Vol 96, No 12 (2017)

The paper presents approaches to the implementation the basic paradigm of the development for the legislative and regulatory framework to ensure the sanitary and epidemiological welfare of the population based on the comprehensive implementation of the methodology of the health risk assessment and management. The consistent implementation of the legislative and regulatory framework should provide getting answers main questions: what, where, when, how we are to assess and above all how we have to manage and control health risks. The suggested approach involves the accumulation capacities and resources of all the stakeholders: "State — Russian Federation constituent — municipality — economic entity — non-governmental organizations — population" in the assessment, management and control health risks both for the public in general and for certain socio-economic groups. This integrated system is aimed at the decline of public health risks to levels that cannot be detected using current knowledge and methods. The described requirements for incorporation of health risk assessment, management and monitoring methods into the health, consumer rights and labor legislation framework and other areas of legislative regulation must be applicable for corporate entities’ and sole entrepreneurs’ various business activities that affect (pose a threat, create a risk, cause harm) public health as well as regulation of the social and economic development of the nation in general.

In the Sverdlovsk Region, the concept of information support of decision making in health risk management for the population is based on the development of the system of socio-hygienic monitoring created in 1991. At the current stage, elaboration of the system is aimed at adequate management of risks and threats to population health and information support of the risk-focused model of supervisory activities in the sphere of security of sanitary and epidemiologic public welfare. The article presents results of socio-hygienic monitoring and recommendations for its improvement at the level of the constituent entity of the Russian Federation. We also formulate tasks to be fulfilled in the support of the development of the system of socio-hygienic monitoring.

The article describes the organizational structure and results of the implementation of a unique interdepartmental system of targeted health care and disease prevention in risk groups of the most vulnerable categories of the population (children and pregnant women) resided in industry-affected areas, which is an integral part of the regional system of the management chemical risks for population health. The system is represented by a modular stepwise principle of taking a set of science-based hygienic, health care and disease prevention measures and includes hygienic diagnostics and multimedia health risk assessment; environmental epidemiology studies; biological monitoring of toxicants; evaluation of the personal multimedia toxic burden in the most vulnerable population groups; biological disease prevention, clinical and laboratory diagnostics and rehabilitation treatment of diseases, informing population about health risks posed by chemical contamination of the environment and measures of risk elimination and prevention; performance evaluation including a cost-benefit analysis. The system health management has been implemented since 2001 in 17 municipalities of the Sverdlovsk Region with the mean annual coverage of 11,000 preschool children, pregnants and women of childbearing age. In 75–80% of enrolled children, clinical and diagnostic indices improved, thus indicates to the health promotion: morbidity rate in these children decreased by 30–40%, disease frequency and duration became 2–4 times lower, and over 80 additional incident cases per 1,000 children were prevented. In 2005–2016, the prevented economic damage to public health exceeded two billion rubles. Since 2009, the system has been applied in the Republic of North Ossetia-Alania (the town of Vladikavkaz), the Orenburg Region (the towns of Mednogorsk and Gay), and the Krasnoyarsk Krai (the city of Krasnoyarsk).

The paper discusses the non-mandatory audit experience aimed at the improvement of the relevance of the risk-based sanitary and epidemiological supervision of public catering facilities. The facilities were assessed with the use of a point scale according to the checklist integrating Technical Regulations of the Customs Union 021/2011 on Food Safety and the current Sanitary Regulations. Each procedure was assessed in terms of thoroughness and efficiency of the preventive measures taken by the catering facility ensuring food safety and complying with the HACCP principles.

In conditions of the formation and development of the civil society, the awareness of the population of their rights to a favorable habitat and the possibility of the practical impact on the state of sanitary and epidemiological welfare and safety of the population, provision of the protection of consumer rights, the role of public associations and the population in managing health risks appears to be undervalued. Sverdlovsk Regional Public Organization «Health and Welfare» was created to implement the idea of the protection interests and positions of the population of the Sverdlovsk region. To ensure its effective activity, the backbone of a public organization is made up of veterans of the sanitary and epidemiological service, who have knowledge, experience, traditions and representing the possibilities of public associations in the sphere of the provision of sanitary and epidemiological welfare and protection of consumers’ rights. The activity of public associations can be most effective in the practical use of non-state, public, independent forms and methods of execution of expertizes, assessments, investigations, the results of which can prevent a negative impact on human beings of harmful factors in the human environment.

