Main stages in the development of public health. Current state of public health and healthcare

1.2 History of the development of public health

Social-hygienic elements and prescriptions are found in the medicine of ancient socio-economic formations, but the isolation of social hygiene as a science is closely related to the development of industrial production.

The period from the Renaissance to 1850 was the first stage in modern development public health (at that time this science was called “social hygiene”). During this period, serious research was accumulated on the interdependence of the health of the working population, their living and working conditions.

The first systematic manual on social hygiene was Frank's multi-volume work “System einer vollstandingen medizinischen Polizei”, written between 1779 and 1819.

The utopian socialist doctors who held leadership positions during the revolutions of 1848 and 1871 in France tried to scientifically justify public health measures, considering social medicine the key to improving society.

The bourgeois revolution of 1848 was important for the development of social medicine in Germany. One of the social hygienists of that time was Rudolf Virchow. He emphasized the close connection between medicine and politics. His work “Mitteilungen uber Oberschlesien herrschende Typhus-Epidemie” is considered one of the classics in German social hygiene. Virchow was known as a democratically minded doctor and researcher.

It is believed that the term “social medicine” was first proposed by the French physician Jules Guerin. Guerin believed that social medicine included “medical police, environmental hygiene and forensic medicine.”

Virchow's contemporary Neumann introduced the concept of “social medicine” into German literature. In his work “Die offentliche Gesundshitspflege und das Eigentum”, published in 1847, he convincingly proved the role of social factors in the development of public health.

IN late XIX century, the development of the main direction of public health to this day was determined. This direction connects the development of public health with the general progress of scientific hygiene or, with biological and physical hygiene. The founder of this trend in Germany was M. von Pettenkofer. He included a section on “Social Hygiene” in the hygiene manual he published, considering it the subject of that area of \u200b\u200blife where the doctor meets with large groups of people. This direction gradually acquired a reformist character, as it was unable to offer radical sociotherapeutic measures.

The founder of social hygiene as a science in Germany was A. Grotjan. In 1904, Grotjan wrote: “Hygiene must... study in detail the influence of social relations and the social environment in which people are born, live, work, enjoy, continue their race and die. So it becomes social hygiene, which acts next to physical and biological hygiene as its complement.”

According to Grotjan, the subject of social-hygienic science is the analysis of the conditions under which the relationship between man and the environment occurs.

As a result of such studies, Grotjan came closer to the second side of the subject of public health, that is, to the development of norms that regulate the relationship between a person and the social environment so that they strengthen his health and benefit him.

England also had major public health figures in the 19th century. E. Chadwick saw the main reason for the poor health of the people in their poverty. His work “The sanitary conditions of laboring populations,” published in 1842, revealed the difficult living conditions of workers in England. J. Simon, being the chief physician of the English health service, conducted a series of studies of the main causes of mortality in the population. However, the first department of social medicine was created in England only in 1943 by J. Raylem at Oxford.

The development of social hygiene in Russia was most contributed by F.F. Erisman, P.I. Kurkin, Z.G. Frenkel, N.A. Semashko and Z.P. Soloviev.

Of the major Russian social hygienists, it is necessary to note G.A. Batkis, who was a famous researcher and author of a number of theoretical works on social hygiene, who developed original statistical methods for studying the sanitary condition of the population and a number of methods for operating medical institutions ( new system active patronage of newborns, method of anamnestic demographic studies, etc.).

1.3 Subject of public health

The nature of the health care system in each country is determined by the position and development of public health as a scientific discipline. The specific content of any public health course varies depending on national conditions and needs, as well as the differentiation achieved by the various medical sciences.

Classic definition content of public health, mentioned in a discussion organized by WHO on the topic “Organization of health care as scientific discipline": "... public health is based on a “tripod” of social diagnosis, which is studied mainly by the methods of epidemiology, social pathology and social therapy, based on cooperation between society and health workers, as well as on administrative and medical preventive measures, laws, regulations, etc. at central and local government bodies."

From the point of view of the general classification of sciences, public health is located on the border between natural science and social sciences, that is, it uses the methods and achievements of both groups. From the point of view of the classification of medical sciences (about the nature, restoration and promotion of human health, human groups and society), public health seeks to fill the gap between the two main groups of clinical (therapeutic) and preventive (hygienic) sciences, which has developed as a result of the development of medicine. It plays a synthesizing role, developing unifying principles of thinking and research in both areas of medical science and practice.

Public health provides a general picture of the state and dynamics of health and reproduction of the population and the factors determining them, and from this the necessary measures follow. No clinical or hygienic discipline can provide such a general picture. Public health as a science must organically combine a specific analysis of practical health problems with research into the patterns of social development, with problems National economy and culture. Therefore, only within the framework of public health can a scientific organization and scientific planning of health care be created.

The state of human health is determined by the function of his physiological systems and organs, taking into account gender, age and psychological factors, and also depends on exposure external environment, including social, with the latter having leading importance. Thus, human health depends on the influence of a complex set of social and biological factors.

The problem of the relationship between the social and the biological in human life is a fundamental methodological problem of modern medicine. This or that interpretation of natural phenomena and the essence of human health and illness, etiology, pathogenesis and other concepts in medicine depends on its solution. The socio-biological problem involves the identification of three groups of patterns and the corresponding aspects of medical knowledge:

1) social patterns from the point of view of their impact on health, namely, on the morbidity of people, on changes in demographic processes, on changes in the type of pathology in various social conditions;

2) general patterns for all living beings, including humans, manifested in molecular biological, subcellular and cellular levels;

3) specific biological and mental (psychophysiological) patterns inherent only to humans (higher nervous activity and etc.).

The last two patterns appear and change only through social conditions. Social patterns for a person as a member of society are leading in his development as a biological individual and contribute to his progress.

The methodological basis of public health as a science is the study and correct interpretation of the causes, connections and interdependence between the state of public health and social relations, i.e. in the correct solution of the problem of the relationship between the social and the biological in society.

Social and hygienic factors influencing public health include working and living conditions of the population, housing conditions; salary level, culture and education of the population, food, family relationships, quality and accessibility medical care.

At the same time, public health is also influenced by climatic-geographical and hydrometeorological factors of the external environment.

A significant part of these conditions can be changed by society itself, depending on its socio-political and economic structure, and their impact on the health of the population can be both negative and positive.

Consequently, from a social and hygienic point of view, the health of the population can be characterized by the following basic data:

1) the state and dynamics of demographic processes: fertility, mortality, natural growth population and other vital statistics;

2) the level and nature of morbidity among the population, as well as disability;

3) physical development of the population.

The study and comparison of these data in various socio-economic conditions allows us not only to judge the level of public health of the population, but also to analyze the social conditions and reasons that influence it.

