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Soviet Union [USSR] Declining Health Care in the 1970s and 1980s
After Evgenii Chazov became the new minister of health in
February 1987 and Gorbachev's policy of glasnost' was
extended to the realm of health care, Soviet authorities finally
acknowledged what Western observers had suspected for some time,
namely, that major health indicators depicted a disturbing picture
of the nation's health. Statistics for the 1970s and 1980s showed
rising infant mortality rates, falling life expectancy
(particularly among the male population), increases in infectious
diseases, rises in sexually transmitted illnesses, and a high rate
of new cases of tuberculosis among children and adolescents.
Statistics on the major causes of death were not published for
the total population but were published for the working-age group
(sixteen to fifty-nine for men and sixteen to fifty-four for
women). In 1986 the greatest number of deaths among those of
working age (the total number of deaths was 401 per 100,000) was
caused by cardiovascular disease (120 per 100,000); accidents,
poisoning, and traumas (109 per 100,000); cancer (94 per 100,000);
and lung disease (20 per 100,000). On a population-wide basis,
official Soviet sources ranked the major causes of death somewhat
differently: cardiovascular diseases, malignant tumors, and
accidents and injuries. Statistics on sex-specific death rates and
cause of death by age-group have not been published since the early
1970s.
A key contributing factor in the major causes of death,
particularly among the male population, was the high level of
alcoholism--a long-standing problem, especially among the Slavic
peoples (Russian, Ukrainian, and Belorussian). Alcoholism was often
referred to as the "third disease," after cardiovascular illness
and cancer. Soviet health organizations and police records put the
total number of alcoholics at over 4.5 million, but Western experts
contended that this number applied only to those at the most
advanced stage of alcoholism and that in 1987 the real number of
alcoholics was at least 20 million.
Soon after coming to power, Gorbachev launched the most massive
antialcohol campaign in Soviet history and voiced his concern not
only about the health problems stemming from alcohol abuse but also
about the losses in labor productivity (up to 15 percent) and the
increased divorce rate. The drive appeared to have an almost
immediate effect on the incidence of diseases directly related to
alcohol: for example, cirrhosis of the liver and alcohol poisoning
decreased from 47.3 per 1,000 in 1984 to 23.3 per 1,000 in 1986.
The biggest declines were in the Russian and Ukrainian republics,
where the problem was the most widespread. Some attributed the
modest rise in male life expectancy between 1985 and 1986 to
success in the battle against the "green snake," a popular Russian
term for vodka. But to counter the major cut in government
production of alcohol, people distilled their own alcoholic
beverages at home. One-third of illicit alcohol reportedly was
produced using government agricultural facilities.
To succeed in the battle against alcoholism, Soviet health care
had to expand significantly its alcohol-abuse treatment and
education programs. Of particular concern was increased alcohol
consumption and another major health problem--smoking--among women
and teenagers. The rise in infant mortality, as well as other early
childhood disease and abnormalities (8 to 10 percent of children
reportedly suffered from congenital or infantile abnormalities),
was linked to increased drinking and smoking among females in their
childbearing years.
A Soviet statistical study (based on a 1987 survey of 62,000
families) indicated that about 70 million people smoked--nearly 70
percent of men and nearly 5 percent of women more than eighteen
years of age. Although an antismoking campaign was also under way
in the 1980s, it was on a much smaller scale than the campaign
against alcohol, and the government did far less to decrease
production of tobacco products. In fact, output reached 441 billion
cigarettes in 1987, which was an increase of 23 percent over 1970
production.
In addition to increased infant mortality rates in the 1970s
and 1980s, the Caucasian and Central Asian republics experienced a
rise in infectious diseases, such as typhoid fever and other
gastrointestinal illnesses, and viral hepatitis. Poor sanitation
and contaminated water supplies were largely responsible for
outbreaks of typhoid fever and other gastrointestinal infections;
the lack of disposable syringes was blamed for the upsurge in
hepatitis infections.
Deteriorating environmental factors, crowded living conditions,
and poor nutrition were seen as principal contributors to negative
health trends. But the low quality of health care available to the
general populace was a major culprit and stemmed in large measure
from the widespread lack of modern medical equipment, technology,
and pharmaceuticals. For example, the low life expectancy rate,
particularly for males, was linked in part to the lack of medical
equipment needed to perform bypass surgery and angioplasty
procedures in the treatment of heart disease. Indeed, deaths from
cardiovascular diseases increased from 88 per 100,000 to 120 per
100,000 between 1970 and 1986.
With glasnost' came publication in Soviet newspapers of
numerous articles and letters--written by physicians as well as by
ordinary citizens--highlighting the crisis in the country's health
care system. Frequently attacked was the severe shortage of modern
medical equipment in medical facilities; for example, women's
consultation centers had no fetal heart monitors, ultrasound units,
or equipment for monitoring labor and delivery, resulting in
thousands of additional infant deaths. Poor training of physicians
was singled out as the cause of 600 to 700 deaths of women each
year in childbirth and following abortions in the Russian Republic
alone. The poor treatment and care of terminally ill cancer
patients was openly decried; mentioned were the serious shortage of
beds in cancer wards, lack of painkillers, blatant neglect, and
absence of compassion from medical staff. The widespread and
long-standing practice of exchanging bribes and gifts for slightly
better medical care and attention was specifically attacked, as
were overbureaucratization and its major product, "paper fever,"
and the common practice of falsifying medical statistics to fulfill
planned quantitative quotas. People also wrote to newspapers
documenting personal tragedies involving the deaths of small
children--deaths that need not have happened and that were caused
by gross negligence on the part of hospital staff and physicians.
