Medical and Social Differences in Population Mortality (on the Example of Moscow)

The dissertation is devoted to the study of medical and social differences in population mortality on the example of Moscow. The work comprehensively examines the patterns of social differentiation of health and mortality of the working-age population using census and statistical data. The trends in mortality in the pre-Soviet and post-Soviet periods, territorial differences between districts and areas of the capital, and the social portrait of the deceased in various social strata, taking into account the level of education and the nature of employment, are investigated. Special attention is given to the role of social factors in shaping the scale and structure of mortality causes, including socially conditioned causes preventable at the current level of healthcare. The results obtained substantiate the necessity of developing differentiated strategies to reduce population losses directed at various social groups.

In any society, at any historical period, differences in the health status of population groups exist, associated with a person's position in the social hierarchy. The primary direction of evolution of social systems is the reduction of differences in health status and mortality levels, primarily through the improvement of the condition of persons occupying lower positions in the social hierarchy and possessing poorer health parameters.

Throughout the Soviet period of development of our country, within the framework of achieving the goal of social homogeneity of Soviet society, the enormous differences in the health status of individual population groups that existed in the early twentieth century were substantially reduced. The brief period of reforms of the 1990s, primarily as a result of the methods of their implementation, led to a sharp deterioration in the condition of the Russian population in terms of living standards and, consequently, in relation to the entire complex of conditions determining attitudes toward their own health and the possibilities of its preservation and strengthening (Rachevskaya I.M. et al., 1999; Inequality in Life Expectancy, 2000; Prokhorov B.V., 2001; Population Health in a Social Context, 2003, etc.; Rybakov L.L. 2003).

As the period of increasing polarization extends, an additional factor that aggravates the problem comes into force — the factor of reproduction of morbidity in poor families. Thus, we can expect that the replacement of the "natural" homogeneity of population health will give way to a period of ever-increasing differentiation.

Despite the objective necessity of transitioning from the study of population problems as a whole to specification by socio-status characteristics of population groups, in order to develop adequate measures to improve health and reduce losses directed at specific groups, such studies have been virtually absent. The exception constitutes a small number of studies oriented, primarily, toward marginal groups, including homeless persons and some others (Mikhailova Yu.V. et al., 2001, Som I.M. et al. 2000, Ivanova A.E., Sechenova V.G. et al. 2000, 2005, etc.).

Thus, taking into account the relevance of the topic, the degree of its development in the scientific literature, and its demand for applied use of scientific results, the goal of the present study is to investigate the patterns of medical and social differences in population mortality as a basis for developing adequate solutions to reduce losses in various population groups (on the example of Moscow).

In connection with this, the following tasks were set:

- to establish, based on census data, the mechanisms of influence of socio-economic factors on the health and mortality of the population;

- to determine the main trends in mortality in Moscow in the post-Soviet and post-Soviet periods;

- to identify territorial features of mortality in Moscow taking into account the social composition of its residents;

- to determine the features of the mortality picture in various social strata of the population.

The object of the study was the working-age population of Moscow. The choice of the object is determined by the following circumstances: a large population size, the polymorphism of social groups and their differentiation. The possibility of simultaneously examining different approaches to studying the differentiation of mortality at working ages is associated with the fact that it is precisely in this group that mortality trends were the highest. Both in the Soviet and post-Soviet periods, which determined the losses in life expectancy of the population as a whole.

The subject of the study is the features of mortality, its scale and structure of causes, taking into account place of residence, education, and employment status of the working-age population.

The scientific novelty of the conducted study lies in the following.

In a comprehensive medical and social study, approaches developed for investigating the social differentiation of health and mortality were tested, and the possibilities of their use for solving analogous tasks in Russian conditions were substantiated.

The universal nature of the influence of social factors on the formation of mortality has been established: its trends (more positive in a rapidly developing socially oriented economy), territorial differences (lower mortality levels and a more civilized nature of causes in respectable districts), and the deceased (lower risks of death among educated persons with a corresponding employment status).

The role of various social strata (level of education and nature of employment) in the formation of mortality at working ages has been determined, in accordance with which the priority of mortality reduction should be directed toward marginal groups (unemployed, poorly educated, irregularly employed persons with a low level of education). The practical significance of the results consists in the following.

As a result of ongoing socially oriented reforms, the phenomenon of relatively high "natural" homogeneity of society has been largely lost, and, consequently, the necessity of developing differentiated strategies to reduce losses has arisen, which are especially important for different social groups. The substantiation of such strategies and the monitoring of their implementation require adequate information.

Based on the results of the conducted studies, the following conclusions are drawn in the work:

In conditions of a rapidly developing socially oriented economy (on the example of Moscow), mortality trends even in risk groups (the working-age population) develop more positively than against the background of society as a whole, especially in relation to socially conditioned, preventable at the current level of healthcare, causes.

In relation to homogeneous macroeconomic, cultural, and ecological conditions, territorial differences in mortality levels and patterns of the active-age population are determined, primarily, by the social composition of the residents of these territories, an indicator of which may be the level of education.

Medical and social inequality reflects the scale of losses, primarily from socially conditioned causes, through the distortion of the social structure of the population (in particular, the level of education and, even more so, the absence of socially acceptable employment).