About the Regional Office and Center
History of the Regional Sanitary and Epidemiological Service
The first government agencies controlling the sanitary and epidemiological situation were established in the Perm Province, which included the territory of the current Sverdlovsk Region, in 1872. Under the provincial administration, a permanent sanitary commission headed by Ivan Molesson, a graduate of Kazan University, was organized. He became the first public health (sanitary) doctor in Russia. Ivan Molesson was engaged in sanitary and statistical studies of climatic and geographical conditions of the area, living and working conditions, infectious and non-infectious disease incidence and prevalence.
In 1908, the position of the county public health doctor was created in the Perm Province. Yet, it was difficult to provide each county with such a doctor due to low wages.
In 1918, the Ural Regional Commissariat of Health was organized in Yekaterinburg. At that time, infectious diseases were a great challenge. In the Perm Province the situation was the worst. Tens of thousands of people died of typhoid fever, typhus, malaria, and cholera annually.
During the civil war, an epidemic wave in the Urals swept over everything. A large network of hospitals was created to fight it. The first public health institutions appeared at the same time. They were organized as epidemiological bureaus consisting of three people – a health instructor, a vaccine immunization specialist, and a disinfector. In 1919, the first disinfection bureau was organized in Yekaterinburg on the basis of one of the hospitals, later reorganized into a disinfection station.
The 1920s were marked by a sharp increase in the incidence of such infectious diseases as tularemia, brucellosis, tick-borne encephalitis, septic tonsillitis, etc. In order to study them, a chemical and bacteriological institute was established in Yekaterinburg in 1920, later reorganized into the Institute of Microbiology and Epidemiology (as of today - the Institute of Viral Infections). In the same year, a medical faculty was opened at the State University in the Urals.
In 1922, a Decree of the Council of People's Commissars "On the Sanitary Bodies of the Republic" was issued launching the sanitary and epidemiologic service in the country. Its organizational period lasted from 1922 to 1933 and included formation and strengthening of the governmental public health authorities as mandatory healthcare elements.
In 1923, the Sanitary Anti-epidemic Department was organized in the Yekaterinburg People's Commissariat of Health headed by Dr. Nestor I. Ivanov, the first Chief Sanitary Doctor in the Sverdlovsk Region. Clinical and bacteriological laboratories, a malaria station, a Pasteur station, a sanitary and hygienic laboratory at the Water and Food Quality Department appeared in the region.
In 1926, the first occupational health consulting room was opened in the premises of the Verkh-Isetsky district polyclinic in Sverdlovsk (in 1924, the city was named Sverdlovsk after the Bolshevik leader Yakov Sverdlov). In 1930, the Ural State Institute of Pathology, Hygiene and Scientific Organization of Labor was established (as of now, the Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers).
The period of 1933 to 1948 was marked by the development of the government sanitary inspection, strengthening of its monitoring functions, and differentiation of sanitary and epidemiological activities.
In 1933, the Decree of the Central Executive Committee and the Council of People's Commissars of the USSR "On Organization of the State Sanitary Inspection" was issued. The main tasks assigned to the government inspection included supervision of public catering, working conditions, and cleaning of populated areas.
In 1933-1937, standards were developed for the sanitary protection of water bodies, wastewater discharge, and city planning; maximum permissible concentrations of chemicals in industrial emissions were proposed.
In 1935, the Decree of the Central Executive Committee and the Council of People's Commissars of the USSR "On Organization of the All-Union State Sanitary Inspection" was issued, which dealt with issues of preventive surveillance in occupational, nutrition, housing and communal, and pediatric hygiene. In accordance with this decision, the Regional State Sanitary Inspection headed by the first chief state inspector Irina Leonova was organized at the Sverdlovsk Regional Health Department.
In 1938, the Institute of Microbiology and Epidemiology was established in Sverdlovsk headed by Dr. Alexey Pshenichnov. Later, he organized the first Virology Laboratory in the Urals.
