Ill-health: causes and predisposing factors

The following classification of the main causal factors leading to health disorders can be proposed. It takes into account the importance of the action of these factors both in the previous period of life and at present.

First of all, it is necessary to discuss any forms and origins of deficiency of essential conditions for optimal development.

1. Deficiency of essential development factors
   • Orphanhood or life in an asocial family, stress, abuse or humiliation.
   • Insufficiency and suboptimal balance of nutrition in utero or in subsequent periods of postnatal life.
   • Hypokinesia or "sedentary" lifestyle.
   • Sleep deprivation.
   • Impoverished development environment, lack of communication, new experiences, learning, abandonment.
   • The presence of aggressive factors in the development environment
2. Unfavorable epidemiological situation.
   • High risk of violence.
   • A natural endemic feature of a region of residence.
   • Environmental problems in the region, housing, water, air, food.
   • The influence of bad habits (smoking, alcohol, drugs), early sexual activity, eating disorders and regimen.
3. Unfavorable heredity.
4. Ill health resulting from previous illnesses, including intrauterine ones, or injuries.

Another approach to classifying determinants of ill health may be considered appropriate - by their origin in connection with the will or independently of the will of a person, for example, by the will of parents or as a result of conditions beyond the control of the family, dictated by the state and laws of society. On this basis, it becomes possible to distinguish "autopathogenies", "parental pathogenies" and "sociopathogenies".

Sociopathogenies include:

1. wars, terrorism, violence;
2. transport and man-made disasters, accidents;
3. family breakdown and child abandonment;
4. poverty and starvation;
5. insufficient and unsettled housing, drinking water sources, heating systems, water supply and sewerage systems;
6. uncontrolled chemicalization of the environment, including air, water and food;
7. inadequate or limited availability of medical care and preventive measures;
8. limitations in accessibility of education and low level of health education among broad sections of the population;
9. primitivization of life values, propaganda of violence, enrichment at any cost, irresponsible sexual relations, etc.;
10. open or hidden advertising of auto-aggressive behavior (smoking, alcohol).

Very close to "sociopathogenies" are many voluntarily chosen forms of behavior. They are called "autodestructive" behavior. Some scientists call them, in contrast to "sociopathogenies", "autopathogenies". This is voluntarily chosen behavior, accompanied by changes in personality traits and leading to a high risk of chronic diseases and a reduction in life expectancy. There are only a few such particularly significant forms of behavior, but the damage they cause to health exceeds that from violence, accidental injuries and poorly controlled infections.

Autopathogens include:

1. suicides;
2. self-mutilation;
3. smoking;
4. alcohol;
5. drug addiction and substance abuse;
6. promiscuous sexual behavior;
7. physical inactivity;
8. inappropriate eating behavior.

Let us consider the main determinants of “non-realization” or health losses from the group of “sociopathogenies”.

[ 1 ], [ 2 ]

Sociopathogenies

Violence

It happens almost everywhere. In 2002, WHO Director-General Gro Harlem Brundtland's report contained these impressive facts:

1. Every year, more than 1.6 million people die as a result of various forms of intentional violence;
2. On average, 2,233 people commit suicide every day; that's one suicide every 40 seconds;
3. Every day, 1,424 people are killed in interpersonal conflicts (one murder every minute);
4. Every day 849 people are killed in intergroup or interethnic, interreligious, interstate conflicts (35 people every hour); in total, more than 300,000 people died in armed conflicts in the first year of the new millennium alone.

The murder rate in Russia is very high. The probability of dying from a violent death during the life of a newborn in Russia is 1:4, while in England it is 1:30, and in Sweden - 1:50. Child murders also have an upward trend. Parents alone kill from 200 to 1000 or more of their own children every year, unintentionally or intentionally.

Children who die as a result of accidents are an indicator of the degree of their actual neglect, which has its origins in the organization of social life, where parental responsibilities recede into the background before the tasks of obtaining food and money.

