== Definition of a concept. Social and economic fundamentals of health care ==
Health care — system of the social and economic and medical actions aiming to keep and increase the level of health of each certain person and population in general. Character and contents 3. at various stages of social development is defined by way of production, extent of development of productive forces, the level of development of science and technology in general and medical sciences in particular.
Theoretical and organizational principles of creation of system 3. are caused first of all by relations of production, a social system which define degree of responsibility and participation about-va in the solution of problems of health protection of the people. However within one socioeconomic structure there can be various forms of the organization 3., caused by peculiar features of historical development, character of a political system, level of economic development, sharpness of class fight and other factors. Extent of performance 3. functions on public health care depends on its material and technical resources, existence of the qualified medical shots, the level of development of medical science and implementation of its achievements in practice 3.
Founders of scientific communism for the first time proved a feedforward of public health with a social system, opened harmful influence of capitalist system on health of workers. V. I. Lenin defined social essence 3., showed continuous communication of fight for health of workers, their rescue from physical. and moral degeneration with revolutionary change about-va, with a victory of a new social system, free from enslavement, the oppression and operation capable to use all economic and social opportunities about-va, all achievements of science for the benefit of a wide people at large, for harmonious physical. and spiritual development of each person, for preservation and steady increase in level of public health. He proved that the radical solution of problems 3. perhaps only in the conditions of socialist about-va.
Socialist 3. — it is system of the governmental social and economic and medical activities which are carried out about-vom for preservation and continuous improvement of health of each person and all population, providing optimal conditions of work, life and rest, harmonious physical. and spiritual development of the person, active creative longevity of all members about-va. The base providing problem solving socialist 3. — constantly increasing material and cultural level of the people which is result of operation of the fundamental economic law of socialism — steady satisfaction of constantly growing material and spiritual needs of all members about-va. Main condition of progress 3. — broad prevention, the free and public qualified medical aid, the maximum use of achievements of scientific and technical progress in interests of protection of public health.
Creation of socialist system 3. was qualitatively new, highest stage of protection of public health which is clearly demonstrating advantages of a socialist system.
Continuous communication socialist 3. with social and economic life about-va follows from the nature of socialist relations of production, policy and ideology of a socialist system which for the first time in the history of mankind not only proclaimed, but also guaranteed full responsibility of the state for health of each person. «The socialist state — the only state which undertakes care of protection and continuous improvement of health of all population» (The program of the Communist Party of the Soviet Union).
In the conditions of socialism preservation of health stopped being only a personal record of the person, health turned into public property, is designed to preserve and strengthen a cut everything about-in and each citizen. Health protection in the conditions of socialism is socially necessary social requirement, unlike bourgeois about-va, a cut aims to confer material, social and moral responsibility for health protection on the person, considering health and its preservation as a personal record. Partial participation of the state in implementation of a number of social and recreational actions does not eliminate basic defects of capitalist system 3. Been result of class fight and interest of businessmen in preservation of hired labor, capitalist 3. does not solve problems public 3. according to the valid needs of the population, and only partially participates in defrayal on medical aid.
Being guided first of all by the humanistic principles in the solution of problems of health protection, socialist about-in at the same time sees in increase in potential of public health one of essential conditions of progress of economy which in turn provides the new, all extending possibilities of active purposeful implementation of complex measures for providing and improvement of level of health of the people. 3. in socialist about-ve — an integral part of the state system, the major component in the multidimensional social and economic mechanism about-va.
General line of development socialist 3. — preventive direction. Its gnoseological basis is the dialektiko-materialistic understanding of unity social and biological, an organism and the environment, an active role of the person and about-va in transformation of the nature for the benefit of health. In the conditions of socialist about-va prevention finds expression in the governmental social economic activities directed to implementation of measures for improvement of conditions of the environment, work, life and rest, and also broad medical actions. Prevention — a basis of activity of all to lay down. - professional, and a dignity. - epid, institutions, defining the direction in development of medical science, in system of preparation of medical shots.
Construction socialist 3. demanded implementation of the legal regulation guaranteeing the free, public qualified medical aid for each person, holding broad governmental activities on ensuring environmental control, a dignity. - a gigabyte. conditions of production, life etc. The right to health protection is guaranteed by the Constitution of the USSR. Legal sides of protection of public health found reflection in «Bases of the legislation of USSR and federal republics about health care» where functions of the state in the area 3 are regulated. (see. Legislation on health care ).
Ethical standards, the attitude towards health, relationship of the doctor and patient were changed radically. Each member about-va exempted from a burden of financial costs of medical aid, who obtained a guarantee of material security in case of a disease and disability gained ample opportunities to use the right for preservation and strengthening of the health granted to it by the state. The exempted from need to provide the existence at the expense of personal means of patients, the Soviet doctor, any medic considers the activity as performance of a civic and professional duty, being guided by the high humane principles of socialist morals.
Organizational structure socialist 3. opens ample opportunities of the most rational use of material and personnel resources, provides necessary integration and evidence-based specialization, allows to carry out purposeful reorganization of activity of network of medical institutions in connection with the new tasks rising before health care to liquidate completely characteristic for capitalist 3. individual medical practice. Along with financial difficulties of a contradiction between opportunities modern capitalist 3. and its organization are an insuperable barrier on the way of upgrading of medical aid.
One of determinal factors of modern development 3. — the scientific and technological revolution covering all spheres of social and economic life about-va. Sots. - a gigabyte. aspects of a scientific and technological revolution gain escalating value. Ecological shifts, urbanization, change of a demographic situation, rough process of reorganization of technology industrial and page - x. productions, use of new energy sources and the increasing use of chemical substances define need not only developments of multidimensional scientific and technical tasks, but also a wide range of problems a dignity. - a gigabyte. the plan, providing preservation and promotion of health of the population. Automation and an intensification of work impose new increased requirements to physical. and to mental health of all professional categories of modern production. In the USSR complex scientific research on development of measures of protection of the population from influence on health of negative factors of scientific and technical progress is conducted.
Ideologists and apologists of bourgeois science make many efforts to disprove Marxist regulations that exploitation of workers inherent in capitalism is a source of pathology for a wide people at large that the capitalist system is not able to resolve considerably the major social problems, including a problem of protection of public health. Reformists of various plan aim to prove, as in the conditions of capitalist system in the course of peaceful evolution of capitalism it is possible to make necessary progress in ensuring health of a wide people at large. They try to explain obvious insolvency in the solution of a number of problems with the «universal», «objective» laws of social development having above class character and, therefore, not connected with a capitalist system. The major methodological reception used by bourgeois theorists for the proof of the constructions is the attempt of the data of difficult laws of social development to biological patterns. One of the first such concepts was maltuzianstvo (see), to-rogo mechanical transferring of laws biol is the cornerstone, of development to the sphere of the public relations. Conceptually the political anthropology, social Darwinism, etc. are connected with a maltuzianstvo. Theoretical constructions of the psikhosomatikov-Freudians seeing the reasons of the diseases in the psychosomatic conflict considering a disease as lack of a will to health are more veiled (see. Freydizm ). The concept of a genetic determinism aims to prove fatal dependence of health of an individual on genetic factors. A number of bourgeois scientists, formulating concepts of a social, ethical and psychological stress, mechanically transfers patterns of stressful reaction to an explanation of the social phenomena. Some modern theories recognize also influence of social conditions on formation of nature of pathology, but, speaking about biosocial interaction, they give a priority biol, to factors, eclectically approach assessment various on character and the importance of social factors, do not recognize the dominating value of relations of production. Theoretical concepts of the similar plan among which the greatest distribution was gained by the theory of factors and the theory of a vicious circle are metaphysical on the ideological essence and reformist on a social orientation. Their main objective, being covered with the multifactorial analysis of the biosocial phenomena, to disprove the original position of Marxism about the defining influence of a social system on health and 3. and by that to relieve from capitalism responsibility for inhuman, antinational policy in the area 3.
In the conditions of the developed socialism constructed in our country about-va when socialism, developing already on own basis, more and more fully opens the creative opportunities, the deep humanistic essence, problems of protection and strengthening of health gain the escalating social importance. The constitution of the USSR (1977) creates opportunities to comprehensively govern the public relations in the field of public health care, to solve unprecedented on the scales and the importance of a task. The purposeful integrated activity of all links of multidimensional state mechanism, comprehensive use of all advantages of a socialist system, scientific and technical progress in interests of protection and strengthening of public health create conditions for transition to general medical examination of the population, implementation of national programs for fight with cardiovascular, onkol, and other diseases on a new material, scientific and organizational basis.
«At us free and probably the widest in the world — L. I. Brezhnev said, appearing on television of Germany on May 6, 1978 — medical care of the population. One third of all doctors working in the world — the Soviet doctors. But that with maximum efficiency to guarantee constitutional right of citizens on health protection, further heavy capital investments, social actions, scientific search are necessary».
- 1 HISTORY of HEALTH CARE
- 2 HEALTH CARE In the USSR.
- 2.1 Philosophy of the Soviet health care
- 2.2 Formation and development of the Soviet health care
- 2.3 Structure and functions of bodies and healthcare institutions
- 2.4 Sources of financing of health care. Economic efficiency of healthcare institutions
- 2.5 Health care workforce, their preparation and improvement
- 2.6 Treatment-and-prophylactic help
- 2.7 Health protection of women and children
- 2.8 The sanitary and epidemiologic service
- 2.9 System of sanitary education
- 2.10 Sanatorium help
- 2.11 Organization of the medicinal help
- 2.12 the Medical industry
- 2.13 International value of the Soviet health care
- 3 The HEALTH CARE IN FOREIGN COUNTRIES
- 4 The INTERNATIONAL COOPERATION in HEALTH CARE
- 5 Tables
- 6 Bibliography
HISTORY of HEALTH CARE
During all historical periods along with the actions providing preservation and promotion of health of ruling classes also measures for rendering medical aid to other segments of the population were carried out. However the government, religious and social and political in-you, being the tool of a ruling class, held events for public health care only in the limits limited to interest of a ruling class or as a result of the aggravation of an economic and political situation caused by revolutionary activity of masses. The sequence of expansion medical - a dignity is historically traced. the organization providing with medical aid first of all a ruling class, and also various layers and groups of the population — at first army, then government and further (depending on an era) merchants, handicraftsmen, the intellectuals, peasants, workers. Achievements of medical science promoted development of new effective forms of the organization to lay down. - prof. of the help, influenced the content of actions on 3. However impact of science and technology on a state 3. depended on opportunities of implementation of their achievements in practice which eventually were caused by degree of interest of the state in public health care. History 3. up to the 70th 20 century know many examples of discrepancy of a state 3. to the opportunities given by achievements of science and technology. It is characteristic that at any stabilization of a socio-political situation the exploiter classes «withdrew» the obligations in health protection of workers, reducing them to an extreme minimum. Though history 3. begins with creation of system of the state and public aid at treatment and especially prevention of diseases — in the period of the developed capitalism, its premises took place in the most ancient times of empirical doctoring.
Archaeological researches prove that along with assistance in case of accidents, wounds, childbirth measures for health protection of collectives were carried out. And special attention was paid to those members of the tribe, from physical. which forces depended success of hunting, economic activity and possibilities of fight against hostile tribes. Activity of medical character (maintenance of purity and an order to the dwelling, observance a gigabyte. rituals all members of the tribe, rendering to lay down. help, collecting medicinal plants, etc.) long time was in hands of women thanks to what the last kept the influence even in the conditions of the developed patriarchy, up to the period of decomposition of a primitive community. Further, in process of economic development, complication of forms of economic activity and class stratification of a community, emergence and development of religion, a gigabyte. rituals gradually gain character of sacraments in which only the elite is devoted. Their storage and development becomes a duty of elders of the childbirth which laid the foundation for a priestly caste in hands a cut and art of healing from diseases and extension of life concentrates. Priests were the first carriers of function 3., and temples — places of rendering medical aid.
Apparently, value 3. as one of effective tools of domestic policy it was realized early enough since with formation of the first states the state or religious legislative establishments a gigabyte are found. and protivoepid, governed, and also attempts of introduction of a regulation in to lay down. help. Treat them creation medical - a dignity. the organizations in army (e.g., in Ancient Egypt apprx. 3 millennium BC; in China — army regulations U-tszy, 4 — 5 centuries BC), carrying out measures for isolation of patients epid, diseases (e.g., in Assyria and Babylon — apprx. 1 thousand years BC; in Judea — 8 — 7 centuries BC), establishment of control of qualification of doctors and protection of their rights concerning practice, establishment of responsibility for illegal doctoring, medical errors and t. and. Already in the first ancient legislations class character of measures on 3 clearly is shown. So, in the laws of the Babylon tsar Hammurappi cut on a basalt column (18 century BC), articles (points) 218 — 223 directly belong to various measure of responsibility of doctors for unsuccessful treatment, production of operations depending on class accessory of patients, up to cutting off to the surgeon of a hand if the rich person, the representative of the highest caste, and only rather modest fine if the patient — the slave was a patient. The considerable attention is paid to questions of education of healthy generation, especially from the environment of exclusive classes. E.g., Lycurgus's laws (9 — 8 centuries BC) the system a gigabyte was installed. and physical. education of spartiat. Control of marriages was entered, healthy newborns intended for public education, weak-willed were destroyed. All system of public education was in hands of special officials — efor. On indigenous people of the valley of Lacedaemon (elot, etc.) the system of Spartan education did not extend.
Also the most rational had the expressed class character in the Ancient world the Roman system of the organization 3. In 499 control for a dignity. by improvement of the cities and quality of the foodstuff sold in the markets it is assigned to the special city officials who do not have medical educations — ethyls. Over time the number of ethyls in the cities increases; their specialization is carried out: ethyls on control of foodstuff, water supply, supervisors behind prostitution, etc. are emitted. Achievement of the Roman system 3. there was also a construction of hospitals that costs in a direct connection with the organization of medical aid in army. Doctors of legions gave only surgical help and had small infirmaries. The diseased went to a long term for treatment home. However with expansion of borders of the Roman state it became impossible, and in strategic points, and also boundary provinces military would be based — valetudinariya (see); a bit later in provinces would begin to be organized for numerous imperial officials and members of their families.
Policy of imperial Rome and continuous wars led to deterioration of the situation of a people at large, considerable accumulation among the civilian population of disabled. Danger of epidemics forced the government to take measures for the organization of medical assistance, including and urban poor. For involvement of doctors to Rome Julius Caesar granted the Roman citizenship to all studying medicine. Due to epidemic of plague (166 — 180) Marcus Aurelius for rendering medical aid to the poor ordered to city councils to contain at the expense of means of city treasury of so-called national doctors (archiateri populares). Except assistance to the poor, national doctors were obliged to take on training of pupils. Positions of national doctors after epidemic of plague remained and existed in the territory of the Roman Empire, and then Byzantium up to 8 — 9 centuries. Approximately at the end of 1 century AD would begin to be created for the poor whose financing was carried out by bodies of the municipal government. In a number of the cities private would begin to receive subsidies from the government, becoming in whole or in part public institutions. National doctors, apparently, rendered medical aid not only to the poor, but also the well-to-do of the population, earning for it extra fee in a private order. Eventually the private practice becomes the leader in their activity. Justinian in whose reign there was a pandemic of plague (531 — 580) in the Code reminds national doctors of their fundamental obligation «to help in all sincerity, giving preference to the poor before prosperous».
The Christian movement which arose in 1 century, adjoined Krom city plebs, colons and slaves, had to assume functions of the help to the disadvantaged and patients, especially to members of the Christian community. In fight against Christianity until it became the only state religion, the imperial government was forced to resort to charity. Starting with Antonin Pius (138 — 161), the number of BC and shelters for the poor increases, funds for improvement of the quarters inhabited by poor people are allocated.
In process of transformation of Christianity into the dominating religion and formations of the church organization the leveling principles lose the value in a community, and charity stops being its main function. The church quickly becomes stronger economically and within several centuries becomes the owner of huge land grounds. E.g., by the end of 7 century she owned in Gallia a third of all lands, and in 8 century the church landed property in the Franksky kingdom was so considerable that the dynasty of Carlovingians in the state and military purposes carried out alienation of its considerable part. Position of church as largest feudal lord generated opposition among ordinary Christians. The measure resisting to this opposition was the organization of monastic settlements. Monasteries during a number of centuries performed functions of treatment of the poor and contempt of poor. The numerous monastic orders formed in the Middle Ages (Franciscan, Benedictine, Dominican) allocated in the monasteries rooms for patients. Becoming gradually a component of official church, monasteries on a nek-swarm time reduce the volume of blagotvoritelsky activity, to-ruyu for the purpose of growth of popularity in masses undertake heretical sects (e.g., begina and begarda in Flanders, lollarda in England). However for the benefit of fight against heretics the official church is forced to expand the help to patients, again «orphaned and poor».
In an initial stage of the domination the church does not create any special to lay down. institutions. Only eventually the clergy began to turn ksenodokhiya (inns of the East) into shelters for patients, decrepit, widows and orphans. Funds for their contents formed from donations. In 370 g in connection with effects of hunger by the bishop Vasily Bazill's ksenodokhiya consisting of a large number of well-planned buildings in which beds for sick and decrepit were provided and care of them was based in Caesarea it was charged to doctors and attendants. A little later such hospital arise in Gallia: in 5 century in Lyon, in 651 g in Paris (reorganized from 18 century in «Hotel-Dieu»). So there was a medieval system of hospitals almshouses under the auspices of the church aiming to strengthen it the influence on a people at large.
As at the time of the Middle Ages (up to the end of 16 century) there was no centralized government, function of the organization 3. did not belong to the state in general, and it was carried out by certain feudal lords and bodies of city self-government. During this period special development is gained by court medicine at kings, fathers, sovereign princes and system of «family doctors» of grandees and the nobility. The duty of these doctors consisted in supervision of food, improvement of dwellings, the prevention and treatment of diseases. Since 9 century feudal lords involve doctors, hl. obr. surgeons, for the teams. This tendency gained special development during an era of crusades.
Due to growth of the cities, since 12 century of function 3. begin to enter a sphere of bodies of city self-government. In the cities, along with shelters on a case of a disease for the poor, would be under construction for all citizens. Thus in rudiments civil 3. temporal powers as well as church, combined the help to patients with function of public contempt. Funds for these actions were created at the expense of contributions of citizens, the volume of the help corresponded to the size of contributions.
For the management of hospitals doctors were called, control of them was exercised of magistrates which of structure the special persons (usually two) controlling were excreted to lay down. and economic activity of hospitals, including (sometimes considerable) hospital subsidiary farms (mills, slaughters, bakeries, etc.). Participation of temporal powers in management of hospital business and attraction to the direct guide of doctors would be a step forward in the organization to lay down. help.
In 13 century in connection with a drift of a leprosy to Germany began to be created-tsy there. The first German hospital (St. Joachim's infirmary in Leipzig, Bartolomeevsky hospital in Dresden) would not be in modern understanding of this word since not treatment, but isolation of patients was their task. In process of decrease in Europe in incidence of a leprosy they turned into almshouses and orphanages. However the idea of isolation of the patient well affected development of actions for fight against epidemics, for a cut, in addition to the structure of hospitals, the city authorities took such measures as dispatch for city boundaries of patients with nek-ry infectious diseases, prohibition by the patient and to their relatives to trade in foodstuff, etc.
In 12 — 13 centuries certain governors publish the nation-wide establishments directed to a regulation of medical practice and improvement a dignity. conditions of the country. E.g., according to an edikt of the king Roger Sitsiliysky (1140) independent medical practice in the territory of the kingdom were allowed only after the state testing in special board. Frederick II Gogenshtaufen (1224) enters in the territory of the Sacred Roman Empire the state tests for surgeons, druggists and midwifes and, besides, for doctors an obligatory year training at the famous experienced doctor. Medical edikta of Frederick II concerned also control of quality of pharmaceuticals, rules of cleaning of the cities, the device of cemeteries; they entered prohibition to contaminate the rivers, a conclusion for city boundaries of some productions contaminating the territory and free air, etc. was ordered. However Frederick II's edikta in which many researchers see influence of the Salerno school did not result in a little essential result and in the majority of the cities of medieval Europe simply were not carried out.
Only after the devastating pandemic of the plague which carried away in Europe apprx. 25 million lives in 14 century some shifts in the field of the organization 3 were outlined. Special attention to holding actions on 3. during this period it was given in the Italian cities where the trade capital reached high development and interests of international trade demanded the fastest termination of epidemics. In 1348 in Venice the special body combining a dignity is created. - police functions with the management to lay down. business — Sanitary council (Proveditori di sanita); further similar councils are created in other Italian cities subject to Venice. In 1370 — 1374 in Venice and Milan the system of quarantine actions providing isolation of patients, and also the persons arriving from «suspicious» areas is entered. Quarantines were followed by full destruction fire of all things belonging to infected. Thanks to these measures plague in the 20th 15 century had no for Venice of serious consequences.
Venetian system protivoepid. measures and organization 3. had significant effect on development a dignity. legislations in other cities of Europe. In 1385 in Nuremberg it was forbidden to lower sewage to the rivers, to soak in the rivers of skin and to wash clothes. In 1388 in England it was forbidden to contaminate the rivers and ponds garbage and sewage. By the end of 14 century practically in all cities of Western Europe the system of plague quarantines is accepted. In 1426 the German
emperor Sigismund II founded in all imperial cities a position of the city doctor — the shtadt-physicist who contained at the expense of means of city treasury. Holding actions for fight against epidemics, the management-tsami, control of activity of the practicing doctors, druggists, midwifes, fight against sorcerers and court belonged to duties of city doctors. - medical functions. However the cities long time did not carry out the imperial decree and only after confirmation by its diet in 1512 positions of shtadt-physicists began to be entered everywhere, than the foundation of medical police was laid.
Thirty years' war (1618 — 1648) led to economic decline of the German states which population a part died, was ruined by a part. Recovery of the country demanded carrying out a number of the economic and political reforms directed to growth of agriculture, trade, improvement of the population, etc. In 1685 the Brandenburg Elector Friedrich Wilhelm creates the center of medical management — Medical board (Collegium medicum), overseeing by activity of all medical personnel, reception of examinations on the right of independent practice at doctors and druggists, control of sale of medicines belonged to duties a cut. In 1719 for the management and the organization of fight against epidemics the special body — Sanitary board (Collegium sanitatis) is created, Appropriate authorities were created in local instances, each provincial council was given the doctor — landes physics. In 1794 both boards were united in one ober-board, and on places provincial Medical and sanitary boards (Provincial-Collegium medicum et sanitatis) were created. This so-called Prussian system 3. became a sample for other German states. Some small German states of a duty of landes physics were combined with duties of the physician-in-ordinary of this or that duke or sovereign prince.
At the end of 17 century the leading economic situation in Europe was reached by England where bourgeois revolution promoted bystry development of technology and the industry. The bourgeoisie in a new way approached a problem of improvement of the state. Not only carrying out already known a dignity was reaction to the heavy epidemics of the 70th of 17 century caused by long civil war and economic ruin. - protivoepid. died, but also attempt to estimate value 3. for economic activity of the state. For this purpose the first begin to be carried out a dignity. - demographic researches [W. Petty, 1662; Gallium (E. Hailey), 1697, etc.] in which attempts to subject to the analysis become and to determine consistent patterns of the movement of the population, causes of death, influence of diseases on productive activity of the population. At the beginning of 18 century progressive English doctors act with the new principles 3., which provided studying of natural and household factors by accumulation of the facts and their systematic obligatory registration, ensuring sufficient number of medical personnel and organized environmental impact. These principles were implemented in systems of medical providing English army and first of all navy in what the undoubted merit belongs to J. Pringl and J. Lindout. Reforms concerning the civilian population concerned hl. obr. dignity. improvements of the cities, inflow of the population to which in connection with development of industrial production was exclusively big. Institutions were at the same time created state protivoepid.
Development of capitalism involved rapid growth of working class. Poverty and diseases followed industrial revolution within many decades. Lengthening of the working day, severe living and material conditions, operation of female and child labor affected in the most adverse way the state of health of working class. In process of development of capitalism and emergence of large-scale industry concentration of working class and its organization grew. Separate spontaneous speeches of workers against severe conditions of work and life gradually went to a bed of organized labor movement, under pressure to-rogo the government of the capitalist countries and the top of the industrial and financial bourgeoisie was forced to make concessions, including and in the area 3. However 3. during this period it was directed generally to care about health of the bourgeoisie and the intellectuals which left preferential bourgeois layers.
First reform of the organization 3., entering it into the general system of public administration, it was carried out in France. In 1822 at min.-ve internal affairs the highest dignity was created. council. In total medical - police officers and a dignity. - protivoepid, functions were assigned to the state administrative facilities: at prefects were created departmental a dignity. the commissions, at subprefects — district, at mayors — cantonal. The forms of the organization 3 created further in other countries of Europe. generally repeated structure of the French. Almost in all European states the leadership in the case 3. concentrated under the authority of special department or department of min.-va internal affairs, to-rogo the official appointed by the government, and in some countries — not having medical educations was at the head. In the majority of the countries at the central operating controls 3. the collegial advisory body was created, scientists-physicians, practical doctors, and also representatives boundary with 3 were a part to-rogo. areas. In provinces (areas) the management 3. entered competence of bodies of internal management and it was usually presented by collegial body (council), the consisting hl. obr. from the doctors who were in public service. In the cities (communities) the commissions on health protection which consisted of representatives of a prosperous part of the population and worked iod with the guide of the communal doctor were created. It is characteristic that the state management concerned only measures on a dignity. to improvement, control for a dignity. condition of territories, protivoepid. works, but did not raise the questions at all to lay down. help. Having reached thanks to accumulation of the capitals of high living standards, the bourgeoisie was able to resolve an issue about a dignity. improvement of the dwelling, food, rendering to lay down. the help by rather qualified private medical practitioner. Only what it was impossible to solve individually — a question of protection against epidemics. And in this question the bourgeoisie called to the aid the state, «one fear of infectious diseases — K. Marx wrote —... caused not less than 10 sanitarnopolitseysky parliamentary acts, and the frightened bourgeoisie of some cities as Liverpool, Glasgow etc., used for protection the municipalities» (K. Marx and F. Engels, SOBR. soch., prod. the 2nd, t. 23, page 672). In the 40th 19 century under the influence of the chartistsky movement the English government created the special commission for studying a dignity. conditions of densely inhabited cities, a dignity. effects of pollution of sources of water supply, free air and soil, reasons of high mortality of industrial workers. As a result of work of the commission in 1848 «The bill of elimination of sanitary vrednost and the prevention of diseases», according to Krom in densely inhabited areas was adopted if mortality exceeded 23 for 1000 zhit., the local medical management was established upon the demand of Vio of payers of direct taxes. The same year in England the Main department of public health (General Board of Health) was organized; his inspectors on places used big powers, up to the right of increase in taxes. However in practice all these innovations had the expressed class character. Dignity. the legislation did not provide improvement of service living conditions. The bourgeoisie willingly used carried out by the state due to the general tax taxation a dignity. - protivoepid. actions, without undertaking any obligations to medical aid by the worker, fight against child mortality, care about health of children of workers, etc. The bourgeoisie did not wish to suffer any expenses from the income, any coercion from the state. The help to the diseased — business of private charity and church. So, in the first half of 19 century on a new social basis charity of church is revived and in parallel with it there is a significant amount of private charitable institutions and funds (so-called philanthropic 3.), which, naturally, could not even provide partially necessary to lay down. the help of those who are not able to pay the fees to private medical practitioners.
