SOCIAL HYGIENE (in the USSR since 1966 — social hygiene and organization of health care) — science about patterns of public health and health care. This year is a subject of teaching in the highest and average medical educational institutions. In the conditions of socialist society social hygiene is theoretical base and a scientific basis of the organization of the state system health care (see).
Studying problems of public health and health care in specific historical, economic and social and political uslovy, gains class character This year that predetermines its ideological and public value.
The term «social hygiene» was applied for the first time, apparently, in the first half of 19 century. It occurs in the thesis to J. A. Rochoux in 1838; it was used also by Fourcaut in 1844 in the work devoted to occupational chronic diseases.
This year as the young developing integrative science has still no the unified definition. At the same time in the majority of these definitions its basic element — studying of influence of social factors on health of the population, a research of social problems of health care is emphasized. In such direction her founders Gro-tyan defined This year (And. Grotjahn) ^ninep(A. Fischer), N. A. Semashko, 3. P. Solovyov, etc.
wrote N. A. Semashko: «The main objective of social hygiene consists in deeply to study influence of the social environment on health of the person and to develop effective actions for elimination of an adverse effect of this Wednesday». Almost same definition of social hygiene as the scientific discipline studying influence of socio-economic factors on public health and health care, developing measures of protection and strengthening of public health contains in the 2nd BME edition. As examples we will give other definitions: social hygiene — science about public health and health care, about social problems of medicine and health care (N. A. Vinogradov) science about interrelation of health of the population with all parties of socialist construction (3. G. Frenkel); one of hygienic disciplines which subject are questions of a sanitary condition of the population and the organization of health care (G. A. Batkis); the science developing social problems of medicine, studying influence of the social and economic and public relations on the state of health of the population (A. F. Serenko); the science about health of society and social problems of medicine — studies patterns of influence of social factors on health of human collectives, defines ways of its preservation and strengthenings (E. Ya. Belitskaya); science about health of society, about social problems of medicine and health care (K. V. Maystrakh, I. G. Lavrov). Bulgarian authors (P. V. Kolarov, etc.) write: «Social hygiene of the socialist countries studies interaction between social factors and health of the population, including changes of need for medical care, for the purpose of creation of rational, economic system of measures of public health care». In definition This year by specialists from the socialist countries emphasize its appointment to serve as the instrument of protection and improvement of health of the population, improvement of the organization of medical care, management of health care.
It was specified in the resolution adopted by the XV All-Union congress of hygienists and health officers that This year shall form a scientific basis of planning and management of health care, developments of questions of economy of health care, studying of efficiency of the governmental and public activities directed to improvement of the environment and further strengthening of public health. This year as the science about public and health care in socialist society studies health improving, and also adverse influence of social factors on health of the population and its separate groups and develops scientifically based recommendations for implementation of actions for elimination and the prevention of the unhealthy population of influence of social factors, protection and increase in level of public health.
The major task This year — to serve protection and improvement of public health — makes a basis of its definition in the training program developed (1983) staff of departments of social hygiene and the organizations of health care of the country. This year it is qualified in the program as the science studying impact of social conditions and environmental factors on health of the population, putting the main task development of actions for elimination and the prevention of the unhealthy population of influence of separate adverse social factors, to the maximum use of favorable social conditions for the benefit of protection and increase in level of public health. The training program provides division of social hygiene into a number of sections.
I. Social hygiene and organization of health care as science and subject of teaching. History of development of social hygiene and organization of health care. II. Theoretical fundamentals and organizational principles of socialist health care, main stages of its development. III. Bases of the legislation of USSR and federal republics about health care. IV. Theoretical and social and hygienic aspects of medical ethics and medical deontology. V. Bourgeois theories of medicine and health care. VI. Growth of welfare of the Soviet people and its social and hygienic value for health. VII. Bases and methods of medical statistics. VIII. Health of the population and methods of its studying. IX. Bases of the organization of the treatment-and-prophylactic and sanitary and epidemiologic help to the population of the USSR. X. The major diseases and their social and hygienic value. XI. Soviet state social insurance and social security. XII. Bases of planning, economy and financing of health care. XIII. Scientific bases of management of health care.
This year covers a wide range of biological, medical, economic, philosophical, sociological and political affairs in connection with a research of patterns of formation of public health, development of pathology, bases of demographic processes, improvement of systems, forms, health services, etc. problems. In essence it is the integrating medico-social science having the purposes and specific objectives, object of studying, methods and means of a research.
Modern This year and the organization of health care include: studying of theoretical and organizational problems of health care; studying of influence of social conditions and a way of life on health of the people in various social and economic formations; development of criteria of public health; studying of its structure and level (condition of physical development, incidence, related temporary disability, disability, mortality); development of scientific forecasts in the field of health protection; research of sotsialnogigiyenichesky problems of the population and their bonds with public health and health care (medical demography), and also influences on it of industrial and agricultural production, culture, life, rest, all parties of scientific and technical progress; research of process of an urbanization; studying of human ecology; detection of the social, economic and medical importance of health care as public system and development of rational ways of its development; studying of medical aspects social insurance (see) and social security (see); legal and ethical fundamentals of health care; development of a question of needs of the population for the polyclinic and stationary help in different economical and geographical regions of the country and the most effective methods and forms of their satisfaction; development of sanitary and epidemiologic aspects of health care; social and economic and medical measures of prevention; comprehensive programs of decrease and elimination of the most widespread and serious illness; theoretical and organizational problems of medical examination of the population; development of questions of planning and management of the treatment-and-prophylactic help to the population; problems of specific economy of health care, its financing; actions for promotion and implementation of a healthy lifestyle, hygienic education of the population. This year uses for this purpose systems approach, methods of mathematical modeling, electronic computer facilities, develops the principles of scientific medical information. Besides, This year studies history of health care; patterns of development of socialist health care; carries out the critical analysis of bourgeois theories in the field of health care; studies the international experience of development of health systems; questions of cooperation of the USSR with other countries in health care.
