MEDICAL INFORMATICS IN OCCUPATIONAL
AND ENVIRONMENTAL HEALTH OF RUSSIA:
Need of Reforms
Nikolay V. Matveev, MD, PhD
Research Institute for Hygiene and Occupational Pathology
Nizhny Novgorod, Russia
International Policy Fellowship
Open Society Institute
Budapest, Hungary
Summary
Occupational and environmental health
(OEH) is one of the most socially important fields of public health in majority
of industrially developed countries. Unfortunately, currently in Russia (as
previously in The Soviet Union) little societal attention is paid to OEH issues,
while it was estimated that the economical burden only due to occupational
health disorders in Russia was not less than 10% of national GDP (N. F. Izmerov,
E. I. Denisov, 2000).
To substantiate the most optimal managerial decisions
in public health, the system of medical informatics is used, providing collection,
analysis and distribution of healthcare information. Unfortunately, medical
informatics in Russian OEH is less developed, compared to other countries
(including some former socialist countries).
Our investigation has demonstrated that main problems
of Russian medical informatics in OEH were connected not with analysis of
information, but with collection of primary data and the use of analyzed information
at societal level. The collection and the distribution of information (mainly
outside the healthcare system) are very important to make the available information
reliable and useful for the society.
Some changes in Russian OEH medical informatics system
are proposed:
1) The existing communication possibility of regional
Centers for Occupational Pathology in Russia should be used to provide distant
telemedical consultations, to provide better availability of occupational
health for workers of distant areas of Russia and, therefore, higher rate
of occupational cases.
2) The National Register of Occupational Patients should
be established in Russia in the nearest future; to provide full and reliable
registration of occupational cases.
3) Special epidemiological investigations should be performed
in Russia, to collect reliable information on real occupational morbidity
in the country.
4) The reliable information on occupational and environmental
health in Russia must be available not only to medical and social insurance
specialists, but also to public and mass media.
5) The existing system of Social and Hygienic Monitoring
(SHM) in Russia is a very promising tool to analyze the factors influencing
the population health; still it lacks a subsystem modeling the results of
possible response actions of the society, therefore such a subsystem should
be created.
6) Calculation of occupational and environmental risks
should be used to create the economic stimuli for the society to improve the
environment (including work environment) and, therefore, decrease adverse
health effects for the population.
The proposed changes could be relatively easily implemented
within the existing Russian healthcare system. Their implementation would
help collecting more reliable OEH data, as well as distributing the analyzed
information within the society and making effective political and managerial
decisions aimed at population health preservation.
Introduction
Occupational and environmental health
is the branch of public health that has the strongest association with important
societal obstacles (work safety issues and environment pollution respectively).
Therefore, the collection and the distribution of reliable information on
occupational and environmental health are essential to provide proper managerial
and political decisions in this socially important sphere.
The necessary data flow should be provided using medical
informatics system. According to WHO definition, “medical informatics is the
field of information science concerned with the collection, analysis and
dissemination of medical data through the application of computers to various
aspects of health care and medicine”. Unfortunately, the state of Russian
medical informatics system in occupational and environmental health appears
to be not sufficiently developed – the relative number of publications in
this sphere per 1000 physicians in Russia was approximately 2 times less than
in Ukraine, 8 times less than in the USA and 15 times less than in Finland.
Currently the system of Social and Hygienic Monitoring
(SHM) is introduced in Russian environmental and occupational health. SHM
system is supposed to be “the state system of surveillance, analysis, estimation
and prognosis of state of population health and human environment” (“The statement
on Social and Hygienic Monitoring”, approved by RF government on June 1,
2000). The existing SHM system provides collection and analysis of environmental,
health, social and, partially, occupational data throughout the country –
from district centers for sanitary and epidemiological control to Federal
Center in Moscow. There are special computer programs that were developed
especially to provide data flow within SHM system. A number of computerized
systems were also developed in regional centers of Russia, to calculate occupational
and environmental risks. Still there is belief that, despite of developed
system for analyzing occupational and environmental data, there are problems
in collecting the reliable primary data and use of received information for
making effective managerial decisions.
Occupational health
The issues of occupational health
are extremely important in all industrial countries, there are advanced systems
providing compensations for workers in case of work-related injuries or illnesses
in most of the countries. The estimated burden of occupational disorders is
very high – up to $170 billion annually in the USA, which is about 5 times
higher than the US burden of AIDS (Leigh JP, Markowitz SB, Fahs M et al.,
1997), and up to 10-20% of GDP in Russia (N. F. Izmerov, E. I. Denisov, 2000).
