Age-specific mortality rates have a general pattern that is characteristic not only for Russia, but also for most countries of the world. The highest risk of death of children in the first hours, days, weeks of his life. The older the child is, the less likely it is to die. The lowest mortality rates are in the period 5-20 years. After 20 years, there is a gradual increase in the indicator, which reaches its maximum after 60 years.
The increase in mortality in recent decades is typical for most developed countries of the world, which is mainly associated with the aging of the population. In Russia, the increase in mortality is associated primarily with social factors.
In the structure of causes of death in economically developed countries and Russia, the first places are taken by:
1.Diseases of the circulatory system
2.neoplasms
3.accidents, poisoning and injury
4.other reasons
In economically developing countries, the structure of the causes of death of the population looks different: the first place is shared by accidents, poisoning, injuries and infectious diseases; second place - neoplasms and diseases of the circulatory system.
Question No. 2 Indicators characterizing the reproduction of the population: calculation method, assessment, basic demographic data for Russia and the Krasnodar Territory.
Fertility =
Mortality =
Natural increase rate = Fertility rate - Overall mortality rate
Demographic indicators for 2010:
Krasnodar region:
Fertility 12.2% 0
Mortality 13.6% 0
Natural increase -1.4% 0
Russia:
Fertility 12.5% 0
Mortality 14.6% 0
Natural increase -2.1% 0
Situational task number 24
Specialty 060101 - general medicine
Question No. 1 Social and hygienic problems of medical demography.
Demographic indicators are one of the criteria used to quantify public health.
Medical demography studies the relationship of population reproduction with medical and social factors, develops, on this basis, measures of a medical, social, organizational nature, aimed at ensuring the most favorable development of demographic processes and improving the development of the population.
The population of Russia, according to international criteria, is demographically old. About 13% of its inhabitants are aged 65 and over.
The extremely dynamic and far from favorable nature of the development of the demographic situation in the country at the end of the twentieth century, testifies to the dependence of current changes in the age-sex composition of the population on the events of the past. The aging of the population objectively contributes to an increase in the death rate, as well as a decrease in the birth rate.
Question No. 2 Population census, methodology, critical moment of the census.
The population census is a special scientifically organized state statistical operation for recording and analyzing data on the population size, its composition and distribution over the territory.
Features of the census
Periodicity (carried out after 10 years, in economically developed countries - after 5 years).
Universality (coverage of the entire population).
Unity of methodology (availability of a unified census program in the form of a census form).
One-time (the population is taken into account at a certain point).
Collecting information by the method of polling with the help of scribes without the obligatory confirmation of documents.
Centralized way of data processing.
The critical moment of the population census is the exact moment in time, uniform for the whole country, to which the information collected during the population census is dated. Establishing a critical moment allows you to get a kind of instant photograph, an instant snapshot of a population that is constantly changing. Usually the critical moment is set at midnight on the eve of the first day of the census. This is due to the fact that censuses are usually conducted at the place of residence of people (at least temporarily) and most of them are indoors (under a roof) at night.
Situational task number 25
For the final state certification
Mortality
Health and longevity are the most important and indisputable values of social development. Over the past decades, life expectancy at birth has grown significantly due to increased attention to health problems and a reduction in child and infant mortality. Accordingly, the proportion of countries whose governments consider the prevailing mortality rate to be acceptable has increased, from 37% in the mid-1970s and 1980s to 43% in 2007. This tendency is more pronounced in the group of developing countries, among which the proportion of those satisfied with the mortality rate increased from 24% to 36%.
However, significant differences persist between developing and developed countries in objective and subjective assessments of mortality trends. Average life expectancy at birth in 2000-2005 was 76 years in developed countries, 64 years in developing countries and only 53 years in the world's least developed countries.
One of the reasons for the stagnation and even the increase in mortality in some African countries is the epidemic of HIV infection and AIDS. Therefore, it is not surprising that the assessment of the acceptability of the current level of mortality largely depends on the level of development of the country. In 2007, the prevailing mortality rate was considered unacceptable by slightly more than a third of developed countries (although this is noticeably higher than in the mid-1970s and 1980s), and among developing countries - almost two-thirds. Among the 50 least developed countries, none considered the prevailing mortality rate to be acceptable.
