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Концептуальные основы определения детерминант общественного здоровья
Significance. Public health is defined as a medical and social resource that ensures national security and potential for socio-economic development of the country. The possibilities of state management of public health as a medical and social resource are limited by the lack of methodology for assessing determinants that affect it. The presented study outlines the conceptual framework for defining determinants of public health from the standpoint of the risk-based approach to its protection, as well as its components of labor, military, reproductive, and reserve resources. Developing a concept of public health management serves as a theoretical justification of public policy measures to develop strategies to control the risks of reducing the quality of public health.
The purpose of the study is to develop a conceptual framework for defining determinants of public health.
Material and methods. When developing the conceptual framework, the provisions of the following standards have been used: GOST R ISO 31000-2019 standard “Risk management. principles and guidelines”, WHO standard “The urban health index”, GOST R ISO/TS 21667-2009 standard “Health informatics. A conceptual model of health indicators”, as well as “Glossary of health promotion terms”, 2021 by the World Health Organization. The study presents the procedure for identifying risk factors, differentiating them by types of determinants and controlling the risks for the loss of public health under the influence of these determinants. Factors can be identified based on expert assessments, as well as confirmed statistical significance of the factors.
Results. The possibilities of public health management are limited by the lack of a comprehensive methodology for measuring determinants of public health. The authors evaluate a set of determinants of public health, including social, biological, behavioral, medical, and environmental determinants. The article has developed a four-stage model for identifying factors that contribute to public health strengthening and risk factors for the loss of public health. A set of unique factors should be identified for each determinant of public health.
Conclusion. The developed conceptual framework for defining determinants of public health is focused on the fact that the determinants of public health should be correlated with the components of public health as a medical and social resource that ensures attainment of the strategically important national security goals: national defense capability, viability, reproduction, and protection of society. It is necessary to consider territorial differences in the set of risk factors associated with the causes of loss of public health, as well as changes in their significance depending on the state of determinants, the period of society's life, including the period of pre-crisis, crisis and sustainable development.
Scope of application. The determinants of public health should be considered as a methodological basis for the development of strategies to improve public health in the interests of the national security. Developing a list of public health risk factors and a list of factors contributing to its growth plays an essential role in improving effectiveness of strategic planning tools for this resource.