Factor model of the health of the Russian population in the border areas

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, Altai Territory, Barnaul, Dimitrova str., 66a, office 515 cher_67@mail.ru Other publications by this author     Ebeling Evelina Olegovna ORCID: 0000-0002-6291-4743 PhD in Sociology Associate Professor, Department of Social and Youth Policy of Altai State University 66 Dimitrova str., office 515, Barnaul, Altai Territory, 656002, Russia eva-ebeling@yandex.ru

Chukanova Tat'yana Viktorovna ORCID: 0009-0005-6837-4097 PhD in Sociology Associate Professor, Department of Social and Youth Policy, Altai State University 656002, Russia, Altaiskii krai, g. Barnaul, ul. Dimitrova, 66 chukanova.64@mail.ru

Introduction

The full-fledged health of the Russian nation is a basic component of human capital. The effectiveness of the implementation of socially significant activities and breakthrough technological projects depends on its condition and quality. At the same time, the individual health of citizens depends on the social health of society as a whole. The applied aspect of the study of social health is the implementation of priority tasks for its strengthening, disease prevention, motivation for a healthy, long and fulfilling life in Russian society ^[1]. In the context of the permanent demographic crisis, this is becoming a significant task for the state and Russian society.

Health as a complex phenomenon is the main investment of a personality, a decisive contribution to the capital of a person's identity, since it determines a number of social acquisitions, such as successful professional activity, growth of social status, and material security. The human health resource as a whole determines its success, can contribute to rapid career growth. Good health of the population as a whole will ensure more effective development of a particular region of the country. WHO experts have convincingly proved by examples that the good health of the country's population leads to an acceleration of the economic development of the state, the growth of its gross national product ^[13].

However, a review of modern statistical data on the health status of the Russian population, an analysis of secondary data from domestic sociological studies of recent decades, suggests negative trends. Among such trends, one can note the rejuvenation of morbidity, the downward dynamics of the health of the population of most Russian regions, and an increase in primary morbidity in Russia by 9% in 2012-2022 ^{[20; 21]}.

A number of Russian researchers note that an increase in the age of marriage and the delayed nature of the birth of the first child leads to the reproduction of a less healthy generation. According to scientists, in Russia in the last decade, one in three children has already been born sick or becomes ill immediately after birth ^{[18; 19]}.

In the modern society of risk, the relationship between public and individual health is becoming more and more conditioned, and the scientific discourse of public health research requires an understanding of the determinants and conditions of its change. It should be noted that the health of the Russian population is an indicator of general changes in a country, region, city or village.

In order to study the individual health of a particular person, it is necessary to analyze subjective and objective assessments of his indicators. For the analysis of public health, it is important to study the dynamics of such indicators as the total fertility rate, causes and classes of mortality, life expectancy and real life expectancy, the level and types of morbidity, indicators of disability of the population, etc.

A comparative analysis of subjective indicators of the population's attitude to health, their self-esteem, willingness to seek medical help, and motivation for health-saving practices is possible based on the results of sociological regional studies. At the same time, the data obtained not only reflect population trends, but also reveal territorial specifics. It is important to note that the territorial heterogeneity of Russian society is quite large.

The sociological survey of the results presented in the article was conducted in seven regions of Russia, namely in the Altai Territory, Belgorod, Voronezh, Chelyabinsk regions, the Republic of Buryatia, Khabarovsk, Primorsky Territories, and Moscow. These regions have their own specific territorial typicality, population structure, specifics of demographic development, different levels of investment in the health of citizens, and specific health care models. All this makes it possible to extrapolate the results obtained to similar Russian territories of this type.

Review

According to the WHO interpretation, health is conditioned by three basic components: a physical component that provides the body with an adaptive existence in the environment; a mental component that promotes mental comfort and adequate behavior; a social component that includes values and motives of human behavior in relation to its existence in society ^[12].

