Conclusions

MINISTRY OF EDUCATION AND SCIENCE OF THE REPUBLIC OF KAZAKHSTAN

SOUTH KAZAKHSTAN MEDICAL ACADEMY

Manuscript copyright

SUNATULLA MERUYERT NIGMATULLAKYZY

Annotation to the master’s thesis

The impact of the socio-economic crisis on the population’s health, as a condition of the labor potential of South Kazakhstan region.

Shymkent, 2018

The work was carried out at South Kazakhstan Medical Academy

Scientific Supervisor:	Doctor of Philosophy (PhD), Acting Associate Professor А. М. Buleshova
Official Reviewer:	Ph. D. Professor Bekturganov RS

The master’s thesis is available for viewing at the scientific library of South Kazakhstan Medical Academy at: 1 Al-Farabi Ave., Shymkent city.

The relevance of the research. The implementation of active socio-economic reforms in our country since the 1990s has been accompanied by a number of negative trends in the society’slife: inflation, growth in unemployment, decrease in real income of the population and deterioration of the quality of its citizens’life.

In recent years (2015-2017), against the backdrop of another unfavourable social and economic processes, the health problems of Kazakhstan’s population have a special significance. The significant deterioration of the medical and social status of the population is due to many reasons, including a reduction in the volume of preventive measures to protect public health, an increase of economic tension, environmental, sanitary and epidemiological problems.

There is a need to significantly increase the impact of healthcare on the population’s health with a view to improving the situation in the country, as the parameters and trends of demographic development and the state of public health do not meet the strategic interests of development of the Republic of Kazakhstan.

To improve the sustainability mechanisms of the medical and demographic situation in South Kazakhstan region an in-depth analysis of the environmental-hygienic, economic, social and medical-demographic processes is required. The effectiveness of the measures taken is extremely needed to ensure an effective state policy in the sphere of public health management. The fundamental basis of the analysis should be the results of comprehensive assessment of the impact of socio-economic factors on the processes of formation ofthe population’s morbidity, disability and mortality rates in the studied territory.

The need for a comprehensive study of the impact of the socio-economic crisis on the formation of health indicators determine the tasks of this research, solving which made it possible to achieve the goal.

Thepurposeoftheresearch – comprehensive assessment of the socio-economic crisis’role in the formation of medical-demographic and socio-hygienic processes, morbidity and mortality of the population of South Kazakhstan region.

Objectives of the research:

1. To assess the medical and demographic processes taking place in South Kazakhstan regionduring the period of a new socio-economic crisis.

2. To assess the dynamics of morbidity and mortality rates of the population of South Kazakhstan region during the period between 1996-2017.

3. To study the dynamics of socio-economic indicators and to identify their relationship with the changes in medical and demographic processes and morbidity rates of different groups of the population of South Kazakhstan region.

4. To develop and implement recommendations for the preservation of health and prevention of socially-induced diseases among the adult population.

Target of the research. Men aged 16-59 years, women aged 16-54.

Methods of the research. To compare the structure and mortality rate of the working-age population in South Kazakhstan region with other developed countries, the age-standardized mortality rates were calculated.

The standardization was carried out by a direct method. For calculation the European standard of the age structure was used. To ensure comparability, the analysis was carried out in terms of mortality rates of the male and female population of 15—59/54age group in South Kazakhstan region for 1996 and 2017. The calculation of standardized indicators was carried out on average in all 27 countries for both 2017 and 1996.

The scientific novelty of the research is that for the first time:

- comprehensive assessment of the impact of the dynamics of socio-economic processes on the health indicators of the population of South Kazakhstan region during the economic crisis;

- it is established that changes in social and economic factors are closely interrelated with the levels of shaping the population’s health;

- it is proved that during the period of socio-economic crises, the role of the healthcare service in shaping public health significantly increases.

The ideas of the thesis to be defended are:

1. The degree of tightness of the relationship between the medical-demographic and socio-hygienic situation and the primary morbidity of the population in the territory of South Kazakhstan region for the period between 1996-2018 is characterized by considerable severity. Positive trends, observed since 2017, are currently not sufficiently intensive, which, in turn, may cause a predicted deterioration in the demographic situation in the near future.

2. During the period of socio-economic transformation, the level of severity of crisis factors and financing of the healthcare system exerts a significant influence on the primary morbidity of the population.

3. Financial flows entering the healthcare system of South Kazakhstan region, have differently directed effects on the level of primary morbidity of the adult population, adolescents and children.