Width and versatility in the USSR is shown This year in structure of scientific coordinating body on this discipline — Scientific council on social hygiene and the organization of the health care at Presidium of the USSR Academy of Medical Sciences incorporating the problem commissions on social hygiene, the organization and management of health care; on stories of medicine and health care; to sanitary education; to bases of scientific medical information; to use of the COMPUTER in planning and management of health care. At the same time the commission on social hygiene, the organization and management of health care possess the following scientific directions: theoretical problems of social hygiene and organization of health care; social conditions and health of the population; scientific bases of the organization of medical care to the population; scientific bases of planning and forecasting of health care; scientific bases of the economy of health care; scientific organization of work of employees of institutions and bodies of health care; health care in foreign countries and cooperation with WHO; the automated system of planning and management of health care.
Interest in the social party of medicine was shown since the most ancient times. The aspiration to establish svlz between a way of life, health and developing of diseases is visible already in works of Sushruta, Hippocrates, K. Galen, A. Tseljs, Ibn-Sina and other outstanding physicians of the past. Important milestone in disclosure of social conditionality of health of workers, bonds of conditions of professional activity and incidence were the researches of the Italian doctor B. Ramatsshchini which found lighting in its work «About diseases of handicraftsmen» (1700).
However social hygiene as science, its main components arose and gained the development in the period of capitalism. The aggravation of class contradictions in capitalist society which found reflection in deterioration in health of the proletariat and a negative impact of it on development of productive forces обусло-^ twisted need of studying of public health. One and a half centuries were required to create that scientific base which allowed to consider social hygiene as independent scientific discipline.
One of sources of social hygiene was the political economy of the period of early capitalism developing problems of reproduction of labor, and in this regard problems of mortality, incidence, demographic processes etc. The contribution utopian socialists brought the Pestilence in disclosure of the social importance of health and ways of its preservation (T. More), Kampanell (T. Campanella), F. Fourier, Saint-Simone (S. N. Saint-Simon), R. Owen in which works for the first time health and care of it are considered as the major public task. Doctors of X spoke about influence of the environment and social factors on health of the person French philosophers-mat-rialisty. De Rua, Zh. Lametri, P. Iabanis, etc. The works they promoted development of ideas of social problems of medicine and about public responsibility for health.
Industrial revolution in England put forward public health in a row of important social and political problems, «Protection of national health», creation of factory inspection etc. caused statement by progressive figures, including health inspectors, a question of the state regulation of health care, introduction of the charter.
Growth of the chartistsky movement promoted emergence of the acute works large conceptually convicting disastrous influence of capitalism on health of workers. Chedvik's researches (E. Chadwick), J. Simon, Grinkhau (E. N. of Greenhow), etc. were widely used by classics of Marxism for scientific justification of the major provision on full disinterest and insolvency of capitalism to provide necessary measures for preservation of public health.
Rapid development of the capitalist relations in Germany made this country at the end of the last century the center of formation of social hygiene as independent discipline which elements in the majority of the European countries developed before within the so-called medical police which received the greatest reflection in I. Frank's works, Pay (W. Th. Rau), F. A. Mai, Z. G. Huzty. Grotyan whose efforts in i of 920 g created the department of social hygiene first in the history at the Berlin university that was an important stage of organizational completion of formation of social hygiene as independent scientific discipline was at the head of the German social hygiene.
The previous years and this period put forward a galaxy visible, fruitfully working in the field of social problems of health and public hygiene of the Western European researchers — such as E. Resle, Fischer, JI. TV sets, Hayez (V. Cha-jes), J. Pringl, J. Graunt, S. Neumann, W. Petty, W. Farr, F. Printsit. Noting their role in development of a social and hygienic thought, it is necessary to consider, however, that many of them stood on positions of reformism: recognizing influence of social factors on health, they at the same time denied the defining influence of relations of production and socio-political systems in general on the level of public health and a condition of health care. Their purpose was research of solutions of the acute social issue within the existing capitalist system by «improvement» of separate forms and health services, changes of working conditions, life, social policy.
For bourgeois social hygiene, including modern, not only the reformism, but also eclecticism — mixing of tasks, methods, object of studying, sometimes noncritical, not always a consecutive exit out of limits of a subject, attempt of the solution of all social problems in medicine on the basis of only this science is characteristic. Are not accidental therefore diversity of definitions and the directions of social hygiene, and also distinction of names of this discipline («social medicine», «medical sociology», «sociology of medicine», «public health and health care», «preventive medicine», «administration of health», etc.). The terms «social medicine» and «medical sociology» are most remarkable. To qualify them and the concepts belonging to their authors, only as social-reformist, bourgeois would be unilaterally since J. Guerin, Dyuklo (E. Duclaux), Blekuell (E. Black-well), R. Debra, A. Gottstein, etc., including modern theorists and figures of the international medical organizations R. Sand, D. Mechanic, Winslow (S. E. A. Winslow), Person (T. Persons), Freydson (E. Freidson), Zh. Parizo, G. Canaperia, To. Evang, M. Kandau, A. Aujaleu, R. Dubaut nflp., widely used the specific sotsiodogichesky and applied by social hygiene other methods for studying of various problems of public health and health care, for detection of social conditionality of health, a role of ecological factors, political and organizational conditions for health care. However their views, remaining within bourgeois sociology, will bear on themselves at the same time the stamp of the reformist, revisionist, quite often mechanistic, idealistic views reflecting bourgeois ideology, interests of ruling classes of capitalist society and are subject therefore to Marxist criticism.