Social health is a significant determinant of social change. Any such transformations form a new environment for the life of the population. In this context, it is obvious that demographic trends will run in parallel with trends in changing attitudes towards health, the prevalence of health-saving practices, etc. ^[8]. Despite the adoption in the Russian Federation of the Concept of Demographic Policy for the period up to 2025, the problem of saving the Russian people continues to be relevant in modern times.

The category of "health" is related to the quality of the country's population. This system category includes such complex indicators as socio-hygienic, physiological, economic, demographic, social, etc.

The state and quality of health, as well as the level of care for it, are mutually determined by the economic and socio-cultural development of the region, depends on the state of medical care. There are also ethnocultural and climatic conditions that determine the specifics of health and care for it. Thus, health is a system–forming indicator of the vital activity of the population in its various manifestations ^{[21, p. 18]}.

In modern postmodern society, a high level of health and all the prerequisites for achieving it are considered a basic right individuals and nations are socially significant goals of social development. On the contrary, a low level of health is an indicator of a serious threat to the national security of a country, hindering progress ^[17].

According to a study by Russian sociologists, among the economic correlates of poor health, one can note a high level of material inequality, a low level of material life of the population as a whole ^{[14; 16]}. In addition, the correlation of the health of the population of Russian territories was revealed with satisfaction with their work, unfavorable external living conditions in the region ^[3].

The economic aspect of the study of health is based on the fact that "health is not just a benefit, it is one of the economic resources of society" ^{[3, p. 8]}. In the context of socio-economic theories of human capital, health care becomes the main investment in a person, designed not only to improve his health, but also to increase his working capacity. In this sense, health capital is the basic basis of integral human capital ^[6].

Analyzing generalized ideas about health in the context of various humanities, it is possible to identify a biological discourse, according to which a person's potential is a healthy heredity, the full–fledged work of all human body systems ^[2].

In a demographic context, it is important to analyze such indirect indicators of national health as population size, fertility, mortality, population density in a particular territory, the general structure of morbidity and the prevalence of disabilities among the population ^{[6, p. 38]}.

Ecological discourse considers health in the continuum of human adaptation and maladaptation in relation to the environment ^[4].

The physical aspect of the study of health is aimed at analyzing the integral indicators of the human body, allowing it to conduct an effective work activity, as well as to be an active social member of modern society ^[5].

A reproductive approach to health analysis is extremely important for studying the reproduction of the country's population.  It is associated with the study of an individual's potential abilities to prolong the genus, the specifics of orientation and motivation for the birth of healthy children ^[7].

  The psychological approach to health is based on the study of mental and personal well-being, the ability to effectively regulate behavior, and focus on activities satisfying the individual ^[8].

Emotional health is associated by modern researchers with the ability to overcome stress and develop emotional intelligence ^[9].

The spiritual context of the study of the phenomenon of health is based on the analysis of its vital values, which determine the uniqueness of an individual's life path.

Social health is associated with the analysis of the adaptability of a person in society, necessary for engaging in socially significant activities.

Cultural scientists study health in the context of studying the experience of forming a healthy lifestyle in the context of regional or national culture. Scientists evaluate the influence of a certain lifestyle on the culture of self-preservation behavior.

Summarizing the approaches proposed in various humanitarian areas, it can be stated that health is a multidimensional complex phenomenon that is realized in specific social conditions, ensuring the optimal functioning of human biological and social functions ^[10].

Solving applied research problems requires highlighting the following essential provisions. According to the first of them, health reflects a person's ability to effectively self-preserve behavior, contributing to the concentration of human vitality.

According to the second position, health is related to the ability to counteract disease. This aspect is an indicator of the fashion for a healthy lifestyle.

The reproductive potential of health is determined by the individual's ability not only to produce offspring, but also to transmit his cultural and spiritual values. In addition, health is not only ensuring the process of vital activity, but it is also the result of a person's contribution to their longevity and a full life.

The assessment of the state of health is possible based on the analysis of statistical data. The analysis of modern statistical data allows us to state that in 2020-2021 the life expectancy of Russians decreased to 70.1 years, but in 2022 there was an increase in life expectancy to 72.8 years. However, according to forecasts of life expectancy of Russians by 2022, we have not even reached its lowest level at 73, 75 years ^[20]. In addition, according to this indicator, we are still several years behind the Western countries.   In this regard, our society still has a lot of work to do to further improve the health and safety of Russian citizens ^[11].

