Medical Encyclopedia - Healthcare in the USSR. Health During the USSR, the first health care organizer in the USSR
Health - System of state and public events for the protection of public health. In the USSR and other socialist states concern about health The population is a national task, in the implementation of which all units of the state and social system take part.
In pre-revolutionary Russia, there was no state organization of health care. The opening of hospitals, ambulatory and other medical institutions was carried out by various departments and organizations without a single state plan and in quantities, extremely insufficient for the needs of the health of the population. A significant place in medical assistance to the population (especially urban) was held by private attractive doctors.
For the first time, V.I. Lenin was developed for the first time in the field of workers' health. In the program of the party, written by V. I. Lenin and adopted by the second Congress of the party in 1903, the requirements of the eight-hour working day were nominated, the complete prohibition of child labor, the prohibition of women's labor in harmful production, organizations at the nursery enterprises for children, free medical care workers Entrepreneurs account, state insurance workers and the establishment of a proper sanitary regime in enterprises.
After the Great October Socialist Revolution in the party program adopted at the VIII Congress in 1919, the main tasks of the Party and Soviet government in the field of health care of the people were identified. In accordance with this program, theoretical and organizational foundations of Soviet health were developed.
The main principles of the Soviet health were: state Character and Plannedness Preventive Direction, Accessibility, Free and High Quality medical care, the unity of medical science and health practice, public participation and extensive mass workers in the activities of bodies and healthcare institutions.
At the initiative of V. I. Lenin, the VIII Congress of the Party decided to resolutely conduct in the interests of workers such events as the improvement of settlements, the organization of catering on a scientific and hygienic basis, prevention infectious diseases, creation of sanitary legislation, organized by the struggle with tuberculosis, venereal diseases, alcoholism and other social diseases, ensuring publicly available qualified medical care and treatment.
24/1 1918. V.I. Lenin signed decree on the formation of the Council of Medical Colleges, and 11 / VII 1918- decree On the establishment of the People's Commissariat of Health.
Lenin decrees about Earth, about the nationalization of a large industry, about the eight-hour working day created political, economic and socio-hygienic prerequisites for improving the material well-being of workers and peasants, and thereby to strengthen their health, improving working conditions and life. Decorates about insuring in case of illness, about the nationalization of pharmacies, about the Council of Medical Board, the creation of the People's Commissariat of Health and many others raised health problems to the level of nationwide, nationwide tasks. V. I. Lenin signed over 100 decrees on the organization of health care. They contain guidelines on all the most important sections of the health of workers. They reflect the policies of the Communist Party and Soviet power in the permission of the most important health problems.
Health of the USSR in the postwar period (1952-1991)
During these years, the search for new forms and methods for the provision of medical and preventive care to the population was selected.
Health management reform in rural areas was carried out. The district health departments were abolished, and all administrative and economic functions in relation to the health care facilities were transferred to the district hospital, the chief doctor of which became the chief physician district. Central district hospitals became organizational and methodological centers of qualified medical care.
In 1960, along with the further development of the network medical institutions More and more attention was paid to the development of specialized services, ensuring the population of ambulance and emergency medical care, dental and radiographic development. Specific measures were carried out to reduce the incidence of tuberculosis, polio, diphtheria. Construction of large multidisciplinary hospitals and an increase in the capacity of existing central district hospitals up to 300-400 beds with all kinds of specialized assistance Minister of Health S.V. Kurashov considered as a general development line for health care.
More attention was paid to the organization of medical care patients with pathology of respiratory organs, cardiovascular, oncological, allergic diseases.
However, everything was clearly seen that the results of the activities of health authorities have ceased to comply with the needs of the population, urgent time tasks.
Health financing continued to be carried out on the residual principle. Compared to other countries of the world, where, when evaluating funding, the share of national income on health care, in the 1970-1980, the USSR held a place in the 7th dozen countries. The assessment of the share of the state budget coming to these goals showed that this share was steadily declined: 1960 - 6.6%, 1970 - 6.1%, 1980 - 5.0%, 1985 - 4 , 6%, 1993 - 3.5%. The growth of allocations in absolute values \u200b\u200bof barely covered costs associated with the growth of the country's population.
Health care began to include in the service sector, the attention of the administrative and management apparatus for the protection of people's health decreased.
The preventive direction of medicine in its traditional understanding as a struggle with mass, mainly infectious, acute diseases through sanitary and anti-epidemic measures began to exhaust themselves. One of the reasons for this is the rapid transformation of pathology: an increasing predominance of non-epidemic chronic diseases that resulted in the basis of the modern structure of mortality and morbidity. There were new issues related to underestimation not only in the 1930-1940, but also in the 1950s and 1960s of the environmental problems and occupational hygiene. Thus, the declared preventive direction in practice was not fulfilled, the medical section of the work prevailed, the physicians prevailed, the prevention of the same doctors were practiced formally, often "for the report".
