DEPARTMENT FOR HEALTHCARE AND PUBLIC DEPARTMENT FOR HEALTHCARE AND PUBLIC HEALTHHEALTH

Problems for discussion1. Structure of mortality. The main

causes of population deaths.2. Methodology, model and principles of

health promotion.3. Types of prevention. Federal Program

in Russia.

«Future belongs to preventive medicine»

 N. Pirogov 

Expected changes in the mortality structure for 120 years

Main cause of death 1900 2000 Prognosis for 2020 Trend

infectious diseases 20% 1,7% 1% ↓ 20 times

diseases of the circulatory system

15% 56% 60% ↑ 4 times

cancer 5% 12% 25% ↑ 5 times

20 15

56

60

5

12

25

0% 50% 100%

1900

2000

2020

infectious diseases

diseases of the circulatory systemcancer

others

The main causes of population death in the world

4%16%

12%

21%

48%

diseas es of c irculatory sys tem neoplas ms

chronic pulmonary dis ease diabetes mellitus

others

E urope

52

19

2,44

4

18,6

diseases of circulatory systemneoplasms injury, poisoning…diseases of the digestive system pulmonary diseaseothers

R us s ia

56,8

14,4

10,7

4,5

3,79,9

diseases of circulatory systemneoplasms injury, poisoning…diseases of the digestive system pulmonary diseaseothers

The main causes of population death

The main causes of population deathR us s ia

56,8

14,4

10,7

4,5

3,79,9

diseases of circulatory systemneoplasms injury, poisoning…diseases of the digestive system pulmonary diseaseothers

Diseases of the circulatory system

Medical care Healthy lifestyle

Diseases of the circulatory system

Measures for prevention of mortality due to diseases of

circulatory system are able to increase the average life

expectancy by 10 years!

Cancer1. The 12th place in the structure of prevalence

among adults;2. Increasing trend in primary morbidity

(+28,5% during 10 years).

3. More than 400 000 new cases each year, including 2500 children under 14.

4. The total prevalence 2029 cases per 100 000 people.

Leading localizations of cancer (both sexes)12,6%

11,1%

10,7%

3,7%

6,5%5,1%

50,3%s kin c anc er

breas t c anc er

lung c anc er

s tomac h c anc er

c olon c anc er

pros tate c anc er

others

Leading localizations of cancer (among men and women)

men18,9%

11,9%

11,5%

9,1%

48,6%

lung c anc er pros tate c anc er

s kin c anc er s tomac h c anc er

others

women20,4%

14,7%

7,4%7%

50,5%

breas t c anc er s kin c anc erhys teroc arc inoma c olon c anc erothers

5. The 2d place (15,4 %) in the structure of deaths in Russia.6. 300 000 deaths every year.

7. The 2nd place (22,9%) in the structure of causes of disability among adults.

8. Economic damage about 170 billion rubles.

Cancer

Measures for prevention of mortality due to malignant

tumors are able to increase the average life expectancy

for 8 years!

Keys of NCD prevention Most NCDs are preventable.

Population based approach.

Health promotion is the most cost-effective and sustainable way to improve public health

Methodology, model and principles of health promotion

Main factors Main factors responsible forresponsible for health health statusstatus

18%

20%

10%

52%

lifestyle medical careenvironment heredity

Health promotion is the process of enabling people to increase control over

and to improve their health 

WHO, 21 November 1986, The Ottawa Charter for Health Promotion

8th Global WHO Conference on health promotion - “Health in all policies” From Ottawa to Helsinki (June 2013)

Model of health promotionModel of health promotion

Reorienting the health services

Building healthy public policy

Strengthening community action

Creating supportive environments

Developing personal skills

Ottawa Charter for Health Promotion WHO, 1986

7 key principles of health promotion, WHO

Holistic

Inter-sectoral

Participative

Multi-strategy

Sustainable

Equitable

Empowerment

COMBING PERSONAL AND PUBLIC RESPONSIBILITIES

Personal Responsibility ”Nobody can take better care of your health than yourself”

Public Responsibility ”Make the healthy choices the easy ones”

(Ottawa charter)

18

•POLICY INTERVENTIONS Vision for the future •The future is in our hands •From what to how •Political will and leadership •From predicting the future to making the future

Codes of health and longevity

PreventionPrevention refers to approaches and activities aimed at reducing the likelihood that a disease or disorder will affect an individual, interrupting or slowing the progress of the disorder or reducing disability.

Principles of prevention programspatient - orienteduse of scientific progressmultiple communication channelsincreasing range of preventive servicescreating a market for preventive and wellness

services

Averaged data for the United States, Finland, Great Britain, Holland, New Zealand

55%37%

8%

prevention treatment others

Contribution of curative and preventive measures in reduction Contribution of curative and preventive measures in reduction of mortality from coronary heart diseaseof mortality from coronary heart disease

Socrates

Types of prevention. Federal Program in Russia.

Types of prevention Condition of an organism Healthy Disfunction Symptoms of

pathology Organ failure

Duration decades years months

Donozological prevention Nozological prevention

The purpose of intervention

health promotion

correction of disorders,

strengthening adaptive capacity of the organism

earlier detection of the disease,

achieving long-term remission

prevention of complicationsdisability mortality

primary secondary tertiary

Primary prevention

Outcome Objective Activities Target audience Results

Prolonged HALY

To motivate for healthy lifestyle

Social Healthy people

↑ number of healthy individuals

↑ index of health

↑ percentage of people who lead healthy lifestyle

↑ life expectancy

Based on the formation of people's needs   to keep healthy lifestyle

Secondary prevention

Outcome Objective Activities Target audience Results

Maintaining the health of people in high-risk group

Early detection of disorders, strengthening adaptive capacity oforganism

Medico-social or socio-medical

High-risk group

• ↓Incidence

Based on multi-level screening systems

Tertiary prevention

Outcome Objective Activities

Target audience Results

Prolonged DALY

Prevention of disease progression, relapses, decompensated disabilities, lethal outcomes

Nosological Patientswith chronic

diseases

•↓ frequency of relapses •↓ frequency of complications•↓temporary disability• ↓ disability rate• ↓ lethal outcomes

Based on regular health check-ups

Coverage of population for different types of prevention

Federal Program: "Promotion of healthy lifestyles and prevention of noncommunicable diseases in the Russian Federation for 2013-2017 "

Objective: To increase life expectancy by reducing the premature mortality from NCDs, primarily from cardio-vascular diseases

Ministry of Health

Center for preventive medicine

Population > 150 000

Population 50 000 -150 000.

local hospital rooms of preventive

medicine

Out-patient clinics

Health center

departments of preventave medicine

rooms of preventive medicine

feldsher-midwife station

rooms of preventive medicine

Research institute of preventive medicine

Federal Service for Consumer Rights Protection and Human

Welfare

Ministry of Education and Science of the Russian

FederationMinistry foof Sport, Tourism

and Youth Policy of the Russian Federation

departments of preventive medicine

rooms of preventive medicine

City center for preventive medicine

Population levelIndividual level

Group level

Thank you for your attention!