Settling new territories and the northern regions, and erecting new cities and giant industrial facilities constituted the bright facade of the Soviet Union. But the story behind the scenes concerned the people’s health. The populace paid a high personal price for being able to deliver triumphant reports on the construction of socialism, and the consequences of those hardships are felt to this day. Using a study by researchers from HSE and the Semashko National Institute of Public Health, IQ looks at why the era of stagnation was a period of increased illness and mortality.
In today’s Russia, everything connected with the Soviet period is in dispute, and this includes the subject of healthcare. According to Sergey Zatravkin and Elena Vishlenkova, the study’s authors, discussion about the effectiveness of Soviet-era healthcare is generally more emotional than science-based, with all hard data limited to official information about the state of the country’s network of medical facilities.
Using Soviet-era statistics, the researchers assessed the situation in the 1960s - 1980s, proceeding not from the number of hospital beds, doctors and patients, but from indicators of public health: physical condition, morbidity, mortality and life expectancy. In these terms, the annual data paints an abysmal picture of people’s health.
According to the researchers' 'diagnosis', 'For many Soviet people, the period of stagnation was not a time of calm and stability, but of anxiety for their children and loved ones, as well as of personal illness and a short lifespan'.
Consider the fact that from 1960 to 1988, the incidence of the 25 most common infectious diseases in the Soviet Union more than doubled. In 1972, for example, the incidence of dysentery matched the previous record high seen during the Civil War in 1920.
The rampant spread of an illness traced to unwashed hands resulted not from the poor quality of Soviet medicine. Dysentery was just one example of how non-medical factors came into play. These included unfavourable living and environmental conditions and policies that ignored the recommendations of scientists. The comparison with the Civil War is no coincidence: the historical disturbances of the 20th century similarly tested the population’s ability to survive. Soviet songs spoke of citizens with hearts of fire and fury, but the reality was that people’s health worsened, and it was dealt new blows even during the quiet and calm years of stagnation.
In the 20 years leading up to 1984, the Soviet death rate (the ratio of deaths to the average size of the population) rose by 57%, from 6.9 people per 1,000 population to 10.8 per 1,000. Regarding the cause, researchers cite a significant increase in deaths from cancer, heart and vascular diseases, accidents, injuries and poisoning.
In a separate problem, suicides rose by 250% from 1956 to 1980, from 10.8 per 1,000 people to 26.98. Ten years later, after the anti-alcohol campaign, that figure had dropped slightly to 21.06.
Injuries and poisoning were the main causes of male mortality, claiming the lives of one in every three men (34.5%) between the ages of 15 and 59. Male mortality exceeded that of women, lowering the country’s overall life expectancy.
66.1 years — the average life expectancy of Soviet men in 1964, a figure that was never surpassed during the Soviet era.
58 years — the low point to which the life expectancy of male Russian villagers dropped in 1978.
10 years or more — the gap between male and female lifespans in the Soviet Union between 1978 and 1985.
Although the official policy for settling outlying territories led to major increases in population — 360% in the Khanty-Mansi Autonomous Okrug, 180% in the Chukotka Autonomous Okrug, and 71%-76% in the regions of Kamchatka, Magadan and Yakutia — this also lowered the average age at which people died.
Huge numbers of young people helped build factories, cities and roads in regions with harsh climatic conditions. This fact was often overlooked, and people ultimately paid for these large-scale projects with their health. According to the study, ‘Medical geographers who tested these regions for settlement tried to convince administrators that enabling people to adapt to extreme conditions would require significant government investment in the development of infrastructure and quality of life, and sometimes even special clothing and food. However, the scientists’ recommendations were not taken into account because there was never enough money to implement them’.
Higher infant mortality also contributed to the lower average age of death. In the 1960s, infant mortality in the Soviet Union was 30%-40% higher than the world average, with that gap reaching 150% by the 1980s. What's more, this does not include a reckoning according to Western standards that counts 'children born with a bodyweight of under 1,000 grams and not living 168 hours (seven days)'. By that calculation, Soviet infant mortality would have been an additional 30% to 50% higher.
‘Because there has been a lot of discussion in past and current literature as to the reasons for the decline in Soviet people’s health, we have the opportunity to not reproduce what is already known, but to supplement it with well-grounded hypotheses’, the researchers wrote.
They point to poor environmental conditions and alcoholism as the main reasons for the problems of the 1960s-1980s.
The availability of alcohol contributed to the growth of alcoholism. The result: from 1960 to 1984, annual alcohol consumption increased from 4.6 litres to 10.5 litres per person, and when also counting home-distilled vodka, that figure surpassed 13.5 litres annually.