In essence, all practical and theoretical activities in the field of medicine should have a social and hygienic orientation, since any medical science contains certain social and hygienic aspects. It is public health that provides the social and hygienic component of medical science and education, just as physiology substantiates their physiological direction, which is implemented in practice by many medical disciplines.

Target: Students should have a general understanding of the discipline “Public Health and Healthcare”, know the basic concepts, sections, and methods. Students should be aware of the social determination of public health.

Healthcare in the most general view is a complex social dynamic, functional, open and adaptive system that society at each stage of its development creates and uses to implement a set of measures aimed at protecting and improving the health of each person and the entire society as a whole.

Public health measures in human history began to be carried out with the advent of the state. They changed depending on changes in socio-economic formations, changes in the method of production and production relations, and the state system.

Public health system is a system of scientific and practical measures and the medical and non-medical structures that support them, the activities of which are aimed at implementing the concept of protecting and promoting public health, preventing diseases and injuries, increasing the duration of active life and working capacity by combining the efforts of society.

The subject of public health is the study of the influence of social living conditions on the health and medical care of the population. The methodological basis of public health is systems approach to the definition and study of public health.

It should be noted that definitions and assessments of health have changed throughout the history of health care. Currently, we have to admit that there is no generally accepted unified interpretation of the concept of health. The literature devoted to various aspects of health contains many definitions of this category, based on various approaches and criteria.

Health, according to the WHO Constitution (1948), is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.

As follows from the definition, the health characteristic combines three components: physical(biological), mental(spiritual) and social health.

Physical health is a condition characterized by the level of physical development, physical capabilities and adaptive abilities of individuals, groups of people and society as a whole, ensuring the achievement of quality of life, well-being of society and ensuring the preservation and strengthening of public health.

Mental health is a condition characterized by a dynamic process of mental activity, which is characterized by determinism psychic phenomena, a harmonious relationship between the reflection of the circumstances of reality and the individual’s attitude towards it, the adequacy of the body’s reactions to social, psychological and physical (including biological) conditions of life, thanks to the individual’s ability to self-control behavior, plan and implement his life path in micro- and macrosocial environments.

Social health is a measure of a person’s social adaptation, determined by his place and role in society.

When we talk about health, we mean a harmonious combination of all three components. The consequence of a violation of one of them is disharmony and, ultimately, disease.

According to WHO definition, disease(illness) is a life disrupted in its course by damage to the structure and functions of the body under the influence of external and internal factors. The disease occurs as a result of exposure to external and internal environment exceeding the adaptive-compensatory (adaptation) capabilities of the body.

There are several levels of health:

individual health- human health;

group health– a set of characteristics of the health of persons united according to any criterion: family, work collectives, students, etc.;

regional health– a set of health characteristics of people living in a certain territory);

public health– a medical and social resource and potential of society that contributes to ensuring national security.

WHO recognizes that the enjoyment of the highest attainable standard of health is a fundamental right of every person. All people should have access to the resources they need to stay healthy.

At the XXX session of the World Health Assembly (1977), the most important social goal was proclaimed: “Achievement by the year 2000 by all the inhabitants of the earth of such a level of health that will allow them to lead productive social and economically Lifestyle". The WHO policy “Health for all” is aimed at solving this problem.

Later, the document “Health 21: a policy framework for achieving health for all in the European Region” was adopted (1999). The “Health for All in the 21st Century” strategy is implemented differently in each country depending on social and economic characteristics, health and mortality rates of the population, status and level of development of health care systems.

The history of public health in Soviet Kazakhstan reflects the main stages of the development of state socialism in the USSR. Since the establishment of Soviet power, the main task of public health care has been the theoretical and practical development of preventive health care principles. The focus was also on providing the population with free, publicly available medical care. During the Great Patriotic War all attention was focused on issues of medical and sanitary support for the front and the deployment of rear hospitals. IN post-war years tasks related to the restoration of the national economy and the elimination of sanitary consequences were reflected. In subsequent years, scientific and practical interests corresponded to the ideology of socialist construction, among which the most ambitious were measures for general medical examination of the population.

At the WHO/UNICEF International Conference held in Alma-Ata in 1978, the socialist healthcare system (model of N.A. Semashko) received worldwide recognition, and the adopted Alma-Ata Declaration was proclaimed the Magna Carta of healthcare of the 20th century.

With the acquisition of sovereignty and the formation of market relations, public health care in Kazakhstan has undergone a number of fundamental changes. The modern period can be defined as a stage of accelerated modernization of the healthcare system, including the transition to modern principles and standards in the organization of the healthcare sector.

One of the most important tasks of public health is to identify the nature of the complex influence of factors environment(natural and social) on population health, searching for patterns and trends in the formation of population health, taking into account socio-economic conditions.

The formation of public health is determined by the complex influence of factors that can be combined into the following main groups:

- political(state social politics, health care policy, government regulation of the health care system, legal acts in the field of health care, etc.);

- socio-economic(GDP per capita, financing of the healthcare system, working and living conditions, nutrition, organization of the healthcare system, lifestyle, etc.);

- natural-climatic, environmental(condition and pollution of the environment);

- biological(gender, age, heredity, nationality, constitution, type nervous system and etc.).

In the 20th century, the social conditioning of health was recognized, which is enshrined in the Charter of the World Health Organization. This definition of health overcomes the limitations of approaches that contrast social and biological components human organization.

The ratio of social and biological factors in relation to various diseases is not the same, but still the leading role is given to the social component: conditions and factors.

Social conditions – this is a form of manifestation of production relations, a method of social production, a socio-economic system and the political structure of society.

Social factors – this is a manifestation of social conditions for a particular person: working and rest conditions, housing, food, education, upbringing, etc.

Among the most significant achievements of public health, first of all, medical, social and epidemiological studies should be noted, based on the results of which groups of factors (risk factors) and their contribution to the health of the population were established:

conditions and lifestyle– 49-53%, on average 50% of the total influence (smoking, alcohol abuse, unbalanced diet, stressful situations (distress), harmful working conditions, physical inactivity, poor material and living conditions, drug use, medication abuse, family fragility, loneliness, low cultural and educational level, urbanization, etc.);

- genetic factors– 18-22%, on average 20% (predisposition to hereditary diseases

- environment– 17-20%, on average 20% (climate, pollution harmful substances air, water, soil; increased heliocosmic, radiation, magnetic and other radiation);

- healthcare– 8-10%, on average 10% (ineffectiveness of preventive measures, low quality of medical care, untimely medical care).

The results of the largest ever WHO research project(2002) identified 10 leading risk factors that determine levels of morbidity and mortality in populations at the global level: malnutrition; smoking; arterial hypertension; unsatisfactory state of water supply, sanitation, as well as personal and household hygiene; physical inactivity; occupational hazards; unsafe sex; alcohol abuse; air pollution.