Along with it skilled workers, trade employees and partly petty bourgeoisie for providing to themselves medical aid resort in case of a disease to voluntary mutual assistance at the expense of the means received from systematic contributions (insurance of health). So, in the first half of 19 century are widely adopted in France of «Society of a mutually relief aid», in England — «friendly societies» and «working clubs», in Germany — «free auxiliary cash desks», etc. Revolution of 1848 in Germany allowed to strengthen these organizations. In 1849 the law was issued, according to Krom local governments acquired the right to assess with contributions to «free auxiliary cash desks» as well businessmen. In the 60th 19 century English trade unions began to give to the members grants in case of a disease.
The economic crisis which broke out in 1873 — 1874 and the related deterioration of the situation of working class and growth of the strike and strike movement forced the governments of a number of the countries to make some concessions in the field of health protection of workers. E.g., in England the law about public health» is issued «(1875), are established a dignity. councils in the cities, city and rural communities, and also are published laws on working dwellings, to-rymi measures for improvement of working quarters and a nek-swarm improvement of service living conditions are provided. In many countries of Europe bodies 3 are established., are entered a dignity. codes (in 1871 — in Germany, in 1876 — in Austria, in 1877 — in Hungary, in 1879 — in Sweden) which, in addition to measures of a quarantine and protecting order, establish a number of the norms concerning production and storage of foodstuff, utility sanitation (housing construction, a design of the cities, their cleaning, water supply), rules of isolation and hospitalization of patients with infectious diseases, etc. It is a dignity. the direction was in many respects stimulated also with the fact that a reorganization of the cities and their dignity. - those. the equipment caused development of the corresponding productions which became a place of application of the large capital. Thus, threat of life and to health of the bourgeoisie on the one hand, growth of labor movement — with another, both interests and requirements of capitalist production — with the third brought to life sanitary legislation (see). Introduction to practice (though partially) led it to decrease and elimination of a number of acute infectious diseases.
The first attempts of the organization interstate (regional) and international a dignity also belong to the middle of 19 century. - protivoepid, died (see below — the international cooperation in health care).
Within 19 century the science was enriched with new data on microbiology, physiology and hygiene which defined ways of improvement of the environment. On the other hand, by K. Marx and F. Engels's works it was established that influence of the environment is in many respects mediated by the social environment, a form of the public relations, development of productive forces about-va. Thereby the role of change of social conditions in development 3 was shown., and the working class was hit in the hands the evidence-based program of fight, including and in the area 3. The laws on social insurance in Germany (1883, 1890) and some other countries of Europe providing along with contributions of workers to these purposes, contributions of the state and businessmen were result of fight of working class. However all these measures had vague character, means of social insurance were insignificant, and grants are lower than a living wage. Thus, in general, despite existence of the state measures and creation of services 3., questions of health protection of workers and rendering the qualified medical aid to them in 19 century did not get permission. The hospital help in municipal, private and charitable would appear for a payment, the extra hospital help almost completely was in hands of private medical practitioners. Free medical aid was provided only by some charitable organizations or doctors of local governments only to the faces having the certificate of poverty, i.e. which simply fell into a beggary. Insurance (sick-lists) cash desks partially refunded expenses only on stationary medical aid.
As V. I. Lenin showed, the end 19 — the beginning of 20 century is marked by approach of the highest and last phase of development of capitalism — an imperialism, an aggravation of a general crisis of capitalism, a sharp aggravation of class fight and activation of the trade-union movement. As a result of fight of workers for the social rights the bourgeois governments are forced to go for expansion of measures on 3. In a number of the countries of Europe under pressure of labor movement the laws expanding participation of the state in questions of social insurance are adopted. E.g., in England in 1911 the law on the state insurance on a case of a disease, an old age and unemployment with participation in contributions of the state treasury, businessmen and workers is adopted. Considerably activity of the state in the field of precautionary actions increased. It was promoted first of all by that circumstance that at implementation of a number of large technical and construction undertakings great economic value a dignity was found. actions. Brisk commercial relations caused the necessity of fight against a drift epid, diseases and development a dignity. - quarantine measures of the international character. Besides, actions on 3. gain political value, promoting expansion of influence of this or that country and penetration of its capital into economically poorly developed countries. Such aim was pursued, e.g., by the Rock Feller commission which was actively creating since 1914 in China-tsy, medical colleges and high fur boots.
Great October socialist revolution, creation by the young Soviet republic of the state system 3., the original prevention based on the principles, free and public medical aid, exerted huge impact on development 3. The workers of weight exsanguinated by World War I and the hardest working conditions and life and inspired with an example of the Soviet Russia were stirred to action for the rights. The capitalist states were forced to make big concessions. From 1918 to 1922 in many countries were created min.-va health care or the departments corresponding to them. In a number of the countries the acts concerning labor protection, housing construction, protection of motherhood and the childhood, fight against social diseases, social insurance were adopted. To some countries, the most affected by war, funds an amer were allocated. Red Cross and Rock Feller commission. However as the bourgeoisie strengthened the government its social policy changed. The economic crisis of 1929 — 1933 marked new approach of capitalism to the rights of workers. It was expressed in reduction of allocations on 3. and social insurance funds, the termination of construction to lay down. institutions, sharp reduction of housing construction etc. In Poland, e.g., Min-va expenses of work and social help in 1936 — 1937 were reduced in comparison with 1930 — 1931 almost by 2,5 times, contributions of businessmen to social insurance funds in 1934 made 63% of assignments of 1928. In Czechoslovakia in 1933 insurance grants were lowered by the worker almost by 25%, conditions of receiving old-age pensions worsened. In France in 1934 the budget 3. it was cut down in comparison with 1933 for 30%. Similar measures were taken in other capitalist countries.
World War II was heartrending experience for 3. many countries. In occupied territories Hitlerites pursued policy of mass destruction of the population. The occupied countries of Europe suffered huge material losses, the considerable number of medical institutions was destroyed, a large number of people died. At the same time World War II imposed new requirements to the organization 3. In particular, in England public authorities 3. were forced to organize medical service MPVO and service of emergency medical service. Requirements of wartime, organized fight of workers for the rights, forced many capitalist countries to take measures for expansion of medical aid to the population.
In a number of the countries [[ [GREAT BRITAIN | Great Britain ]] (see), some Latin American countries] are carried out attempts of creation of public services 3. — reorganization of management 3. within bourgeois reforms.
Important event in the history 3. the post-war period progress of the national liberation movement in the colonial and dependent countries, formation of the new states in Africa and on other continents which governments among social and economic and political measures take steps for the organization of public, public services 3 was.
The major historical event was formation of the states of national democracy which then formed the commonwealth of the socialist countries which marked development of new socialist system 3. About further development 3. in capitalist, socialist and developing countries see below the section «Health Care in Foreign Countries», and also in articles about the certain countries.
History of health care in Russia
Elements 3. at ancient Slavs arose during an era of early feudalism (9 — 12 centuries). With emergence of the Kiev state and the subsequent distribution of Christianity (10 century) events on 3 begin to be held. In ancient Russian chronicles, napr, in «The story of temporary years» (the head is 12 century old), there is a description of sanitary cleaning of the inhabited places and the battlefield, burials of the dead during epidemics and fallen in battles. Monasteries with all functions of early Christianity inherent in them — treatment and contempt of widows, orphans, old men and beggars are put. A special role was played in this case by the Kyiv Pechersk monastery, the first brotherhood to-rogo arrived from the Athos monastery, gained wide popularity art of treatment. Unlike Western Europe, the Kiev state did not stand away from church charity. The charter of the Grand duke Vladimir (996) assigned care of widows, orphans, old men and patients to church, and also transferred to their jurisdiction baths,-tsy and doctors. According to the church charter of that time doctors were free people to whom civil laws and jurisdiction of temporal powers did not extend. «The Russian truth» of Yaroslav the Wise (1096) even more consolidates influence of church in the area 3.: the church is entrusted with the construction of baths and BC, gratuitous rendering medical aid, and also function of public contempt. Financial security of this activity is solved by introduction of a special tax — tithe in favor of the poor, orphans and patients. Thus, the system of the organization 3 which developed in 10 — 11 centuries in Kievan Rus'., though on the carried-out functions (treatment and contempt) it is also close to «church», monastic medicine of Western Europe, but nevertheless significantly differs in the fact that activity of the Russian church in the area 3. it was legally and financially provided with the state. The church which early became in Russia an essential element of government in the activity in the area 3. and public contempt actually was state in-volume or at least the spokesman of domestic policy of the state.
Medical aid at churches and monasteries appeared «mean Luda», princes, their team and feudal lords used services of the secular doctors arriving from abroad. Thus, in Russia, as well as in Western Europe, the court and «house» medicine was created.
In 11 — 12 centuries undoubted success in the field of hospital construction and a dignity was achieved. improvements of the cities. It is confirmed by archaeological data of ancient Novgorod, Pskov and other cities, finds of water pipes, pavements, baths and other constructions telling a dignity about the level, high for the time. - a gigabyte. skills. However the period of feudal civil strifes which came since the end of 12 century and the Tatar-Mongolian yoke which followed it suspended development 3. Only in process of elimination of feudal dissociation, formation of the centralized Moscow state and overthrow of the Tatar-Mongolian yoke shifts were outlined in area 3.
Already at Ivan III measures for fight against epidemics are established. Interests of development of trade force Ivan IV to take measures for improvement of the trade cities and to expand fight against epidemics. Isolation of the «infected» territory, frontier posts during epidemics were peculiar quarantine measures during this period, will lock to bury the dead from infectious diseases within the city, etc. The first steps of medical providing army are taken: «on a lechba», depending on weight of wound, the grant in the amount of 1 to 5 rubles was paid to wounded, and medical aid was the freely practicing handicraftsmen-lechtsami accompanying the Moscow host in campaigns. Aiming to strengthen the autocratic power and to undermine positions of church, Ivan IV does attempts to strengthen participation of the state in questions 3., to attract on service of doctors foreigners. On the Stoglavy cathedral (1551) it rejects the aspiration of church to hold business of treatment and contempt in the hands, stating intention to open state-tsy. In 1581 in Moscow the first court opened drugstore (see), played an important role in the subsequent development of pharmaceutical matter in the country. Almost the Pharmaceutical chamber — the special facility knowing court medical affairs is at the same time established, a cut soon turned in Pharmaceutical order (see) — first operating controls medical matter in the state. In materials of the Pharmaceutical order of the first quarter of 17 century there are instructions concerning care of wounded, to actions in the field of contempt, etc. In 1654 at the Pharmaceutical order the doctor school with the five-year term of training was created. The doctors called from abroad went into the disposal of the Pharmaceutical order only after trial test in the Ambassadorial order. Also drugstores were subordinated to the ambassadorial order, it is obvious because medicines were mainly delivered from abroad. Thus, within 16 — 17 centuries in Russia there were three centers knowing questions 3.: Pharmaceutical, Ambassadorial orders and church.
In the second half of 17 century protivoepid. events begin to be held in the state scale. In 1665 in connection with epidemic of plague in London trade with England was temporarily prohibited. Rigid quarantine actions were carried out: the Arkhangelsk harbor is closed for trade, decrees are given to the Arkhangelsk and Novgorod voivodes about strict examination of all coming foreigners. In 1670 the decree of the tsar Alexey Mikhaylovich to the Pharmaceutical order imputes a duty fight against spread of «catching diseases».
In 1682 for the first time construction of almshouse and on the Granite yard in Moscow would be entrusted not to church, but the Pharmaceutical order. According to the decree of the tsar Fedor Alekseevich the almshouse intended for «poor and retired soldiers who, being spoiled on service imperial, could not impregnate already themselves», and-tsa — for treatment of the poor. In it «truly poor» free treatment and food was provided. Serfs and domestics could not use state contents in this connection it was offered to Pharmaceutical order to draft the provision on an order of reception of patients with a payment for treatment and food. The B - tsu was also supposed to be used as base for practice and improvement of young doctors. B-tsa and almshouse were under authority of the Pharmaceutical order, but were financed by church. The order of administrative subordination to lay down. institutions to state bodies with their financing at the expense of the taxes collected from church grounds practiced in Russia up to 19 century. Apparently, such convenient form of withdrawal of church means in favor of the state treasury was connected as with a lack of public funds for the maintenance of BC, shelters and almshouses, and with the aspiration of the state to limit influence of church by reduction of its income and participation in the management 3. and public contempt.
Reformatory activity of Peter I in many respects promoted development 3. in Russia. Intense wars for mastering outlets to the sea demanded not only economic reforms, radical reorganization of army and public administration, but also measures for public health care, especially soldiers and sailors. At Peter I the system medical - a dignity was created. providing army (see. Meditsina military ), the number of doctors considerably increased, to lay down. and pharmaceutical institutions, the numerous acts concerning protivoepid, actions, the organization medical - a dignity are issued. affairs, regulations of medical practice, etc. Military hospital in Moscow, St. Petersburg and other cities and civil-tsy are organized (see. Hospital , Main clinical military hospital ). Creation of the first hospital school (1707) laid the foundation for preparation of domestic medical shots (see. Hospital schools , Medical education ). Introduction (1712) quarterly reporting of the churches on quantity which were born and died and a new form of the accounting of the population — a subear census, laid the foundation sanitary statistics (see).
The aspiration, characteristic of Petrovsky reforms, to centralization and concentration of management of any industry in hands of one department was shown also in reorganization medical - a dignity. affairs. Even a military-medical part submitted not to Military board, but the Pharmaceutical order. In 1707 the Office of the Main drugstore is created, in a cut all questions of management medical - a dignity gradually concentrate. business, and in particular transfers from the Ambassadorial order functions of management of drugstores. For management of all medical affairs the position is entered archiater (see), in to-ruyu Peter I's physician-in-ordinary Scot Ereskin (P. Areskine) was built. Process of centralization of management of all medical part of the state comes to the end with the organization medical office (see), the first head the cut was I. L. Blyumentrost.
As important undertakings of medical office it is necessary to recognize researches of mineral sources, measures for expansion of network of medical institutions, hl. obr. drugstores, the organization of studying of domestic medicinal plants for the purpose of restriction of import of medicines from abroad. Since 1701 opening of private («manumissions») drugstores in Moscow, and then and in other provincial cities was authorized. The regulations of 1721 obliged magistrates to build-tsy and almshouses, however the lack of means, and, above all medical personnel did not allow to carry out these instructions. For fight against sorcery and illegal doctoring the medical office drafted the decree, according to Krom medical practice without obtaining the certificate from medical office was not allowed any doctor or the doctor. However this measure could be executed only in the cities. The peasantry, was not taken for ensuring the medical help to Krom any measures, could use only services of the local sorcerers and «vagrant Aesculapians» who appeared at that time in Russia in a large number.
Concentration of management of all medical - a dignity. matter in hands of uniform governmental body did not exclude financing of medical institutions at the expense of means of church. «Moscow gofshpital» with hospital school at it was under construction (1706 — 1707) by means of the Monastic order and further long time it was financed by the Synod that considerably complicated work of medical office, on to-ruyu the leaders of all hospitals and drugstores of the state were assigned.
With development of industrial production there is a need for medical aid at the plants, especially state. Since 1717 when on construction of Izhora plant for workers log huts for grieving», doctor service, hospital were created «and infirmaries begin to be created at a number of the state and private industrial enterprises (e.g., under the decree of 1724 it was recommended to have at the plants the doctor with medicines). Patients contained in such hospitals at the expense of a deduction of 1% of earnings of workers, and also at the expense of the penal sums and donations.
At the closest successors of Peter I and within only 18 century activity of the state in the area 3. it was sent to hl. obr. on fight against epidemics, expansion of network of medical institutions in the cities and growth of number of medical shots. «General regulations about hospitals» in 1735 hl. to doctors of hospitals it was imputed a duty «to be engaged in manual» young people in medicochirurgical schools (see); the doctors who served term in military department were recommended to be defined on city service. For the organization of medical matter in the capitals positions of the shtats-physicists subordinated to medical office were established. Reception of examinations on the right of medical practice, definition of doctors for public service, overseeing by activity of drugstores, fight against sorcery and illegal doctoring, survey of disabled people, court belonged to their duties. - medical functions, etc. The decree of 1737 to magistrates of 56 cities, and first of all adjacent to the capitals, it was recommended to support policemen of doctors with the duties close to duties of capital shtats-physicists. However in 1756 from 56 positions of policemen of doctors only 26 were replaced. The medical office undertook vigorous measures for expansion of preparation of medical shots. Especially it was in this respect made an archiater of Item 3 much. Kondoidi who undertook reforms of medical education, paying, in particular, much attention to preparation of enough midwives. Opening at the initiative of M. V. Lomonosov in 1755 was the most important action for creation of domestic medical shots. Moscow un-that and medical f-that at it (1764). The progressive materialistic ideas of M. V. Lomonosov exerted huge impact on formation of views of such figures of medicine as H. M. Ambodik-Maksimovich, S. G. Zybelin, I. E. Dyadkovsky, E. O. Mukhin, D. S. Samoylovich, etc., been ancestors of original domestic schools of sciences also is a lot of Russian doctors and development of medical aid who made for preparation in Russia. In 1765 at the initiative of progressive scientists Free economic society was created. Being guided by the purpose «to extend in the state useful to agriculture and the industry of the data», this society from the first days of existence paid much attention to promotion a gigabyte. knowledge and smallpox vaccination, and since the 30th 19 century — fight against child mortality. Assistance to protection of national health was one of tasks fiziko-medical about-va in Moscow and Vilensky medical about-va.
In 1763 the medical office was transformed in Medical board (see) headed by the president from among court dignitaries. The board was divided into two departments from which one managed affairs scientific, and the second — administrative and financial and economic. Fight against ongoing epidemics was the main care of medical board. Epidemics of plague, smallpox, a sapropyra, cholera and other diseases were very frequent phenomenon at the end of 18 and the beginning of 19 century. Among measures of fight against them notices on patients, isolation, early burial of the dead, disinfection, quarantine measures, etc. were used at this time. At the end of 18 century in Russia provincial committees for carrying out smallpox vaccination among the population began to be created that was an essential measure for restriction of developing of this heavy infection. The system of quarantine actions for the prevention of a drift of plague from neighboring countries extended. On the southern borders of the country by the beginning of 19 century there were 27 overland quarantines, 11 seaside, 27 quarantine overland and sea outposts. The senatorial decree of 1763 policemen to doctors and doctors were allowed to attract to fight against the venereal diseases which extended in the second half of 18 century if necessary additional personnel, it was recommended not to ask at patients, «what rank and a surname», but to find out a source of a disease. In St. Petersburg in 1783 the "confidential" hospital was open for patients with venereal diseases on 30 men's and 30 female beds.
In 1775 for strengthening of administration on places in all provinces are entered orders of public contempt (see) as a part of the governor and representatives from estates. For implementation of the tasks assigned to them to each order about 15 000 rub are released. All network of charitable and medical institutions was transferred to the jurisdiction of orders, the duty to build new medical institutions, orphan houses and so forth was ordered them. In-tsakh orders «any rank poor and poor» contained free of charge, «other and domonical attendants» were allowed to be placed only in the presence of empty seats and for a payment. Besides, it was free of charge allowed to accept in St. Petersburg-tsakh mandative attendants, their wives and children, soldiers and sailors> of peasants of state department and the released eternally former serfs, and also the merchants and petty bourgeoises of the St. Petersburg province granting a certain sum on the Order of public contempt. Officials, merchants and petty bourgeoises of other provinces, and also landowner peasants and attendants would have to bring a payment for stay in. Thus, «the mandative medicine» was intended to hl. obr. for service of high-ranking and trade layers of the city.
Along with orders positions of district doctors were founded, and since 1797 medical justices in the provincial cities are created (see. Medical justice ), and then district medical justices — a local operating controls medical business. Thus, decentralization and spraying of management 3 began again. between various departments. However nevertheless in 18 century there were considerable changes in business of providing the population of the country with medical aid. It is enough to tell that if at the beginning of 18 century in Russia there were only 150 doctors, then in 1802 1519 doctors, including in army — 422, in the fleet — 218 were only in public service (without private medical practitioners), in medical justices, quarantines and hospitals — 879.
In 1803. The medical board was abolished; instead of it the medical department at first as a part of min.-va police, and since 1829 — as a part of min.-va internal affairs will be organized. Under the provision of 1836 the department consisted of three departments, its functions came down to governmental medical and a dignity. to the control which turned practically into bureaucratic guardianship. At medical department medical council as body consultative scientific medical consisted. Functions of providing to lay down. were assigned by the help of various segments of the population to the relevant departments, and coordination of activities of these departments for questions 3. completely was absent. In the conditions of an extreme lack of medical shots and to lay down. institutions such decentralization of the management 3. adversely affected a condition of medical aid in the country.
With cancellation of serfdom and introduction of «The provision on territorial institutions» (1864) medical aid to country people in 34 provinces appears only within territorial medicine (see), essentially the first in the history of Russia special medical - a dignity. the organization intended for rendering medical aid to the peasantry. Undoubted achievement of territorial medicine was creation of extra hospital (preferential medical assistant's) help to country people in territorial provinces, introduction of free medical aid to peasants in a number of zemstvoes, expansion of network of stationary institutions, the organization of territorial clinics and the known approach of stationary and medical assistance to country people. Figures of territorial medicine within the limited opportunities which were available at their order saw off protivoepid, actions, organized fight with epid, diseases. The territorial medicine possesses a merit of the organization territorial a dignity. bureau, carrying out deep dignity. - statistical researches, and also development and deployment of the principle of an uchastkovost which was apprehended and developed on essentially new bases Soviet 3. However limited material, legal and personnel resources, dependence on the management of zemstvoes of which the hl were at the head. obr. representatives of the nobility, deprived territorial medicine of an opportunity to resolve such questions at issue 3., as the organization public to lay down. - professional, the help to country people, the organization of obstetric aid and medical service of the children's population, a dignity. improvement of rural settlements, etc.
Due to the country which flashed in the central Promyshlenny district epidemic of cholera in 1865, and also under the influence of the growing strike movement the government published in 1866 the order about opening by businessmen of BC on z-dakh and f-kakh (see. Factory medicine ) also adopted (1882) a number of the laws concerning labor protection of women.
In the 80th in connection with transformation of city self-government the urban medicine gained development. According to «The policeman to situation» (1892) in maintaining bodies of public city self-government in the area 3. construction entered to lay down. institutions and management of them, «development of means of medical assistance», organization and carrying out protivoepid, actions and dignity. improvement of the cities. The City Council was granted the right to publish a dignity. resolutions on measures against damage of water, about the termination and the prevention of infectious and general diseases, about a dignity. the conditions which are subject to observance in rooms for sale of edibles and drinks about the device and an order of contents in a dignity. relation of factory and craft institutions, etc. However a certain responsibility for non-execution of these resolutions was not established by the law; besides, the right to publish a dignity. resolutions it was very limited to the general legal status of the bodies of city self-government which are very constrained in the activity by constant administrative intervention of the police authorities. Structure city medical - a dignity. the organization which began to develop only at the beginning of the 900th it was very various. Usually it was headed by one of members of town council; in many cities at a justice functioned medical - a dignity. council as advisory body, in large — also medical councils. In 39 cities were available a dignity. or dignity. - statistical bureaus. D. N. Zhbankov (1915) who generalized a condition of urban medicine in 1912 — 1914 in 224 cities reported that in 79 of the inspected cities self-government institutions did not start the organization of medical aid, in 77 cities there were no city doctors for rendering even to lay down. the help, in 107 — independent out-patient clinics, in 53 — only the ambulatory care was given. Only in 117 cities there were independent out-patient clinics which are engaged in reception sick 1,5 — 3 hours a day. In 124 cities there were no infectious barracks and special departments for infectious patients, in 160 — obstetrical institutions. For rendering a stationary and ambulatory care in the majority of the cities the payment was raised. Besides, for defrayal on medical aid (1890) so-called sick-list the collecting raised generally from lower-income strata were established. The persons who paid hospital collecting used free hospitalization only in case of an infectious or venereal disease.
Growth of commercial relations with Western Europe forced the government to pay attention to a dignity. a condition of the country since Russia with its high level of incidence of infectious diseases was a dangerous neighbor, and constant epidemics caused significant damage to foreign trade. On Russia which took place in Rome with participation international a dignity. conferences (1885) questions about a dignity were raised. notifications in case of epidemics, about obligatory holding by the State Parties a conference of measures for fight against cholera and yellow fever. N. V. Ekk's report — the representative of Russia at the Roman conference in medical council, and also notes of Italy and the Netherlands concerning the obligations for implementation of decisions of a conference undertaken by Russia forced the government to appoint in 1886 the special commission under the chairmanship of S. P. Botkin for research of measures «to universal improvement of Russia». The offers and projects developed by this commission including question of creation of independent central body for management 3., were not realized. Ideologists of territorial medicine, opposing these offers, specified that the low cultural level and economic backwardness of Russia — the main reasons unsuccessful a dignity. conditions of the country, and it will not be possible to eliminate them with creation of new bureaucratic establishment.
During the period after creation of a zemstvo, in the second half 19 and the beginning of 20 centuries, along with development of medical science, differentiation of medical disciplines, creation of medical science foundations (see. Medical societies ), especially active role was played by the All-Russian society of doctors in N. I. Pirogov's memory (see. Pirogovsky congresses ), a cut was headed and went the famous territorial physicians, figures of public medicine and hygiene F. F. Erisman, N. V. Sklifosovsky, E. A. Osipov, S. S. Korsakov, A. Ya. Kozhevnikov, etc. Congresses of Pirogovsky society and provincial congresses of territorial doctors at which topical issues of the organization of medical aid, a dignity were discussed were of great importance. conditions of the population. Starting with the first international a dignity. conventions, representatives of Russia took active part and in the international medical congresses (see) and the commissions, in creation of the International bureau of public hygiene (see. International medical organizations ).
Growth of the strike movement and peasants' revolts in the 900th and especially revolution of 1905 — 1907 forced the government to declare «civil reforms». In particular, a series of the senatorial commissions for consideration of a question of improvement of medical aid by the worker is created. The law on hospital cash desks (1912) was as a result adopted, however he did not solve problems social insurance (see) and medical service of workers. To a question of Min-va creation of health care Pirogovsky congresses repeatedly were returned, offers were made by the State Council, but they were not accepted. In 1912 at insistance of the State Duma the interdepartmental commission on review a medical dignity was created. legislations under the chairmanship of G. E. Rein. The commission collected big material about a state 3. in Russia also supported creation of Head department of the state health care as mines-va. However and this offer was rejected again.
World War I led to considerable deterioration in the organization of medical aid to the population, paralyzed and brought territorial and city medical institutions into decline.
The political and economic crisis which developed in connection with prolonged war a lack of food stuffs, deterioration in living conditions, etc. hard was reflected on a dignity. condition of the country. The February revolution did not make any radical changes to public health care. Following obviously adventuristic policy of «continuation of absolute war» and tightening the solution of the land question, Provisional government, except a number of declarations, did not take any measures for improvement of the situation of a wide people at large. In April, 1917 at preservation of former forms of the organization 3. the Central medical and sanitary office standing on positions of the minimum intervention of governmental bodies in medical - a dignity was created. business and considering that he needs to be transferred to hands of the numerous local organizations entirely. The government expressing interests of the bourgeoisie did not wish to undertake drastic measures for improvement a dignity. conditions of the country and public health care. Only transition of the power to hands of the revolutionary people could provide the solution of cardinal problems 3.
HEALTH CARE In the USSR.
Philosophy of the Soviet health care
Among the social transformations which are carried out from the first days of the Soviet power for the benefit of workers, creation of socialist system 3. occupies one of the major places. It was not only expression of huge care of the Communist Party, Soviet government and personally V. I. Lenina about health of the people, but also recognition of an important role 3. in creation of socialism.
