It will only get worse
The government discussed the demographic situation in Russia
Irina Reznik, Mednovosti
In Russia, the fertility potential is almost exhausted, and the mortality rate, significantly exceeding the indicators of developed countries, will only increase in the near future – the government discussed the implementation of the demographic policy concept until 2025. Women who give birth after 25 years, old people who have lingered in this world, district doctors and paramedics, anti-vaccination workers and even the WHO, who made a mistake this year with the flu vaccine, were found guilty.
The demographic policy concept approved in 2007 for the period up to 2025 envisaged by 2016: the population at the level of 142-143 million people, an increase in life expectancy to 70 years, and the birth rate to 1.7 children per woman of reproductive age. To date, all these indicators have been met. And in terms of population due to the Crimean Federal District (2.3 million people) and migration growth (280 thousand people) – exceeded.
And today, as Prime Minister Dmitry Medvedev said at a conference call at the end of last week, "there are two trends: one that inspires us all, and the second that should be alarming." It is inspiring that the predictions about the "degeneration and desolation of the lands" have not come true. And the increase in mortality that began last year is alarming. Already from January to April 2015, this indicator increased by 3.7%, and the birth rate decreased by 1.2%.
Before this meeting, President Vladimir Putin instructed the government to analyze the causes of the increase in mortality in the first quarter of 2015, develop and take additional measures to reduce mortality. The Prime Minister, together with the heads of regions, should report on July 30.
Birth rateThe fertility potential in the country is almost exhausted, Maxim Topilin, the Minister of Labor and Social Protection responsible for demographic issues in the country, said at the meeting.
In terms of the birth rate, Russia has reached the average positions of European countries (1.75 children per woman of reproductive age), but the birth rate does not provide simple reproduction of the population (for this, a coefficient of 2.15 is needed). There is no need to wait for further growth, since the achieved level is almost close to the "reproductive attitudes of the population" (1.91). In addition, the age of the mother at the birth of the first child is increasing in Russia and a large number of abortions remain.
It will only get worse, warns Topilin: in the next 8 years, the number of women of the most active reproductive age (from 20 to 29 years) it will decrease by 36% – from 11 to 7.5 million people. The number of women aged 30-44 years will also decrease (by 6%).
MortalityAccording to the state program "Healthcare" by 2020, the mortality rate in Russia should drop to 11.4, now it is 13.1. "World experience shows that the reserves of birth rate growth are insignificant, and the reserves of mortality reduction are significant," Topilin said.
– The coefficient of 11.4 means about 1.7 million deaths per year. And if we can support the birth rate at the level of 1.75–1.8 million with additional measures and still find reserves to reduce mortality, we will be able to keep within the natural growth, albeit small."
Meanwhile, in terms of life expectancy, Russia lags behind developed European countries by an average of 7-10 years. And in terms of mortality, it is 20% ahead of them. The country has a high mortality rate in working age, especially among men. The small generations born during the war are being replaced by numerous generations born in the post-war period, and by 2021 the number of people over working age will increase by 17.8%.
The main thing is to count correctlyThe aging of the population is one of the main causes of the increase in mortality, according to the Minister of Health Veronika Skvortsova.
Therefore, in the near future, mortality will only increase. "The increase in adult mortality is partly due to an increase in life expectancy and the changed age structure of the population," the minister said. – According to Rosstat, the contribution of aging is 1.7 percentage points, therefore, when recalculating the mortality rate in 2014 according to the population structure of 2013, it would be lower by 27.5 thousand people."
The prime minister liked this conclusion. "This is quite an important conclusion," he said. – That is, if we recalculated everything according to the situation in 2013, without the factor of population aging, increase in life expectancy, which we generally assess as absolutely positive, then the mortality rate would be lower."
Another calculation option was suggested to the government by Moscow Mayor Sergei Sobyanin. In his opinion, it is more correct to take into account not the total mortality, but by age groups, which will allow us to more accurately assess the causes of mortality and influence them. "This is a more subtle, more accurate analysis," Medvedev agreed.
WHO errorAccording to Skvortsova, the deterioration of mortality rates in the first quarter of the year is associated with influenza, SARS and pneumonia.
And this trend was observed not only in Russia, but also in 14 other European countries. "The current influenza vaccine strain provided by WHO did not take into account the drift of the H3N2 strain," Skvortsova explained. – Thus, vaccination against influenza in 2014 could not prevent all adverse outcomes: 23% more died (more than 2 thousand patients) than in the previous year."