Thus, the leading role of social factors in the formation of public health is mediated through conditions and lifestyle.

Modern researchers in the scientific knowledge of the problems of health formation are not limited to the medical and social framework and are increasingly considering lifestyle from a broad social perspective, using philosophical and sociological interpretations:

Lifestyle– forms of individual and group life activity, typical for historically specific social relations; or concept characterizing features Everyday life people determined by a given socio-economic formation.

In general, lifestyle summarizes four categories:

- standard of living– an economic category that characterizes the degree of satisfaction of the material and cultural needs of people and can be expressed quantitatively (size of the gross national product, real income of the population, availability and provision of medical care, length of the working day, etc.);

- the quality of life– a sociological category that characterizes the qualitative side of satisfying the material and cultural needs of people through comparison with the level or standard of living (satisfaction with work, quality of food, medical care, etc.);

- life style– a socio-psychological category that characterizes a certain type of behavior of an individual or group of people, which captures consistently reproducible traits, manners, habits, tastes, and inclinations;

- way of life - a socio-economic category that characterizes the system of industrial relations in a socio-political formation.

Despite significant differences in conceptual approaches to assessment and lifestyle criteria, the role of social factors in shaping population health is recognized throughout international health care.

There are social groups whose lifestyle is most predisposed to various diseases, the so-called risk groups:

- demographic: children, old people, single people, widows, widowers, migrants, refugees, displaced persons;

- professional risk: working in hazardous production conditions (heavy engineering, chemical, metallurgical industries, transport, etc.);

- functional, pathological state: pregnant women; premature babies born with low birth weight; persons with genetic risk, with congenital anomalies, defects; disabled children;

- low material standard of living, poverty, misery: the poor, the underprivileged, the unemployed, the underemployed, the “homeless.”

- persons with deviant behavior, the presence of psychopathic, socio-psychological and other conflicts: alcoholics, drug addicts, substance abusers, prostitutes, persons with sexual perversions, persons with mental health and behavioral deformations (neuropathy, psychopathy, etc.), religious and other sectarians with mental and physical disabilities.

Among all diseases, a special place is occupied by socially significant diseases, the list of which is established by the government in order to take additional or preferential measures of medical and social support: oncological and oncohematological diseases, diabetes, rheumatism, systemic lupus erythematosus, cerebral palsy, mental illness, myocardial infarction and etc.

Recognition of the social determination of health justifies the need to consider health problems from a broad social perspective, as well as the fact that ensuring health goes beyond the competence and responsibility of purely health authorities and organizations. Preserving and promoting health is the joint responsibility of the state, employer and citizen, which is implemented through intersectoral cooperation with the active participation of the population itself.

Illustrative material: 20 slides in Row Point software.

Literature:

1.Akanov A.A., Devyatko V.N., Kulzhanov M.K. Public health in Kazakhstan: concept, problems and prospects. – Almaty, 2001. – 100 p.

2. Kamaliev M.A., Bigalieva R.K., Khabieva T.Kh. Story traditional medicine and public health of Kazakhstan. – Almaty, 2004. – 173 p.

3. Lisitsyn Yu.P. Public health and healthcare: Textbook. – 2nd ed., revised. and additional – GEOTAR-Media, 2007. – 512 p.

4. Tulchinsky T.K., Varavikova E.A. The New Public Health: An Introduction to modern science. – Jerusalem, 1999. – 1049 p.

5. Yuryev V.K., Kutsenko G.I. Public health and healthcare. – St. Petersburg, 2000. – 914 p.

Control questions:

1.Define public health and healthcare

2.List the components of health.

3.Indicate your health levels.

4.Name the main sections of the discipline.

5.List the main methods of discipline.

6.What factors influence public health?

7.What contribution do risk factors make to health?

8.What is the social conditioning of health?

9. Define lifestyle and its categories.

10.List the social groups at risk of diseases.

Public health and healthcare as an integrative science. Main sections, tasks, importance in the doctor training system.

The founders of domestic social medicine defined social medicine as the science of public health and healthcare. Its main task is to study the influence of medical and social factors, conditions and lifestyle on the health of various population groups, to develop scientifically based recommendations for the prevention and elimination of unfavorable social conditions and factors, as well as health measures to improve the level of public health. The main purpose of social medicine and health care management as a science and academic discipline is to evaluate the criteria of public health and the quality of medical care and their optimization.

Subject structure: 1) history of health care; 2) theoretical problems of health care; 3) health status and methods of studying it; 4) organization of medical and social security and health insurance; 5) organization of medical care to the population; 6) ensuring the sanitary and epidemiological well-being of the population; 7) economic and planning-organizational forms of improving healthcare, management, marketing and modeling of medical services; 8) international cooperation in the field of medicine and healthcare.

Methods of medical and social research: 1) historical; 2) dynamic observation and description; 3) sanitary-statistical; 4) medical and sociological analysis; 5) expert assessments; 6) system analysis and modeling; 7) organizational experiment; 8) planning and normative, etc.

Social medicine is the science of health care strategy and tactics. The objects of medical and social research are: 1) groups of people, the population of the administrative territory; 2) individual institutions (clinics, hospitals, diagnostic centers, specialized services); 3) health authorities; 4) environmental objects; 5) general and specific risk factors for various diseases, etc.

Definition of the subject of public health and healthcare (V.O. Portugalov, F.F. Erisman, N.A. Semashko, N.A. Vinogradov, V.P. Kaznacheev, Yu.P. Lisitsyn).

In 1902 F.F. Erisman wrote: “there is no doubt that all the main factors of economic life strongly influence the state of public health and that often in these conditions lies the key to explaining the excessive morbidity and mortality of the population.” This statement has not lost its meaning even today. Experts from international organizations have repeatedly pointed out this fact. Thus, at the 52nd session of the World Health Organization, it was again emphasized that “all major determinants of health are related to socio-economic factors... The relationship between health status and employment, income level, social protection, housing conditions and education is clearly visible in all European states".

So, taking into account the biosocial essence of man, Yu.P. Lisitsyn (1973) considers human health as a harmonious unity of biological and social qualities determined by congenital and acquired mechanisms.

V.P. Kaznacheev (1974) defines human health as the process of maintaining and developing his biological, physiological and psychological capabilities, optimal social activity with maximum life expectancy. At the same time, attention is drawn to the need to create such conditions and such hygienic systems that would ensure not only the preservation of human health, but also its development.

Basic methods of the subject public health and healthcare.

Methodology – a sequence of techniques for collecting data about the phenomena being studied.

