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Policy Priorities in the Health Protection Sector of a Northern Region

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Policy Priorities in the Health Protection Sector of a Northern Region SOCIAL DEVELOPMENT UDC 614(470.21) © Toropushina E.E. Policy priorities in the health protection sector of a Northern region The article is devoted to the modernization of the health of a northern region (the example of the Murmansk Oblast) and the promising directions of implementing its own policies in the health protec- tion sector at a regional level. The article gives the analysis of the medical and demographic situation in the Murmansk Oblast, as well as the main priorities of the modern regional policy in the health protection sector. It identifies the priority directions of the policy in this sector, requiring implementa- tion at federal, regional and local levels. Medical and demographic development, health protection, public policy. Ekaterina E. TOROPUSHINA Ph.D. in Economics, Associate Professor, Senior Scientific Associate of G.P. Luzin Institute of Economic Problems of Kola SC RAS [email protected] The level of population health is one of the Medical and demographic situation in the most important aspects of the future develop- North is due to climatic conditions and spe- ment for both country as a whole and each cific features as well that make up the overall region. Numerous external factors influence socio-economic and ecological spheres1. the level of population health: economic, social, All of the northern regions geographically, environmental, institutional, constitutional and economically and politically are distant from genetic characteristics, the effectiveness of the metropolitan areas, therefore all significant health care system. But still now the true role decisions relating to these territories are and nature of the interaction between these fac- made in the centers located in more southern tors is not completely clear [2]. Differences in regions. the level of health observed between countries and regions, between different groups within 1 The level of health is directly influenced by environ- mental conditions. In most northern regions the areas around the country/region, may suggest that most of the concentration of factories, as a rule, are zones of ecological the factors that influence health, including life- emergency with excess of acceptable standards of air, water style, environment, public health effectiveness and soil pollution. In general, in the northern regions over the past 10 years there is an increase in emissions of pollutants into is directly dependent on the overall social, eco- the air from mobile sources in the whole in northern region nomic and political development, i.e. from how by 56.4% (in Russia – 9.6%). The overall ecological status of economic welfare is distributed and used [3]. water bodies is satisfactory, but, for example, in the Murmansk Oblast, the total volume of contaminated waste water the share Low levels of health entail reducing opportuni- of passing through a wastewater treatment plant is 81.5%, and ties for economic growth and competitiveness purified to normative values – only 5.4%. A major problem is of the region’s economy, the growing number disposal of waste oil, solids, and mercury-containing wastes. Some municipal landfills were organized without consideration of social anomalies and social tension. of environmental, sanitary and fire regulations. 76 1 (19) 2012 Economical and social changes: facts, trends, forecast SOCIAL DEVELOPMENT E.E. Toropushina In addition, most regions of the Russian produces the growth and high rates of mortality North are dependent on natural resource from external causes, injuries, poisoning, exports and government subsidies [4]. However, digestive system diseases. There is a trend of a significant role of the North for the country, increased mortality from tuberculosis and neo- the specific features of these territories, caused plasms in most northern regions. In general, by extreme climatic conditions, remoteness the health of the population of the northern from the central regions of the country, single- regions remains low. industry focus, require special government The main health problems of the population attention, constant consideration of the specif- of the Murmansk Oblast are currently the high ics of the northern territories in the develop- level of general morbidity, high mortality rate ment and implementation of policies in the for all classes of determining factors. The community health protection. primary indicator of morbidity is above the Despite some positive trends in recent years, national average (tab. 1). In recent years there medical and demographic situation in the has been a steady increase in cardiovascular northern regions is characterized by a number diseases. In 2009, the total morbidity by coro- of serious problems. Most of the northern nary heart disease in the region increased by regions are characterized by an intensive popu- 3.8% and stroke – 18.1% (in 2009 amounted lation decline, which main source is migration to 5637.8 morbidity