A special place belongs to the significance of extensive ways to develop health care. There is no doubt that at a certain stage of development, when many health problems were associated with a lack of doctors, hospitals, a clinic, sanitary and epidemiological institutions, these paths played a role. But they could lead to success only to a certain extent, under certain conditions. The moment was missed when the quantitative indicators of health development should have been made to carry out a high-quality leap based on additional funding, other approach to the use of resources, search for new forms and methods of all links of healthcare with the inclusion of material incentives, with new approaches in training. Despite the continued growth of the network and the number of medical personnel, the provision of the population with doctors and beds was far from the desired, the availability of highly qualified and specialized assistance decreased and was not even in cities. The shortage of drugs, medical devices and equipment disappeared. Insufficient pace decreased incidence and mortality of the population. The tasks in the field of health were determined by the regulations of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures to further improve health care" (1960, 1968, 1977, 1982): Develop perspective plans development and rational placement of a network of outpatient polyclinic institutions, taking into account the number and structure of the serviced population, bearing in mind the total provision of the population by all kinds of highly qualified and specialized medical care, expanding the volume of mass preventive inspections and clinical examination; carry out the construction of large mainly independent polyclinic with a capacity of 750 and more visits to shift; When deploying new therapeutic and diagnostic cabinets in clinics to strictly observe sanitary standards; Provide a fundamental improvement in the organization of the work of registries, taking into account specific conditions, introduce new forms and methods of their work: self-recording of patients, expanding information about the working time of therapeutic, diagnostic and procedural offices, pre-registration by phone and other, wider use automated systems for these purposes; expand the introduction of progressive forms and methods for organizing the work of the health care facilities for the maximum release of them from work that is not directly related to the examination and treatment of patients (dictaphonic documentation management, the use of cliche stamps, recipes, etc.); organize in agreement with Executives of local councils of people's deputies The mode of operation of polyclinic institutions, providing specialized medical care in the required amount of medical, diagnostic, X-ray cabinets and laboratories to openly at all days of the week, incl. Saturday days, and on Sundays and holidays to provide duty of doctors-therapeutors on the reception of patients in the clinic and the provision of medical care and the implementation of medical prescriptions to the patient at home; In 1978 - 1985, the dissent of the territorial therapeutic and pediatric sites in 1978, bringing the number of serviced adults on a single-part-a-therapist in 1982, an average of up to 2 thousand people and by 1985, an average of up to 1.7 thousand people, and the number serviced children on a single Pediatric Pediatrician by 1980 - 1982, an average of up to 800 people. To ensure, since 1978, the annual increase in the number of medical positions of precinct therapists and pediatricians and their complete staffing by doctors; To establish, starting in 1978, the specific annual tasks of regional (regional) health departments and the Ministry of Health of the Autonomous Republics on the disagreement of medical sites and the increase in the number of positions of precinct therapists and pediatricians. Carry out strict control over compliance with places of planned discipline; Improve the work of emergency institutions and emergency medical care, strengthen their logistical base, deploy construction on typical projects of stations and ambulance substations; Provide for 1985 in all regional, regional, republican centers and large industrial cities, the organization of emergency medical hospitals united with ambulance stations; Provide further development Emergency specialized medical care, primarily the organization of cardiological brigades, brigades of intensive therapy, pediatric, toxicological, traumatological, neurological and psychiatric. Order of the Ministry of Health of the USSR from 31.10.1977 N 972 on measures to further improve public health (from the site http://www.bestpravo.ru)
Much in these decrees also remained at the level of declarations, instead of cardinal solutions, optional semi-dimensions were envisaged.
On the other hand, the methods of therapeutic and preventive assistance for decades and methods of therapeutic and preventive assistance were largely justified and received international recognition. WHO positively appreciated the principles of Soviet health. The International Meeting in Almaty (1978) under the auspices of WHO recognized the organization of primary health care in the USSR, its principles as one of the best in the world.
During these years, a lot of work is carried out to improve the quality of physician training. The medical institutes are improved by the curriculum and training programs, the 6th course is introduced - subordination and after the end of the Institute - an internship with the exam for the main specialty. "Public health and healthcare" ed. prof. V.A. Minyaev, prof. N.I.Vishnyakova Sixth publication, 2012. / P.S. 36-37
On December 26, 1991, the USSR broke up. Political, economic and social changes led to the need to revise the system of medical and preventive care to the population.
So the head in the history of Russia under the name "Soviet Health" ends. In 74, the state was able to build a strong health care system (despite all the difficulties through which the USSR passed), causing admiration and respect for everyone who got acquainted with the statement of health care in the USSR.