 Having analyzed the results of the National Monitoring of Public Health in 2022, prepared by the Interdisciplinary Center for Public Health Research at Sechenov University, it is necessary to state, that the majority of Russians (about 70%) emphasized the presence of various health problems ^{[20, p.22]}. Every third resident of Russia experiences anxiety or depression. These conditions in Russians do not depend on age, gender, income or region of residence ^[21].

More than a third of the Russian population is diagnosed with hypertension, but only half of them take it seriously and take medications. A quarter of Russians suffer from high cholesterol, 10% of residents are diagnosed with angina pectoris ^{[20, p. 28]}.

The most dramatic is the data that every tenth death of a Russian man occurs at working age and could be preventable ^[22].

Summarizing the review of theoretical sources, it is necessary to state that the majority of deaths of the Russian population are due to low health, therefore, reducing mortality is impossible without a systematic scientific study of the determinants of health promotion motives.

The practical part

Let's turn to 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 ^[22].

To identify patterns of behavior aimed at strengthening one's health depending on significant social, economic, sociocultural determinants of social well-being, we conducted a factor analysis. The results are shown in table 1.

Table 1 - Results of a factor analysis of the population's attitude to health and a healthy lifestyle.

,770

,205

Eye diseases

In the process of factor analysis, 4 most significant factors were identified, the cumulative variance due to the influence of which amounted to 72,883%.

The first factor (the variance due to the influence of the first factor was 32.353%). This factor has been called "Chronic diseases as a motivator of health care." The factor combined the population's assessment of their level of health and the presence of chronic diseases.  This situation stimulates the growth of self-care.  This factor includes the following variables: assessment of one's health (r=0.339); the presence of chronic diseases (r=0.498); at the trend level, the presence of heart and vascular disease (r=0.338); hypertension, high blood pressure (r=0.387); at the trend level of eye disease (r=0, 361).  In addition, this factor, at the trend level, includes a variable associated with the assessment of one's sense of security (r=0, 251).

In the conditions of the modern world, the permanent experience of the socio-economic and financial crisis, the transformation of values and requirements for a person from the population is required significant adaptation to the changed conditions of society. 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.  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% of the population is 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).

The structure of diseases of the population of the border territories.

The objective picture of the health of the population of the studied regions is associated with the presence of chronic diseases of various systems and organs. 28.8% of residents of all regions reported having chronic diseases. 71.2% of the population of the studied regions reported the absence of such diseases. The low subjective morbidity rates obtained, in our opinion, indicate the sensitive nature of this issue, reflect the unwillingness to tell the truth about the real state of their health.  On the other hand, the data obtained may indicate a lack of awareness about their health and its indicators.

The revealed morbidity structure corresponds to global and all-Russian trends. Cardiovascular diseases and diseases of the gastrointestinal tract predominate among the population.  Among the first causes in the structure of mortality of the Russian population, cardiovascular diseases, hypertension, and oncological diseases also prevail.

Every sixth inhabitant of the border territories suffers from diseases of the spine, joints, allergies, ophthalmological diseases. The growth and rejuvenation of chronic diseases of Russians exacerbates negative demographic trends.

Since the last decade of the twentieth century, the depopulation of the Russian population has increased significantly. This period is characterized by an increase in mortality, a decrease in life expectancy, and high mortality rates, especially for the group of people of mature, working age. Vladimir Putin called this problem a demographic catastrophe and the main threat to the country's security. As a result, improving the health of the population of all age groups is not only of great social importance, but also determines the forecast of the civilizational development of Russia as a whole.

According to domestic research, almost every third young man of military age is released from military service due to health problems ^{[13; 15]}.

Such negative trends associated with the unsatisfactory state of health of the population of different age groups complicate the demographic situation in our country.