In the mid-1980s, the effects of alcohol on health were quantified. The share of ‘alcohol-dependent mortality’ turned out to be huge, especially among men. It accounted for more than two-thirds (65.5%) of deaths due to external causes, almost one-third (31.4%) due to diseases of the digestive system and more than 40% due to respiratory disease.
More than 1 million people died from alcohol consumption every year in the Soviet Union in the first half of the 1980s.
For every litre of alcohol consumed annually, life expectancy fell by 9.5 months for Soviet men, and by 4.1 months for women.
Vodka accounted for at least 50% of all alcohol consumed and sometimes reached 112 proof (56% alcohol) per official state standards.
The anti-alcohol campaign of 1985-1987 sharply reduced mortality, with the restrictions imposed saving as many as 700,000 lives. However, another destructive factor, environmental problems, not only remained but worsened.
The environment was spoiled by mass industrialisation and collectivisation and was dealt a death blow by the runoff of agricultural chemicals and the discharge of untreated wastewater into reservoirs. Because several years of exposure to high dust content in the air increases mortality by 10%-15%, statistics for the period of stagnation are, we might say, impressive.
Every fifth person (more than 50 million) in the Soviet Union lived in industrial centres with a critically high level of atmospheric pollution containing not only dust but also chemically active substances.
These environmental problems caused cancers that took their highest toll in Belarus, Kazakhstan, Ukraine and the Baltic states. The republics of Central Asia, where there were particular difficulties with the availability of drinking water, suffered more from infections and parasitic diseases.
The researchers cited the example of Turkmenistan, where 'only 13% of rural residents used the central water supply. The rest got their water from dirty reservoirs and irrigation canals'. The national figures are also telling. At least 27% of samples taken from surface water reservoirs in 1988 did not meet sanitary standards. From 1985 to 1988, the release of industrial waster into water bodies rose by almost 80%, while only 30% of all wastewater was considered purified - and in the Russian Republic, that figure was only 16%.
In Moldova in the late 1980s, the spraying of pesticides on local fields reached 15 times the national average and led to deaths from cirrhosis of the liver at seven times the rate for the Soviet Union as a whole.
The widespread chemical 'seasoning' of crops in the 1970s-1980s was so great that it reached disastrous levels in some regions. For example, according to geneticists, in Lithuania, this led to 'mutations that caused spontaneous abortions, stillbirths and congenital malformations'.
360% — the increase in cancer patients in the Soviet Union from 1958 to 1988.
170% — the increase in mortality from respiratory diseases from 1964 to 1976.
9.8 million — the number of patients with mental disorders in 1985, following a steady annual increase that began in 1959.
More than 600,000 people were recognised as disabled (one-third of whom were under 45). What’s more, this did not include non-working citizens and the concept of ‘disabled children’ only appeared in the Soviet Union in 1979.
‘It is not at all true that today’s public health problems arose suddenly or stem from the collapse of the Soviet Union. They have clearly accumulated over time and been inherited’, the researchers concluded.
Statistics show just what accumulated during the period of stagnation, while history shows what the people of that time had inherited. The ineffective healthcare from the 1960s to the 1980s also has roots in the past.
'After the Stalinist trials of doctors, medical workers became fearful, tight-lipped, willing to tolerate everything and, therefore, deprived of funding. They lost their role as experts and failed to fulfil their professional duty to protect people'.
The data used in the study is not declassified archival material but comes from reference books and reports from the years in question, thus underscoring their significance. That is, they indicate that doctors and politicians of the time were aware of the problem but turned a blind eye to it.
The plight of Soviet medicine received official recognition in the late 1980s. A 1987 issue of Soviet Healthcare magazine from 34 years ago offers an interesting perspective, with Soviet Health Minister Yevgeny Chazov discussing the need to reorganise the field entrusted to him.
‘Our country’s achievements in protecting public health are impressive and undeniable’, he reported. Nonetheless, the examples he cited gave the opposite impression.
Doctors were ‘buried’ under the burdens placed on them. ‘A district doctor, for example, is responsible for the health of 1,800 people assigned to him’. There was also heavy bureaucracy. ‘The time has come…to free the doctor from unnecessary paperwork, reports and the filling out of numerous forms’.
The training of specialists left much to be desired. Moscow's main Health Services agency assessed the professionalism of one in every four graduates of the capital's medical universities 'as "3" or lower', and '36% lacked practical skills in their chosen field of work'. Neither did industry produce the equipment urgently required by medical institutions — ‘ordinary baby pacifiers, bedpans and rubber catheters’. There was also a shortage of ‘computer tomography machines, artificial kidneys, and angiographic and ultrasound equipment’.
The Health Minister noted that such problems as pursuing quantity to the detriment of quality, miscalculations in planning, ‘shortcomings in management’ and a decline in medical care and prevention had deepened during the previous 15-20 years — that is, precisely when the country was free of political upheavals and the standard of living was higher than in previous decades.