Scientific Justification of Health-Forming Technologies in Healthcare

The dissertation is devoted to the scientific justification of health-forming technologies in the healthcare system, primarily in the sphere of the sanatorium-resort service. The research analyzes the role of sanatorium-resort institutions in the preservation, restoration, and maintenance of individual and population health, as well as their place in preventive medicine. The study examines current trends in disease prevalence among the population of Chelyabinsk Oblast, identifies priority social, economic, professional, and psychological factors affecting health and quality of life, and develops an organizational-analytical model of health formation based on health-forming technologies at the regional level.

Human health and the health of society have always been the principal treasure, foundation, and meaning of human activity. Any democratic state must regard care for the health of the nation as its primary strategic objective, which corresponds to the ideals of humanism and social justice. Based on the bio-social nature of human beings, their health is determined by physical, spiritual, and social well-being.

From the perspective of A.N. Razumov (2001), health, being a complex bio-social category, represents an integrative final result of state policy that creates conditions for citizens to regard their health as an enduring value.

In our understanding, social health is a category reflecting the level and quality of life of the population, its spiritual and moral values, the ability and opportunity to perform biological and social functions, to fully realize one's creative and labor potential directed toward the creation of material goods, the protection of ecological well-being, state security, as well as the presence of conditions and internal need for maintaining physical and mental health at individual, group, and population levels.

Social health is determined primarily by state policy, which must be interested in creating conditions for population reproduction, preserving its labor capacity, providing medical care and restorative treatment. Consequently, population, group, and individual health depend to a large extent on the priority of national health within the system of state principles and values (Rosenfel'd L.G., Sorokun V.I., 2002).

Given that in the current situation a significant portion of the population is in a state of protracted psychoemotional and social stress, reactive neuroses and suicides, depression, alcoholism, smoking, drug addiction, antisocial outbursts, and crime have reached high levels. All this gives researchers grounds to recognize the state of health of the Russian population as critical (Starodubov V.I., 1997; Gerasimenko N.F., 1998; Venediktov D.D., 1998; Lisitsyn Yu.P., 1998), requiring urgent measures both from the state and from the healthcare system.

Sample studies among the adult population over the past 20 years have revealed a high prevalence of chronic non-communicable diseases, including cardiovascular diseases, in particular ischemic heart disease and arterial hypertension, widespread prevalence among the population of risk factors for the development of these diseases associated with lifestyle, habits, nutrition, low medical activity, low level of public awareness about factors negatively affecting their health, and insufficient readiness of the population to improve their lifestyle (Kalininga A.M. et al., 1999; Shalnova S.A., 1999; Rosenfel'd L.G. et al., 2001).

The extensive path of development of modern healthcare, requiring the investment of ever-increasing funds for the improvement of the diagnostic and treatment process, cannot change the unfavorable situation. In a country experiencing an economic crisis, state guarantees regarding the observance of the right to health protection have sharply decreased, many preventive programs are not being implemented. V.I. Starodubov and N.P. Soboleva (2002) note that during the reform period, the volumes of preventive examinations substantially decreased, the number of persons under dispensary observation was reduced, mass physical education is absent, and the accessibility of recreational services is declining.

The socio-economic situation in the country, having inflicted substantial damage on the health of the population, has already reached a level at which the state and all its institutions cannot but recognize the health of the nation as the highest national priority (Shevchenko Yu.L., 2001). The recognition of the value of public health must be accompanied by an increase in the significance of the principle of preventive orientation of domestic healthcare.

It is becoming increasingly obvious that the existing healthcare strategy is incapable of solving the task of positively changing the health indicators of society. Hence arises the necessity of changing the nature of preventive care for the population, the creation of acceptable models of prevention in modern conditions. Confirmation of the priority of forming state policy on the protection and strengthening of the health of healthy and practically healthy individuals is the adoption and approval by the Ministry of Health of Russia of the sectoral program 'Protection and Strengthening of the Health of the Healthy' for 2003-2010 and the plan of measures for its implementation (2003).

According to the risk factor concept (Lisitsyn Yu.P., 1998), in the system organism — environment — behavior, public health is 50% determined by lifestyle. This circumstance leaves no doubt that in the preservation, maintenance, and management of health, alongside the activity of the state in the proper distribution and use of state resources for social needs, the direct participation of society, population groups, and each individual is also necessary.

One of the possible and necessary directions of activity aimed at raising the level of health of Russians, in the opinion of Yu.P. Lisitsyn (1998, 2003), G.L. Apanasenko (1999, 2002), and others, is the formation of a health culture in our society, the awareness of citizens of the high value of health and the need to follow the principles of a healthy lifestyle.

Motivations for participation in the protection of one's own health may serve as value orientations determined by public consciousness, spirituality, and culture.

