Social medicine Social medicine as a theoretical as a theoretical

basis basis of health of health

protectionprotection

Friedrich Engels (1820-1895)Called attention to the health of the

working class

Rudolf Ludwig Karl Virchow (1821-1902)the “Father” of Social Medicine

Those measures can be divided into 2 groups:

• -measures against the diseases;

• -measures aimed at improving health.

“The physician is the natural attorney (advocate) for the poor.”

Before the beginning of the 20th century 3 ways of health protection

were formed:

• with help of state measures(the promulgation of different medical and social work);

• with help of social measures;

• with help of medical insurance.

Medicine is a social science,

and politics nothing but

medicine on a grand scale.

- R. Virchow, Die Medicinische Reform, 1848

“Social hygiene” studies interaction of social factors and human health including changing of need in medical aid with the purpose of making the rational economic system of civic health protection measures (K.Gargov, 1969).

Social medicine and organization of health protection

is a science about social conformity with human health and the ways of its improvement by rational organization of health protection.

Worsening inequality in the US

Source: Left Business Observer

Old Conceptual Model

HumanRights

Well-BeingHealth

The World Assembly of Health Protection (WAHP) in its resolution number 23.61 considers that the optimum development of health protection in any country needs making use of generalized experience of health protection development in all the countries of the world. The most effective principles marked by experience of different countries of building and development of national health protection system are the following:

New Conceptual ModelFramework for Understanding

Human Rights

Health

Human Rights

Human Rights

Health

Health

Proclamation of the responsibility of state and society for health protection of the population, which is to be incarnate on the basis of carrying out the complex of economic and social measures which promote directly or collaterally to reach the highest health level of population by creating general national system of health protection services on the basis of the only national plan and local plans, and also by goal-directed and effective use of all resources, which society may apport on every stage of its development for requirements of health protection;

The Evolution of Epidemics

Virulence of the Causative Agent(M tuberculosis)

Population Susceptibility

Course of Epidemic

• To ensure all population of the country the highest possible level of qualified, generally accessible prophylactic and medical aid, which is given without financial or other restrictions by creating suitable network of medical, prophylactic and rehabilitation establishments;

• Wide use achievement of world medical science and practice of health protection in every country with the purpose of ensuring conditions for getting maximum effectiveness of all taken measures in health protection sphere;

Reported TB Cases US, 1953-2002

10,000

20,000

50,000

70,000

100,000

Cas

esL

og

Sca

le

30,000

53 60 70 80 90

*Change in case definitionYear

00

*

*

• Sanitary education of citizens and drawing into participation in conducting of all programmers of health protection of wide sphere of population are the argument of personal and collective responsibility of all members of society for health protection of people.

Reported TB Cases US, 1983-2002

10000120001400016000180002000022000240002600028000

83 85 87 89 91 93 95 97 99 2001

Year

1981 1985 1989 1993 1997

No.

of

Cas

es

2002

*

* provisional

The basic principles of the Public Health service:

• The determination of the Public Health service with the priority direction of the sasaity activities and government as the one of the basic factors of the surviving and Ukrainian nation development.

• The observance of the right and liberties of human and citizen according to the Public Health service and securing with the state guarantees.

• The human direction, securing with priority, common to all mankind treasures in classical, national, grope or individual interests, medical-social protection of the most vulnerable part of the population.

Excess TB cases 1985-92

JAMA 1994; 272:536

•Infrastructuredeteriorated

•Epidemic HIV

•Immigration

•Institutionaltransmission

•MDR TB

• Of the citizens, democratism and opened to general use of the medical aid and other services in the Public Health service.

• Accordance to the task and social-economical level and cultural development of the sasaity, scientific explanation, material and technical and financial securing.

• Orientation to the modern health standards and medical aid.

• The unit of the old traditions and achievements in Public Health service.

TB Morbidity US, 1997-2002

Year Cases Rate*1997 19,851 7.41998 18,361 6.81999 17,531 6.42000 16,377 5.82001 15,989 5.62002** 15,087 5.2

*Cases per 100,000 **Provisional

Social medicine

– is a science that studies social laws of peoples health and characterizes the ways of its improvement according to rational organization of public health services.

TB Case Rates, US, 2002

< 3.5 (year 2000 target)

3.6 - 5.2

> 5.2 (national average)

D.C.

Rate: provisional cases per 100,000

Healthis a condition of complete social, mental and biological well-being, and not just the absence of diseases or physical defects

Reported TB Cases by Race/Ethnicity, US, 2001

Hispanic(25%)

Black, non-Hispanic

(30%)

Asian/Pacific Islander(22%)

White, non-Hispanic(21%)

American Indian/ Alaska Native (1%)

• 1. Historical, establishes historical regularities of development of public health and its protection;

• 2. Sociological, that allows studying social structure of a society and its influence on health;

• 3. Experimental, allows studying advantages (lacks) of organizational forms of medical service;

• 4. Expertise, which help quality and efficiency of medical service is studied;

• 5. Economical, that enable to determine economic efficiency of systems of medical service.

Number of TB Cases inUS-born vs. Foreign-born Persons,

US, 1992-2002*

0

5000

10000

15000

20000

US-born Foreign-born

No

. o

f C

ases

*2002 count is provisional

Statistical totality

is the common number of units of supervision, taken in the set borders of space and time.

Countries of Birth for Foreign-born Persons Reported with TB

US, 2002*

Mexico(25%)

Philippines(11%)

Vietnam(9%)India

(8%)China

(5%)

Haiti(3%)

S. Korea(3%)

OtherCountries

(36%)

*Provisional

The ways of formationof the statistic integrity

By the volume of observation

continuous

selective

volume

observation

selection

accidental

mechanic

typological

serial

regionalcombinative

By the time of observation

By the type of observation

flowing

one-moment

direct

copying of the data

By anamnesis

questionnaire

interrogatory

2

22tn

2

2

pqtn

The stages of development of statistical material are following:

• control /logical and technical/;

• enciphering /code/ of registered signs by numbers, letters of alphabet;

• lay-out of cards on groups for the subaccount or groupment;

• report of material;

• deduction of statistical criteria /indexes/, their graphic image.

Thank you!Thank you!