1. Security and comfort of interaction with the environment.

The urgency of the problem. Maintaining a favorable, i.e. a comfortable living environment is the most important condition for ensuring environmental safety and achieving sustainable socio-economic development of society. As emphasized in the WHO Global Strategy for Health and Environment (1993), successful implementation of this task is possible only on the basis of the creation of regional systems for monitoring the environment and health of the population. For Russia, with its unstable economy, deteriorating medical and demographic situation, and deepening environmental degradation in most agricultural and industrialized regions, this problem is especially important and relevant.

Developed in the 70s - early 80s. I.P. Gerasimov /43/, Yu.A. Israel /79/ and developed in the works of B.V. Vinogradova /32/, N.F. Reimers /215/, R.E. Munn /134, 332/ conceptual approaches to monitoring the human environment in the 90s. were logically supplemented with a medical and environmental component. This awareness was largely promoted as fundamental achievements in the field of human ecology, substantiated in the works of A.P. Avtsyna /2/, N.A. Agadzhanyan et al. /3, 87/, A.G. Voronova /34/, V.P. Kaznacheeva /83, 84/, A.A. Keller /88, 219/, S.M. Malkhazova /132/, B.B. Prokhorova /199, 201/, B.C. Preobrazhensky, E.JI. Reich /189, 206/, and the results of regional applied research in geoecology and medical geography /34, 47, 133, 143, 164, 219, 229, 259, 263, 277/. At present, it is already obvious that an effective environmental policy is based on the priority of public health, as the focus reflects the entire range of adverse environmental impacts on humans.

According to the prevailing ideas, "environment-health" monitoring is defined as a system of organizational, technical and preventive measures that ensure the monitoring of the state of the environment, the health of the population, their assessment and forecasting, as well as actions aimed at identifying, preventing and eliminating the influence of harmful environmental factors. habitat (risk factors) on public health. The center of gravity in solving a wide range of issues of ensuring environmental control, monitoring and safe development of society is moving to the regional level. In recent years, against the background of environmental degradation in many industrialized regions of the country, an increase in the incidence of the population has been observed, which correlates with the level of anthropogenic disturbance of the natural environment. In connection with the growing threat to life safety, it is especially important to identify geoecological risk factors for public health, develop methods for assessing health risk, and create regional models of living environment comfort.

These problems are quite acute for the majority of urbanized and industrial-agrarian regions of the country, where more than 60% of the population of Russia lives. In connection with the development of monitoring approaches in the system of environmental control and in the management of environmental quality /1, 79, 249/ certain progress has been made in the development of organizational, technical, informational bases for regional monitoring of public health. A number of specific studies carried out on the basis of the largest regions and industrial centers of European Russia, Siberia and the Far East show the prospects for computer modeling and the use of automated systems to ensure monitoring of public health based on parallel monitoring of environmental quality and public health /41, 47, 73 , 190, 195/. In connection with the development of information technology, the possibilities for the practical implementation of such systems are increasingly expanding.

Various data on the dependence of the state of health of the population on the quality of the environment and socio-economic conditions have been accumulated in domestic and foreign literature. At the same time, a narrow sectoral approach prevails in this subject area, which consists in the analysis of any group of diseases or particular risk factors. Data on the correlation of pollution, other environmental factors and public health are often contradictory and not statistically substantiated. The issue of integral criteria for the medical-geographical well-being of the region and its environmental comfort has been poorly developed. Approaches to complex medical-geographical ranking and territorial zoning remain insufficiently substantiated and debatable. The mechanisms of cause-and-effect relationships in the environment-health system, which are formed under the influence of a complex of natural, socio-economic and health risk factors in specific industrial and industrial-agrarian regions of the country, are largely unclear.

Thus, to date, a holistic approach and a unified methodology for the implementation of regional monitoring of public health, including interrelated organizational, technical and informational and analytical aspects, have not been developed. Approaches to assessing and modeling the levels of comfort of the environment, taking into account regional specifics, have not been developed, which determines the relevance of developing this problem in general and the need for its conceptual justification.

The aim of the work is to develop the geoecological foundations of regional medical and geographical monitoring and substantiate the principles for creating models of the comfort of the environment in industrial-agrarian and urbanized regions.

In accordance with the goal, the following main tasks have been solved.

