Implementation of the Health-Centrist Policy of the System Functioning of Healthcare and Labor Relations in the Context of the Development of Corporate Social Responsibility

In the article, the need to form and implement a health-centrists policy of the health care system, which is implemented with the active involvement of companies in preventive measures in the development of corporate social responsibility, sponsorship and patronage, is substantiated. It is argued that the basic components of the health-centrists policy of the health care system should be the following ones: a high level of income sufficient for expanded reproduction; increasing the national income of the country based on the production of goods with high value added; prevention of sale on the territory of Ukraine of low-quality, counterfeit products; prevention of diseases, and injuries through their preventive measures at the enterprise level. Methodical approaches to assessing the impact of corporate social responsibility on the functioning of the health care system and the development of labor relations are used. They are based on the use of the SWOT-analysis from the standpoint of comprehensive understanding of prospects for improving public health on the principles of prevention, or reduction of injuries and mortality. It is substantiated that the health-centrist policy of the health care system should be formed and implemented comprehensively, involving the population of Ukraine, companies, authorities and government by actively promoting a responsible attitude to their health; activation of social responsibility at the level of the companies and the use of state financial, administrative, organizational levers of the influence on companies and individuals.


Introduction
In Ukraine, in recent decades, we have seen an increase in mortality, infectious diseases, the spread of mental disorders, socially dependent diseases, diseases directly 368 Implementation of the Health-Centrist Policy of the System Functioning of Healthcare and Labor Relations in the Context of the Development of Corporate Social Responsibility related to malnutrition. This led to the violation of the population reproduction process (health -birth rate, health -mortality, health -ability to work). To prevent the deterioration of health from becoming a long-term brake on socio-economic development, it is necessary to intensify measures to preserve health at the level of individuals, companies, and the state, to increase the level of the efficiency of health care facilities.
Poverty alleviation, ensuring a decent standard of living sufficient for expanded reproduction, advocacy, safety and quality of food, water, air, housing, education, employment and environmental risk prevention remains a priority for public authorities and management. The state also guarantees medical care, social services and provision necessary to maintain the health of the population.
At the same time, the revenue base of budgets at various levels is declining, which narrows the potential for financing the health care system at the state level and necessitates the search for new directions for the functioning of the health care system. As is well known, the health care system in Ukraine is formed by preventive, sports and health, medical, sanatorium, pharmacy, scientific (medical) and other health care institutions. At the same time, the efficiency of the system is a matter of great concern, as the indicators of the state of the population health in Ukraine and the level of natural population decline are deteriorating.
Further substantiation of the possibilities of combining the efforts of the state, business, and the individual is needed to solve the key socio-economic problems of the country, in particular, to reduce the level of morbidity and mortality in Ukraine. In this regard, the study of prospects for the implementation of the health-centrists policy of the health care system and labor relations, the use of corporate social responsibility in improving the efficiency of the health care system in the context of reducing mortality. Improving health of the nation is becoming increasingly necessary and relevant.
The "health-centric" policy of the health care system should be based on the principle of prevention, which will avoid the emergence of diseases through their prevention (the dominance of a healthy lifestyle, early detection of the disease, intensification of forms and methods of prevention). The implementation of the main provisions of this policy will contribute to the spread of a healthy lifestyle among the population, improve health and reduce morbidity and mortality in the process of the functioning of medical, physical training and health, sanatorium and preventive institutions.
The implementation of a "health-centric" policy of the functioning of the health care system at the individual level should contribute to the formation of a caring attitude to one's health. In order to disseminate the information needed in this context, it is advisable to launch a national program to promote a healthy lifestyle. This will reduce treatment costs and increase productivity and possible limits of labor intensification.
At the state level, in order to implement the "health-centric" policy, it is necessary to diversify the sources of funds for health care, and the solidarity of the state, local territorial communities, and employers should be provided. At the company's level, it will contribute to the formation and implementation of this policy by increasing accountability for environmental and social offenses and transformation of the labor protection system into the health care system during work, etc.