There are also such human losses that are designated as "disappearances" of people. Both children and adults disappear. In 2003, for example, 118 thousand people went missing, including 24 thousand children. For comparison: the number of the entire British army is 100 thousand people, and during the entire 4-year military campaign in Afghanistan, our losses amounted to about 15 thousand people. This is also "sociopathogeny", i.e. direct aggression of an unsettled society on the health and life of a person.

Poverty

The second, certainly recognized group of non-medical factors are poverty, hunger, lack of housing, unsanitary conditions, ignorance, leading to diseases and death, as well as the lack of accessible medical care. Almost all world mortality statistics demonstrate an inverse correlation between infant mortality and indicators of national income per capita. A direct correlation between life expectancy and the size of national income is also recognized as an axiom of demographic statistics.

In Russia, where in a relatively short period of time economic reforms did not have time to cause profound catastrophes with culture, education, sanitary and hygienic conditions of housing and water supply, one can see a relatively direct determinacy of changes in morbidity by economic living conditions. At the same time, it is not possible to exclude the role of chronic stress, which accompanied the process of impoverishment and a very real deterioration in the quality of medical care. According to materials published by A. A. Baranov and L. A. Shcheplyagina (1998), in just 4 years - from 1992 to 1996, the morbidity of preschool and school-age children increased:

• for heart and vascular diseases - by 59%;
• for nutrition and immunity systems - by 53%;
• tuberculosis - by 38%;
• alcoholism (childhood) - by 66%;
• substance abuse - 11 times;
• drug addiction - 12 times.

There is no doubt that poverty and, especially, destitution are a generalized expression of many different negative factors and circumstances that pose a danger or significant risks to the health of children.

The most direct relationship between the level of material security of the family and the health of children is in such a determinant as nutrition. In this section, we will focus only on indicators of nutrition security. In Russia, at the beginning of economic reforms, studies were conducted on the frequency of hunger in families using the international criteria of Radimer / Cornell.

Starvation in Russian families:

• starvation of women - 77% of all those examined;
• starvation of several family members - 70% of all those examined;
• Child starvation in families - 32% of all those surveyed.

The most "typical" ways of adapting nutrition to the limited financial capabilities of families in St. Petersburg are limiting the variety of food products in the diet and limiting the nutrition of adults in favor of children. In such food groups that are important for health as fish fats, dairy products, fruits and vegetables, deficiencies are determined in 64-87% of children.

Important criteria for the spread of starvation are the findings of delays or lags in children's physical development. Eating disorders become a major problem during the conscription of young men for military service. More than 30% of recruits are deferred from military service due to underweight.

Iatropathogeny (iatrogenesis)

This is a highly debatable issue in terms of its significance, but it is a real problem that is attracting increasing attention.

There are several aspects to it:

1. Rarely, a doctor, like any other person, can commit criminal acts, including negligence and inattention, leading to a dramatic outcome;
2. a physician may make an error in diagnosing and choosing treatments for diseases and critical conditions; such errors are especially likely in relation to complex and rare diseases and syndromes; errors in the use of drugs with their side effects are even more likely; the number of such errors may continue to increase as the spectrum of diseases increases, new diseases appear in medical science, the number of new drugs rapidly expands, and the practitioner is unable to gain sufficient experience in their use;
3. there are also general circumstances that create a risk to the health of some people, regardless of medical errors, by the very existence of the health service, its institutions and methods of carrying out professional activities; there is a certain negative population effect from the use of diagnostic X-ray radiation, from ultrasound diagnostics, from carrying out preventive vaccinations, any surgical interventions and instrumental manipulations; these forms of damage to health are negligible compared to the positive effects of protection and restoration of health associated with the use of these methods;
4. there is also a very significant group of relatively late identified adverse effects from the implementation of certain diagnostic and treatment decisions;
5. A completely separate chapter of iatropathogeny is beginning to be formed by the accumulating data on the remote consequences of medical elements of prevention and treatment in relation to the fetus, newborns and young children, who are characterized by a special sensitivity to extremely small levels of any impacts, while no set of rules on observing the safety of medical interventions for these children yet exists.