In 1939, the Regulations on Urban and Regional Sanitary and Epidemiological Stations were adopted. The main tasks of the emerging stations included laboratory testing, foci investigation, prevention of infectious diseases, and disinfection. In 1943, the first Faculty of Sanitation and Hygiene was opened in the Sverdlovsk State Medical Institute. From the very first days of its existence in the midst of the war, Professor S.V. Miller, Associate Professors V.S. Serebrennikov, V.A. Litkens, L.K. Pashkevich and others began training future professional public health doctors.
Despite its active development, the sanitary and epidemiological service became a single integrated structure only in 1949-1955. In 1949, the Council of Ministers approved new Regulation on the All-Union State Sanitary Inspection and the bodies of the sanitary and epidemiological service. In the same year, the Regional Sanitary and Epidemiological Station was established in the Sverdlovsk Region. Dr. Galina Russkaya was appointed the first chief doctor of the regional office. She was later awarded the title of the Honored Doctor of the Russian Soviet Federative Socialist Republic (RSFSR) and the badge for "Excellence in Health Care".
In 1950-1959, the regional office was headed by Dr. Varvara Bykova. During her leadership, in 1954, the Regional Sanitary and Epidemiological Station and the Regional State Sanitary Inspection were merged. Dr. Bykova became the first sanitary doctor in the Sverdlovsk Region awarded the title of the Honored Doctor of the RSFSR. She was also awarded the badge for "Excellence in Health Care".
In 1956-1970, further improvement of the forms and methods of work and implementation of comprehensive measures aimed at strengthening sanitary supervision took place. From 1959 to 1985, Alla Oshchepkova, Honored Doctor of the RSFSR, holder of the Order of the October Revolution, the Order of the Badge of Honor, the badge "Excellence in Health Care", and the silver medal of the "All-Union Exhibition of Economic Achievements" headed the Regional Sanitary and Epidemiological (SanEpid) Station. During her leadership, municipal and district SanEpid stations were organized in all towns and districts of the region.
At that time, both the regional and city SanEpid stations started systematic monitoring of ambient air, radiation, and infectious diseases; opened radiological and virology laboratories, an air quality laboratory, a toxicology laboratory, a laboratory of physicochemical research methods, of toxic chemicals, an organization and methods department, and three disinfection stations.
The years 1970–1991 were marked by a qualitative improvement in activities of the service, strengthening of its material and technical base, creation of new departments in the structure of SanEpid stations, organization of inter-district SanEpid stations and laboratories, and introduction of automated control systems. Integration of urban and district SanEpid stations was carried out and five houses of health education were opened. In 1978, information systems were introduced in the region enabling regular monitoring and analysis of the levels of immunization, infectious and occupational morbidity. Laboratories of the Department of Pediatric Hygiene, the laboratory of electromagnetic fields, work physiology, Departments of Automated Control Systems, Social Hygiene, and Organization of Laboratory Control and Metrology were organized.
In 1985, Boris I. Nikonov became the Chief State Sanitary Doctor in the Sverdlovsk Region.
In 1989-1990, management and financing of the SanEpid service was centralized and the Regional Association "SanEpid Service" was formed.
During this period, with the immediate participation of SanEpid specialists, a three-year plan for the construction of environmental facilities in the Sverdlovsk Region was developed for the first time in the country. In just 10 years, 493 water protection facilities and 757 air purification plants were commissioned in the region. In 1983, the first "Health" Program was developed in the Sverdlovsk Region and approved for the first time in the Soviet Union.
In 1991–2005, the service was withdrawn from the subordination of health authorities at the level of the constituent entities of the federation. The period was noted for further development of the laboratories, organization and conduct of socio-hygienic monitoring, development of regional and municipal health programs.
In 1991, the first law "On the Sanitary and Epidemiological Wellbeing of the Population" was issued. In 1991, the State Committee for Sanitary and Epidemiological Surveillance of the Russian Federation was formed, which in 1998 was reorganized into the Department of State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Russian Federation.
The legal effect of the law made it possible to withdraw SanEpid bodies of the Sverdlovsk Region from departmental subordination to health authorities and transfer them to centralized management and funding from the federal budget. This also helped strengthen supervisory functions and increase exactingness towards officials, enterprises, organizations, and citizens. Subsequently, much work was done to organize more efficient funding of the service with involvement of the regional budget allowing implementation of activities aimed at monitoring the local environment and health situation.
