Soviet Union Table of Contents
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
Soviet Union Table of Contents