Social hygiene successfully develops in the socialist countries on a joint with Marxist medical sociology, according to tasks of social policy in the field of public health care. Researches of social hygienists and organizers of health care To. Vinter, P. V. Kolarov, S. Stich, A. Bures, E. Shtakheljsky, E. Apostolov and mn. other give examples of the creative solution of problems of public health and health care.
Domestic social hygiene has deep historical roots and has original original character. Already in M. V. Lomonosov's works, and first of all in his known letter «About reproduction and preservation of the Russian people», there are regulations on responsibility of society for health of the people, on a problem of a balanced diet, need of sanitary measures and medical support of a people at large, new and very progressive for the time. Views of professor of the Moscow university F are interesting. F. Keresturi. In «Speeches about medical police in Russia» (1795) he emphasized need of ensuring health with «all means of the state» which shall «prevent diseases, create healthy conditions on advantage of all citizens».
A. N. Radishchev for the first time with a political insight and sharpness spoke about the harmful existing social conditions for health, put forward the idea and the program of studying of level of security of various regions of the country with medical institutions and shots. S. G. Zy-belin, M. Ya. Mudroye, E. O. Mukhin, G. I. Sokolsky, etc. professors-physicians of the Moscow university concentrated attention to roles of conditions, a way of life and personal prevention in prevention of diseases.
Social and hygienic views of N. I. Pirogov are of considerable interest. The great scientist made a new important contribution to theoretical justification of need of the preventive direction for medicine. It went further the predecessors, having got closer to understanding of health care as public, national objective. «Reduction of mortality in masses depends... from efficient, vigorous and rational use of administrative and hygienic measures against initial development of diseases» — N. I. Pirogov specified. «The future of public medicine in hands of public and scientific administration, but not in the medical equipment. Only going hand in hand with rational state orders in all industries of the national economy and education, the medicine can promote reduction of distribution and the prevention of diseases, and then this indirect way, but not treatment can promote, at last, reduction of mortality of masses».
The future belongs to preventive medicine or hygiene in the broadest sense — the domestic therapist G. A. Zakharyin said. S. P. Botkin repeatedly emphasized value of public conditions, responsibility of the state for health of the population. The special importance in development social gigiye-nicheskikh the ideas and the principles of public medicine belongs to a group of outstanding figures territorial medicine (see) — ideological followers of the Russian revolutionary democrats A. I. Herzen, N. G. Chernyshevsky, N. A. Dobrolyubov, D. I. Pisarev. Progressive views and A. V. Petrov, I. I. Molleson, E. A. Osipov, P.F. Kudryavtsev, N. I. Tezyakov, E. M. Dementiev, A. V. Pogozhev, S. A. Novoselsky, A. I. Shingarev, V. O. Portugalov, V. A. Levitsky, D. N. Zhbankov, S. P. Lovtsov's fundamental works and others were an important link in justification of social essence of health and health care. The powerful contribution to formation of the progressive social and hygienic ideas was made by outstanding domestic hygienists F. F. Erisman and A. P. Dobroslavin.
SOCIAL HYGIENE developed in pre-revolutionary Russia as expression public medicine (see), public hygiene along with use of the progressive ideas and experience of the territorial, factory doctors and clinical physicians observing in daily practice and fixing influence of social factors, severe conditions of work and life of the population on his health. Numerous works of territorial, health officers, Pirogovsky' materials, etc. congresses (see. Pirogovsky congresses ) contain the numerous facts incontestably testimonial of destructive influence on health of cruel exploitation of workers; they sounded in this respect a conviction to a tsarism. B is not accidental. I. Lenin highly appreciated and widely used in the works devoted to development of capitalism in Russia, works of territorial and factory doctors. Pre-revolutionary social hygienists of Russia saved up not only extensive observations about social conditionality of health, but methods of studying of health of the population, especially incidences, mortality, physical development are developed applied and until now, progressive forms of the organization of medical care, health service, training of medical personnel are offered.
However conditions of the existing system did not allow to apply in practice of health care appeals of representatives of public medicine, even those which reflected obviously reformatory bourgeois and conciliatory moods of her representatives.
In 19 century the first attempts of the organization of teaching social hygiene (public health, public hygiene, etc.) are made. Along with a statement of nek-ry questions of social hygiene it is aware of hygiene and other disciplines (that was traditionally carried out at medical faculties of universities) at the end of 19 — the beginning of 20 century A. I. Shingarev, A. V. Korchak-Chepurkovsky, 3 began to give an independent course of public hygiene (medicine). G. Frenkel, S. N. Igumnov, L. A. Tarasevich. In 1910 P. N. Diatroptov was elected professor of department of public hygiene of the High female courses in Moscow.
Originally scientific Marxist SOCIAL HYGIENE was created in our country after the victory of Great October socialist revolution. Relying on methodology of dialectic materialism, the Marxist-Leninist doctrine about social conditionality of public health, comprehensively using all positive, reached by a world and domestic thought, Soviet This year in new public conditions turned into the creative science capable to solve multidimensional problems of preservation and promotion of health of all people. Tasks of social policy of the Communist Party and the Soviet state in the field of health protection of workers and the tasks set by party for health care became the target program of development This year (see. Communist Party of the Soviet Union ). Purpose of social hygiene was carried out; it became, according to B. V. Petrovsky, socialist health care in operation, its real scientific-theoretical base. Health protection of workers as the major social problem found comprehensive justification in program documents of party.
