Soviet Union: Facts and Fictions (Part 4: Healthcare)

This series (Parts 1, 2, 3) is to discuss a popular greentext story that gets shared around numerous leftist circles, and to provide greater context behind many of the claims made.

The Somewhat Suspect Greentext

It may seem trivial to discuss at length a 4chan greentext post, but importantly, a number of sources have now been provided for these claims alongside the meme. This allows for deeper discussion and interrogation of the claims made.


>have most doctors per capita in the world

Along this claim is the comment that “ The Soviet Union had the highest physician-patient ratio in the world, my notes say 42 per 10,000 population, vs 24 in Denmark and Sweden, 19 in US.” The first source for this claim is Red Medicine: Socialized Health in Soviet Russia by Englishman Sir Arthur Newsholme. It is important to note that this was published in 1933, which limits the veracity of its claims to only a very small period of the Soviet Union. Unfortunately, a page number is not given for the claim, but I was able to find a number of figures. In Chapter 11 we see in a footnote that:

According to Dr. Roubakine, in 1930 there were about 30,000 female and about 39,000 male doctors in the U.S.S.R.

Which amounts to 69,000 doctors. This data set places Soviet population in 1930 at 157,700,000. This works out to 4.3 doctors per 10,000 people. Interestingly, the source list for the greentext says that Denmark and Sweden had 24 doctors per 10,000 people, which is clearly higher than 4.3.

In Chapter 17:

We were informed by Dr. Vladimirsky, Commissar of Health of the R.S.F.S.R., that in 1932 there were 36,000 medical students, and it was hoped that by 1937 the present deficiency of doctors would be overtaken. He estimated that Russia was still short of 20,000 physicians, as compared with the quota of the Five Year Plan, and that this meant retardation of public health and of medicine. It was officially considered that eventually as an ideal there should be one doctor to 1,000 population. [emphasis mine]

From this we can deduce that the R.S.F.S.R had not reached its goal, set by the Five Year Plan, and the eventual goal was 1 doctor per 1,000 people, or 10 doctors to every 10,000 people had therefore not been met.

In Chapter 18 we hear that:

In Russia, before the Revolution, there were approximately 26,000 physicians. In 1931, according to Dr. Roubakine, the total number of physicians was about 76,000.

Using our previous source, 1931 has a population of 160,600,000. This leads to 4.7 doctors per 10,000 people. How does this compare to other countries at the time? According to statistics in Exclusions: Practicing Prejudice in French Law and Medicine, 1920–1945 (page 35), in 1931 France had one doctor for every 1,645 inhabitants, or 6 doctors per 10,000 people. Exclusions goes on to state that in a study of doctors per capita across 18 countries, France ranked twelfth. This means that in 1931, at the very least, the USSR had less doctors per capita than Hungary, Italy, Switzerland, Japan, Latvia, Denmark, Norway, Belgium, Czechoslovakia, Germany, the Netherlands, and France.

Returning to Red Medicine, a shortage of doctors is mentioned in the introduction:

…it was everywhere frankly stated that their arrangements were not yet complete, that the dearth of doctors made more adequate provisions difficult for a few years; and when we were told openly of the great difficulties which were being experienced in extending the medical provisions of cities to the vast rural communities of Russia, and of the only partial success hitherto achieved in overcoming these difficulties…

And again in Chapter One :

It was extremely helpful to us to meet Dr. Vladimirsky and to hear his survey of the present medical situation in Russia, including a reminder that because of the shortage of physicians there had necessarily been delay in progress according to plan.

It is interesting that throughout the book, Newsholme consistently defers to communist party officials for statistics and facts, rather than any first hand investigation. To me this is reminiscent of Walter Duranty whose coverage of Holodomor was eventually denounced by the New York Times as “some of the worst reporting to appear in this newspaper.” At the very least, Newsholme seems somewhat aware of the risk of propaganda, and he notes in the introduction “We realized all the time that we were seeing the best that the U.S.S.R. had succeeded in developing.”

The second provided source for this claim is this journal article, which states:

Emergency medical care is rendered by emergency stations (departments). As of January 1, 1983, 4,627 stations were functioning, staffed by some 40,000 physicians…

I do not believe this is the correct figure to be cited, as it only looks at emergency stations. Furthermore, with an estimated population of 270,000,000 in 1982 this leads to only 1.4 physicians per 10,000 people. Although data is hard to find on this stat, World Bank data shows many countries having over ten times this rate as early as the 1960s.

However, in the journal following the cited article is another journal article which finally includes a useful statistic, from 1984:

There are approximately 700,000 physicians in the Soviet Union, resulting in a physician/patient ratio of 266/100,000, compared with 158/100,000 in the U.S.

26.6 physicians per 10,000 people is half the 42 physicians to 10,000 people noted in the comment, and I am unsure of where that number came from. So was 26.6 physicians per 10,000 the highest in the world? Data from the Israeli Medical Association places Israel as having >30 physicians per 10,000 people in 1984.