For Russia, during the period of the formation of market relations, a new social phenomenon is characteristic: a firm psychological orientation toward health as a source of socio-economic well-being in conditions of business competition is being formed.

The problem of raising a moral, spiritually rich person oriented toward the preservation, strengthening, and maintenance of their own health is an important state task, in the solution of which the leading role belongs to practical healthcare.

A special place in the healthcare system is occupied by the sanatorium-resort service, which has high social significance, as it is directed toward the preservation of health of healthy individuals, persons with reversible functional impairments, as well as toward medical rehabilitation of patients and disabled persons with the aim of increasing their functional reserves, compensating for impaired functions through curative natural factors (Razumov A.N. et al., 1996; Razumov A.N., 2000).

For the purpose of forming and implementing motivation toward health as a fundamental life value, the 'Concept of the Preservation and Management of Population Health through Methods and Means of Hygienic Education and Upbringing' (1997) has been developed and implemented at the federal level, and the sectoral program 'Protection and Strengthening of the Health of the Healthy' for 2003-2010 has been adopted (2003).

In the opinion of N.P. Soboleva, Yu.V. Mikhailova (2000), A.I. Vyalkova (2001), the foundation of the concept is the shift of emphasis in prevention toward increasing the activity of the individual themselves in preserving their own health, toward involving the population in health-strengthening programs, forming skills and abilities for a healthy lifestyle, creating a system of knowledge about methods and means of health assessment, control, monitoring, and correction, as well as toward real efforts of the preventive orientation of medicine.

Psychological orientation and the formation of health culture are becoming increasingly significant tasks of the healthcare system.

Sanatorium-resort institutions, whose activities are currently directed not only toward the restoration of health but also toward expanding the functional reserves of a person reduced under the influence of unfavorable conditions and life factors, toward compensating for impaired functions, secondary prevention of diseases and their complications (A.N. Razumov 2000, 2001), should play a significant role in forming healthy lifestyle stereotypes among healthy individuals and those suffering from chronic diseases.

At the pre-morbid stage, as well as in the presence of functional impairments, methods of resort therapy can eliminate the initial mechanisms of disease development, and in the case of chronic diseases, resort treatment slows the progression of the disease and reduces the number of relapses and exacerbations.

Among the extensive arsenal of traditional and modern corrective technologies in resort medicine, in our view, a significant place should be occupied by bio-social-informational impacts of a health-preserving nature, which are necessary for the formation of health culture, the enhancement of its value, and the restoration and preservation of individual, group, and population health at the modern stage of societal development (Rosenfel'd L.G., Sorokun V.I., 2002).

During the period of new economic relations, in connection with the disordered process of privatization and joint-stock conversion of sanatoriums and resorts, substantial destruction of the system of functioning and financing of the sanatorium-resort service occurred, with a notable decrease in the accessibility, volume, and quality of sanatorium-resort assistance to the population. Control over the state of resort resources has been weakened, and irrational use of health-improving territories is observed.

This research is aimed at analyzing the capabilities of the sanatorium-resort service in the preservation, restoration, and maintenance of health, its role in the preventive activity of the entire healthcare system in the formation of population health at the regional level.

The aim of the research is to scientifically justify, based on a comprehensive medico-social study, the necessity and expediency of health-forming technologies for raising the level of individual and population health, and to develop an organizational-analytical model for their implementation.

In accordance with the set aim, the following tasks were determined:

1. Based on domestic and foreign literature, conduct an analysis of the problem, and develop a plan and program of the research.

2. To study current trends in the morbidity of the population of Chelyabinsk Oblast and the City of Chelyabinsk, general and primary morbidity of diseases of the circulatory system, and their forecast for the next 5 years.

3. To identify priority social, economic, professional, and psychological factors influencing the subjective assessment of health and quality of life, and the role of personality-motivational orientations toward a healthy lifestyle in the formation of health.

4. To conduct a marketing analysis of the population's need for health-forming technologies in resort conditions. To compose a social portrait of consumers of rehabilitation services in modern conditions.

5. To evaluate the personnel, material, and technological capabilities of the Sanatorium 'Kisegach' in providing rehabilitation, health-improving, and bio-social-informational services.

6. To analyze medical effectiveness and social satisfaction with the quality of health-forming services. To determine the competitiveness of the sanatorium and the degree of patient loyalty to it.

7. To develop an organizational-analytical regional model of public health formation based on health-forming technologies.