The aim of the article is to identify the strengths, weaknesses, threats and opportunities for the impact of corporate social responsibility on the formation and implementation of the health-centrists policy of the health care system and reduce mortality in Ukraine.
The authors of the articles [1][2] argue that in the current conditions of the development of the health care system it is necessary to develop and explore new conceptual and regulatory frameworks for the health care assessment. The authors suggest the use of artificial intelligence and to explore how big data can help achieve the goals of this system. The purpose of the study [3] was to analyze the concept of the health safety network during the COVID-19 pandemic. Researchers say the health safety network is an important concept during the COVID-19 pandemic. According to the results of research, the authors recommend to develop standardized tools for measuring the health care network, and to improve ways to solve the problem of health care in the situation of COVID-19. The study [4] is based on the process of updating the conceptual features of health care modeling using the conceptual analysis method by Walker and Avant. Based on the analysis of the concept, the authors propose an updated definition of preliminary analysis in health modeling, which can be used for simulating education and research.
In the study, the author [5] monitored the ecological state of the regional economic systems, which has a significant impact on the formation of a health-centric policy. Considerable attention in the publications of scientists [6][7][8][9] is devoted to the peculiarities of the social infrastructure development as a component of sustainable development of the regions. The purpose of the research [10] is to evaluate different approaches to the concept of sustainability of the health infrastructure, as well as to study possible improvements. The result of the study is the author's development of a new evaluation tool based on semi-quantitative and quantitative models. Researchers say the model can be scaled and applied to internal health infrastructure systems. The authors [11][12] argue that for public health, it is important for health authorities to optimize treatment facilities for water and wastewater and to improve the ventilation and plumbing systems of buildings to minimize the transmission of pathogens in buildings and transportation systems. Within the article, it is proved and analyzed that toxicological research and health risk assessment are necessary to properly inform about the use of quarantine, to minimize their socio-economic impact and to focus on the actual justification of social policy measures.
The authors [13] are convinced that the results of their research can potentially become a translator for the translation and application of medical data into the planning policy and practice, giving those responsible for community design and development policy and practice access to quantitative, evidence-based data, how their decisions can affect community health. The authors of the article [14] emphasize that improving the quality and accessibility of health services by involving responsible stakeholders can increase the use of health services. According to the study, health authorities proposed to improve diagnostic capabilities in medical centers, the skills and attitudes of health professionals, as well as the availability and physical accessibility of services. As a result of a series of studies and publications by the authors [15], there are several advantages of using the concept of social license as a guide to ethical management: compliance with the new scale of risks associated with the data; focusing on reliability. Researchers believe that greater trust can be achieved in the management of science-intensive health care through strategic dialogue with both data patients and the public.
The authors of the articles [16][17] explored that self-empowerment and practical skills for everyday health are key elements of desirable health behaviors. The study is based on the development of a scale of health behaviors for older people living separately, receiving state aid (HBSO). The authors note that HBSO is an easy-to-manage and reliable tool. HBSO can contribute to the proper assessment of wellness behaviors and can be used to determine effective support. Research by leading scientists [18][19][20] focuses on the development of business structures, investment processes and labor relations in the context of the development of corporate social responsibility.
The authors [21][22][23] use an adaptive system-wide approach to understanding how interrelated elements in the application of pathogen genomics to public health affect public health processes and outcomes. The articles of scientists [24][25][26][27][28][29][30] reveal the methodological approach to economic analysis and management of enterprises in the transformation of economic systems, innovative development in a creative economy, as well as features of socio-economic viability of public administration in the context of European integration processes.
The importance of this study is that the implementation of the results of the study will provide an opportunity to improve the health of the population of Ukraine; to reduce mortality by diversifying sources of funding for the health care system, to promote a healthy lifestyle, to increase the level of business performance of social functions in terms of corporate social responsibility, sponsorship, preventive health measures, creating safe working conditions, minimizing the risk of injury etc.