cases and 144.8 per 100 decline, and despite the fact that in recent thousand inhabitants, respectively [1]). There years in most northern regions it has decreased is an increase of malignant neoplasm cases – and stabilized, there is still a high outflow of for the last five years the figure rose among the population. With regard to population move- male population by 10.4% among women – by ment, here, unlike in Russia in general, in most 9%. Of a particular concern is the high mortal- regions there is natality. However, this is mainly ity rate of people of working age, particularly due to the increase in crude birth rates, but males (death rate of men of working age is not reduced mortality. The high level of infant approximately 4 times higher than the same of mortality is of particular concern, and in some women), which indicates a low level of health regions – its growth. The main indicator of life of the workforce. quality – expected life interval of the popula- There is the deterioration of social diseases. tion – the average for the northern regions lags One of the most serious problems in this area behind the national average by 2.5 years (only is the prevalence of alcoholism in the region. in the Khantia-Mansia and Nenetsia Autono- Despite the fact that in 2009 the prevalence of mous Okrugs expected life interval is above the alcoholism in the Murmansk Oblast was lower national average) [5]. Of a particular concern is than the average for Russia, the incidence rates the extremely high sickness rate of alcoholism and prevalence of alcohol psychosis are still cases and alcoholic psychosis, which in turn higher than the average Russian index (in 2009, Table 1. Common sickness rate of the population of the Murmansk Oblast (number of cases per 1,000 inhabitants) [1] Sickness cases Sickness Territory 2007 2008 2009 Murmansk Oblast 818.1 816.5 855.0 Primary RF 771.0 721.7 802.5 Murmansk Oblast 1623.5 1631.4 1696.1 Total RF 1544.2 1560.9 1607.2 Economical and social changes: facts, trends, forecast 1 (19) 2012 77 Policy priorities in the health protection sector of a Northern region the prevalence of alcoholic psychosis was 108.1 In the administrative centers of the RF ter- per 100 thousand inhabitants of the Murmansk ritories and municipalities where economic Oblast, at 74.0 for the Russian Federation [6]). activity is carried out by corporations with A similar situation exists on the incidence of social responsibility, infrastructure indicators, drug abuse – indicators are almost twice above such as the level of personnel and infrastructure average in Russia [7]. provision of medical facilities and the effective- Such a medical and demographic situation ness of the health care system, correspond to is largely the result of socio-economic trans- the levels reached in the inhabited regions of formations of the 1990s and in the future, the Russia. Here, for example, the availability of level of health can only deteriorate. And here, medical staff in 2009 was: Naryan-Mar – 46.3 one of the most significant problems is the persons per 10 thousand inhabitants, Norilsk poverty of the population (despite the notable – 48.5 persons, Murmansk – 80.3, Salekhard achievements of recent years in overcoming it, – 119.4, Anadyr – 148.1 [9]. the official poverty rate in the region exceeds For the closed administrative-territorial the national average – 14.7% of the population units (CATU), with yet an acceptable level of versus 13.2% in Russia in 2009 [6]). Poverty is personnel and infrastructure provision of medi- a consequence of the low level of health, and cal facilities, problems of its development are its main factor, regardless of the root cause (the increasing. This is mainly a consequence of the amount of income, socio-economic status, municipal reform led to a significant narrowing living conditions, and education level) [8]. of the tax base of a closed administrative-terri- Poverty determines a shorter life expectancy, torial unit, and “divarication” of their status: on high infant mortality, low reproductive health the one hand, these are territories, performing care, high risk of communicable and noncom- tasks of national security and supervised by the municable diseases, alcoholism, drug abuse, federal government, on the other – usual urban suicide, etc. [3] districts with a standard set of local issues. The Unemployment, low incomes, lack of per- level of medical service in CATU is low: in sonal safety, crime, fear of the future, conflicts 2008, the number of inhabitants satisfied with at work and family problems, job instability, the quality of medical service in Severomorsk social disintegration – in the aggregate, this was 49.4%, in Polarniy – 50.6, in Skalistiy – leads to a sharp increase in the manifestations 51, in Zaozersk – 54, in Ostrovnoy – 55, in of psychosocial stress conditions. Social ill Snezhnogorsk – 67% people2. health produces cardiac diseases, manifests in The problem of the low level of health sys- the growth of social abnormalities and antiso- tem development is the most acute for settle- cial behavior: drug addiction and alcoholism.
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