HEALTH CENTRES – NEW
PREVENTIVE STRUCTURE IN
PUBLIC HEALTH SERVICE OF THE
RUSSIAN FEDERATION
Nana GV Pogosova
Sergey A Boytsov
Irina D Sapunova
Yulia M Yufereva
Rafael G Oganov
More than 50 percent of deaths and disability from
heart disease and strokes, which together kill more
than 12 million people world-wide each year, can
be cut by a combination of simple, cost effective
national efforts and individual actions to reduce
major risk factors such as high blood pressure, high
cholesterol, obesity and smoking.
• It is very important that the First Global Ministerial
Conference on healthy lifestyle and non-
communicable diseases is held in Russia, which has
declared the human health a state priority, and is
implementing large-scale programs of healthcare
development emphasizing the reduction of mortality
from non-communicable diseases and the healthy
lifestyle.
• Since 2005, Russia has been implementing the Health
national project having among its key components the
development of primary healthcare institutions and
enhancement of prophylactic measures.
Since 2005 Priority National Project “Health” special attention to CVD
April 2008 Russia has signed the WHO Frame Convention
Against Smoking
June 2010 Not less than 80% of surface of 2 sides of
sigarettes pack– information about tobacco harm
Sept 2010 Vladimir Putin has signed the National
Antismoking Concept:
Ban on advertising of sigarettes in shops.
21% increase of taxes on sigarettes.
Ban on smoking in public places from 2015.
• From the last year, we have started shifting to the “physician – healthy man” interaction scheme by opening the special healthcare institutions called Health Centers.
• We have opened 502 Health Centers for adults and 193 pediatric and juvenile Health Centers.
• They focus on preventive and awareness raising efforts, examination of health people for risk factors and the development of individual recommendations as to the maintenance of healthy lifestyle.
• During their first year of operation, the Health Centers were visited by about 2.5 million people.
The aim was to increase citizens’ responsibility
towards their health, to motivate people to give up
unhealthy habits, including smoking and excessive
alcohol intake, and to obtain the risk factors goals.
In 2009-2010 in the Russian Federation was
developed a new preventive state health
service structure - health centers (HCs)
502 HCs for adults were opened
across the Russian Federation
Each HC, equipped equally, provides
preventive service for 200 thousands of
population on free of charge basis.
All health Centers have a identical equipment
HEALTH CENTERS
Basic characteristics of health on a free of charge basis:
● Weight, Hight, BMI
● Blood pressure
● Total Cholesterol
● Glucose
● Ancle-bracial index
● Spirometric parameters
● Smoking status
Ministry of Health and Social Development of the Russian Federation
HEALTH CENTERS
Basic characteristics of health on a free of charge basis:
● Carbon monooxide in the enhailed air (smokelyzer)
● Spyrometry
● Prophilaktic dental examination
● Ophthalmometry
● Bioimpedancemetry (percentage of water, muscle and
adipose tissue)
Ministry of Health and Social Development of the Russian Federation
Ishemia is shown
in red color
CARDIOVIZOR
rapid assessment of the
functional state of dispersion
mapping of the ECG signal
(sensitivity 90%, specificity
not less then 75%)
RAPID SCREENING
DOPPLER: handheld peripheral doppler
Vascular screening system with
automatic measurement of systolic
blood pressure and calculation of
ankle-brachial index to identify
persons with obstructive diseases of
the peripheral cardiovascular system.
Ankle-brachial index - 0,9 or less
(Circulation. 2004;110:3075-3080. The Edinburgh Artery
Study American Heart Association, Inc. Coronary Heart
Disease )
SMOKELAYZER:
Carbon monoxide in the exhaled air
Allows to control smoking cessation
Express determination of total
cholesterol and blood glucose
Diagnostics of caries and
parodentium diseases
Education on tooth hygiene
Individual program on
prevention of dental diseases
Prophylactic dental examination
Assessment of refraction
(automatic
pneumorephractometer)
Assesment of the eye bottom
pressure
Ophthalmometry
Physicians of Health
Centers:
1. assess risk factors
2. assess of functional
and adaptive body
reserves
considering age
characteristics
3. estimate the total
risk of
cardiovascular
events
4. give
recommendations
on healthy lifestyle
5. Held education
programms
Based on the results of
the standard health
status study visitors of
HCs are given personal
recommendations on
lifestyle modification.
HCs provide educational
programs and
supervised exercise
training
Hypertension was diagnosed in 60 % (prevalence of
hypertension in population is about 40%)
In 2010-2011 more than 2,5 million
people have visited HCs
Less than 500 000 who came for a visit were considered to be healthy
68% of НСs visitors were owerweight,
58% had low level of physical activity,
45% - hypercholesterolemia,
20% - hyperglycemia. These data correspond with the results of previous
epidemiologic studies.
92 % of smokers who have visited HCs are willing to quit
smoking
24
First experiense of the Health Centers in Russia
• Health Centers are a new structure in the healthcare
system, which is developing a healthy lifestyle
among the population.
• Health Centers allow conducting individual primary
prevention among the population, especially for
those who do not apply for medical care to
healthcare institutions.
• Analysis of the health centers activity demonstrates
that they are visited by 70% of women.
Our aim now is to attract males of working age. In
this case there are mobile health centers for working
at enterprises and reaching remote areas.
First experiense of the Health Centers in Russia
• In some regions at the expense of regional budgets purchase
equipment for mobile health centers (Moskow, Samara, Novosibirsk,
Barnaul….
• Analysis of the health centers showed a high frequency of major risk
factors of chronic noninfectious diseases (70%).
• Assessment of risk for cardiovascular events and diabetes melitus
can identify individuals at high risk and start active prevention.
The algorithm of health status
study in CHs aimed to identify
risk factors of NCDs is highly
effective.
The methodology of risk factors
reduction need further improvement.
According to the opinion of Heads of Health Centers people are
pleased to visit our Centers. They want to know more about their
health and get recommendations..
Cardiovascular prevention in
Russia: time of hope and optimism
0,0
500,0
1000,0
1500,0
2000,0
2500,0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Years
Thousands
Men Women Both sexes
TOTAL MORTALITY in the RUSSIAN FEDERATION
© Russian Federation Federal State Statistics Service 2011
67,9
61,8
74,2
67,5
64,8
65,365,4 65,7 65,3
65,366,6
58,559,059,1 58,8 58,9 58,960,4
61,4
72,0
72,372,372,0 72,4
72,3
73,2 73,9
50
60
70
80
2000 2001 2002 2003 2004 2005 2006 2007 2008
LIFE EXPECTANCY in the RUSSIN FEDERATION
years
Ministry of Health and Social Development of the Russian Federation, 2008
Women
Men + Women
Men