Of the 105 countries (representing 50% of the world's population) that, in accordance with the World Program of Action, have set themselves the goal of achieving an average life expectancy of at least 70 years by 2000-2005, 90 have not been able to achieve it. Moreover, in 48 of these countries (14% of the world's population), located mainly in the African continent south of the Sahara, life expectancy dropped much below the target criterion - to below 60 years. Such a low level of life expectancy is explained by many factors, including military and political conflicts, economic crises, socio-economic shifts, the prevalence of unhealthy lifestyles and bad habits, the return of such formidable infectious diseases as malaria, tuberculosis, cholera, as well as epidemic the spread of HIV and AIDS. In many low-income countries, the cost of a minimum package of health care is much higher than government spending on health. For example, in 2004, per capita health spending in developing countries was about US $ 91 per year, while in the least developed countries it was only US $ 15. The situation is complicated by the fact that in a number of countries it is impossible to use additional resources and there is a shortage of medical workers due to low wages, difficult working conditions and the emigration of qualified personnel.
As mentioned above, the problems of child and maternal mortality took, according to the estimates of national governments, respectively, the second and third places among the population problems of particular concern to the countries of the world. True, over the past decade, concern about these problems has somewhat eased - the share of governments that consider the mortality rate of children under 5 years old to be acceptable in their countries has decreased from 77% in 1996 to 73% in 2007. But this happened mainly due to developed countries, while among developing countries it, on the contrary, increased. The rapid decline in child mortality observed before 1990 in developing countries gave way in the 1990s to almost stagnation. In 2006, it was estimated that the number of children who died before the age of 5 fell to 10 million a year for the first time. But half of them still die from preventable causes such as acute respiratory infections, diarrhea, measles and malaria.
The high maternal mortality rate is also a major concern. In 2007, 70% of national governments (135 out of 193 countries) considered the current level of maternal mortality unacceptable, among developed countries - 33% (16 out of 49 countries), among developing countries - 83% (119 out of 144), including among the least developed - 98% (48 out of 50). It is estimated that about half a million women die each year during pregnancy or childbirth, most of them in sub-Saharan Africa and Asia.
The HIV / AIDS epidemic is one of the most serious challenges that the international community has faced in recent years. Since 1981, when the disease was first diagnosed, more than 25 million people have died from it. In 2007, over 33 million people were infected with HIV. The spread of this infection in a number of countries practically canceled out many achievements of socio-economic development, leading to an increase in the level of morbidity and mortality and undermining the foundations of the existence of households, enterprises, certain industries (agriculture, education, health care) and national economies. If in 1996 71% of national governments (89 out of 125 countries) expressed serious concern about the spread of HIV infection, then in 2007 it was already 90% (175 out of 194). At the same time, the governments of the least developed countries of the world are the most concerned - 98%.
Already in the mid-1980s, some governments began to take action to counter the onslaught of the epidemic, but these were more often fragmented and focused mainly on solving health problems. But in recent years, whole strategies have been developed to counter HIV infection and AIDS, which include the following areas: preventive measures aimed at preventing the spread of the disease; treatment and care of the sick; protection from discrimination and alienation of the sick; development of coordinated interagency strategies; the creation of bodies to coordinate activities in the fight against AIDS and HIV infection; developing partnerships between civil society, groups of people living with HIV-infected people, local communities, nongovernmental organizations and the private sector of the economy.
For better public awareness of the problem, governments seek to draw attention to them by supporting special information and educational programs in the media and communications. The participation of nongovernmental organizations, people living with HIV, religious leaders and international donor organizations in these programs greatly enhances the effectiveness of such programs.
Antiretroviral therapy can significantly increase the life expectancy of HIV-infected people and alleviate their suffering, but it still remains very poorly available. Although almost 85% of countries (165) declared their support for the availability of antiretroviral therapy in 2007, in many of them the actual coverage of such treatment remains extremely low. Despite joint international and national efforts to reduce the cost of medicines, only 2 of the 7.1 million people needing such treatment in developing countries received it at the end of 2006.