During this period, for the first time in the Sverdlovsk Region, 17 regional laws were adopted aimed at disease prevention and improvement of sanitary and epidemiological wellbeing of the population. Both regional and municipal health programs were developed. The health status of the population living in environmentally disadvantaged territories was studied and remediation activities were elaborated. In 1992, the first State Report on the Epidemiological Situation in the Sverdlovsk Region was published, which subsequently became annual.
In 2005, the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) was established. The regional SanEpid Service was reorganized and subdivided into the Office of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing in the Sverdlovsk Region (a supervisory authority) and the Federal State Healthcare Institution "Center for Hygiene and Epidemiology in the Sverdlovsk Region" (an institution supporting the activities of the Office). Twenty-nine territorial departments of the Office and the same number of branches of the Center were set up in the cities and districts of the region. As a result of the reorganization, supervisory functions were separated from the functions of rendering paid services, including laboratory testing.
The process was managed by Chief State Sanitary Doctor for the Sverdlovsk Region Boris Nikonov who headed the regional sanitary and epidemiological service for 22 years. Dr. Nikonov is a Doctor of Medical Sciences and Honored Doctor of the Russian Federation; he was awarded the Orders of Honor and "For Services to the Fatherland" of the fourth degree, the badges "Honorary Worker of the State Sanitary and Epidemiological Service of Russia", "Excellence in Health Care of the Russian Federation", and the Honorary Sign "For services to the Sverdlovsk Region", as well as diplomas of the Ministry of Health of the Russian Federation, the Governor and Government of the Sverdlovsk Region.
In 2010-2018, the Chief State Sanitary Doctor in the Sverdlovsk Region was Dr. Sergey Kuzmin, D.M.Sc., Professor. He was awarded the badge "Excellence in Health Care", the Order "For Merits in the Development of Medicine and Health Care" of the Russian Heraldic Chamber, and the I. Pavlov Medal of Honor by the Russian Academy of Natural Sciences, Certificates of Honor by the Ministry of Health of the Sverdlovsk Region, etc.
The Regional Service Today
In December 2018, Dr. Dmitry Kozlovskikh, PhD, was appointed Chief State Sanitary Doctor in the Sverdlovsk Region.
Today, more than 2.5 thousand specialists work in Rospotrebnadzor bodies and institutions of the Sverdlovsk Region. Twenty-eight public health doctors of the Office have the title of Honored Doctor, 21 specialists are Candidates of Sciences, and one is a Doctor of Medical Sciences. More than 50 % of the regional Rospotrebnadzor personnel have a qualification category.
Much attention is paid to training of young professionals. The Ural State Medical University has organized a targeted admission of applicants to the Faculty of Preventive Medicine. Today, about 150 students study at the faculty as part of the targeted admission.
The main method that is currently used in the activities of the service is a health risk management including risks posed by chemical and biological pollution of environmental media, food, radiation, noise, etc. It is a comprehensive set of administrative, social, economic, technological, and informational measures.
The development of managerial decisions on reduction of environmental and health risks is based on socio-hygienic monitoring, i.e. a system of studying human health effects of environmental factors. Planning and control of these activities is also carried out within the framework of health risk management. The main tasks include a decrease in the size of the regional population exposed to biological and chemical contaminants of food products, occupational disease prevention, childhood disease prevention, reduction of the health burden associated with living conditions, etc.
As part of this activity, the municipalities of the region are given priority tasks to ensure sanitary and epidemiological wellbeing of the population; departmental targeted programs are developed and implemented to solve these tasks.
Service staff also participate in the development of the Concept of Preservation of the Population of the Sverdlovsk Region, the Concept of Environmental Safety of the Sverdlovsk Region, the Concept of Developing Occupational Medicine in the Sverdlovsk Region, the Regional "Ural Family" Demographic Development Program until 2025, and a Comprehensive Action Plan for health improvement in the population living in environmentally disadvantaged territories of the Sverdlovsk Region.