Our Soviet experience is used by the whole world, and only here it is destroyed for the root. International companies love collective work, planned economy, governments in strategic areas provide state control. In the UK, Sweden, Denmark, Ireland and Italy, there is a budget health system for the first time created in the Soviet Union by Nikolai Semashko, known worldwide as a system of Semashko. G. Zigerist - a historian of medicine, who visited our country twice and highly appreciated the achievements of Soviet medicine, in his book dedicated to health in the USSR, wrote:"What is happening in the Soviet Union today is the beginning of a new period of history in medicine. Everything that has been achieved so far for 5 thousand years of medicine history is only a new epoch - a period of therapeutic medicine. Now a new era, a period of preventive medicine, began in the Soviet Union. "
After the revolutionary destroyed, the Government and part of the medical community came to the conclusion that the only way to exist and develop health care of the young republic is the concentration of resources and centralization of management and planning industry. At the V All-Russian Congress of Soviets, who adopted the new Constitution of the RSFSR, on July 11, 1918, the People's Commissariat of Health was established. N.A. is appointed first addict. Semashko, his deputy - Z.P. Solovyov.
Nikolay Semashko laid a few ideas as the health care system proposed by him:
- unified principles of organization and centralization of the health system;
- equal accessibility of health care for all citizens;
- priority attention to childhood and motherhood;
- unity of prevention and treatment;
- elimination of the social foundations of diseases;
- attracting the public to the case of health care.
A slender system of medical institutions was built, which allowed us to provide unified principles for the organization of health care for the entire population, from distant dealers to metropolitan cities: Feldshera-obstetric item (FAP) - Local Polyclinic - District Hospital - Regional Hospital - Specialized Institutions. Although the departmental medical institutions of the army, railway workers, miners, etc. remained.
The accessibility of healthcare was ensured by the fact that medical care was free, all citizens were attached to the district polyclinics at the place of residence and, depending on the complexity of the disease, could be sent to treatment more and higher on the steps of the health pyramid.
A specialized system of medical institutions for children repeating the system for adults, from the precinct polyclinic to specialized scientific institutions. The medical system paid special attention to issues of motherhood and birth. To support motherhood and infancy, the same vertical system was organized - from women's consultations (the number of which increased from 2.2 thousand in 1928 to 8.6 thousand in 1940) and district hospitals again to specialized institutions. For young mothers, the most top medicines And the conditions, and the training of obstetrics and the wife of gynecology was considered one of the most prestigious medical directions. In parallel with this, the Government itself stimulated the birth of a new generation, paying solid subsidies for children. A network of specialized children's clinics, who contributed to a serious decrease in child mortality rates is also created. Thus, the population of the country for the first 20 years has increased almost twice.
Another important reform was the prevention of diseases, as well as the elimination of the initial reasons for their occurrence, moreover, both medical and social ones. At various manufacturing enterprises of the country, which at the time were created at high speed, medical units were organized, which were detected by prevention and treatment professional diseases. Also they provided the first emergency help When obtaining production injuries of varying degrees of severity, and supervised the appointment of workers in actively underly under construction sanatoriums. 
Prevention was understood by Semashko and in a narrow, and in a broad sense. In a narrow - like sanitary activities, wide - as recovery, prevention and prevention of diseases. The task of each doctor and the entire system of medical institutions, as Semashko considered, consisted not only to cure, but to prevent the disease that was considered as a consequence of adverse social conditions and the wrong lifestyle. In this regard, special attention was paid to such social diseases as venereal, tuberculosis and alcoholism. For this, a system of relevant dispensaries was created, which should not only be treated, but also monitor the living conditions of patients, informing the authorities on the inconsistency of these conditions by sanitary standards and the potential threat that patients can be submitted for others.
An important measure of prevention, according to Nikolai Semashko, were vaccination, which for the first time accepted a nationwide nature and helped the congestion of many infectious diseases, and sanitary-hygienic propaganda, which paid great attention to as one of the means of preventing epidemics and formation healthy image Life.
In a slender system of recovery, prevention and health care, the holiday homes and sanatoriums are naturally included. Sanatoriums, staying in which was part of the medical process, were subordinated to drug addresses, and recreation homes - trade unions, that is, the public, or, speaking modern tongue, civil society, which should have followed the recovery of workers.
By the decision of the CEC and the USSR Soviet Council of December 23, 1933, a state sanitary inspection was established to lead the work of the state sanitary anti-epidemic service bodies throughout the country.
VIII Extraordinary Congress of the USSR Soviets on December 5, 1936 adopted a new Stalin's Constitution of the USSR,which first in the world of Article 124 guaranteed the right of citizens to free health ..