Methodology is a set of techniques, methods, approaches to assessing the phenomena being studied.

c) theoretical justification of state policy in the field of health protection and development of organizational principles of health care in the state.

d) development and practical implementation of organizational forms and methods of work of medical organizations and doctors of various specialties

e) preparation and education medical workers, as community doctors, doctors-organizers, organizing work in their specialty.

Object of health care research: society as a whole, a social group, a team, as well as the health care system that serves them.

Subject of OZZ:

1) the health of the population as a whole, teams, social groups, depending on the influence of the social environment

2) a set of measures aimed at strengthening it: forms, methods, results of the work of the organization.

Basic methods of SG research:

1) historical - it is necessary to know the past in order to understand the present and foresee the future

2) statistical (sanitary-statistical) - allows a) to quantitatively measure indicators of public health and the activities of medical institutions; b) identify the influence of environmental factors on health; c) determine the effectiveness of therapeutic and recreational measures; e) assess the dynamics of AO indicators and predict them; identify the necessary data for the development of new healthcare standards.

3) methods of experiment and modeling - research and development of the most rational organizational forms of work

4) method of economic research - makes it possible to establish the influence of the economy on the environmental protection and vice versa

5) method of expert assessments

6) method of sociological research - identifying the population’s attitude towards their health, the influence of working and living conditions on health

7) system analysis method

8) epidemiological method

9) medical-geographical

Health Study Levels:

a) individual

b) group

c) regional

d) public

The main stages in the development of the subject of public health and healthcare. History, foreign and domestic scientists. Sections of the subject public health and healthcare as.

academic discipline

Stages of healthcare development

The development of healthcare in the Republic of Kazakhstan is historically connected with the development of medicine in Russia from the moment of annexation in 1731 and in subsequent years until the end of the 19th century. And then there is the history of Soviet Kazakhstan and sovereign Kazakhstan since 1991 Preparation medical personnel

was carried out in medical-surgical schools (since 1786), and since 1798 - in the St. Petersburg and Moscow medical-surgical academies. In 1755, the first Moscow University in Russia with a medical faculty was created. An outstanding contribution to health care was made by M. V. Lomonosov, who in his work “The Word on the Reproduction and Preservation of the Russian People” gave an in-depth analysis of health care and proposed a number of specific measures to improve its organization. In the first half of the 19th century. The first scientific medical schools are formed: anatomical (P. A. Zagorsky), surgical (I. F. Bush, E. O. Mukhin, I. V. Buyalsky), therapeutic (M. Ya. Mudrov, I. E. Dyadkovsky) . N. I. Pirogov \

The first sanitary doctors I. I. Molleson, I. A. Dmitriev, G. I. Arkhangelsky, E. A. Osipov, N. I. Tezyakov, Z. G. Frenkel and others did a lot for the development of zemstvo and city sanitary organizations. I. I. Molleson, the first sanitary doctor in Russia, created the first medical and sanitary council - a collegial body designed to manage zemstvo medicine. He proposed a project for organizing medical stations in rural areas, the position of a district sanitary doctor to study the sanitary condition of the population, working and living conditions, the causes of diseases and the fight against them. Organizer and leader of more than 20 provincial congresses of zemstvo doctors. I. I. Molleson emphasized: “Social medicine as a branch of knowledge and activity is broad and covers ... all activities that can improve the living conditions of the masses of the population.” E. A. Osipov is one of the founders of zemstvo medicine and sanitary statistics. For the first time in Russia, he introduced card registration of diseases. Created the zemstvo Moscow provincial sanitary organization (1884). He developed the principle of operation of a medical district with a hospital-hospital, the functions of a rural doctor, as well as a program for sanitary inspection of the province. N. A. Semashko - theorist and health care organizer, first people's commissar health care (1918-1930). Under his leadership, the principles of healthcare were developed - state character, preventive orientation, free and generally accessible qualified medical care, unity of science and practice, broad public participation in solving health issues. N. A. Semashko created new science- social hygiene and became the first head of the department of social hygiene (1922). He created new types of healthcare - maternal and infant health care, sanatorium and resort business. With his active participation, the State Scientific Institute of Public Health named after. L. Pasteur, the system of higher medical education was rebuilt, institutes of physical culture were organized in Moscow and Leningrad. Z. P. Solovyov - theorist and organizer of civil and military health care, deputy people's commissar of health care, head of the Main Military Sanitary Directorate. In 1923 he organized the Department of Social Hygiene at the 2nd Moscow Medical Institute. Contributed huge contribution in the development of preventive health care, in the reform of medical education. Z. G. Frenkel is one of the founders of social hygiene in the country. Organizer and head of the department of social hygiene of the 2nd Leningrad Medical Institute (1923-1949), a major specialist in municipal hygiene, demography and gerontology, head of the Hygienic Society of Leningrad for 27 years. The period of the Great Patriotic War and the post-war years are associated with the development of military medicine, the restoration of the material base of healthcare and the active training of medical personnel. Since 1961, a number of legislative acts and resolutions of the Union Government have been adopted aimed at developing the healthcare system. The protection of public health has been declared the most important social task. The material base of health care is being strengthened, medical care is being specialized, and the primary health care system is being improved. In 1978, a WHO conference was held in Almaty on the organization of primary health care for the population, at which there were 146 participating countries. The Magna Carta developed at this conference formed the basis of new thinking about the health of nations and divided the history of healthcare organization into before and after Alma-Ata. The greatest merit in organizing and holding the conference, and in the development of healthcare in the Republic of Kazakhstan belongs to the first academician of medicine of Kazakhstan T.Sh. Sharmanov. Laureate of international prizes and awards, founder and director of the National Research Institute of Nutrition T.Sh. Sharmanov continues to produce new medical knowledge and technologies today.

System of legislation on health protection in Russian Federation.

The legislation of the Russian Federation on the protection of the health of citizens consists of the relevant provisions of the Constitution of the Russian Federation and the Constitutions (statutes) of the constituent entities of the Russian Federation, these Fundamentals, other federal laws and federal regulatory legal acts, laws and other regulatory legal acts of the constituent entities of the Russian Federation.

These Fundamentals regulate the relations of citizens, state authorities and local governments, business entities, subjects of state, municipal and private healthcare systems in the field of protecting the health of citizens.

The laws of the constituent entities of the Russian Federation, regulatory legal acts of local government bodies should not limit the rights of citizens in the field of health care established by these Fundamentals.

Protecting the health of citizens is a set of political, economic, legal, social, cultural, scientific, medical, sanitary and hygienic and anti-epidemic measures aimed at preserving and strengthening the physical and mental health of each person, maintaining his long active life, providing him with medical care in case of loss of health.

Citizens of the Russian Federation are guaranteed the right to health care in accordance with the Constitution of the Russian Federation, generally accepted principles and international norms and international treaties of the Russian Federation, the Constitutions (charters) of the constituent entities of the Russian Federation.

