Any road traffic system is very complicated and can be dangerous to health. Elements of this system include motorized transport vehicles, roads, road users as well as physical, social and economic environment. Countries with high automobilization have long ceased to consider traffic accidents as a pure “chance”; furthermore, efforts aimed at preventing and mitigating negative consequences of traffic accidents are thoroughly designed and structured.
In 1972, William Haddon published his study with incorporated approaches that used to be individually applied to trauma epidemiology and transport engineering. Haddon suggested a model to analyze traffic situations that were dangerous to health. Haddon’s approach allowed to achieve a notable progress in understanding factors related to driver’s behavior, vehicle characteristics and road infrastructure conditions affecting emergence of traffic accidents and severity of consequences for participants. Haddon’s approach turned out to be a useful analytical instrument and became widely used in healthcare.
The main purpose of public health is quality improvement of medical care. Ranking of healthcare organizations is rather effective information and marketing tool for external quality management of medical care. The author reviewed international experience in selecting quality measures of medical care to rank healthcare organizations that could be used as a methodological framework for designing rankings of healthcare organizations in Russia. The aim of the study was to identify methodological basis of international rankings of health care facilities: major indicators and criteria for evaluating quality of medical care. The author analyzed methods for developing rankings of international healthcare organizations through the analysis of international scientific sources and information made public by state organizations working in the area of health management as well as through four expert interviews with experts in health management. The author attempts to structure indicators and criteria for quality evaluation of medical care based on Donabedian’s triad as well as identify definitions, content and balance between clinical and non-clinical indicators.
Significance. During the recent decades, Russia has experienced significant shifts in mortality. Considering the heterogeneity of the Russian regions, it is important to analyze how those shifts were experienced at the regional level and how they influenced the inter-regional mortality inequality.
Purpose. To evaluate how the inter-regional mortality inequality in Russia changed during the period 1989-2016; to measure contribution of different age groups and causes of death into the inter-regional mortality inequality in Russia and changes in those contributions over time.
Methods. In the current study, we used gap in life expectancy between the two groups of regions as the main measure of inter-regional inequality. The first group included regions with the highest levels of life expectancy inhabited altogether by 15% of the total Russian population. The second group included regions with the lowest levels of life expectancy, which also altogether accounted for 15% of the total Russian population. The contribution of different age groups and causes of death into the gap in life expectancy between the two groups was estimated with the stepwise replacement decomposition technique.
Results. Life expectancy inequality between regions increased substantially in the 1990s. The recent period of mortality improvements in Russia did not result in any significant changes in the inter-regional inequality. In 2016, the difference between the two 15%-groups of regions performing the best and the worst in terms of life expectancy amounted to 9.6 years in males. Mortality inequality in ages 15-39 contributed 2.6 years to this gap, in ages 40-64 – 4.2 years, and in ages over 65 – 2.9 years. In females the gap amounted to 5.3 years; 1.2 years, 2.0 years, and 2.0 years contributed by age intervals 15-39, 40-64, and 65 years and over respectively. Among the causes of death, the major contribution in inequality is attributable to external causes of death at the young and middle ages and circulatory diseases at the middle and elderly ages.
Conclusions. Decreased contribution of external causes of death in the young and middle ages, and circulatory diseases in the middle age had a positive effect on the inter-regional inequality in life expectancy after 2005 contributing to its decline. At the same time, mortality decline in the elderly contributed to divergency in life expectancy across regions. Those positive changes in the elderly mortality towards reduction, which are associated with the beginning of cardiovascular revolution in Russia, did not equally affect the Russian regions.
One of the main reasons of the low life expectancy in Russia, compared with developed countries, is a high mortality rate from external causes. The aim of this work is an assessment of the contribution of mortality from external causes and its various types in the change of the life expectancy in Russia by sex and age. The analysis is carried out by using the decomposition method proposed by Е.М. Andreev.
During the 1990-2010 external causes of death, along with diseases of the circulatory system, had the greatest contribution on the change of life expectancy. There are accidental poisoning by alcohol and assaults among leading external causes, which defined the dynamics of the life expectancy of both sexes during this time. There are intentional self-harm on 3rd place in male and transport accidents in female population It should be noted that, by the end of 2010, there was not a significant contribution of the external causes class of death in the increase of life expectancy - violent mortality, reducing the years of life expectancy in some periods, had restored them, but no more, in others. This suggests that in Russia there was the same high traumatic death rate in 2010 as in 1990. That means that in the almost twenty years mortality rate from external causes had not decreased. On the contrary, at the beginning of 1990s there was so significant increase in mortality from events of undetermined intent that compared to 1990 its negative contribution to the reduction in life expectancy is preserved in 2010. In other words, the death rate from this cause remains higher than in the beginning of the study period.
Given that the external causes of death play a significant role in the life expectancy indicator, the socio-demographic policy aimed at reduction of mortality from these causes would significantly reduce the backlog of Russian life expectancy from similar indicators of developed countries.
Having data on the contribution of causes of death to changes in life expectancy by sex and age, it is easier to specify priorities of the state policy.