By 1950, the destroyed war economy was restored. The number of medical institutions, hospital beds, doctors not only reached the pre-war level, but also significantly surpassed it. In 1950, there were 265 thousand doctors in the country (including dental) and 719.4 thousand medium-sized medical professionals, 18.8 thousand hospital institutions were worked with 1010.7 thousand kids. In rural areas, there were more than 63 thousand Feldsher and Feldsher-obstetric items. From the 50s from year to year, allocations for health care increased, and by 1965, for 4 post-war five-year-old, financing approached a record number - 6.5% of GDP. It was possible to increase all the main indicators of the material and health base. The number of doctors from 14.6 per 10 thousand people. population in 1950 grew to 23.9 in 1965; Medical professionals from 39.6 to 73.0; hospitalization in cities increased at this time from 15% of the population to 20.1%, in rural areas - from 7.7% to 18.9%; The number of beds in hospitals increased from 57.7 to 96.0 per 10 thousand population; The number of polyclinic and ambulatory reached 36.7 thousand, women's consultations and a clinic for children - 19.3 thousand (Source: The System of Public Health Services In The USSR / by Red. Uplisitsin. - M.: Ministry of Health Of The USSR, 1967. - R. 44.)
Since 1948, with the Minister of Health of the USSR E.I. Smirnov, a reform was carried out, aimed at restructuring the structure of the health organization, the establishment of hospitals and a clinic was envisaged, the creation in the areas of so-called Central (CRH) and simply combined (license number) hospitals, as well as a change in subordination Sanitary and epidemiological service, according to which district SES became independent institutions. Subsequently, the entire service of SanEpidadzor became independent, was allocated from the submission to the Ministry of Health.
In the 1960s Received a new branch of medicine - Space Medicine. It was associated with the development of cosmonautics, first flight Yu. A. Gagarin on April 12, 1961 and other events in this area.
In the 60-70s, at the Ministers of Health, S.V. Kurashov and B.V.Petrovsky made steps towards the intensive development of the industry.
Along with the further development of a network of medical institutions, more and more attention was paid to the development of specialized services, providing the population of ambulance and emergency medical care, dental and radiopiological assistance. Preem preferential development of the so-called primary links - outpatient polyclinic institutions and the construction of large multi-profile hospitals (per 1000 beds or more) and an increase in the capacity of existing central district hospitals up to 300-400 beds with all kinds of specialized assistance (individual specialties (cardiology, pulmonology, etc., and tons began to be developed and developed in therapy. d.).
Surgery went ahead with seven-mile steps, as the principles of microsurgery, transplantology and organ prosthetics and tissue were developed. In 1965, the first successful transplant of the kidney from the living donor was held.) It was the general line of health development.
In the mid-1970s. actively opened and equipped diagnostic centers, Improved guards of motherhood and childhood, paid a lot of attention to cardiovascular and oncological diseases.
Despite all the achievements, by the end of the 1970s. Soviet medicine experienced a decline period due to insufficient financing and underdevelopment of certain state health programs.
In the 70s, an experiment began to strengthen the economic independence of bodies and health institutions. This is already a departure from the traditional Soviet health system - from its purely budget version and fully state regulation. The main doctors receive the right to operate with financial resources on the estimate of therapeutic and preventive institutions. This experiment limited on the scale was the forerunner of the introduction of a new economic mechanism (NHM), developing a commercial relations establishing new economic principles of distribution of funds (not at the institution, but per residents of the territories); reinforcing the economic independence of the regions and districts; permitting paid medical services; binding to define wages By the number and quality of the work of medical professionals. And in the late 80s. The difficult financial condition of the budgetary LPU led to the introduction of the USSR NHM in a number of regions. NHM caused changes in the structure of the management bodies of medical and preventive institutions, in particular, the creation of so-called territorial medical associations in a number of regions. Many medical facilities transferred their activities on the principles of Hoshchette and received right along with budget financing to receive income from other sources, and, above all, from the provision of paid services. From this point on, the transition from a rigid system of budget funding of healthcare, to a multichannel system.
An experiment in the form of nhm healthcare provided:
· The transition from the selection of facilities from the budget for individual items of expenses for financing on long-term stable standards, comprehensively reflecting the target activities of institutions;
· A combination of budget financing with the development of additional paid services to the population, as well as the implementation of works on contracts with enterprises and organizations on a trade-based basis;
· Development of independence and initiatives of labor collectives of health institutions in solving the main issues of production and social development;
· Establishment of the close dependence of the sizes of funds for the industrial and social development of the LPU and wage of each employee from the final results of the activities of the institution (divisions),
· Use various shapes Management, including intrasystem leases, cooperative and other activities.
For territorial clinics and territorial-medical associations, budget financing standards were established in the calculation of one resident at the perverse standard. Polyclinics should have paid hospital treatment patients living in their territory, according to the system of pre-reimbursement of costs at the calculation of the average cost for the treated patient, taking into account the bike profile; Services of emergency medical care and advisory-diagnostic centers. Polyclinics were interested in reducing inpatient treatment costs, in connection with this, day hospitals and ambulatory surgery centers in clinics, as well as hospital at home, were greatly developed.
Along with budget funds, LPU was able to use additional sources of financing including:
· paid services population and enterprises;
· Social insurance funds saved as a result of reducing incidence with temporary disability;
· Voluntary contributions of enterprises, institutions and citizens, etc.