At present, the latter circumstance is another branch of the doctrine of modifications or alterations of development, programming the duration and quality of subsequent periods of life. An illustration can be the remote complications from the use of corticosteroids in perinatology (Neil N. Finer 2000; Keith J. Barrington 2001; A. Dodic 2001):

• decreased learning ability at age 6 years and older;
• the outcome was cerebral palsy in 49% of children who received the drugs, versus 15% in those who did not receive them;
• areas of leukomalacia in the brain tissue in 23% of children who received hormones, versus 9% who did not receive them;
• myocardial hypertrophy.

There is no doubt that the urgency of the problem of iatropathogenies is progressively increasing. Even such specific aspects of this problem as the adequacy of diagnostics and provision of medical care in critical conditions and the correctness (safety) of drug prescriptions are extremely socially significant. The experience of taking measures to improve emergency diagnostics and strict justification of therapeutic measures, accumulated in the USA during a specially conducted program, has shown that these measures allow saving the lives of more than 20,000 patients per year. At the same time, from 100 to 784 thousand people die annually due to erroneous or suboptimal medical prescriptions. In comparison with losses from terrorism, the danger of medicine is 32,000% higher.

Toxic aggression on health

The next group of non-medical factors is chemical pollution of the environment, including water, air, food and all everyday life in general (detergents, washing powders, cosmetics, paints, plastics, etc.). The significance of environmental disasters, despite their importance, fades into the background in comparison.

Of primary importance is the shift of attention from the danger of direct and obvious toxic effects of aggressive substances to the effects of modification or reprogramming of development with very delayed manifestations. Concentrations of pollutants and xenobiotics in the household environment, food products, cosmetics and even in medicines can be negligibly small, but quite sufficient to exert a toxic effect on the geno- and phenotype and change the qualities of development.

The saturation of modern life with factors of potential chemical aggression and the highest sensitivity of the child's organism to them, especially in the prenatal period, is only now beginning to be revealed. As follows from the report of the European Working Group on the Study of the Habitat of 14.07.2005, of the 287 chemical substances of artificial origin that we identified in the umbilical cord blood of newborns, 180 substances are well-studied carcinogens for humans and animals, 217 are toxic to the developing brain and nervous system, and 208 are classified as teratogens that cause malformations and dysplasia. The potential effects and dangers of prenatal or postnatal exposure to the entire sum of identified chemical substances or their total effect have never been studied by anyone.

The most natural environment, previously considered harmless to humans, may prove unfavorable for the development of the fetus and child with a very delayed manifestation of this effect during subsequent life. This has been proven today both in experimental studies and in the clinic.

City air, as a mixture of aggressive pollutants, has an adverse effect on the fetus and leads to (News Releases from the National Institutes of Health, 2005):

1. to a decrease in body length and weight, and a decrease in head circumference in newborns;
2. to an increase in the number of chromosomal abnormalities in umbilical cord blood leukocytes:
3. at average exposure - 4.7/1000 leukocytes;
4. at high exposure - 7.2/1000 leukocytes.

The main mass and non-threshold toxic effects on humans are:

• lead in concentrations below 100 mcg per 1 liter of blood;
• radon in residential premises at a content below 4 pCi per 1 liter of air;
• trihalomethanes formed during chlorination of drinking water at concentrations below 800 μg per 1 liter of water;
• tobacco smoke from passive smoking.

The list of these substances should be significantly expanded in relation to the fetus, newborn and infant. Thus, mercury and methylmercury cause damage to the fetus's brain and subsequent decrease in intelligence and attention in the child even at negligible concentrations in the blood of a pregnant woman. The risk of a decrease in intelligence in a child is proportional to the concentration of mercury in the woman's blood. Substances contained in ordinary plastic dishes, refrigerator parts, plastic bottles for drinking water or lemonade may have toxic and hormone-like properties that change the rate of development and increase the risk of cancer. One of such substances is the plastic component bisphenol A. A component of many food products, such as chips, fried potatoes, canned olives, acrylamide combines toxic and carcinogenic properties and can accumulate in the body.