The paper presents results of the application of the system approach to carcinogenic risk assessment and management based on the identification carcinogens, prediction carcinogenic effects and rationale for targeted preventive and curative measures. Evidence from metallurgical shops where various blister copper production processes are used regardless of the existing smelting technologies shows the risk of cancer to be Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeingeptable even when the working conditions are classified as permissible (class 2) in terms of chemical factors. The highest carcinogenic risk values are observed for occupations with workplaces characterized by a significant release of dust, arsenic being the main risk contributor. In cases of the blast furnace and reverberatory furnace smelting, carcinogenic risks for workers with a 25-year length of employment exceed the permissible level by 17.6 and 28.8 times, respectively, and in the case of bath smelting, carcinogenic risks exceed the permissible level by 5.1 times. The maximum length of employment for bath smelting shop workers amounts to 5.14 years, being by 1.42 and 0.89 years higher than that for the blast furnace and reverberatory furnace smelting shop workers, respectively. The observed cancer mortality rates exceed significantly the expected mortality rates for the tumor of all sites in cases of combined and respiratory cancers. The highest cancer mortality rates were recorded for batch loaders (60%) and smelter (40%) with the highest predicted carcinogenic risk values. Cancer-specific marker levels higher normal ones were detected in 73% of workers from the increased individual carcinogenic risk group. The proposed system approach to carcinogenic risk assessment and management will make it possible to try out components of the risk-based approach in the supervisory activities at industrial facilities with exposure to carcinogens, to establish the acceptable risk levels depending on the length of employment, identify the priority carcinogens; it will also allow indicating a rationale for additional testing for occupational carcinogenesis predictors as part of routine medical examination procedures and to develop preventive measures against key risk factors.

Working conditions of employees are characterized by concomitant exposure to chlorine and hydrochloride vapors, dust, industrial noise, total vibration, levels of microclimate indices higher than normal ones and the hardness of the labor. They are classified as hazardous: working conditions class 3.3 – 3.4. The combined exposure to PM₁₀ particles (most of the total suspended particles mass), irritants (sulfur dioxide, nitrogen oxide, hydrogen chloride, chlorine) results in the predominance of respiratory diseases in the morbidity pattern in employees (p < 0.05). A strong statistically significant causal relationship was established between the respiratory diseases and the working conditions (RR=2.9 95% CI=1.81-4.64; EF=65.49%). Higher prevalence of upper respiratory airway diseases (chronic rhinitis, nasopharyngitis) was observed (p < 0.05). The development of these diseases was found to depend on the length of employment, no statistically significant prevalence being observed in the control group. The assessment of the respiratory function showed no deviations from the physiological norm both in the study group and the control group, making it difficult to identify diseases of the lower respiratory airways during the routine medical examination. At the same time, diseases of the lower respiratory airways (simple chronic bronchitis; mucopurulent chronic bronchitis) were diagnosed in 25.6% of workers of the study group and 13.7% of workers of the control group (p < 0.05). The changes found during echocardiography, without any impairment of the respiratory function and clinical symptoms at the stage of the routine medical examination, indicate the lower respiratory airway diseases to be latent. For the workers there was proposed the program for the prevention of a risk-based respiratory disease, which involves the division of workers into 4 groups and the development of individual recommendations and program of the prevention for each group.

The authors consider critically some inconsistencies of applying the officially established standards for inorganic dust permissible concentrations in ambient air to amorphous silica nanoparticles-containing industrial aerosols and, relying upon their previously published experimental results, propose a feasible temporary solution to this problem for the purposes of hygienic monitoring.