Having personified all political width and depth of the Lenin principles of protection of national health, Soviet This year and her founders of N. A. Semashko, 3. P. Solovyov, the heading first departments of social hygiene created in 1922 their colleagues and numerous pupils and followers from new dialektiko-materialistic positions comprehensively developed cardinal problems of public health care.
Having the fullest information on the nature of health and the factors defining it, the socialist health system and its scientific basis social hygiene were components of the public mechanism where strategic tasks in the field of protection and strengthening of public health which after consideration by party and public authorities become a component of uniform social policy began to form and be proved.
Implementation of strategy of party in the field of health care demanded broad expansion of social and hygienic and organizational researches which center was an All-Union research institute of social hygiene and the organization of health care of N. A. Semashko and department of social hygiene of medical higher education institutions and institutes of improvement of doctors of the country. Created in these centers Marxist This year it was enriched with a number of the researches which became an invaluable contribution to development of theoretical bases and the practical beginnings of the Soviet health care. To studying of social conditionality of health, patterns of its formation, a role of demographic processes, the states of health of various groups of the population, to the critical analysis of bourgeois concepts of medicine and public health, development of programs and methods of a research of health of the population, especially the most perspective complex methods, are devoted to development of problems of history of medicine and health care works E. D. Ashurkov, M. I. Barsukov, G. A. Batkis, E. Ya. Belitskaya, A. Ya. Boyarsky, S. M. Bogoslovsky, L. A. Brush-linskaya, V. V. Bunak, N. A. Vinogradov, 3. A. Gurevich, Yu. A. Dobrovolsky, P. M. Kozlov, P. A. Kuvshinnikov, P. I. Kurkin, L. G. Lekarev, Yu. P. Lisitsyn, A. M. Merkov, V. A. Nesterov, S. A. New rural, V. K. Ovcharo-va, V. V. Payevsky, B. D. Petrov, E. A. Sadvokasova, A. F. Serenko, B. Ya. Smulevich, I. D. Strashun, 3. G. Frenkel, S. Ya. Chikin and others. Problems of the organization of health care as the industries of the socialist national economy, management, economy, planning, improvement of forms and methods of health protection of the people, questions of development of specialized medical care found extended coverage in I. D. Bogatyrev, I. S. Weger, D. V. Gorfin, P. G. Dauge, N. G. Ivanov, I. V. Rusakov, S. Ya. Freydlin, V. V. Kanep, W. I. Kant, E. P. Pervukhin, V. V. Trofimov, D. I. Ulyanov's researches. Scientific bases and the principles of the organization of health protection of mothers and children, hygienic education and sanitary education are formulated in works as L. S. Bogolepova, V. M. Bonch-Bruyevich, And. M. Kollontay, V. P. Lebedeva, D. N. Loransky, O. P. Nogina, etc. Problems of foreign health care became a subject of researches of D. D. Venediktov, I. V. Pustovy, O. P. Shchepin, etc.
Continuity of problems of development of socialist health care and social hygiene defines a big role of activity and scientific works of heads of health care, first of all national commissioners, and in the subsequent Ministers of Health of the USSR — N. A. Semashko, M. F. Vladimirsky, G. N. Kaminsky, E. I. Smirnov, M. D. Kovrigina, S. V. Ku-rashova, B. V. Petrovsky, S. P. Burenkov.
In the USSR numerous schools of sciences of social hygienists and organizers of health care were created. The big contribution to development of urgent problems was made by social hygienists of Ukraine, Belarus, Latvia, Moldova and other republics.
Social hygiene as the science studying patterns of influence of living conditions on health of the population develops methods inherent in it and uses methods of other sciences. Among methods of social and hygienic researches the main place is taken sanitary and statistical, sociological and a method of an organizational experiment. Along with it the set of other methodical receptions revealing features of health of various groups of the population, conditions of their life and the organization of medical care is used. Methodical methods of sanitary statistics (see. Statistics sanitary ), in particular the analysis of variational series, the standardized indicators, identification of dynamics, extrapolation and the multifactorial analysis, provide measurement of force and an orientation of influence of separate factors and definition of those characteristics of health of the population which are necessary for development of the corresponding forms of prevention of diseases and medical care by the patient.
Use of sociological methods allows to reveal the attitude of representatives of various groups of the population towards the health and their behavior in the conditions of the operating system of the treatment-and-prophylactic help, and also feature of their way of life, with to-rymi the state of health is connected. The so-called complex social and hygienic researches combining the sociological, sanitary and statistical, economic-mathematical and other methods allowing to reveal fullestly a social oposredovaniye of health are very perspective. Also the so-called kliniko-social researches consisting in use of complex social and hygienic methods during the studying of the major characteristics of groups of the patients first of all having chronic diseases were widely used. This method is especially important in connection with the increasing role of a healthy lifestyle and for assessment of efficiency of fight against the addictions occurring among various groups of the population.
The method of an organizational experiment was health care, very useful at justification of the new forms of government, and improvement of medical care, in particular during creation of institute of chief physicians of areas, preparation of reform on expansion of the rights of heads of institutions, association of fast and acute management in the large cities, development of specialized medical care in the interdistrict centers, increase in number of stages of delivery of health care due to inclusion of sanatoria for recovery of health, etc. As option of such experiment the method of comparative analytical assessment of two or several (most often experimentally created) systems of the organization of medical care is applied on the basis of comparison of indicators of expenses and dynamics of health of the population to reveal the most perspective and effective option. This method is available, it allows to make reorganization of the organizational forms existing in different territories only after detection of unconditional advantages of one of them.