Article 2. Basic principles of protecting the health of citizens

The basic principles of protecting the health of citizens are:

1) respect for human and civil rights in the field of health protection and provision of state guarantees related to these rights;

2) the priority of preventive measures in the field of protecting the health of citizens;

3) availability of medical and social assistance;

4) social protection of citizens in case of loss of health;

5) responsibility of state authorities and local governments, enterprises, institutions and organizations, regardless of the form of ownership, and officials for ensuring the rights of citizens in the field of health protection.

Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (2011), main provisions.

This Federal Law regulates relations arising in the field of protecting the health of citizens in the Russian Federation (hereinafter - in the field of health care), and determines:

1) legal, organizational and economic foundations for protecting the health of citizens;

2) the rights and obligations of a person and a citizen, certain groups of the population in the field of health care, guarantees of the implementation of these rights;

3) powers and responsibilities of state authorities of the Russian Federation, state authorities of constituent entities of the Russian Federation and local governments in the field of health protection;

4) rights and obligations of medical organizations, other organizations, individual entrepreneurs when carrying out activities in the field of health protection;

5) rights and obligations of medical workers and pharmaceutical workers.

See comments to Article 1 of this Federal Law

Article 2. Basic concepts used in this Federal Law

1) health - a state of physical, mental and social well-being of a person, in which there are no diseases, as well as disorders of the functions of organs and systems of the body;

2) protection of the health of citizens (hereinafter referred to as health protection) - a system of measures of a political, economic, legal, social, scientific, medical, including sanitary and anti-epidemic (preventive) nature, carried out by government bodies of the Russian Federation, government bodies of the constituent entities of the Russian Federation Federation, local government bodies, organizations, their officials and other persons, citizens in order to prevent diseases, preserve and strengthen the physical and mental health of each person, maintain his long active life, provide him with medical care;

3) medical care –

4) medical service –

5) medical intervention –

6) prevention - a set of measures aimed at preserving and strengthening health and including the formation of a healthy lifestyle, prevention of the occurrence and (or) spread of diseases, their early detection, identification of the causes and conditions of their occurrence and development, as well as aimed at eliminating harmful influence of environmental factors on human health;

7) diagnostics –

8) treatment –

9) patient –

10) medical activities –

11) medical organization –;

12) pharmaceutical organization –

13) medical worker –

14) pharmaceutical worker –

15) attending physician - a doctor who is entrusted with the functions of organizing and directly providing medical care to a patient during the period of observation and treatment;

16) disease –

17) condition –

18) underlying disease –

19) concomitant disease –

20) severity of the disease or condition –

21) quality of medical care -

Article 3. Legislation in the field of health protection

1. Legislation in the field of health protection is based on the Constitution of the Russian Federation and consists of this Federal Law and other federal laws adopted in accordance with it

2. Health protection standards contained in other federal laws and other regulatory legal acts of the Russian Federation

3. In case of inconsistency between the norms on health protection contained in other federal laws, other normative legal acts of the Russian Federation, laws and other normative legal acts of the constituent entities of the Russian Federation, and the norms of this Federal Law, the norms of this Federal Law are applied.

4. Local government bodies, within their competence, have the right to issue municipal legal acts containing health protection standards in accordance with this Federal law, other federal laws, other regulatory legal acts of the Russian Federation, laws and other regulatory legal acts of the constituent entities of the Russian Federation.

5. If an international treaty of the Russian Federation establishes rules other than those provided for by this Federal Law in the field of health care, the rules of the international treaty apply.

Principles of health protection in the Russian Federation. The main ways to organize health care.

Basic principles of healthcare in the Russian Federation:

1) Responsibility of society and the state for the protection and promotion of public health, the creation of a public system that integrates the activities of institutions and organizations of all forms of ownership, all forms and structures, guaranteeing the protection and promotion of public health.

2) Provision by the state and society of all citizens of accessible, qualified medical care, free of charge for its main types.

3) Preservation and development of social and preventive areas of protection and strengthening of healthcare based on sanitary and hygienic, anti-epidemic, public and individual measures, the formation healthy image life, protection and reproduction of health of healthy people – sanology (valeology).

4) Personal responsibility for your health and the health of others.

5) Integration of health protection in a set of measures for protection, environmental protection, environmental policy, demographic policy, resource-saving, resource conservation policy.

6) Preservation and development of planning in accordance with the goals and objectives of the development of society and the state, health care strategy as a branch of the state and the function of society based on an interdisciplinary approach.

7) Integration of science and healthcare practice. Use of scientific achievements in healthcare practice.

8) Development of amateur medical activities - participation of the population in health care.

9) Protecting and improving health as an international task, a global problem, a sphere of international cooperation.

10) Humanism of the medical profession, compliance with the norms and rules of medical ethics and medical deontology.

Federal Law “On Compulsory Health Insurance in the Russian Federation” (2010), main provisions.

Article 1. Subject of regulation of this Federal Law

This Federal Law regulates relations arising in connection with the implementation of compulsory health insurance, including determining legal status subjects of compulsory health insurance and participants of compulsory health insurance, the grounds for the emergence of their rights and obligations, guarantees of their implementation, relations and responsibilities associated with the payment of insurance premiums for compulsory health insurance of the non-working population.

Article 2. Legal basis of compulsory health insurance

1. The legislation on compulsory health insurance is based on the Constitution of the Russian Federation and consists of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, Federal Law of July 16, 1999 No. 165-FZ “On the Fundamentals of Compulsory Social Insurance”, this Federal Law, other federal laws, laws subjects of the Russian Federation. Relations related to compulsory medical insurance are also regulated by other regulatory legal acts of the Russian Federation and other regulatory legal acts of the constituent entities of the Russian Federation.

2. If an international treaty of the Russian Federation establishes rules other than those provided for by this Federal Law, the rules of the international treaty of the Russian Federation apply.

3. For the purpose of uniform application of this Federal Law, if necessary, appropriate clarifications may be issued in the manner established by the Government of the Russian Federation.

Article 3. Basic concepts used in this Federal Law

For the purposes of this Federal Law, the following basic concepts are used:

1) compulsory health insurance - a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, upon the occurrence of an insured event, guarantees of free medical care to the insured person at the expense of compulsory health insurance funds within the territorial compulsory health insurance program and in the cases established by this Federal Law within the framework of the basic compulsory health insurance program;

2) object of compulsory health insurance

3) insurance risk

4) insured event

5) insurance coverage for compulsory medical insurance

6) insurance premiums for compulsory medical insurance - mandatory payments that are paid by policyholders, are impersonal in nature and the purpose of which is to ensure the rights of the insured person to receive insurance coverage;

7) the insured person

8) basic compulsory health insurance program

9) territorial compulsory health insurance program - an integral part of the territorial program of state guarantees of free medical care to citizens, which determines the rights of insured persons to free medical care on the territory of a constituent entity of the Russian Federation and meets the uniform requirements of the basic compulsory health insurance program.