Crucial importance in creating favorable conditions for the organization medical - a dignity. services in the country had such historical actions of the Soviet state as nationalization of the earth, banks, large-scale industry, housing stock. The decree on peace, the Declaration of the rights of the people of Russia, laws on the eight-hour working day, etc. created political, economic and sots. - a gigabyte. premises for improvement of material well-being of workers and peasants, and thereby for strengthening of their health, improvement of working conditions and life. Decrees about insurance on a case of a disease, about nationalization of drugstores, about Council of medical boards, about creation of the National commissariat of health care and many others lifted problems 3. to the level of nation-wide, public tasks. V. I. Lenin signed St. 200 decrees concerning protection of national health, they reflect policy of the Communist Party and Soviet power in permission of the major problems 3.
The program of the Communist Party developed by V. I. Lenin and accepted by the VIII congress in 1919 was the guide to action at creation socialist about-va. In this program tasks and ways of development Soviet 3 were defined.
In socialist about-ve human health it is regarded as the main richness of the country. Health and working capacity — concepts inseparable. Recovering health and efficiency of workers, 3. thereby promotes increase in labor productivity, increase in the output, growth of the national income.
Preservation and promotion of health of workers — a necessary condition of socialist construction. This great Lenin idea about need of preservation and promotion of health of the people was fundamental during the development of theoretical bases and the organizational principles Soviet 3.
For years of the Soviet power depending on tasks of socialist construction, development of economy and achievements of medical science forms and methods of work of bodies and institutions 3 were improved. However original positions socialist 3. — state character and planned character 3., free of charge and general availability of medical aid, preventive direction, unity of the theory and practice, broad participation of workers in activity of bodies and institutions 3. — remain firm. They provided and provide successful performance of the tasks set by the CPSU in the field of health protection of the Soviet people. These major principles developed by V. I. Lenin gained further creative development in the third Program of the CPSU (1961) and the new Constitution of the USSR (1977). «Citizens of the USSR — article 42 of the Constitution states — have the right to health protection. This right is provided with the free qualified medical care provided by State Healthcare Institutions; expansion of network of institutions for treatment and strengthening of health of citizens; development and improvement of the accident prevention and production sanitation; holding broad preventive actions; measures for improvement of the environment; special care about health of younger generation, including prohibition of the child labor which is not connected with training and labor education; expansion of the scientific research directed to the prevention and decrease in incidence on providing long active life of citizens». Along with the broad rights guaranteed to the Soviet citizens in the field of protection of their health, the legislation of the USSR imposes on each citizen of the USSR a duty to make thrifty use of the health, health of members of the family and other members about-va, to strictly follow the laws and rules directed to public health care. More and more the concept about public health becomes stronger, in particular the Soviet person is obliged to keep the health not only in own interests, but also for the benefit of collective and business, for to-rogo it lives and works. Neglect personal and others' health, the wrong relation to problems of improvement of working conditions and life of people contradict interests of the state. Soviet about-in demands from each citizen of high personal responsibility and care of the health and health of people around since in Sovetsk the state national health is public property.
The state socialist character of health care in the USSR. Soviet 3. radically differs from systems of the organization 3. and medical aids in the capitalist countries. In the countries of capitalism even in the presence of public administration 3. to lay down. the help is, as a rule, not connected with prevention, free medical aid is provided only partially, there is a significant amount private to lay down. the institutions having immeasurably great opportunities for rendering the qualified and specialized medical aid, than state. Interests of workers are alien to the capitalist state; its activity in the area 3., resulted from persistent political struggle of a wide people at large, it is in many respects caused by economic interest of maintenance of health of hired labor. For the socialist state expressing interests of workers, health protection of the people — the major social function, and economic opportunities of the state define only degree of the practical embodiment in life of the humane principles socialist 3. As the proof to it serves the fact that the principles Soviet 3. began to be realized during the most difficult period of history of our country and that with growth of economic power of the USSR expansion of the rights of workers in the area 3. was not followed by any change of its basic bases. Therefore it is possible to claim that the state character 3. it is inseparably linked with a socialist system.
State character Soviet 3. it is shown also that the Central Committee of the CPSU and Council of ministers of the USSR periodically consider radical questions 3., sum up the results and plan further ways of its development. The state on a scientific basis plans and finances all actions in the area 3. and medical sciences, guarantees to citizens health protection, material security in old age, and also on a case of a disease or disability, creates network to lay down. - the prof., a dignity. - the prof., a dignity. - hens., recreational, research and child care facilities, carries out their material and medicamentous providing, prepares shots of specialists for 3., issues the acts governing the public relations in the area 3., thus provides all city and villagers highly skilled, modern medical, to lay down. - professional, the help, guarantees the right for protection and strengthening of health of each citizen at the expense of public, public funds.
State character Soviet 3. consists also in full use created under the direction of V. I. Lenina of the theoretical principles and experience of management of the socialist state. To them the leading, directing role of the Communist Party, the principles of democratic centralism, a combination of one-man management, collective nature and personal responsibility, individual approach belong to selection, arrangement and use of shots etc. Management 3. it is integrally combined with activity of public authorities. The m3 of the USSR directs bodies 3. on places through min.-va federal republics (see. Ministry of Health ), regional, regional, city and regional departments 3. local councils of People's Deputies.
Thus, state character Soviet 3. causes unity of the purposes, tasks and all actions in the field of public health care, and also provides use by all medical institutions of the most effective methods of treatment and the prevention developed by research in-ta, clinics and laboratories and recommended by them for implementation in practice. In total medical - a dignity. institutions in the country, irrespective of departmental accessory, work by uniform methods. Their activity serves the uniform purpose — decrease in incidence, strengthening of health and extension of active life of the Soviet people. Development of system 3. — the integral part of nation-wide development plans for the national economy of the country is also carried out on the basis of studying of need of the population for different types of medical aid.
The legislation of the USSR and federal republics determines obligations of all public authorities, public organizations and officials by protection of national health. The constitution of the USSR and the Basis of the legislation of USSR and federal republics about health care affirm the right of each citizen for health protection, govern the public relations in the area 3. for providing harmonious physical. and spiritual development of the person.
Free of charge and general availability of the qualified medical care. State character Soviet 3. creates necessary conditions for providing the population with free and public medical aid. The rights of citizens for the free qualified medical aid are affirmed legislatively and guaranteed by the Constitution of the USSR. In the territory of the USSR all types of medical aid — out-patient and stationary (including specialized), surgeries, consultations, laboratory researches, the help at childbirth, etc. — are provided free of charge, irrespective of existence of the Soviet nationality and citizenship. Also food of the patient, and also all types of consumer services is free during stay in to lay down. establishment. Expenses on 3. and physical. education in the USSR are manufactured from means of the state budget, from funds of the state, cooperative, trade-union and other public organizations, and also at the expense of means of collective farms.
In the USSR considerable means are spent also on social security (see) and the state social insurance (see). The state assumes all expenses connected with social insurance. In case of temporary disability the grant at the rate to 100% of the salary depending on length of service is paid. Also maternity allowances, old-age pensions and disability are given, the most part of expenses on a dignity is paid. - hens. treatment and rest, on to lay down. food; funds for development of tourism, the structure of recreation camps for school students and students etc. are allocated. General availability of medical aid for the population is provided with broad system of the organizational actions directed to its approach to the population — development of network of polyclinic institutions, services of fast and acute medical aid, creation of mobile out-patient clinics in the remote districts, etc.
A preventive orientation — the leading principle of the organization Soviet 3., based on Marxist-Leninist understanding of dialectic interrelation of an organism with the environment. Speaking about difference of the Soviet medicine from medicine in the capitalist countries, 3. P. Solovyov specified that the last cannot take a way of broad public prevention, without encroaching on the bases of a capitalist system. Full realization of the ideas of prevention in life was possible only after a victory of Great October socialist revolution when its tasks completely matched interests of the Soviet social order, interests of the state. In the USSR health protection of the people is not only departmental function of bodies 3., and it is provided with all system of the social and economic actions about-va directed to labor protection and improvement of living conditions (social insurance, social security, improvement of the inhabited places, mass physical. education, rise in cultural level of the people, etc.). Prevention at us, was said by N. A. Semashko, it is necessary to understand not narrowly as a departmental task of bodies 3., and it is wide and deep as care of the state of strengthening of health of the Soviet people. Prevention at socialism has comprehensive character. It is directed not only to health protection and the prevention of diseases, but also on harmonious development of the person and in the broadest sense covers all aspects of life of the Soviet people — a working condition, life, food, the dwelling, education, rest.
Preventive (it is more correct social and preventive) the direction 3. is, thus, one of levers of social policy of the Communist Party and the government of the USSR directed to care about health and wellbeing of the people, the strategic line in protection and strengthening of public health. The preventive direction is provided with carrying out broad system special a dignity. - a gigabyte. actions for improvement of the working conditions, life, rest of the population provided by the sanitary legislation (see). Sanitary and epidemiologic service (see) provides the state dignity. control of its performance, all its activity it is directed to health protection of healthy.
To implementation of the preventive direction Soviet 3. promotes widely carried out in the country sanitary education (see), gigabyte. education of the population.
Synthesis of preventive also to lay down. medicine, unity to lay down. and dignity. affairs are best realized in a dispensary method (see. Medical examination ), which in combination with a local form of the organization of medical aid is the main method of work not only special clinics, but also all to lay down. - professional, institutions both in the cities, and in rural areas.
The unity of the theory and practice, wide use of achievements of science and technology in activity of healthcare institutions belongs to the major basic bases Soviet 3. Speaking at the II All-Russian congress of workers medical - a dignity. work in 1920, V. I. Lenin told: «Cooperation of representatives of science and workers — only such cooperation will be able to destroy all oppression of poverty, diseases, dirt... The union of representatives of science, the proletariat and the equipment will not be resisted by no dark force» (V. I. Lenin, Poln, SOBR. soch., 5 prod., t. 40, page 189). These words of V. I. Lenin formed the basis for establishment of the creative union of medical science and practical 3. All activity of institutions 3. in the USSR it is carried out on scientific bases. In the country is available USSR Academy of Medical Sciences (see), the wide network of research institutes is developed (see) and laboratories. At the same time scientific in-you, departments and clinics along with carrying out basic researches perform numerous works on urgent problems of applied medicine, constantly arming army of practical doctors with modern methods of prevention, diagnosis, treatment of various diseases. It is characteristic that in the conditions of the Soviet reality of opening in the field of science quickly become property of practice. At the same time experience of the advanced practice finds broad theoretical justification.
Achievements of the equipment are more and more widely used in various fields of medical science, providing the successful solution of new problems. As convincing confirmation of it huge successes of surgery operation on a brain, lungs, kidneys, heart and other vitals, implementation of an artificial hypothermia, neyroleptanalgeziya, hyperbaric oxygenation, organ transplantation, resuscitation methods, etc. can serve. This progress became possible thanks to creation of the difficult medical equipment and other achievements of a technical thought.
Principle of unity of science and practice 3. thus, means creation and guaranteeing from the socialist state and society of such conditions which as much as possible would promote implementation of scientific achievements in daily practice of bodies and institutions 3., to use of practical experience in interests of scientific research.
Participation of workers in activity of bodies and healthcare institutions. Soviet 3. was under construction and developed with active participation of broad masses of workers.
V. I. Lenin considered that efforts of our party in fight for revolutionary change about-va would be sterile if it in the activity did not rely on the greatest revolutionary energy and creative amateur performance of broad masses of workers and the working peasants. It entirely belonged also to Soviet 3., one of features to-rogo was that it was under construction on a wide public basis.
Throughout all history Soviet 3. numerous public organizations along with medical workers fought against epidemics, participated in construction of medical institutions, promoted carrying out protivoepid., dignity., preventive actions. At different stages organizational forms of this participation changed: weeks of fight for purity, community work days were spent, at the enterprises cells 3 were organized. the commissions on fight for purity, at to lay down. institutions — the commissions of improvement of work and life (see), in villages worked a dignity. representatives, etc. In the Supreme Council of the USSR and in the Supreme Councils of federal and autonomous republics, and also in local councils of People's Deputies the constant commissions on 3 are formed. and to social security. Active participation in work of bodies and institutions 3. accept labor unions. At policlinics,-tsakh and other medical institutions there are public councils (see). At the industrial enterprises, in collective farms, schools, houses are created a dignity. posts.
In work on increase a dignity. cultures of the population take part many state and public organizations, the Union of societies of the Red Cross and Red Crescent of the USSR (see), All-Union about-in «Knowledge». The most mass form of amateur performance of the population are people's movement for a dignity. improvement, purity and dignity. culture. It is widespread in the republics, areas, the cities and districts of the country. For increase a dignity. cultures of the population are created national high fur boots (St. 2 thousand, 1975), schools of health, etc. Scientists and doctors popularize achievements of medical science, tell about searches of ways of the prevention and treatment of diseases.
Fight for health of workers becomes the most important part of party, trade-union and economic activity more and more. Escalating role and activity of the public in the organization 3. reflect the general pattern of process of increase in a role of a people at large in construction communistic about-va. Broad participation of public, trade-union, scientific and other organizations in work of bodies and institutions 3., interest of the population in its progress and development define nationality of health care.
The Soviet health care is constructed on the principles of socialist humanity. Socialist about-in serves interests of the person, his benefit is promoted, and from here by radical difference Soviet 3. from 3. the capitalist countries, sharp distinction in understanding of humanity of the doctor. So, e.g., free of charge medical aid in the Soviet Union is not only great social gain of the October revolution, but also the most important condition of truly humane attitude of the doctor towards the patient. In such conditions health of the patient — the only purpose of professional and human aspirations of the doctor. It is accurately stated also in to the oath of the doctor of the Soviet Union (see).
In the capitalist countries where medical aid is based by hl. obr. on a private practice and where the relations between private medical practitioners and patients are constructed on a commercial basis, the doctor should fight for clients, regions are able to pay its work. Thus, the doctor is interested in perhaps bigger number of the patients providing it the income. The Pharm, the industry in the capitalist countries in a pursuit of profit quite often puts on the market the medicamentous means which did not undergo sufficient testing, in some cases without caring for their advantage for patients.
In the USSR interests of the state and the doctor in health protection of the people completely match. The relations between the doctor and the patient are free from material calculations, between them there are no antagonistic contradictions, they are based on mutual respect. Professional unselfishness and daily dedicated work — characteristic features of the Soviet doctor. In Soviet 3. finds bright expression the socialist humanity inherent in our social order, original care about-va about health and working ability of the Soviet person, about development its physical. and mental capacities, about longevity. The essence of socialist humanity is defined in the Program of the CPSU: «... The person to the person — the friend, the companion and the brother». Such friend is also the Soviet medic, the doctor, free from egoistical calculations, protecting and returning to people the most valuable in life — health, disinterestedly serving of
the Nature Soviet 3., its socialist, state, national character, humanity, wealth of experience, which 3. got for historically short term, aspiration to pass on this experience to other people and the countries, the real disinterested brotherly aid, to-ruyu renders the USSR 3. other countries, especially fighting for the freedom and independence, speak about its internationalism as one of the major features. Not accidentally philosophy 3. the USSR was used in decisions of the XXIII session of the World Assembly of health care (1970) which adopted the resolution on philosophy of development of national health care.
Formation and development of the Soviet health care
Health care on the eve of Great October socialist revolution. The imperial government did not pay sufficient attention to health protection of the people. All over the country, the population a cut in 1913 made 159,2 million people, there were only 28 thousand doctors (about 1 doctor on 5,7 thousand zhit.), most of which was practiced in the large cities of the European part of the country, and by 46 thousand average medics. The number of BC, out-patient clinics was extremely insufficient and others to lay down. institutions. To the countries there would be only 207,6 thousand beds (1,3 for 1000 zhit.), to 35% of the cities there was no BC at all. The possibility of the organization of specialized stationary medical aid was excluded since 26% of BC had less than 5 beds, 53% — from 6 to 20 beds and only 21% — more than 20 beds.
Extra hospital medical aid was rendered by 5,7 thousand medical institutions. To protection of motherhood and the childhood it was given the small attention is insignificant. In all Russia in 1913 there were only 9 women's and children's consultations and several small children's BCs and clinics at a medical f-takh of high fur boots with a general power of 750 beds, 19 day nursery on 550 places and apprx. 5 thousand places in kindergartens. Medical aid to pregnant women, as a rule, was absent, and obstetric care at childbirth in most cases was healers and midwives since in the country there were only 7,5 thousand obstetric beds (about 1 on 6,7 thousand women of childbearing age). The laws directed to health protection of the pregnant woman and mother did not exist. On f-kakh and z-dakh they worked till last day pregnancies, often carrying out heavy physical. work, and right there at the machine, and peasants — quite often gave birth in the field during field works. Existing extremely limited governmental a dignity. resolutions in essence were not carried out.
Insufficient forces and slender means 3. were distributed extremely unevenly. So, to lay down. the help to the country people of Russia making 130,7 million people in 1913 was rendered by only 4975 doctors (1 doctor approximately on 26,2 thousand zhit.), which were concentrated preferential in provinces where there was a territorial self-government. In 55 provinces where it was not entered, one doctor had to service up to 70 thousand people living in the territory from 2 to 13 thousand sq.km. In medical institutions was available apprx. 30 thousand beds (about 2,3 on 10 000 zhit. or 1 bed on 4,4 thousand people).
Especially badly the situation with medical aid in the territory of the present Central Asian and Transcaucasian republics, and also in sowing was. and sowing. - vost. suburbs of the country. So, in the territory of present Kyrgyz and Tajik SSR one doctor fell on 50 thousand zhit., Uzbek — one doctor on 35 thousand zhit., the population of the majority of districts of Far North (Yamal-Nenets, Evenki, Koryak, Chukchi and other national districts) in general was deprived of medical assistance. One hospital bed in the territory of present Tajik SSR fell on 25 thousand zhit., Kyrgyz — the St. 8 thousand zhit., Uzbek and Turkmen — the St. 4 thousand zhit., in the territory of sowing. and sowing. - vost. autonomous republics and national districts — on 15 — 20 thousand zhit., and in the territory of Tuva the ASSR, the Evenki, Koryak and Chukchi national districts of medical institutions was not at all.
Imperial Russia was the most unsuccessful in a dignity. relation country of Europe. Only 20,6% of the cities with the population of St. 10 thousand people had the water supply system delivering water to the houses located in the central quarters. Even in Moscow only 20% of households had water supply systems. The sewerage was available only in 23 large cities. The vast majority of the population used for drink the water unsuitable on bacterial, to indicators, many settlements were unsanitary. Adverse dignity. - epid, the situation was aggravated with poverty and low cultural level of the population. Efforts of progressive figures of medicine and zemstvoes could not exert a little noticeable impact on improvement a dignity. - epid, situations in the country; created in the provincial cities a dignity. bureaus were engaged in preferential statistical work. As a result of unsuccessful dignity. - epid, situations, absence a dignity. - protivoepid. the organizations the country was defenseless before an impact of infectious diseases. Sypna and returnable typhus, cholera, plague, natural smallpox, malaria, syphilis and tuberculosis caused enormous damage to health of the population and national economy. So, according to incomplete data, the St. 1 million persons annually died of infectious diseases in Russia. About 40 — 50 thousand people perished from natural smallpox, and among surviving many remained blind people. Annually malaria got sick with 5 — 7 million persons. From 1907 to 1911 2.8 million cases of diseases of cholera from which 334 thousand ended with death were registered. From 1896 to 1913 268 thousand people from whom 25% died had a malignant anthrax. During 1912 13 million patients with various infectious diseases were registered.
Unsatisfactorily the situation and with preparation of medical shots was. In all Russia in 1913 there were only 17 highest medical educational institutions which were releasing annually apprx. 900 doctors.
In the country was not medical - tool and chemical - pharm, the industries therefore the capital medical equipment, tools and pharmaceuticals were imported.
The hard work, poverty, ignorance, alcoholism, diseases and early death was destiny of most of the population. Mortality in imperial Russia in 1913 made 29,1 for 1000 zhit., average life expectancy — 32 years. On everyone 1000 been born living 269 children died, without having lived till 1 year, 43% of children died aged up to 5 years.
V. I. Lenin, creatively developing K. Marx and F. Engels's regulations on social bases 3., always connected questions of health protection of workers with an economic and political system about-va; considered their decision as an integral part of the general tasks facing the proletariat. In 1895 — 1896 in the draft of the Program of Social Democratic Party V. I. Lenin formulated tasks and requirements of the proletariat in the field of health protection. In the Program adopted by the II congress in 1903, the big place was allocated to questions 3. Questions of health protection of the people were discussed at the VI Prague party conference in January, 1912, at a meeting of the Central Committee RSDRP in Krakow passing in December, 1912. In April — May, 1917 at the request of the Central Committee RSDRP V. I. Lenin wrote the brochure under the name «Materials on Review of the Party Program». In it questions of labor protection and health of workers gained further development.
Health care during Great October socialist revolution and civil war (1917 — 1921). From the first days of the Soviet power, realizing original positions of the Program, the party and the government began to carry out democratic and social transformations for the benefit of working class and the labor peasantry. Already the vital issues of health protection of workers found reflection in the first decrees of the Soviet government. Noting an important role of national health in development of national economy, in construction of socialism, V. I. Lenin took measures in order that health protection of workers became one of the main functions of the Soviet state.
On October 26 (on November 8), 1917 at Revolutionary-military committee of the Petrograd Council of working and soldier's deputies the Medical and sanitary department which was headed by M. I. Barsukov was organized. The tasks to organize medical aid by the worker and to soldiers, to begin reorganization of all medical - a dignity were set for this department. affairs in the country to break sabotage of a conservative-minded part of medics, to involve all sympathizers of the Soviet power of doctors.
On January 24, 1918 I. Lenin signed the decree about formation of the supreme governmental medical body — Council of medical boards (see), A were a part to-rogo A. N. Vinokurov (chairman). I. Artemenko, M. I. Barsukov, B. M. Bonch-Bruyevich (Velichkina), C. Yu. Bagotsky, I. S. Weger, M. G. Vecheslov, M. V. Golovinsky, S. I. Mickiewicz, E. P. Pervukhin. In March, 1918 Council of medical boards moved to Moscow where it was replenished with new members — N. A. Semashko, 3. P. Solovyov, I. V. Rusakov, A. P. Golubkov, N. A. Post and B. S. Veysbrod. Following V. I. Lenin's instructions, Council of medical boards did a great job on the organization and strengthening medical - a dignity. departments at local councils of working and soldier's deputies, on unity of medics around the Soviet power.
On July 10, 1918 at the V All-Russian congress of Councils the Constitution of the Russian Soviet Federative Socialist Republic was approved, a cut among other national commissariats the organization and the National commissariat of health care was provided (see. Ministry of Health ). On July 18 V. I. Lenin approved the provision on the National commissariat of health care of RSFSR which defined its tasks, the rights and duties. The first national commissioner of health care it was appointed N. A. Semashko, his deputy 3. P. Solovyov, members of board — V. M. Bonch-Bruyevich (Velichkina), A. P. Golubkov, P. G. Dauge, E. P. Pervukhin. At Narkomzdrava as advisory bodies were created Central medical - a dignity. council with participation of representatives of the working organizations and Academic medical council, the most visible scientists led by L. A. Tarasevich were a part to-rogo.
Main objectives and ways of development Soviet 3. were defined by the Party program developed by V. I. Lenin and accepted by the VIII congress in 1919. The program provided crucial importance of prevention not only in the organizations of medical aid, but also in all socialist system of the structure of work and life of workers.
As a basis of all activity in the field of protection of national health the party put forward the following tasks:
«... 1) resolute holding broad sanitary actions for the benefit of workers, somehow: a) improvement of the inhabited places (protection of the soil, water and air); b) statement of public catering on the scientific and hygienic beginnings; c) the organization of the measures preventing development and spread of infectious diseases; d) creation of the sanitary legislation;
2) fight against social diseases (tuberculosis, venerizm, alcoholism etc.);
3) ensuring the public, free and qualified medical and medicinal help».
Questions of health protection of workers found the reflection not only in the special section of the Program about health protection of the people, but also in other its sections. So, for improvement of public education and liberation of the woman in the section of the Program about national education the demand about creation of network of preschool institutions was made. In the section of the Program for a housing question the party put forward the following tasks: «... in every way to aim at improvement of living conditions of workers of masses; to destruction of density and an antisanitarnost of old quarters, to destruction of unusable dwellings, to reorganization old, construction of the new, corresponding to new living conditions working masses, to rational resettlement of workers».
First years of construction Soviet 3. matched the most difficult period in life of the Soviet state. Imperialists of 14 countries undertook military intervention. The young Soviet republic surrounded with a ring of fronts the most severe hunger, cholera, the Spaniard and typhus tormented. The first task Narkomzdrava during this period was to organize to lay down. - evacuation and a dignity. providing Red Army. August 30, 1918. The head military and sanitary department was transferred to the jurisdiction Narkomzdrava. In the shortest possible time the new system medical - a dignity was created. providing army, providing approach of the surgical help to the front line, sorting of wounded and patients, restriction of evacuation of infectious patients out of borders of the front. Were organized pro-thinned out hospital — therapeutic, surgical, infectious, etc. For fight with epid, diseases on fronts developed network of bath-and-laundry and disinfection groups. By the end of 1920, on fronts there were already more than 300 stationary and flying bath-and-laundry groups and St. 30 trains baths and trains short meetings. which general capacity made more than 130 thousand people a day. Big help to military public health service was given by the public. Russian about-in Red the Cross, 3 was the chairman to-rogo since July, 1918. P. Solovyov, organized short-term courses of «red sisters and nurses» and directed to fronts of civil war of St. 400 institutions (hospitals, laboratories, points of food) and groups (dressing, anti-epidemic, bath-and-laundry, etc.).
On October 29, 1919 under the resolution VTsP K with active participation of V. I. Lenin the Committee of the help to wounded and sick Red Army men was founded. As a result of the taken measures medical aid by the wounded considerably improved, terms of treatment were reduced, the lethality and disability decreased, tens of thousands of wounded were returned to a system again.
World War I (1914 — 1918), civil war and hungers and economic ruin caused by them considerably worsened already extremely heavy a dignity. - epid, a situation. Epid, diseases were widely adopted all-time. So, for 1918 — 1922, according to L. A. Tarasevich, had a sapropyra apprx. 25 million people, returnable — 10 million persons. Considerable distribution was gained by cholera, malaria, the Spaniard, in 1919 the threat of epidemic of natural smallpox was created.
Mobilizing workers for fight against typhus, V. I. Lenin strengthened their confidence in success of this fight: «It is possible to save millions and tens of millions from hunger and from typhus, rescue is close, it is possible to overcome and win against the approached hungry and typhus crisis quite. To despair it is ridiculous, silly, shameful» (V. I. Lenin, Half-N of SOBR. soch., 5th prod., t. 37, page 467).