Physicians per 1000 people in Israel and the OECD

Further notes on Healthcare

The Soviet Union’s Constitution promised free, qualified medical care to all Soviet citizens. Unfortunately, this was not realised in the course of the USSR’s existence. Writing in 1988, a Russian physician noted:

There is ample documentation in the Western literature of the USSR’s rising infant and overall mortality rates, of the decline in spending on health care that by one estimate now amounts to just 2 % of the gross national product, and of the technologic backwardness that characterizes most hospitals and clinics. To this we would add that dissatisfaction with the poor quality and corruption of the health care system is widespread among both patients and physicians.
While the illegal practice of payment on the side to physicians and nurses-required simply to have one’s operation done or one’s medication given-is so prevalent that it has recently been acknowledged in the Soviet press (Izvestia, Sep 24, 1987), worse yet is the fact that many people are distrustful of the system at any price, official or unofficial. Physicians themselves complain about policies that stress quantity, not quality, low prestige and pay, and lack of professional autonomy. Professional input in health policy and public health is also lacking, as may be judged by recent measures that mandate human immunodeficiency virus testing for many groups and prison terms for those who deliberately expose another to the virus.
We… emphasize the abysmally low level of care that is a fact of life for Soviet citizens.

A CIA report noted that in the Soviet Union:

Healthcare is notoriously bad: insufficient funding, lack of qualified personnel, and shortages of supplies have helped lower Soviet life expediencies.

A 1990 study on the Soviet healthcare system reports:

Since the early 1970s, however, the state of the nation’s health and, to many Western and Soviet observers, the quality of its health care system have declined… male life expectancy declined from 67 years in 1964 to 63 years in the early 1980s, and average life expectancy now ranks thirty-second in the world…

Alcoholism was particularly problematic in the late Soviet Union.

Cardiovascular disease and alcoholism are epidemic — deaths from cardiovascular diseases have increased by 50 percent since the early 1960s, accounting for half of all Soviet deaths in 1980, although the rate of increase has recently slackened. Alcohol is associated with one-fifth of all premature deaths, over one-sixth of the average Soviet household budget goes for hard liquor, and one-fourth of the families in the Slavic republics (Russia, the Ukraine, and Byelorussia) spend more than one-third of their income on alcohol.
Anti-Alcohol Propaganda Poster

The report goes on to say:

In a country as developed and industrialized as the Soviet Union of the 1970s, these declining health indicators probably reflect a deterioration of general economic conditions… Partly because of general declining standards, the early promise of the health care system has not been sustained, and its recent development has not been as auspicious as hoped…
Contrary to its stated principles,’ the Soviet medical care system is neither unified nor egalitarian. Most people get care in hospitals and clinics operated and funded by the Ministry of Health, a system of free care that includes 94 percent of all health care facilities. A parallel “closed” system is maintained by certain elite government ministries and by large factories. This “closed” system is considered to be of higher quality than the “public” one and draws a disproportionate share of all health funding.”
… Also contrary to its design, Soviet health care is not free. Patients treated in the public system are often required to pay doctors and nurses under the table in order to assure that medications be administered or that an operation be performed…
The Minister of Health has acknowledged that many hospitals are “little more than places to sleep,” … Countrywide, 40 percent of hospital beds are in buildings originally constructed for other purposes, and rural hospitals often lack hot water and sewage.

In short, healthcare in the Soviet Union was neither effective nor egalitarian, and was leading to stagnating life expectancy and chronic shortages.


Bibliography

Arthur Newsholme, Red Medicine: Socialized Health in Soviet Russia.

Population Trends in the Soviet Union.” Population Index 5, no. 1 (1939): 4–7. doi:10.2307/3030379.

Julie Fette, Exclusions: Practicing Prejudice in French Law and Medicine, 1920–1945, Cornell University Press, 27 Mar 2012.

Feshbach M. The Soviet Union: population trends and dilemmas. Popul Bull. 1982 Aug;37(3):3–44.

World Bank, Physicians (per 1000 people).

Boris D.Komarov, Emergency medical care in the Soviet Union. The American Journal of Emergency Medicine, Volume 2, Issue 5, September 1984, Pages 453–455.

Jeffrey A.Coles MD. Emergency medical services in the Soviet Union. The American Journal of Emergency Medicine, Volume 2, Issue 5, September 1984, Pages 455–456.

Israeli Medical Association, The percentage of physicians in Israel — the current state of affairs.

Michael Rafferty, MD. Medicine in the USSR. The Western Journal of Medicine. May 1988 148:5, pg 155.

CIA, A Comparison of the US and Soviet Economies: Evaluating the Performance of the Soviet System: A reference aid. October 1985 (released 1999).

Daniel Schultz, MD and Michael Rafferty MD, Soviet Health Care and Perestroika. American Journal of Public Health. February 1990, 80:2. 193–197.