The health of the population of the region as a systemic object of sociological analysis (results of the pilot study)

Deriugin Pavel Petrovich ORCID: 0000-0002-5380-8498 Doctor of Sociology Professor, Department of Applied Sociology, St. Petersburg State University 194354, Russia, Saint Petersburg, ul. Artists Ave., 15, k-1, office 456 ppd333@rambler.ru Other publications by this author     Cimtikov Zhomart Kudaibergenovich ORCID: 0000-0003-0770-488X Doctor of Politics Professor, Department of Political Science and Social and Philosophical Disciplines, Kazakh National Pedagogical University. Abaya 050000, Kazakhstan, Alma-Ata region, Alma-Ata, Dostyk str., 13 zhomart-67@mail.ru Other publications by this author     Malinina Tat'yana Borisovna ORCID: 0000-0003-2420-1993 Doctor of Sociology Associate Professor, Department of Social Analysis and Mathematical Methods in Sociology, St. Petersburg State University 190000, Russia, Saint Petersburg region, Saint Petersburg, ul. Artists Ave., 15, k-1, office 456 tatiana_malinina@mail.ru

Glukhikh Vladimir Aleksandrovich ORCID: 0000-0001-9260-6420 PhD in Philosophy Associate Professor, Department of Sociology and Political Science, St. Petersburg State Electrotechnical University "LETI" named after. V. I. Ulyanova (Lenin) 190000, Russia, Saint Petersburg region, Saint Petersburg, ul. Artists Ave., 15, k-1 vladimirglu@mail.ru

Introduction. The systematic sociological study of the health of the population of Russian regions is characterized by a number of features that distinguish the sociological approach itself from approaches relevant to other scientific disciplines. First of all, this refers to a holistic understanding of the main category of analysis, the category of health.

The relevance of the study is due to the practical need to further strengthen health, reduce morbidity and mortality of Russians (See Golikova reported a decrease in mortality in Russia https://www.interfax.ru/russia/933698 (date of application - 11/29/2023), as well as the development of the human capital of the regions ^[1,171].In this regard, the sociology of health faces new tasks of scientific explanation and ensuring decisions on healthcare ^{[2, p. 134]}, giving this work a systemic character in the regions ^[3].Problem. Health is an object of study of sociology, medicine, biology, cultural studies, philosophy, economics in modern science and appears as a medical-social, socio-economic, socio-political problem. Scientific research outlines a range of approaches to understanding health: (1) physical, mental ^{[4, 56]} and social health are treated equally ^{[5, 124]}; (2) as a set of human living conditions and social well-being (See Regional indicators of socio-economic well-being. Research note. – 2016. – № 9); (3) as a set of social benefits ^{[7, 79]} and as an opportunity to meet the social needs of an individual ^{[8, 34]}; (4) as an assessment of the fairness of the distribution of benefits in society ^[9] and a number of others. The multidimensional nature of the health phenomenon suggests the need for an interdisciplinary approach to its study. But in reality, such a statement of the question can only be considered as a prospect. The first step in the formation of an interdisciplinary platform should be recognized as the development of a systematic approach. At the same time, a contradiction has developed between the theoretical discourse and at the level of empirical health research: health and mortality are described in theory as interdependent phenomena, but in empirical procedures, indicators of the links between health and mortality are analyzed as autonomous indicators.

Methodology. The theoretical and methodological foundations for the study of an integrative approach to the study of health are the fundamental ideas of the classics of sociological science M. M. Kovalevsky, P. A. Sorokin, V. A. Yadov and others, which show that sociology is essentially an integrative science ^{[10, 12]}, generalizing existing social knowledge and providing analytical tools for synthesizing new knowledge ^{[11, 151]}. This is also typical for research on the systemic nature of health.