Confidence of the leader is that fight of the workers headed by party against hunger, cold weather and a sypnyaka for the educated, full and healthy Russia will terminate in the same resolute victory, as well as fight against White Guards and interventionists, had huge value. All forces of the country — medics, the party and Soviet organizations, economic heads, the general public were mobilized for fight against epidemics of parasitic typhus. On January 28, 1919 I. Lenin signed the decree of SNK RSFSR «About actions for a sapropyra»; in pursuance of its Narkomzdravom was developed a number of actions for fight against parasitic typhus, the instruction about the organization of the working commissions but fight for purity which creation was provided by the special decree of SNK is published. At Narkomzdrava the Central extraordinary commission on fight with epid, diseases, paying special attention to elimination of a sapropyra was created. In 1920 for patients with a sapropyra are in addition in detail 250 thousand beds; on. - and waterways of the message for fight against parasitic typhus insulating check points were created. On December 6, 1919 I. Lenin signed the resolution of Council of Workers' and Peasants' Defense «About „Week“ of cleaning» on all network of the railroads, to time the cut was given in ought a dignity. state rolling passenger stock, ways, stations and others. - of the room. Mass carrying out protivoepid, actions, broad development dignity. educations in combination with active participation of the population in fight against epidemics led to falloff of incidence: in 1921 the number of diseases of a sapropyra decreased in comparison with 1920 by 6 times.
On April 10, 1919 I. Lenin signed the decree about obligatory smallpox vaccination (see), all children within the first year of life, all coming to educational institutions and child care facilities, and also the faces which are called up for Red Military service and the Fleet were subject to Krom.
On July 25, 1921 the decree «About actions against cholera epidemic» is issued. In the threatened districts the extraordinary commissions on fight against cholera were created, Narkomzdrava for this purpose the special credits were allocated. In the cities and settlements, on. - stations, river and marinas were quickly carried out a dignity. - a gigabyte. and protivoepid, actions. As a result of accepted extraordinary protivoepid, and strict quarantine measures on prevention of a drift of this disease through ports it was succeeded to achieve falloff of incidence of cholera.
Along with protivoepid, work widely held all-sanitary events. The decree of SNK RSFSR «About sanitary protection of dwellings» of June 18, 1919 in the country established the state housing sanitary inspection. Housing and sanitary inspection was allocated with the rights of participation in development of housing projects both in city, and in rural areas, in the correct resettlement in premises of poor groups of the population. The current dignity was established. supervision of observance of housing health regulations. On November 8, 1919 the resolution of Council of Workers' and Peasants' Defense «About formation of the special All-Russian commission on improvement of a sanitary condition of the Republic» was issued, a cut large powers were conferred. In activity Narkomzdrava from the first days of his work questions of fight against heavy heritage of the past — tuberculosis and venereal diseases figured prominently. On October 25, 1918 N. A. Semashko signed the provision on section of fight against tuberculosis, on to-ruyu the organization and association of all social actions for fight against this disease were assigned; development and preparation of legislative measures and obligatory resolutions on fight with tuberculosis (see). The same year in Moscow the first tubercular clinic was open.
On November 2, 1918 N. A. Semashko signed the provision on a subsection on fight against venereal diseases (see. Venereology ), In 1921 the first was open venerol, a clinic.
In 1918 — 1920 the foundation of the Soviet organization was laid protection of motherhood and childhood (see), a number of the decrees directed to improvement of health of mother and child is issued. Completely free medical aid was provided to them. Pregnant women, nursing mothers and babies received the doubled rations. Especially the question of baby food was particularly acute, it depended on the decision not only physical. development, but also preservation of life of young citizens of the Soviet Russia. A number of decrees and resolutions of the Soviet government signed by V. I. Lenin provided the organization of free food of children.
On December 28, 1918 I. Lenin signed the decree «About nationalization of drugstores». For the organization of the medicinal help to the population in Narkomzdrava it was created pharm, department, and in departments 3. local councils — pharm, sections.
In the first years of the Soviet power along with holding practical actions for the organization medical - Sep. affairs the foundation for system of medical education was laid (see) and Soviet medical science. In 1918 — 1922 16 new medical in-t opened and f-tov high fur boots, social composition of students sharply changed. In 1920 it was organized State by in-t of national health care (GINZ) — the first complex research establishment of the country. In 1920 GINZ combined 7 in-t (food, control of vaccines and serums, microbiological, tropical, biochemical, experimental biology and sanitary and hygienic). Around Academic medical council Narkomzdrava the most visible scientists taking active part in permission of scientific and practical questions Soviet 3 were grouped.: A. N. Bach, P. N. Dia-troptov, D. K. Zabolotny, H. K. Koltsov, E. I. Martsinovsky, L. A. Tarasevich, A. N. Sysin, M. N. Shaternikov, etc. In Petrograd I. P. Pavlov, V. M. Bekhterev, N. P. Kravkov's works, etc. were continued. At the beginning of March, 1919 the All-Russian union of health workers was finally registered (Vsemedikosantrud). Vsemedikosantrud I made a speech March, 1920 at the II All-Russian congress of the union V. I. Lenin. The congress accepted the address «To workers of medical and sanitary business of all countries», in Krom urged to help to tear chains of blockade and to give help in supply of our country disinfection and pharmaceuticals, surgical instruments etc. for improvement of a sanitary condition of the Soviet republic and destruction of epidemics.
On March 16 — 20, 1920 the II All-Russian congress of zdravotdel took place. N. A. Semashko provided the data testimonial of improvement in the report medical - a dignity. affairs in the country: total number of medical institutions increased in comparison with 1914 by 40%, improved to lay down. - professional, the help to the population, medical aid at home, first-aid stations at the enterprises was organized, medics conducted active fight against epidemics and social diseases.
Health care during recovery of the national economy (1921 — 1925). After the end of civil war the country started recovery of the national economy. As a result of World War I and civil wars the national economy fell into decay: the volume of industrial output in 1921 made 40% pre-war, agricultural — 14%. The X congress (March, 1921) made the decision on transition from military communism to the new economic policy. The new stage and in activity Soviet 3 began. The main attention was paid to elimination a dignity. effects of war, on recovery in the cities and villages old and creation of new medical institutions, on carrying out wide preventive measures for improvement of working conditions and life, on fight against tuberculosis, venereal and other diseases. Main «front» 3. the front of fight with epid, diseases continued to remain. In December, 1921 SNK RSFSR adopted the decree «About measures of fight with sypny and a typhinia», and in April, 1922 the resolution «About Measures of Fight against Cholera». By 1923 incidence of parasitic typhus and cholera decreased. Systematic work on elimination of malaria began, cover incidence, especially in the south, increased. In 1920 it was organized Tropical by in-t of GINZ; 1921 — the Central malarial commission Narkomzdrava, under the direction of a cut was created wide network of antimalarial institutions. On May 12, 1924 the resolution SNK «About Actions for Fight against Malaria», the Crimea is issued, in particular, economic organizations undertook to carry out according to the instruction Narkomzdrava a number of the measures preventing spread of malaria.
Fight against distribution epid, diseases was conducted in parallel with implementation of measures for improvement a dignity. conditions of the country. On March 21, 1921 the decree of SNK «About Measures for Improvement of Water Supply, the Sewerage and Sewage Disposal in the Republics», since June, 1921 all questions a dignity is issued. protection of dwellings are transferred to sanitary housing inspectorate Narkomzdrava, in October, 1921 Council of national food Narkomzdrava and on bodies 3 is created. the dignity is assigned. supervision of production, storage, transportation and sale of foodstuff. A big role in the organization a dignity. affairs were played by the decree of SNK «About Sanitary Bodies of the Republic» (on September 15, 1922) which established uniform state a dignity. service (see. Sanitary and epidemiologic service ), its tasks, the right and a duty and defined harmonious system of precautionary and current sanitary inspection (see).
Introduction of the new economic policy caused considerable difficulties with financing to lay down at first. institutions. The budget of peace time only began to be created and to keep everything to lay down. institutions would transfer some zdravotdela separate to the maintenance of the industrial enterprises and insurance bodies. The private practice renewed, even private clinics opened. Using temporary difficulties, opponents of uniform Soviet medicine began to support elimination of the principles of free of charge and general availability of medical aid, suggesting to keep them only for insured, and to transfer medical aid to other population to cost accounting. Despite a difficult economic situation, the party helped to overcome these wrong views. The III All-Russian congress of zdravotdel (1921) confirmed firmness of the principles of unity of the Soviet medicine, free of charge and general availability of medical aid again.
In December, 1922 the IV All-Russian congress of zdravotdel which took place under the sign of fight against deviations from the principles established by the Party program Soviet 3 gathered in Moscow., which it was validated by all previous activities for health protection of the people. The congress adopted the detailed program of protection of motherhood and an infancy, fight against social diseases, urged zdravotdela to take all measures for strengthening and expansion of network of medical institutions in the village.
The destroyed network of medical institutions in the village was recovered with huge difficulties. The local budgets financing rural local network during the first period of the new economic policy were low-power and did not provide needs rural 3. Only for the first half of the year 1922 the number of rural medical sites decreased in comparison with 1921 by 10%, and number of hospital beds in the village — for 28%. Bodies 3. took all measures for strengthening of a rural link 3., established connection with committees of country mutual assistance, organized amateur performance of the population in the help to lay down. to institutions. In 1921 the government completely took on the state budget city and rural medical institutions in national areas and districts, and also in districts, victims of a crop failure. Later, in 1924, on the state budget a considerable part of expenses on the maintenance of the general network of rural medical institutions was accepted.
On December 30, 1922 in Moscow the I congress of Councils of federal republics which approved the Declaration and the Contract on formation of the Union of Soviet Socialist Republics opened. Due to the formation of the USSR there was a question of coordination of actions in the area 3. The meeting of people's commissars of health care of federal republics authorized N. A. Semashko to be their representative to the Government of the USSR.
For providing rural medical institutions with shots the resolution SNK RSFSR «About providing rural areas with medical care and about improvement of materialnobytovy position of local medical personnel», providing a number of privileges to workers rural 3 was issued on December 2, 1925. On December 14, 1925 the resolution of VTsIK and SNK of RSFSR «About bases of creation of the normal volost (regional) organization of health care» is issued, the Crimea the organization in each regional and volost center-tsy with out-patient clinic, therapeutic, surgical, maternity and infectious departments, a dental surgery, consultation for women and babies, ospoprivivatelny point, disinfection installation was provided. Big role in the organization rural 3. played the I All-Union congress of district doctors which took place on December 8 — 15, 1925, planned a number of specific actions for strengthening of scheduled maintenance on the medical site. It marked a new stage of development of rural medicine.
Considerable work was carried out on fight against social diseases, and also in the field of protection of motherhood and an infancy.
The fight against tuberculosis and venereal diseases begun even in the years of civil war continued to extend. In RSFSR the network of tubercular clinics grew with 4 in 1919 to 223 in 1925. Tubercular sanatoria began to be developed, connection of clinics with out-patient and polyclinic institutions was established, the obligatory accounting of TB patients was entered. In 1921 in Moscow in-t Narkomzdrava opened State venereologic. Since 1923 rapid growth of number venerol began, clinics, at the beginning of 1925 in the territory of RSFSR their number reached 58. Progress of socialist construction, growth of material and cultural level of the people, equality of women led to elimination of prostitution and falloff of venereal diseases.
Protection of motherhood and the childhood was considered by the Communist Party as the major task. Constantly the number of institutions of protection of motherhood and the childhood extended; in 1925 in the USSR there were already St. 520 children's consultations, apprx. 280 consultations for pregnant women, 120 rural consultations of protection of motherhood and an infancy, the St. 770 day nursery, was organized 6 research in-t on protection of motherhood and the childhood. Child mortality in 1925 decreased in comparison with 1913 more than by 1,5 times.
The V All-Russian congress of zdravotdel (1924) proclaimed the slogan: «From fight against epidemics to improvement of work and life». Successful elimination dignity. effects of war and epidemics provided a possibility of organized and systematic carrying out in life of the preventive direction Soviet 3. The dispensary method applied only as a measure of fight against social diseases and in institutions of protection of motherhood and an infancy admitted the most important form of work of all to lay down. - professional, institutions.
On May 12, 1925 the XII All-Russian Congress of Councils heard N. A. Semashko's report and approved the work which is carried out by Narkomzdrav.
Health care during reconstruction of the national economy and construction of bases of socialism (1926 — 1940). Having completed recovery of the national economy in the country, the party started creation of material and technical resources of socialism. Carrying out decisions of the XIV congress (1925), the Soviet people began building of the socialist industry for transformation of agrarian Russia into the powerful advanced industrial power.
The XV congress of the All-Union Communist Party (bolsheviks) (1927) defined ways of socialist development of agriculture — a course on collectivization. XVI party conference (April, 1929) accepted the first five-year plan. The new tasks facing the country demanded review of forms of the organization of medical aid by the worker, development of new methods of work to lay down. - professional, institutions and first of all the differentiated approach to the organization of medical aid to various groups of the population. On the agenda the question of preferential medical service of industrial workers and toilers of the socialist sector of the village, of rise a dignity was raised. cultures of the population. 3. had to promote in every possible way implementation of plans of socialist construction, decrease in losses of operating time in connection with disability, to growth of labor productivity.
VI All-Russian congress of zdravotdel (May, 1927) summed up the results of development Soviet 3. in 10 years. Dignity. the condition of the country considerably improved, incidence of infectious diseases sharply decreased. In 1926 the general mortality decreased to 20,3 for 1000 zhit., child mortality — to 174 on 1000 been born live, the natural increase of the population increased with 16,4 (in 1913) to 23,7 for 1000 zhit.
Progress in socialist reconstruction of the national economy, development of the socialist industry, agriculture created a new economic basis 3. also caused its further development: the number of hospital beds in 1928 in comparison with 1913 increased almost by 20%; the number of women's and children's consultations increased;
the number of the doctors servicing country people increased more than twice; the dispensary method was implemented and the contingent of the persons which are subject to medical examination extended, considerably became stronger a dignity. - epid, service. Nevertheless rates of development 3. still lagged behind growth of the national economy and the increased needs of workers.
On December 18, 1929 the Central Committee of the All-Union Communist Party (bolsheviks) adopted the resolution «About Medical Care of Workers and Peasants», a cut planned ways of radical reorganization 3. according to tasks, the laid-down new historical conditions. In the resolution need more resolutely to put into practice the proletarian class line in 3 was emphasized. — improvement to lay down. - professional, the help and a dignity. - a gigabyte. providing large industrial centers, expansion of network of medical institutions in rural areas. With the plan of implementation of the tasks set by party before 3., the national commissioner of health care of RSFSR M. F. Vladimirsky made a speech at the VII All-Russian congress of zdravotdel (March, 1930). Economic problems — the rational organization of medical aid as powerful factor of rise in labor productivity, decrease in losses of operating time in connection with disability, increase of a role of planning 3 were on the agenda. In reorganization of medical aid by the worker the leading role was assigned to health centers (see) to which medical staff not only rendering the first medical aid, but also holding broad preventive actions at the enterprises was assigned. By the major method to lay down. - professional, the help to the population is a medical examination (see). «Facing production» — this slogan of Narkomzdrav called for differentiation of medical aid to various groups of the population according to their role in socialist construction, for fuller satisfaction with stationary and extra hospital medical aid of industrial workers in large industrial districts and toilers of the socialist sector of the village.
As a result of the taken measures for years of the first five-years period the quantity of health centers at the enterprises increased more than by 3 times, the number of the doctors working directly at health centers increased, operational injuries decreased. Since 1939 on the large industrial enterprises the medical and sanitary parts (see) equipped with all necessary for carrying out to lay down began to be created. - professional, and a dignity. - epid. works. In process of development of the industry the number of medical and medical assistant's health centers at the enterprises increased: in their 1940 there was already St. 9,9 thousand.
Along with the organization of medical aid by the industrial worker underwent reorganization also rural 3. The number of rural medical sites increased (see), the number of beds in medical institutions increased. For approach of medical assistance to country people of SNK USSR in 1938 allocated in addition from the all-union budget considerable funds for expansion and the equipment of network of rural medical institutions. Material living conditions of district doctors improved, events for increase in their qualification were held. By 1941 the number of rural medical sites increased to 19,1 thousand, infirmaries — to 40 thousand.
The new tasks which arose in connection with the huge growth of the industrial enterprises demanded review of work a dignity. bodies and expansion of their rights. On February 19, 1927 SNK RSFSR issued the resolution «About Sanitary Bodies of the Republic», and on October 8, 1927 approved the provision on them. According to the new legislation the dignity everywhere became stronger. supervision, functions in the area a dignity extended. protection of the inhabited places, dwellings and places of public use, foodstuff, public catering, etc.; specialization a dignity was provided. affairs with allocation of housing, food, industrial hygiene and epidemiology. Dignity. doctors were granted the right of free inspection of objects for identification and elimination a dignity. disturbances, closing of constructions and the enterprises in case of gross violation a dignity. norms and rules, and also forced hospitalization and isolation of patients with infectious diseases. Measures are taken for radical improvement a dignity. states and improvements of the inhabited places, a dignity. protection of sources of the centralized water supply, a number of the government resolutions providing measures for prevention separate infectious and parasitic diseases is issued. To work a dignity. bodies broad masses of workers were attracted. So, the resolution SNK RSFSR and other federal republics «About a sanitary minimum» (1930) along with holding the main actions on a dignity. to improvement, planned by the five-year plan, implementation with broad participation of the working protozoa a dignity was provided. - recreational actions (a sanitary minimum) for water supply, removal of garbage and sewage, to improvement and gardening of territories, a dignity. to the maintenance of dwellings, enterprises, institutions, collective farms and state farms. At the beginning of the 30th there was a new form of participation of the population in 3. — dignity. representatives — widely adopted afterwards. Dignity. representatives observed for a dignity. a condition of dwellings also carried out recreational actions under the leadership of medical staff. At to lay down. - professional, institutions the commissions of improvement of work and life were organized (see); at the enterprises, in institutions, at the cultural and community commissions of collective farms cells 3 were created. In the late twenties in the country the new type of institutions — sanitary and epidemiologic stations (see) arises.
In 2,5 years after the publication of the resolution «About Sanitary Bodies of the Republic» SNK RSFSR in the resolution «About a Sanitary Condition of the Republic» (1929) noted sharp reduction epid, diseases and aimed a dignity. bodies on preferential service of industrial workers and toilers of the socialist sector of the village. For the purpose of strengthening a dignity. supervision were formed by the resolution of the CEC and SNK USSR of December 23, 1933 as a part of narkomzdrav of federal republics state a dignity. inspections, and in 1935 the resolution SNK USSR created All-Union state sanitary inspection at SNK USSR, on to-ruyu management of bodies state a dignity was assigned. inspections in all territory of the USSR. With the organization state a dignity. inspections considerably extended control functions and competences a dignity. bodies. Main thing dignity. to inspectors of federal republics and state dignity. inspectors on places were granted the right in case of disturbance a dignity. norms and rules to bring criminal case, to impose penalties and to take measures of administrative character, up to closing of the enterprises (see. Sanitary inspection ).
In the years of reconstruction of the national economy actions for fight against tuberculosis and venereal diseases extended, the number of tuberculotherapists and dermatovenerologists increased. By 1940 the quantity of tubercular clinics reached 554, venereologic — 609, number of beds in tubercular and venerol, hospitals increased in comparison with 1930 almost twice. The system of identification, the account and treatment of patients promoted decrease in incidence of tuberculosis and venereal diseases, their early and effective treatment and sharp reduction of number of patients with severe forms and complications.
Socialist construction was followed by involvement of women in production and public life. The number of medical institutions of health protection of mother and child steadily grew. In January, 1927 SNK RSFSR was accepted the resolution on special fund of protection of motherhood and an infancy, the order of transfer and an expenditure of the means coming to bodies 3 was provided in Krom. on protection of motherhood and an infancy, in addition to the state budget. In the late twenties — the beginning of the 30th special preventive policlinics for health protection of children of school age and teenagers open, recreational events in kindergartens and a day nursery are held. In addition to the organization of stationary institutions of protection of motherhood and an infancy, mobile groups (mobile consultations) which rendered medical aid to women and children went to the republics, organized on site obstetric points, women's and children's consultations (see. Children's policlinic , Clinic for women ), conducted a dignity. - a gleam, work. In 1928 in the country there were already 2,2 thousand women's and children's consultations.
Active involvement of women in the sphere industrial and page - x. demanded production from bodies 3. researches of new forms of work of institutions of protection of motherhood and infancy. In 1930 in rural districts day nursery of the extended day, two-shift day nursery, mobile day nursery in the field for children of chest age, etc. began to be organized. All-Russian meeting on protection of motherhood and childhood (April, 1931) recognized as the main establishment the day nursery of the extended day working without the days off, and for service of the women occupied in night shifts — the round-the-clock day nursery. Since 1931 at large consultations children's food stations where the milk kitchen producing milk mixes and a feeding up for children of chest age and the children's kitchen producing products and semi-finished products for children of babyhood entered began to be organized. The big role in development of protection of motherhood and an infancy was played by the resolution of VTsIK and SNK of RSFSR of September 20, 1932. «About yaselny service of children in the cities, industrial centers, state farms, MTS and collective farms».
Implementation of decisions of a November Plenum of the Central Committee of the All-Union Communist Party (bolsheviks) (1929) on improvement of training of specialists demanded reorganization of system of medical education. In 1930 medical f-you were transformed in independent medical in-you and are transferred to the jurisdiction of narkomzdrav of federal republics. The term of training in them was originally established 4 years and 3,5 years for a dignity. doctors and stomatologists, and then it is extended respectively up to 5 and 4 years. In view of an acute shortage of medical shots enrollment of students was considerably increased and are open new medical in-you. From 1930 to 1934 13 new in-comrades were open. In 1933 — 1940 medical in-you were open in all federal republics, their number reached 72, the release of doctors in 1940 made 16,4 thousand people (18,2 times more, than in 1913). Professional development of teachers of medical higher education institutions was promoted in many respects by the resolution on introduction of academic degrees and ranks.
In days of the first five-years period in many fields of medical science considerable success was achieved, arose new research in-you. The most important action of party and government for development of the Soviet medical science was the organization in 1932. All-Union institute of experimental medicine.
The XVI All-Russian congress of Councils which took place in January, 1935 heard the report of the people's commissar of health care of RSFSR G. N. Kaminsky. A congress Narkomzdrava approved activity and planned specific ways of further improvement of medical aid by the worker.
On July 20, 1936 the soyuznorespublikansky National commissariat of health care was created that was of great importance for further improvement of the management 3. in the country. G. N. Kaminsky was appointed the first people's commissar of health care. To the direct jurisdiction Narkomzdrava the USSR transferred the largest highest medical educational institutions and in-you improvements of doctors, the enterprises chemical - pharm, and the medico-tool industry, a considerable part of research in-t, resorts of all-union value, medical - a dignity. institutions on the water transport and some to lay down. - professional, and a dignity. - protivoepid. institutions. Creation of Academic medical council at Narkomzdrava the USSR facilitated planning and the leadership in all research in medical institutions of the country. Uniform forms and methods a dignity were entered. - the statistical account and the reporting. Planning 3 improved. in allied scale (see. Planning of health care ), considerable development was gained by the sanitary legislation (see). Development of general provisions, standards and methodical recommendations of activity to lay down was of great importance. - professional, and a dignity. - protivoepid, institutions.
Essential changes to the organization of medical aid were made the order by Narkomzdrava the USSR and the All-Union Central Council of Trade Unions of August 4, 1938. «About improvement of work of institutions of the extra hospital help and measures for decrease in incidence», the Crimea was established the local and territorial principle of the extra hospital help (see), the structure and function of each type of establishment of the extra hospital help are defined and duties of all categories of medics are specified.
By the end of 1936 the number of hospital beds in the USSR increased in comparison with 1913 almost by 3 times, number of doctors — by 4 times. Considerably the network of institutions of the extra hospital help in federal republics, napr, in RSFSR — 5,9 thousand instead of 0,9 thousand in 1913, in USSR — respectively apprx. 1,8 thousand instead of 187 grew. For the same period the number of out-patient and polyclinic institutions grew in Georgia by 30 times, in Turkmenistan — by 20 times. The number of stations of ambulance increased in the country to 456 (in 1931 — 154). If in 1914 the number of beds in maternity homes made 5,5 thousand, then in their 1936 became apprx. 33,4 thousand. Contrast among nurseries and clinics for women is especially striking: in their 1913 was 9, in 1931 — apprx. 2,5 thousand, in 1936 — apprx. 4,0 thousand. The number of places in a children's day nursery in 1913 did not exceed 550, in 1936 in a constant and seasonal day nursery there was a St. 3,7 million places.
Profound changes in life of the country found reflection in the Constitution of the USSR adopted on December 5, 1936 at the VIII Extraordinary congress of Councils. The constitution sealed a clear victory of a socialist system, the main social gains of workers — the right for work, rest, the eight-hour working day with its reduction at heavy and especially severe conditions, right to maintenance on an old age and on a case of a disease, free medical aid, social insurance at the expense of the state.
In March, 1939 the XVIII congress approved the third five-year development plan for the national economy. The plan provided to lay down further improvement of working conditions and life of the Soviet people, growth of network. - professional, and a dignity. - protivoepid, institutions and security of the population with medical assistance, including specialized. By 1941 the country had wide network stationary, out-patient and polyclinic and a dignity. - protivoepid, institutions, institutions of protection of motherhood and the childhood, enormous army of doctors and average medics. Mortality decreased to 18,0 for 1000 zhit., incidence of infectious diseases considerably decreased. Huge successes were achieved in development 3. federal and autonomous republics.
For short historical term in the USSR the modern material and technical resources 3 were created., the large number of doctors and average medics is trained, the medical industry is created, the medical science gained development: on the basis of the progressive, advanced principles for the first time in the world the system socialist 3 is constructed., capable to provide need of all population for the qualified medical aid, in preventive a dignity. - protivoepid. measures.
Health care in days of the Great Patriotic War (1941 — 1945). The treacherous attack of Hitlerite Germany to the Soviet Union interrupted peaceful socialist construction and forced to turn all resources of the country on achievement of a victory over fascism. «All for the front, all for a victory!» — this appeal of Party became the program of fight of the Soviet people for honor, freedom and independence of the Homeland. In the shortest possible time new divisions formed and equipped, the industry, transport were reconstructed for satisfaction of needs of the front. From the front and threatened districts in vost. districts of the country of the enterprise of the medical industry, the huge number of the state and collective-farm property, medical educational institutions, research in-you was evacuated the St. 1300 large industrial enterprises, including, to lay down. - professional, institutions, millions of Soviet citizens. With unprecedented speed on new places the plants and factories were developed, acreage were expanded, everything became to provide all necessary army, to stop the enemy, to save the Homeland from danger of death.
The powerful contribution to business of a victory over the enemy was made by the Soviet physicians. Return of St. 72% of wounded and 90% of patients, a low lethality among wounded, prevention of epidemics in field army — results of activity of the Soviet military, unprecedented in the history of wars, 3 are that. If to consider that the number of wounded and patients in days of the Great Patriotic War was estimated in millions, becomes clear that the medical service was the main supplier of reserves for field army.
Progress of the military 3. were result of dedicated, really heroic work of the Soviet physicians and outstanding achievements Soviet the soldier. - medical sciences. On the basis of the deep scientific analysis of previous experience by the beginning of the Great Patriotic War original positions of military medicine were reconsidered and strictly scientific, corresponding to the reached level of military art and features of war system medical and evacuation, a dignity is created. - a gigabyte. and protivoepid. providing field army (see. Meditsina military ).
In a basis of system of the organization of treatment of wounded and patients, and also preventions of complications the uniform field medical doctrine developed by outstanding scientists of the country under the leadership of the chief of the Head military and sanitary department of Red Army E was put. I. Smirnova. This doctrine provided a combination of treatment and evacuation of wounded and patients. Well-known negative influence of evacuation on the state of health of wounded and patients. In overcoming such influence unanimity of views on an origin, a current and treatment of pathological processes was established by the doctrine that allowed to perform successive treatment at all stages of evacuation by the uniform evidence-based and acceptable in field conditions techniques. Thereby inevitable harm from use of different techniques of treatment in relation to the same wounded or the patient at various stages of medical evacuation was prevented. The failure from groundless evacuation and its reasonable restriction following from a being of the doctrine had not smaller value.