The novelty of the research lies in the fact that: the first scientific and theoretical justification of the fundamental role of the sanatorium-resort service in preventive medicine; a new direction of activity in the resort sphere and its place in the healthcare system for the management and formation of population health have been substantiated; an organizational-analytical model of individual and population health formation has been proposed and created, encompassing the entire healthcare system, departments and services participating in the socio-forming function and activity of the state, executive and legislative bodies; the organizational structure of disease prevention and health culture formation has been developed, uniting all links of healthcare at the territorial level, the scientific-methodological center at the Sanatorium 'Kisegach', the regional interdepartmental coordinating council on health issues under the Governor of Chelyabinsk Oblast, and the regional scientific research institute of health; the role and significance of personality-motivational orientations toward a healthy lifestyle and their role in the formation of health and the improvement of quality of life of the population have been identified, which constituted the theoretical justification of health-forming technologies; the novelty of the marketing analysis lay in determining the need of various population groups for information on healthy lifestyle; for the first time, a comprehensive strategy for the implementation of information technologies in preventive activity in sanatorium conditions has been developed, a methodology for controlling patient quality of life has been elaborated, and the high effectiveness of bio-social-informational impact has been demonstrated.

The scientific and practical significance of the work is determined by the fact that, based on the results of the research: the Sanatorium 'Kisegach' has been identified as a basic institution for preventive care; a scientific-methodological center for sanitary-hygienic education and upbringing using health-forming technologies has been created there for medical personnel of all links of healthcare, including the sanatorium-resort service; a systemic approach to the problem of health formation has been employed, extending beyond healthcare and uniting the capabilities of all departments and services in the sphere of health management. To this end, a regulation on the interdepartmental coordinating council, implementing a cross-sectoral approach to the formation of public health at the regional level, has been developed and approved by the Governor of Chelyabinsk Oblast (Decree of the Governor of Chelyabinsk Oblast No. 434 of April 21, 2002); a regulation has been developed and a regional scientific research institute of health has been created at the Chelyabinsk State Medical Academy, which ensures scientific analysis of social processes affecting public health, develops and proposes measures to reduce the negative influence of health-destroying factors and conditions, prepares analytical materials for the executive and legislative authorities, conducts educational activities for the improvement of medical personnel qualifications in preventive medicine, and implements bio-social-informational and health-forming technologies; the developed 'Card-insert' in the medical history has enabled physicians to determine patients' readiness to perceive bio-social information, conduct differentiated education on healthy lifestyle, and ensure continuity with curative-preventive institutions on prevention issues.

Implementation in Practice: The results of the research are used in the activities of: the regional interdepartmental coordinating council; the regional scientific research institute at the Chelyabinsk State Medical Academy; the scientific-methodological center based on the Sanatorium 'Kisegach'; in the practice of sanatorium-resort institutions of Chelyabinsk Oblast; in the preventive work of the Clinic of the Chelyabinsk State Medical Academy.

The data obtained as a result of the scientific research are used in the educational process at the departments of public health and healthcare of the Chelyabinsk State Medical Academy, the Bashkir State Medical University, the Perm State Medical Academy, and the Basic College for Advanced Training of Mid-Level Medical Workers (all implementation acts are attached). The main provisions submitted for defense: identified priority factors exerting a negative influence on the subjective assessment of health and quality of life; results of the marketing analysis of the demand for health-forming technologies among sanatorium patients, the capabilities of the sanatorium in health formation, its preservation and restoration; the role of the sanatorium in preventive medicine in health formation among healthy and sick individuals; the organizational-analytical model of public health formation based on health-forming technologies at the regional level.

Testing of the Work.

Based on the results of the research, 35 scientific works have been published, including: 10 at the international level, 6 at the Russian level, 15 at the regional level, and one monograph. The main provisions of the research were reported at the V International Scientific-Practical Conference 'Family Health — XXI Century' in Marmaris (Turkey), the VI International Scientific-Practical Conference 'Family Health — XXI Century' in Barcelona (Spain, 2002), the III and IV International Scientific-Practical Conferences 'Health and Education in the XXI Century' in Moscow (2002, 2003), the III International Congress of Valologists in St. Petersburg (2002), the International Congress 'Zdravnitsa-2002' in Moscow (2002), the first international conference on population health issues — Chelyabinsk-Montreal, Chelyabinsk (2003); at scientific meetings and conferences of federal, regional, and oblast levels.

An informational-methodological letter titled 'Organizational-Analytical Model of Health Formation Based on Health-Forming Technologies at the Regional Level' has been published.

Volume and Structure of the Work.

The dissertation research is presented across 293 pages of typed text and consists of an introduction, six chapters, a conclusion, conclusions and proposals, a bibliography, appendices, and documents confirming the implementation or practical use of scientific results. The structure of the research is determined by the set tasks. The work is illustrated with 62 tables, 46 figures, and 11 schemes. The bibliography contains 438 sources, including 95 foreign ones.