Medical-Social and Hygienic Aspects of the Management of Quality of Life of the Urban Population

The dissertation is devoted to the medical-social and hygienic aspects of the management of quality of life of the urban population. The city of Naberezhnye Chelny (Republic of Tatarstan) was selected as the base territory for the study. The work comprehensively examines the influence of social-hygienic, ecological, and economic factors, the quality of medical care, actual nutrition, and health status on the quality of life of the urban population.

The study includes a systemic analysis of medical-demographic indicators, an assessment of the sanitary-hygienic situation (state of atmospheric air, water supply, natural-climate conditions), sociological research on quality of life, food status and actual nutrition of the residents, as well as mathematical modeling and forecasting of quality of life. The author developed a multidimensional mathematical model for the determination of priority factors, formed indicative indicators for the management of quality of life and health, and prepared medical-management and sanitary-hygienic recommendations.

RELEVANCE OF THE STUDY

The health of the population is one of the principal conditions for sustainable economic development of the country. The sharp changes occurring at the turn of the centuries in the socio-political and economic structure of the country have given rise to negative changes in all spheres of life, characterized by insufficient financing of healthcare, significant deterioration of living conditions for the majority of the population, and weakening of its social protection. All of this has led to serious negative consequences—an increase in the natural decrease of the population and morbidity (Vyalkov A.I., 2001; 2002; Onishchenko G.G., 2002; 2004).

Under conditions of ongoing socio-economic crisis and unsatisfactory ecological and hygienic conditions in the country, when the threat to the health of the population and the hygienic safety of the country persists, the implementation of effective measures for the prevention, improvement, and strengthening of the health of Russian citizens and the optimization of the ecological situation has also been weakened (Sidorenko G.I. et al., 1998; Kutsenko G.I. et al., 1999; 2000; Kutepov E.N. et al., 1999; Revich B.A., 2001; Amirov N.Kh. et al., 2000, 2001, 2003, 2004; Ivanov A.V. et al., 2004).

In accordance with the "Concept for the Protection of the Health of the Population of the Russian Federation for the Period up to 2005," the state should possess appropriate mechanisms necessary for monitoring, assessing, and combating dangerous health-related environmental factors that pose a threat to the health of its residents (Vyalkov A.I., 2001; Rakhmanin G.I. et al., 2001; Rumyantsev G.I. et al., 2001; Sitdikova I.D. et al., 1999, 2000, 2003; Dautov F.F. et al., 2002).

Protection of health, increase in labor capacity, and extension of the full active life period of the population are the primary functions of the healthcare system and constitute a vital link in the social policy of the state. The health of the population, being a complex, multicomponent problem, requires adequate systemic approaches to its study. Among these approaches, the most promising appear to be multidimensional studies of the relationships between natural and social environmental factors and the state of human health (Kucherchenko V.Z. et al., 1991; Galiullin A.N. et al., 1997, 2001, 2002, 2003; Starodubov V.I., 1999, 2000, 2002, 2003; Maimulov V.G. et al., 2000; Kuchma V.R., 2001; Nizamov I.G., 2000, 2001, 2003).

As noted in the "Concept for the Protection of the Health of the Population of the Russian Federation" (2003), in recent years the overall mortality of the population in the Russian Federation has increased significantly, and it is now 1.5 times higher than in developed countries, primarily due to extremely high mortality rates from cardiovascular diseases, injuries, and oncological diseases. Among the factors negatively affecting the health status of the population, the Concept notes a decline in the quality of life of a significant portion of the population (low wages and pension provision, deterioration of living conditions, labor, rest, environmental conditions, quality and structure of nutrition, etc.), excessive stress loads, and a decline in the overall level of culture, including sanitary-hygienic culture, which promotes the spread of harmful habits and an unhealthy lifestyle.

However, to date, indicative indicators of quality of life and health of the population have not been developed that would allow a comprehensive, reliable, and full assessment of the living standards and health of the population and the conduct of social-hygienic monitoring of quality of life, which has determined the choice of the subject of this study and its relevance.

From the above, it is obvious that the assessment of the results of the study should be based on a set of indicators reflecting the characteristics of quality of life and health.

OBJECTIVE of the study: on the basis of a comprehensive study of the impact on the quality of life of the population of social-hygienic, ecological, and economic factors, the quality of medical services, actual nutrition, and health, to develop a model for the management of quality of life.

Tasks:

1. Conducting a systemic analysis of medical-demographic indicators and the patterns of health formation of the population by quantitatively measurable criteria.

2. Carrying out an analysis of sanitary-hygienic and ecological factors affecting the quality of life and health of the urban population.

3. Studying the opinions of the population on quality of life, the environment in which they live, lifestyle, and medical services on the basis of sociological research data. Qualitative and quantitative assessment of the nutrition of the urban population with the calculation of the consumption levels of major food groups.

