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массовыми болезнями, пораженное алкоголизмом и наркоманией, поколение детей-инвалидов.
Официальная статистика подтверждает, что в результате либерализации рынка, экономики с целью реализации США, ЕС товарной, лекарственной и продовольственной интервенции, практически ликвидированы все наукоемкие отрасли промышленности и сельского хозяйства. Завершается ликвидация отрасли сельхозмашиностроения, основы продовольственной безопасности РФ, стремительно нарастает техногенная катастрофа, что привело к катастрофическим демографическим последствиям в РФ.
Огромный ущерб и людские потери - это не ошибки и просчеты органов власти РФ, а результат реализации МВФ всесторонне обоснованных и тщательно скоординированных с чиновниками РФ программ США и ЕС.
Katja Lahikainen
EMPOWERMENT OF LOCAL DECISION-MAKERS AND PRACTITIONERS TO TACKLE THE PREVENTION OF LIFE-STYLE RELATED NONCOMMUNICABLE DISEASES3
Coordinator, Northern Dimension Institute, Lappeenranta University of Technology, Finland, katja. lahikainen@lut.fi
Introduction
This paper describes how to combine the "top-down " and "bottom-up " approaches in order to highlight the socioeconomic burden of noncommunicable diseases (NCDs), and to facilitate the empowerment of local stakeholders to tackle the prevention of premature avoidable deaths, which are usually caused by the typical risk factors related to non-communicable diseases.
NCDs represent one of the world's major health challenges in terms of both human suffering and their negative impact on the socioeconomic development of societies. Tackling the increasing number of noncommunicable diseases is also one of the priorities of the World Health Organization (WHO). (WHO 2010 and 2012)
3 Работа выполнялась в рамках международного проекта «Здоровые люди: управление изменениями через мониторинг и действия», при финансовой поддержке Европейского Союза и Комитета по социальной политике Санкт-Петербурга.
The WHO Regional Office for Europe (WHO 2012) has set four priority areas for the prevention and control of NCDs: 1) governance for NCDs, including the building of alliances and networks, and fostering citizen empowerment; 2) strengthening surveillance, monitoring, evaluation, and research; 3) promoting health and preventing disease; 4) reorienting health services further towards the prevention and care of chronic diseases.
In the Russian Federation, Health is one of the four National Priority Projects launched in 2006 by President Vladimir Putin. In 2009, new components to tackle the burden of preventable mortality were included as an additional priority area to the National Priority Project Health (NPPH). The new priority area reflects the high levels of mortality from noncommunicable diseases and accidents in the Russian Federation. (Popovich et al. 2011)
The above-mentioned priorities serve as guidelines when planning and implementing the national NCD prevention programmes and strategies, but they do not offer practical tools or financial support for their implementation.
Evidence-based and cost-effective interventions exist to prevent and control NCDs at the global, regional, national and local levels, but their implementation requires strong political commitment and interventions in all policies. Despite the multitude of NCD prevention strategies, their effective implementation at the local and regional level is often hindered due to inadequate engagement and dialogue with communities to share priorities, as well as a lack of financial, human and institutional resources. (e.g. Laverack 2009)
Contextual Framework
Health promotion programmes targeted to implement the international and national strategies are typically launched as "top-down" initiatives. In the "top-down" approach, problem identification comes from those in top structures "down" to the community, whereas "bottom-up" refers to initiatives where the community identifies its own problems and communicates them to the decision-makers (Laverack 2012).
Multi-sector collaboration as well as intensive stakeholder analysis and extensive stakeholder involvement are proved to be effective means for both understanding the complex public problems and for formulating solutions to them (e.g. Head 2008; Crosby et al. 2005). "Forums'' and "arenas" are platforms in which stakeholders develop a shared understanding of the common problems and find solutions to tackle them. In "forums", stakeholders consider different interpretations of public problems and evaluate potential
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solutions, whereas in "arenas", decision-makers consider whether and how to adopt and implement proposed policy changes (Crobsy et al. 2005).
The project Healthier People - Management of Change through Monitoring and Action aims at overcoming the problems related to NCDs by helping local decision-makers and practitioners to understand the core problems and their impact, and by improving methods for "managing the change" locally and regionally4.
Case: Healthier People - Management of Change through Monitoring and Action
The Healthier People project tackles the prevention of lifestyle related NCDs by facilitating the cooperation between the EU and Russian non-state actors and local authorities. The overall objective of the project is to reduce premature mortality of preventable causes in the target region in the Kalininsky district in St. Petersburg, Russia.
The actions of the project support the institutional capacity building and networking of key stakeholders by practical interventions promoted by necessary policy decisions. This is done to motivate better and prepare the stakeholders to participate in decision making and policy formulation in the field of health and social protection.
The project is supported by the Northern Dimension Partnership in Public Health and Social Well-being (NDPHS), which is a cooperative effort of ten governments, the European Commission and eight international organisations (e.g. ILO, UNAIDS and WHO). The NDPHS provides a forum for concerted action to tackle challenges in health and social well-being in the Northern Dimension (ND) area and offers a channel for top-down initiatives and recommendations5. In addition, one of the project partners is the Baltic Region Healthy Cities Association (BRHCA), the goals of which are to promote health conditions in urban areas in the Baltic Sea Region and to support the programmes of WHO, which concentrate on urban health issues. The BRHCA also acts as a WHO Collaborating Centre for Healthy Cities and Urban Health in the Baltic Re-gion6.