 The first factor, in addition to indicators of their health, includes an indicator of the population's subjective sense of their safety, let's describe it in more detail.

A complex phenomenon reflecting the well-being of the population is a sense of social security. Let's consider the interpretations of their security among the population of six border territories.

Only (12.1%) of the population feel completely safe. Other groups of the population feel some vulnerability in terms of their personal security. About half of the citizens (51.7%) rather feel safe. One in four citizens does not feel very safe and is most likely experiencing discomfort in terms of their mental and physical health. Representatives of the population do not feel safe at all (6.7%) and found it difficult to answer (3.3%). Thus, every tenth inhabitant of the border region experiences significant problems with the feeling of personal security, which requires further investigation of the determinants of this condition.

Regional differences in the population's assessment of their security 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 for not effectively using the potentials of human capital in these territories.

The data revealed in the process of population surveys reflect only a small percentage of the border region's population with disabilities (3.4%). The vast majority of citizens (95.5%) do not have disabilities.

The regional characteristics of disability problems in six Russian territories coincide in structure with the aggregate responses of citizens and reflect identical trends.

 According to official statistics, at the beginning of 2020, 11.9 million people (8.1% of the total population of Russia) the disability status was established.  In 2011, this figure reached its maximum of 13.2 million people (9.2% of the total population), and over the next 10 years it gradually decreased ^[21].

The third factor (the variance due to the influence of the third factor was 12.223%). The factor was called "Motivation for health care through employer investments", linked the indicators of employers' investments in improving the health of citizens.  This factor includes the following indicators: the use by representatives of the population of full or partial payment of vouchers to sanatoriums, rest homes, camp sites, children's camps (r=0.770); free treatment in departmental medical institutions, full or partial payment for treatment in other medical institutions (r=0.784).

Investments in the health of citizens are a significant indicator of the formation of human capital.

According to the conducted surveys, only a third of the employees of enterprises noted that they received free treatment in departmental health institutions or received partial or full compensation for their treatment. Thus, a significant part of the citizens (about 70.5%) of the population have never received such services. This fact indicates a low level of investment by the administrations of institutions in the health of their employees.  Nevertheless, the health of employees, their psychophysical well-being, is one of the main reserves of production.  The company can save significant financial resources by reducing losses from the presence of specialists on sick leave, preventing various kinds of disabilities.

  The distribution of responses from citizens of six regions on full or partial payment of vouchers to sanatoriums and rest homes is characterized by even more negative trends. Only one in four employees has ever received such bonuses at their enterprises. The revealed trend confirms the insufficient interest of the management in improving the health of its staff. However, the health of employees of an enterprise of any form of ownership is a crucial reproductive component of human capital.

The fourth factor (the variance due to the influence of the third factor was 10.118%). The factor was called "The pursuit of health-saving technologies and a healthy lifestyle." The identified factor included the following variables: at the trend level, "I regularly go to the pool, swim, exercise in the gym or fitness center (with or without a trainer)" (r=0.355); I regularly undergo a medical examination, medical examination, seasonal and/or routine vaccination (r=0.642); I do physical education, gymnastics, running, walking, cycling, tempering, drinking vitamin and mineral complexes (r=0.665).

Lifestyle and behavioral patterns of representatives of the population, according to experts, are the leading cause of health disorders ^{[18; 19; 20]}. The attitude to a healthy lifestyle, self-preservation behavior, the value of health and a peculiar philosophy of attitude to one's physical and mental well-being are of increasing importance.

To identify the significance of the influence of lifestyle on health, the attitude to the statement was analyzed: "I think that my lifestyle is in no way the cause of my illnesses."

 An analysis of the results showed that almost half of the population believes that their lifestyle does not affect their health, and it is determined to a greater extent by objective circumstances or factors that are difficult to control. The revealed trend can be described as the presence of an external locus of control in a significant part of Russians in relation to their health and life, which indicates ineffective patterns of self-preservation behavior.  In addition, the revealed feature confirms a certain fatality of the relationship the population, not the desire or the ability to be the master of their health and life. Slightly more than half of the population demonstrated more effective self-preservation attitudes. Lifestyle, as this cohort of the population believes, can determine the specifics of the quality of health, morbidity. Thus, the identified population group is characterized by greater activity and responsibility in monitoring their lives and health.  This population group has an internal locus of control in the context of maintaining its health, which is a more positive trend.

