N.A.Semashko Institute for Research on Social Hygiene, Public Health, Economics and Management of the Russian Academy of Medical Sciences
Social-hygienic approaches for evaluation of health population formation under the different social and ecological conditions
The evaluation of the environment changes influence on population health is an important social problem and a complicated theoretic and methodic target. Human activity and technic development on a large scale are accompanied by natural environment changes, but at the same time they insure the progress in the areas of human well being, health protection and medical services.
In the highly industrial developed countries life expectancy is higher, as a rule, mortality rates of all age-groups are lower, the indexes of rising generation physical development are more satisfactory. According to the social- hygienic studies under worse environment conditions there are retarding of children growth and development and acceleration of the aging processes and presenilation in adult. So higher level of well being in the wide sections of the population has a positive influence on health.
Actually under present conditions of world regions differentiation in accordance with their social and economic development and living standards of population we have on the agenda the question about the principal possibility to ensure for all world population the high living standards and corresponding level of health existing in industrially developed countries. It means to bring into proper correlation the social plans and the possibility of the biosphere and processes having place in it.
In our country there are social instability, property differentiation, changes of value orientations in the great mass of the population, the concrete territories with a high local ecological burden and sufficiently large regions with a satisfactory ecology. Therefore it must be developed our-self strategy for perspective development inserting in the world actions. This strategy must be developed on the base of the accurate scientific data about general regularities and local peculiarities (problem situations) of health population formation under concrete environment conditions.
Study of regularities of health population formation must be based on the conception of integration, reciprocal imposition of biological characteristics and social conditions and in the end biosocial unity. And social hygiene studying the population health status and factors influencing on it must have a sufficiently definite position about the diapason of the acceptability in the selection of means for the health population management.
The influence of technogenic changes on the population health status supposes the realization of genetic materials under the concrete environment conditions. The environment peculiarities are considered from the point of view of the nature remaking and suppose the strong reciprocal connection among the quality of environment and health (it is supposed in advance that the more of nature changes we have, the worse health rates are). At the same time there are supporters of more optimistic point of view considering human organism as a system having large possibility for adaptation (naturally not out of nature changes incompatible with life).
Human organism is a complicated system, his reaction must not be considered as direct action and the manifest changes can reveal not only in the places where the pollutants enter in the organism (respiratory organs and according to some data digestive organs). It would be too simple to consider that there is only direct dependence the population morbidity level from the intensity of environment changes. And what is more, an organism can to react on environment changes by both illness and hypo and yet are active conditions. The changes can appear not only in places of direct contact with pollutants (the connection among respiratory organs diseases and air pollution for example), they can mainly influence upon mechanisms of adaptation and main regulative systems endocrine and nervous.
To all appearance there is a mechanism for biological regulation of population quality particularly at the early stages of development. In any case there is not sufficiently convincing data on quantitative changes in the prevalence of congenital defects of development under the changed ecological conditions.
The rising generation growth and development rates and their accordance with known fundamental regularities of age changes in the process of ontogenesis are the most important part of population health evaluation in ecological aspect. The condition of environment can cause both acceleration and retardation of growth and development; it can influence upon the prevalence of different disharmonies. The extent of age changes deviations from the biological caused ones (standard) can be an indicator for revealing problems and their gravity.
The study of children growth and development processes using strong standardized methods must be an integral part of any ecological examination by experts. This is sufficiently available instrument and it can be ensured for mass population examinations. The absence of deviations in characteristics of the rising generation growth and pubescence processes under the unfavorable conditions must to direct energy of scientific thought to study deep processes and mechanisms of the population adaptation to the specific environment conditions.
Quantitative evaluations of environment changes influence on population morbidity require a clear notion of background levels of prevalence of different kinds of pathology. The science of today does not have such data about most diseases, particularly comparable data in dynamic for a sufficiently long period of time.
General and local ecological problems can influence on deep processes of age dynamic of pathology formation, changes of diseases clinic and characteristics, duration and results of pathologic processes. Under modern conditions there is a modification of pathologic conditions clinical form but there are also changes of diagnosis means capacity and biological environment and according to some data the chemical composition of human organism is changing too.
However without knowledge about a counting point, quantitative criteria of preceding frequency all evaluations of the environment changes influence on the population morbidity can be considered only as a hypothesis.
Over the last years in different regions of Russia the general regularities of morbidity population formation, characteristics of composition and frequency ranges of the most widespread diseases, their connection with main biological and social factors be revealed with using of standardized methods. An instrument was developed to reveal problem situations in morbidity (including their ecological aspects) and to evaluate trends.
At the same time with the strengthening of health system correcting importance for the great masses in the highly developed society the necessity is rising to examine conceptual approaches from a position of evaluation by different population groups the realization of their biological functions corresponding to their sex and age under the real social-historical conditions. The health system activity (including large using chemical drugs and hospital ecology) also needs ecological evaluation and proper control.
Social factors affecting the vital interests of the great masses intensify or smooth out the influence of natural environment changes. Under the conditions of social instability the situation is aggravated by stresses, changes of residences, using value orientations and living conditions. Ecological disturbing can be intensified and under appropriate conditions can grow into deep social-economic problems. It is necessary to take into consideration also relatively new ecological aspects of the result of the armament liquidation.
It makes the necessity of the interdisciplinary approach to studies on the influence of all complex of contemporary life factors on health status. And that can be realized in the limits of social-hygienic monitoring. The functioning of such monitoring must be the main link among scientific examinations and the purposeful activity of society.