For the first time in the history of domestic medicine on the basis of stage treatment with evacuation the accurate system of rendering specialized medical aid in the relevant pro-thinned-out hospitals was to destination carried out (see. the Specialized help, in field conditions ). The harmonious system of treatment lightly wounded, providing their hospitalization on site, i.e. in army and front districts was developed and quickly implemented, and also complex treatment using the latest surgical methods and pharmaceuticals in combination with to lay down. physical culture, work therapy, physical therapy and use of climatic factors.
Creation of therapeutic hospitals, and also therapeutic departments in surgical evakogospitalyakh and hospitals for lightly wounded arranged system of treatment of patients, the Crimea in last wars due attention was not paid. The most strict system protivoepid, actions, including creation protivoepid, barriers between the front and the back, systematic observation for early detection of infectious patients with their immediate isolation, regular a dignity. processing of troops, use of effective vaccines etc., yielded striking results.
To understand a huge contribution of physicians to preservation of epidemiological wellbeing of troops in the period of the Great Patriotic War, it is necessary to remember that mass epidemics in the past were always constant satellites of wars. Losses from infectious diseases, as a rule, exceeded losses by wounded. World War II, unknown on the scales, which was followed by devastation of huge territories and mass migration of the population, apparently, created premises for distribution of mass epidemics, but they were not allowed.
Military 3., being a component of Armed Forces, at the same time is also an integral part civil 3. Therefore, all achievements of theoretical and scientific and practical character civil 3. were implemented in practice of treatment of the wounded contused, burned and patients, certainly, taking into account the nature of war and the developing fighting situation in each case.
As a result of the wide-ranging studies undertaken as in pre-war years, so especially in the course of the war, and also systematic observations and scientific generalizations the new principles and methods of treatment of wounded and patients which kept the relevance about one today were defined. In the course of war to lay down. - professional, and protivoepid. actions were continuously improved. The created system of institute of chief specialists of fronts, armies, evacuation centers working under the leadership of military-medical organizers played a crucial role on distribution of the best practices and the last scientific achievements. Plenums of Academic medical council at the chief of the Head military and sanitary department, plenums of Hospital council of the National commissariat of health care, numerous front and army conferences also promoted public awareness of the best practices. It is characteristic that Academic medical council gathered in the very first days of war. For the first time in the history of our fatherland doctors had an opportunity to be guided in the practical work as the uniform installations which are based on the last achievements of medical science. Scientific search in large scales was carried out as in scientific institutions, and directly in MSB, field and evacuation hospitals. Experience of military medicine in the course of war was widely covered in periodicals. According to incomplete data, for years of war the St. 12 thousand works on military medicine was published. All this positively affected activity of medical service and allowed medics to achieve so outstanding progress, thereby having passed difficult examination on a maturity, ability in incredibly difficult conditions to fulfill the holy duty.
Mass heroism of medics, their dedicated work, the perfect organization of their activity constructed on scientific bases, providing medical service with necessary equipment and pharmaceuticals, and also close interaction with bodies civil 3. allowed the soldier. - medical service with honor to fulfill the military duty and to make an essential contribution to a victory of the Soviet people.
Experience of war with all persuasiveness proved correctness of basic bases on which the Soviet medicine in general and the Soviet military medicine in particular was created, under construction and developed. Health workers saved life and recovered health to many millions of defenders of the Homeland. Not accidentally, handing a gold Medal of Hero of Socialist Work to the chief surgeon of Red Army of the academician of H. N. Burdenko, M. I. Kalinin told: «This rewarding means that medical care of our Red Army costs in the same row with aviation, artillery service that health workers in the ranks of army are as necessary as fighters and commanders». More than 115 thousand soldier. - medical workers were awarded by awards of the Soviet Union, including the Order of Lenin — 285, an award of the Red Banner — more than 3550. The highest award — ranks of the Hero of the Soviet Union — were awarded 44 military physicians (see Physicians — Heroes of the Soviet Union).
From the first days of war the best efforts were directed to the front. Bodies civil 3. at sharply reduced opportunities had to provide successful treatment in evakogospitalyakh Narkomzdrava of wounded and sick soldiers, keep a dignity. - epid, wellbeing of the back to preserve work of workers and collective farmers the, including women and teenagers who replaced the husbands and fathers who left on the front, to establish strict medical supervision of the evacuated children, to create medical - a dignity. service at divisions of MPVO.
Providing dignity. - epidemiol, wellbeing of the front and the back becomes the major nation-wide task. The people's commissar of health care of the USSR G. A. Miterev was appointed the representative of the State Committee of Defense on protivoepid, work that allowed to concentrate all actions for fight for prevention of epidemics in hands of uniform body. In February, 1942 the State Committee of Defense planned actions for the prevention epid. diseases in the country. On May 22, 1942 Narkomzdrav of the USSR issued the order «About Anti-epidemic Work of City Policlinics and Out-patient Clinics and Strengthening of Local Territorial System of Medical Care of Urban Population». All medical workers undertook to see off protivoepid, work, attracting to the aid the population, trade-union and other public organizations. Work of local network was reconstructed and went to the prevention epid, diseases. Medics of sites regularly carried out household bypasses, immediately hospitalized the patients with infectious diseases, carried out a dignity. processing of the center. The huge attention was paid to the general a dignity. to supervision, fight for purity, strengthening of bathing and disinfection service.
In the districts of the country freed after temporary occupation by fascists a large number of patients with infectious diseases, especially a typhus, malaria, intestinal and children's infections came to light. Fight against epidemics in these districts was developed at once after the introduction of parts of the Soviet Army, and a dignity. - epid, the state them, as a rule, quickly improved.
Practice showed that in the conditions of the socialist state at the correct holding necessary anti-epidemic actions (see) it is possible to prevent development mass epid, diseases even in the most severe military conditions.
Ensuring smooth operation of the industrial enterprises in many respects depended on decrease in incidence and traumatism among working. At many defense enterprises MSCh were created, the network of out-patient clinics, policlinics, BC, health centers, night and day sanatoria considerably extended. Creation of wide network of medical institutions and dedicated work of doctors, medical staff, a public asset provided systematic decrease in incidence and traumatism among the working industrial enterprises.
For years of war in a number of the republics the network of rural medical institutions increased, the specific weight of the rural medical sites having-tsami considerably increased. E.g., in the Uzbek SSR before war 39% of rural medical sites, and by 1945 — 81%, in the Kyrgyz SSR — respectively 32% and 58%, in the Turkmen SSR — 11% and 43% etc. would have. In the years of war inclusion in the highest and average medical educational institutions, continued to extend at the front and in the back scientists-physicians did not stop work.
Care of Party and Government of development of medical science was brightly shown in establishment in 1944 of the USSR Academy of Medical Sciences (see) which combined leaders research in-you. The first president of Academy elected H. N. Burdenko.
And difficult work on health protection and life of children was especially responsible. A large number of pupils of orphanages, kindergartens, a day nursery, children's homes, unorganized children was evacuated in depth of the country. Evacuation of children was carried out under the direct management of the State Committee of Defense. The evacuated children were provided at the expense of the state with food, clothes, footwear, the dwelling.
On an initiative of the trade-union and Komsomol organizations the public fund of the help to children was created. The St. 60 thousand orphans and children of veterans was directed to the means which came from workers to this fund only in 1943 in recreational the camp. At the expense of the state, trade-union and other organizations 1,5 million children, in 1944 — 2,5 million, in 1945 — apprx. 3,3 million were taken out to child care recreational facilities in 1943.
Set of the actions which are carried out in the state scale caused considerable achievements in the field of protection of motherhood and the childhood — for all years of war there was no little noticeable increase in incidence of children's infections. Expression of attention and cares to health protection of mother and child was the decree of Presidium of the Supreme Council of the USSR of July 8, 1944. «About increase in the state help to pregnant women, having many children and lonely mothers, strengthening of protection of motherhood and the childhood, about establishment of an honorary title «Mother heroine» and establishment of the award «Maternal Glory» and the medal «Medal of Motherhood».
Great scientific value had the edition according to the decision of the government of the multivolume work «Experience of the Soviet Medicine in the Great Patriotic War» which generalized outstanding achievements and observations of doctors, scientists and organizers 3.
As a result of joint efforts of military and civil bodies 3. in the most difficult military conditions unprecedented success in business of treatment of wounded and patients and preservation a dignity were achieved. - epid, wellbeing on fronts and in the back. Undoubtedly, this progress substantially promoted a victory of the Soviet people.
Development of the Soviet health care in 1946 — 1965. War made to the Soviet people a huge sacrifice and destructions. St. 20 million people died on fields of battles, are buried under ruins of the cities and villages, shot by fascists, tortured in Hitlerite concentration camps. Millions of people became disabled people, remained homeless. For years of war it was destroyed and plundered apprx. 40 thousand BCs, policlinics and other medical institutions. According to incomplete data, damage caused Soviet 3., it was estimated in 6,6 billion rubles.
In March, 1946. The Supreme Council of the USSR accepted the fourth five-year plan. The task to recover affected districts of the country, to reach pre-war level industrial and page was set - x. productions and then to surpass this level in considerable sizes; actions for further improvement of medical aid to the population, growth of number of hospital beds, network of women's and children's consultations, a children's day nursery, recovery of network of rest houses, sanatoria, increase in production of pharmaceuticals, medical tools and the equipment, etc. were provided. Overall appropriations for health care and physical culture by 1950 in comparison with 1940 were supposed to be increased by 2,6 times.
The important and repaid in the conditions of the recovery period organizational action would be merging of out-patient and polyclinic institutions with in uniform to lay down. - professional, institutions, carried out under the leadership of the Minister of Health of the USSR E. I. Smirnov. This association was made during 1947 — 1949. As a result the material and technical resources became stronger and indicators of activity of BC improved, however it is essential to strengthen extra hospital medical aid in a number of the cities it was impossible. It was connected with the fact that during merging of BC with policlinics some miscalculations were allowed (several policlinics would combine with one, the power of policlinics did not correspond to the power of BC, territorially remote institutions, etc. combined). Difficulties for work of doctors at the same time in polyclinic department and in a hospital came to light. However correctly organized merging of BC with policlinics promoted upgrading of the extra hospital help, the best use of medical institutions, succession of the extra hospital and stationary help, professional development of the doctors working in out-patient clinics and policlinics.
Serious changes in the first post-war years happened in rural 3. Along with further growth to lay down. institutions and increase in number of doctors the system of the organization of specialized medical aid to country people began to develop. In 1947 the order of the Ministry of Health of the USSR «About structure and standards of lechebnoprofilaktichesky institutions in the rural centers and standard states of medical personnel of rural district police officers and regional hospitals» was issued. Installation on reorganization of out-patient local institutions in hospital was taken, merging of regional BCs with others regional to lay down. - professional, institutions, providing them with specialists doctors and the modern medical equipment. In short terms in all regional departments on 5 main specialties would be created. In April, 1949 the I All-Union meeting on medical service of country people emphasized value in rural 3. regional hospital (see), edges, except rendering highly skilled to lay down. the help to the population, shall be the advisory and organizational and methodical center for upgrading of work of regional institutions 3. By 1950 in 99% the rural regional centers of the country would be created; only from 1947 to 1950 the number of doctors (without tooth) in rural medical institutions increased more than by 9 thousand. Development of specialized medical aid promoted elimination of distinctions in medical aid to urban and country people.
In high gear developed a dignity. - epid, service. In 1946 in the USSR a dignity. - epid, stations was twice more, than before war, in a dignity. - protivoepid. institutions the St. 88,5 thousand persons worked. Work on a dignity amplified. to protection of sources of water supply, air basin, soil, approval of bodies 3. projects of industrial and civil engineering. In 1948 the new nomenclature a dignity was approved. - protivoepid, institutions.
For further improvement of training of doctors in 1945 in medical in-ta the 6-year term of training was established, curricula and programs are revised, the practical orientation of training is strengthened, measures for strengthening of the faculty are taken.
As a result of successful performance of tasks of a five-years period by 1950. The Soviet state not only quickly recovered, but also considerably exceeded indicators 3. 1940.
By 1950 the number of doctors reached 265 thousand, paramedical staff — more than 719 thousand, quantity of hospital beds — apprx. 1011 thousand, the release of medical products in the country several times increased.
Recovery and development 3., along with other social and economic actions, affected improvement of indicators of public health: in comparison with 1940 the general mortality decreased twice (to 9,7 by 1000 people of the population), child mortality more than twice (81 on 1000 been born live), infectious incidence was many times over reduced.
The XIX congress of the CPSU accepted directives according to the fifth five-year plan (1951 — 1955) in which, in particular, it was offered to increase number of hospital beds not less than by 20%, number of places in sanatoria — for 15%, in rest houses — for 30%, in a children's day nursery — for 20%, in kindergartens — for 40%; to increase number of hospital beds on the Lithuanian SSR by 40%, across the Latvian and Estonian SSR — for 30%.
For years of the fifth five-years period the Soviet scientists-physicians made and implemented in practice many valuable discoveries. In particular, were developed and surgical methods of treatment of heart diseases began to be applied successfully, work on elimination of malaria as mass disease is complete. New m were offeredetoda of conservation of blood, original blood substitutes, vaccines and serums for prevention and treatment of infectious diseases, etc.
Due to the further expansion of the rights of federal republics were transferred to their maintaining medical in-you, in-you improvements of doctors, resorts, sanatoria and other institutions.
The XX congress of the CPSU (February, 1956) approved directives according to the sixth five-year plan. Problems of development 3. in the light of decisions of the XX congress of the CPSU were discussed on the All-Union asset of workers 3., the report on Krom was made by the Minister of Health of the USSR M. D. Kovrigina. Realizing the program of further development planned by a congress 3., medical in-you trained St. 100 thousand doctors, by 1960 their number in comparison with pre-revolutionary 1913 increased more than by 15 times, the number of hospital beds increased by 8,4 times (for years of the sixth five-years period annual mean increment made 90,4 thousand beds). In 1955 in the country there was already St. 334 thousand doctors, apprx. 1 million paramedical staff, nearly 1,3 million beds in-tsakh. In the mid-fifties on an initiative of bodies of health care of Altai Krai and the Moldavian SSR carried out reorganization of management 3. in rural districts: regional departments 3. were abolished, and all organizational functions connected with the management of institutions 3., would be transferred regional. The chief physician regional would become the chief physician of the district.
Among the social actions which are of great importance for 3., it should be noted acceptance by the Supreme Council of the USSR on July 14, 1956 of the law «About the State Pensions», according to the Crimea the size of pensions considerably increased and the age of the workers and employees receiving old-age pension, and also the Decree of Presidium of the Supreme Council of the USSR of March 26, 1956 about increase in duration of maternity leaves from 77 to 112 calendar days decreased. During this period the international cooperation of the USSR in the area 3 amplifies.
From January 27 to February 5, 1959 there took place the extraordinary XXI congress of the CPSU. The seven-year plan (1959 — 1965) approved by a congress provided further development Soviet 3. On January 14, 1960 the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of medical care and public health care of the USSR» was accepted. For providing the population with highly skilled specialized medical aid in the resolution the task to build in the cities large-tsy with power not less than 300 — 400 beds, and in big cities — on 600 and more beds, to carry out integration of rural regional BCs to 200 and more beds and to provide them with the modern medical equipment, to stop construction of rural local BCs less than on 35 beds was set. In the resolution questions of preparation of medical shots and their improvement figured prominently. For professional development and the correct use of medical shots the system of certification of doctors was entered. In the resolution measures for further decrease in incidence, first of all were planned by infectious diseases, ways of increase in production of medicines, etc. were specified. The tasks of research of new effective remedies of prevention and treatment of the most widespread diseases were set for medical science. The solution of these tasks became a basis of activity of M3 of the USSR headed then by S. V. Kurashov.
A historical event in life of our country was the XXII congress of the CPSU which was taking place in 1961. The congress adopted the new Program of the CPSU — the program of construction of communistic society. In the Program the task to completely satisfy needs of urban and country people with all types of highly skilled medical aid, to considerably expand network of medical institutions, rest houses, boarding houses, country hotels and tourist centers, to capture all population medical examination is set. Special attention is paid to expansion in the city and the village of network of institutions on health protection of mother and child. In the Program it is emphasized that performance of the main objectives on protection of national health is provided not only special medical events, but also not less important for preservation and promotion of health of the people social and economic and a dignity. - a gigabyte. actions.
During this period the increasing value was gained by problems of specialization of medical aid. Would be created by more intensive rates specialized and departments of multi-profile hospitals, specialized offices in policlinics, the centers on the basis of clinics and scientific research institute; in medical in-ta for the benefit of a profiling and specialization on osn. to medical disciplines the subinternship is entered.
Health care during construction of the developed socialist society (1965 — 1977). Present stage of development 3. passed under the influence of the largest political and economic actions of the Communist Party. The graphic evidence of monolithic unity of party, fidelity to its Lenin principles of inner-party democracy and collective leadership were decisions October (1964) Plenums of the Central Committee of the CPSU. In decisions of the Plenum it was indicated the need of increase in responsibility of heads to masses, specific measures for elimination of subjectivity, administration, further improvement of forms and methods of the leadership in economic and cultural construction were stated.
The outstanding role in further development of national economy was played by decisions of March and September (1965) plenums of the Central Committee of the CPSU. The CPSU of comrade of JI accepted by a March Plenum according to the report of the Secretary general of the Central Committee. And. Brezhneva the agrarian program largest in the history promoted steady rise in agriculture, growth of culture and technical armament of page - x. productions, to increase in material well-being of the people, further deleting of sides between the city and the village.
Bystry development of productive forces of the country, increase in level of management and planning by all industries of the national economy, growth of interest in results of work of staff of the enterprises and each certain worker, development of welfare actions, housing construction, considerable rise in welfare of the Soviet people were result of a September (1968) Plenum of the Central Committee of the CPSU.
Incentive of further progress 3. there was the XXIII congress of the CPSU. Directives of a congress by the five-year development plan for the national economy of the USSR for 1966 — 1970 provided further strengthening and expansion of material and technical resources 3. and medical sciences, upgrading, development of specialized types of medical aid.
Decisions XXIV and XXV of congresses of the CPSU in which the Program of the world and the program of social and economic development found reflection are imbued with spirit of Lenin humanity, care of welfare, life and happiness of the people of the whole world and the future generations, the main directions of further construction of communism are developed. These historical decisions defined ways of further construction 3. in the period of developed socialist about-va.
In 1965 the main tasks of the seven-year development plan 3. were executed. By this time the powerful material and technical resources 3 were created. and medical sciences, allowed to achieve considerable progress in business of health protection of the Soviet people.
For years of a semiletka in the country it was in addition developed apprx. 700 thousand beds, the number of doctors increased by 166 thousand and made 554,2 thousand people in 1965, security of the population with medical shots increased with 18,6 in 1958 up to 23,9 doctors on 10 Ltd companies zhit. in 1965, the release of medicines and the equipment increased by 2,7 times. The general was reduced (to 7,3 by 1000 people) and especially child mortality (to 27,2 on 1000 been born live).
The decree of Presidium of the Supreme Council of the USSR of December 10, 1965 established the holiday «Day of the Health Worker» which is celebrated annually over all country on the third Sunday of June.
Fighting for the further upgrading of medical aid to the population, M3 of the USSR directed by B. V. Petrovsky develops and implements the most rational and evidence-based forms of the organization of specialized medical aid.
Growth of economic power of the country and welfare of the population, high rates of development of socialist production and increase in its efficiency, scientific and technical progress defined new tasks 3. also created favorable conditions for considerable strengthening of its material and technical resources, the basic transformations promoting further upgrading to lay down. - professional, the help and a dignity. - a gigabyte. providing population. The main objectives set by party before 3. on the eighth; and the ninth five-years periods, is a high quality of medical aid, effectiveness and efficiency of the preventive measures promoting decrease in losses of operating time, increase in level of health and active longevity; providing population with all types of specialized medical aid; creation large equipped with modern appliances and staffed by highly qualified specialists multi-profile and specialized to lay down. - professional, institutions; expansion of functions and competences dignity. supervision, especially in the area a dignity. protection of objects of the environment; rapprochement of levels of medical aid to urban and country people; further improvement of system of health protection of women and children and working industrial enterprises. These tasks were accurately formulated in decisions XXIII and XXIV of congresses of the CPSU, the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of health care and development of medical science in the country» (1968), «Bases of the legislation of USSR and federal republics about health care» (1969) ^ and others the major for 3. party and state documents.
In 1967. The Supreme Council of USSR adopted the decree on formation of the all-union Ministry of the medical industry (see), the enterprises producing pharmaceuticals and the medical equipment, state farms on cultivation of medicinal plants and a number of the scientific and design organizations were transferred to Krom. For further development of the medical industry the Council of ministers of the USSR adopted the resolution «About Development of the Medical Industry in 1967 — 1970» in August, 1967. In it specific objectives were determined by growth of capacities of production of antibiotics, vitamins, synthetic chemical - pharm, drugs, main types of the medical equipment.
Basic value for further development Soviet 3. had consideration on the IV sessions of the Supreme Council of the USSR of the question «About a Condition of Medical Care to the Population and Measures for Improvement of Health Care of the USSR» and adoption on July 5, 1968 of the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of health care and development of medical science in the country». The resolution obliged the Central Committee of communist parties and councils of ministers of federal republics, marginal and regional party and Soviet organs, M3 of the USSR, and also others of mines-va and department to develop and carry out actions for improvement of work of medical institutions and increase in responsibility for further improvement of medical aid and public health care. The main objectives standing before Soviet 3 were specified in the resolution. during the developed construction of communism. An event of huge political importance, new expression of care of Lenin party of health protection of the people was acceptance by the Supreme Council of the USSR on December 19, 1969 of the law «About the Statement of Bases of the Legislation of USSR and Federal Republics about Health Care» (see the Legislation on health care).
[[ File: | thumb | alt = the President of the USSR Academy of Medical Sciences academician V. D. Timakov opens for zdravoohranenie16.jpg the session of the USSR Academy of Medical Sciences. | the President of the USSR Academy of Medical Sciences academician V. D. Timakov opens the session of the USSR Academy of Medical Sciences. ]]
March 26, 1971. The presidium of the Supreme Council of the USSR approved the Oath of the doctor of the Soviet Union (see).
Carrying out outlines of party and the government, the Soviet physicians successfully performed a task of the eighth five-years period. The number of hospital beds increased almost by 20% and reached 2663,3 thousand, doctors — for 20,6% and were reached by 668,4 thousand, average medics — almost for 25% and were reached by 2123,0 thousand. There was an integration of city and rural BCs. So, the number of the regional BCs having St. 600 beds made in 1970 41,1% instead of 16,9% in 1960, the city, having more than 260 beds — respectively 26,3% instead of 15,8%, regional BCs with power more than 200 beds — 26,8% instead of 4,8%. In a number of the cities are constructed large-tsy ambulance. Considerably the network of out-patient and polyclinic institutions grew and became stronger, the level of extra hospital medical aid increased, the coverage of the population dispensary observation extended. The quantity of MSCh at the industrial enterprises increased for 37,8%, number of beds in them — for 58,1%, shop medical sites — for 90,1%. Considerably the base rural 3 became stronger.: in institutions of the USSR M3 system in 1971 medical aid to country people was rendered 188 regional (regional, republican), 3,7 thousand central regional and regional BCs, St. 11 thousand district police officers of BC, more than 2,7 thousand rural medical out-patient clinics and apprx. 90 thousand medical assistant's and medical and obstetrical centers. In 1967 — 1970 30 thousand graduates of medical in-comrade were directed to work to rural areas. For years of the eighth five-years period specialization of medical aid extended, the material and technical resources 3 became stronger., grew a dignity. - epid, service. Considerably the number increased to lay down. - the prof. of institutions for women and children, supply of medical institutions and the population with medicines improved.
The XXIV congress of the CPSU (1971) developed the program of further economic development of our country, powerful raising of all industries of the national economy, increase in material well-being and cultural level of workers, improvements of working conditions, life, protection and strengthening of health of the Soviet people.
As comrade L. I. Brezhnev said in the report at the XXIV congress of the CPSU, «The next five-years period shall become in this respect a big stride forward and at the same time lay the foundation for even more considerable achievements in the future» (L. I. Brezhnev. «A Lenin course», t. 3, page 254).
According to Directives of the XXIV congress of the CPSU preventive direction Soviet 3. gained further development. In December, 1972 the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of nature protection and rational use of natural resources» was issued. For years of the ninth five-years period events for improvement a dignity were held. conditions of the inhabited places. Since 1971 actions for environmental control (see) join in economic plans of federal republics as its obligatory part. A row a gigabyte is developed. the standards and GOST guaranteeing a dignity. protection of sources of water supply, the air basin, soil, and also directed to further improvement of working conditions at the industrial enterprises. On the basis of the new situation approved in 1973 about state a dignity. supervision in the USSR events for its improvement and specialization, strengthening of organizational bases and material and technical resources a dignity are held. - epid, services.
Synthesis to lay down. and a disease-prevention service brought a dispensary method of service to the first place. Construction of large multi-profile and specialized BCs continued. In 1971 — 1975 60 BCs on 600 — 1000 and more beds are constructed, in 1977 tens of such BCs were in a stage of construction.
Construction of a row large to lay down. - by the prof. of institutions it was carried out at the expense of the means received from communistic community work days. Only on construction of children's policlinics, multi-profile BCs, clinics at pediatric f-takh of medical in-t, children's sanatoria, maternity homes and obstetric ginekol, scientific center St. 360 million rubles were allocated. At the expense of the means earned by workers from Lenin community work days also construction kardiol is carried out. and onkol, scientific centers, therapeutic and kardiol. cases of the operating large BCs. The bed fund in the country is increased by 346 thousand beds and made St. 3 million by the end of 1975; security of the population with the stationary help reached 118 beds on 10 000 zhit. against 109 in 1970; the number of the regional BCs having more than 600 beds reached 60,2%, the city, having more than 200 beds — 30,3%, regional (rural districts), with power more than 200 beds — 34%.
The ninth five-years period was marked by further development of the out-patient and polyclinic help. At the construction plan of out-patient and polyclinic institutions on 402 thousand their visits per shift more than on 560 thousand visits is entered for a five-years period. Twice construction of new policlinics increased. The number of therapeutic sites in policlinics grew. The number of visits of out-patient and polyclinic institutions made in 1975 St. 2 billion a year.
Further development was gained by specialized types of medical aid. In the country the wide network of the specialized centers and departments — cardiology, oncology, vascular surgery, resuscitation, pulmonology, endocrinology, allergology, hematology and hemotransfusion, gastroenterology, urology, hyperbaric oxygenation, etc. is organized. In rural areas for approach of the medical out-patient and polyclinic assistance to the population development of medical out-patient clinics and policlinics is carried out. For years of the ninth five-years period their number increased almost for 40%. With the same purpose, especially in districts of distant-pasture livestock production and hardly accessible districts, mobile out-patient clinics and specialized medical offices are used. Policlinics of the central regional BCs are considerably strengthened. All highly specialized help is concentrated in policlinics of regional, regional and republican BCs, interdistrict specialized departments are created (see. Specialized help).
