Regression Model of Population Health in Russian Regions

Cherepanova Mariya Ivanovna ORCID: 0000-0001-8892-837X Doctor of Sociology Professor of the Department of Social and Youth Policy of Altai State University 656002, Russia, Altaiskii krai, g. Barnaul, ul. Dimitrova, 66a, of. 515 cher_67@mail.ru Other publications by this author

Shcheglova Dar'ya Konstantinovna Postgraduate student, Altai State University 656002, Russia, Altai Krai, Barnaul, Dimitrova str., 66, office 515 daschul9@mail.ru

Introduction

The relevance of the study of Russians' attitude to health and health-saving technologies is due to the fact that an important priority of the social policy of the Russian Federation is to increase the efficiency of human capital, especially its reproductive mechanisms, and the formation of citizens' motivation for a healthy long life, what is the basic basis for the full participation of citizens in the socio-economic life of society and the prosperity of the state.

At the present stage of development of Russian society, opposite trends are being realized. The first trend reflects the negative consequences of the Covid-19 pandemic, a set of structural violations in the system of providing medical care to the population and an increase in morbidity of various kinds, which caused an unprecedented increase in mortality in all territories of Russia. In addition, the permanent economic and financial crisis of most groups of the Russian population, especially in the border depressive territories of the country, negative changes in the lifestyle of people associated with the spread of gadgets, increased physical inactivity, bad habits among the younger generation of the country, led to significant health disorders, an increase in the number of disabilities, rejuvenation of common diseases ^{[1,3, 6]}.

The opposite and positive trend can be called the formation of the legislative framework of a new health protection strategy in Russian society. The main goal of this strategy is to preserve and increase the human capital of the country, including, first of all, the health of the nation, as well as its motivation for a long and fruitful life for the benefit of Russian society ^{[7, 9, 11, 12]}.

Nevertheless, negative trends in the health status of the population of the border territories, which make up 70% of the Russian Federation, exacerbate the already difficult demographic situation in the country ^{[2,4,5,13,14]}.

The health of different age and status groups of the population of the Russian border territories has a significant socio-economic role as a decisive prospect for sustainable economic development of the country.

In this regard, let's consider the results of a large-scale all-Russian study of various components of the human capital of Russians conducted in six border regions of Russia.

Review

The analysis of the demographic crisis of the Russian population, as well as its health, has not lost its relevance and social significance over the past decade. The role of health and a healthy lifestyle is increasing for the socio-economic development of the country. Russian society at the turn of the twentieth and twenty-first centuries is characterized by rapid population decline, deterioration of health indicators, and rejuvenation of diseases. In 2021, the natural decline of the Russian population exceeded 1 million people. Previously, such indicators were recorded only in 2000 ^[20].

In 2021, a decrease in life expectancy was recorded in Russia. This indicator reached an average of 67.5 years for women and 60.7 years for men. However, in a country with its significant socio-economic heterogeneity, this indicator varies greatly. Between the most prosperous and the most problematic regions for the life of the population, the difference in life expectancy is about 15 years ^[8]. The maximum life expectancy of the population is observed in the North Caucasus, in particular in Ingushetia, as well as in Moscow, St. Petersburg and Sevastopol. The minimum life expectancy was recorded in the regions of the Far East and Chukotka ^{[20, p.38]}.

The difference between the life expectancy of men and women in different regions of Russia in 2021 was more than 15 years ^{[20, p.41]}.

This fact indicates a significant regional specificity affecting the quality of life and health of Russians.

The most dramatic trend for the country's economy is related to the fact that a tenth of Russian citizens, especially men, die at working age. The country is suffering significant economic damage ^[18].

Thus, the optimization of the demographic situation in the country requires a comprehensive improvement in the quality of health of Russians and stimulates research interest in the mechanisms of reproduction of health and life of the population. Knowledge of the determinants and factors of preserving the life potential of the country's population should be the basis for social control and effective management decisions.

According to domestic research, the most significant determinants affecting the health and well-being of the Russian population are socio-economic indicators ^{[19, 20, p.118]}. According to the statistics obtained in 2021, about 94.3 million people in 53 regions of the Russian Federation (64.6% of the population of the Russian Federation) were influenced by social and economic factors ^{[20, 83]}.