4 Healthier People - Management of Change through Monitoring and Action, http://www.ndinstitute.org/healthier-people/healthier-people-home-eng
5 Northern Dimension Partnership in Public Health and Social Well-being (NDPHS), http://www.ndphs.org
6 Baltic Region Healthy Cities Association, http://www.marebalticum.org
Посвящается 200-летию со дня Бородинской битвы Application of the bottom-up approach in practice
This section describes in more detail how the bottom-up approach is utilised in the Healthier People project, and how external influences are taken into account when planning the project activities (see Table 1).
Table 1 Project concept
n
The internationally approved indicator "potential years of life lost" (PYLL) forms the baseline of the project. The PYLL figures of the Kalininsky district will be calculated and analysed. The analysis will provide a solid basis for the elaboration of a strategic intervention plan and good motivation for its implementation. In addition to the PYLL results, other types of information are also used in the elaboration of the intervention strat-
7 Potential years of life lost (PYLL) is a summary measure of premature mortality which provides an explicit way of weighting deaths occurring at younger ages, which are, a priori, preventable. The calculation for PYLL involves adding up deaths occurring at each age and multiplying this with the number of remaining years to live until a selected age limit, http://stats.oecd.org/glossary/detail.asp?ID=2095, visited 17 October 2012
egy, e.g. existing strategies and programmes, as well as the GOSCOMSTAT Table C51, which offers complementary information to the PYLL data.
The PYLL results will be debated extensively by stakeholders from different sectors in public discussions. Furthermore, a strategic intervention plan will be formulated with the sector leaders and other branches of administration, whose involvement will be paramount to tackle the problems and bring about a real change in the underlying problems causing premature avoidable deaths, diseases and injuries.
The main aims of the third phase of the project are to improve methods for "managing the change " locally and regionally and to establish a model for utilising the expertise of NGOs in the improvement of health. The stakeholders' views are heard in various stakeholder meetings during the implementation phase of the project. Moreover, health in all policies approach is followed by inviting not only health-care professionals, but also representatives from other sectors of the society, e.g. police, the church, schools and NGOs, to participate in the information-consultation meetings to discuss intervention actions.
Finally, the findings based on district-level PYLL figures as well as the developed tool for the management of change can be replicated in other regions in Russia and also other
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Northern Dimension countries through the involvement of NDPHS and BRHCA. Conclusions
Since the Healthier People project is ongoing, its concrete results can be evaluated only after the end of the project. However, some concluding remarks can be already made.
Firstly, the PYLL methodology, once in place, will provide a possibility for systematic surveillance and will also allow comparing the development vis-à-vis other areas in Russia and other countries/regions. Secondly, public discussions with the broad involvement of stakeholders, including media, increase awareness of common problems and the motivation of those involved, and enhance the management of change. Moreover, the public discussions promote inter-sector collaboration and the commitment of other sectors beyond health. (Crosby et al. 2005)
In summary, the project addresses local, national and global health agendas, builds ca-
8 The Northern Dimension (ND) policy is an instrument of cooperation between four equal partners, the European Union, Russia, Norway and Iceland, www.northerndimension.info.
pacity and develops "bottom-up" initiatives that can be channelled to the decisionmakers at the regional, national and international level. The above-mentioned factors are identified by Laverack (2009) as crucial factors that can build a more effective and empowering public health practice.
References
1. Head, B. W. 2008. Assessing network-based collaborations. Public Management Review. 10, 6, 733-749.
2. Crosby, B. C. & Bryson, J. M. 2005. A leadership framework for cross-sector collaboration. Public Management Review. 7, 2, 177-201.
3. Laverack, G. 2009. The future of public health programming. J Public Health 17: 281286.
4. Laverack, G. 2012. Parallel-tracking bottom-up approaches within chronic disease prevention programmes. Int J Public Health 57: 41-44.
5. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, and Mathivet B. 2011. Russian Federation: Health system review. Health Systems in Transition. 13(7): 1-190.
6. World Health Organisation (WHO), Regional Office for Europe 2010. Action Plan for implementation of the European Strategy for the Prevention and Control of Noncommu-nicable Diseases 2012-2016. http://www.euro.who.int/ data/assets/pdf file/0019/170155/e96638.pdf Accessed 9 October 2012.
7. World Health Organization (WHO), Regional Office for Europe 2012. Health 2020: a European policy framework supporting action across government and society for health and well-being. http ://www. euro. who. int/en/who-we-are/governance/re gional-committee-for-europe/sixty-second-session/working-documents/eurrc628-health-2020-policy-framework-and-strategy
Артамонова О.Е.
ГЕНДЕРНЫЕ РАЗЛИЧИЯ ОТНОШЕНИЯ К ЗДОРОВЬЮ
Новгородский государственный университет имени Ярослава Мудрого,
Великий Новгород, oart@list.ru
Одним из значимых факторов общественного здоровья является признак пола. Структура гендерной обусловленности здоровья включает такие факторы, как особенности экономической активности мужчин и женщин, исторически сложившиеся и воспроизводимые позиции мужчин и женщин в общественном
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