In social and hygienic researches also epidemiological, medico-geographical, historical and analytical, psychological, anthropological, and also anamnestic and other methods are applied. Data on epidemiology of the major noninfectious diseases are especially useful to development of actions for fight against malignant new growths, cardiovascular diseases, mental disorders, endocrine diseases, diseases of digestive organs, etc. In these researches consider social and hygienic and etiological factors, results of studying to-rykh promote development of measures of primary and secondary prevention of noninfectious diseases. Methods of the medico-geographical analysis are widely used in actions for fight against prirodnoochagovy diseases and at justification of regional features of the organization of medical care and standards of need of the population for different types of the specialized help.
Method of expert evaluations gained recognition in works of economical character and in definition of perspectives of development of health care. Personal experience and profound knowledge of patterns of the processes which are subject to examination and specific situations is the cornerstone of examination, in the relation to-rykh experts do the corresponding conclusions. As a result scientific ideas of the forthcoming negotiability of the population behind medical care, about the expected terms of treatment, etc. form.
As methods of special studying of labor processes the self-photo, timing, moment observations are used. Receptions of the economic analysis of efficiency of material inputs taking into account positive shifts in health of the population find application in the analysis of incidence with temporary and permanent disability and at cost assessment of decrease in frequency or complete elimination of some infectious and chronic diseases.
In modern conditions as a methodical basis of large social and hygienic, economical and organizational researches it is used systems analysis (see) in which development of logical model, its information support, mathematical expression and assessment of the expected results figures prominently at various versions of organizational decisions. Such methodological approach provides the account in interrelation of household, production, ecological factors, features of the organization of medical care to the population and its results. Health of the population in such researches finds expression in indicators of a harmony of physical development, incidence, disability, mortality, in the analysis of causes of death. Indicators of health are estimated, being conformed with data on population, its age and sex, professional, national structure, migration, density and accommodation of the population as these factors have significant effect on incidence and mortality. Systems analysis with use of all methods of social and hygienic researches finds application during the development of concepts of health care, the choice of basic decisions and development of specific actions.
Researches of health of the population reached a high level in the first years of the Soviet power. As a result of performance of large forwarding works on studying of the medikodemografichesky tendencies and living conditions which were in the threatened condition of small nationalities there was an opportunity to prove actions for prevention of the outlined extinction of these nationalities. In the late twenties large researches of incidence of the population in Moscow, the Moscow region and in Ukraine began to be used also for justification of need of the population for medical care and new forms of its organization. In the subsequent such inspections in scales of all country were carried out in connection with population censuses 1939, 1959, 1970. The last complex studying of health of the population, in addition to studying of shifts in health of the population, for the first time allowed to prove regional features of the organization and standard of need of the population for medical care in various economical and geographical regions of the country and in federal republics. In modern conditions wide medico-demographic and planned and organizational estimates of health of the population are carried out in experimental conditions on the basis of use of avtokhmatiziro-bathing systems of registration and dynamic overseeing by incidence and factors of social character and quality of the medical help influencing it.
Patterns of spread of preferential chronically proceeding diseases were revealed in works on epidemiology of noninfectious diseases (see. Prevention primary ). It researches 60 — the 70th years on epidemiology and medical geography of malignant new growths, mental diseases, cardiovascular diseases, a diabetes mellitus, a peptic ulcer. On the basis of results of researches warning systems, uniform for the country, about the revealed diseases and efficiency of their treatment formed. Results of the same researches created conditions for improvement of the organization of prevention, especially for early identification, creation of registers of such patients, for early and their active treatment.
New social and hygienic patterns were investigated in works on studying of the reasons of abortion, not incubation of pregnancy, perinatal and child mortality, in works on studying of vrekhmenny disability and disability in connection with diseases and injuries.
Studying of activity of healthcare institutions as one of factors of public health resulted in need of merging of hospitals and policlinics in the late forties that allowed to improve skills of district doctors and level of an ambulatory care to the population. In these works widely indicators of quality of medical care for the first time began to be used: its timeliness, correctness of establishment of the diagnosis, result of treatment, succession, systematicity of observation, etc.
Large works of medico-demographic character give generally generalized estimates of shifts in health of the population and efficiency of health care. Radical improvements in indicators of health were noted in works but to studying of materials of population censuses 192(3 and 1939. Carried out under the direction of N. A. Semashko the research of effects of the Great Patriotic War of 1941 — 1945 and materials of population censuses of 1959 and 1970 reflected the heaviest social and hygienic effects of war (see. Population census ). Creation of tables of survival, the analysis of the differentiated indicators of birth rate, death rate and causes of death allowed to measure efficiency of all social and economic activities for strengthening of health of the population.
In addition to the materials relating directly to public health during the studying of its patterns researches of financial budgets of families, budgets of their time and food which reflect welfare, cultures of the population, its sanitary wellbeing and by that — his health figure prominently. These indicators systematically collect on the basis of the dynamic selective observation covering more than 60 thousand representatively selected families. The same materials to a great extent form a basis for the statistical characteristic of that new way of life of various groups of the population which more and more defines creation of systems of modern health care. In general recently the increasing value is gained by statistical characteristics of a way of life (see. Socialist way of life ) and sanitary and hygienic behavior of various groups of the population, on to-rye extent of use by the population for the benefit of the health of components of social and material well-being — education level and culture, quality of the dwelling, the sizes of the income, quality of food, the organization and availability of medical care, etc. influences.