Article 4. Basic principles of compulsory health insurance

The basic principles of compulsory health insurance are:

1) ensuring, at the expense of compulsory health insurance funds, guarantees of free provision of medical care to the insured person upon the occurrence of an insured event within the framework of the territorial compulsory health insurance program and the basic compulsory health insurance program (hereinafter also referred to as the compulsory health insurance program);

2) the stability of the financial system of compulsory medical insurance, ensured on the basis of the equivalence of insurance coverage with compulsory medical insurance;

3) mandatory payment by policyholders of insurance premiums for compulsory medical insurance in the amounts established by federal laws;

4) state guarantee of observance of the rights of insured persons to fulfill obligations under compulsory health insurance within the framework of the basic compulsory health insurance program, regardless of the financial situation of the insurer;

5) creating conditions to ensure accessibility and quality of medical care provided within the framework of compulsory health insurance programs;

6) parity of representation of subjects of compulsory health insurance and participants of compulsory health insurance in the governing bodies of compulsory health insurance.

National project "Health". Key priorities.

The National Project “Health” is a program to improve the quality of medical care, announced by the President of the Russian Federation V.V. Putin, launched on January 1, 2006 as part of the implementation of four national projects.

Project goals[edit | edit wiki text]

Strengthening the health of citizens

Increasing accessibility and quality of medical care

Development of primary health care

Revival of preventive health care

Providing the population with high-tech medical care

(Brief history of development)

As is known, most disciplines and subspecialties in medicine study various diseases, their symptoms and syndromes, various clinical manifestations of the course of diseases, their complications, methods of diagnosis and treatment of diseases and the probable outcomes of the disease in the case of using modern methods of complex treatment known today. It is extremely rare that the basic methods of disease prevention and rehabilitation of people who have suffered from one or another disease, sometimes severe, with complications and even resulting in disability, are described.

The term “recreation” is even less commonly used in medical literature, i.e. a set of preventive, therapeutic and health measures aimed at preserving the health of healthy people. People's health, its criteria, ways to preserve and strengthen it in the difficult socio-economic conditions of our lives have almost completely fallen out of the sphere of interests of modern medicine and healthcare in Russia. In this regard, before talking about public health, it is necessary to define the term “health”, identify the levels of its study in medical and social research and determine the place of public health in this hierarchy.

So, the World Health Organization (WHO) formulated back in 1948 that “health is a state of complete physical, spiritual and social well-being, and not merely the absence of disease or infirmity.” WHO has proclaimed the principle that “the enjoyment of the highest attainable standard of health is a fundamental right of every person.” It is customary to distinguish 4 levels of health study:

Level 1 - health an individual person.

Level 2 - health of small or ethnic groups - group health.

3rd level - population health, those. people living in a specific administrative-territorial unit (region, city, district, etc.).

4th level - public health- the health of society, the population of the country, the continent, the world, and the population as a whole.

Public health and healthcare as an independent medical science studies the impact of social factors and environmental conditions on the health of the population in order to develop preventive measures to improve the health of the population and improve their medical care. Public health and healthcare studies a wide range of different medical aspects, sociological, economic, managerial, and philosophical problems in the field of public health in a specific historical setting.

Taking into account the order of the Ministry of Health of the Russian Federation No. 83 of 03/01/2000 “On improving the teaching of public health and healthcare issues in medical and pharmaceutical universities,” as well as as a result of the work carried out on the initiative of the MMA named after. I.M. Sechenov and with the support of the Ministry of Health of the Russian Federation a seminar of heads of departments of organizational profile medical universities Russia " Modern approaches, forms and methods of teaching “Public Health and Healthcare” (Moscow, 2000), the following definition of the concept of “public health” was developed, approved by the majority of seminar participants: “Public health is the most important economic and social potential of the country, determined by the impact various factors environment and lifestyle of the population, allowing to ensure an optimal level of quality and safety of life.”

Unlike various clinical disciplines, public health studies the health status not of individual individuals, but of groups, social groups and society as a whole in connection with conditions and lifestyle. At the same time, living conditions and production relations, as a rule, are decisive for the state of people’s health, so scientific and technological progress, socio-economic revolutions and evolutionary periods, the cultural revolution bring the greatest benefits to society, but at the same time they can have a negative impact on its health. Greatest discoveries modernity in the field of physics, chemistry, biology, urbanization of the population in the 20th century, rapid development of industry in many countries, large volumes of construction, chemicalization of agriculture, etc. often lead to significant violations in the field of ecology, which has a detrimental effect, first of all, on health population, causes certain diseases, which sometimes become epidemiological in nature.

Antagonistic contradictions between scientific and technological progress and the state of public health in our country arise due to the state’s underestimation of preventive measures. Consequently, one of the tasks of our science is to reveal such contradictions and develop recommendations for the prevention of negative phenomena and factors that negatively affect the health of society.

For the planned development of the national economy, information on the population size and the determination of its forecasts for the future are of great importance.

Public health identifies patterns of population development, studying demographic processes, predicts the future, and develops recommendations for state regulation of population size.

Thus, public health is characterized by the simultaneous, complex impact of social, behavioral, biological, geophysical and many other factors. Many of these factors can be identified as risk factors. What are disease risk factors?

Risk factors- potentially hazardous to health factors of a behavioral, biological, genetic, environmental, social nature, environmental and industrial environment, increasing the likelihood of developing diseases, their progression and unfavorable outcome.

Unlike the direct causes of diseases (bacteria, viruses, deficiency or excess of any microelements, etc.), risk factors act indirectly, creating an unfavorable background for the occurrence and further development of diseases.

When studying public health, the factors that determine it are usually combined into the following groups:

1. Socio-economic factors(working conditions, living conditions, material well-being, level and quality of nutrition, rest, etc.)

2. Socio-biological factors(age, gender, predisposition to hereditary diseases, etc.).

3. Environmental and climatic factors(habitat pollution, average annual temperature, the presence of extreme natural and climatic factors, etc.).

4. Organizational or medical factors(provision of the population with medical care, quality of medical care, availability of medical and social care, etc.).

Academician of the Russian Academy of Medical Sciences Yu.P. Lisitsyn gives the following grouping and levels of influence of risk factors that determine health (Table 1.1).