Pollution of the environment with metals, in particular aluminum, contributes to its presence not only in food products, but even in medicines and medical solutions. With a decrease in the functional reserves of the urinary system, the toxic effect of aluminum can occur quickly and have the character of a severe neurotoxic reaction, which is most likely in low-weight and premature newborns. Other children and adults have a risk of long-term accumulation of metal in brain tissue with remote periods of detection of intellectual loss.

Autopathogenies and parentopathogenies

Suicides

This is the most dramatic manifestation of autopathogeny. Every year in Russia 55,000 people commit suicide, of which 2,500-2,800 are children. About 1 million people attempt suicide. The frequency of completed suicide is 40 per 100,000 per year, which is significantly higher than the frequency of murders - 30-33 per 100,000 per year - or deaths from alcohol poisoning - 25 per 100,000 per year.

In 2000, 29,350 people died by suicide in the United States. More than 90% of them had mental disorders, mainly depression, and many had drug addictions. Men die by suicide four times more often than women, but women attempt suicide two to three times more often than men.

To some extent, suicides reflect complex interactions between borderline mental states and the environment that puts the child in a state of complete hopelessness. For children and adolescents, such borderline states that can be recognized and treated promptly should include depression, including latent depression, and psychoemotional disorders such as hysteria, bipolar syndrome, etc. Children who attempt suicide, as a rule, talk about the attractiveness of death for a long time. The risk of suicide is especially high in cases where specific plans are formed in conversations with friends and suicide weapons are outlined. Suicide attempts in children are observed 50-200 times more often than completed acts. A significant relationship has been found between the frequency or risk of suicide and the frequency of a child's participation in physical conflicts with other children (fights), as well as manifestations of cruelty to other children or pets. There is also a clinical marker of significant risk of suicide in schoolchildren and adolescents - this is juvenile fibromyalgia or chronic fatigue syndrome. Unfortunately, in real pedagogical practice and in the practice of medical observation, these features are revealed extremely rarely.

It is quite possible that the properties of the environment and the force of its impact on the child's inner world are so strong that they can be realized in suicide even against the background of normal initial mental health. The child finds himself in a situation that is incompatible with life within the framework of his personal life and spiritual experience. And he is brought to this situation, as a rule, by the adults around him or, much more rarely, by other children. The terrible thing is that there was no adult around such a child who could recognize the complexity and drama of the situation and, most importantly, help the child get out of it with his love and support. In very many cases of child suicide, one can see an example of suicide provoked by adults - a family, a team or even society as a whole.

Smoking

Active smoking of varying intensity is found in Russia in 61% of men, 36% of women, 28% of senior schoolchildren. About 62% of children smoke "passively". Smoking is the cause of 30-35% of all diseases leading to death in adults. This is mediated through a significant increase in the risk of a number of cardiovascular diseases and malignant neoplasms.

Under optimal living and nutritional conditions, smoking shortens a person's life by 18 years. However, when combined with poor nutrition and other unfavorable factors, this figure can double.

It must be assumed that smoking makes a very significant contribution to the differences in life expectancy in men and women. At the same time, a relatively small difference in the spectrum of chronic diseases and the reduction in life expectancy was found in "active" and "passive" smokers. The average level of danger from passive smoking is determined to be 40-48% of the danger of active smoking. Regular exposure to smoky rooms already after 3-4 years significantly changes the spectrum of blood lipids in school-age children, increasing the overall atherogenicity index.

The prevalence of smoking largely depends on the age of the first contact of a child or teenager with tobacco smoke. Regular presence in a room with smokers, even for the youngest child (1-3 years old), is a high-risk factor for early smoking. The first experience of smoking at school or adolescence determines the extremely rapid formation of tobacco addiction. Thus, if for an adult addiction occurs when smoking about 10 cigarettes a day for about 3 months, then for a teenager addiction is formed by smoking 2-5 cigarettes a day and a smoking period of 2-4 weeks.