The leading directions of scientific research in the field of the organization and planning of health care (see) are defined by those patterns of public health which come to light on the basis of the analysis of results of overseeing by health of the population. According to these data take place stabilization of indicators birth rate (see), increase as a part of the population of a share of persons of advanced ages, change of nature of pathology towards increase in chronically proceeding diseases and strengthening of the migratory processes defining regional features both in characteristics of structure of the population and in his health. Therefore the main researches in the field of the organization of health care are devoted to justification of standards of need for medical care and development of the organizational forms answering to features of health of the population of various regions of the country.
Economical and organizational and administrative researches use materials of a set of periodically carried out medico-demographic researches, works on complex studying of incidence, and also researches of ecological and medico-geographical character as a basis. Standards of need of the population for specialized types of medical care for various economic region of the country are as a result proved.
Scientific development of problems of management is carried out on the basis of the created automated control system «Health care», the main subsystems a cut are: the automated analysis of medico-statistical information and automation of planned calculations for health care; the automated system of the account and distribution of medicines; automated control system for shots. Development of similar researches in federal republics and areas increases the scientific level of management of health care on places (see. Automated control system , Management of health care ).
The large section of researches is economy of health care (see), including development of questions of work, the salary, efficiency of use of fixed assets of health care. In these researches economic effects of decrease and elimination of a number of diseases are defined, the economic principles of expansion of the rights of heads of health care directed to increase in efficiency of medical care to the population are offered, optimum indicators of power of hospitals, etc. are established.
Works in the field of the organization of health care are devoted generally to optimization of creation and placement of network of healthcare institutions, improvement of activity of various treatment and prevention facilities, ensuring succession and interaction in their work. In modern conditions the independent place in researches on health care was taken by questions of development specialized medical care (see), the organizations of fast and acute management (see. Emergency medical service ), systems of step-by-step treatment of patients with the subsequent their medical, professional and social rehabilitation (see). Scientific bases of activity of the large centers of oncology, cardiology, surgery, motherhood and childhood are created (see. research centers ). Pilot studies of organizational character are devoted to justification of further development of prevention (see), to formation of a healthy lifestyle (see. Socialist way of life ), to development medical examinations (see) with coverage dispensary observation of all population.
Pilot studies on organizational subject are directed also to justification of centralization of laboratory service, improvement of sanitary and epidemiological surveillance (see. Sanitary inspection ), creation of the large advisory centers of an ambulatory care, justification of a teamwork of work of doctors, development of two-sedate service of patients in hospitals and development of an optimum duty of policlinics. In relation to rural areas the researches devoted to development of specialized medical aid on the basis of interdistrict hospitals and policlinics are conducted (see. Rural medical site ). Researches on improvement of system of primary health care (see), on organizational strengthening of work of the district doctor are perspective (see. Medical site ).
On the basis of generalization of specific researches in the field of health care improvement of theoretical fundamentals of health care is carried out.
In the conditions of the developed socialism and scientific and technical progress before health care and consequently, before social hygiene and the organization of health care there are new problems. In a situation when reach a high level of development of material and technical resources of health care and when the problem is in a quantitative sense solved medical shots (see), defining there is a problem of providing snowballing of the industry. Not only establishment of quantitative parameters, but also justification of priorities, staging and rates of proportional development of all links of health care is necessary.
The real base for development of the long-term comprehensive programs directed to decrease in incidence and mortality, extension of creative activity and longevity as net results of public health care is created.
Modern health care and social hygiene are armed with mathematical methods and modern computer facilities that considerably deepens possibilities of opening of patterns of influence of social and economic conditions on public health and expands possibilities of improvement of a control system of the industry.
Escalating value is gained by social and hygienic aspects of a scientific and technological revolution. Ecological shifts (see. Ecology ), urbanization (see), change of a demographic situation (see. Demography ), rough process of reorganization of technology of industrial and agricultural production, use of new energy sources and the increasing use of chemicals define need of the solution of a wide range of the questions of the social and hygienic plan concerning preservation and promotion of health of the population (see. Environmental control ). Automation and an intensification of work impose new increased requirements to physical and mental health of all categories of workers of modern production.
Broad, complex and multidimensional prevention, the social and preventive direction becomes the trunk link of the theory and practice of health care (see. Prevention , Prevention primary ), aimed at providing optimum, from positions of health, working conditions, life and rest of workers in combination with medical examination of all population.
History of health care and social hygiene is characterized by bitter ideological struggle. Ideologists and apologists of bourgeois science put and apply a lot of effort to disprove the Marxist provision that capitalism is a source of pathology for broad masses that the capitalist system is not able to resolve considerably the major social problems, including a problem of protection of public health. Reformists of various plan aim to prove, as in the conditions of capitalist system in the course of evolution of capitalism it is possible to make necessary progress in ensuring health of all members of society. They try to explain obvious insolvency of capitalist society in the solution of a number of problems of health care with the «universal», «objective» laws of social development having above class character and, therefore, not connected with a capitalist system.
