Socialist Medicine: Prevention, Propaganda, and Pain in the USSR
In the USSR, healthcare was especially important. The population needed to be strong and healthy to be productive so that the Socialist utopia could be realised. The Soviet Revolution promised a radical transformation: healthcare for all, not as charity, but as a fundamental right. Workers were no longer faceless cogs in a machine, but vital contributors to a shared socialist future. A healthy nation would pave the way to a just and prosperous society.
Life was hard in Tsarist Russia. Outside a few cities, healthcare was virtually non-existent. People relied on untrained healers or clergy, and life expectancy was a mere 31-34 years – 15 years lower than in the US. The 1921 famine further devastated the nation, killing an estimated 5 million people. Seed-grain was often eaten rather than sown. Urgent action was needed.
But a new era was dawning. The new Soviet state established the world's first fully government-funded, centralised healthcare system. Created in 1918, the People's Commissariat of Health had the monumental task of providing healthcare for an entire nation. The right to health was officially enshrined in the Soviet constitution, making the Soviet Union one of the first countries to promise universal, free, cradle-to-grave healthcare. They viewed healthcare costs as a natural part of production. Since the worker's labour generates value, the worker is entitled to healthcare.
Workers’ Committees, Trade Unions, Women’s Organisations, and Youth’s Organisations joined the struggle against disease. Their task was to inspect lodgings, public institutions, teach hygiene practices, distribute soap, and combat the spread of lice. Bright colours and striking graphics were a common theme of healthcare posters which were developed in the hopes of communicating to an often illiterate population. Posters advised how to prevent diarrhoea, not to drink unclean water, and to temper nipples with cold water. They were hung in nurseries, hospitals, and schools across the country, while workplaces held lectures or screened hygienic films to educate the masses. It was a fight not only for health but for the success of socialism itself.
Science replaced traditional healers. Over the next two years, the USSR Ministry of Health published more than 13 million pieces of public health literature. Posters were produced to denounce healers and their practice was outlawed a few years later. The results were unprecedented. Over the next two decades, life expectancy in the USSR increased by 15 years, and infant mortality plummeted as infectious diseases receded. It was a lifeline when none existed before.
Preventative Medicine: The Soviet Model
The Soviets prioritised prevention from the get-go. Free compulsory annual health checks aimed to catch and treat problems early, while mandatory immunizations targeted infectious diseases. This focus on simple, inexpensive interventions – including basic hygiene education – was key in the early years. The Soviet system, with its extensive control over citizens' lives and limited privacy concerns, offered unique advantages in implementing this preventative care model compared to Western democracies.
This proactive, preventative approach extended into every aspect of healthcare, particularly motherhood and infant care. O. P. Nogina, head of the Department for the Protection of Motherhood and Infants, said, "The sanitation of the population begins with the protection of a pregnant woman and her infant." Posters of loving mothers and healthy, smiling children became powerful symbols of national health and vitality.
Yet, this system had its limitations. In stark contrast to the West's emphasis on pain management, Soviet doctors dismissed it. Painful medical procedures, especially in dentistry, typically lacked anaesthetic, and a compassionate bedside manner was uncommon, even in paediatrics and childbirth.
By the 1960s, the early victories over infectious diseases and improvements in primary care began to reach their peak. Life expectancy gains began to plateau around 70 years, similar to Western Europe. The ambitious early goals of the Soviet healthcare revolution faced challenges. While the system excelled in tackling injuries and diseases like cholera, it struggled to address complex conditions and mental illness. Mirroring trends across the industrialised world, a new threat emerged: cardiovascular diseases.
Doctors in the USSR: In Contrast to the West
Soviet doctors faced a unique landscape. While respected, they lacked the prestige and high salaries often associated with the profession in the West. Medical education, though free, came with strings attached: graduates were obligated to accept government-assigned positions for several years. In a further departure, Soviet doctors pledged an "Oath of Physician of the Soviet Union." This oath emphasised Communist morality and, notably after 1983, included a commitment to preventing nuclear war.
The Soviet medical workforce had a striking gender imbalance, with women dominating nursing and up to 80% of physician roles. However, men were far more likely to occupy higher-ranking positions as consultants, senior staff, and surgeons. Despite the USSR's developing nation status, the country boasted an exceptionally high ratio of physicians to population, peaking at around 37 per 10,000 people in the late 1970s to early 1980s – nearly double that of the US.
Yet, this abundance of doctors did not translate into high pay. In the late 1980s, a physician's salary hovered around 120-150 roubles, well below the national average of 185 roubles and even further behind engineers. Nurses earned even less, between 90-130 roubles, despite regular and often uncompensated overtime. While doctors received state-provided housing with low rents, many still struggled financially. They often took on second jobs or resorted to growing their own food. This is illustrated in the popular Soviet comedy "The Irony of Fate," where a successful surgeon lives in a tiny apartment with his mother.