According to the Great Russian Encyclopedia, the main systemic features of research objects are goal setting, integrity, value, structurality, interaction with the environment, hierarchy, multiplicity (See System. The Great Russian Encyclopedia. https://bigenc.ru/c/sistema-4284c7 (date of reference: 3.12.23). In the works specifically devoted to the analysis of health carried out by N. A. Lebedeva-Nesevrya and S. S. Gordeeva (2015), ten relevant scientific approaches to the definition of the concept of "health" were summarized ^{[12, 201]}, which, as the authors show, largely reveal its systemic signs. These signs are as follows. Goal setting. The "expediency" of health is immanently determined by the goal (V. I. Vernadsky, V. P. Kaznacheev, E. A. Spirin). Any manifestation of human nature is recognized as healthy, depending on its expediency for general species adaptation and as a condition for the actualization of human acmeological abilities (A. A. Bodalev, G. T. Ganzhin). Integrity. Health is integrated from the "set of average norms", but cannot be reduced to a simple sum of these indicators. As representatives of the holistic theory of health show, its integrity is acquired in the process of ontogenesis, presupposes personal maturity and assimilation of life experience in the natural environment and society (E. Erickson, G. Allport, K. Jung). The axiological value of health is an indicator of the state of society and the value of a person in this society, it is a universal value. The dominance of certain social values is considered as factors determining the value of an individual's health (A. Kempinski, A. Maslow). The structurality of health can be described through a set of elements determined by its nature. Interaction with the environment. Health is considered by the "harmony" between the inner world of a person and the external social environment as a socio-cultural and national variable, provided by constant influences that contribute to its reproduction (G. Marcuse, E. Fromm, Z. Freud, K. Horney). Hierarchy. Each component of the health system, in turn, can be considered: 1. as located on the levels from the lowest to the highest; 2. as a component of a broader system. Health integrates various macro and micro levels of a person in the system of social stratification ^[13]. The multiplicity or "multidimensionality" of health characterizes the unity of physical, mental and social well-being, which are revealed through a comprehensive study of the characteristics of levels, layers, time, etc. (M. Murray, V. Evnas). In the present case, the multiplicity of health is studied as a social phenomenon that is a projection and as a product of a certain discourse that has its own internal logic of construction (M. Foucault). In the aggregate of the shown properties of health, as the authors emphasize, it should be understood as a systemic education.

The conclusions of the sociology of medicine correlate with the results of research by medical scientists. In particular, this concerns the works of the Russian Doctor of Medical Sciences P. I. Kalyu ^[14], who in the late 90s of the last century (1988) made two important conclusions: first, the conclusion about systemic signs of health. P. I. Kalyu's generalizations are based on 79 definitions of health formulated by scientists from different countries and the World Health Organization (WHO). There are six such signs of health: this is a normal function of the body; it characterizes the dynamic balance of the body and the environment; makes it possible to perform social functions; allows the body to adapt to environmental conditions; this is the optimal functioning of the body in the absence of signs of disease; the ability to self-regulate. As you can see, we are talking about the numerous connections of health, its functions, dynamics, adaptive properties, self–regulation - the essence of systemic properties. Secondly, the scientists concluded about four conceptual models for understanding the sources of health: the medical model - the absence of diseases ^[15]; the biomedical model – the absence of feelings of ill health ^[16]; the biosocial model – the priority of social signs ^[17]; the value-social model - health as a value (See Sobolkova O.V. Health, how is the value of a person 03.08.2021 https://sobolkova-ds130.edusev.ru/folders/post/2748993 (date of access: 11/21/2023). In the latter case, the consistency lies in the fact that health is understood as the integration of two vectors: the objective/subjective and the personal/social order. Such an intersection forms numerous relationships that act as systemic properties of health.

In modern sociological science, the essence of health is increasingly recognized as the idea of consistency. Thus, V. I. Gorovaya and N. F. Petrova (2006) in their work "The idea of consistency in defining the concept of health" formulate the task of harmonizing knowledge about levels, spheres and elements of health "revealing the interrelationship of these levels, which is especially important from the standpoint of a systematic approach" ^{[18, 26]}. This conclusion also correlates with the results of a special study by I. A. Gareeva, who examined the theoretical and methodological foundations of the healthcare system ^{[3, p. 134]}. The author emphasizes that the systemic representation of both the health of an individual and public health is the basis of the entire health care system. The previously shown characteristics of health allow S.S. Shmatova to conclude that the modern understanding of the category of health is the most adequate – a systematic approach to determining its essence ^{[19, 430]}. In the present case, health is considered multidimensional from the point of view of the subject of sociological science itself, which involves the study of objects as interconnected integral complexes of phenomena of social reality ^[20]. In 2019, in an article by authors G. S. Nikiforov, Z. F. Dudchenko, E. A., Rodionova, V. I. Dominyak, the idea of health was interpreted as a systemic education ^[21]. Thus, modern health research presupposes its analysis as a systemic education. The main feature of the systemic understanding of health is the presence of a set of significant connections both within the object of research itself – health, and in the external environment – with other health factors.