The major methodological reception used by bourgeois theorists for the proof of the constructions is the attempt to consolidate difficult laws of social development to biological and psychological patterns. The first such concepts were maltuzianstvo (see) and a neomaltuzianstvo which cornerstone mechanical transferring of laws of biological development to the sphere of the public relations is. Conceptually the political anthropology, social Darwinism and social ecology, an etologizm, a so-called sotsiobiologiya, etc. are connected with a maltuzianstvo. Theoretical constructions of neofreudians, the psikhosomatikov-Freudians seeing the reasons of diseases in the subconscious psychosomatic conflict are more veiled. The concept of a genetic determinism aims to prove fatal dependence of health of an individual on genetic factors. A number of bourgeois scientists, representatives of a so-called social selyizm, formulating concepts of a social, ethical and psychological stress, mechanically transfer patterns of stressful reaction to an explanation of the social phenomena. Authors of some modern theories recognize also influence of social conditions on formation of nature of pathology, but, speaking about biosocial interaction, give a priority to biological factors, eclectically approach assessment various on character and the importance of the social phenomena, do not recognize the dominating value of relations of production. Theoretical concepts of this kind and among them the theories of factors and the theory of a vicious circle of poverty and diseases which gained distribution are metaphysical on the ideological essence and reformist on a social orientation. Their main objective — being covered with the multifactorial analysis of the biosocial phenomena, to disprove the original position of Marxism about the defining influence of a social system on health and by that to relieve from capitalism responsibility for inhuman, antinational policy in the field of health care.
Also bourgeois interpretation of the theory of «diseases of a civilization» and «social disadaptation» leveling as well as the theory of «convergence» in health care, a paramount role of a social order, capitalist and socialist relations of production reducing the reasons of pathology to influence of modern technology and «a technical civilization» behind a mask of which sovrekhmenny capitalist society with its social defects disappears is close to these theories.
Social hygiene occupies one of foregrounds in system of the highest medical education (see). As a subject of teaching she received the independent place at the Soviet higher school in 1922. The first departments of social hygiene were created at the first and second Moscow universities. Them the people's commissar of health care N. A. Semashko and the deputy people's commissar 3 directed. P. Solovyov. In the next years similar departments are organized in other cities — at all medical faculties; they were headed by the famous scientists and figures of health care: 3. G. Frenkel (Leningrad), L. V. Gromashevsky (Odessa), T. Ya. Tkachyov (Voronezh), M. G. Gurevich (Kharkiv), S. S. Kagan (Kiev), A. M. Dykhno (Smolensk), etc. The organization of departments was preceded by creation in 1919. The museum of social hygiene transformed in 1923 to research institute (The state institute of social hygiene) at the head of which there was a large hygienist and the organizer of health care A. V. Molkov. Similar institutes then were formed in other cities of the country. Institute in Moscow and other scientific institutions of this profile not only carried out big research work, but actively participated in training of teachers and scientists. Thanks to creative activity of departments and institutes the higher medical education in the USSR was reconstructed on the preventive beginnings, and the corresponding training of doctors promoted formation doctor-obshchestvenni-@, the active organizer of health care. With the advent of departments of social hygiene that differentiation of hygienic sciences which to the middle of the 20th years led to creation of departments of occupational health, utility hygiene, hygiene of children and teenagers, hygiene of food accelerated. Departments of social hygiene became ideological base for development of understanding in students of social conditionality of health of the population and need of formation of such policy of health care and system of actions which would provide protection and strengthening of health of the population is preferential through development of system of public prevention.
In the subsequent the departments of social hygiene which received the name of departments of the organization of health care (1940) were initiators of large researches on development of forms and methods of delivery of health care to various groups of the population. A specific place was held in these researches by questions of dispensary observation and its use in fight against social diseases and in service protection of motherhood and childhood (see).
Since 1967 at departments and at institute (now — social hygiene and the organization of health care of N. A. Semashko) broad development get a job on studying of the social and hygienic factors influencing the level and the nature of health of the population, and also defining quality of the treatment-and-prophylactic help to the population.
Now scientific, pedagogical and organizational and methodical work in the area and the organizations of health care is carried out This year in the USSR by All-Union research institute of social hygiene and the organization of health care of N. A. Semashko of the Ministry of Health of the USSR, more than 100 departments of social hygiene and the organization of health care at medical institutes (see) and institutes of improvement of doctors (see) and about 300 departments as a part of various research establishments (see. Research institutes ). The largest departments work as a part of hygienic institutes of the Russian Federation, Ukraine, Belarus and as a part of Institute of regional medicine of Kazakhstan. The institute of N. A. Semashko is head, carries out coordination of scientific research on social hygiene and the organization of health care in the country; on its base the Scientific council on social hygiene and the organization of health care of Presidium of the USSR Academy of Medical Sciences combining work of several problem commissions is for this purpose created. Besides, at Academic medical council of the Ministry of Health of the USSR the Committee on social hygiene and organization of health care as advisory body on planning and coordination of scientific works is created.
The question of work of departments, research institutions on social hygiene and the organization of health care is in the center of attention of the Ministries of Health of the USSR and federal republics. Only recently (1980 — 1982) on boards allied and the republican ministries the question of work of departments of social hygiene and the organization of health care of medical schools of the country was specially discussed. The special orders which set the important tasks in the field of scientific research and training were issued.
Scientific councils and the problem commissions on social hygiene and the organization of health care are created at the Ministries of Health of federal republics. Allied and republican councils and the commissions regularly hold plenums and conferences which participants discuss the directions of scientific research and results of their implementation in practice. In recent years all-Union plenums and conferences were held in Gorky (1981) and Moscow (1982).
Results and problems of development of social hygiene and the organization of health care are discussed also at All-Union and republican congresses and conferences of science hygienic foundations, in to-rykh there are sections on social hygiene and the organization of health care (see. Congresses medical ). In a number of the cities (Leningrad, Chisinau, Riga, etc.) independent science foundations of social hygienists and organizers of health care function.
The publications which are systematically covering problems This year and the organizations of health care, are the Soviet Health Care magazine, the Health Care of the Russian Federation magazine and similar periodicals in other federal republics (see. Medical periodicals ).
