Healthy lifestyle strategy from the Ministry of Health of the Russian Federation: “dictation of doctors” or necessity. Healthy lifestyle strategy: Food products Basic strategies for a healthy lifestyle

On January 25, public hearings were held at the Public Chamber on the topic: “Problems and prospects of state policy in the field of promoting a healthy lifestyle of the population.” Milknews studied the recommendations formulated as a result and analyzed what the healthy lifestyle strategy in the field of food products provides.

Healthy lifestyle strategy
The project aimed at creating a healthy lifestyle in Russia is the “Strategy for the formation of a healthy lifestyle of the population, prevention and control of non-communicable diseases for the period until 2025”, it includes measures to develop the population’s commitment to healthy eating, combating the formation of bad habits, and also motivate citizens to play sports. The strategy should reduce the mortality rate of Russians from cardiovascular and cancer diseases, diabetes and respiratory diseases by 25%.

On January 25, public hearings were held at the Public Chamber on the topic: “Problems and prospects of state policy in the field of promoting a healthy lifestyle of the population.” Representatives of the Ministry of Agriculture, FAS, Rospotrebnadzor, Chamber of Commerce and Industry, RSPP, Business Russia and other organizations of the expert community took part in the hearings. The Ministry of Health ignored the invitation to the event.

During the congress, the participants unanimously gave a negative assessment of the project in its current form, because, in their opinion, the strategy should reflect a systematic approach, and not propose measures that not only do not allow achieving the set goals, but may also entail negative consequences for the food market. The hearing participants highlighted the main aspects that need to be focused on:

  • Increasing the availability of foods that make up a balanced diet
  • Popularization of healthy lifestyle
  • Reducing the consumption of tobacco and alcohol products
  • Increasing physical activity of citizens
  • Forming the habit of balanced and rational nutrition among consumers

According to the data presented in the text of the project, more than half of all deaths of Russians in 2014 were caused by cardiovascular diseases. Today, among all citizens (healthy and sick), the frequency of high cardiovascular risk is 53.3% in men and 37.7% in women. According to the Ministry of Health, the main causes of health problems are bad habits and lack of balanced nutrition, poor environment and lack of physical activity.

To combat unhealthy diets, the department proposed:

  • organize a network of canteens and cafes with healthy and dietary food. For citizens who are below the poverty line, service there can be free.
  • legislatively provide tax benefits to producers of healthy food products
  • limit the amount of time advertising for unhealthy food is shown on Russian TV (sweetened carbonated drinks, chips, fast food, chocolate bars, other confectionery products with excess fat and sugar, sausages)
  • introduce excise taxes on harmful products(excise taxes on sweet drinks have been discussed for a long time, but not so long ago the FAS refused to support this idea).


Criticism
President of the Union of Soft Drink Manufacturers Maxim Novikov notes that products are divided into “harmful” and “healthy” according to unclear criteria. The terminology used makes it possible to classify dairy products with a low fat content as healthy products, and with a high fat content as harmful, explains Artem Belov, executive director of the National Union of Milk Producers.

Deputy Head of the Ministry of Telecom and Mass Communications Alexey Volin has repeatedly stated that the ministry is against the initiative to regulate the advertising of certain products. According to him, “it is not the job of the Ministry of Health to determine which products to advertise and which products not to advertise. If we follow this logic, then only dietary cottage cheese can be advertised. People themselves must be aware of what they are doing and what they are consuming. Allowing doctors to dictate over the everyday behavior of ordinary citizens is excessive.” The main problem of the project, according to the Ministry of Telecom and Mass Communications, is that at the moment the strategy involves discrimination against certain food products (it contains provisions according to which some products are recognized as contributing to the development of diseases).

The report of the Public Chamber following the hearings indicated that international practice shows that restricting advertising and sales of products based on their non-compliance with healthy lifestyle does not produce results, because does not change consumer behavior. In addition, restrictions on the sale of actually safe goods will only lead to an increase in the consumption of surrogate products.