Condom support programs (safe sex) are fairly widespread (in 86% of countries around the world), but the demand for them is still unmet and the quality is low. According to UN experts, the supply of condoms is 50% lower than necessary.
In 2007, 182 governments out of 195 countries (93%) indicated that their countries performed preventive blood tests for HIV. Among developing countries, there were 135, or 92%, and among developed countries - 47, or 96%. However, it is important to emphasize that countries differ in the extent to which the population is covered by such programs.
An increasing number of governments are enacting legislation to protect people affected by HIV infection. In 2007, 63% of national governments announced measures to ensure non-discrimination against HIV-infected people. Among developed countries, their share reaches 76%, among developing countries - only 58%, including among the least developed - 38%. In Africa, where the epidemic is particularly widespread, 47% of countries said they had implemented such measures.
Maternal mortality in many countries of the world is still high
Despite the advances made in reducing maternal mortality, pregnancy and childbirth still pose significant risks to the health and lives of women in many developing countries. It is estimated that the number of deaths from complications of pregnancy, childbirth and the postpartum period was 358 thousand in 2008, of which 355 thousand, or 99% in developing countries.
The main causes of maternal death in developing regions are bleeding (35% of cases) and hypertension (18%). Abortions (about 9%), primarily unsafe, also contribute to maternal mortality.
If we compare the values of the maternal mortality rate for countries of the world with the number of legal grounds for abortion, which were mentioned above, it turns out that with a more liberal attitude of the state towards artificial termination of pregnancy, maternal mortality is usually lower (Fig. 15). The highest rates of maternal mortality are found in countries with stricter abortion laws. According to 2008 estimates for 171 countries around the world, the maternal mortality rate ranged from 2 per 100,000 live births in Greece to 1,400 in Afghanistan. The median value was 68 deaths from complications of pregnancy, childbirth and the postpartum period per 100,000 live births (Venezuela).
In most countries with lower maternal mortality rates, abortion legislation was the most liberal (legal grounds for abortion were 7 in 56% of countries, 5 or more in 71% of countries). The only exceptions were Malta and Chile, in which the legislation does not provide for any grounds for artificial termination of pregnancy.
The other half of the countries in which the maternal mortality rate exceeded the median level had rather strict legislation on abortion - in 70% of the countries there were no more than three grounds for abortion (usually associated with a risk to the life and health of the mother).
Of course, a decisive role in this distribution is played by the fact that a more liberal attitude towards abortion is characteristic of developed countries with a higher level of health protection in general. However, legislative provision of the safest medical abortion in developing countries could also contribute to the reduction of maternal mortality and the preservation of the reproductive health of women.
Figure 15. World countries by maternal mortality rate and legal grounds for abortion, 2008
The risk of mortality from complications of pregnancy, childbirth and the postpartum period from the number of pregnancies, and, therefore, from the birth rate. In half of the countries in which the value of the maternal mortality rate is below the median, the value of the total fertility rate does not exceed 3.5 children per woman, and in most countries - in 80% of countries - it does not exceed the level of simple reproduction (2.1) and only in 5 countries ranges from 3.1 to 3.5 (Fig. 16).
In the other half of the countries where the maternal mortality rate is higher than the median value, the total fertility rate is markedly higher. Only in one country - North Korea (DPRK) - its value is below 2 (1.9 children per woman with 250 deaths from complications of pregnancy, childbirth and the postpartum period per 100 thousand live births). In the rest, the value of the total fertility rate exceeds 2.2, in half - 4.0 children per woman.
Figure 16. World countries by maternal mortality rate (2008) and total fertility rate (2005-2010)
Since the reduction in maternal mortality (by ¾ by 2015, compared to 1990) is among the Millennium Development Goals, the analysis of this indicator is given constant attention in all UN Millennium Development Goals reports. The data presented in 2011 indicate a steady downward trend in maternal mortality in all major regions of the world (Fig. 17). However, the rate of decline does not allow us to hope that the task at hand will be achieved.
In developed countries, maternal mortality decreased from 26 deaths from complications of pregnancy, childbirth and the postpartum period per 100 live births in 1990 to 17 in 2000 (that is, it decreased by 35%). In 2008, it remained at the same level as in 2000.