Professional development of teachers and scientists This year and the organizations of health care carry out institutes of improvement of doctors to areas (see) and faculties of improvement of doctors of medical institutes. Besides, preparation is carried out through a postgraduate study (see. Postgraduate study, graduate military course ) and doctoral studies (see) corresponding departments, in the All-Russian Research Institute of N. A. Semashko and departments of research institutes, and also in workplaces, by a training etc.
The international cooperation in social hygiene gained rather broad development in pre-revolutionary Russia (with Germany). These relations proceeded in the subsequent generally a pathway specialists, participations in the international and national congresses discussing problems of public health and health care, development of social hygiene within international medical organizations (see) — WHO, UNICEF, the ILO, etc. with participation of the USSR, in societies and associations (it is especially active in the congresses of the International association on studying of living conditions and health).
Systematic cooperation is carried out with member countries of SEV on bilateral and multilateral bases. Scientific content of cooperation is development of methodical bases of studying of health of the population, methods of planning of health care and, in particular, planning of training in the conditions of the growing specialization of medical disciplines. Also questions of development of dispensary observation of various groups of the population, organizational issues of improvement of step-by-step and successive medical care to the population, design of modern treatment and prevention facilities, and also use of modern computer facilities in health care are jointly developed. The unity of the principles of health care in the socialist countries and methods of the solution of modern problems of health care allows to provide cooperation in performance of scientific works. Regularly held meetings of Ministers of Health of the socialist countries considering urgent problems of development of scientific research along with organizational problems including in the area became authoritative body of the international cooperation in health care and social problems of medicine This year.
Special programs of cooperation are carried out with a number of the capitalist countries. For example, cooperation with France is carried out preferential in the field of scientific justification of development of health care of children and aged. Also joint researches of economy of health care and technology of planning of health care in the large cities are conducted. Exchange of information and the direction of specialists to the capitalist countries are also carried out within bilateral agreements with England, Germany, Italy. Cooperation with these countries finds, besides, expression in joint permission of scientific problems within World Health Organization.
In the socialist countries institutes of health care which at the same time carry out also researches in the field of hygienic sciences are engaged in scientific research of problems of social hygiene. The largest of them — Institutes of health care in Prague, Berlin, and also Institute of hygiene and health care in Bucharest and scientific centers in Budapest and Sofia. In all countries there are relevant departments and training courses.
In economically developed capitalist countries questions of social hygiene and the organization of health care are developed generally at medical faculties of universities (departments of institutes). There are also large research centers in the USA (The national center of statistics), in England (Institute of tropical medicine), in France (National institute of epidemiological researches). In Germany, Sweden, Belgium, Holland the research of questions of social hygiene and the organization of health care is conducted as in the state medico-statistical organizations and at the relevant departments of higher education institutions, and in special divisions of the Ministries of Health. In this respect a specific place is held by activity of the General register — the central statistical body of England in which are developed materials about mortality of the population and activity of healthcare institutions.
The victory of a socialist system in a number of the states and creation of the international socialist health system which philosophy reflect the most progressive lines of the public health care capable to solve cardinal problems of health protection of a wide people at large became a powerful factor of development of health care in the world.
Value of socialist health care as international system is defined not only by scientific validity of the major problems, but also comprehensive development of strategy in public health care. A bright illustration to it is acceptance by the XVII Meeting of Ministers of Health of the socialist countries jointly of the developed document «Main Directions and Perspectives of Development of Socialist Health Care» which received a wide response in circles of the international medical public. It is natural that the principles of socialist health care find the increasing recognition and creative application in many, first of all developing countries of the world.
In 1970 the XXIII session of the World assembly of health care in the special resolution (VAZ 23.61) «About philosophy of development of national health care» in essence recognized the socialist principles — the state character, unity and planned character of health care, communication of science and practice, a preventive orientation, general availability of the qualified medical care, attraction of a general population to implementation of programs of health care. These principles in quality «the most effective and the countries checked on experience of a row» are recommended to all states taking into account their national, historical, social and economic and other conditions.
The evidence of authority and the international influence of theoretical and organizational fundamentals of socialist health care, first of all attractiveness for the countries which dumped a colonial yoke and followed a way of national revival carrying out in 1978 was. World Health Organization and UNICEF in our country, in Alma-Ata, the International conference on problems of the primary health care to the population which planned the main ways of development by the countries of the national health care. In the Almaty declaration adopted at a conference and other documents value of primary is emphasized medical and sanitary help (see) as kernels of public health care and as bases of strategy of WHO and the countries on achievement «health for all by 2000». In this document it is specified value of experience of the USSR, etc. socialist countries in the field of health care, for a paramount role of the state in public health care, the social and preventive direction of the Soviet health care, etc. principles in which development the activest participation is accepted by representatives This year and the organizations of health care. WHO included in the programs scientific research in the field of public health and health care (administration) and on training.
Scientific research, training, questions of teaching social hygiene and the organization of health care, scientific and technical cooperation in this area receive lighting as in the general national and international medical periodicals, and in the publications of regions of WHO, Public Health Reports, Hospital, Medical Review of Reviews, the international magazine of the socialist countries which are specially oriented to a problem of public health and health care (The chronicle of WHO, the Bulletin of WHO, the International forum of health care) — «Health care».
The big material devoted to various problems This year and its stories, is available in the articles Health care, the Communist Party of the Soviet Union, Lenin and health care, Medicine, etc.
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A. F. Serenko, Yu. P. Lisitsyn, V. K.Ovcharov, O. A. Alexandrov.