In turn, socio-economic habitats are determined by the level of industrial and economic development of the territory, the presence of social tension, the degree of feeling of social well-being, satisfaction with working conditions, the quality of medical care received, etc. ^[6,7].

Sanitary and hygienic factors, which are determined by the chemical, biological and physical characteristics of the living environment of Russians, are in second place in terms of the importance of influencing the health of citizens ^[17]. The group of sanitary and hygienic factors includes the presence of biological contamination of food, water, air and soil conditions. Among the territories in which the greatest influence of sanitary and hygienic factors on the health of the population was recorded were the Republics of Karelia and Komi, Arkhangelsk and Novgorod regions, Primorsky and Khabarovsk Territories, and other territories ^{[20, p. 45]}.

33 subjects of the Russian Federation are characterized by a significant impact of working conditions on the health of the working population of the region ^[14].

The third place in terms of the importance of influencing the health of citizens is traditionally occupied by the lifestyle of the population. Its manifestations such as alcohol consumption, smoking, physical inactivity, malnutrition and overeating and other components are especially significant. Together with the motivation of the population for a long, productive and fulfilling life, lifestyle indicators determine the specifics of national self-preservation/self-destructive behavior ^[16].

Lifestyle factors of the population have the greatest contribution to the deterioration of health. According to the state report on the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2021, alcohol and tobacco use, violation of norms and quality of food consumption, was typical for 64.9 million people, 46 subjects of the Russian Federation ^{[20, p.109]}.

In conclusion of the theoretical review, it should be noted that the health of citizens is a basic characteristic of the country's human capital. It determines not only the quality of life of Russians, but is also the basis of the economic power of the state. According to WHO experts, an increase in the quality of life of the population, an increase in life expectancy provides a positive dynamics of growth in the gross national product ^[7].

The practical part

Let's present the results of a sociological study on the topic "Human capital, migration and security: transformation in new migration conditions in Central Asia" conducted by the scientific team of Altai State University. The study of human capital in the system of preserving socio-demographic security and migration was conducted in six border regions of Russia (2021-2022). A multi-stage stratified sample was used, n=600 in each region, the age of the respondents was 18-70 years. The specifics of the functioning of the reproductive components of human capital were measured based on the analysis of relevant regional statistics and questionnaire questions, an expert survey. The survey made it possible to study the current conditions and factors of motivation of the population of the Russian border region to preserve their health and use health-saving technologies.

The article includes a primary analysis of descriptive statistics, as well as the results of regression analysis of the obtained data presented in the form of a model.

According to modern scientific concepts, health is defined not only as the absence of disease, but also as a feeling of a state of complete and comprehensive well-being, in a comprehensive understanding of this phenomenon.

According to modern Russian researchers, well-being and health are interacting concepts, and they have some common determinants ^[3,6].

The psychophysical and social well-being of the population is an indicator of the overall satisfaction of existence as a whole, as well as significant components of modern life in Russian territories. Figure 1 shows the distribution of responses from the population of six border regions of Russia on life satisfaction in general.

Figure 1 – Distribution of responses from the population of six border regions of Russia on life satisfaction in general (%).

As shown in the figure, every second resident of the border area (55.5%) is rather satisfied with his life, a small part of the residents (17.5%) states complete satisfaction. Almost one in five residents (20.3%) is not very satisfied or finds it difficult to assess the quality of their lives. The identified category of citizens probably cannot fully realize their human potential.

Let's turn to the regional differences in the assessment of the degree of satisfaction by residents of the border area, which are presented in table 1.

Table 1 - Distribution of the population's responses to the question: "How satisfied are you with the quality of your life in general", depending on the region %. (?2, p ?0.001).

As shown in table 1, there is some regional differentiation of life satisfaction due to significant social and financial stratification, and therefore different levels of income and living.

Rather, slightly more than half of the population of the studied regions are completely satisfied. In the Voronezh Region 61.7%; Chelyabinsk Region 60.4%, Belgorod 55.6%, Khabarovsk Territory 52.6%, Altai Territory 49.9%, Republic of Buryatia 48.7%. The regional vector of well-being of the population coincides with the vector of living standards, financial and material well-being reflected in objective statistical indicators ^[6].