Healthcare in Crisis: The Decline of the Soviet System
Despite its early triumphs, the Soviet healthcare system faced an insidious threat: chronic underfunding. Between 1960 and 1970, healthcare spending remained stagnant at around 2-3% of GDP. In 1983, the US, with a similar population size, invested nearly four times as much in healthcare as the USSR.
This lack of resources devastated the system. By the late 1970s, less than 1,000 pacemakers and under 150 kidney machines were available in the entire USSR. CT scanners were so rare that estimates place their number around 50 nationwide. Hospitals were forced to reuse basic medical supplies like needles, gloves, and intravenous tubing. Even non-medical essentials like cars, construction materials, and textiles were in short supply, crippling hospitals' ability to function – some lacked enough gasoline to run their vehicles. Crumbling facilities were another symptom of the crisis. Over half of the X-ray film used was virtually worthless due to poor quality. Doctors and nurses wasted approximately 11 days per year hand-copying patient charts.
The consequences for patients were dire. As the population aged and urbanised, the Soviet system, designed for different healthcare needs, failed to adapt. Despite the sheer number of doctors, their training lagged behind Western standards. Hospital food was meagre, prompting families to supplement the diets of their loved ones. Overcrowding and hospital-induced infections became rampant, while preventable medical errors, including AIDS infections from improperly sanitised equipment, skyrocketed . Infant mortality, once a symbol of progress, began to rise again alongside general mortality rates. Diseases like influenza, typhoid fever, and even rickets resurfaced. Cancer screening lagged tragically behind the West, leaving over half of all cases undiagnosed until their fatal stage.
The system's founding ideal of healthcare equality was also eroding. To receive timely, personalised care, many resorted to bribes at every stage of treatment – despite a public system. Some procedures unofficially exceeded an average monthly salary. In effect, two systems co-existed: a crumbling, underfunded public one serving the majority, and a parallel 'closed' system catering to elites, offering superior care with vastly better resources.
A Mounting Crisis: Drug and Alcohol Abuse in the USSR
As the Soviet system crumbled, so did its ability to address a growing threat: substance abuse. Alcoholism was exacting a devastating toll, with some estimates suggesting tens of thousands died annually in alcohol-related accidents. By the late 1980s, HIV rates were surging towards epidemic levels. Heavy smoking and rising substance abuse plagued the population.
In a desperate attempt to combat alcoholism, Mikhail Gorbachev increased controls on alcohol in 1985, even attempting a partial prohibition. This deeply unpopular campaign initially saw some success, reducing consumption and improving certain quality of life measures. However, its benefits proved short-lived and it ultimately failed.
Drug policy had similarly failed to keep pace. While a 1974 decree, 'On Reinforcement of the Fight Against Drug Addiction' introduced criminal penalties for drug offences, the escalating consequences of the war in Afghanistan drove a spike in illegal drug use. The Soviet government continued to downplay the crisis.
As late as the mid-1980s, Soviet officials claimed that serious drug addiction was nonexistent in the USSR. They boasted of having ‘not a single case’ of addiction to amphetamines, cocaine, heroin, and LSD, contrasting their "problem-free" society with the supposed decadence of the West. Dr. Eduard A. Babayan asserted that his country of 277 million people had only 2,500 drug addicts – primarily disabled medical patients addicted to prescription painkillers. Babayan contrasted this with the half a million heroin addicts he claimed were rampant in the United States. He cited unemployment, discrimination, prostitution, and vagrancy as leading causes of Western drug use, all of which, he insisted, had been eliminated in the Soviet Union.
The reality was starkly different. Soviet youth, drawn to Western trends and increasingly disillusioned by the failing system, became vulnerable to drug use. Censorship hid the true extent of the problem. Official pronouncements rang hollow as articles in publications like Moskovsky Komsomolets blamed the issue on inadequate parenting and education rather than deeper societal ills. At the same time, censorship strictly limited discussion of drug abuse, except as it served to illustrate the West’s asserted decadence and the contrasting moral strength of Soviet society.
For almost 50 years, the Soviet health system led the world. It was held up as a model for developing countries and other socialist states. But its early achievements were overshadowed by a marked decline. Starting in the 1970s, the USSR became the first industrialised country to record a drop in life expectancy and a rise in infant mortality. The collapse of the USSR in 1991 triggered an even sharper decline in life expectancy across many of the former republics. Once a symbol of progress, the Soviet model evolved into a cautionary tale. What began as a groundbreaking experiment ultimately succumbed to economic decay and systemic flaws.