NHM failed to solve the problems of health financing. There were many reasons for this. First, budget funds were allocated, all in smaller sizes and could not ensure the normal functioning of medical institutions. And additional income could not even ensure the scarce functioning of the LPU, and consider them as a serious source of financing.
(NHM was a prerequisite for the Multichannel LPU financing system after the collapse of the USSR).
But this system is already starting to move away from the set canons of the Semashko system.
Often leads the structure of the semashko system for its disadvantage, the Patients were attached to a particular doctor, to a certain hospital, then patients could not choose a doctor and a medical institution, which made it impossible to compete between them. This "liberal" flaw, which was most likely contemporaries. Competition between hospitals or doctors of Russian-Soviet doctors is generally nonsense. The traditions of Soviet medicine envisaged mutual assistance and collegiality.
The main problem of the semashko system is the underfundancy. But is it the problem of the health care industry itself? This is the problem of the whole state! And this at all can not characterize the system itself.
Health financing began to be carried out on the residual principle. The assessment in the share of the state budget coming to these goals showed that this share was steadily declining: 1960 (65) G. - 6.6% (6.5%), 1970 - 6.1%, 1980 - 5 , 0% 1985 - 4.6%, 1993 - 3.5%. The growth of allocations in absolute values \u200b\u200bof barely covered costs associated with the growth of the country's population. Health care began to include in the service sector, the attention of the administrative and management apparatus for the protection of people's health decreased.
At the same time, health expenditures were in the 90s. Xx in. per capita: in the USA - $ 2000, Turkey - $ 150, in Russia - $ 50. The residual principle of financing the health industry has led to the fact that the state of health of the Russian Federation has become constantly worsening.
Defalo with the collapse of the Soviet Union financing the healthcare industry sharply collapsed. The discredit of the Semashko system and the Soviet health care system began Total. There was a paid part of the previous health care. Medicine was divided into paid for wealthy and on state for the poor.
Twenty-five years after the collapse of the Soviet Union, we understand that, despite all the problems, the health care system in Soviet Russia was exemplary and rather needed grinding than in the cardinal reform. The International Meeting in Almaty (1978) under the auspices of WHO recognized the organization of primary health care in the USSR, its principles as one of the best in the world. Demographic processes in the USSR, the population of which increased by 1976 compared with 1913 more than 96 million people. The growth of the urban population reflects changes in the structure of production (industry growth and mechanization of agriculture). The predominance of women's population (136.8 million women and 118.7 million men as of January 1, 1976) was mainly due to older ages and was mainly caused by the consequences of the war. The gap in the number of men and women is gradually decreasing: by 1976, the number of men and women under the age of 45 years inclusive was almost equal. The proportion of the elderly has increased in the population. At the same time, the share of young people (up to 20 years) continues to significantly exceed the specific weight of the elderly (60 years and older), which is a favorable demographic sign.
The processes of the natural movement of the population in the USSR compared with pre-revolutionary Russia are characterized by a decrease in fertility and decrease in mortality while maintaining sufficiently high indicators of natural growth. Compared to 1913, a significant decline in fertility (45.5 per 1 thousand live. In 1913 and 18.1 - in 1975) is due, in particular, with an increase in the number of elderly people; A certain role in reducing the birth rate plays the active involvement of women in the sphere of production. A particularly pronounced birth rate in the 60s. It is related to the consequences of the war, t. The birth rate in 1941-46 was extremely low. Starting from 1970, with the entry into the prolonged age of the post-war generation, the birth rate stabilized and gradually begins to increase.
The total mortality in the USSR during the years of Soviet power decreased by more than 3 times (9.3 per 1 thousand lives. In 1975 compared with 29.1 in 1913), child mortality - almost 10 times (27.9 per 1 thousand . Livorny in 1974 compared with 268.6 in 1913). Some increase in total mortality in the 70s. Partly caused by a change in the age structure of the population. This can be found when comparing standardized in the age structure of the population of indicators and the analysis of age-related mortality rates. As a result of a decrease in mortality in the USSR, the average life expectancy has increased significantly compared with the pre-revolutionary period (70 years in 1971-72 compared with 32 in 1896-97).
Improving the living conditions, the activities of the Soviet state for the protection of children's health contributed to the steady increase in the level of physical development of representatives of all sectors of the USSR population. Already in the 30s. In the USSR there was no difference in the level of physical development of children and young people from the families of workers and employees. Events held by the state to eliminate the sanitary consequences of the Great Patriotic War of 1941-45 contributed to the fact that by 1956, the indicators of physical development were higher than in the pre-war years.
Health Organization. The first information about the organization of assistance to patients in the territory of Kievan Rus (the institution of refuge for patients and disabled in monasteries and churches) belongs to 10-11 centuries. The first state department of medical care is the Pharmaceutical Chamber (subsequently the pharmacy order) - originated in Russia in 1581 simultaneously with the first ("tsareva") pharmacy. In 1592, the first border station was established, designed to prevent the importation of contagious diseases.