1. Development of a methodological framework and operating layouts of automated information and reference systems to ensure monitoring of the health of the population of industrial-agrarian regions and industrial cities.

2. Studying the patterns of formation of public health v-» /1 and cause-and-effect relationships in the environment-health system based on the created information systems (health risk assessment).

3. Determination of approaches to the calculation of integral criteria for the medical and geographical well-being of industrial-agrarian and urbanized regions.

4. Implementation of a comprehensive medical-geographical ranking of risk factors according to the degree of impact on health and criteria for the state of health in terms of the level of "response" to the quality of the environment.

5. Creation of regional models of environmental comfort in industrial-agrarian and urbanized regions according to a set of geo-ecological criteria with substantiation of the principles of integrated medical-geographical zoning.

6. Development of a conceptual model of regional medical-geographical monitoring, taking into account the priority criteria for health status, the quality of the environment and assessing the effectiveness of regional environmental policy.

The object of the study was the state of the environment and public health. The subject of research in the dissertation is the state of the environment and public health of a number of large industrial-agrarian and urbanized regions of the Central Chernozem and Kuban regions, including Belgorod, Voronezh, Lipetsk, Tambov regions, as well as industrial cities: Voronezh, Krasnodar, Tambov, Rossosh Voronezh region. More detailed comprehensive studies were carried out on the example of the base (model) Voronezh region.

The work was based on complex medical-geographical studies carried out by the author in a number of regions of the Middle and Southern Russia using probabilistic-statistical approaches and computer modeling over a 10-year period (1988-1997), and for malignant neoplasms - for a longer time (1981-1997

The research allowed us to formulate the conceptual provisions of the regional system of comprehensive monitoring of public health, which, from our point of view, should be called medical-geographical monitoring, taking into account the control of natural, socio-economic, environmental-hygienic and health-care health risk factors in a number of regions Central and Southern Russia, as well as to determine the main directions of regional environmental policy and improvement of the environment.

Scientific novelty and the theoretical significance of the studies are connected, firstly, with the development of the theory and improvement of the methodology of evaluative medical and geographical studies aimed at identifying cause-and-effect relationships in the "environment-health" system, ranking risk factors by priority, regional zoning according to the criteria of medical and geographical well-being ; secondly, with the development of a conceptual approach to the integrated monitoring of public health in regions of various sizes, brought to a practical solution based on automated information technologies; thirdly, with the substantiation of the concept of "environmental comfort", which combines the parameters of the quality of the environment and the state of health of the population, and the principles of its assessment, differentiated for industrial-agrarian and urbanized regions.

For the first time, on the example of a number of territories of the Chernozem and Kuban regions, a comprehensive assessment of the risk to public health associated with natural, socio-economic and medical factors was carried out, which made it possible to establish priority criteria for medical and geographical monitoring for various regional levels of environmental protection and public health. The original approaches to the creation of information resources for providing medical-geographical monitoring and the construction of mathematical-cartographic models of the comfort of the environment according to integral medical-geographical criteria with the priority of the health criterion, implemented on the basis of the studied regions, are substantiated. For the first time, a classification system for the levels of environmental comfort was developed and the “quality of life standards” of the population in the agrarian and urbanized regions were characterized. The general scheme of the pathogenesis of the population living in insufficiently comfortable conditions of an agrarian region and a polluted urban environment has been supplemented with new data.

The research made it possible to advance in the theoretical study of the processes of human adaptation to harmful environmental factors, as well as to formulate a number of new fundamental provisions for improving the environment and implementing an effective regional environmental policy.

Practical significance. Based on the identification of priority risk factors and health criteria, complex medical-geographical ranking and zoning, based on the developed conceptual provisions, the study made it possible to develop and implement operating layouts of automated information and reference systems to ensure monitoring of the health of the population of the Voronezh region and the city of Voronezh.

Voronezh, to determine the main directions of regional environmental policy.

Methodological and software-algorithmic support for the formation of computer databanks have been proposed and introduced into the practice of a number of regional environmental and treatment-and-prophylactic departments of the cities of Voronezh, Krasnodar, Tambov, Voronezh, Belgorod, Lipetsk, Tambov regions "environment-health" at the regional and municipal (urban) levels of government, health risk assessment associated with environmental factors, as well as the methodology of integrated medical-geographical zoning of regions.