The solution of a problem of universal providing the population with all types of the specialized help is promoted in many respects by reform of the higher medical education. The essence of reform consists in a profiling of graduates to lay down. and pediatric f-tov with the subsequent one-year training (internship) on the chosen specialty — therapy, surgery, obstetrics with gynecology, psychoneurologies, pediatrics, infectious diseases of children's age and children's surgery (see the Internship, Medical education). From 1965 to 1975 the number of doctors of all specialties increased from 554,2 up to 834,1 thousand and security on 10 000 people of the population with 23,9 to 32,6, and for 1971 — 1975 the number of doctors increased by 165,7 thousand. In one other country of the world there is no such number of doctors, as in the USSR. The number of paramedical staff reached 2,51 million people by the beginning of 1976, or 98,4 on 10 000 zhit., while in 1965 the number of paramedical staff made 1,69 million people, or 72,8 on 10 000 zhit. (see Health care workforce).
The system of emergency medical service extended and improved. Only for 1965 — 1975 the number of stations of fast and acute medical aid increased by 1,4 times, in rural areas — by 4 times. Further development was gained by the organization of specialized medical crews of emergency medical service (infarctive, shock, children's, etc.). The organization of the BC of emergency medical service joint with stations became a recent trend; by 1976 60 such BCs functioned. It allowed to improve rendering the emergency medical aid to the population, to expand its volume and quality (see. Fast and acute management). The material resources of blood transfusion stations became stronger (see), the volume of preparation of blood doubled. Further development was gained by sanitary aircraft (see). The powerful network of intensive care units is organized (see. Intensive care unit, Resuscitation).
For years of the ninth five-years period the network medical and pharm, in-t and f-tov extended: it is open Central Asian medical pediatric for in-t, it is organized 8 new f-tov medical in-t, and also a number of departments in the most important directions of medical science. Considerably the material resources of the highest and average medical educational institutions became stronger (see. Medical institutes, Medical schools, schools).
By 1975 reform of the higher medical education is fully complete. It meets the requirements modern 3. in increase in level of training of doctors. For increase in level of training of students programs of teaching medicobiological, clinical, special preventive disciplines are significantly improved. Teaching physics, chemistry, biology is conducted with big, than earlier, a medical bias.
In the country the network of research institutes (see) which collectives carry out scientific research on various urgent problems of medical science continued to extend and be improved. Only in 1971 — 1975 16 scientific institutions are created, including. All-Union scientific research institute of eye diseases in Moscow, Ying t of physiology of the Siberian branch USSR Academy of Medical Sciences, branches. All-Union scientific research institute of clinical and experimental surgery in Tashkent and Yerevan, Ying-that food of the USSR Academy of Medical Sciences in Alma-Ata, All-Union scientific research institute of hygiene and toxicology of pesticides, polymers and plasts in Yerevan. In 1976 in system 3. functioned St. 400 scientific institutions, the St. 74 thousand scientists worked. The main efforts of scientists-physicians were directed to the solution of problems of fight against cardiovascular, oncological and viral diseases, development of questions of medical genetics, creation of new physiologically active drugs etc. For development of urgent problems of medical science and use of scientific achievements in practice of 3. the big group of scientists was awarded the highest scientific awards. Only for 1971 — 1975 in the field of medicine 3 Lenin and 15 State awards were awarded (see. Lenin awards, State awards of the USSR).
Considerable funds in the ninth five-years period were allocated for resort service. In 1975 in comparison with 1970 they increased more than for 300 million rubles. Dignity. - hens. treatment and the organization of rest of the population figure prominently in a package of measures, directed to the prevention and decrease in incidence, on further increase in life expectancy of the Soviet people. In 1976 in sanatoria and rest houses it was treated and 32 million people had a rest. It is 3 times more, than in 1970. In 1975 in the USSR there was a St. 2 thousand sanatoria and dispensaries, and also more than 7 thousand rest houses and boarding houses, recreation facilities, tourist centers.
According to the Resolution of the Central Committee of the CPSU and Council of ministers of the USSR of July 5, 1968 No. 517 in system 3. implementation of economic-mathematical methods and computer facilities and creation of automated control systems began (see) and processings of medical information at the allied, republican, regional and city levels. In 1971 — 1975 in the country 23 automated control systems and processings of medical information, including 13 systems in institutions of allied subordination are entered.
The specified actions allowed to increase during 1965 — 1975 the level of medical aid to the population, and efficient prevention became more reliable, level state a dignity increased. supervision. Average life expectancy of the Soviet people reached 70 years for all population and 74 years — for women (1971 — 1972).
As a result of improvement of living conditions of the people, and also thanks to achievements Soviet 3. and medical sciences in the USSR are noted considerable progress in fight against infectious diseases. Only for 1965 — 1974 incidence of diphtheria decreased by 18,5 times, poliomyelitis — by 2,6 times, whooping cough — by 6,7 times, to a bark — almost by 6,2 times, a typhoid — by 1,3 times, scarlet fever — by 1.6 times. Incidence of such infections as diphtheria, poliomyelitis, malaria, makes isolated cases and is almost close to elimination.
Implementation of Lenin national policy provided rough blossoming of the national economy, science, culture and 3. in all federal republics, especially in those which in the past were backward suburbs of imperial Russia. It is known that medical aid to indigenous people of these suburbs then practically did not appear. Now there is an extensive network of medical institutions, a highly qualified national personnel of medics grew, large scientific centers are created.
Implementation of a Lenin foreign policy, the Program of the world adopted by the XXIV congress of the CPSU exerts a great influence on development of international relations in the field of medical science and 3. The international cooperation in the area 3 extends.: the Soviet specialists actively participate in the international and national medical congresses, symposiums, conferences, WHO sessions, scientific exchange, interinstitute cooperation, the conclusion of contracts on the international cooperation widely practice in area 3. and medical sciences. Regularly held meetings of Ministers of Health of the socialist countries became important form of cooperation. In 1975 SEV are created the Constant commission on cooperation in health care and Public health department of the Secretariat of SEV. Cooperation with developing countries in which more than 1000 Soviet medical specialists work amplifies. Successfully scientific bonds with the USA, France, Great Britain, Italy, Finland and other countries develop. Positions of the USSR in World Health Organization became stronger (see).
The responsible tasks are set for the Soviet health care and medical science the XXV congress of the CPSU. In the tenth five-years period development and improvement of material resources 3 is planned. on the basis of a rational combination of building of multi-profile and specialized medical institutions (see Hospital, Hospital construction). It is planned to bring by 1980 total quantity of hospital beds approximately to 3,3 million, and security with hospital beds on 10 000 zhit. to 125. The close attention is paid to the out-patient and polyclinic help taking into account its maximum approach to the population, development of the local principle not only in the cities, but also in rural areas in this connection it is planned to expand construction on an outpatient basis - polyclinic institutions and drugstores. Special attention will be paid to improvement kardiol. and onkol, help to the population. The endocrinology, psychiatry and neurology, stomatology, ophthalmology and many other types of specialized medical aid will gain further development.
Production of the medical industry will increase for 44 — 46%. It is necessary to provide creation and development of serial production of St. 200 new highly effective medicines, the automated unified electronic devices and devices for mass medical inspections of the population, improvement of diagnosis of diseases and treatment of patients. Considerably the production of synthetic hormones, insulin, finished pharmaceutical products for children, endocrine and X-ray contrast agents will increase.
Further actions for improvement of the accident prevention and labor protection are provided in decisions of the XXV congress (see). If to consider that in the USSR the level of operational injuries and occupational diseases one of the lowest in the world, then it demonstrates continued, consecutive care of party of the benefit and strengthening of health of workers once again. Exclusive importance should solve problems in the tenth five-years period also to rural physicians. Development and integration of regional and central regional BCs, strengthening of their material and technical resources and searches of forms of the maximum approach of the specialized help to the rural toiler will be continued. At the same time the important place will be taken by expansion of network of medical, rural out-patient clinics (see) and medical and obstetrical centers (see).
Among the main social and economic objectives of the tenth five-years period it is paid to protection of motherhood and the childhood much attention (see). It is planned to carry out a number of new actions in this area, including providing to women partially paid issue for care of the been born child before achievement of one year by it, improvement of working conditions and life of the working women, expansion of network of preschool institutions, schools and groups with prolonged in the afternoon, improvement of medical aid in them. Also further development of the industry making products of baby food is provided. Expansion of volume and improvement of quality obstetric ginekol, and pediatric a spetsia is plannedlizirovanny help in the cities and rural areas. The considerable sums will be assigned on construction of standard children's policlinics on 300 — 500 visits per shift, multi-profile children's BCs on 420 beds, infectious — on 240, maternity homes — on 250 and 130 beds.
Further development will be gained by a dignity. - epid, service. Work on improvement of a control system a dignity is planned. - epid, service and to strengthening of its material resources, development of new methods and means of fight against emissions of harmful substances in the atmosphere, production, transport and other noise, vibration, influence of electric and magnetic fields and radiations. Not less than 11 billion rubles will be spent for environmental control in the tenth five-years period.
Also big tasks are set for scientists-physicians in the tenth five-years period. Special attention is paid on fundamental theoretical problems, on strengthening of researches in the field of molecular biology, physiology, biochemistry and immunology. The program of the main divisions of science included problems of endocrine, nervous and occupational diseases, researches in the field of improvement of working conditions and a balanced diet. Since 1975 began a gigabyte. and fiziol, researches of working conditions and the state of health of workers on construction of the Baikal-Amur Mainline.
In the center of attention 3. there will be questions of preparation, education and rational use of medical shots. Security with doctors will approach for years of the tenth five-years period optimum planned standards — 35,7 on 10 Ltd companies of the population, and average medics — 109,2 on 10 Ltd companies zhit. Due to the high level of security with shots of the Soviet medical institutions the main accent in training will be made on development of system of improvement of doctors and pharmacists.
In the tenth five-years period — a five-years period of efficiency and quality — the important direction in work of bodies and institutions 3. there will be a further increase in level and culture of medical aid, improvement of style of organizing work. The great value is attached to the proportional, balanced development 3. and its industries.
The program of social development and further rise in the standard of living of the people developed by the XXV congress the CPSU is systematically realized.
Huge social and political gains of the Soviet people found reflection in the new Constitution of the USSR (1977). Further development of socialist democracy is combined in it with care of growth of welfare and health protection of the Soviet people. The country constitution guarantees to all citizens the right to health protection, providing it with free medical aid, development and improvement of the accident prevention and production sanitation, measures for improvement of the environment, expansion of network of institutions 3. etc.; carrying out special safety arrangements and health of women, legal, material and moral support of motherhood and the childhood, including providing the paid issues and other privileges to pregnant women and mothers, gradual reduction of operating time of the women having juvenile children; material security in old age, in case of a disease, and also full or partial disability; right to housing, education, use of achievements of culture, etc.
The new Constitution of the USSR promotes the further growth of economic power of our country, blossoming of science, culture and 3., to preservation and promotion of health of the Soviet people.
New manifestation of care of the Communist Party and Soviet government about health of the Soviet people, the next step on implementation of decisions of the XXV congress of the CPSU was the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care», published on October 15, 1977, on the eve of the celebration of the 60 anniversary of Great October socialist revolution.
In the resolution it is noted that as a result of the deep social and economic transformations which happened in 60 years of the Soviet power, the national health care achieved outstanding successes.
At the same time it is noted that development of network to lay down. - professional, institutions, especially in the village, and also medical - a dignity. parts for employees of the industrial enterprises, the construction and transport organizations still lags behind the growing requirements. There are shortcomings of the organization of work of policlinics, BC, drugstores and other healthcare institutions. Work on coordination of scientific research, increase in their efficiency, implementation of achievements of science in practice of health care, to fuller satisfaction of need of the population and healthcare institutions in medicines,-point optics, the medical equipment, a dignity demands further improvement. and specialized motor transport, medical furniture, means small mekhanization.
The resolution planned the wide comprehensive program of measures for further improvement of protection of national health.
The central committee of the CPSU and Council of ministers of the USSR obliged the Ministry of Health of the USSR, councils of ministers of federal republics, the ministries and departments to concentrate attention on improvement of the organization of work of healthcare institutions, prevention of incidence and injury prevention, upgrading of medical aid, expansion of its specialized types, development of material and technical resources of health care, improvement of activity of scientific research institute and medical higher education institutions, widespread introduction in medical practice of achievements of science and technology, the best practices and the scientific organization of work, increase in vocational training and ideological and political education of medical shots.
The resolution it is entrusted to give to the Central Committee of the Communist Parties of federal republics, regional committees and regional committees of party, councils of ministers of federal and autonomous republics, krayispolkoma and regional executive committees, the All-Union Central Council of Trade Unions, the ministries and departments constant help to bodies of health care in problem solving, put before them, to provide efficient control of full use of the financial means and material resources allocated for development of health care and also of construction and timely commissioning of health care facilities.
The Central Committee of the CPSU and Council of ministers of the USSR obliged the ministries and departments of the USSR, councils of ministers of federal republics to increase insistence to heads of the industrial enterprises and construction organizations for performance a dignity. rules and norms for the purpose of the prevention of environmental pollution by emissions of firm, liquid and gaseous connections, behind respect for standards of intensity of noise on production and in life.
In the resolution actions for further development of the out-patient and polyclinic help to the population, expansion of use in policlinics and out-patient clinics of methods of recovery treatment, to development of cardiological service, improvement of the medicinal help are planned.
The resolution provided since 1978 the direction of the capital investments allocated for construction of facilities of health care, first of all for construction of out-patient and polyclinic institutions, maternity homes, nurseries, the central regional, large multi-profile and specialized BCs, for providing in 1981 — 1985 of commissioning of out-patient and polyclinic institutions on 630 thousand visits per shift, BC on 364 thousand beds and children's specialized sanatoria on 40 thousand beds. Construction new, expansion and reconstruction of the operating MSCh and policlinics for employees of the under construction and reconstructed enterprises due to the capital investments allocated for construction of facilities of production appointment is authorized since 1978, and at the operating enterprises construction to lay down. - professional, and pharmaceutical institutions at the expense of fund of welfare actions. It is provided also for strengthening of material and technical resources of out-patient clinics, regional and local BCs it is wider to use means of the enterprises, state farms and organizations.
In the resolution side benefits to district and rural doctors, doctors of fast and acute medical aid are established. The honorary title «The national doctor of the USSR» is founded, a cut it will be appropriated to the doctors who are the caused most a stir in work (see. Honorary titles ).
Structure and functions of bodies and healthcare institutions
Management 3. according to the Constitution of the USSR, constitutions of federal and autonomous republics carry out the supreme bodies of the government and state bodies of USSR, federal and autonomous republics, and also local councils of People's Deputies. Activity of state bodies pursues the aim to provide effective functioning of the medical institutions which are directly rendering to lay down. - the professional, and medicinal help to the population, and also carrying out the state dignity. supervision.
The direct organization of public health care is carried out by territorial and departmental authorities 3. Territorial authorities 3. extend the sphere of the activity to a certain administrative territory. Operating controls of system of Min-va of health care of the USSR belongs to their number: min.-va health care of federal and autonomous republics, regional, regional, city and regional public health departments. The specified bodies 3. and institutions subordinated to them, organizations and enterprises 3., research in-you, the highest and average medical and pharm, educational institutions and other institutions make uniform structure of health care of the USSR.
Departmental medical dignity. services provide carrying out to lay down. - professional, and a dignity. - a gigabyte. actions among workers of the separate industries of the national economy (e.g. - transport, civil aviation). Departmental bodies 3. are created as a part of the corresponding mines - in, but, directly submitting in operational and administrative activity to the relevant department, they are obliged to execute all orders and the methodical M3 installations of the USSR concerning questions to lay down. - professional, and a dignity. - protivoepid, works and also to coordinate the work with territorial authorities 3. (see. Medical and sanitary service of departments).
Organizational structure of public authorities and institutions 3. it is dictated by the tasks of public health care assigned to them. Structure of the office of bodies 3. it is constructed on the functional and production and industry principles. Structural divisions of functional type are urged to organize a certain type of activity: planning, financing, logistics, construction. Production and industry structural divisions direct homogeneous medical institutions or a certain industry 3. (to lay down. - professional, the help, a dignity. - protivoepid, providing, etc.). Concerning subordinate bodies and institutions subordinated to them they carry out all main functions according to the management of them, i.e. planning, financing, logistics, control and check of execution, selection and placement of personnel, rendering the organizational and methodical help etc. Creation of management personnel 3. on functional and production industry allows to provide to the principles the most qualified management on each site of work.
The organizational structure of M3 of the USSR and mines - in health care of federal and autonomous republics is defined by Council of ministers of the USSR and councils of ministers of the republics. Councils of ministers of federal republics approve also organizational structure of public health departments of executive committees of local councils. Concentration under the authority of these bodies of the questions connected with the statement of structure of bodies and institutions 3., provides stability and unity of their organizational creation.
The structure of central office of M3 of the USSR is presented on the scheme 1.
Min-va of health care of federal republics generally have similar structure. Min-va of health care of autonomous republics, regional (regional), and also public health departments of executive committees of the large cities usually have the following divisions: to lay down. - professional, the help to lay down. - professional, the help to women and children, planning and statistics, shots, etc. The chief physician of the corresponding SES is the deputy head of body 3. on a dignity. - epid. to questions.
In M3 the USSR and mines Vakh of health care of federal republics, regional and regional public health departments, and also in head departments of health care of Moscow, Leningrad and the Moscow Region are available established posts of chief specialists — the chief surgeon, the chief obstetrician-gynecologist, the chief pediatrician, the chief epidemiologist, the chief therapist, the chief radiologist (see. Chief specialist). Besides, there are non-staff chief specialists (the stomatologist, the traumatologist, the otorhinolaryngologist, etc.). Their tasks are the methodical management of specialized services, development and implementation of actions for development and improvement of specialized types of medical aid, vocational training and education of specialists of the corresponding profile, active implementation of new means and methods of prevention, diagnosis, treatment and rehabilitation.
The combination of one-man management in the management with joint discussion of the major questions is provided with existence of boards to mines Vakh of health care of the USSR, federal and autonomous republics, boards and medical councils in departments 3. local councils. The structure of board is approved by appropriate authority of the general competence (structure of board of M3 of the USSR — Council of ministers of the USSR on representation of the minister etc.). The main questions concerning practical guidance 3 are submitted for discussion and the decision of board (medical council)., development and upgrading of specialized medical aid, interaction of medical higher education institutions, research and practical institutions, states 3. in certain territories, etc. Decisions of board are put into practice by orders of heads of bodies 3., who bear personal responsibility for performance assigned to bodies 3. tasks and duties, and also establish degree of responsibility of deputies, chiefs of structural and other divisions, chief specialists.
As a part of bodies and institutions 3. advisory bodies work. E.g., at M3 of the USSR — all-Union council a dignity. educations, pharmakol, and pharmacopoeian committees; at chief physicians of BC, clinics, policlinics, etc. — medical councils, hospital councils, councils of nurses. Advisory bodies can be independent or enter into structure of industry body. In some cases they function as public advisory bodies. The rights and functions of advisory bodies are defined by tasks and powers of body, at Krom they are organized.
Functions of bodies 3. are defined by the provisions approved by appropriate authority of the general competence. According to the Provision on the Ministry of Health of the USSR approved by Council of ministers of the USSR on July 17, 1968 the main tasks of M3 of the USSR are: ensuring every possible development 3. for the fullest satisfaction of needs of the population for public free highly skilled medical aid; implementation of actions for development of the preventive direction; protection of motherhood and childhood; providing dignity. - epidemiol, wellbeing of the country; providing the population of the country also to lay down. - professional, institutions by pharmaceuticals, products of medical appointment; performance of tasks on development of network to lay down. - professional, institutions and other tasks of the state plan, ensuring the state discipline, development of scientific research in the field of medicine, increase in their efficiency, and also implementation of achievements of science, the equipment and the best practices in medical practice; preparation medical and pharm, workers, improvement of knowledge and their practical skills in the specialty; implementation of the scientific organization of work, etc. (see the Ministry of Health).
The m3 of the USSR directs 3. through min.-va health care of federal republics also manages directly (or through the bodies created by it) the institutions subordinated to it, the enterprises and the organizations.
The m3 of the USSR studies the state of health of the population, defines the main directions of development 3. in the country, develops and together with min. - you both departments of the USSR and councils of ministers of federal republics carries out actions for the prevention and decrease in incidence, disability and mortality, further increase in duration of active life of the Soviet people; develops standards of medical aid to the population; generalizes practice of use of the legislation on health care, develops offers on its improvement and submits them in accordance with the established procedure for consideration of Council of ministers of the USSR; in coordination with the State Planning Committee of the USSR and Min-vom of finance of the USSR approves the uniform nomenclature and standard categories of institutions 3., standard sheets of equipment of institutions 3. medical equipment, special and other equipment; develops and approves regular standards medical, pharm., technical and pedagogical personnel of institutions 3.; develops on the basis of data of medical science of the recommendation about questions of physiology and occupational health; provides work on research of new medical drugs, on creation of pieces of the medical equipment and other products of medical appointment; approves the state pharmacopeia and temporary pharmacopoeian articles on the pharmaceuticals which are valid state standards and medical - tekhn. requirements of other products of medical appointment etc.
In the activity the M3 of the USSR is guided by laws of the USSR, and first of all Bases of the legislation of USSR and federal republics on health care (see the Legislation on health care), decrees of Presidium of the Supreme Council of the USSR, resolutions and orders of the Government of the USSR and other regulations, provides the correct use of the current legislation about health care in institutions, the organizations and at the enterprises 3.
Of health care of federal republics perform of Min-va management 3. directly, and also through min.-va health care of autonomous republics, public health departments of executive committees of local councils. They exercise control of carrying out in life of laws of the USSR and the republics, resolutions and orders of the government of the USSR and the republics within the competence, orders and the indications M3 of the USSR; direct to lay down. - the prof., a dignity. - protivoepid., educational, research establishments, jurisdictional enterprises and organizations of republican subordination; make perspective and annual development plans 3. and medical sciences in the republics. Within the competence they issue orders and instructions which are obligatory for all subordinated bodies and institutions 3., and also have the right to suspend or repeal their orders and instructions if they contradict the existing laws.
Organizational operation of the device mines - in is directed to improvement of a control system 3., style and methods of the scientific management, development and deployment of the scientific organization of management.
Bodies 3. on places on behalf of local councils of People's Deputies and their executive committees direct the bodies and institutions 3 subordinated to them., take measures to development, the correct placement and strengthening of material and technical resources to lay down. - professional, institutions, will organize medical aid; coordinate and control activity of all enterprises, institutions and organizations for development and carrying out measures in the field of health protection, providing a dignity. wellbeing of the population, the organization of rest of workers, development of physical culture, protection and improvement of the environment, and also exercise control of compliance with the law about public health care. Managers of public health departments, chief physicians of areas — chief physicians of the central regional BCs within the competence issue orders and instructions, check their execution.
Direct rendering to lay down. - the prof. and the medicinal help, carrying out state a dignity. supervision and other actions for public health care institutions 3 are engaged. According to the uniform nomenclature of institutions 3., established by Council of ministers of the USSR, all institutions 3. institutions court are subdivided on treatment-and-prophylactic, sanitary and preventive. - medical examinations and pharmaceutical. At the same time independent institutions 3. only the institutions 3 listed in the nomenclature are.
To independent to lay down. - professional, to institutions belong: hospital (see) — local, regional, central regional hospital (see), city, central city, regional (regional, republican), the nursery city, children's regional (regional, republican), district, children's district-tsa (see. Children's hospital), city-tsa emergency medical service (see Ambulance hospital), central district-tsa,-tsa on the water transport (central basin, basin, port, linear),-tsa on. - transport (central, road, otdelenchesky, nodal, linear), the nursery-tsa on. - transport, hospital for disabled people of Patriotic war (see Hospital for disabled people) specialized-tsy — ortopedo-surgical-tsa recovery treatment, physiotherapeutic hospital (see), etc.; a clinic (see) — antitubercular, oncological, etc.; out-patient and polyclinic institutions — city, children's city, central regional policlinics, policlinic on water. - transport, stomatol, policlinic, the nursery stomatol, policlinic (see. Children's policlinic, Policlinic), etc.; institutions of fast and acute medical aid and blood transfusion institution — the station of fast and acute medical aid (see. Fast and acute management), edges would be a part as structural division, blood transfusion station (see); institutions of protection of Motherhood and the childhood — a maternity home (see), a collective-farm maternity home, a children's day nursery (see Day nursery, a day nursery gardens), milk kitchen (see), etc.; dignity. - hens. institutions — sanatorium (see), sanatorium dispensary (see), children's sanatorium, resort policlinic, balneol. a clinic (see the Balneary), the nursery balneol. a clinic, mud baths (see), children's mud baths.
To independent a dignity. - prof. to institutions belong: the sanitary and epidemiologic station (see) — regional, city, district, regional (regional, republican), on water. - transport; disinfection station, etc.; institutions dignity. educations — the house of sanitary education (see).
To independent institutions court. - medical examinations the bureau court belongs. - medical examinations.
The central regional drugstore, pharmaceutical shop, control and analytical laboratory, a pharmaceutical warehouse belong to independent pharmaceutical institutions a drugstore (see), (see); to institutions of the medical equipment — shop and a warehouse of the medical equipment, etc.
In the area (the region, the republic) one will be organized regional (regional, republican)-tsa and one nursery regional (regional, republican)-tsa (see. Regional hospital). The medical institutions intended for rendering stationary medical aid on several specialties are called multi-profile. The center for rendering different types of medical aid is called the medical institution or its structural division intended for rendering specialized medical aid to the attached population. The establishment performing functions of the medical center keeps the name according to the nomenclature.
Development of network of institutions 3. and their placement are carried out according to the established standards of medical aid and taking into account features of resettlement of the population, and also economic, geographical and other features of districts of the country. Rights and duties of heads of institutions 3. are defined by the provisions approved by M3 of the USSR.
Chief physicians to lay down. - professional, institutions completely are responsible for statement of medical and diagnostic work in policlinic, a hospital, at home, for service of fast and acute medical aid, the organization of professional development of doctors and paramedical staff, their correct arrangement on all sites of work. They control efficiency of treatment, study incidence of the population in the serviced territory and take measures for its decrease.
Management and taxonomy of bodies and institutions 3. by the industry principle are combined with control of their activity by a local operating controls of the general competence (scheme 2). The principle of double subordination allows to consider both state interests, and local features.
Sources of financing of health care. Economic efficiency of healthcare institutions
3. in the USSR it is financed by the state budget; besides, expenses on 3. are made at the expense of means of the state enterprises, and also cooperative, trade-union and other public organizations. Budgetary appropriations provide holding all recreational actions, and also the maintenance of network of medical institutions and bodies 3.
The patients who are on treatment in-tsakh, clinics of in-t, maternity homes and other hospitals in addition to free medical aid and leaving, free of charge receive food, medicines, linen, bedding and objects of cultural and community appointment. During the receiving the extra hospital help (see) the population does not pay expenses, work-related ambulatornopoliklinichesky institutions which at the expense of the state contain all personnel, the equipment, medical and other stock are bought, bandagings and some surgeries, laboratory, clinicodiagnostic, rentgenol are made, and other types of researches, physiotherapeutic and to lay down. procedures etc.
Considerable means are spent for rendering a dignity. - hens. help, carrying out dignity. - protivoepid, actions and some other the measures directed to improvement of the population. Expenses on 3. at the expense of means of the state budget of the USSR and other sources constantly increase (tab. 1) that is the evidence of continuous care of the Communist Party and Soviet government on health protection of the people.
Actually to health protection of workers serves also the funds spent under the budget of the state social insurance for payment of temporary disability benefits, to pregnancy and childbirth for holding summer recreational actions among children, etc. (tab. 2).