Market participants, in turn, propose to revise this policy and pay more attention to popularizing healthy eating and encouraging the release of products in this category, and believe that if the strategy is adopted in the form in which it is now, the Russian Federation will lose its reputation as a manufacturer of high-quality and safe food products on the world market. At the same time, the market itself does not stand still: manufacturing companies vote for self-regulation, because They themselves introduce food standards based on data from WHO, the European Food Safety Authority and other agencies, and adhere to the principles of socially responsible marketing.

Representatives of the consumer market noted that the popularization of a healthy lifestyle is impossible without increasing the availability of healthy food products and increasing the income of the population. The document contains a clause on revising the consumer basket, the FAS called it useless - according to the agency, the consumption of certain products depends to a greater extent on the financial situation of the consumer than on updating the consumer basket.

The Ministry of Economic Development, following the FAS and the OP, also criticized the draft strategy of the Ministry of Health for the formation of a healthy lifestyle due to the lack of financial and economic calculations. The Ministry of Health believes that the implementation of the strategy will not require additional spending from the budget, but there are no calculations confirming this in the document.

The Ministry of Economic Development saw proposals in the strategy that would “definitely require additional money”: “Expanding the state’s obligations to provide free services to citizens is currently not possible, since there are no sources of financing,” the Ministry of Economic Development concluded. We are talking about medicines for new categories of patients (medicine provision is now provided for the treatment of certain diseases and for some preferential categories of citizens).

What needs to be changed
In general, based on the opinion of all participating departments, the strategy needs to be finalized - first of all, in the area of ​​restrictive and prohibitive measures for certain groups of food products.
For example, according to the document it is necessary to limit the sale of the so-called. “sweet drinks” near educational institutions - such a vague wording can lead to a ban on products with added sugar of any kind.

Such non-standardized terms are found everywhere in the project - for example, a restriction on “fruit and berry drinks” can lead to a ban on an entire food group, because without taking into account the specifics of the production of nectars and juice-containing drinks, the entire group of drinks may not correspond to healthy food products. Likewise, it is unclear what is meant by the abstract formulation “junk food” and “processed meat products.”
In the field of tobacco and alcohol products, there are also many inconsistencies - the document contains the term “products harmful to health,” while according to technical legislation, only products that are safe for health are allowed for sale.
Previously, the Ministry of Health

The Russian Ministry of Health has prepared an “Information and communication strategy for promoting a healthy lifestyle, combating the consumption of alcohol and tobacco, preventing and combating non-medical use of narcotic drugs and psychotropic substances for the period until 2020.” The main objectives of the document are to reduce mortality from all causes from 13.3 in 2012 to 11.4 per 1000 population by 2020. Life expectancy is also expected to increase - from 70.5 to 74.4 years.

The Ministry considers the main ways to achieve these goals to be informing the population about the main risk factors for the development of chronic non-communicable diseases; ensuring accessibility of medical care for the diagnosis of non-communicable diseases. And in addition, reducing the consumption of alcohol and tobacco, narcotic drugs and psychotropic substances, increasing the level of physical activity. The number of medical prevention centers should increase from 90 to 320, the number of health centers - from 695 to 850. The network of medical assistance offices for smoking cessation should reach 5000 from today's 669, and the "Helpline" services - from 516 to 1050. The line is being formed The Ministry of Health outlined the principles of a healthy lifestyle for the population at the beginning of the priority national project “Health”. It was then that health centers began to be created throughout the country, which are visited by 2.5-3 million people annually.

Here you can check your heart and blood vessels, lung function, blood sugar and cholesterol levels, that is, all the main indicators that reflect whether a person is healthy, whether everything is in order,” the acting head of the health center at Moscow city clinic N 69 Margarita Smolskaya. - Bioimpedance is in particular demand - a study that shows how much fat and muscle mass a person has, how much fluid is in the body, etc. We give recommendations on nutrition, quitting smoking, oral care, etc. And all this is free and you don’t have to wait in line.

Many people are surprised when they see their heart for the first time on the screen of a cardiovisor, and this makes a great impression,” added Alevtina Gutnik, a therapist at the health center in Kaluga. - We are very happy when a grandmother or mother comes and brings their son or grandson to us - you need to start taking care of your health from a young age. And lately more young people have been coming.

