People's Democracy

90TH ANNIVERSARY OF THE GREAT OCTOBER REVOLUTION

The Soviet Health System

Amit Sen Gupta

THE Soviet Health system was introduced in the 1920s with an emphasis on securing health for all working people. The "socialised medicine" system was based on prevention, access and equity. This national health system was based on the right, guaranteed by the Constitution, to free medical care from qualified personnel provided by State health institutions. It was run, financed and managed by the State. This resulted in the best organised system of universal health coverage at that time. The system functioned with excellent results till the 1960s, at which time life and health expectancies in Russia approximated those in the US and other parts of Europe. This was no mean achievement, given that the Soviet Union was far more backward as compared to most of Europe at the time of the Russian Revolution in 1917. Moreover, during the Second World War the Soviet Union faced devastation and loss of lives that was greater than the rest of Europe put together. Hospitals and dispensaries were distributed throughout Russia to the remotest areas of Siberia and the Far East, and the Soviet Union had a huge number of physicians, mostly specialists, working within the national health system.

The positive impact of this could be seen from the fact that even till the 1980s, the Soviet Union had a huge network of neighborhood and work-site clinics and first-aid facilities to provide readily accessible primary care, together with large hospitals and polyclinics to diagnose and treat more complex illnesses and to perform surgery. In 1986 the Soviet Union had 23,500 hospitals with more than 3.6 million beds. Such facilities included about 28,000 women's consultation centers and pediatric clinics, together with emergency ambulance services and sanatoriums. Many large enterprises operated clinics that provided workers health care without requiring them to leave the work site.

In the 1980s, the Soviet Union was first in the world in the ratio of hospital beds to population. Every year a large part of the national health care budget went to construction of new facilities. The Ministry of Health administered the budget from the center to the periphery through the republic, oblast (state), rayon (district), and city levels. (The population of a rayon varies from 40,000 to 150,000 persons, and 10 to 50 rayons compose an oblast.) The entire population had access to all health services free of charge. Until 1991, health care facilities were allocated fixed amounts of money based on the number of hospital beds and polyclinic patient visits.

RAPID DECLINE AFTER COLLAPSE OF SOCIALISM

Soon after the abandonment of socialism, the quality of health services declined in nearly every aspect, except the facilities designated for the elite. In 1992 Russia had 662,700 doctors, a drop of about 32,000 since 1990, and 131 hospital beds per 10,000 population, a drop of 97,000 beds since 1990. By the early 1990s, the public health delivery system in Russia was in crisis. Elderly people were hit especially hard by this situation. Meanwhile, a sharp decline in State funding affected all aspects of medical care, from prevention to emergency treatment. Between 1990 and 1994, State funding declined from 3.4 per cent of the national budget to 1.8 per cent. The shortage of medicines in Russia became chronic and catastrophic. Soviet-era supplies of materials and drugs were severely depleted and were not being adequately replenished. Domestic production plummeted because of shortages of requisite raw materials and supplies.

In the first four post-Soviet years, that decline was typified by significant increases in infant and maternal mortality and contagious diseases and by decreases in fertility and life expectancy. The life expectancy of men fell from 64 to 57 from 1990 to 1994, and throughout the 1990s alcohol-related deaths increased 60 per cent and infectious and parasitic diseases increased by 100 per cent. Mortality rates increased in the 1990s and life expectancy declined.

Today in Russia, deaths among working-age males contribute most to declining life expectancy. A 20-year-old male in Russia now has only a 1 in 2 chance of living up to age 60, while one in the United States has a 9 in 10 chance. Russian male life expectancy is now 13 years less than that for Russian females -- one of the largest differences by sex in the world. Male life expectancy in Russia is now below that in Guatemala, Indonesia, Mexico, Morocco, and the Philippines. The rise in the death rate is a reflection of deep social crisis. Alcohol poisoning kills 42,000 Russians a year. Statistics for death from smoking, heart disease, violent crime and suicide are amongst the highest in the world. 'Poverty diseases', such as TB, are escalating.

The birth rate remains very low, partly reflecting pessimism about the future. The 144-million-strong country is "losing" around 700,000 people a year, which caused Putin to warn about the "death of the nation".

Opinion polls show that many older workers and pensioners hark back to the old Soviet system. They express support for the benefits of a nationalised planned economy, a welfare state, free education and health care, and a job for life. The decline of the Health Secor in the former Soviet republics today is a grim reminder of all that the Soviet people have lost in the space of less than two decades.