The timing of the onset of smoking in adolescents is a good indicator of the child's general inclination or readiness to display "protest behavior." This is evidenced by statistics cited in the report of the US Surgeon General (1994).

Teenage smokers compared to non-smokers later in life:

• 3 times more likely to suffer from alcoholism;
• 8 times more likely to use marijuana;
• 22 times more often use cocaine;
• significantly more often become instigators or victims of interpersonal or intergroup conflicts, including those involving the use of weapons (including firearms).

When a pregnant woman actively or even passively smokes, the toxicity of tobacco smoke can directly induce a wide range of developmental defects and diseases in later years of life. The life expectancy of children of a mother who smoked during pregnancy is reduced by 11.6 years. The life expectancy of children of a smoking father is reduced by 8.3 years. If a child has one smoking parent, his intelligence by the age of 10 is lower by 6.4 units K}, if both parents smoke, then by 8.8 units 1(3 compared to peers from non-smoking parents. In children of smoking parents, the risk of early (before 5 years) occurrence of malignant tumors of the blood system and brain is increased by 3.3 times compared to children of non-smoking parents. New evidence has been obtained of a significant increase in brain dysfunction in children when a pregnant woman smokes. According to the data of this study, smoking in combination with unfavorable environmental factors associated with smoking increases the probability of the birth of children with minor brain dysfunction threefold, and smoking alone, as the only causal agent, excluding the influence of other factors, increases the probability of minor brain dysfunction by two times.

Alcohol

The aggressiveness of alcohol increases with the increase in the dose of alcoholic beverages taken orally, the frequency and duration of such abuse. Chemical properties of alcohol, i.e. the degree of purification or the quality of technological processes, are of great importance for its toxicity. In Russia, the tradition of intensive alcohol use is very strong. According to official data, per capita consumption of absolute alcohol per year in 2002 was 7.6 liters, or 15.4 liters according to the actual amount of recorded and unrecorded sales of alcoholic beverages. In addition to this, beer consumption in Russia on average is 40 liters per capita per year, and in cities such as Moscow and St. Petersburg - 70 liters per year.

Alcohol is a major cause of death. Since 1996, the annual number of deaths from accidental alcohol poisoning in Russia has been 30,000-35,000. By comparison, in the United States, where the population is almost twice as large, about 300 people die from alcohol intoxication.

Alcohol can cause chronic damage to the gastrointestinal tract, brain (psyche), reproductive organs, decreased immunity, chronic nutritional disorders, chronic cardiovascular diseases. Indirect losses from alcoholism are significant - murders while intoxicated, road and domestic injuries, family breakdown, abandonment of one's own children or cruel treatment of them. But even more significant are the transgenerational effects of alcohol, i.e. the impact on the health of children and grandchildren.

The main transgenerational effects are the induction of fetal alcohol syndrome and a wide range of alcohol-associated effects. Fetal alcohol syndrome and alcohol-associated effects are the most common causes of intellectual disabilities, aggressiveness, and antisocial behavior in children and adolescents.

[ 3 ], [ 4 ], [ 5 ]

Addiction

Over the past 15 years, the incidence of drug addiction has increased by 10.8 times, and regular drug use without dependence has increased by 6.9 times. According to official statistics, there are currently 2.2 million drug addicts in Russia, and according to unofficial data, there are about 8 million.

[ 6 ], [ 7 ], [ 8 ]

HIV infection

The growth rate in Russia has approached that of African countries. In 2003, 240,000 cases were officially registered, while experts estimate that there should be between 750,000 and 1.2 million. At the same time, about 80% of patients are under 30 years old, but more often 15-19 years old. By 2020, 14.5 million patients are predicted. The epidemic is accompanied by outbreaks of other sexually transmitted infections and an increase in the incidence of treatment-resistant tuberculosis.