The Sverdlovsk Region was the first to launch a rehabilitation program for the population living in industrially polluted areas as part of environmental and health monitoring. Techniques of monitoring the incidence of socially significant diseases, such as congenital malformations, cancer, poisoning, etc., were developed and implemented on the regional level.
Approaches to assessing the economic efficiency of the regional risk management system using cost-effectiveness and cost-benefit analyses were elaborated. In 2009, the total cost of measures taken to achieve sanitary and epidemiological wellbeing exceeded 13 billion rubles (i.e. 2,966 rubles per capita). This is several times lower than the amount of damage that could have been caused to public health in the absence of such measures. In monetary terms, its size could have amounted to 89 billion rubles.
Another important area is the control of the epidemiological situation, infectious morbidity, and vaccination of the population.
The Sverdlovsk Region was the first constituent entity of the Russian Federation to develop its own immunization schedule. In addition to the 10 vaccinations imposed by the national schedule (or calendar), it includes seven more vaccinations against tick-borne encephalitis, chicken pox, influenza, cervical cancer, etc.
The Immunization Program implemented in the region helped prevent more than 182.3 thousand infectious diseases in 2009 and the prevented economic damage amounted to 2.9 billion rubles.
Since 2005, as part of the activities of the service, consumer protection has been actively developed. The priorities under surveillance include sales of food and non-food products, household, housing and communal services, transport and communication services, equity construction, tourist, medical, insurance, and educational services, etc. The Sverdlovsk Region was the first to introduce the system of control over banking services. In 2007, the local Rospotrebnadzor Office was the first to speak out in defense of consumers and against bulk mailing of credit cards. Since that time, judicial practice with banks grew rapidly. On the account of the Office, there are many cases won in favor of consumers related to a unilateral increase in the interest rate on loans, collection of various commissions and other violations by credit organizations. Much attention is paid to supervising observance of the rights of citizens by property management companies rendering housing and communal services. Recently, the supervisor has won several high-profile cases with management companies that violated the rights of consumers in the provision of housing and adjoining territory services and electricity billing.
For the first time in Russia, the procedure for filing lawsuits in defense of an indefinite number of people was developed. At present, the successful experience of the Sverdlovsk Reginal Rospotrebnadzor Office is being taken over by the local Rospotrebnadzor bodies in other regions of the country.
In 2009, by means of removal of low-quality and dangerous products from the market, filing lawsuits in defense of an indefinite number of people, and pre-trial settlement of disputes officials of the Rospotrebnadzor Office prevented material damage to consumers in the amount of 271.2 million rubles.
Today, the main tasks facing the Sverdlovsk Regional Office of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing include:
1. Improvement of the state control and supervision in ensuring sanitary and epidemiological welfare of the population and protecting consumer rights, implementation of Federal Law No. 294-FZ "On protection of rights of legal entities and individual entrepreneurs in implementation of state surveillance and municipal control" dated 26 December 2009, plans and programs of interagency and interdepartmental interaction, development of a common information system and an electronic document management system, improvement of the state system of socio-hygienic monitoring.
2. Implementation of the Concept of Administrative Reform, the Concept of Socio-Economic Development of the Sverdlovsk Region for the period until 2020, the "Ural Family" Demographic Development Program of the Sverdlovsk Region for the period until 2025, and the priority National Health Project.
3. Improvement of the state sanitary and epidemiologic surveillance.
4. Epidemiologic surveillance of infectious and parasitic diseases, sanitary protection of the territory, and securing biological safety.
5. Improvement of the personnel policy and training, postgraduate professional education of specialists of the Regional Rospotrebnadzor Office and the Center for Hygiene and Epidemiology in the Sverdlovsk Region.
6. Enhancement of the regulatory and methodological support of activities of the Regional Rospotrebnadzor Office and the Center for Hygiene and Epidemiology in the Sverdlovsk Region.
7. Scientific support for activities of the Regional Rospotrebnadzor Office and the Center for Hygiene and Epidemiology in the Sverdlovsk Region and the development of interaction with governmental and local authorities in ensuring sanitary and epidemiological wellbeing of the population and consumer protection.
8. Improvement of the state surveillance in the sphere of consumer protection, implementation of plans and programs for interaction with the civil society in issues of consumer protection.