The decrease in maternal mortality in developing countries for the entire period was 34%: from 440 per 100 thousand live births in 1990 to 370 in 2000 and 290 in 2008.
The greatest successes in reducing maternal mortality were noted in East Asia, where it decreased by 63% (from 110 per 100 thousand live births in 1990 to 41 in 2008), North Africa - by 60% (from 230 to 92), East Asia - by 58% (from 380 to 160). The smallest decline - by about a quarter - was noted in Oceania, the Caucasus and Central Asia (with relatively low rates), as well as in sub-Saharan Africa (with extremely high values of maternal mortality).
Figure 17. Maternal mortality in some regions of the world, per 100 thousand live births, 1990, 2000 and 2008
The high risk of mortality from complications of pregnancy, childbirth and the postpartum period in developing countries is associated with the low availability of medical services (observation, consultation and, if necessary, medical care during pregnancy and after childbirth, skilled obstetric care). In developed countries, almost all childbirth is accompanied by qualified medical care; in developing countries, obstetrics are not always available.
The proportion of women who received skilled obstetric care during childbirth rose in developing countries from 55% in 1990 to 65% in 2009 (Figure 18). Improvements in this indicator have been observed in all developing regions, but especially significant progress has been achieved in North Africa, where the proportion of births performed with skilled attendants increased by 80% (from 45% to 81%). The provision of obstetric care in South Asia and sub-Saharan Africa remains extremely low, with half of all births occurring without skilled attendance.
Figure 18. Proportion of births performed with skilled attendance at birth,
%, 1990 and 2009
Sources of
:
United Nations, Department of Economic and Social Affairs, Population Division.
World Abortion Policies 2011. - http://www.un.org/esa/population/publications/2011abortion/2011abortionwallchart.html
The Millennium Development Goals Report 2011. United Nations New York, 2011. -
The Millennium Development Goals Report 2011. United Nations New York, 2011.11-31339-June 2011-31 000. Sales No. E.11.I.10 - P. 28.
Mortality is the main indicator of the health status of the population. Causes of death change over time: if in the distant past people died mainly from infectious diseases - plague, malaria, smallpox, etc., now the main cause of death has become circulatory diseases, especially in developed countries, where the number of deaths from these diseases is about 50% (in other countries - 27%). In second place is mortality from malignant tumors; for this reason, in developed countries, 21% of the deaths die, in the rest - 11%. A new dangerous disease is AIDS X (acquired immunodeficiency syndrome), which has spread in many countries of the world, including Russia. Other causes of death include mental illness, drug addiction, alcoholism, and diseases caused by malnutrition.
Poor nutrition is the lot of the inhabitants of many underdeveloped countries, one of the main causes of illness in children and adults, and often their death. Thus, 40 million children suffer from a lack of vitamin A, and more than 500 million people suffer from iron deficiency. In Africa, 15% of births are underweight due to maternal malnutrition during pregnancy, and 20% in Asia. A baby's birth weight is one of the important factors in determining his chances of survival and normal development. In African countries, 70% of children have stunted growth, half of them have pronounced atrophy, which carries the threat of fleeting death. Africa's infant mortality rate is approaching 200%; there are 200 deaths per 1000 newborns.
In developed countries, the infant mortality rate was 15%, and in three of them - Finland, Sweden and Japan - 6.5-7%. Low infant mortality rates are the result of a high standard of living, highly effective therapeutic agents and medical care. Thus, in most African countries there is one doctor for every 10 thousand inhabitants, and in Europe - more than 20. But not only the number of doctors, but also the quality of their work affects the indicators of infant mortality. For example, the former USSR ranked first in the world in terms of the number of doctors (42.1 per 10 thousand people), but the level of service was lower than in many other countries, and infant mortality rates were not the best in the world.
Accidents are one of the most common causes of death, and their number is constantly growing. Here the first place is occupied by road traffic accidents. Many people are victims of incidents involving chemical and radioactive substances. Big
health damage is caused by pesticides. Every year, about 1 million people receive severe poisoning and more than 220 thousand people die from this. With an increase in the rate of resource exploitation, intensification of production, new foci and causes of danger to human health arise.