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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!
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