With taking into account the biological toxicity of metallic and metal oxide nanoparticles to be a well-established fact, the widespread use of nanotechnologies and the significant proportion of nanoscale particles in industrial aerosols released during many pyrometallurgical and electric welding processes determine the importance of searching for approaches to increase the organism’s resistance to them. Results of a number of experiments show the application of combinations of some bioactive agents composed in accordance with sound theoretical premises and used in innocuous doses to be potent of the significant attenuation of the integral and specific toxicity of metallic nanoparticles and even their genotoxicity. Further research followed by practical application of the results is a promising trend in the occupational risk management strategy.

There are presented methodological approaches to assess the risk of negative factors associated with characteristic areas of metallurgical enterprises in pollution of the environment with heavy metals to human health. The use of noninvasive biotesting, based on established correlations of indices of trace elements and oxidative status in the body is suggested. As a non-invasive biological material, alveolar moisture condensate from the person (expirate) is used. The basis for the health risk assessment is information on the balance of two components of the oxidative process responsible for the adaptive function of the body — free radical oxidation and antioxidant defense system. An imbalance of these processes contributes to the development of oxidative stress, the complication of the course of many diseases. The deviation in quantitative indices of a number of elements, primarily of metals of variable valency, which participate in reactions of lipid peroxidation, showing pro- or antioxidant properties can also serve as the indicator of the effects of complex heavy metals. The identified relationship of trace elements and oxidative status allows providing the approach to the assessment of processes of peroxidation in the assessment of microelement exchange indirectly. To study the intensity of peroxidation and capacity of the antioxidant defense system in expirate a number of methodological solutions was proposed — methods of chemiluminescence and spectrophotometry, as well as biotest, allowing detect deviations in the oxidative status and based on the level of bioluminescence of lyophilized bacteria by oxidative potential of investigated expirate of alveolar moisture. The complex of methods for assessment of the degree of the health risk associated with pollution by heavy metals can be used for screening observations in selected contingents with the purpose of formation of risk groups such as individually for the choice the optimal ways of correction of disorders and the assessment of the efficiency of preventive or corrective measures. Examples of methodological approaches in one of the regions of accommodation of the enterprises of nonferrous metallurgy, and in the estimation of risk development of pathological conditions and the efficiency of the treatment for a particular worker of the metallurgical plant, as the patient in the clinic of occupational diseases.

A comparative analysis of occupational health risk based on special evaluation of working conditions (SEWC), workplace inspection as well as medical and biological criteria (realized risk) showed occupational hazards to be underestimated during special evaluation of working conditions and the predicted risk (estimated using the SEWC technique) fail to correspond to the realized occupational risk. As a rule, the realized risk due to the exposure to chemicals, predominantly fibrogenic aerosols, the noise was higher than the risk predicted by using the Size-exclusion chromatography (SEWC) technique. Both the distorted reality of working conditions, inadequate real occupational risk assessment leads to the incomplete information for occupational disease identification, establishment of the causality for health conditions, as well lower quality and efficiency of measures aimed at the improvement of working conditions and preservation of employees’ health.

The oil industry, transporting industry and processing industry is the most hazardous branches of the national economy as an increase of their production inevitably leads to an increase in volumes of petroleum pollution and waste. This is accompanied by an increase in environmental threats, a decrease in the area of economic lands, a decrease of soil fertility and a degradation of human health. The large-scale exploitation of subsoil and the increase in volumes of oil refining contributes to the increased risk of an environmental pollution, beginning from the stage of oil exploration and production and ending with the use of oil products. The pollution of environment takes place with the implementation of drilling processes and preparation of wells for operation. The drilling processes are accompanied by dispersed rock destruction, the formation of drill cuttings and removing it with washing liquid. The formation of significant quantities of oily wastes decreases the economic efficiency of enterprises in oil and gas industry due to the need of alienation of the territory of those enterprises for the oily waste storages, the increase of environmental payments for waste storage and pollutant emissions. According to Federal law “On production and consumption wastes”, every enterprise must develop “passports of hazardous waste”. The study of the chemical composition of a wide range of organic substances, metals and elements migrating to aquatic environments by modern highly sensitive methods of physical and chemical analysis provides the possibility to identify early unknown and unaccounted matters in oily wastes, which are capable of entering environmental water bodies. There were identified up to 100 organic compounds among substances that migrate to aquatic environments. The spectrum of detected organic substances is presented by aromatic, polycyclic aromatic, naphthenoaromatic hydrocarbons, biphenyls and oxygen-containing compounds, including alcohols, phenols, aldehydes, ketones, complex ethers, furans, quinones and nitrogen- and sulfur-containing compounds. The analysis of the inorganic component of oily wastes that migrate to aquatic environments showed that among 70 metals and elements studied the largest mass fraction was in alkaline-earth metals (< 82%) and alkali metals (< 33%). There was established the presence of sulfur (< 1%), iron (< 0,25%) and heavy metals: copper and tin (0.002% in total). The studies of the anion composition of oily wastes’ water extracts established the presence of chlorine, carbonate and bicarbonate ions. The concentration of sulfate ion was below the method’s sensitivity level.