The aim of the empirical part of the study was to identify and study the systemic links between the basic factors of health and mortality in Russian regions based on correlation analysis methods, i.e., to study the relationship between health, morbidity and mortality. The object of the study was the regions of the Central Federal District (16 regions). The choice of this district as an object of study is due, firstly, to the significant population of Russians living in them. Secondly, in the regions of this district, a significant number of social relations significant for the health of the entire Russian society are collectively represented. Thirdly, numerous statistical and scientific research data have been accumulated on the state of health, diseases and mortality in these regions. The subject of the study is to identify the degree of influence of both objective and subjective factors of health, morbidity and mortality in the regions. The choice of 2020 as the period for analyzing the problem was determined by the interests of having complete data on the regions of the Central District previously published in open sources.

Objective factors of health/mortality formation (See Fertility, mortality by regions of the Russian Federation. https://statprivat.ru/demo2020?r=3 (Date of reference: 11/18/2023) included: average per capita income, housing stock, budget orientation for social purposes (See Regions of Russia. Socio-economic indicators. 2022: P32 Statistical collection / Rosstat. M., 2022. 1122 p.) The average per capita income objectively shows how much financial resources are on average per person (See the average per capita income of the population in Russia https://rosinfostat.ru/srednedushevoj-dohod / (Accessed: 11/18/2023). The concept of housing stock includes all types of housing that are suitable for permanent human life (See Housing Stock https://advokat-malov.ru/zhilishhnyj-fond/zhilishhnyj-fond1.html (Date of access: 11/18/2023), calculated according to objective statistical data. The orientation of the budget for social purposes provides for the allocation of public funds for social programs and measures to support poorly protected segments of the population, the indicator is presented in statistical information (See What is a socially oriented budget? https://foto-skazka.ru/znacheniya/socialno-orientirovannyi-byudzet-cto-eto-znacit (Date of access: 11/18/2023). The subjective indicators of health/mortality include the social well-being of the population of the regions (See the Foundation for the Development of Civil Society. Rating of social well-being of Russian regions. The second issue http://civilfund.ru/mat/44 (Date of application: 11/18/2023) and a healthy lifestyle. Social well-being is considered as an integral characteristic of the implementation of a personality's life strategy, attitude to the surrounding reality, and its subjective sides ^[33] (See Social well-being https://bigenc.ru/c/sotsial-noe-samochuvstvie-862f36 (Date of application: 11/18/2023), i.e. as a manifestation of consciousness reflecting the relationship between the level of claims and the degree of satisfaction of the needs of the subject ^[22]. It is calculated on the basis of subjective information based on the results of sociological research. A healthy lifestyle (HLS) is a lifestyle of a person that helps to maintain health and reduce the risk of diseases by controlling behavioral risk factors (See Healthy Lifestyle (HLS) https://yandex.ru/search /?text=healthy+lifestyle+life&lr=165874&clid=2357978-133&win=604&src=suggest_T (accessed: 11/18/2023), it is calculated based on surveys (See the rating of regions by population commitment to healthy lifestyle https://riarating.ru/infografika/20220919/630229493.html (Date of access: 11/18/2023). The hypothesis of the study assumed confirmation/refutation of the fact of significant links between morbidity and mortality with objective and subjective factors of social health. The second part of the hypothesis was aimed at confirming/refuting the leading role of social factors in the modern human health system.

Empirical data on the health and mortality of residents of the Central Federal District, where 40240256 people live, are summarized and summarized in Table No. 1.

Table No. 1.

Data on indicators of health, morbidity and mortality of residents of the Central Federal District

Table No. 1.

Data on health indicators, morbidity and mortality of residents of the Central Federal District

The further procedure of the study involved a correlation analysis between the health and mortality indicators of the regions, which can be used to assess the dependence of variables revealing the system characteristics of the object ^[23] (See Correlation.https://yandex.ru/search/?text=coefficient+correlation&clid=2357978-133&win=604&lr=165874 (accessed: 11/27/2023). The results of the correlation analysis are presented in Table 2.

Table No. 2.

Correlations between indicators of health, morbidity and mortality

Table No. 2.

Correlations between indicators of health, morbidity and mortality

The analysis of the correlation matrix of the relationship of health factors with morbidity and mortality reveals the main characteristics of these dependencies. As will be shown below, most of the identified connections turned out to be important and significant. At the same time, it should be borne in mind that, as experts in correlation analysis in the field of human problems say, the significance of correlations, even at the level of 0.15, should be recognized as requiring attention (See What is considered a "strong" correlation? https://www.codecamp.ru/blog/what-is-a-strong-correlation / (date of access: 11/27/2023).