At the expense of the state budget actions for preparation and professional development medical and pharm are carried out, personnel, and also research establishments of the USSR M3 system are financed.
The most considerable expenses on 3. (to 80% of the overall budgetary appropriations) are made under local budgets since wide network of institutions 3. it is subordinated to hl. obr. to local councils of People's Deputies. Under budgets of federal republics maintenance costs of research in-t, the highest and average medical educational institutions are made generally, to lay down. - professional, and a dignity. - the prof. of institutions of republican subordination, and also expenses on the centralized actions of republican value (epid, fund, the centralized funds on acquisition of the equipment etc.). At the expense of the allied budget expenses on international relations, the centralized actions of allied value, and also on the maintenance of research in-t, higher educational institutions are made, to lay down. - professional, and other institutions of allied subordination. 70 — 75% of budgetary appropriations on 3. it is spent for contents to lay down. - the prof. of institutions which are a basis of material resources 3.
Costs planning on the maintenance of institutions 3. it is made on the basis of the relevant settlement standards of financial expenses. For the same institutions 3. level of homogeneous expenses which provide the identical volume of costs of their contents undertakes. The norms of financial expenses approved by Council of ministers of the USSR on food of patients, acquisition of medicines and dressing means, soft stock and regimentals are provided in estimates of expenses of institutions in full. The settlement norms established to Min-vom of finance of the USSR can be differentiated by an operating controls depending on features of activity of institutions and the area where they are. Expenses on the salary are defined generally proceeding from the wages fund necessary on keeping of doctors, an average and junior medical staff, workers of hospital drugstores, kitchens, and also administrative and managerial and auxiliary workers on the established posts established on the basis of the regular standards approved by M3 of the USSR for this type of institutions and standard states of administrative and managerial personnel. Besides, from the wages fund payment of the consultants who are not permanent members of staff of this establishment, a tenure of office during issue and also for work of personnel at night and holidays, medical watches is made if they are executed over number of the watches established for doctors due to reduction of operating time by it. Financing of household expenses is made depending on climatic conditions, a dignity. - tekhn, and economic providing institutions taking into account the corresponding standards of the expenses established by local councils of People's Deputies on water supply, heating, lighting, etc. At the same time the expected execution of the estimate on these purposes in the current year and the actual expenses for last years is taken into account.
The majority of the recreational events held 3., brings noticeable economic economic effect. Investigating economic efficiency 3., S. G. Strumilin (1965) showed that each 100 rub invested in 3., thanks to strengthening of personal and public health, the prevention and decrease in incidence and mortality, increase in life expectancy and active working capacity 220 rub of newly created national income allow to gain. Researches of economic efficiency 3. were carried out also by other authors.
Considerable economic effect can be gained from decrease in incidence with temporary disability. It is expressed by the size of the national income made in time saved as a result of decrease in incidence.
The preventive actions allowing to avoid at rather small expenses the significant damage which is expressed in expenses on treatment, keeping of patients, losses of operating time and irreplaceable reduction of a manpower as a result of mortality and disability are most cost-efficient. As a result of (1958 — 1966) researches of economic efficiency on elimination of poliomyelitis conducted to the USSR and falloff of incidence of diphtheria it is established that for each spent ruble on actions for fight against poliomyelitis economic effect made 42 rub, from falloff of incidence of diphtheria — 44 rub.
Big reserves of economy of public funds are connected with the correct and rational use of material, financial and personnel resources 3. E.g., capital investments at construction of BC counting on 1 bed in-tsakh are much higher than smaller power, than in large-tsakh. Therefore the course towards construction of large BCs allows not only to improve quality of medical aid, but also provides more economical expenditure of means at their operation since in process of increase of power of BC the average cost of the contents of a bed in a year decreases to 400 — 600 beds. Quality of medical aid and its cost in many respects are defined by equipment of institutions 3. modern equipment and its correct use, introduction to practice of highly effective pharmaceuticals and progressive diagnostic methods and treatment, rational use of bed fund. In 1975 the median number of days of use of a bed made in city institutions 328, in rural — 306, in all stationary institutions 57,8 million persons were hospitalized. The average duration of stay of one patient on a bed in city institutions of the USSR M3 system (without psychiatric beds) equaled 15,2 days, and in the village 13,6 days, more than 800 million koyko-days are spent by all patients in a year in hospitals. Reduction of average duration of stay of the patient on a bed only for one day releases 57,8 million koyko-days a year that allows to hospitalize without input of new beds in-tsy apprx. 4 million people, i.e. nearly 7% to total number of hospitalized. Reserves of improvement of use of bed fund are diverse. The accurate organization of reception and extract of patients, reduction of the diagnostic period at hospitalization is for decrease in terms of stay of patients in a hospital without prejudice to quality of treatment of great importance, rational profiling of bed fund etc. Considerably increases efficiency of use of bed fund accurately carried out succession in treatment of patients: policlinic — a hospital — institutions of rehabilitation. In 1975 only due to increase in number of days of work of a bed in a year in comparison with 1970 593 thousand patients, i.e. more than 1% to total number of hospitalized would be hospitalized in without expansion of their capacity in addition.
Since January 1, 1977 according to the resolution of Council of ministers of the USSR the rights of heads of institutions 3 are expanded., consisting on the state budget. System of financing of institutions 3., established by this resolution, allows heads of institutions to maneuver within estimate allocations personnel, material and financial resources, to redistribute allocations under separate articles of the budget.
Heads budget to lay down. - prof. of institutions have the right in the presence of economy on the wages fund to award the best workers within 1,5% of the wages fund established to establishment. These actions are directed to expansion of an initiative of workers, strengthening of labor discipline, reduction of turnover of staff, increase in interest of personnel in rational use of material and financial means for upgrading of medical aid.
Improvement of quality of medical aid is promoted also by systematic increase in financial norms of expenses on acquisition of medicines and dressing means, on food of patients, on acquisition of the equipment and stock, and also growth of such financial performance as the economic working costs providing the maintenance of buildings in which institutions 3 are placed at due technological level., correct operation of the equipment, stock, transport, dignity. - a gigabyte. and economic service of patients, etc. Considerably allocations for acquisition of medicines for treatment of patients increased in out-patient and polyclinic conditions, especially in stomatol. policlinics and departments, norms of expenses on medicines on separate specialties in hospitals are increased. It generally departments, treatment of patients in which demands use of a large number of medicinal and dressing means: departments of nephrology, on renal transplantation, burn, cardiovascular and thoracic surgery, resuscitation and an intensive care etc.
Since 1976 for more effective use of the funds allocated for treatment of patients in hospitals and out-patient and polyclinic conditions differentiation of expenses on medicines on types of institutions 3 is carried out. Because in regional institutions, clinics of in-t and a wedge, the patients demanding more difficult diagnostic methods and treatment for departments of a therapeutic and surgical profile of these institutions would concentrate the increased norms of expenses on medicines are established, differentiation of these norms also for institutions of a regional link is continued.
According to the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) since January 1, 1978 settlement norms of expenses on food, acquisition of medicines and dressing means in maternity homes, children's, regional, oncological-tsakh and other specialized institutions increase again.
Efficiency 3. it is necessary to estimate first of all from the medical point of view, studying as the held events influence changes of indicators of incidence, an invalidism, mortality, physical. development of the population, etc. Separate medical actions can not give economic effect. However need of their implementation is dictated by a humanistic orientation Soviet 3., care of the socialist state about health and wellbeing of each member about-va. Economic effect at socialism cannot be the main and the more so the only criterion of usefulness of recreational actions. Their main result — satisfaction of pressing need of the person in preservation and in recovery of health. See also Planning of health care .
Health care workforce, their preparation and improvement
Achievements Soviet 3. and medical sciences are closely connected with steady carrying out in life of evidence-based Lenin personnel policy. Pre-revolutionary Russia had is insignificant trace amount of doctors and average medics. Security with doctors made 1,8, average medics — 2,9 on 10 000 zhit. Vast majority of the population former Central Asian and Transcaucasian, sowing. and sowing. - vost. districts and suburbs of the country it was almost deprived of medical aid. So, e.g., security with doctors in the territory of present Tajik and Kyrgyz SSR made 0,2 on 10 000 zhit., the Uzbek SSR — 0,3, the Kazakh SSR — 0,4; in the territory apprx. 8 million sq.km, on a cut are nowadays located sowing. and sowing. - vost. autonomous republics and national districts, in 1913 49 doctors worked; in Central Asia was available apprx. 900 average medics, in Transcaucasia — apprx. 1300.
Having proclaimed health protection of the people the most important question of domestic policy and having started construction of the state system 3., the prevention based on the principles, free of charge and general availability of medical aid, the young Soviet state from the first days of the existence undertakes vigorous measures for providing the country with medical shots. At all stages of socialist construction the CPSU and the Soviet government systematically increased network of the highest and average medical and pharm, educational institutions, in-t of improvement, strengthened their material and scientific base, carried out reforms of medical education, distributions of medical shots according to needs of the population for medical aid and problems of development of the national economy resolved issues. Thanks to the taken measures of the USSR strongly wins first place in the world on the number and security of the population with doctors and average medics, and medical shots are generally evenly distributed on all territory of the country (tab. 3, 4, 5). Considerable shifts happened in security with specialists doctors (tab. 6). Thus, for years of the Soviet power according to policy of the Communist Party and Soviet government in training 3. there was a harmonious system of preparation and improvement of medical shots of various qualification.
Personnel policy Soviet 3. in days of the eighth, ninth and tenth five-years periods was defined by decisions XXIV and XXV of congresses of the CPSU, the resolution of the Central Committee of the CPSU and Council of ministers of the USSR of July 5, 1968 No. 517 «About measures for further improvement of health care and development of medical science in the country». The problem of universal providing the population with all types of specialized medical aid, along with further increase in number of annually trained specialists, demanded to undertake radical reform of the higher medical education, all system of preparation and improvement of medical shots. The resolution of the Central Committee of the CPSU and Council of ministers of the USSR of July 5, 1968 installed system of training of young specialists with a profiling on the VI course of medical institutes (subinternship) with the subsequent one-year specialization of graduates to lay down. and pediatric f-tov on the basis of large to lay down. - professional, institutions (see the Internship). The main f-tov pass a one-year training across the place of distribution. The accumulated experience of probation of graduates in an internship showed that the form of training of doctors meets the main requirements modern 3. also allows to solve successfully problems of increase in level of training of the qualified medical shots. Introduction of an internship did not reduce rates of preparation of medical shots. For years of the eighth and ninth five-years periods 396,8 thousand doctors are trained, and security with doctors increased by 10 000 population with 23,9 in 1965 to 32,6 in 1975
a problem of primary specialization — acquisition by doctors of necessary qualification and practical skills according to the main sections of medicine, development of the principles correct a wedge, approach to patients, mastering modern methods of treatment and diagnosis. For graduates to lay down. f-tov primary specialization in therapy, surgery, obstetrics with gynecology and psychoneurologies, for graduates pediatric f-tov — on pediatrics, infectious diseases of children's age and children's surgery is established. These wide profiles a wedge, medicine create conditions for further development of narrower medical specialties. In 1973 transfer is complete to lay down. and pediatric f-tov medical in-t, and also medical f-tov high fur boots on system of an internship. Since 1975 the internship is entered on stomatol, f-takh. Graduates dignity. - a gigabyte. and pharm.
According to the resolution of the Central Committee of the CPSU and Council of ministers of the USSR of July 18, 1972 «About measures for further improvement of the higher education in the country», defined the most important directions of development of the higher school, improvement of medical education was followed by entering of considerable changes into curricula and programs of medical institutes (see). For increase in level theoretical and a wedge, training of doctors courses of genetics, biophysics, oncology, anesthesiology and resuscitation, neurosurgery and some other disciplines are entered into the curriculum of medical in-t, strengthening of practical training of students in relation to specifics of work in institutions 3 is provided. (see. Medical education).
Introduction of an internship changed system of specialization and improvement of doctors. Release of institutes of improvement of doctors (see) from function of primary specialization on the basic wide: to profiles allowed to increase considerably number of the doctors undergoing improvement on narrow specialties.
By 1970 the uniform system of postdegree preparation of medical shots was issued. Thanks to the taken measures the power of in-t and f-tov improvements increased at medical in-ta. So, in 1971 — 1975 it is organized 4 new f-that improvements, their material and technical resources considerably became stronger, 70 new departments opened. The number of the doctors who underwent professional development considerably increased. Only in 1975 taking into account training on bases large to lay down. - professional, institutions professional development there underwent 84 thousand doctors. In 1976 the state system of professional development of doctors and pharmacists included 13 in-t of improvement of doctors and 26 f-tov improvements at medical in-ta. In them annually improve skills apprx. 50 thousand doctors and pharmacists. Besides, professional development of specialists is carried out in a wedge, an internship (see the Internship clinical) at medical in-ta, research establishments and in-ta of improvement of doctors. A serious incentive to professional development of doctors was introduction of system of certification for all medical specialties. For January 1, 1976 in system 3. The USSR worked apprx. 158 thousand doctors (without dentists) who underwent certification from which the highest qualification category was received by St. 29 thousand, the first — apprx. 100 thousand, the second — St. 29 thousand persons.
The successful solution of questions of further upgrading of training of doctors and pharmacists is inseparably linked with providing higher education institutions with the qualified research and educational personnel. In 1975 in scientific institutions of system 3. 74,1 thousand research and scientific and pedagogical associates, including 37,3 thousand — in higher education institutions worked. The main form of preparation scientific and research and educational personnel is the postgraduate study (see the Postgraduate study, a graduate military course). Training of graduate students is carried out in 82 medical and pharm, in-ta and at 178 research institutes (see). The number of graduate students for January 1, 1975 made apprx. 5 thousand. In the country the system of professional development of teachers of the highest medical educational institutions is created. From the moment of its organization in 1968 for 1973 qualification was increased by St. 80% of teachers.
In the light of the resolution of the Central Committee of the CPSU and Council of ministers of the USSR No. 656 of August 22, 1974. «About measures for further improvement of the management of average special educational institutions and about improvement of quality of training of specialists with secondary vocational education» the great job directed to improvement of training with an average medical and pharm, education is done.
Considerably training of average medics increased. In 1975 in the country 632 average medical educational institutions functioned (see. Medical schools) in which about 397 thousand persons studied. Each federal and autonomous republic satisfies the need for shots of average medics due to release of specialists by own average medical educational institutions. Training of average medics is carried out on 11 specialties.
Training of the modern medical specialist both with the highest, and with secondary education is not limited to teaching special disciplines. Communistic education of the Soviet doctor and average medic has special value as for 3., and for all our state. In the Soviet Union the relations between the doctor and the patient are under construction on the basis of mutual trust and respect. Each patient knows that the aspiration to personal enrichment is alien to the Soviet medic that he is interested in reduction and elimination of diseases that its professional interests are inseparable from interests of the state and about-va in general. Love to a profession, respect for the patient, the relation to performance of the duties as to a high civic duty, the aspiration to be at the level of modern knowledge most and to transfer reasonably medical knowledge to the population — the main qualities of the Soviet medic (see the Deontology medical).
Requirements imposed about-vom to the doctor are accurately formulated in the Oath of the doctor of the Soviet Union (see) approved by Presidium of the Supreme Council of the USSR on March 26, 1971. Tasks, the rights and duties of all medics are determined by «Bases of the legislation of USSR and federal republics about health care». With this act, in particular, it is confirmed that the huge public wealth — health and life of people is entrusted to physicians (see the Legislation on health care).
Constantly growing personnel, financial and material resources 3. demand improvement of forms and methods of management, improvement of selection, preparation and education of shots. M3 of the USSR and mines - you health care of federal and autonomous republics, presidium of the USSR Academy of Medical Sciences, an oblkrayzdravotdelama constantly conduct work on improvement of structure of the managerial personnel 3. and medical sciences, further improvement of system of preparation and professional development of the managerial personnel of all categories and levels is carried out. The events held according to the order M3 USSR «About improvement of system of professional development of the managerial personnel of bodies and healthcare institutions» (1968) in this respect are of great importance. This order, in particular, defined the list of positions of executives which substitution demands special preparation on social hygiene and the organization of health care, scientific bases of management. According to the plan of improvement of executives 3. it is annually carried out the St. 70 cycles of the general and thematic improvement on social hygiene and the organization of health care covering
the XXV congress of the CPSU to 3000 people defined that the main social and economic objectives of development of our state are further increase in welfare of the Soviet people, improvement of working conditions and life, progress 3., educations and cultures. The successful solution of the tasks set by party will demand further improvement of system of preparation and education of medical shots. In the tenth five-years period training of doctors and average medics will continue the increasing rates. By 1980 the number of doctors will increase approximately up to 957,9 thousand people, and security with doctors — to 35,7 on 10 000 zhit.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) increase in training of pediatricians and druggists, and also paramedical staff is planned. For further professional development it is solved at least once in five years to carry out the direction of doctors and pharmacists of improvement of doctors in in-you and on f-you improvements and specializations at medical and pharm, in-ta for what considerable expansion of network of these institutions is provided; in federal republics in 1979 — 1981 20 schools for professional development of workers with an average medical and pharm, education are for the first time created. It will allow to raise even above the level of medical aid to the population of the country.
State character Soviet 3. it is accurately expressed in the organization to lay down. - professional, the help to the population, edge it is presented by system of the public institutions rendering the public and free qualified medical aid. General availability of medical aid is provided with wide network on an outpatient basis - polyclinic, hospital and a dignity. - hens. institutions, institutions of fast and acute medical aid, protection of motherhood and childhood. The special group is made by the institutions intended for rendering the medicinal help (pharmaceutical institutions).
Medical aid in the USSR is brought closer to the population and it appears as at the place of residence (territorial to lay down. - professional, institutions), and in the place of work (to lay down. institutions of the industrial enterprises) is also based on the local principle (see. Medical site, Rural medical site, Shop medical site). The local principle creates necessary conditions for carrying out the medical examination (see) which is the main method of work to lay down. - professional, institutions.
In the USSR the basic to lay down. - professional, the establishment rendering to the population all types of medical aid would be, integrated with policlinic (see Hospital, Policlinic). In 60 — the 70th in connection with construction of large multi-profile BCs (on 600 — 800 — 1000 and more beds), and also for further approach of the polyclinic help to the population, first of all to workers of the industrial enterprises, independent out-patient and polyclinic institutions remain and created (see Out-patient clinic). It caused emergence of a new form of connection of polyclinic and stationary medical aid — a functional attachment of independent policlinics and out-patient clinics to city and local-tsam.
The general direction in upgrading to lay down. - the help to the population of the USSR its specialization and integration at base large is professional to lay down. - professional, institutions. This way of development is defined by the Program of the CPSU and a number of special resolutions of the Central Committee of the CPSU and Soviet government. Specialization and integration of medical aid are expressed first of all in development profile (on the main specialties — surgery, therapy, pediatrics, etc.) and highly specialized (cardiorheumatological, infarctive, endocrinological, burn, hematologic, gastroenterological, etc.) departments in hospitals and offices or departments in policlinics, completion by their highly skilled specialists doctors and the necessary equipment. The most important condition of creation and development of specialized medical aid and integration of its different types is radical improvement of material and technical resources to lay down. - professional, institutions: construction of multi-profile and large specialized BCs, clinics, large policlinics, reconstruction and integration of the existing institutions; equipment to lay down. - professional, institutions by the modern medical machinery and equipment, use of the electronic and analytical and telemetric equipment, means and methods of cybernetics; centralization of medical and diagnostic and auxiliary services, use of highly effective pharmaceuticals. Besides, the all-Union, interrepublican and republican, interregional and regional centers for various profiles will be organized. Specialized departments and the centers provide the maximum possibility of comprehensive examination and treatment, create a certain comfort to patients and optimal conditions for work of personnel.
Specialized medical care on the main and the majority of narrow specialties will be organized so that the population could receive it, without leaving areas, edges or the republics. Development of the specialized help (see) and increase in its quality is provided with scientifically based system of development of specialized services and synchronous planning of training of specialists doctors. During the planning of further development of specialized services the system of medical providing the population by the administrative-territorial principle is supplemented with the division into districts not always matching administrative division of territories. Processes of specialization and integration of medical aid cause staging of its rendering both in hospitals, and in out-patient and polyclinic conditions.
In general the organization to lay down. - professional, the help to the population of the USSR it is carried out on the basis of the orders M3 of the USSR, methodical instructions and special provisions, the published mines-vom determining norms of medical aid and establishing organizational forms of its rendering.
The extra hospital help to urban and country people in the USSR is provided with wide network of policlinics (see), polyclinic departments of clinics (see the Clinic), in rural areas medical and obstetrical centers (see), out-patient clinics (see), and at the industrial enterprises medical and sanitary parts (see) and health centers (see). Idiosyncrasy of this type of medical aid is its general availability, a possibility of active identification of early forms of diseases, the wide embodiment in practice 3. the dispensary method based on conducting the principle in Soviet 3. — to prevention and on the most important organizational form of work of extra hospital network — a territorial and shop uchastkovost.
The system of the out-patient and polyclinic help as a form of public, highly skilled and specialized medical providing the population was for the first time created in our country. She gained wide recognition in the socialist countries, a row capitalist and developing countries and is recommended to World Health Organization (see) for the countries creating national services 3.
Lead agency of the extra hospital help (see) the policlinic, independent and integrated with-tsey is. The main objectives of policlinics in the USSR — rendering medical aid, including specialized, on reception in policlinic and at home, and also the organization and holding preventive actions for the prevention and decrease in incidence, disability and mortality. The patients who asked for medical assistance in policlinics are provided with inspection, treatment, and also the domiciliary care (see) given by preferential district doctor (see the district doctor). The role of the district, family doctor constantly increases. Bodies 3. carry out actions for strengthening of a local link. It is promoted, in particular, by disaggregation of territorial medical sites: the number of therapeutic sites in the cities of the country increased with 24 560 in 1960 to 43 243 in 1976, and pediatric — according to 24 581 to 35 562.
By 1977 in the country there was a St. 35 thousand medical institutions giving out-patient and polyclinic help. Much more the number of doctors and average medics increased in them. Out-patient clinics and policlinics expand scheduled maintenance: the number of the persons which are subject to periodic surveys grows, the contingent of subjects of medical examination increases. In 1976 in institutions of the USSR M3 system 2.3 billion visits, including a domiciliary care, against 1,8 billion in 1970 and 1,1 billion in 1960 are made.
In 1971 — 1977 development of the polyclinic help was carried out by the organization and construction of large policlinics (on 800 — 1200 and more visits per shift). At the same time there was an integration of the existing policlinics, equipment by their modern equipment, expansion of specialized medical aid, creation of services of rehabilitation, etc. For further development of the specialized extra hospital help in the 70th city advisory policlinics with specialized receptions which part the large diagnostic centers are, the centralized laboratories, the centers of recovery treatment, etc., the cities intended for service in general or several of its districts began to be created (on 120 — 200 thousand zhit.). Broad development is gained by also consulting and diagnostic specialized centers created at clinics of medical in-t and in-t of improvement of doctors, research in-t and also on the basis of large specialized and multi-profile BCs. At the same time the number of specialized offices grows in policlinics of the general network. E.g., from 1970 to 1976 the number endokrinol, offices increased in city policlinics for 30%, nevrol. — St. 11%; offices on allergology, hematology and other specialties are created.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) provided: since 1978 to carry out further disaggregation of territorial therapeutic sites, having brought the number of the serviced adult population on one local therapist in 1982 on average to 2 thousand people, and by 1985 — to 1,7 thousand people; further development of the out-patient and polyclinic help, and construction of new policlinics and out-patient clinics is provided to be carried out first of all in districts of new buildings and rural areas, at the same time to raise the level of work of these institutions, it is better to equip them with the necessary equipment, the equipment, a dignity. transport; to expand use in policlinics and out-patient clinics of methods of recovery treatment, having organized for this purpose in large policlinics the relevant departments; since 1981 to provide purpose of allocation for the maintenance of network of out-patient and polyclinic institutions.
The stationary help to the population of the USSR develops the increasing rates. Expansion of network of stationary institutions is a component of the economic plan. In the USSR the most high level of security of the population with hospital beds. So, by 1976 in the country there were 24 thousand medical institutions having 3076,0 thousand beds (119,3 beds on 10 000 population against 80,4 in 1960 y 40,2 in 1940). And St. 50 their % it is concentrated in regional (regional, republican), city, regional and central regional-tsakh. Growth of bed fund of stationary institutions in federal republics is shown in tab. 7.
Patients whose condition demands systematic medical observation and use of the most difficult medical and diagnostic methods and means go to stationary institutions. The issue of the direction on hospitalization (at planned hospitalization) is resolved by the doctor of out-patient and polyclinic establishment, and at the emergency (unplanned) cases — the doctor of fast and acute medical aid or the doctor of reception at the address of the patient to a hospital. In 1976 in hospitals of the USSR M3 system 56,3 million people against 38,5 million in 1960 and 15,2 million — in 1940 were treated.
In 1971 — 1977 the network of medical institutions developed in osn. due to construction according to standard projects large (400, 600 and more beds) multi-profile and specialized BCs (see. Hospital construction). So, if in 1971 39 such BCs, then in 1975 — 82, including 30 on 1000 beds and more were under construction. For the same period construction of BC with a power up to 100 beds was reduced by 3 times. Events for reconstruction and integration of the operating BCs were at the same time held. For 1970 — 1976 the average power of the Region of BC increased from 597 to 736 beds, city — with 166 to 197, central regional — from 165 to 213 beds.
Construction of the new large BCs, expansion existing due to reconstruction and construction of additional cases had significant effect on level and quality of the hospital help. As a part of the Region, city and central regional BCs the specialized departments equipped with modern diagnostic are created and to lay down. the equipment and staffed by qualified personnel.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) obliges to provide further improvement of the organization of the stationary help to the population, upgrading of diagnostic and medical work, more effective use of bed fund, expansion of network of BC and departments of recovery treatment. Measures for further development in the country of cardiological service, on the organization in 1979 — 1985 in the republican, regional and regional centers of cardiological clinics, to expansion of network of cardiological departments in-tsakh and offices in policlinics, to increase in number of cardiological crews of emergency medical service are provided.
The service of ambulance and emergency medical service is presented by network of the special facilities (the stations, BC or departments of fast and acute medical aid) subordinated to directly relevant department 3. or the large BCs which are a part. Institutions of fast and acute medical aid (see. Fast and acute management) have the staff of medical and support personnel, necessary rooms and the equipment, the park a dignity. transport. In 1976 in the USSR there were 4051 stations of fast and acute medical aid in which worked apprx. 30 thousand doctors and St. 70 thousand average medics.
Since 1965 snowballing of specialization of emergency medical service, improvement of methods of the emergency diagnosis and treatment began. In the cities and large rural districts specialized crews of emergency medical service — resuscitation, cardiological, neurologic, toxicological pediatric, an intensive care, etc. are organized. A new form of the organization of fast and acute medical aid at the present stage of development 3. expansion of BC of fast and acute medical aid and their merging with the stations of fast and acute medical aid is. Such association creates real premises for rapprochement of the pre-hospital and hospital periods of rendering the urgentny help, provides possibilities of the bystry organization of specialized crews of any structure, promotes broad use of uniform tactics and a technique of the emergency medical aid, the wedge, training of doctors of emergency medical service creates real opportunities for increase.
Medical care by the worker of the industrial enterprises. At all stages of socialist construction bodies and institutions 3. special attention is paid to health protection and improvement of medical aid by the worker of the industry, construction and transport. This contingent of the population has in the USSR the right preferential medical - a dignity. providing that it is expressed first of all in creation and development of network of special medical facilities at the industrial enterprises, an attachment of territorial and to lay down. - the prof. of institutions to the industrial enterprises for first-priority providing workers with medical aid, in first-priority completion by doctors, equipment and the medical equipment of the institutions rendering medical aid by the industrial worker.