The effectiveness of the proposed optimization measures was evaluated according to the most important medical and social criteria for stabilizing and reducing environmentally caused morbidity and mortality in the region. The result of the study was a set of regional targeted programs developed jointly with the Centers of the State Sanitary and Epidemiological Supervision, the Health Departments of the Voronezh Region and the City of Voronezh to ensure environmental and hygienic safety in the region (regional program "Urgent measures to ensure health protection and sanitary and epidemiological welfare, disease prevention and reducing the level of premature mortality of the population of the Voronezh region for 1997-2001", 1997; target citywide program "Ecological and hygienic safety of the city of Voronezh", 1998). The effectiveness of the developed programs was positively assessed based on the results of practical implementation.

The results of the study in the form of methodological recommendations and educational automated geo-eco-information systems are implemented in studying proccess Voronezh state university(according to the courses taught by the author "Human Ecology", "Medical and environmental monitoring", " Geoinformation systems”), Voronezh State Medical Academy, Voronezh State technical university and the Voronezh State Technological Academy for students of environmental and medical specializations.

Approbation of work. The dissertation was approved at the following major international and regional conferences: 7, 8 and 9 Interstate Conferences on Medical Geography (St. Petersburg, 1987, 1991, 1995); All-Union Symposium on Microelements (Moscow, 1989); All-Union scientific conference "Ecological problems of wildlife protection" (Moscow, 1990); Interstate scientific conference "Geoecological aspects of management, health and recreation" (Perm, 1993); Interstate scientific symposium "New organizational forms of anti-cancer fight" (Chelyabinsk, 1994); International Scientific Conference on the Environment (Vilnius, 1994); International Scientific and Practical Conference "Region and Geography" (Perm, 1995); International scientific conference "Geoecological problems of sustainable development of the urban environment" (Voronezh, 1996); All-Russian Scientific Conference "Modern Geography and Environment" (Kazan, 1996); International Russian-American Ecological Congress (Voronezh, 1996); Regional scientific conference "Modern hygienic problems of environmental protection and public health in the regions of Russia" (Voronezh, 1997); 3 International Conference " environmental education in Universities" (Vladimir, 1997); International Ecological Readings in memory of K.K. Saint-Hilaire (Voronezh, 1998); 2 International Open Session "Ecology and Humanity on the Threshold of the XXI Ulyanovsk, 1998).

The information resources created by the author are registered in the STC "Informregister" (databases "Geoecological data of the Voronezh region", No. 0229703211; "The state of the environment and health of the population of Voronezh", No. 0229703212). The approaches and methodology outlined in the dissertation, as well as specific research results, were reflected in a number of targeted and federal projects carried out under the guidance of the author under the scientific programs "Universities of Russia" (project "Development of theoretical and applied aspects of medical-geographical analysis and monitoring of the environment", 1993 -1997), "Universities of Russia - fundamental research" (project 8.6.8. "Medical and environmental zoning of the urban environment", state registration number

01.9.90000314, 1998-1999); grants from the Russian Foundation fundamental research(projects: 95-07-19244 "Creation of a database for the organization of regional medical and geographical monitoring", 1995-1997; 98-07-90047 "Development of an information and reference system to provide medical environmental monitoring industrial cities", 1998-1999), state budgetary scientific topics of the VSU ("Development of a regional information system for the organization of medical and geographical monitoring", state registration No. 01.9.60000629, 1995-1997; -ecological monitoring of the industrial region”, state registration No. 01.9.90000906, 1998-1999).

Defense provisions.

1. Scientific and methodological approaches to a comprehensive risk assessment of public health and medical-geographical ranking of risk factors and health criteria based on probabilistic-statistical methods and computer modeling.

2. Methodological principles and algorithms for calculating the integral criteria of medical and geographical well-being, taking into account the priority of public health.

3. Conceptual model of regional medical-geographical monitoring, including organizational, technical and informational-analytical support, formed on the basis of automated information systems.

4. Geoecological principles for creating regional models of environmental comfort and integrated medical-geographical zoning of industrial-agrarian and urbanized regions.

5. The general scheme of the pathogenesis of the population living in regions of reduced comfort of the environment with the justification of the system of compensatory health-improving and preventive measures.