In 18 V. Healthcare issues were provided with a medical office, and from 1763 - the Medical College. In 1775, "orders of public charity" were established in the provinces (in which charitable and medical institutions were managed), and then - medical councils in the provincial cities (except both capitals) and county medical counters - local organs Medical management. In 1803, the medical board was replaced by the Medical Department as part of the Ministry of the Interior. From the end of 19 century. The development of such forms of health care, like Zemskaya medicine, factory-factory medicine have been developed. Each department had its medical parts; The unified state health authority did not exist. Hospitals, ambulance and others medical institutions Opened by various departments and individuals in insufficient quantities. Medical assistance It turned out mainly by private doctors. Residents of the outskirts were practically deprived of medical care. Pre-revolutionary Russia did not have a state health care system.
The health care system created in the USSR is one of the outstanding achievements of the Soviet people. The objectives of the state in the field of health protection were identified by V.I. Lenin and reflected in the 1st Program of the RSDLP (1903). It has noted the need to establish an 8-hour working day, prohibiting child labor, devices at nursery enterprises, state insurance workers, sanitary supervision at enterprises, etc. From the first days of the Soviet government, concern for the protection of workers' health is proclaimed the most important task of the socialist state. In terms of destroying, epidemics and the fight against internal and external enemies, construction began in the world in the world of the state health care system, which was based on the most progressive and most humane principles: the publicly availableness and free medical care, preventive direction, the participation of the broad masses of workers in resolving protection issues Health. The policy of the Soviet state in the field of health was formulated in the 2nd RCP program (b) adopted on the 8th Congress in 1919. Among the priority tasks were envisaged to the improvement of settlements, the protection of soil, water, air, the development of public catering on scientific and hygienic The basis, the creation of sanitary legislation, ensuring the public with publicly available free qualified medical care, etc. For the years of the 1st five-year plan (1929-32), health care costs and physical culture increased in comparison with 1913 almost 4 times. The number of doctors by 1940 increased almost 6 times, secondary medical workers - more than 10 times, a kainy fund - by 3.8 times (see Table 1).
During the Great Patriotic War, 1941-1945, all health efforts focused on helping patients and wounded soldiers and prevent epidemics in the current army and rear. The activities of medical institutions contributed to the victory of the Soviet people above the fascism: more than 72% of the wounded and 90% of patients were returned; For the first time in the history of the wars, the rear and the army from epidemics managed to protect the rear. War caused huge damage to Soviet health, calculated at 6.6 billion rubles; 40 thousand hospitals, a clinic and other medical institutions were destroyed and destroyed. Mobilization of the country's economic potential and the heroic work of Soviet people contributed to the rapid restoration of the material base of health care: in 1947 its main indicators reached a pre-war level. In 1950 compared with the 1940, the number of doctors increased by 71%, secondary medical workers by 52%, hospital beds by 28%. From 1940 to 1975, healthcare alliances rose more than 13 times.
The basic principles of the Soviet health have been further developed in the CPSU program adopted at the 22nd Party Congress (1961). The issues of health care and medical science are devoted to a number of decisions of the Central Committee of the CPSU and the Soviet government (for example. Resolution of the CPSU Central Committee and the Council of Ministers of the USSR on January 14, 1960 "On measures to further improve the health care and health of the public health of the USSR" and on July 5, 1968 "On Measures Further improvement in health care and the development of medical science in the country "). Approval by the Supreme Council of the USSR in 1969 the foundations of the legislation of the USSR and the Union republics on health care, the principles and forms of medical care to the population - free, publicly availableness, qualifying, preventive focus, maternity and childhood protection, sanitary and anti-epidemic service, etc. He emphasizes that health protection The population is the responsibility of all state bodies and public organizations. Measures to further improve health care are provided: the continuation of the construction of large specialized and multidisciplinary hospitals, a clinic, dispensaries in order to improve the quality of medical care and more complete support of the population by all its species; expanding the network of ambulance stations and sanitary and epidemiological stations; Increasing the number of hospital beds, etc. (Health Development Indicators in 1940-75 are presented in Table. 2).
