Public health and healthcare as a science studies patterns of influence of social

and economic factors on the health of the population (its different social groups). It gives
the theoretical basis for system of state and social arrangements to protect and improve
population health. In contrast to clinical medical disciplines, Public health and healthcare
studies the health state not of separate individuals but of people organizations, social
groups and population health in the whole (demographic processes, morbidity, invalidity,
physical development) in connection with life conditions.

Sections of Public health and healthcare:

• Health of the population;
• Healthcare system;
• Medical statistics.

Basic research methods of Public health and healthcare:

 Statistical
 Sociological
 System analysis
 Expert assessment
 Economic research
 Organizational experiment
 Historical
etc.

World Health Organization (WHO) accepted the following definition of health:

”Health is a state of complete social, biological and psychological well-being but
not only absence of illnesses or physical defects”.
In case of population health and health of its separate groups world statistics use the
complex approach of population health definition. There is the conventional statistic
definition which is described with complex of indices. There are the following groups of
population health indices:
1) Demographic indices: birth rate, death rate, natural increase and life expectancy
at birth;
2) Morbidity indices: incedence, prevalence, pathological affection etc.
3) Physical development indices: morpho-functional and biological, harmonic;
4) Invalidity indices (primary and general).
 The sources of data to study population health:
 Official reports of medical, public health and social service establishments,
statistic institutions
 Special registration of diseases and death cases in medico-preventive
establishments – perspective research
 Retrospective information from registration documents for past period of
time
 Data of population questionnaire
 Data of medical examinations
 Results of mathematic model

Statistics is the science which studies quantitative side of mass phenomena and its
connection with qualitative features.
Medical statistics is the section of general practice and a field of statistics studying
the questions connected with the medicine and health protection.
Medical statistics studies:
1) the health of the whole population and its separate groups investigating the data
about number, structure, natural movements, physical development, morbidity and
others;
2) interactions between the health indices and different factors of environment;
3) data about structure, activity and staff of medico-preventive and sanitary-
antiepidemiological institutes;
4) organization and realization of laboratory-clinic investigations with
assessment of the reliability of observed results.

Statistical research is a scientific - organizational process in which an observation

of certain events and processes, collection, registration of the primary data, their
processing and analysis is carried out according to common program.

Statistic research stages:

I To work out a design of statistical study (design includes program and working
plan);
II To register and collect statistical data;
III To work out and summary
data;
IV Statistical analysis;
V To introduce study results into practice.

The program of the study:

• Formulation of the topic of the investigation,
• Formulation of purpose and tasks of the study,
• Selection:
 - Object and unit of observation,
- Type of the study,
- Place and time of the study,
- Sources of data,
- Forms of practical realizations,
- Methods of statistical analysis.

Aims of the study:

- To identify typical regularity of the phenomenon, its connection with other ones;
- To work out measures to reduce impact of unfavorable factors to health,
- To introduce results in practice of health care and work out measures to
improve quality of medical care.
Possible tasks of statistical research:
1) To study level and structure of the phenomenon (morbidity, mortality) in
certain population groups,
2) To study occurrence (incidence) of the phenomenon in the groups that are
affected by many factors (environment, biological, social)
3) To study size and quality of medical care to the separate population groups.

The object of statistical research is a statistical totality of individuals or events,

consisting of units, phenomena that are studied. Collection, registration and ordering of
data in any study are completed by statistical totality creation.

STATISTICAL TOTALITY is a set of objects or phenomena of one kind (units of

observation), united by a certain sign.
The unit of observation is a primary element of the statistical totality, which is
characterized by variables to register and study (gender, age, birth weight, length of
work, outcome, length of stay in a hospital, etc.).

Types of the study:

By time
1) Current: collection of data is carried out systematically, with constant
registration of the facts as they occur
2) Periodical: collection of data is carried out regularly but not constantly
3) Cross-sectional: show the status of the event at a
specific time. By completeness of data registration
1) Complete (all-round): involves all units of observation in population studied.
2) Non-complete:

 Monographic: is used for detailed, deep characteristics of the typical

totality units; for study of any establishment development and causes which provide
success or fail
 Basic massif: allows studying the objects which have many observe units.
 Selective: a study in which characteristics of population is given by its some
part (sample), selected randomly.
Sample - …

Selective method (Sampling) is possible when sample is quantitatively and

qualitatively representative to population:
• Sufficient number of cases to register,
• Sample reproduces all variety of the studied phenomenon.
In this case, the results can be extended to the study population.

Representativeness of the sample is achieved by correct selection of units of

observation. Only in that case results can be used for population.
Methods to select units of observation:
• Random sampling: casting of lots, lottery, and mechanical selection in random
order;
• Mechanical selection: according to a certain number of population with use of
the definite way (every fifth, tenth or other);
• Cluster: first groups (the most common objects) are formed from the
population, which are then studied by complete or selective method;
• Directional selection: people with the same work length, age or sex are selected.

The working plan (appendix to the program) is a mechanism for the implementation
of the research program and includes a list of key activities:
• the procedure for selecting, training and organizing the work of direct performers;
• development of regulatory and methodological documents;
• determining the required volume and types of research resources (personnel, finance,
logistical, information resources, etc.);
• determining the timing and responsible for individual stages of the study.

Methods to register and collect medical - statistical data:

1) Direct registration (examination, measuring, weighing and record in the
individual cards of observation).
2) Documentary registration (systematic recording of data in medical-
preventive establishments)
3) Data copying from official documents into specially prepared statistical ones
4) Opinion poll (Interrogation):
- Expeditionary way
- Corresponding method
- Self-registration.
5) Questionnaires.

Grouping is the distribution of population (or sample) units into homogeneous

parts according to essential characteristics (VARIABLES). Any quantity that varies is
termed a VARIABLE.
The aim of grouping: to separate studied facts into individual qualitatively similar
parts.

Any variable can be one of two types:

1. CATEGORICAL (qualitative, attributive):
Nominal data are not ordered but simply have names. Example: blood group (A, B,
AB, and 0).
Ordinal data are ordered in some way. Example: degree of pain (severe, moderate,
mild, none).
Binary or dichotomous when there are only two possible categories. Example:
'Patient has disease/patient does not have disease'.
2. NUMERICAL (quantitative): variable takes some numerical value.
Discrete data can only take certain whole numerical values (the number of visits
to a GP in a
Continuous data- when there is no limitation on the values that the variable can
take, e.g. weight or height.
The unification of the statistic data is realized in the form of the statistic tables.

Statistical tables are the form of systematic, rational, and visual presentation of
digital material, which characterizes the studied phenomenon and processes.
Types of statistical tables:
• Simple: includes numeric distribution of the data on a single variable. Such a
table has no groupings. It doesn`t describe the connection between the variables.
• Group: represent two and more unconnected variables.
• Combined: the grouping of two or more variables taken in combination.

Sample of simple table:

 Sample of group table:

Sample of combined statistical table:

Faculty Average number of smoked cigarettes per day Total
<10 10-20 >20
M F Both M F Both M F Both M F Both
General 55 28 83 67 10 77 51 4 55 173 42 215
Medicine
Pediatrics 45 11 56 47 2 49 69 12 81 161 25 186
Pharmaceutical 36 14 50 58 7 65 46 9 55 140 30 170
Dentistry 45 20 65 72 19 91 50 11 61 167 50 217