1. In the system of a comprehensive regional health risk assessment and medical-geographical ranking (risk factors, health criteria), a probabilistic-statistical method is proposed based on assessing the “weight contribution” of health and environmental quality criteria in the formation of the medical-geographical situation. The basis for ranking and medical-geographical territorial differentiation are integral normalized criteria for the state of health and quality of the environment, calculated by combining private criteria for the bioclimatic comfort of the environment, levels of technogenic load, sanitary and hygienic safety and social development.

2. Regional monitoring of public health (medical-geographical monitoring) is an integral part of integrated geoecological monitoring and is based on the functional interaction of three main blocks: "Automated data banks on the state of health and the environment", "Health risk assessment system", "Management of medical environmental situation", implemented on the basis of information technology. Among the necessary types of system support, the leading one is information and analytical, focused on identifying priority regional criteria for the state of health and environmental quality, as well as building regional models of environmental comfort. The introduction of the proposed model of regional monitoring of public health in the Voronezh region has shown its sufficient effectiveness in developing a regional environmental policy, reducing the risk of environmentally caused diseases of the population, in particular, stabilizing the incidence and mortality from malignant neoplasms.

3. The basis of medical and geographical monitoring of the industrial-agrarian region are such priority, environmentally determined health criteria as the mortality of the working population (the relative "statistical weight" of the response to the quality of the environment is -43%), oncological morbidity, especially cancer of the lung and stomach

45%), incidence of coronary heart disease (27%); and in the conditions of a large industrial city - the incidence of the child population, including diseases of the blood and blood-forming organs (17 - 55%), respiratory organs (25 - 48%), congenital anomalies (17 - 39%), infections (27 - 43% ), neoplasms (14 - 30%). The conditionality of the health status of children by the quality of the environment is more stable for children of middle and older age (over 4 years old).

4. The medical and geographical situation in the industrial-agrarian region is formed under the influence of factors that reflect the natural resource potential and characterize the ecological and climatic conditions, in particular, the meteorological potential for self-purification (the share of “statistical impact” on health is 41%), as well as natural soil-geochemical background (52%). The leading health risk factors include a set of parameters of the bioclimatic comfort of the environment (33-48%). The deterioration of the health status of the population, including reproductive dysfunction, is observed in areas with low social development (22 - 41%), a higher level of chemicals in agriculture (25%).

5. The leading risk factor for the health of the population of large industrial cities is the state of the air basin (the share of "statistical impact" on health is 38%), the indicators of which are dust, phenol, formaldehyde, benzo(a)pyrene. The parameters of the architectural, planning and landscape structure (about 30%) have a significant impact on health. The quality of drinking water and the level of soil contamination with heavy metals are of selective importance as risk factors for diseases of the digestive system (stomach ulcers), stomach cancer, anemia, and congenital anomalies.

6. Regional models of environmental comfort are specific to industrial-agrarian and urban areas, which indicates different levels, i.e. "standards" of a comfortable environment, depending on the scale and industry specialization of the region. The levels of environmental comfort are differentiated into types corresponding to the industrial-agrarian region, large and small industrial cities, local (intra-urban) territory. In the industrial-agrarian region, the comfort of the environment is formed by the natural resource potential and the level of social development, and in the urbanized region, environmental, hygienic and planning factors. The role of the technogenic factor (the degree of environmental pollution, the nature of the social infrastructure) increases as the scale of the study area is detailed from the regional to the intracity local level.

7. Comprehensive medical-geographical zoning of the territory, based on the priority of public health, serves as the basis for improving the comfort of life support in the region. The medical-geographical zoning of the Voronezh region based on the combined use of cluster analysis and the statistical method of weighted points made it possible to identify gradations of the comfort of the environment in terms of the parameters of self-purification of the atmosphere, thermal, radiation climatic characteristics, as well as the level of development of the agro-industrial complex (load on land resources), social sphere and environmentally conditioned diseases. When identifying zones of different comfort in the urban environment, it is advisable to rely on the emission concept of their formation, due to the quality of the air basin, and the analysis of landscape and planning conditions.

8. The general scheme of the pathogenesis of the population living in less comfortable environmental conditions, based on the hypothesis of a decrease in the immunological resistance of the body due to the stress of adaptive mechanisms in individuals of the respective regions, has been supplemented with new ideas. As confirmed by the example of the Central Chernozem region, the first pathological reactions to a decrease in the comfort of the environment are manifested in a violation of the functioning of the most labile systems of the body - hematopoiesis, respiration - and with prolonged exposure in "low doses" - in the growth of socially dangerous (mass) diseases - neoplasms, vascular pathology, impaired reproductive function - and increased mortality of the working population.