Table 1.1Grouping of health-related risk factors

(Brief history of development)

As is known, most disciplines and subspecialties in medicine study various diseases, their symptoms and syndromes, various clinical manifestations of the course of diseases, their complications, methods of diagnosis and treatment of diseases and the probable outcomes of the disease in the case of using modern methods of complex treatment known today. It is extremely rare to describe the basic methods of disease prevention and rehabilitation of people who have suffered from one or another disease, sometimes severe, with complications and even resulting in disability for sick people.

So, the World Health Organization (WHO) formulated back in 1948 that “health is a state of complete physical, spiritual and social well-being, and not merely the absence of disease and physical defects.” WHO proclaimed the principle that “the enjoyment of the highest attainable standard of health is a fundamental right of every person.” It is customary to distinguish 4 levels of health study:

Level 1 - individual health.

Level 2 - health of small or ethnic groups - group health.

Level 3 - public health, i.e. people living in a specific administrative-territorial unit (region, city, district, etc.).

Level 4 - public health - the health of society, the population of the country, continent, world, population as a whole.

Taking into account the order of the Ministry of Health of the Russian Federation No. 83 of 03/01/2000 “On improving the teaching of public health and healthcare issues in medical and pharmaceutical universities,” as well as as a result of the work carried out on the initiative of the MMA named after. I.M. Sechenov and with the support of the Ministry of Health of the Russian Federation of the seminar of heads of departments of organizational profile of medical universities in Russia “Modern approaches, forms and methods of teaching “Public health and healthcare” (Moscow, 2000) the following definition of the concept of “public health” was developed, approved by the majority of the seminar participants: “Public health is the most important economic and social potential of the country, determined by the influence of various environmental factors and the lifestyle of the population, allowing to ensure an optimal level of quality and safety of life.”

Unlike various clinical disciplines, public health studies the health status not of individual individuals, but of groups, social groups and society as a whole in connection with conditions and lifestyle. At the same time, living conditions and production relations, as a rule, are decisive for the state of people’s health, since scientific and technological progress, socio-economic revolutions and evolutionary periods, the cultural revolution bring the greatest benefits to society, but at the same time they can have a negative impact on its health. The greatest discoveries of our time in the field of physics, chemistry, biology, urbanization of the population in the 20th century, rapid development of industry in many countries, large volumes of construction, chemicalization of agriculture, etc. often lead to significant violations in the field of ecology, which has a detrimental effect, first of all, on the health of the population, causes certain diseases, which sometimes become epidemiological in nature.

For the planned development of the national economy, information on the population size and the determination of its forecasts for the future are of great importance.

Public health identifies patterns of population development, studying demographic processes, predicts the future, and develops recommendations for state regulation of population size.

Risk factors are potentially hazardous to health factors of a behavioral, biological, genetic, environmental, social, environmental and work environment that increase the likelihood of developing diseases, their progression and unfavorable outcome.

When studying public health, the factors that determine it are usually combined into the following groups:

1. Socio-economic factors (working conditions, living conditions, material well-being, level and quality of nutrition, rest, etc.)

2. Socio-biological factors (age, gender, predisposition to hereditary diseases, etc.).

3. Environmental and natural-climatic factors (pollution of the environment, average annual temperature, the presence of extreme natural-climatic factors, etc.).

4. Organizational or medical factors (provision of the population with medical care, quality of medical care, availability of medical and social care, etc.).

Academician of the Russian Academy of Medical Sciences Yu.P. Lisitsyn gives the following grouping and levels of influence of risk factors that determine health (Table 1.1).

At the same time, the division of factors into certain groups is very arbitrary, since the population is exposed to the complex influence of many factors, in addition, factors influencing health interact with each other, change in time and space, which must be taken into account when carrying out complex medical and social research.
Table 1.1 Grouping of health-related risk factors*
Sphere of influence of factors on health Groups of risk factors Share (in%) of risk factors
Lifestyle Smoking, drinking alcohol, unbalanced diet Stressful situations (distress) Harmful working conditions Physical inactivity Poor material and living conditions Drug consumption, medication abuse Fragility of families, loneliness Low cultural and educational level High level of urbanization 49-53
Genetics, human biology Predisposition to hereditary diseases Predisposition to so-called degenerative diseases (hereditary predisposition to diseases) 18-22
External environment Pollution with carcinogens and other harmful substances in the air " Pollution with carcinogens and other harmful substances in water Soil pollution Sudden changes in atmospheric phenomena Increased heliocosmic, radiation, magnetic and other radiation 17-20
Healthcare Ineffectiveness of preventive measures Low quality of medical care Lack of timeliness of medical care 8-10
* Social hygiene (medicine) and healthcare organization: Educational manual / Ed. Yu.P. Lisitsina. - Kazan, 1998. - P. 52.

The second part of the science of public health and healthcare includes the development of science-based, most optimal methods of healthcare management, new forms and methods of operation of various medical institutions, ways to improve the quality of medical care, and substantiates optimal solutions to economic and managerial problems in healthcare.

The rapid growth of medical science has armed doctors with new, modern methods diagnostics of complex diseases, effective means of treatment. All this simultaneously requires the development of new organizational forms and conditions for the activities of doctors, health care facilities, and sometimes the creation of completely new, previously non-existent medical institutions. There is a need to change the management system of medical institutions and the placement of medical personnel; There is a need to revise the regulatory framework for healthcare, expand the independence of heads of medical institutions and the rights of doctors.

As a consequence of all of the above, conditions are being created for reviewing options for a more optimal solution. economic problems healthcare, introducing elements of intradepartmental economic accounting, economic incentives for quality work of medical personnel, etc.

These problems determine the place and importance of science in the further improvement of domestic healthcare.

The unity of theory and practice of domestic healthcare is expressed in the unity of theoretical and practical problems, methodological techniques domestic public health and healthcare.

Thus, of leading importance in science is the question of studying the effectiveness of the impact on the health of the population of all activities carried out by the state and the role of health care and individual medical institutions in this, both with state and non-state forms of ownership, i.e. the subject reveals the significance of the entire diversity of the country’s socio-economic life and determines ways to improve medical care for the population.

Public health and healthcare have their own methodology and research methods. Such methods are: statistical, historical, economic, experimental, timing research, sociological methods and others.

The statistical method is widely used in most studies: it allows you to objectively determine the level of health of the population, determine the efficiency and quality of work of medical institutions.

The historical method allows the study to trace the state of the problem being studied at different historical stages of the country's development.

The economic method allows us to establish the influence of the economy on health care and health care on the economy of the state, to determine the most optimal ways to use public funds to effectively protect the health of the population. Planning issues financial activities health authorities and medical institutions, the most rational use of funds, assessment of the effectiveness of health care actions to improve the health of the population and the impact of these actions on the country’s economy - all this constitutes the subject economic research in the field of health.

The experimental method includes setting up various experiments to find new, most rational forms and methods of operation of medical institutions and individual health services.