Glasnost' brought into the open other previously taboo
subjects, as the press began to publish articles on drug abuse,
venereal disease, and even acquired immune deficiency syndrome
(AIDS). Drug abuse and venereal disease were reported to be on the
rise in some regions of the country, most notably in the Georgian
Republic. The number of drug addicts nationwide varied depending
upon the official source: the Ministry of Health claimed 50,000;
police records documented 130,000 addicts.
In early 1987, the Soviet press began publishing a number of
articles about AIDS, referring to the deadly virus by the Russian
acronym SPID (sindrom priobretennogo immunodefitsita).
Although little concrete advice was being made available to the
public regarding prevention and high-risk groups, by the summer of
1987 a number of AIDS testing centers had been opened, and a Moscow
center reportedly was testing about 100 people each day. Claiming
the infection was "imported," Soviet medical authorities required
mandatory testing of all foreign students in the country; they also
required compulsory testing of suspected Soviet carriers, namely,
prostitutes and members of other high-risk groups. In August 1987,
the Supreme Soviet passed the strictest anti-AIDS law in the world,
making the knowing transmittal of an AIDS infection a criminal
offense punishable by up to eight years in prison.
By the time the law was passed, 130 AIDS cases were officially
registered; only 19 of these were said to be Soviet citizens. But
numerous Soviet sources indicated the actual number of cases was in
the thousands; this figure still represented a minuscule percentage
of the population compared with AIDS incidence in the United States
and other Western countries. Nevertheless, Soviet virology
specialists foresaw serious spread of the infection, noting that
domestic production of AIDS testing equipment had to be
significantly increased. They claimed that the 1987 output of 2
million units was 8 million short of the required number and
anticipated that 20 million test sets would be needed within two or
three years. Public education about AIDS transmission and infection
was hampered by general Soviet prudishness about sex, but of
greater importance was the fact that the government ranked
homosexual activity and prostitution as criminal offenses
punishable by imprisonment, which meant that these high-risk groups
were unlikely to cooperate in the battle against AIDS. The chronic
shortage of condoms (which Soviet medical officials euphemistically
called "Article Number 2") further increased the threat of the
spread of AIDS among the Soviet population. But the widespread
shortage of disposable hypodermic syringes in hospitals and
clinics, which often led to the repeated use of unsterilized
needles, posed the greatest danger to checking the spread of AIDS
in the Soviet Union. This fact was shockingly demonstrated by the
tragic case involving the infection with the AIDS virus of up to
forty-one children and eight mothers in late 1988 at a children's
hospital in the Kalmyk Autonomous Republic.
Major reforms of the health care system were announced in
November 1987, underscoring the growing alarm over the nation's
deteriorating health. The reforms reaffirmed the antialcohol and
antismoking campaigns and called for improving personal hygiene and
physical fitness training of the population in general and of
schoolchildren in particular. The reforms stressed improving the
quality of care, as opposed to the past practice of quantitative
expansion alone, and advocated increasing the salaries and prestige
of medical personnel. They called for shifting physician training
from the narrow specialization of the past to family or general
practice, as well as expansion and improvement in certification of
medical school graduates and periodic recertification of practicing
physicians. The central role of mid-level medical personnel--such
as physician's assistants, nurses, and pharmacists--was reaffirmed,
and improvements in the quality of their training were promised.
The quality of medical teaching was to be raised by directly
involving medical teachers in research and development in the
country's leading medical research institutes. The reforms also
stressed expansion of biotechnical and other advanced medical
research and called for increasing domestic production of the most
modern medical equipment, high-quality pharmaceuticals, and
biotechnology products.
Special efforts were planned to rectify the low level of health
care found in rural areas, where 80 percent of the 18,000
polyclinics and outpatient facilities did not have specially
constructed medical buildings. A majority--65 percent--of regional
hospitals in rural areas had no hot water supply; 27 percent were
not equipped with sanitation systems; and 17 percent had no water
supply at all. To correct these serious deficiencies, plans called
for construction of more than 14,000 outpatient clinics equipped
with pharmacies, as well as living quarters for medical and
pharmaceutical personnel. Along with continued emphasis on
providing outpatient polyclinic care, a significant expansion--a
fivefold increase--of fee-for-services medical care was planned by
the year 2000.
The country's need for maternity wards and pediatric facilities
was to be met by 1995; the population's outpatient and hospital
needs were to be met by the year 2000. To this end, the reforms
called for a significant increase--between 100 and 150 percent--in
capital expenditures for renovation, equipment, and construction of
polyclinics and hospital complexes. A final goal was the
establishment by the year 2000 of a "unified system of health care"
for the entire population.
To achieve these ambitious goals and to ensure the full health
of its population, the Soviet Union would have to increase
substantially the level of funding allocated to its health care
system. Since the 1960s, the percentage of the gross national
product
(
GNP--see Glossary) spent on health had continuously
eroded, dropping from a high of 6.6 percent of GNP in 1960 to about
4 percent in the mid-1980s. (In 1986 the United States spent 11.1
percent; the Federal Republic of Germany [West Germany], 8.1
percent; and Britain, 6.2 percent of GNP for medical services.)
According to Minister of Health Chazov, more than 8 percent would
be needed to meet fully the medical needs of the entire Soviet
population.
Data as of May 1989
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