CONCLUSION

The study, carried out on the example of a number of industrial-agrarian regions, as well as industrial cities of the Central Chernozem Region and the Kuban Region, illustrates the possibilities and prospects for creating regional systems for monitoring the health of the population based on the use of computer information technologies. Concluding the study, we can state that with the current level of knowledge, the problem of regional modeling of the levels of comfort of the environment lends itself to a completely satisfactory solution. In any case, methodically justified quantitative approaches, as well as methods of mathematical-statistical and mathematical-cartographic modeling, are preferable to still widespread intuitive estimates and descriptive judgments.

On the other hand, the significant expansion in recent years of technical means and methods of monitoring the environment, the accumulation of a large amount of various information about the habitat often puts researchers and specialists from practical monitoring and environmental departments into a paradoxical "information dead end", not giving an answer to the question of the expediency of accumulating numerous data, priority monitoring criteria, the degree of their interdependence and role in shaping the regional geoecological situation. The development of a common methodology for such studies, in our opinion, is especially important, which largely determines the expediency of the geographical approach, which is characterized by regionalism and a comprehensive analysis of the problem.

The main results of the study can be formulated in the following provisions, the totality of which represents the scientific concept of regional medical-geographical monitoring and methodological principles assessing the comfort of the environment. no-cm am ist and h it to their methods and computer simulations, allowing to achieve quite adequate results.

The principle of health risk assessment is based on probabilistic-statistical approaches associated with the use of correlation-regression analysis both in a continuous medical-geographical survey of the region, which we have undertaken in the Voronezh and other regions of the Central Chernobyl region, and in the case of using a special sampling method of cohort groups ( i.e. analysis of the contingents of the population living in ecologically contrasting environmental conditions), tested in the city of Krasnodar.

In the process of medical-geographical ranking, the proportion of reliable correlation models of a particular factor with health parameters was chosen as a measure of the significance of a risk factor, and the proportion of reliable correlation models of this indicator with the studied complex of environmental factors was chosen as the degree of “response response” of the population health indicator. The main ranking criterion was, firstly, a fairly high relative share of significant correlation models (which, with a certain assumption, can be considered as the degree of statistical influence of environmental factors on the level of public health, i.e. the degree of their interdependence), and, secondly, - logicality (plausibility) of connection according to the type "dose (factor) - effect (disease, death)".

2. Integral criteria of medical and geographical well-being, among which the criteria of public health are of priority, serve as an objective basis for building models of the comfort of the environment and its territorial differentiation.

The need to generalize the results of mathematical and statistical analysis required the introduction of a number of derivatives and integral medical and geographical criteria for the quality of the environment and the state of public health. Taking into account the approaches of N.S. Kasimova et al. (1993,1995) on the substantiation of the geochemical principles of the ecological and geographical systematics of cities, B.B. Prokhorova (1999), S.M. Malkhazova (1999), G.P. Krasno-shchekova, G.S. Rosenberg et al. (1994,1996) on the medical-geographical zoning of the regions of the world and Russia, N.P. Tikhomirov (1992) on the development of index-normative criteria for the quality of the environment, we calculated some of the most important parameters of the degree of self-purification of the environment (meteorological potential, etc.) and the anthropo-technogenic load on natural environments - air, water, soil.

In particular, on the example of the Voronezh region, for the first time, using the original method, the author calculated complex criteria for health and the quality of the habitat. These include: the health rating calculated according to the hygienic method, as well as the complex normalized health criterion (Knip), calculated according to the main environmentally determined private health criteria by normalizing them according to the standard normalized deviation formula and subsequent summation. The quality of the habitat is characterized by the criterion of bioclimatic comfort (Kcl), the criterion of technogenic load (Khn), the criterion of sanitary and hygienic safety (Ksg), the criterion of environmental quality (Kks), the criterion of social development (Ksr), the criterion of medical support (Km). The methodology for their calculation is based on the choice of the leading private criteria for the quality of the environment in a particular subject area, their ranking, association and expression in normalized deviations from the average value, which subsequently made it possible to compare them quite adequately, excluding differences in units of measurement of qualitatively different factors.