Materials and Methods
Strengths, weaknesses, threats and opportunities to improve health in Ukraine as a result of activating the components of corporate social responsibility through the SWOT-analysis were assessed. Also, in the course of research, methods of abstraction, expert estimations, multicriteria point estimations, and statistical analysis are used.
Such methods as abstraction, expert assessments, multi-criteria scores, focused only on key strengths, weaknesses, threatening aspects of improving the efficiency of the health care system and the development of labor relations in Ukraine on the use of corporate social responsibility is evaluated.
Statistical analysis has conspired to systematize retrospective changes in key indicators of the health care system in Ukraine.

Results and Discussions
Today, the generally accepted criterion of health in the country is the mortality rate. In Ukraine, the last few decades have seen a natural decline in population due to increased mortality. In 2018-2020 just, 1,785,614 people died in Ukraine (the natural reduction during this period was 847,500 people). In Table 1, causes of mortality, among which the predominant diseases of the circulatory system, from which during this period died 66.6% of the total number of deaths, are shown. This is directly related to changes in the lifestyle of the majority of the population of Ukraine: accelerating the pace of life, reducing physical activity as a result of increasing the share of mental work, spreading bad habits, and rapid changes in public life. By analyzing the statistics, it is proven that Ukraine has a high mortality rate from tumors, respiratory and digestive diseases.  The challenge today is not only to treat pre-existing diseases, but also to prevent them. It is generally accepted in the world that there are differences in the health status not only of different individuals, but between social groups, which confirms the importance of research and the use of social determinants to correct this process.
Many diseases appear with the inability of a person to eat properly, eat healthily, optimally combine work and rest, the inability to minimize the impact on the body of psychological trauma and industrial conflicts. There is an opportunity to reduce mortality, and increase life expectancy and quality without disease through the centrist health policy. The main principle of the organization of labor relations should be to prevent or reduce the risks of injury, disease and mortality.
The task is to reform the health care system and the organization of labor relations on the basis of prevention, implementation of treatment and prevention and rehabilitation strategies. In Ukraine, the lack of opportunity to increase budget expenditures for financing medical activities, actualizes the use of alternative ways to improve health, in particular through the use of the mechanisms of corporate social responsibility.
In Ukraine, a rather low level of social responsibility is manifested in the large number of sold counterfeit food, alcoholic beverages, medicines, fuel, and frequent cases of unfair advertising.
With regard to the health care system, the costs by firms of part of income (profit) for social purposes at the enterprise level, payment in full of taxes and fees allows to:  reduce the cost of compensation to employees as a result of accidents;  improve the health of employees, while reducing the cost of treatment;  expenses for social insurance in case of incapacity for work.
In the scientific literature there is an interpretation of social responsibility of business as the ultimate goal of economic activity, which contributes to the state's social functions in terms of maintaining health care facilities and reducing mortality.
It is expedient to divide social responsibility (using the method of abstraction) into internal (guaranteeing safety at work, stable wages; social and medical insurance; additional training: training programs, advanced training; providing financial assistance in emergencies) and external (social investment, charitable donations and sponsorship, cash grants, the company's responsibility to consumers, interaction with government and administration, civil society).