The draft new strategy complements measures already taken to promote a healthy lifestyle. But its implementation will require changes in the mentality of the population, and this, as we know, is the most difficult and long-term task. How achievable are the goals?

The strategy for creating a healthy lifestyle is a very correct policy, and this has been proven by the experience of many countries, says Professor Sergei Boytsov, director of the State Scientific Center for Preventive Medicine. - The feeling that there is now a lot of information about maintaining health is false: at the state level, its importance for reducing mortality and increasing life expectancy began to be realized and disseminated only 2-3 years ago, although scientists have known about the role of such information for a long time. However, until now, not only have we not taught this to children in school, which is a must, but doctors have not been taught what they should teach their patients.

True, experts also note that the stated goals are somewhat declarative - it is not always clear how exactly to achieve them, using what resources.

The appearance of the document can be welcomed, since the proposed measures are generally correct, says Professor Farit Kadyrov, Deputy Director of the Central Research Institute of Organization and Informatization of Health Care of the Russian Ministry of Health. - Many indicators that must be achieved, unfortunately, are not based on clear statistical data; they can be manipulated. For example, the prevalence of tobacco use among children and adolescents. Here you cannot trust the reports of the regions - special surveys are needed.

The goals and objectives set by the strategy are absolutely correct, there is nothing to argue with here,” comments the director of the Research Institute of Public Health of the Russian Academy of Medical Sciences, academician of the Russian Academy of Medical Sciences Ramil Khabriev. “However, what is confusing is that the draft does not specify the responsibilities of “allied partners” - other ministries and departments on which their implementation depends. The strategy should become intersectoral, and the Ministry of Health can act as a coordinator.

The Ministry of Health of the Russian Federation presented a draft strategy for a healthy lifestyle (HLS) until 2025, which is designed to reduce the mortality rate of Russians from non-communicable diseases by 25%. These include cardiovascular diseases, malignant oncological diseases, chronic respiratory diseases and diabetes mellitus. According to the Ministry of Health, they are the cause of almost three quarters of all deaths in Russia.

According to the department, health problems among Russians are mainly associated with bad habits, such as smoking, drinking alcohol and lack of a balanced diet, unfavorable environment and insufficient health care: lack of physical activity and neglect of medical examination.

The authors of the strategy note that lifestyle and the presence of bad habits are closely related to the level of education, the nature of work activity and place of residence. For example, citizens with primary and secondary education, compared with holders of a college degree, are more likely to smoke, excess salt intake, insufficient consumption of fruits and vegetables, symptoms of depression and anxiety, and less likely to have a low level of physical activity.

The Ministry of Health also points out the dependence of mortality rates on the region. For example, in the Tver region they are 2.4 times higher than in Moscow. This is due to the level of economic development of the regions, living conditions of people, and the sale of vodka and other alcoholic beverages.

Prevention comes first

According to the Ministry of Health, the contribution of prevention to reducing mortality from non-communicable diseases ranges from 40 to 70%. Therefore, an important part of the strategy is the active promotion of a healthy lifestyle and regular medical examinations. For this, the Ministry of Health offers:

  • build sports grounds and bicycle paths accessible to all segments of the population and age groups, including people with disabilities;
  • increase medical examination coverage to 23% of the adult population per year, or to 70% in three years;
  • increase vaccination coverage of the population. So, in the coming years, according to the authors of the strategy, it is necessary to ensure that the entire adult population is vaccinated against influenza.
  • ensure that by 2025, both private and public health facilities meet the standard of care, which involves 80 percent provision of basic technologies and essential medicines.

Even at the stage of developing the strategy, Minister of Health Veronika Skvortsova noted that the proposed measures should encourage healthy lifestyles, but not be restrictive. “We do not plan to introduce any direct coercion,” she said.

The Ministry of Health of the Russian Federation has submitted for public discussion a draft Strategy for the formation of a healthy lifestyle for the period until 2020. The document with the full title “Information and communication strategy for promoting a healthy lifestyle, combating the consumption of alcohol and tobacco, preventing and combating non-medical use of narcotic drugs and psychotropic substances for the period until 2020” defines priority areas for promoting a healthy lifestyle. You can read the document and give your comments on the Unified State Portal http://regulation.gov.ru/project/7287.html.