Among the various approaches tested by us for the implementation of the territorial medical-geographical ranking and zoning, the most adequate results were obtained in the case of applying the statistical method of weighted points, which had not previously been widely used in medical-geographical research. Moreover, the necessary additional information is provided by the conjugated application of complex health criteria (mortality at working age, morbidity in children and the entire population, including neoplasms and coronary artery disease) and the quality of the environment, combined in the process of cluster analysis and the mathematical-statistical method of weighted scoring.

However, it should be noted that only general approaches to identifying risk factors and medical-geographical zoning can be universal. Specific parameters of habitat comfort models are determined on the basis of regional specifics, i.e. regional "standard" of comfortable conditions. So, insufficiently comfortable areas

The Central Chernozem region may well correspond in terms of basic natural and climatic parameters to the most comfortable regions of the Non-Chernozem region, Siberia, or even exceed them. The objectivity of differentiation of such microzones, even in a relatively small area, to which the Voronezh region as a whole (on the scale of Russia) can be attributed, is confirmed by a significant difference and correspondence between public health levels and environmental quality ratings.

3. Regional medical-geographical monitoring should be considered as an integral part of integrated geoecological monitoring and a necessary additional mechanism for ensuring environmental safety and creating comfortable living conditions.

A conceptual model of regional health monitoring of the population (medical-geographical monitoring) has been developed, based on the functional interaction of three main blocks: "Automated data banks on the state of health and the environment", "Health risk assessment system", "Medical and environmental situation management", implemented based on information technology in a continuous-cyclic mode. Among the necessary types of system support, the leading one is information-analytical, focused on identifying priority criteria for health and environmental quality, as well as building regional models of environmental comfort for industrial-agrarian and urbanized regions.

The key block of the monitoring system is the "Health risk assessment" subsystem, aimed at solving three main tasks: 1) building models of the impact of environmental factors on public health; 2) ranking of environmental factors, health parameters and substantiation of priority criteria for medical and geographical well-being; 3) regional medical-geographical modeling and zoning of the territory according to the comfort of the environment. The ultimate goal of the system and the task of the management unit is to choose the most appropriate option for optimizing the medical and geographical situation by correcting "controllable" risk factors and ensuring maximum protection of the population from "little controllable" harmful environmental factors.

The software and hardware complex effectively complements the traditional administrative and control (monitoring, environmental control, expertise) and economic methods environmental management and public health protection.

4. Regional models of living environment comfort are specific for industrial-agrarian and urbanized territories, which indicates different levels, i.e. "standards" of a comfortable environment, depending on the scale and industry specialization of the region.

The results obtained by us testify to the specifics of the formation of zones of different environmental comfort in specific industrial-agrarian and urbanized regions. It is shown that against the background of a general deterioration in the medical and environmental situation in Russia in the 90s. the dynamics of this process has an obvious regional aspect and lends itself in general

66 99 »-» successful correction with a targeted impact on "managed" risk factors. The formation of environmental comfort zones at the regional level has a certain specificity, which allows us to speak about different levels of environmental comfort: regional, urban (large and small industrial city), local (intracity for a large industrial city).

As shown by the example of the Voronezh region and confirmed by a number of parameters by the example of other regions of the Central Chernozem Region, at the regional level of assessing the comfort of the environment, the general patterns of landscape differences, the nature of the bioclimatic comfort of the environment, the balance of biologically active microelements in the soil cover, i.e. natural resource potential. Contrary to the traditional point of view about the direct dependence of the level of public health on the degree of technogenic load (emission load factor, surface water pollution factor), in the Voronezh region the role of these factors turned out to be insignificant and unreliable. To a certain extent, this is apparently due to the general low technogenic industrial pressure on the environment of the rural areas of the Chernozem region, where the main deteriorant processes and factors are manifested in the agro-industrial complex. Apparently, it is quite natural that parameters reflecting the level of agro-industrial impact on the environment, characterized by the degree of plowing of land and the volume of chemicalization in agriculture, are included among the more significant risk factors.