Incidence. Pre-revolutionary Russia held 1st place in Europe for prevalence among the population of infectious diseases; The epidemics of natural smallpox, cholera, plague, intestinal infections, rapid and returnful types, malaria and other diseases that caused huge damage to the health of the population and the economy were not ceased. In 1912, about 13 million infectious patients were registered. The main cause of high child mortality was children's infections. The sanitary condition of the country remains extremely disadvantaged. 1-J. world War 1914-18, Civil War And the military intervention of 1918-1920 created an extremely heavy sanitary and epidemiological situation. According to incomplete data, from 1917 to 1922 right typhoma about 20 million people were overgrown, from 1919 to 1923 returning title - about 10 million; For 1918-19, about 65 thousand cases of cholera were registered; In 1919, the threat of the development of the natural smallpox epidemic was created, the incidence of malaria and other infections increased. Under these conditions, the fight against infectious diseases was considered as one of the main issues of the internal policy of the Soviet state. Sanitary-anti-epidemic activities, improvement of housing conditions, landscaping of settlements in a short time allowed the incidence of increasing infectious diseases, eliminate especially dangerous infections. Already in 1922, the incidence of rapted typhoid decreased compared with 1919 more than 2 times, and in 2927 - 89 times. After 1927, it wore a sporadic character (some climbing it in 1942-45 was predominantly in the territories liberated after the temporary fascist occupation). The incidence of recurrent sewn typhoid by 1927 decreased more than 100 times; By 1938, it was practically eliminated. April 10, 1919 V. I. Lenin signed the decree of the SNK on compulsory preciseness. As a result of mass milio immunization, genuine smallpox in the USSR was completely eliminated by 1936-37. In pre-revolutionary Russia, it was annually registered from 5 to 7 million cases of malaria. In 1920, the Central Institute of Procal Diseases was organized, in 1921 - the Central Malari Commission for People's Commission, under the guidance of which a scientifically based program of malaria liquidation in the USSR was developed. By 1930, the incidence decreased compared with the pre-revolutionary period by more than 3 times. Starting from 1963, malaria in the country is not registered as a massive disease. Significant success was achieved in the fight against other infectious diseases: in 1971, compared with 1913, the incidence of Siberian ulcer decreased in 45 times, abdominal typhoids and parathy - almost 40 times, cough (1975) - 53 times; Radine steel diphtheria, poliomyelitis, tularemia.
From the 50s. The structure of the incidence and causes of death in the USSR became typical for economically developed countries. Characteristic distribution of cardiovascular diseases and malignant neoplasms It is connected, in particular, with the "Tariff of the population. The successes of medicine provided the elongation of the terms of life of patients with the pathology of the heart and blood vessels, which contributes to the well-known "accumulation" of such patients. More advanced diagnosis determines, in turn, more complete detection of diseases. Atherosclerosis, hypertensive diseases have the greatest distribution, ischemic disease Hearts, rheumatism. Infectious diseases are dominated by flu and others respiratory infectionswhich are one of the main causes of temporary disability. Intestinal infectionsIn particular, dysentery, as a rule, do not have an epidemic distribution. Respiratory and gastrointestinal infectious diseases are pronounced seasonal. From children's infections are measured, Scarlatina, Poklush, parotitis; The number of diseases is constantly decreasing. In the structure of accidents, the leading place is occupied by non-production injuries, in some cases related to the state of intoxication.
Medical frames. In 1913, Russia had 28.1 thousand doctors, most of whom lived in major cities. One doctor accounted for 5656 people. The uneven distribution of doctors led to the fact that the population of many areas was practically deprived of medical care. On the territory of the current Tajik SSR and Kyrgyz SSR, 1 doctor accounted for 50 thousand lives., Uzbek SSR - for 31 thousand, Kazakh SSR - by 23 thousand lives. By 1975, the number of doctors increased compared with 1913, 30 times, the security is 18 times (see Table 1). The USSR takes the 1st place in the world in the number of doctors and the provision of their population.
In pre-revolutionary Russia, most residents could not use specialized medical helpSince it was possible only in large cities. In 1975 compared with the 1940, the number of therapists and the doctors of the sanitary and anti-epidemic profile increased by more than 4 times, surgeons - 6.9 times, obstetrician-gynecologists, pediatricians, ophthalmologists - almost 5 times, neuropathologists - almost 7 times, radiologists and radiologists - more than 10 times. The provision of the population by medical professionals in most union republics has reached a public-union level.
In 1913 there were 46 thousand medium-sized medical professionals (including t. N. Rotable paramedics and obedala grandmas). By 1976, the number of secondary medical workers increased 55 times (see Table 1). The security of the population by Middle medical workers in some union republics (for example, Ukrainian, Estonian) is higher than the Union-Union.
The USSR occupies a leading place in the world to produce doctors, pharmacists and medium-sized medical professionals. In pre-revolutionary Russia, 17 medical faculties of universities and medical institutions issued 900 doctors annually. By 1975, the number of physician students increased 36 times, the release of doctors - more than 50 times. There are higher and secondary medical schools on the territory of each union republic, the release of specialists meets the needs of the population in medical personnel. Among students of medical schools have representatives of more than 100 nationalities. A network of institutions and faculties of improvement of doctors have been created (in 1974 there were 13 institutes and 18 faculties). Doctors pass specialization or improvement at least 1 time in 3-5 years.