Professional associations in health care: presentation on the internet
Abstract. A significant number of professional associations in Russia operate in the field of health care delivery (medical services) and health protection. The activities and functions of such organizations and professionals in the associations are understudied. Aim. The research aim was to analyze information that professional associations provide about themselves and information about professional associations in the public access and to identify major types of activities, functions, associations and professionals within the professional organizations. Methods and data. Content analysis method was used in the research. Self-presentations of professional associations in healthcare and care delivery posted on the Internet were analyzed. Results. Besides the basic functions inherent to professional organizations, i.e.: unity, communication, knowledge creation – there are other functions that depend not only on the membership of a professional association as such, but also on the status of the organization – issues related to professional development within a particular specialty or the profession in general. Organizations make priorities for each type of activity: professional development, expertise, education and protection of rights of colleagues and/or patients, commerce, integration into society and public life at various levels. United professionals carry out a social mission - work for the good of the society – organization and implementation of social activities. They participate in the territory development at different levels, creating infrastructure: promoting development of practical organizations, expanding technological infrastructure of organizations that provide medical care to the catchment area. United professionals initiate activities and participate in them in order to improve management of healthcare system and development of specialized care (including elaboration and discussion of the legislation). Professional associations create a unique communication environment, which includes all-level professionals, among them future professionals – students. A professional association is not limited to the interaction of its peers only; it is also interested to extend boundaries to all stakeholders, who are keen on further development of the profession. The professional association provides for the environment of knowledge exchange, ideas for further development of the profession, cooperation and organizational unity. However, there is no common positive attitude of professionals towards the processes of uniting into an integrated community on the basis of self-organization. Scope of application. Information in this article can be used in practical activities of associations, development of trainings on healthcare organization and management as well as expertise learning of the profession.
Health self-assessment of the Russian population is lower compared to self-assessments in many developed countries. Rural dwellers tend to assess their health status worse than urban residents. This is mainly due to low self-protective behavior, low individual responsibility for their health that is manifested in the relevant self-protective behavior of rural dwellers. The purpose of the work is to find reasons for different health conditions and life expectancy between rural dwellers and summer (urban) residents in Kostroma Region.
The analysis is based on data of the International Social Survey Program (ISSP, 2011) and in-depth interviews collected in summer 2014 in Ugorsky district, Kostroma region.
Statistics shows that life expectancy of rural and urban population differs: according to the Federal State Statistics Service data for 2013, life expectancy at birth of rural males was 1.89 years lower and for rural females – 1.57 lower compared to urban males and females correspondingly. Among other things this gap in life expectancy is due to different health status of rural and urban population. Qualitative data helped to understand main reasons for different health status of urban (summer residents) and rural dwellers in Kostroma region.
Prevalence of self-treatment, untimely application for medical advice, unbalanced diet, smoking and alcohol abuse – all these things combined with limited access to quality health care negatively affect health status of rural dwellers. However, there is a tendency towards better self-protective behavior among younger rural dwellers compare to the older rural population.
Abstract. Relevance of the work is determined by the need to reduce high mortality from external causes, compared with the developed countries, and to create conditions for increasing life expectancy in Russia. The article tests the working hypothesis that a high level of traumatic mortality in Russia is associated with behavioral risk factors.
The aim of the study was to identify factors of mortality from external causes based on the study of expert opinions and develop ways to reduce it.
Methods. An expert interview of 18 experts was conducted. Besides demographers the interviewees also included sociologists, statisticians, doctors, lawyers, and community leaders.
Results. The article provides results of the analysis of the expert interviews. The interviews covered factors of high traumatic mortality in working age as well as measures for prevention and reduction; furthermore, the interviews also discussed the existing priorities of socio-demographic policy related to mortality from external causes, and possible scenarios of dynamics of mortality and life expectancy in Russia.
Conclusions. The working hypothesis was partially confirmed: high mortality from external causes is associated with behavioral, environmental and economic risk factors. Therefore, the crucial objectives include developing a self-protective, vital behavior as well as creating favorable physical and social conditions of work, leisure and travel.
These actions should be accompanied by increasing funding of programs on injury prevention and improving living standards of the population in general.
The younger generation is the demographic, socio-economic and labor potential of the society. Quality of labor resources directly depends upon health status of this population group and is one of the most important components of the country's resource potential. In this regard, a thorough analysis of the pediatric health status determinants is a topical issue.
Currently, within the context of a stable ecological imbalance, factors reflecting environmental situation are one of the essential determinants of the pediatric health.
The purpose of the study is to analyze influence of environmental factors on health of children aged 0 to 14 years exemplified by the Nizhny Novgorod region. The object of modeling was incidence rate in children aged 0 to 14 in 50 municipalities of the Nizhny Novgorod region in 2000-2016.
The study used methods of econometric analysis, including panel regression with fixed and random effects, as well as Wooldridge tests for the unobserved effects and Darbin-Woo-Hausman for the regressions’ diagnostics. Calculations were carried out on the basis of the data of the Nizhny Novgorod Statistics Service and Ministry of Health of the Russian Federation.
Results of the model estimation suggest a statistically significant effect of the considered factors on the level of the pediatric incidence rate. Factors that have a significant impact on health of the younger generation include availability of pediatricians and district doctors providing outpatient primary health care to children aged 0-14; current expenditures on environmental protection; proportion of unpurified emissions in the total amount of pollutants discarded from the stationary sources; emissions of pollutants into atmosphere from the stationary sources; number of water samples analyzed according to sanitary-chemical indicators taken from sources of the centralized water supply with a breakdown on districts, that do not meet the sanitary standards. The obtained econometric model can be used to predict pediatric incidence in relation to environmental factors to develop programs aimed at improving quality of life of the younger generation.