The publication represents the first fragment of the large comparative study, directed to the investigation of factors which negatively influenced to the state of health and emotional sphere of students from Chemical Faculty (CF, 102 persons) and economic (EF, 68 persons) faculties of the same university. For this goal, the genetical, psychological and sociological investigation was included into the study. The block of standard psychological scales, detecting levels of expression of social adoption, alarm, overfatigue and interpersonal relations as well as the subjective welfare scale, are used for anonymous psychological testing. For the analysis of the conduct of life, state of health and influence of socioeconomic factors the special card-interview is created. For the levels of genomic instability evaluation, the micronuclear test on the buccal epithelium cells is used. We found out that students from CF had 3 times more level of stress expression than students from EF. We detected the two significant factors, negatively influenced to emotional sphere: the student’s relation to their future profession and the duration of the contact with chemical compounds during laboratory studies. In the latter case, in addition to correlation with category “faculty”, the dependence on time of duration (hours/week) of laboratory work is revealed. The influence of material prosperity and indicators of a conduct of life on the state of health and the emotional sphere of students aren’t revealed. As the relation to the future profession is proved as an essential factor of students’ quality of life and health, it is represented to be correct to reveal the true relation to the future profession during admission examinations by means of special psychological tests. Such approach can not only become base of a new technology of health protection during the training in higher schools, but also to increase the number of students who after release will work on the chosen specialty will allow increase.

The development of Russian legislation aimed at providing safety based on the risk assessment and management methods and technologies is a key paradigm in regulating relations in the field for the next few years and in the longer term. The importance of applying these technologies and methods to the field of maintaining sanitary and epidemiological welfare of the population is due to the hazards related to residential environment (exposure to chemical, biological, physical, psychophysiological factors), occupation, consumption of goods and services, lifestyle (imbalanced diet, alcohol consumption, smoking, low physical activity), social and other environmental factors that account for adverse health effects. Therefore it is necessary to revise the regulatory and methodological framework for the health legislation including the definitions for the fundamental health risk concepts based on identifying the acceptable risk limits as well as the concepts of safe and non-hazardous conditions and favorable conditions of human vital activity closely related to them. The suggested approach will make it possible to apply risk management technologies and methods more effectively in legislative regulation in the field of sanitary and epidemiological welfare, which in the short term will provide the capacities required to reach the strategic objective of Russia’s policy to provide safety, i.e. higher life expectancy and quality of life of Russian citizens.

Начиная с 1989 г , в рамках Европейского процесса «Окружающая среда и здоровье» (ЕПОСЗ) проводятся министерские конференции по окружающей среде и охране здоровья Они являются уникальной политической платформой межсекторального характера, которая объединяет на равноправной основе представителей министерств здравоохранения и министерств окружающей среды 53 государств-членов Европейского региона ВОЗ, наряду с заинтересованными сторонами, представляющими международные и неправительственные организации из различных секторов, в том числе и представителей молодежи, для определения приоритетных задач политической деятельности в области окружающей среды и охраны здоровья, а также для принятия политических обязательств по решению этих приоритетных задач.