Absolutely and not very satisfied with the quality of life minimally, relative to other regions, 37.5% were found in the Voronezh Region, 38.1% in the Chelyabinsk Region, 43.7% in the Belgorod Region, 45.6% in the Altai Territory, 48.6% in Buryatia.

Thus, a significant part of the population of the six border territories experiences social frustration, which is an indicator of incomplete well-being, and therefore incomplete health, in the context of the interpretation of health in modern WHO concepts.

The functioning of modern society in conditions of numerous risks and dangers actualizes the problem of personal and public safety of the population. Let's look at the responses of the population about their sense of security and identify their regional specifics.

Figure 2 - Distribution of responses from the population of six regions of Russia to the question "How safe do you feel? (%).

As shown in Figure 2, almost every second inhabitant of the border region feels more secure. The other half of the population experiences problems of varying degrees of intensity regarding the safety of their lives in a particular region.

Table 2 - Distribution of the population's responses to the question: "How safe do you feel", depending on the region %. (?2, p ?0.001).

Regional differences in the population's assessment of their safety, presented in table 2, are insignificant. The rating of a low level of feeling of security (a set of answers "not very and "I don't feel safe at all") is headed by the Khabarovsk Territory (36.3%). Approximately the same number of the population responded in a similar way in the Altai Territory (34.8%), the Chelyabinsk Region (33.0%), the Voronezh Region (33.4%), the Belgorod Region (32.3%), the Republic of Buryatia (27.0%). Thus, every third inhabitant of the Russian border area experiences insecurity of their life in society, which may be a condition and result of inefficient use of human capital potentials in these territories.

In the process of the existence of the modern world, the permanent experience of socio-economic, financial, geopolitical crises, the transformation of values and requirements for a person, significant adaptation to the changed conditions of society is required from the population. All this requires an optimal level of health and vitality. In this context, health is essential for the full and effective implementation of educational or professional activities. Let's turn to the subjective assessments of the population of the degree of their health.

Figure 3 - Distribution of responses from the population of six regions of Russia to the question "How do you assess your health status? (%).

Table 3 - Distribution of the population's responses to the question: "How do you assess your health status?", depending on the region %. (?2, p ?0.001).

As shown in Table 3, average, not good, but not bad health prevails in the regions. Every second resident of the border region gave a similar answer (from 53.7% in the Chelyabinsk region to 63.7% in the Voronezh region). Only only a third of the residents of the border regions can boast of their good health (from 29.5% (relative minimum) in the Voronezh Region to 37.6% (relative maximum) in the Chelyabinsk region).

Subjective assessments of one's health "as very good" have statistically significant regional differences. For example, in the Voronezh and Belgorod regions, 1.9% of the population were identified with a high level of their health. In the Altai Territory, 9.8% of the population with excellent health is recorded. In the Khabarovsk Territory - 4.7% are characterized by excellent health. In Buryatia, 2.2% and in the Chelyabinsk region 2.1% of the population have the highest reserves of health for a full and fruitful life. Thus, there are regional specifics that determine the quality of public health and, in some cases, provoke specific "medical" interregional and external migration (for example, the opportunity to change their place of residence to improve medical care). To identify statistically significant complex factors that determine the strategies of the population of six border regions regarding saving their health, let's turn to the regression model we have obtained.

A factor was determined as a dependent variable – a subjective assessment of the level of one's health, determined as a percentage. As independent variables, the following indicators were established: socio-demographic (type of settlement, gender); socio-economic (level of material prosperity, job satisfaction, satisfaction with quality of life, satisfaction with wages, satisfaction with one's financial situation, satisfaction with life in general, availability of financial savings, the ability to buy quality products, medicines, etc.); investments in human capital, in particular in health; indicators of the use of health-saving technologies in their lives and the motivation of the population for healthy lifestyle; the specifics of self-preservation behavior; psychological indicators, for example, the locus of control, in the context of their attitude to health, etc.

Table 4 Regression model of population health factors in six border territories of the Russian Federation

Note: R-(R is the square of Cox and Snell) is the coefficient of difference in prevalence; B is the coefficient of mutual influence of variables; p is the level of significance.