The most important result of the regional stage of the study (on the territory of the Central Chernozem Region) in theoretical terms is the conclusion that the zones of more comfortable natural conditions correspond to the zones of reduced morbidity and mortality. This testifies, in essence, to the manifestation of deep geographical patterns (phenomena of zoning, etc.) in the formation of the medical and geographical situation in a large region. The health of the population in a certain sense can be considered as one of the characteristic features ecosystems and geosystems in general. In the conditions of the Central Chernozem region, among the factors of environmental comfort essential acquire climatic (radiation and thermal) characteristics, in particular, the meteorological potential of the atmosphere, which characterizes the degree of natural self-purification of the environment. A good "indicative" sign is the balance of a number of microelements in the soil cover (molybdenum, barium, iodine, zinc, copper).

The level of social development (including social and domestic comfort) of rural areas, the insufficient development of which provokes a decrease in health rating, an increase in morbidity, disability and mortality of the able-bodied population. Indicators of the general deterioration of the medical and geographical situation in the agricultural region are neoplasms (especially lung and stomach cancer), the frequency of coronary heart disease, which determine the main causes of death in working age, as well as the general morbidity of children and the entire population.

Therefore, when organizing health monitoring in vast industrial-agrarian areas, it is necessary, first of all, to identify zones of reduced comfort of natural (bioclimatic and soil-geochemical) conditions with underdevelopment of the social sphere against the background of intensive agricultural anthropogeogenesis and to carry out purposeful landscape-reclamation and social improvement in them. -oriented optimization policy for "correction" and mitigation of the negative impact of harmful environmental factors on the health of the population living in these territories.

As shown in our study, in the system of medical and environmental zoning of large cities, the least comfortable are areas with high transport and industrial pressure, irrational planning without sufficient sanitary protection zones between industrial and residential buildings. In most cases, the "risk zone" becomes the territory immediately adjacent to the main-line railway within a radius of 300 to 800 m. Quite reliable "indicators" of the general deterioration of the medical and environmental situation in urbanized regions should be considered the prevalence rates among children of anemia, bronchial asthma, congenital anomalies, as well as neoplasms, especially cancer of the digestive system.

Thus, when organizing health monitoring in large industrial cities, it is advisable, first of all, to rely on the emission concept of the formation of zones of different comfort of the environment, aimed at a detailed analysis and monitoring of the state of the air environment, as well as at the "correction" of the architectural and planning organization of the urban environment. . Differences in the formation of discrete zones of environmental comfort at the urban and regional levels of assessment of the situation indicate, in essence, different "standards" of comfortable life for the population in urban and rural areas, where a specific "background" of landscape-ecological and socio-professional conditions for adapting a person to habitat.

5. Features of adaptation to the environment and pathogenesis of the population are specific in regions of various sizes and require a differentiated system of compensatory health-improving and preventive measures.

As confirmed by our studies on the example of the Central Chernozemsk Region, in order to explain the mechanism for reducing the level of public health in less comfortable regions, it is preferable to take into account the point of view of a decrease in the compensatory-adaptive capabilities of the human body in them. The essence of this process lies in the tension of adaptive mechanisms and the decrease in immunological protection in the population living in a polluted urban environment and insufficiently comfortable landscape-climatic, landscape-geochemical conditions of the agricultural region. Pathological "rapid response" reactions in cities manifest themselves in the child population in the form of functional and organic disorders of the hematopoietic, circulatory, respiratory and digestive systems. With a more intense, prolonged exposure, these reactions are manifested in the growth of more dangerous lesions of the gene pool - neoplasms, congenital anomalies. It is these last classes of diseases that should, with a certain degree of conventionality, be considered as a marker of an environmentally dangerous situation that requires the organization of compensatory measures.

Thus, the first pathological reactions to a decrease in the comfort of the environment are manifested in a violation of the functioning of the most labile systems of the body - hematopoiesis, respiration, and with prolonged exposure in "small doses" - in a "failure of adaptation" and the growth of socially dangerous (mass) diseases - neoplasms , vascular pathology, impaired reproductive function - and, as a result, an increase in the mortality of the working population. Moreover, in the conditions of vast regions, where factors of low intensity, for example, climatic comfort of the environment, harsh weather, imbalance of biologically active microelements (zinc, copper, iodine, etc.), act stably and almost continuously, the tension of adaptive mechanisms manifests itself in a decrease in the immune status and the growth of neoplasms, vascular pathology in the population, even with relatively weak regional differences in the state of the environment, as it manifests itself in the conditions of the Chernozem region.

Summing up the work, at the same time, it should be noted a number of debatable points that we discovered in the course of the study, complementing the fundamental ideas about the nature of cause-and-effect relationships in the “human-environment” system.