 Assessment of a fatal attitude to health and life, as well as the presence of/ the lack of an internal locus of control over one's health manifested itself in the responses of representatives of the population to the following question: "Illness is a matter of chance; if one is destined to get sick, then nothing can be done?"  About half of the population of the border region agrees with this statement, stating a certain passivity in relation to their health, subjection to fate and negative circumstances. All this can be described as a reduced level of responsibility for your health. More than half of the population (60%) showed a more responsible and serious attitude to the control of their health and emphasized the desire to preserve and increase it.

 In the context of lifestyle analysis, it is important to analyze the attitude of the population of Russian regions to the impact of health on the financial situation of citizens.

Almost one in three residents of the border area associates their financial condition with their health status. Most of the citizens do not consider the existence of such a relationship obvious. Such an understanding of the problem, in our opinion, indicates that a significant part of the Russian population considers health to be a tool rather than a resource for a prosperous financial life. The revealed attitude may stimulate insufficiently effective self-preservation strategies.

About one in three citizens of the Russian border region is confident that a person's financial situation determines the quality of their health. Most citizens consider such dependence to be rare or completely absent.  It is obvious that at the household level, the population implements the installation "money can't buy health!". Thus, the fatalistic attitude towards health, the possibility of treatment, etc. described above is confirmed.

Let's consider the attitude of Russians towards a healthy lifestyle and describe the specifics of their use of health-saving technologies.

Every second citizen of the Russian border region tries to abstain from alcohol and does not smoke. Slightly less than half of the population regularly undergoes medical examinations, medical examinations and vaccinations. About a third of the population is engaged in physical education, gymnastics, and running. The same cohort of the population takes vitamins to maintain their health. A small part of the citizens, about one in eight regularly goes to the pool and swims. Every tenth representative of the population of the Russian border territories does not adhere to any of the above-mentioned healing practices.

Numerous domestic and foreign studies prove that health models are mutually conditioned by an appropriate lifestyle ^{[8; 21; 22]}.

Conclusion

To date, the Decree of the President of the Russian Federation No. 254 dated June 6, 2019 "On the Strategy for the development of healthcare in the Russian Federation for the period up to 2025" is being implemented in Russia. Nevertheless, in our opinion, it is necessary to formulate effective and achievable goals and guidelines in optimizing the public and personal health of the country's citizens. It is important to propose clear criteria for the real achievement of the proposed strategy, based on objective scientific indicators. In this regard, it is difficult to overestimate the problem of constantly monitoring the health of Russian citizens.  It is important not only to develop innovative strategies for saving public health, but first of all to create an environmentally friendly environment for its full implementation and reproduction of health-saving practices.

The problem of creating a health-saving environment must be replicated in medical, educational, scientific, public, and industrial communities. To ensure the continuity of the implementation of this technology from childhood to old age. Significant components of such an environment should be: the ecology of consumer products, affordable and high-quality medicine, effective management decisions of the administrations of the state and individual regions of the country.  Protecting the health of Russians should become a central issue of the state's social policy.

In addition, it is important to replicate a culture of self-preservation behavior that increases the personal responsibility of each citizen for his health, a full, long and happy life in the Russian state.

The formation of a health-saving environment favorable to citizens must be implemented at the macro level - at the level of the state and the basic directions of its policy; at the meso level, including consideration of the specifics of regional health care; at the micro level of the family and self-awareness of each individual citizen.

The formation of such a healthy living environment for Russian citizens should be comprehensive. It is important to optimize a whole range of socio-economic living conditions, such as: stable material income, affordable and comfortable housing, adequate nutrition, accessibility and a high level of medical care. These measures should encourage the Russian population to achieve good health.