It should be noted that most studies predominantly use a complex methodology using most of these methods. So, if the task is to study the level and state of outpatient care to the population and determine ways to improve it, then the morbidity rate of the population, attendance at outpatient clinics is studied using a statistical method, its level in different periods and its dynamics are historically analyzed. The proposed new forms in the work of polyclinics are analyzed using the experimental method: their economic feasibility and effectiveness are checked.

The study may use timing research methods (chronometry of the work of medical workers, study and analysis of the time spent by patients receiving medical care, etc.).

Often sociological methods (interviewing method, questionnaire method) are widely used, which makes it possible to obtain a generalized opinion of a group of people about the object (process) of study.

The source of information is mainly state reporting documentation of treatment and preventive medical institutions, or for a more in-depth study, the collection of material can be carried out on specially designed cards, questionnaires, which include all the questions to obtain the necessary information, according to the approved research program and tasks that presented to the researcher. A personal computer can also be used for this purpose, when the researcher, using a special program, enters the necessary data into the computer from the primary registration documents.

The vast majority of socio-hygienic studies of group health, population health and public health in previous years dealt with the quantitative assessment of health. True, with the help of indicators, indices and coefficients there is always scientific research tried to assess the quality of health, i.e. tried to characterize health as a parameter of quality of life. The very term “quality of life” in Russian scientific literature began to be used recently, only in the last 10-15 years. This is understandable, because only then can we talk about the “quality of life” of the population when in a country (as has long happened in the developed countries of Europe, America, Japan and some other developed countries) basic material and social benefits are available to the majority of the population.

According to WHO (1999), quality of life is the optimal state and degree of perception by individuals and the population as a whole of how their needs (physical, emotional, social, etc.) are met and opportunities are provided to achieve well-being and self-realization.

In our country, quality of life most often means a category that includes a combination of life support conditions and health conditions that allow one to achieve physical, mental, social well-being and self-realization.

Despite the absence of a globally accepted concept of “quality of health” as the most important component of “quality of life,” attempts are being made to give a comprehensive assessment of public health (quantitative and qualitative).

As a subject of teaching, public health and healthcare primarily contributes to improving the quality of training of future specialists - doctors; developing their skills not only to be able to correctly diagnose and treat a patient, but also the ability to organize high level medical care, the ability to clearly organize their activities.

Social problems of medicine interested outstanding scientists of antiquity - such as Hippocrates, Avicenna, Aristotle, Vesalius and others. In Russia, major contributions to the development of social medicine were made by M.V. Lomonosov, N.I. Pirogov, S.P. Botkin, I.M. Sechenov, T.A. Zakharyin, D.S. Samoilovich, A.P. Dobroslavin, F.F. Erisman.

It was in Russia in the second half of the 19th century, under the influence social movement advanced intelligentsia, representatives of zemstvo and factory medicine, famous medical scientists, as well as under the influence of the growing dissatisfaction of the majority of the country's population with the level of medical and social care, in the conditions of the approaching series of revolutions and wars of the early 20th century and other factors, the foundations of science and academic discipline about public health and healthcare. Thus, at Kazan University in the 60s of the 19th century, Professor A.V. Petrov lectured students on public health and social hygiene. At the end of the 19th century, the medical faculties of many Russian universities (St. Petersburg, Moscow, Kyiv, Kharkov, etc.) taught courses in public hygiene, as well as courses in medical geography and medical statistics. However, these courses were sporadic and were often part of other disciplines. Only in 1920 in Germany, at the University of Berlin, the world's first department of social hygiene was established. This department was headed by its founder, the German scientist social hygienist Professor Alfred Grotjan. Thus began the history of the independent subject and science of social hygiene. Following the department of A. Grotjahn, similar departments began to be organized at other universities in Germany and other European countries. Their leaders (A. Fischer, S. Neumann, F. Prinzing, E. Resle, etc.) directed the research work of the departments to develop current problems public health and medical statistics.

The formation and flourishing of social hygiene (as the science was called in Russia until 1941) during the period of Soviet power are associated with the names of major figures in Soviet health care N.A. Semashko and Z.P. Solovyov. On their initiative, departments of social hygiene began to be created in medical institutes.

The first such department was created by N.A. Semashko in 1922 at the Faculty of Medicine of the First Moscow State University. In 1923, under the leadership of Z.P. Solovyov, a department was created at the II Moscow State University and under the leadership of Professor A.F. Nikitin - at the I Leningrad State University medical institute. Until 1929, such departments were organized in all medical institutes.

In 1923 it was opened State Institute social hygiene of the People's Commissariat of Health of the RSFSR, which became the scientific and organizational base for all departments of social hygiene and healthcare organization. Scientific social hygienists conduct important research on the study of sanitary and demographic processes in Russia in the first half of the 20th century (A.M. Merkov, S.A. Tomilin, P.M. Kozlov, S.A. Novoselsky, L.S. Kaminsky, etc.), new methods for studying population health are being developed (P.A. Kuvshinnikov, G.A. Batkis, etc.). In the 30s, G.A. Batkis published a textbook for the departments of social hygiene of all medical institutes.

During the Great Patriotic War, the departments of social hygiene were renamed the departments of “health care organization”. All the attention of the departments during these years was focused on issues of medical and sanitary support at the front and the organization of medical care in the rear, and the prevention of outbreaks of infectious diseases. In the post-war years, the work of departments to strengthen connections with practical healthcare was intensified. Against the backdrop of increasing development of theoretical problems of health care, sociological and demographic research, research in the field of health care organization is expanding and deepening, aimed at developing scientifically based health care planning, studying the population's needs for various types of medical care; Comprehensive research is being widely developed to study the causes of the prevalence of various non-communicable diseases, in particular cardiovascular pathology, malignant neoplasms, injuries, etc.

A great contribution to the development of science and teaching in the second half of the 20th century in Russia was made by: Z.G. Frenkel, B.Ya. Smulevich, S.V. Kurashov, N.A. Vinogradov, A.F. Serenko, S.Ya. Freidlin, Yu.A. Dobrovolsky, Yu.PLisitsin, O.P. Shchepin and others.

In 2000, the departments were renamed into departments of public health and healthcare.

On modern stage development of domestic healthcare with the introduction of new economic mechanisms for managing and financing healthcare, new legal relationships in the healthcare system, and the transition to health insurance, the future doctor is required to acquire a significant amount of theoretical knowledge and practical organizational skills. Every doctor must be a good organizer of his business, be able to clearly organize the work of the medical personnel subordinate to him, and know medical and labor legislation; master the elements of economics and management. An important role in fulfilling this task belongs to the departments of public health and healthcare, which represent both science and the subject of teaching in the higher medical school system.