Mortality and morbidity. Mortality and morbidity of residents of the regions are in a direct positive relationship: the higher the incidence in the region, the more deaths. The relationship of these events is +0.32, i.e. it can be characterized as an average positive one. Reducing the level of morbidity and subsequent mortality, as noted by doctors, requires the use of new approaches to organizing a system for detecting diseases of the population and providing them with medical care. The gigantic pace of industrialization and urbanization, under certain conditions, can lead to a violation of the ecological balance and cause degradation not only of the environment, but also of human health. Therefore, with good reason, health and disease can be considered interrelated derivatives of the environment ^[24].

Mortality. First of all, it should be noted that there are significant negative correlations between mortality rates and indicators of objective data on the socio-economic situation: on average per capita income (-0.92); on the availability of housing stock among the population (-0.87); on the orientation of the budget for social purposes (-0.84). As you can see, these factors significantly reduce morbidity and mortality. The average indicator for these coefficients is a negative value of the correlation coefficient -0.88, which characterizes a very high negative relationship: the more important the indicators of objective factors are, the lower the values of morbidity and mortality. Thus, the high wages of the residents of the regions, the provision of housing and the orientation of the budget towards social goals have a significant impact on the prevention of mortality.

As for the correlation of mortality rates with subjective health factors, they are significantly lower (total -0.04). Such a relationship in the theory of correlation analysis is interpreted as a weak negative one. At the same time, the influence of factors is unequal and multidirectional. Thus, the indicator of social well-being is associated with mortality rates at the highest limits of the characteristic of an average negative relationship (-0.49), while the indicator of orientation to a healthy lifestyle is associated with mortality with an average positive relationship (+0.39). This is a paradoxical situation. Perhaps this suggests that the mortality of people who share the interests of a healthy lifestyle increases the risk of death. In fact, this trend is attracting more and more attention from doctors, nutritionists, and fitness trainers. A lot of materials have already been written on this topic, and studies have been conducted confirming the validity of this conclusion (See Scientists explained why adherents of healthy lifestyle die earlier. https://www.km.ru/zdorove/2016/10/03/issledovaniya-rossiiskikh-i-zarubezhnykh-uchenykh/785502-uchenye-obyasnili-pochem (date of application: 11/28/2023), (See Death from a healthy lifestyle: why do "healthy people" die earlier? https://dzen.ru/a/Ylkk7PAF7AkxXLND (date of application: 11/28/2023). The real problem requires more scrupulous independent research.

Morbidity. Objective factors significantly affect the reduction of morbidity in the population, but the degree of their influence is significantly lower, only -0.17. In general, the indicators of the correlation of morbidity and objective health factors are at the level of statistical error. The most significant factor influencing morbidity is again the average per capita income (-0.25). To a lesser extent, morbidity is influenced by the orientation of the budget towards social goals (-0.2) and even less mortality is associated with the availability of housing (-0.07).

The connectivity of factors. In general, the connectivity of objective factors (+0.88) is several times higher than the connectivity of subjective factors (-0.21).

Conclusion. The conducted pilot study confirmed the presence of significant dependencies in the characteristics of the links between health, morbidity and mortality in the regions, i.e. proved their systemic nature. The obtained data also allowed us to conclude about the leading role of objective socio-economic living conditions of residents of the regions as decisive factors in preventing morbidity and mortality. In particular, this result confirms that in theoretical developments on the systemic nature of health, important conclusions have been formulated about health as an integrative result of the addition of a set of heterogeneous factors.

The obtained result of the piloting allows us to outline new areas of research on systemic signs of health and their relationship to morbidity and mortality. In particular, this can be achieved by differentiating health indicators and diagnosing their dependence on a variety of living conditions and factors. The obtained results can also be applied to adjust the formulated principles and approaches for the development of interdisciplinary knowledge about health, the peculiarities of the influence of objective and subjective factors on health.

Generically, we can talk about the understanding of health as a category of sociology, which has passed through some stages: firstly, when it was understood as a combination of various physiological and mental phenomena in the human body; secondly, the understanding of health as a set or complex of bodily, social and natural living conditions; thirdly, the understanding of health as a systemic phenomenon and the result of the interaction of individual and social factors. The results of the study confirm that the modern definition of health is revealed through the category of interaction of internal and external factors contributing to the successful adaptation of a person to a social and natural environment, with the decisive role of social factors. Health is characterized by the ability to resist diseases, infirmity and mortality, the onset of which indicates a violation or destruction of systemic connections.

A regional approach is becoming one of the promising areas of systemic health research. Highlighting the regional aspect is important for two main reasons, firstly, the natural conditions of the regions reflect the special characteristics of the territories that specifically affect the promotion of public health. Secondly, the administrative and managerial potential of regulating health issues is being formed in the regions, the ability to influence objective determinants of health, which in turn are the main factors in preventing diseases and mortality.