death rate characterizes the frequency of cases of death per year on 1000 population, that lives on the concrete territory.
The special indices of death rate are a death rate for the article (at men and women), after age (in separate age groups) and after reasons (from separate classes, groups and nosology forms of diseases).
A death rate among the rural population in 1,5 times is higher, than among a city population. In 2002 it made accordingly 19,1 ‰ and 14,0 ‰, in that time both indices are standardized by the age for rural as well as for the urban population were identical. These information testify that a difference in the death rate of urban population and rural is largely conditioned by a difference in the age structure of population (among the rural population there are more persons of senior age).
In
The death rate of population in a sexual-age cut has stable enough features, namely the death rate of men in all age groups is higher than the death rate of women. This feature shows up in a whole world, but the measure of predominance of masculine death rate above womanish in different countries is different.
A difference is especially showed up in working age. If at 15-19-years-old men a death rate exceeds womanish in 1,5 times, in 40-49 years this exceeding already makes 3,5 times.
The structure of general death rate among the population of
Death rate of babies
Death rate of babies is one of age indices of the death rate. It characterizes the frequency of death of children of the first year of life.
The death rate of babies is selected from the problem of death rate as a result of its social value.
This index of WHO among others, such as the particle of internal gross product (IGP) in a calculation per capita, general charges on the health protection from IGP and others like that, is used for estimation of socio-economic prosperity of country.