Thus, often accepted as a postulate of the "hygienic thesis" about the direct (to a greater or lesser extent) dependence of public health on the level of environmental pollution, the quality of the health care network is not always reliably confirmed in practice. We have quite definitely traced this regularity only by the level of air pollution in a number of large cities, primarily Krasnodar. Apparently, the hygienic triad "air-water-soil" plays an unambiguous role when comparing ecologically contrasting urbanized areas (for example, in Krasnodar, where the comfort of natural conditions is optimal for a person). In the Voronezh region (both in the cities of Voronezh, Rossosh, and on the territory of the region), the hygienic significance of the purity of drinking and surface waters, soil is strictly selective in relation to various diseases, and in some cases increased environmental pollution is not accompanied by any ill health. The role of social factors is also ambiguous, and a sufficiently high level of social development in a number of large regional urban-type centers of the Voronezh region is able to some extent compensate for the insufficient comfort of natural conditions and ensure a completely satisfactory level of public health through effective prevention and a higher hygienic culture of life. For example, the frequency of registration of cancer and cardiovascular pathology is largely determined not by demographic and hygienic, but by landscape-ecological (climatic, soil-geochemical) conditions in the region, and the historical picture, in principle, is not changed by such a powerful environmental factor like Chernobyl radiation pollution. The reason for this, apparently, on the one hand, is the effect of the summation of harmful factors in specific regional conditions with varying degrees of self-purification of the environment, and, on the other hand, in the threshold, determining value of the leading risk factors (confirmation of Liebig's ecological law). It is characteristic that in industrial cities the role of the landscape factor, which is inferior to environmental and hygienic conditions in terms of immediate significance, is manifested indirectly (for example, through the planning infrastructure).

As noted in our study, not all criteria for the state of health of the population equally "respond" to the quality of the environment, i.e. can serve as a kind of indicator of its quality, and at the regional and local city levels they also differ. More reliable indicators at the regional level are neoplasms, coronary heart disease - the main causes of death of the population of working age, while in the urban environment, diseases of the blood, respiratory organs, and infectious pathology of the child population, reflecting their immune status, become more important.

Finally, the very concept of “environment comfort”, which is often interpreted quite arbitrarily, should be more clearly and unambiguously substantiated by a system of quantitative environmental criteria in relation to specific types of regions, which was undertaken in our study on the example of industrial-agrarian and urbanized industrial regions. Obviously, an integral criterion of health should be included in the description of the region's comfort in order to combine qualitatively different concepts that reflect the favorable environment - "climatic comfort", "landscape aesthetics", "hygienic safety", etc. In this aspect, the integrated medical-geographical approach can largely concretize and objectively reflect the situation. For example, the Ramon administrative district in the northern Podvoronezhye, which is quite comfortable in terms of natural and recreational conditions (aesthetic in terms of the diversity of forests within the Voronezh biosphere reserve, picturesque landscapes of the Don region), is moderately comfortable in terms of the potential for self-purification of the atmosphere and is not comfortable enough in terms of technogenic load on the environment ( chemicalization is significant in agriculture, there are pockets of radiation pollution), which, apparently, determines the trouble in most parameters of public health. Aesthetic in terms of recreation, but unfavorable in terms of other particular criteria for the quality of the environment and health, this region corresponds to the worst gradation of environmental comfort according to the integral medical-geographical criterion, which is consistent with the low health rating of the population living in it.

The described regularities and practical recommendations form the basis of the environmental policy developed by us in relation to the conditions of the Central Black Earth region. As follows from the estimated medical and geographical studies, it is inappropriate to limit the system of regional health monitoring to the framework of only one department, for example, sanitary and epidemiological surveillance, as from 1994 to the present, this has been developing in most Russian regions after the organization of regional units of social and hygienic monitoring in the system of the State Sanitary and Epidemiological Supervision. The interdepartmental nature of this problem at the junction of geoecology, hygiene, and medical geography orients further research towards the search for a wider range of dependences of population health indicators on environmental factors and elucidation of the mechanisms of the discovered relationships. With the purposeful unification of the efforts of various departmental services, the development of computer medical-geographical monitoring in the future will make it possible to create an interconnected and coordinated system for monitoring the health of the population at the national level, which will serve as a key block in the system of national environmental security.

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