A Socio-Hygienic Study of Health Problems and Healthcare in the Taimyr (Dolgano-Nenets) Autonomous Okrug

The dissertation is devoted to a comprehensive socio-hygienic study of the health status of the population and the organization of medical care in the Taimyr (Dolgano-Nenets) Autonomous Okrug — a territory of the Russian Far North with unique natural-climatic conditions, a specific population composition including small-numbered northern peoples, and features of economic development. The work analyzes healthcare problems of the Arctic region in the context of administrative reform and the reunification of the okrug with the Krasnoyarsk Krai, evaluates the influence of socio-economic factors on the health of residents, including extreme living conditions, structural changes in the population, and the level of accessibility of medical care. The study justifies a strategy for the modernization of the healthcare system on the basis of a comprehensive analysis of medico-demographic and medico-social problems of the region.

Relevance of the Problem.

During the administrative reform, when a number of northern autonomous okrugs are reunified with the administrative territories of metropolises, there arises a need to generalize the experience accumulated by them during their existence as independent subjects of the Federation, including in the sphere of healthcare. The results of this work serve simultaneously as a starting position for further reforms.

The need for modernization of the organizational foundations of healthcare for the residents of the Russian Arctic is determined by:

- extreme living conditions, compounded by problems of violent causes of death, diseases of socially significant pathology, chronic degenerative diseases of the elderly population, and pathology of pregnant women, mothers, and children;

- the structure of the population: small-numbered northern peoples, descendants of settlers, long-residing migrants and members of their families, migrants of the latest wave (geologists, shift workers, etc.);

- changes in the conditions of socio-economic development of the Far North. The separation of autonomous okrugs into independent subjects of the Federation altered the conditions of medical care organization and limited patients' access to highly specialized types of care;

- the growth of the permanently poor population, especially in rural areas. Deterioration of material well-being, a high level of unemployment, and the breakdown of families increase the number of chronic patients and contribute to the moral degradation of the population, primarily as a result of alcoholism.

In the studies of Klocov K.B. et al. (1999), Krivonogov V.P. (2001), Mukhachev A.D. et al. (2001), Zelenksy V.M. et al. (2004), the features of life in the Taimyr (Dolgano-Nenets) Autonomous Okrug were studied; however, the authors did not investigate issues of medical care for the population taking into account their type of settlement.

This determined the goal of the work: on the basis of a comprehensive socio-hygienic study of the health status, medico-demographic, and medico-social problems of the residents of the Taimyr (Dolgano-Nenets) Autonomous Okrug, to develop directions for the improvement of medical care for the residents of the Russian Arctic region.

To achieve this goal, the following tasks were set and solved:

- to study, based on literature data, the problems of population health and healthcare organization in the regions of the Russian Far North;

- to characterize the features of socio-economic development as a basis for the financial provision of healthcare in the Taimyr (Dolgano-Nenets) Autonomous Okrug;

- to conduct a comprehensive assessment of the health status and the level of medical care organization for the residents of the Taimyr (Dolgano-Nenets) Autonomous Okrug;

- to develop measures for the improvement of healthcare protection for the residents of the Arctic.

Scientific Novelty.

The scientific novelty of the work lies in the fact that for the first time:

- the organization of medical care for the residents of the Taimyr (Dolgano-Nenets) Autonomous Okrug, their health status, the influence of the territory's economic resources, and healthcare institutions on population health were studied, and priorities for the modernization of medical care were determined;

- the experience of healthcare restructuring in a vast, sparsely populated Arctic territory of Eastern Siberia, with a low population density, including representatives of small-numbered northern peoples, was generalized, when the okrug, becoming an independent subject of the Federation, lost the support of the Krasnoyarsk Krai;

- on the basis of the results of a socio-hygienic study using the example of the Taimyr (Dolgano-Nenets) Autonomous Okrug, a strategy for the modernization of the healthcare system of the Arctic population was justified in the context of the reform of medical care in Russia.

Practical Significance.

The results of the work were used by the Ministry of Health and Social Development of Russia in the preparation of strategic decisions on problems of the Far North, and by the Okrug Government — in the adoption of operational resolutions on population healthcare protection.

By substantiating the priorities for the modernization of medical care for the residents of the Taimyr (Dolgano-Nenets) Autonomous Okrug, the work simultaneously addresses the problems of healthcare organization for the residents of autonomous okrugs of the Far North and Siberia.

The analysis of the socio-economic portrait of the region makes it possible to coordinate sectoral economic claims in the process of population healthcare improvement and the optimization of preventive, diagnostic, therapeutic, and rehabilitational measures with the resource capabilities of the territory.

The propositions put forward for defense:

1. The social portrait of autonomous okrugs declared in the 1990s as independent subjects of the Federation determines their geographical location, historical development, population structure, level of business activity, state of the labor market and finances, efficiency of the operation of economic sectors, consistency of levels of social provision and economic development, and the correspondence of the healthcare system to the health status of the population.

2. The separation of the Taimyr Autonomous Okrug as an independent subject of the Federation destroyed established inter-territorial connections and necessitated the accelerated creation, in conditions of socio-economic crisis, of an independent healthcare infrastructure.

3. The features of the modernization of healthcare in the Taimyr (Dolgano-Nenets) Autonomous Okrug are associated not only with the pattern of settlement, living and working conditions of the population in the Arctic, but also with different, compared to other regions of Russia, starting positions in the healthcare protection of the population. The results of modernization constitute the basis for the transformation of healthcare development in new conditions of the reunification of the okrug with the Krasnoyarsk Krai.

Validation and Implementation of the Results.

The obtained results were used in the preparation of the Collegium of the Ministry of Health and Social Development of the Russian Federation in 2004, in normative-methodological documents of the okrug level, in sectoral administrative orders and directives on healthcare protection and the organization of medical service for the residents of the Taimyr (Dolgano-Nenets) Autonomous Okrug. The materials were presented at All-Russian Scientific and Practical Conferences in 2003, 2004, and 2005 (Moscow), and at conferences of local significance. The implementation of the developed methodological handbook concentrated the efforts of municipal governing bodies, healthcare workers, and employees of social development, education, and internal affairs on one of the critical directions of healthcare protection for the residents of the Russian Far North — narcotics.