The above contributes to the implementation of the health-centrists policy of the organization of the health care system and labor relations, the formation and implementation of corporate social responsibility at three levels. In the first turn, due to timely payment of taxes, fees, creation and maintenance of jobs, which will create conditions for the social functions of the state, in particular in terms of increasing expenditures on health care facilities, clinics, sanatoriums, etc. In Figure 1, SRB-levels and their impact on the health-centrist health care system and labor relations are shown.  At the second level -by providing decent working and living conditions for employees (housing, training, etc.); reducing the level of risks, injuries, numerous sources of danger (chemical, physical, biological, ergonomic, mechanical, energy, psychological nature); promoting the health of a particular employee. In order to ensure favorable conditions for study, work, life, recreation, as well as a high level of efficiency, prevention of injuries and occupational diseases, poisoning and other possible damage to health, uniform sanitary and hygienic requirements for the organization of production and other processes related to human activities, as well as the 372 Implementation of the Health-Centrist Policy of the System Functioning of Healthcare and Labor Relations in the Context of the Development of Corporate Social Responsibility quality of machinery, equipment, buildings, consumer goods and other objects that may have a detrimental effect on health.
Sponsorship is considered to be the third level of the influence of corporate social responsibility on the organization of health care and labor relations. Sponsorship on a stable and long-term basis can take the form of patronage, for example, the creation of boards of trustees, the creation of funds to support the patronized medical institution, and so on. The level of sponsorship in order to maintain the health of the population of Ukraine is influenced by numerous factors (e.g., rising unemployment, falling living standards, rising mortality and morbidity, structural economic imbalance, declining purchasing power of the population and firms, declining profitability, etc.).
Factors influencing the level of corporate social responsibility, patronage and sponsorship in Ukraine are presented in Figure 2.
The implementation of social responsibility of business, charity, sponsorship creates additional benefits for business in terms of:  improving the external business environment by strengthening social ties with customers, suppliers, investors, and authorities;  improving the reputation, formation and promotion of an attractive image, brand, a kind of advertising of the company, which is especially important for companies working with the mass consumer;  expansion of consumer, customer base, development of new markets, additional sales opportunities, and additional competitive advantages;  increasing staff loyalty and reducing staff turnover.
At the same time, weak coordination of charitable activities and sponsorship at the state and local levels, lack of tax benefits for companies that will be hospitals, keep on their own balance of prophylaxis, health camps, provide medical services for their employeesnecessitates the state-level use of administrative, economic levers, to improve the mechanism for stimulating the development of corporate social responsibility and patronage. Source: developed by the authors. The imbalance between the revenue and expenditure side of budgets makes it impossible to finance health care facilities in the level necessary to maintain the health of the population, reduce mortality, and provokes a low level of state performance of social functions in general. In this regard, to maintain the health of the employee at the company's level in the context of the health-centrist policy of health care and labor relations, socially responsible business can provide its employees with medical services, promote through various methods of material and intangible motivation for a healthy lifestyle, improve the quality of food by increasing the time for breaks for meals and sports, provide sports equipment for employees or financial subsidies for the purchase of sports facilities or equipment. In addition, it is still possible to take the following measures to maintain health in terms of corporate social responsibility by reducing negative effects of the alcohol consumption; promotion of rational nutrition of employees; introduction of social advertising for a healthy lifestyle.
Using as a basis the SWOT analysis methods, improving the efficiency of the health care system and the development of labor relations in Ukraine on the use of corporate social responsibility is assessed using a score (from 1 to 5). The SWOT weighted score assessment of strengths and weaknesses of improving the efficiency of the health care system and the development of labor relations in Ukraine on the use of corporate social responsibility is presented in Table 2. Thus, at the first stage the expert estimation concerning strong -S and weak -W characteristics, which is carried out on the basis of the collected empirical data based on author's researches and a database of domestic, world analytical centers is given.
The importance of weaknesses and strengths, opportunities and threats to the impact of corporate social responsibility on the effectiveness of the health care system and the level of health of the population of Ukraine in modern conditions is assessed in the Table using the indicator of significance and characteristics of the health care system and labor relations. Next, we'll calculate the rank of each strengths and weaknesses, opportunities and threats of the component using the formula: where R is the rank of the characteristics of the state of the health care system using corporate social responsibility (in our case, R t will be calculated -the rank of the threatening party; R o -the rank of opportunities; R w -the rank of weaknesses; R s -the rank of strengths); i -characteristics of the i-th efficiency of the health care system and labor relations; S i -the importance of the i-th characteristics of the state of health care using corporate social responsibility; А i -assessment of the i-th characteristics of the state of health care using the social responsibility of business; Q j -weighted scores of weaknesses, strengths, threats and opportunities.