According to the presented model, the desire of Russians to preserve their health is determined by a whole complex of complex, interrelated indicators that form certain strategies. Among the socio-demographic indicators, the type of settlement and gender significantly mediate health care. Thus, according to our research, citizens are more focused on preserving and strengthening their health than residents of villages and villages. Women, to a greater extent than men, tend to take care of their health and lead a healthy lifestyle. In addition, women are much more likely than men to resort to health-saving technologies such as fitness, swimming pool, spa treatments, etc.

The socio-economic cluster has gained the largest number of indicators that indirectly and/or directly affect the level and quality of health. Factors such as job satisfaction, salary, one's financial situation, and life in general stimulate the process of health care and lead to higher subjective assessments of one's health level. The feeling of citizens' own safety is associated with the motivation of the population to protect and increase their health. These cohorts of the population understand that financial well-being and a high level of health are mutually dependent on each other, and therefore need timely monitoring and optimization. The state of health depends on the financial condition, so the vast majority of citizens of the Russian border region believe. Financial well-being directly stimulates such components of health promotion as the opportunity to buy high-quality products, purchase high-quality goods for beauty and health, pay for sports, fitness, massage parlors, spa treatments. These indicators revealed statistically significant indicators that determine, in the opinion of the population, the quality of their health. Thus, the level of material prosperity has become one of the integral indicators of a high level of health of citizens.

The population emphasized the importance of investments in the health of citizens, assessing the positive financial contribution of employers to the health of their employees. Such an option as free treatment in departmental sanatoriums is relevant.

The use of health-saving technologies by the population included such statistically significant indicators that determine the level of health as: physical education, gymnastics, running, taking vitamins, regular medical examinations, medical examinations, vaccinations (p ? 0.0001, respectively, for all indicators).

The specifics of self-preservation behavior, in our opinion, is a decisive factor in the context of preserving the health and motivation of Russians for a long and fruitful life. Its most significant indicators are lifestyle changes, namely the rejection of bad habits, abstinence from alcohol and smoking. In addition, it is important for citizens to establish an internal locus of control over their lives and health, which are generally associated with the individual's faith in the ability to manage their health. Confidence in your ability to be the master of your life is associated with the actualization of an independent solution to your problems. A positive regulator of one's behavior is the attitude that lifestyle can cause diseases. Understanding that the state of health affects the financial situation stimulates the use of health-saving technologies by the population, discipline in relation to their health and life in general. The possibility of freedom of choice and self-control in life also positively affect the subjective feeling of well-being, including psychophysical well-being.

Conversely, some of the attitudes, in our opinion, contribute to the negative impact of personality on their health. In particular, attitudes such as "the idea of illness is like a case, if you are destined to get sick, then nothing can be done, the feeling of fatality in your life ("I feel that I have little influence on what happens to me") provoke passivity in relation to your health.

The current state of one's health, namely the presence of chronic diseases, stimulates health care. However, such a feature of behavior indicates the delayed nature of taking care of one's health rather than preventing diseases.

Summarizing all the above, it should be noted that motivation for a healthy lifestyle, the use of health-saving technologies by the population, the basic components of self-preservation behavior of the population, turned out to be equally with the socio-economic situation of the regions, the most significant determinants of the quality of health of Russians. Besides. According to scientists, lifestyle is the most significant determinant of health and life expectancy, regardless of material factors ^{[1,8,9, 15]}.

Conclusion

The evolution of modern Russian society strengthens the interdependence of public and individual health

The effective solution of social tasks by social actors is largely determined by the level of individual health. On the other hand, the health of individual citizens is determined, including the state of society itself, by the standard of living in a particular region of the country. National health is thus an integral assessment of individual indicators.

The presence of such a two-sided mutual contour makes it possible to define health as a significant social phenomenon. All this stimulates the relevance of the state's social control of the national health of Russians, the development of effective and scientifically sound management decisions aimed at optimizing the health of citizens.

The study of public and individual health should be based on sociological studies of regions, including those related to border territories, generally reflecting the typical model of health conservation in modern Russian society.

The work was carried out within the framework of the state task of the Ministry of Science and Higher Education of the Russian Federation FZMW-2020-0001 "Human capital, migration and security: transformation in new migration conditions in Central Asia"