Sanitary and epidemiological service. In 1913-14, a sanitary organization had in 73 cities and 40 of the provinces of Russia, 257 doctors worked, there were 28 sanitary and hygienic laboratories; Zemstvo sanitary bureau performed mainly statistical work. The USSR created a single state sanitary and anti-epidemic service. Already in 1918, the Sanitary and Epidemiological Section was organized as part of the Naroscital, and in the Health Departments of the Executives of Local Soviets (from 1919) - Sanitary and epidemiological subsets; The decree of the SNK RSFSR "On Sanitary Bodies of the Republic" (1922) established a single organization of a sanitary case, the tasks, rights and obligations of sanitary bodies were determined. The rapid pace of development of a sanitary-anti-epidemic organization demanded the training of qualified personnel and the expansion of a network of special institutions. In 1936, the first sanitary and hygienic faculties opened in medical institutes; In 1939, the Regulation on sanitary and epidemiological stations as comprehensive and leading institutions of the sanitary and epidemiological service was approved. By 1940, a sanitary-anti-epidemic organization covered over 12.5 thousand doctors, 1943 Sanitary and epidemiological stations, 1490 sanitary bacteriological laboratories, 787 disinfecting stations, items, detachments (see Table 2). Elimination of the consequences of the Great Patriotic War 1941-45 and economic development The USSR has identified new requirements for the work of sanitary bodies, demanded changes in their structure. In 1948, a mandatory organization of sanitary and epidemiological stations was introduced with all territorial health authorities (republican, regional, regional, urban, district); In 1963, a resolution of the USSR Council of Ministers "On State Sanitary Supervision in the USSR" was adopted. The basis of the legislation of the SSR Union and the Allied Republics on Healthcare (1969) and the Regulation on State Sanitary Supervision in the USSR (1973) provide a sanitary-anti-epidemic service of broad authority on the protection of the external environment from pollution, oversight of industry, construction, public catering, water supply, improvement, planning settlements, etc. In the USSR, the commissioning of industrial enterprises without treatment facilities is prohibited; In all pollutants of the external environment, extremely permissible concentrations included in the mandatory norm and rules are established; The construction of any object and layout of settlements is carried out in compliance sanitary norms and rules; The prescriptions of a sanitary doctor are mandatory for all state and public organizations, institutions and individual citizens. Sanitary service organizes holding preventive vaccinations The population, performs anti-epidemic measures in the threat of the occurrence and distribution of infectious diseases, as well as sanitary-quarantine measures, etc.
Table. 1. - Hospital network of the USSR and the Union republics; The number of doctors and medium-sized medical workers and the security of the population of the USSR and the Union republics
| the USSR | Number of hospital institutions | Number of hospital beds, thousand | The number of hospital beds for 10 thousand lives. |
||||||
| 1913 | 1940 | 1975 | 1913 | 1940 | 1975 | 1913 | 1940 | 1975 |
|
| 5300 | 13793 | 24250 | 207,6 | 790,9 | 3009,2 | 13,0 | 40,2 | 117,8 |
|
| Including the RSFSR | 3149 | 8477 | 13066 | 133,4 | 482,0 | 1649,2 | 14,8 | 43,3 | 122,5 |
| Ussr | 1438 | 2498 | 4122 | 47,7 | 157,6 | 578,3 | 13,6 | 37,7 | 117,8 |
| BSSR | 240 | 514 | 913 | 6,4 | 29,6 | 107,0 | 9,3 | 32,6 | 114,2 |
| Uzbek SSR | 63 | 380 | 1159 | 1,0 | 20,3 | 145,6 | 2,3 | 30,1 | 103,4 |
| Kazakh SSR | 98 | 627 | 1770 | 1,8 | 25,4 | 178,6 | 3,2 | 39,5 | 124,6 |
| Georgian SSR | 41 | 314 | 500 | 2,1 | 13,3 | 48,0 | 8,0 | 36,0 | 96,9 |
| Azerbaijan SSR | 43 | 222 | 748 | 1,1 | 12,6 | 54,8 | 4,8 | 37,8 | 96,3 |
| Lithuanian SSR | 44 | 77 | 229 | 2,2 | 8,9 | 36,9 | 7,7 | 30,0 | 111,2 |
| Moldavian SSR | 68 | 109 | 354 | 2,5 | 6,1 | 42,0 | 12,2 | 24,6 | 109,2 |
| Latvian SSR | 50 | 89 | 187 | 6,2 | 12,0 | 31,7 | 24,9 | 63,0 | 126,9 |
| Kyrgyz SSR | 6 | 112 | 263 | 0,1 | 3,8 | 37,4 | 1,2 | 24,1 | 111.2 |
| Tajik SSR | 1 | 121 | 278 | 0,04 | 4,5 | 33,5 | 0,4 | 28,6 | 96,0 |
| Armenian SSR | 6 | 96 | 228 | 0,2 | 4,1 | 24,4 | 2,1 | 30,1 | 86,0 |
| Turkmen SSR | 13 | 99 | 270 | 0,3 | 5,6 | 25,8 | 2,7 | ||