The main goal of the Strategy is to reduce morbidity and mortality in the population of the Russian Federation by reducing the prevalence of the main risk factors for the development of chronic non-communicable diseases and promoting a healthy lifestyle among the population.

Main objectives: informing the population about the main risk factors for the development of chronic non-communicable diseases; ensuring accessibility of medical care for the diagnosis of non-communicable diseases; reducing alcohol and tobacco consumption among the population; preventing and reducing the level of non-medical consumption of narcotic drugs and psychotropic substances and increasing the level of physical activity, adherence to a balanced diet, reducing the level of psycho-emotional stress among the population of the Russian Federation.

The strategy provides for a number of measures aimed at solving the above-mentioned tasks and concrete results. In particular, by 2020 it is expected:

Increasing the number of medical aid offices for smoking cessation from 660 to 5000,

Decrease in alcohol consumption (liters per capita) from 13.0 (2012) to 10.0 (2020),

Reducing the prevalence of tobacco among children and adolescents to 15%; among the adult population – from 35% to 25%,

Decrease in overall mortality from all causes - from 13.3 (2012) to 11.4 per 1000 population,

Increase in life expectancy to 74.4 years.

Along with the state’s obligations to ensure health protection, the Strategy also imposes obligations on citizens of Russia to take care of their own health and comply with certain norms and rules.

Expert comments:

As leading prevention experts note, non-communicable diseases cause 75% of deaths in Russia. Moreover, 40% of the population dies before the age of 60. According to the World Health Organization, cardiovascular diseases, cancer, chronic obstructive pulmonary disease and diabetes mellitus are the main causes of death. Since 2003, the mortality rate in Russia has been gradually decreasing. We have now reached 729 deaths per 100 thousand population. These numbers could be much lower. But it is impossible to reduce mortality only through the efforts of doctors; comprehensive work is important here. Informing the general public is one of the most important parts of this work. In addition, this strategy provides for an increase in the number of Health Centers, in which any citizen can undergo free diagnostics and receive recommendations aimed at improving their lifestyle, as well as the opening of prevention rooms and smoking cessation assistance rooms. In addition to fighting bad habits, it is important to be attentive to your level of physical activity and your diet. Simple measures such as walking at least 10,000 steps and eating at least 5 servings of vegetables and fruits a day help protect the body from cardiovascular disease and diabetes.

Ivan Blanarik, Co-Chairman of the Russian-American Healthcare Foundation, CEO of Boehringer Ingelheim: “Today, 8 out of 10 deaths are caused by chronic non-communicable diseases. According to international studies, over the past 100 years, twice as many people have died from cardiovascular disease alone than from conflicts and wars, including World War II. However, most of these deaths could have been prevented. Despite huge financial investments and scientific developments, there is no magic pill yet and is not expected. Today, non-communicable diseases remain a serious adversary. We can only defeat it together: the state taking steps such as this Strategy; a business that must care not only about its employees, but, to the extent possible, about society as a whole, both through a scrupulous attitude to its work and through information and socially significant projects. And most importantly, each of us must be responsible for our own health, following the minimum recommendations that can improve the health of society: giving up bad habits, movement and proper nutrition.”

Dmitry Borisov, executive director of the non-profit partnership “Equal Right to Life”, deputy chairman of the board of the Association of Oncologists of Russia, Chairman of the branch of the Public Council for the Protection of Patients’ Rights under the Office of Roszdravnadzor in Moscow and the Moscow Region: “In my opinion, the main focus of the Strategy is to reduce mortality from non-communicable diseases is extremely relevant. After all, they are the cause of more than 60% of all deaths, according to global statistics. Accordingly, thanks to constructive government policies in the field of prevention and treatment of major non-communicable diseases (primarily cancer, cardiovascular diseases, diabetes, lung diseases), a large number of deaths and, consequently, losses in the national economy and human potential indices can be prevented. However, the current version of the document is unidirectional, placing the main emphasis only on prevention and early diagnosis, and completely excludes the importance of such an important aspect as the availability of treatment. At the same time, all UN and WHO recommendations in the field of combating NCDs call on countries to use a balanced approach when forming national strategies. Today, we have big problems in this area in our country, primarily due to serious underfunding of healthcare. As a result, every year Russia loses hundreds of thousands of patients who could have been saved. Therefore, the approach to the implementation of the Strategy, the main goal of which is to reduce mortality, must be very balanced: one cannot skew only towards prevention or only early diagnosis. It must be remembered that without effective treatment, patients cannot be provided with full care.”