Further in her report, the minister said that among the Russians who died from influenza and its complications on the heart, only two people had vaccinations, despite the fact that more than 42 million people were vaccinated against influenza in the whole country. "Accordingly, it can be concluded that certain segments of the population – and, according to our detailed analysis, 69% of patients were patients from socially disadvantaged categories suffering from domestic drunkenness and alcoholism – are outside our preventive measures," the minister complained.
In addition, Skvortsova said that according to the results of monitoring "the main technological indicators of medical care" in many regions, "gross violations of clinical protocols for the management of patients" were recorded. And, in addition, supermortality was found in areas where one particular person, a doctor or a paramedic, works ineffectively. Last year, the number of violations detected by inspectors exceeded 22.5 thousand, the amount of fines amounted to 73 million rubles, 41 criminal cases were initiated, the activities of 22 medical organizations were suspended and 29 regional ministers of health were removed from their posts.
Doctors should be fully responsible for their work, up to criminal, Medvedev responded. "Doctors are held in high esteem by us, we will continue to take measures to support them, but they must understand that they bear a certain professional responsibility, which can be different – from administrative to criminal. I believe that all measures of responsibility should be applied," he said.
RegionsIn general, the causes of death are the same across the country.
But there are also regional peculiarities. Thus, according to the head of the Khabarovsk Territory Vyacheslav Shport, tuberculosis mortality in the region remains at the same level, in particular, due to the fact that many people who are released from prison (and there are 2.5-3 thousand of them annually) are released with an open form of tuberculosis.
The most exotic version of the increase in regional mortality was given by the acting governor of the Leningrad region, Alexander Drozdenko. In his opinion, one of the reasons why people began to die more often in the region is connected with the attractiveness of local paid cemeteries. According to the governor, over the past three years there has been a sharp increase in the number of registrations of deaths among nonresidents – now they account for 11% of the total number of deaths. "Recently, commercial cemeteries have been appearing on the territory of the Leningrad Region, they are quite efficient, they are quite well equipped. Considering that by law any cemetery is municipal, and a commercial structure can only operate it, municipalities set a condition that those people who have death registration on the territory of the Leningrad Region are buried in the cemetery," Drozdenko explained.
But they do not want to give birth in the region, since things are worse with medical institutions here than with cemeteries. "One of the reasons (we analyzed it, because we are among the three regions of Russia today in terms of social support measures for young families, large families, and at the same time we have such a birth rate) is the insufficient level of healthcare institutions, primarily maternity hospitals, perinatal centers." Therefore, residents of the region prefer St. Petersburg for childbirth.
The mayor of the capital Sobyanin said that the birth rate continues to grow in Moscow (for 4 months of this year – 2.7%). At the same time, as the mayor admitted, "a huge number of migrants from Central Asian countries, as well as residents of other regions, come to Moscow to give birth." As for the number of people passing away, even here visitors make their contribution, only already negative. So, the mortality rate from cancer remains above the established targets, but if you do not take into account visitors, it will be even a quarter lower.
What to doAll participants of the meeting assured that they understood the problem, and the ways to solve it, too.
So, Skvortsova promised "to bring the schemes of territorial planning of primary care and routes of delivery of patients in full compliance with the order of organization of medical care." "In addition, taking into account the huge contribution of non–medical factors to mortality rates (this is 50-60% lifestyle and lifestyle), it is necessary, of course, to take additional measures to prevent domestic drunkenness and alcoholism (this is 43% of the contribution to the mortality of men of working age and 31% - in the formation of pre-mortality of women of working age). And also the culture of healthy eating and all the other conditions of a healthy lifestyle," Skvortsova said.
In order to force Russians to give birth, according to Topilin, it is necessary to increase measures to support families at the federal level. Now it is left to the regions. For example, in the Khabarovsk Territory, a mortgage loan is written off for families in which the third and subsequent child was born. But they do not do this everywhere. In addition, Topilin believes, it is necessary to extend the maternity capital program, which ends in 2016. Moreover, receiving this support cannot be associated with "neediness" in any way. "It is very important to make this decision, it will provide us with the birth of second children in a cohort of women from 30 to 40 years old," the minister explained. "There is still potential ... and it will need to be supported."
Medvedev partially agreed with Topilin – in his opinion, it is necessary to help residents of not all regions, but those where the situation is most deplorable. So, this year, the regions where there is an unfavorable demographic situation will be provided with subsidies for the payment of monthly allowances for the third child upon reaching the age of three. "In addition, there are a number of proposals to support women who give birth to their first child before the age of 25," Medvedev said. – Of course, we should talk about those regions where the birth rate situation is the most difficult. This also requires discussion, including, of course, taking into account our current financial situation."
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16.06.2015