Scientific and practical significance. Research materials are of great practical importance for assessing the health of the population in the South Kazakhstan region, during the period of the socio-economic crisis. Correctly collected and well-analyzed statistical data on public health serve as the basis for planning health-improvement measures for preserving and strengthening public health at the state and municipal levels, developing modern forms and methods of work of health organizations, monitoring the effectiveness of their activities. Similarly, the materials of the thesis work is used at the Public Health Department of the South Kazakhstan Medical Academy in the preparation of students of the Faculty of Medicine and Public Health.

Results of own research. Active socio-economic reforms that occurred in the Republic of Kazakhstan at the turn of the century were accompanied by negative changes in the health of the population. In order to stabilize them both in the country as a whole and at the level of individual regions, an in-depth analysis of environmental-hygienic, economic, social and medical-demographic processes is required. Its results are extremely needed to ensure an effective state policy in the field of health management.

The basis for such an analysis should be the results of a comprehensive assessment of the impact of socio-economic factors on the processes of shaping the health of the population of this territory. We studied the demographic indicators characteristic of the population of the SKO: the number and structure of the population, its natural and mechanical movement.

It was found that the determining factor of the demographic processes in the region during the study period was a natural increase in the population. When studying the statics of the population, it was revealed that during the analyzed period there was an annual and significant increase in the population of the region. During the analyzed period, the change in the sex and age structure of the population was revealed in SKR. The gender structure of the population was characterized by the fact that there were marked disproportions, especially in the main reproductive age groups (in 2010, there were 108 women per 100 men). In older age groups, the difference reached even greater values - up to 121. 8 females per 100 males (Figure 1). One of the main trends of the studied demographic processes in the SKR has also been the increase in the proportion of elderly people in the rural population, associated with a drop in the birth rate, and with an insignificant level of life expectancy.

Accordingly, starting from 2016g. the share of the population at working age decreased (figure 2). The process of reducing labor potential in rural areas was aggravated by an increase in the proportion of the unemployed. At the same time, the proportion of the able-bodied population and children under 14 is growing in the urban environment, which is associated with the migration of this category from urban areas (Figure 3). 90s, reaching its highest level in 2014 (29. 9 per 1, 000 population). 18. 9 people per 1000 population (Figure 4). The increase in demographic development, and subsequent migration processes,

The study of the general morbidity of the population shows that in the South Kazakhstan Oblast for the period 2015-2017. it grew by 1. 1%. At the same time, its level from 4851. 8 ± 45. 3 cases increased to 4919. 3 ± 47. 2 cases per 100, 000 population. To assess the impact of socio-economic factors on the incidence of the population, the most informative classes for this task were identified, which are listed in Table 1. Of all the most " socially-dependent" classes of diseases included in this group, the highest level of development of morbidity in conditions of social (13. 9% from 2015 to 2017), psychiatric disorders (12. 9%), and circulatory system diseases (6. 5%), including myocardial infarction (4. 9%), and other diseases. stroke (5. 4%).

Conclusions

1. The results of studying the morbidity and mortality of the population made it possible to determine a number of “socially-dependent” classes of diseases (mental disorders, diseases of the nervous system, diseases of the digestive organs), as the most informative to assess the relationships with various socio-economic factors. These classes of diseases are characterized by the sharpest change in the level of indicators (especially among the population capable to work) during the period of intensive social and economic transformations in society.

2. Polynomial regression models characterize the dynamics of morbidity in the most informative, “socially-dependent” classes of diseases and allowed us to reveal a significant (4, 5 times) increase in the overall morbidity of the adult population.

3. Despite the revealed for the period between 2010-2017 the increase in the costs of population’s labor by 8. 5 times, the subsistence levelincreased over the same period (by 3, 2 times) and the growth in average prices for consumer goods (by about 3, 1 times), as well as the growth of tariffs for certain types of paid services (by 7, 2 times) adversely affected the standard of living of the population, which led to a decrease in the population’s ability to use a number of paid medical services.

4. The increase in financing of the healthcare system from the budget and the standardized reserve funds has a statistically significant positive effect on the birth rate of the population (Pearson’s correlation coefficient ghu is 0, 93 and 0, 98, respectively). In addition, the birth rate of the population is positively affected by the increase in the subsistence level and social benefits (ghu = 0, 97 and 0, 86). The indicator of total mortality is in a strong negative correlation with the increase in allocations for healthcare from the standardized reserve funds (-0, 83) and budget (-0, 75).

5. The increase in financing the healthcare system has the largest impact on the decrease of the morbidity of adult population.

Publications. The main provisions of the thesis are presented in 3 published works. The Republican scientific journal " Vestnik" No. 4 (81), 2017; Bulletin of Doctors of the Republic of Kazakhstan No. 1, 2017; Bulletin of Doctors of the Republic of Kazakhstan No. 2, 2018.

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