Dmitry Napalkov, Doctor of Medical Sciences, Professor of the Department of Faculty Therapy No. 1 of the Faculty of Medicine of the First Moscow State Medical University named after I.M. Sechenov: “This bill is indeed extremely important. The situation with cardiovascular morbidity in the country is quite serious: unfortunately, we are among the leading group of countries in terms of mortality from heart and vascular diseases. At the same time, strokes and heart attacks leading to death can be prevented both by medicinal measures (continuous use of antihypertensive drugs for arterial hypertension, modern anticoagulants for atrial fibrillation, etc.) and non-medicinal measures. But, as has been repeatedly noted by all the leading cardiologists of the country, without a general strategy for improving the health of the population, all non-drug measures that can reliably reduce cardiovascular risk and increase life expectancy are practically not used by our patients. Most patients want to get medications that will solve all their problems, but few are ready to change their unhealthy lifestyle to a healthy one. I see the only difficulty not in the strategy, but in its implementation: if it is entrusted in addition to the main work (“overload”) to outpatient doctors, then I am afraid that they will not be able to implement it in full.”

Oleg Lobanov, General Director of the KorpusGroup group of companies: “Our company organizes catering at the largest production sites in the country, such as AvtoVAZ, GAZ, Rusal, Bashneft, etc. Over the years of work, we have collected interesting statistics . The number of sick days is reduced if workers go to lunch in the canteen rather than carry snacks with them. Large enterprises introduce subsidies for employee meals, thanks to which the number of people eating in the canteen increases to 90%. Among those who do not visit the canteen, up to 24% do not eat at all at work, which leads to serious disorders of the digestive system. According to Rosstat, every tenth sick leave is taken by employees of mining enterprises due to disorders of the gastrointestinal tract.”

The Ministry of Health presented a draft document aimed at developing a commitment to a healthy lifestyle among Russians. “Interdepartmental strategy for promoting a healthy lifestyle of the population, prevention and control of non-communicable diseases for the period until 2025” was prepared by Russian specialists with the support of WHO experts. The main goals of the strategy are to promote a healthy lifestyle and reduce the incidence of major non-communicable diseases (cardiovascular pathologies, oncology, diabetes, chronic respiratory diseases). The authors of the document calculated that every ruble invested in the “piggy bank” of their initiative should bring a profit of approximately six rubles.

The strategy developers noted that major non-communicable diseases claim almost 70% of lives, and according to the experience of other countries, mortality reduction is achieved mainly through preventive measures. The creators of the document propose to engage in prevention, focusing on informing the population about the benefits of a healthy lifestyle, as well as taking the initiative to minimize as much as possible everything that does not correspond to it. Research conducted in 2012-2013 in 12 regions of Russia showed that about half of respondents consume too much salt, about a third suffer from obesity or high blood pressure, three out of every five people have problems with high cholesterol, half are men and a little more a third of women eat too little fruit and vegetables, many smoke and are not very physically active. All this does not have the best effect on the condition of the body, and therefore, ultimately, on mortality. In addition, the environment and untimely provision of medical care contribute.

Experts offer a comprehensive solution to the problem. In their opinion, first of all, it is necessary to promote a healthy lifestyle and create conditions for citizens to play sports. Also, experts believe, it is important to limit as much as possible the advertising of products harmful to health, including indirect ones (the last point most likely applies to advertising of tobacco and alcohol, which are formally prohibited). The authors of the document come up with the following initiatives:

  • ban advertising of foods high in calories, saturated and trans fats, and sugar (i.e., fast food);
  • reduce the availability of alcohol and tobacco, including by raising the minimum legal drinking age to 21 years;
  • reduce salt intake;
  • provide opportunities for sports for everyone, including people with disabilities;
  • reduce the incidence of major non-communicable diseases in patients at risk, to ensure the earliest possible diagnosis.