4. Mathematical modeling and forecasting of the quality of life of the urban population based on medical-social, ecological risk factors, nutrition, quality of medical services, and lifestyle.

5. Development and substantiation of indicative indicators for the management of quality of life and health of the urban population.

The scientific novelty of the work lies in the fact that, for the first time, on the basis of a comprehensive multidimensional study of the simultaneous influence of a group of factors (social-hygienic, ecological, quality of medical care, actual nutrition, sociological assessment, and health), indicative indicators of the quality of life of the urban population have been formed.

A multidimensional mathematical model has been constructed that allows the determination of priority factors influencing quality of life and scientifically substantiated approaches to their management.

An algorithm for the assessment of quality of life has been developed, calculated taking into account a complex of factors through indicative indicators.

Theoretical and practical significance of the work:

The multidimensional comprehensive analysis has made it possible to identify the most significant factors involved in the formation of the individual assessment of quality of life. The research materials serve as the basis for the development of a scientifically substantiated system of indicative management and the substantiation of measures to reduce exposure factors for the purpose of improving the quality of life of the population. The developed indicative indicators of quality of life and health of the population of factor blocks (medical-social, ecological, quality of medical care, food status, etc.) make it possible to assess the living standards and health in the studied territories.

A methodological manual entitled "Quantitative Medical-Social and Hygienic Assessment of the Quality of Life of the Population," 2005, has been developed and approved by the Ministry of Health of the Republic of Tatarstan.

The results of the research have been implemented in the work of the Republican Medical Information and Analytical Center and the Republican Center for Medical Prevention of the Ministry of Health of the Republic of Tatarstan.

The method of comprehensive assessment of risk factors affecting the quality of life and health of the population of an industrial city has been implemented in the activities of physicians of the social-hygienic monitoring department of FGU "TsGSEN in Kazan" and FGU "TsGSEN in Nizhnekamsk."

The dissertation materials have been integrated into the educational process of the Department of Public Health and Healthcare Organization, as well as into the educational plans of the medical-preventive faculty of Kazan State Medical University.

Main provisions for defense:

1. Standardized indicators of disease prevalence, models for the forecasting of medical-demographic processes and disease levels indicate an unfavorable prognosis for birth and death rates, as well as a steady increase in the number of diseases among persons of working age.

2. The developed quantitative and qualitative criteria for the hygienic assessment of risk factors have made it possible to rank territories, identifying priority groups of factors influencing the quality of life of the population.

3. The results of sociological surveys of various population groups regarding health status, nutrition characteristics, and living standards are of priority importance when carrying out organizational and management measures aimed at improving the quality of life of the population.

4. The developed mathematical model reflects the structure of the system of factors influencing quality of life, forms a rational approach to improving monitoring, and makes it possible to use indicative management of the quality of life of the population at the regional level.

ACQUAINTANCE WITH THE STUDY

The dissertation materials have been reported and discussed at the following All-Russian and republican conferences, symposia, and meetings:

• Scientific and Practical Conference "Problems of the Sanitary-Epidemiological Service" (Kazan, 1999);

• International Scientific and Practical Conference "Prospects for the Development and Preservation of Human Potential in the Republic of Tatarstan" (Kazan, 1999);

• All-Russian Scientific and Practical Conference "Juvenology as a Science: Problems of Formation and Prospects" (Kazan, 1999);

• V Scientific and Practical Conference of Young Scientists (Kazan, 2001);

• International Symposium "Current Problems of Reproductive Health under Anthropogenic Pollution" (Kazan, 2001);

• IX All-Russian Congress of Hygienists and Sanitary Physicians "Hygienic Science and Practice at the Turn of the XXI Century" (Moscow, 2001);

• All-Russian Scientific and Practical Conference "Agroecological Problems of Agricultural Production under Technogenic Pollution of Agroecosystems" (Kazan, 2002);

• Scientific and Practical Conference "Economic Efficiency of Medical Care for the Population" (Moscow, 2002);

• VIII Scientific and Practical Conference of Young Scientists (Kazan, 2003);

• Scientific and Practical Conference "Current Problems of Regional Healthcare Development" (Kazan, 2003);

• Republican Scientific and Practical Conference "State and Prospects for the Development of Out-of-Hospital Medical Care for the Population" (Kazan, 2004).

• The work was discussed at the sessions of the problem commission on preventive medicine, public health, and healthcare of KGMU in 2001 and 2005.

PUBLICATION OF RESEARCH RESULTS

The research materials are reflected in 19 printed works, including two educational and methodological manuals.

STRUCTURE AND VOLUME OF THE DISSERTATION

The dissertation work consists of an introduction, a literature review, the scope and methods of the study, three chapters of original research, a discussion of the results of the work and a general conclusion, summary, practical recommendations, a list of references, and appendices.