Despite of available pessimistic estimation for possible
economical loss due to occupational disorders in Russia, little attention
is currently paid to improvement of occupational data flow system in. The
available official figures of occupational morbidity (2.24 new cases per 10,000
workers in 2001) are too low to be considered as reliable (the US and European
figures are 20-50 times higher). One of probable reasons for occupational
illnesses underreporting is little availability of occupational physicians’
services for the workers of distant Russian areas.
No system for registration of occupational diseases is available
in Russia yet, though the discussions on the topic have being led for many
years. Now the information on different aspects of occupational health is
collected in at least 4 different systems, having virtually no interconnections.
Though numerous systems of occupational risk assessment have
been created in Russia, the obtained data must not be reliable, as the primary
data are questionable. Even if the received information of occupational risks
is fully reliable, there is no political or economical mechanism to transfer
the obtained information into response action to provide necessary support
for those groups of workers who suffer from occupational diseases more frequently.
Unfortunately, the existing system of Social Insurance in Russia does not
connect the employers’ payments to Social Insurance Fund with occupational
risk for the workers.
To make the medical information system in occupational
health of Russia more effective, several changes should be made:
1) The existing communication possibility of regional
Centers for Occupational Pathology in Russia should be used to provide distant
telemedical consultations, to provide better availability of occupational
health for workers of distant areas of Russia and, therefore, higher rate
of occupational cases.
2) The National Register of Occupational Patients should
be established in Russia in the nearest future; to provide full and reliable
registration of occupational cases.
3) Special epidemiological investigations should be performed
in several branches of Russian industry, to collect reliable information on
real occupational morbidity in the country.
4) Calculation of occupational risks should be used to
create the economic stimuli for the employers to improve the working conditions.
5) The reliable information on occupational health must
be available not only to medical and social insurance specialists, but also
to public and mass media.
Environmental health
WHO gave the following definition
for environmental health (1993): “Environmental health comprises of those
aspects of human health, including quality of life, that are determined by
physical, chemical, biological, social, and psychosocial factors in the environment.
It also refers to the theory and practice of assessing, correcting, controlling,
and preventing those factors in the environment that can potentially affect
adversely the health of present and future generations”. The problem of responsibility
for health disorders due to environmental factors (especially, anthropogenic
environment pollution) can be very important, especially now, when a great
attention of the society is paid to environmental issues. There should always
be a balance between interests of industry, producing e.g. hazardous pollutants,
and interests of the population exposed to the pollutants.
The Social and Hygienic Monitoring system, introduced
in Russia since 1990s, seems to be rather a powerful tool, able to provide
the necessary analysis of information both on population health in specified
regions and various hygienic and social factors in the same regions.. Unfortunately,
currently the Russian SHM system is considered to be mainly an information
system, not a system to propose some response action. To suggest the healthcare
managers and politicians some alternatives for action in sphere of public
health, the system must provide also a kind of population health model. The
model should be used to predict the consequences of possible actions, to maximize
positive effects.
Numerous investigations were performed in Russia to estimate
environmental risks for several population groups. Still there is an official
statement now, that “the results of risk estimation are not used to adjust
the payments to ecology funds or by State Control institutions to impose sanctions”.
It obviously diminishes societal effectiveness of environmental risk assessment.
Were there a mechanism, connecting calculated environmental risk with either
payments to ecology funds or sanctions, the importance of risk assessment
system (and also the whole SHM system) would be significantly higher.
Without such a mechanism the estimated environmental
risk is mainly of academic interest, not a practical tool.
To increase the effectiveness of the existing system
of Social and Hygienic Monitoring in Russia, several changes are suggested:
1) Within SHM system, a subsystem should be created, able
to model the possible population health effects due to activity of healthcare
system.
2) Calculation of environmental risks should be used to
create the economic stimuli for the society to improve the environment and,
therefore, decrease adverse health effects for the population.
3) The reliable information on environmental health risks
in Russia must be available not only to medical and environmental specialists,
but also to public and mass media.
Conclusions
Currently the Russian system of medical
informatics in sphere of occupational and environmental health is probably
less developed than that of industrially developed countries (European countries
and the USA). Still there are the possibilities for reforms of the Russian
system in the nearest future. The suggested directions of the reforms are
not something absolutely new for Russia; they could easily be accepted by
the professional community. Partial implementation of some suggested ideas
started during 2002 (e.g. Registry of Occupational Diseases); this demonstrate
the feasibility of our suggestions.
It is supposed that the implementation of suggested changes
would help collecting more reliable data in occupational and environmental
health, as well as distributing the analyzed information within the society
and making effective political and managerial decisions aimed at population
health preservation. This will result in decreasing the burden of occupational
and environmental diseases for the Russian society.