The developers of the document hope to achieve certain numerical indicators by 2020: reduce mortality from these diseases by 25%, reduce alcohol and tobacco consumption by 10%, salt by 15%, fats and sugars by 30% and 5%, respectively. These and other goals take up as many as 6 pages, and experts hope to improve the ecological state of the environment, cover 70% of adults with medical examinations (in three years), preventive vaccinations - 70% of children, and also reduce the proportion of Russians living below the poverty line by 20 %. Whether this will succeed, time will tell.

Source:

The draft Interdepartmental Strategy for the promotion of a healthy lifestyle of the population, prevention and control of non-communicable diseases for the period until 2025 (hereinafter referred to as the Strategy) was prepared on behalf of the Russian Ministry of Health on the basis of officially published domestic and foreign data and materials presented by freelance specialists of the Russian Ministry of Health. The materials are summarized, designed and edited in accordance with the requirements of the Federal Law of June 28, 2014 No. 172-FZ “On Strategic Planning in the Russian Federation” and the Rules for the development, adjustment, monitoring and control of the implementation of sectoral strategic planning documents of the Russian Federation on issues under the jurisdiction of the Government of the Russian Federation, approved by Decree of the Government of the Russian Federation dated October 29, 2015 No. 1162, by employees of the Federal State Budgetary Institution GNITSPM P.V. Ipatov and M.V. Popovich with the direct participation of the chief freelance specialist in medical prevention of the Ministry of Health of Russia S.A. Boytsov and WHO experts Sylvie Stachenko, Frederiek Mantingh, Jill Farrington, Enrique Loyola, E.D. Yurasova. The draft Strategy was prepared with the support of the WHO European Office within the framework of the Biennial Cooperation Agreement between the Ministry of Health of the Russian Federation and the Regional Office for Europe of the World Health Organization 2016/2017 and the WHO Project for the Prevention and Control of Noncommunicable Diseases (NCD Project), funded by a grant, allocated by the Ministry of Health of the Russian Federation

Comments (6)

    20.01.2017 21:30

    Everyday life in Zadrischensk

    I read the title of the article, then read the goals... The title says “propaganda,” but the goals are complete prohibitions. It seems to me that the authors of the program and Boytsov do not know how to work with the population. They can only prohibit and not let in. They don’t know how to motivate the population to be healthy. No brains either. Well, you will reduce the availability of tobacco and alcohol for open sale... They will start selling shag (the amount of tar and the likelihood of cancer is higher than that of store-bought tobacco), and moonshine, and they will start drinking alcohol substitutes. Health problems are solved not by prohibitions, but by brainwashing. This is exactly what modern preventive specialists do not know how to do.

    20.01.2017 22:19

    Someone.

    Increase your salary! And there will be a healthy lifestyle! When we can eat right and not skimp on everything.

    21.01.2017 17:33

    Vasilisa

    I believe that in order for the population to be healthy, it is necessary to sell medicines in pharmacies, and not tablets with palm oil. We have our own vitamins A and E and others in normal Russian plants! So why aren’t they used to produce medicines for Russian people? and they shove palm oil! for black people with a temperature of 39 degrees, and for any white person 3.6 degrees. Palm oil causes cancer and oncological diseases, and generally weakens the body! So why ban something when the main cause of the disease has not been eliminated??? This article simply blamed everything on ordinary people! It’s very easy to slander people, but it’s difficult to ban the source of the disease in the form of palm oil?
    In practice, an accusation of an unhealthy lifestyle looks like this:
    - You smoke cigarettes! Don't eat fruits from Africa? These are radioactive bananas, peanuts that cause DNA mutations and others. Let us cure you? Here are some tablets and vitamins containing palm oil, which causes cancer. Go and get treatment, Russian people!