Rank allows you to determine the level of favorable (or unfavorable) of each factor influencing corporate social responsibility for the effectiveness of the health care system and social and labor relations.
The SWOT weighted assessment of the strengths of the impact of corporate social responsibility on the effectiveness of the health care system indicates that the most favorable are the available factors such as: promoting the health of workers by improving working conditions, R = 0,144927, payment by business on time and in full taxes and fees, which increases the level of social functions of the state R = 0,144927, production of quality products, goods R = 0,115942, payment of decent wages to employees; R = 0.115942, and purchase of medical equipment at the expense of sponsors R = 0.108595.
The SWOT weighted score assessment of the weaknesses of the impact of corporate social responsibility on the effectiveness of the health care system has identified problems that need to be addressed as a matter of priority to reduce mortality and increase life expectancy in Ukraine. Among them are as follows: lack of sufficient funds to finance medical services, maintaining a healthy lifestyle of employees Rw = 0.116279, lack of effective levers and tools to influence the state, medical institutions on the health of the population Rw = 0.116279, imperfect policy in the field of protection health to prevent the incidence of Rw = 0.116279, incomplete structure of the health care system by location Rw = 0.116279.
The SWOT weighted score assessment of opportunities to improve the efficiency of the health care system and the development of labor relations in Ukraine on the use of corporate social responsibility, which among the most important are such opportunities as: implementation and further development of corporate social responsibility functioning of the health care system 0,131579, use and promotion of a healthy lifestyle 0,131579. reduction of social inequality 0.105263, and introduction of social advertising for a healthy lifestyle 0.105263.
Thus, according to the calculations, as presented in Table  3, a high level of disadvantage is caused by such factors as: reduction of budget revenues, which worsens the financing of medicine, the purchasing power of the population; reduces the financial base of corporate social responsibility (Rt = 0.129870); damage to health as a result of counterfeit consumption (Rt = 0.129870), and lack of medical facilities and quality medical services in villages and settlements (Rt = 0.114286).

Conclusions
According to the results of the study, in order to ensure the formation and implementation of the health-centrist policy of the health care system and reduce mortality, the SWOT analysis was performed. The results make it possible to note that in order to reduce the mortality rate, to strengthen the health of the nation and to reduce the need for potential funding for medicine, corporate social responsibility should be intensified, a system of incentives to develop a healthy lifestyle and eradicate bad habits. The consequence of the dominance of a healthy lifestyle, the provision of quality services by health care institutions, preventive measures in terms of social responsibility of business is labor savings, which can be expressed in the preservation of life expectancy and absolute growth of national income.
Practical significance of the study is that it will reduce the mortality rate in Ukraine, improve the image of companies and reduce staff turnover, as a result of increased corporate social responsibility, as well as in the long run reduce budget expenditures at various levels for treatment.
The scientific novelty of the study is to improve the methodological approach to assessing the strengths, weaknesses, threats and opportunities to improve health in Ukraine by implementing the basic principles of the "health-centric" policy of health care and activating the 376 Implementation of the Health-Centrist Policy of the System Functioning of Healthcare and Labor Relations in the Context of the Development of Corporate Social Responsibility components of corporate social responsibility. The authors conducted the SWOT-analysis, which is based on the analysis of existing research methods to improve the efficiency of the health care system and the development of labor relations in Ukraine on the use of corporate social responsibility, which in contrast to existing methods allows multicriteria scores.
Prospects for further development to implement the health-centrist policy of the health care system and to reduce mortality are to develop a methodological approach to calculate the balance of labor resources taking into account health of the population, mortality and the impact of geopolitical factors.