The most widespread type of the institutions intended especially for service of the working industrial enterprises is the medical and sanitary part (see) created at the large enterprises - with number of workers 4000 and more, and at the enterprises of chemical, coal, ore mining, oil-processing industry — with number of workers 2000 and more.
MSCh represents the complex hospital and polyclinic establishment which is carrying out the qualified medical aid on all main specialties. As a rule, it is city-tsa (policlinic), intended only or generally for rendering medical aid to employees of the industrial enterprises and construction organizations. The hospital, health centers (see) located in workshops of the enterprise and also sanatorium dispensary (see), dietetic dining hall are its part (see) and other institutions consisting on the budget of labor unions. In case MSCh provides with medical aid not only workers, but also members of their families, and sometimes all population in a certain territory, in its structure, in addition to shop medical sites (see), territorial medical sites will be organized (see. The medical site) according to the existing standards. By 1977 there was 1348 MSCh. In their structure there were 239 medical and 6765 medical assistant's health centers, 7427 shop medical sites.
At the same time medical aid by the worker of the industrial enterprises appears also network of territorial offices. Existence at the enterprise even does not provide to large MSCh his workers with all types of specialized ambulatornopoliklinichesky and stationary medical aid. So, e.g., the domiciliary care is given, as a rule, at the place of residence by the local therapist of territorial policlinic, and in case of emergency — the station of fast and acute medical aid. Some types of specialized medical aid are provided with specialists of the general or specialized city BCs, policlinics and clinics. Workers of the industrial enterprises which do not have MSCh are attached to territorial to lay down. - the prof. to institutions which will organize them preferential service: the special registrar, specialists doctors etc. is allocated or first priority of reception, obtaining medical and diagnostic procedures etc. is provided; the service of shop district doctors is created. These institutions health centers of the attached enterprises are included. By 1977 as a part of territorial network to lay down. - professional, institutions there were 15028 shop medical sites, 2485 medical and 32124 medical assistant's health centers.
Distinctiveness to lay down. - the prof. of the institutions providing preferential service of workers is holding broad recreational actions. In general to lay down. - professional, the help to workers is carried out on the basis of the unified comprehensive plan of recreational actions made by administration of the enterprise together with factory local committee of labor unions, department of the accident prevention and the chief physician of MSCh, and at its absence — with a gate to lay down. the establishment servicing this enterprise.
Medical care to country people is in essence created for years of the Soviet power. The principles of the organization to lay down. - professional, the help to urban and country people in the USSR are uniform. However specifics of resettlement of villagers, conditions of their work and life define some features of the organization rural 3.
Medical aid provides to country people a complex to lay down. - professional, institutions, to-rogo are a part: regional (regional, republican), central regional-tsy, regional and local-tsy and out-patient clinics, medical assistant's both medical and obstetrical centers and other institutions. The system created in the USSR rural 3. it is based on the principle of staging, at Krom the level of rendering medical aid increases at each subsequent stage.
The first stage — the rural medical site (see) combining under the uniform management a number of the medical institutions (local-tsa or out-patient clinic, medical assistant's and medical and obstetrical centers, collective-farm maternity homes, health centers, etc.) which are providing the population of a certain territory with the public, medical and pre-medical assistance and carrying out wide a dignity. - protivoepid, actions. Local-tsa or out-patient clinic — the main establishment of the rural medical site. New form of the organization to lay down. - the help to country people creation on the basis of the district police officers of BC MSCh allowing to render medical aid by the worker of state farms, industrial enterprises and collective farms by the shop principle is professional. Medical assistance by the adult and to children, and also acute medical aid would appear in local any power. For approach of medical aid to the population and systematic carrying out protivoepid, and sanitary and recreational actions in the villages remote from local (out-patient clinic) also medical and obstetrical centers, collective-farm maternity homes would will be organized medical assistant's. During field works mobile out-patient clinics, and directly on field camps — first-aid posts form. By 1977 in the country there were 9640 district police officers of BCs against 12941 in 1960, and also 89547 medical and obstetrical centers in which worked apprx. 200 thousand paramedics and midwifes. Reduction of number of local BCs generally happens in connection with reorganization of small local BCs in out-patient clinics and departments central regional-tsy.
The second stage — regional to lay down. - professional, institutions (central regional-tsa, regional-tsa, clinics) where villagers receive specialized medical aid on its main types. The main establishment providing the population of the rural district and the regional center with highly skilled stationary and polyclinic medical aid is the central regional hospital (see). In it receive the stationary help apprx. 50% of villagers. The central regional would have a hospital with departments on the main specialties, policlinic with advisory receptions of specialists doctors, lechebnodiagnostichesky departments (offices), department of fast and acute medical aid and other divisions. By 1977 in the country there were 3728 central regional and regional BCs, from them only 1,2% had power lower than 50 beds; 75,4% _ St. 100 beds. The polyclinic help to the population of the regional center and the assigned site is organized by the local principle.
The third stage — regional (regional, republican) to lay down. - the prof. of establishment, where to villagers there are all types of specialized medical aid. The main establishment is regional (regional, republican)-tsa (see. Regional hospital). By their 1977 was 180, and average power reached 736 beds. Regional-tsy are staffed by doctors-siyetsialistami and are well equipped. In their structure there are departments emergency and planned konsul-tativnoy the help, the villages providing highly skilled out-patient advice to inhabitants. The majority regional to lay down. institutions has boarding house for visitors of patients that allows to carry out consultation, inspection, and if necessary and treatment in out-patient conditions. At departments of the emergency and planned and advisory help stations of sanitary aircraft are organized (see), K-rye would be structural divisions and operate on the rights of department. Existence of these stations provides the urgent direction of doctors to rural districts for rendering the emergency medical aid or delivery of patients in regional (regional, republican) to lay down. - professional, institutions. For the same purposes of department of the emergency and planned and advisory help have a dignity. motor transport. For approach of the specialized help to country people regional-tsy and others to lay down. - professional, institutions will organize planned departures of specialists doctors, mobile out-patient clinics, fluorographic offices, etc.
Bodies and institution 3. under the direction of and with assistance of local party and Soviet bodies continue to carry out a number of the major actions for development of network rural to lay down. - professional, institutions, to strengthening of their material and technical resources, equipment by the special equipment and stock, to completion by shots, to upgrading and cultures of medical service. At the same time bodies 3. proceed from the main objective — to provide country people within the district with specialized medical aid not less than on 10 medical specialties. This task is generally reached. Special attention is paid to every possible development and strengthening of the central regional BCs as main centers of the specialized help and organizational and methodical leadership in all business of rendering medical aid to country people, and also development of network of rural policlinics and out-patient clinics. As a result of the held events the bed power of the central regional and large local BCs increases. Rapprochement of levels of security with the stationary help of urban and country people is reached. In 1975 on everyone 10000 zhit. in the cities 105,9 beds, and were developed in rural areas — 105,0. Not only volume increases, but quality of rendering stationary medical aid to country people to some extent increases. It is caused by systematic increase in hospitalization of villagers in regional, regional and city medical institutions (nearly 1/4 hospital beds in city institutions of the USSR M3 system it is employed by patients from rural areas); significant increase in hospitalization in central regional-tsy and, as a result of it, reduction of hospitalization in rural district police officers-tsy.
Approach of the specialized hospital help to country people and increase in its quality are carried out also by the organization of large specialized BCs and interdistrict specialized departments, and also mobile types of medical assistance.
See also Treatment-and-prophylactic help .
Health protection of women and children
Care about health of the woman and education of the healthy comprehensively developed younger generation — the most important problem of the socialist state. It is provided with system of the governmental, public and medical activities in which implementation to bodies and institutions 3. the leading role belongs. The constitution of the USSR guarantees carrying out special safety arrangements and health of women; legal protection, material and moral support of motherhood, including providing the paid prenatal and puerperal issues and other privileges to pregnant women and mothers; the state help to lonely mothers (see Protection of motherhood and the childhood, Social insurance).
Health protection of women and children is carried out by carrying out a complex of special events to lay down. - the prof., a dignity. - hens., preschool and recreational institutions. Growth of network and power of institutions of protection of motherhood and the childhood is shown in tab. 8.
Treatment-and-prophylactic help to women. Extra hospital akushersko-ginekologichesky help is given in clinic for women (see), work a cut is based on the principle of a territorial uchastkovost (see. Medical site). On the large industrial enterprises clinics for women are created as a part of MSCh. The states of clinics for women are completed at the rate of service by 1 doctor by the obstetrician-gynecologist of 2 — 2,5 thousand women. Except an obstetric ginekol, the help, clinics for women carry out patronage service (see Patronage), carry out a dignity. - a gleam, and social and legal work. The main method of work of clinic for women is medical examination (see). All pregnant women are put under medical observation in early durations of gestation (up to 3 months). For overseeing by the pregnant woman doctors of various specialties are attracted, broad laboratory inspection is carried out. Special attention is paid to dispensary observation for pregnant women of «high risk» of perinatal pathology. It allows to give specialized help at different stages of pregnancy and at the time of delivery. Work on promotion of the correct mode and food of pregnant women, and also psychoprophylactic preparation for childbirth is carried out.
For early diagnosis ginekol. diseases planned routine maintenances are carried out (see. Medical examination) with use kolposkopichesky, tsitol, and other methods of inspection. According to the general tendency modern 3. to development of the specialized help and enlargement to lay down. - professional, institutions in the 70th construction of large clinics for women is carried out. In these consultations offices (receptions) on prevention of not incubation, infertility, ginekol, endocrinology, contraception, etc. will be organized.
In rural areas an effective form extra hospital obstetric ginekol. the help exit clinics for women are. Teams of doctors (the obstetrician-gynecologist, the therapist, the laboratory assistant) from regional and central regional BCs carry out planned departures on rural medical sites (see).
New form of the work intended for early detection of hereditary diseases and the forecast of health of posterity in families where there are persons with hereditary diseases or malformations are medicogenetic consultations (see. Medicogenetic consultation). The network of the consultations «Marriage and a family» dealing also with issues of infertility and sexual pathology begins to develop.
Stationary help to women is given in maternity homes (see), maternity and ginekol, departments of BC. In the 70th the network of specialized maternity homes or departments intensively develops at large multi-profile-tsakh for women with extragenital pathology, not incubation of pregnancy, immunoconflict pregnancy, puerperal complications. Specialized departments for women with the complicated pregnancy open also in rural areas as a part of interdistrict and large central regional BCs. In ginekol, hospitals and departments there is a medical aid to women with inflammatory diseases, disturbances of reproductive function, etc. As a part of children's policlinics offices of gynecology function.
The important place in the organization and providing a high level to lay down. - the prof. of the help to women of rural areas belongs obstetric and ginekol, to departments of republican and regional (regional) BCs which are the scientific and advisory and organizational and methodical centers obstetric ginekol. the help in the serviced territory. Considerable advisory work is carried out also by departments of obstetrics and gynecology of medical in-t and in-t of improvement of doctors. Improvement of doctors of obstetricians-gynecologists is systematically carried out on the basis of in-t of improvement of doctors, republican, regional (regional) BCs, and also large maternity homes, city multi-profile and specialized BCs.
Constantly held social events providing protection of the rights and special attention of the state to labor protection of women a high level to lay down. - professional, the help and systematic preventive overseeing by a condition of their health caused considerable decline in mortality of pregnant women, women in labor and women in childbirth, and also reduction of number of complications of pregnancy and puerperal diseases.
Health protection of children. The extra hospital help to children from the moment of an extract from a maternity home up to 15 years, and also to all school students irrespective of age appears in the children's policlinic (see) working by the principle of a territorial uchastkovost. The independent pediatric site is created in the presence of 800 — 1000 children in the serviced territory.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) it is planned to bring by 1980 — 1981 the number of the serviced children on one local pediatrician on average to the 800th persons. Children's policlinics became the centers for education of the healthy child. A lot of work is carried out on antenatal protection of a fruit: prenatal patronage, wide network of schools of mothers and fathers provide training of parents for education of the child and creation of necessary conditions for the newborn in a family. Everywhere in children's policlinics offices of the healthy child where young mother is trained in the correct care of the child, elements of gymnastics are created, give advice on physical. to education, hardening, rational feeding and food of the child. The big section of work of children's policlinic is medical overseeing by newborns and babies, and also medical examination of the children who were born premature, patients with a hypotrophy, rickets, hron, pneumonia, rheumatism, hron, tonsillitis, had an infectious disease, dysentery, etc.
Children's policlinics provide all program of preventive inoculations, and also the organization of medical aid to children in preschool institutions and schools. In the organization of the out-patient and polyclinic help to children in rural areas much attention is paid to scheduled maintenance with the healthy child at all stages, since medical and obstetrical center and finishing central regional-tsami at which children's policlinics and out-patient clinics are created. Fast and acute medical aid to children appears pediatricians of points of acute management at children's policlinics and linear specialized pediatric crews of emergency medical service.
For development of the extra hospital specialized pediatric help in the 70th integration of children's policlinics, and also construction of large children's policlinics on 250 — 500 visits per shift is carried out. In such policlinics reception on 8 — 12 specialties is carried out. In a number of the cities centralization of several types of specialized medical aid to children in one or several children's policlinics is carried out, the centers organizing all complex are created to lay down. - professional, actions for the children having a certain pathology. E.g., by 1976 in the USSR there were St. 90 nurseries pulmonol, and 70 nurseries allergol. centers.
Medical overseeing by teenagers (from 15 to 18 years) is carried out by teenage offices in policlinics for adults.
Stationary help to children is given in children's hospital (see) and pediatric departments of the general and specialized BCs for adults. In the cities the principle of a functional attachment of several children's policlinics to a certain nursery or department city-tsy would be carried out, specialized stationary help is given to hl. obr. in the relevant departments of city multi-profile BCs. Since 1965 in the cities construction of the 300 beds standard children's BCs, and in the large cities — multi-profile children's BCs on 600 and 1000 beds is more and more widely developed. The new standard project of the nursery-tsy of recovery treatment on 420 beds is developed. In nurseries-tsakh with power from 300 beds and above departments of anesthesiology and resuscitation and specialized departments will be organized. As a part of most children's BCs departments for sick newborn children, departments for nursing premature, the boxed departments, in a number of BC — department of semi-sanatorium type for recovering are developed. The course towards construction of large children's BCs with specialized departments will allow to transfer completely rendering the specialized stationary help to children from city BCs for adults to pediatric hospitals in the near future.
Stationary help to children in rural areas is given according to the principles of staging to lay down. - professional, the help to country people (see above «The treatment-and-prophylactic help»). Stationary help on the main specialties is given in children's departments of the central regional BCs, specialized — in regional (regional) and republican nurseries-tsakh, being the scientific and advisory and organizational and methodical centers of the pediatric help in the serviced territory.
The organization of medical aid to children provides also broad implementation of the principle of step-by-step treatment of the sick child: a hospital — local sanatorium — policlinic. In these conditions the profiling of local children's sanatoria is carried out (see). For children with certain forms of pathology during the summer period will be organized pioneer the camp of sanatorium type (see. Summer camp). In children's policlinics special dispensary observation for children convalescents and for children with hron is made, diseases, a cut includes also medical and recreational actions.
Training of pediatricians is carried out on 57 pediatric f-takh medical in-t, improvement — in in-ta of improvement, at departments pediatric f-tov medical in-t, and also on the basis of republican, regional (regional) and city children's BCs.
The state system of public education of children in the USSR is provided with preschool institutions, boarding schools (see), day-care centers at comprehensive schools (see), orphanages and children's homes (see Orphanage, Children's home), various out-of-school institutions. A day nursery (see), a day nursery gardens (see) and kindergarten belongs to preschool institutions (see). The most perspective type of these institutions — a day nursery gardens. Preschool institutions are created both on territorial, and by the production principle (departmental, collective-farm). There are round-the-clock institutions (groups) for children whose mothers work in shifts or study. In the village, except constant state-farm and collective-farm child care facilities, seasonal will be organized. For the summer many city child care facilities are gone out of town. Parents pay 1/4 costs of the contents of the child in kindergartens and 1/5 costs — in a children's day nursery. For having many children and lonely mothers side benefits are established.
Out-of-school institutions take great interest in education of school students (Palaces and Houses of pioneers, children's libraries, stadiums and pools, music, choreographic and art schools, children's technical stations, stations of young naturalists, pioneer the camp).
Further improvement of health of women and children is the major national objective. In these:: the purposes in light of decisions the XXV congress of the CPSU and the resolution of the Central Committee of KPS and Council of ministers of the USSR «About a measure:: on further improvement of national health care» (1977) further strengthening of material and technical resources obstetric ginekol is provided, and nurseries to lay down. - professional, institutions.
In particular, in 1978 — 1985 the network of children's policlinics, clinics for women, maternity homes, children's BCs extends. Special attention is paid on increase in number of BC (departments) for children with acute diseases of a respiratory organs and premature children. Measures for improvement of the help to children of preschool age are taken. Production of products of baby food increases.
See also Hygiene of children and teenagers., Health protection of children and teenagers.
The sanitary and epidemiologic service
In the USSR developed harmonious system a dignity. - epid, providing the population, the cut is the basic organizational element the territorial sanitary and epidemiologic station (see) exercising control of observance established for all country a dignity. - a gigabyte. norms and rules (see Standards hygienic, the Sanitary legislation).
Dignity. - epid, service — one of primary branches Soviet 3. Its main objective is implementation of precautionary and current supervision of carrying out a dignity. - a gigabyte. the actions directed to elimination available and the prevention further environmental pollution (reservoirs, the soil and air basin), on improvement of working conditions, training, life and rest of the population, the organization and carrying out a dignity. - protivoepid, measures for ensuring prevention, decrease and elimination of infectious diseases.
The modern structure of sanitary and epidemiologic service (see) is defined by the orders M3 of the USSR, and its right and a duty — «Bases of the legislation of USSR and federal republics about health care» (see the Legislation on health care) and «The provision on the state sanitary inspection in the USSR» (1973). The circle of the questions which are within the competence a dignity is comprehensively reflected in these acts. - epid, services, the major all-union provisions concerning improvement of working conditions and life of the Soviet people are fixed, bases of the organization a dignity are formulated. - epid, services and state a dignity. supervision to the USSR, the rights and duties a dignity. - epid. services at implementation of the state sanitary inspection (see), powers and duties of heads of mines - in, departments, the organizations and institutions, and also certain citizens in providing a dignity. - epid, wellbeing of the country, responsibility of officials and certain citizens for disturbance a dignity. norms and rules. In the legislation it is emphasized that the state dignity. supervision is exercised by bodies and institutions a dignity. - epid, services with broad involvement of the population, a trade-union asset, asset about-in Red the Cross and Red Crescent, public councils at a dignity. - epid, institutions, scientific medical about-in and about-in nature protection. Thus, providing dignity. and epidemiol. wellbeing in the USSR the cut along with a dignity is a nation-wide task, in implementation. bodies active part is taken by the party, Soviet, trade-union and Komsomol organizations, the enterprises, institutions and the organizations of the industry, transport, construction and agriculture, and also the general public. Implementation state dignity. supervision the dignity is exclusive function. - epid, services. The law guarantees its independence. All instructions of the chief state health officers concerning a dignity. and protivoepid, the mode of the territory, objects of the environment, the industry, construction, transport, agriculture, catering establishments, trade, the public, public and other institutions, are obligatory for performance. Bodies and institution dignity. - epid, services carry out the activity on uniform with other industries 3. to the plan, using uniform forms and methods of work. Dignity. the bodies and institutions which are a part departmental medical - a dignity. Min-va services of means of communication, Min-va of internal affairs, etc., submitting in the administrative and economic relation corresponding mines - to you and to departments, coordinate the work with the appropriate territorial authorities and institutions a dignity. - epid, services M3 of the USSR, carry out the state dignity. supervision of subordinated objects, being guided by the current legislation and instruktivnometodichesky documents approved by M3 of the USSR. It provides unity a dignity. - epid, services of the USSR.
System of the organization and creation dignity. - epid, services in the USSR at all levels of management completely corresponds to a control system 3. (scheme 3). Leadership in activity dignity. - epid. services are carried out by the chief state health officer of the USSR (see. Chief state health officer) — the deputy minister of health care of the USSR through the Head sanitary and epidemiologic department of M3 of the USSR, and in the federal republic — respectively the chief state health officer — the deputy minister of health care of the federal republic through a dignity. - epid, management and the republican sanitary and epidemiologic station.
In each regional, regional and republican center, the city, the district the regional, city, regional SES which is carrying out a precautionary and current dignity functions. supervision of the objects located in the respective territory, carrying out and checking protivoepid, actions.
The regular and organizational structure of SES M3 USSR depends on type and category of this establishment, edges in turn is defined by population of the serviced administrative territory.
Are assigned to SES: organization and carrying out state dignity. supervision, and also dignity. - protivoepid, the actions directed to decrease and elimination of infectious diseases; improvement of working conditions in the industry, construction, on transport and in agriculture, carrying out measures for the prevention and elimination of occupational diseases; ensuring radiation safety; dignity. protection of objects of the environment (water, soil, air); control of creation optimum gigabyte. conditions for normal development of children and teenagers; gigabyte. control of food of the population; organization of events on promotion medical and a gigabyte. knowledge among the population.
Performance assigned to a dignity. - epid. service of functions the dignity is provided with an extensive network. - epid, the institutions equipped with the necessary equipment and laboratory property and staffed by qualified personnel, and also carrying out researches in in-ta a dignity. - a gigabyte. a profile and at departments of hygiene and epidemiology of medical in-t and in-t of improvement of doctors. By 1976 in the USSR M3 system the St. 4,7 thousand SES as a part of which there were 4256 bacteriological, 179 virologic laboratories and 877 laboratories a dignity functioned. - a gigabyte. departments. In bodies and institutions a dignity. - epid, services of the USSR worked apprx. 50 thousand doctors.
Dignity. - epid, the service is invested by the following rights: to develop and make offers on a dignity. to improvement of various objects, and in the field of state a dignity. supervision — to give obligatory for performance by all officials and citizens of the instruction, directed to reduction of an object in the state corresponding acting a dignity. to norms and rules; to stop construction works and operation of objects in cases of gross violation a dignity. the mode and acting a dignity. legislations; to impose penalties on the persons who are systematically not carrying out instructions a dignity. bodies; to bring a dignity to trial of officials for gross violations. legislations; to demand obligatory hospitalization of patients with infectious diseases and carrying out protivoepid, actions in the center; to suspend from operation of carriers of causative agents of infectious diseases.
For improvement of management dignity. - epid, service, increases in level state a dignity. supervision, strengthenings of operativlo-organizational functions of institutions began to be used the principles of centralization and specialization. The system of centralization of management of SES and their financing deserves attention, the initiator a cut acted as Min-in of health care of the Uzbek SSR. Its being comes down to the fact that regional, city SES are brought out of subordination of local bodies 3. also are transferred to subordination of regional, regional SES with the centralized financing at the expense of the regional, regional budget. However such system demands check time.
One of ways of improvement of management is concentration personnel and the SES material resources servicing at the same time the cities and rural districts adjoining to them (RSFSR, USSR, etc.), and also creation of interdistrict SES in the cities with regional division. Enlargement of SES as in general, and due to use of various forms of centralization happens taking into account providing the most rational forms a dignity. - epid, service of the population.
One of the main sections in work of bodies a dignity. - epid, services control of implementation of measures for environmental control is (see) and dignity. - a gigabyte. conditions of production activity, life and rest of the population. System wide, planned nationally a dignity. - a gigabyte. actions for protection of free air and reservoirs allows to carry out fullestly and practically to realize the requirement about the maximum preservation for the benefit of health of the population of our country of high quality indicators of a condition of the environment surrounding the person. Direct relation to strengthening of activity dignity. bodies, the environment directed to every possible improvement, to the Soviet people of necessary living conditions, work and rest, the resolution of the Supreme Council of the USSR «About measures for further improvement of nature protection and rational use of natural resources» (1972), and also the resolutions adopted by Council of ministers of the USSR has public health care, providing: about measures for prevention of pollution of the Caspian, Baltic, Black and Azov seas, preservation of natural wealth of Lake Baikal, for further improvement of the Volga Rivers, the Urals, Tom, etc.
For coordination research and construction work, the solution of scientific and technical problems in this area at the State committee of Council of ministers of the USSR on science and technology the interdepartmental Scientific and technical council on complex problems of protection of the surrounding environment and rational use of natural resources is created. In work of council active participation representatives take orders. - epid, services of the country.
As a result of close interaction of bodies state a dignity. supervision with the Soviet bodies and full support from the party organizations, increase in insistence to min. - to you both departments and strengthenings in general state a dignity. supervision in the country considerable events for environmental control are held. It is constructed and continues to be under construction a large number of constructions for sewage treatment and industrial pollutions, at the enterprises the system of reverse water supply widely is implemented. All this led to the fact that, despite the continuing growth of capacities of the enterprises, a dignity. the condition of a number of reservoirs considerably improved. Considerably the condition of the air basin of a number of the cities improved. In improvement of water supply of the population the statement of new GOST on drinking water is of great importance, in Krom more high requirements to its quality are imposed. Due to construction of new water supply systems, reduction of a consumption of drinking water for technological needs of the enterprises average daily water consumption on one inhabitant systematically increases, the number of the cities having the sewerage with a full complex of cleaning increases. In business a dignity. environmental controls the significant contribution is made by scientists-hygienists. In development of a problem «Scientific bases of hygiene of the environment» the St. 70th gigabyte takes part. institutions, 26 scientific research institutes and 45 departments gigabyte. profile of medical in-comrade. Only for 1971 — 1976 researches on 812 subjects are complete. Many of them have fundamental character. They are directed to improvement of theoretical bases, a regulation chemical, physical. and biol, environmental factors, development of methodology of assessment of their combined and combined effect on an organism; maximum allowable concentrations of 557 harmful substances for water of reservoirs and 155 substances for free air of the inhabited places are established (see Maximum allowable concentrations). A lot of work conduct a gigabyte. institutions on complex forecasting of state of environment of the certain cities. Researches are conducted according to the coordination plan of the State Committee for Construction of the USSR and cover all complex a dignity. the conditions and factors characterizing the modern city and its development for the next years, including a design and building (see Town planning, the Design of the inhabited places), sanitary protection of free air (see) and reservoirs (see. Sanitary protection of reservoirs), water supply (see), a dignity. cleaning (see Cleaning of the inhabited places), the organization of rest of the population. Their main objective — scientific development a gigabyte. recommendations about optimization of the urban environment in the general plan of town planning according to the modern level of development a gigabyte. knowledge and dignity. technicians. In the tenth five-years period 11 billion rubles are allocated for construction of facilities of environmental control.
An important place in activity a gigabyte. in-t and dignity. - epid, services occupy questions an industrial dignity. supervision, carrying out in the country of the nation-wide actions directed to improvement of working conditions and preservation of health of workers. With adoption of the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of health care and development of medical science in the country» (1968) work on drawing up and implementation of «Comprehensive plans of improvement of conditions, labor protection and sanitary recreational actions» amplified. These plans are prepared taking into account offers of the trade-union organizations, mines - in, workers a dignity. - epid, services, and their performance is controlled by bodies state a dignity. supervision. GOST included in system of standards on safety of work are developed. Gostirovaniye gigabyte. standards increases the responsibility of heads of the enterprises, organizations, mines - in and departments for providing safe and healthy working conditions on production. In the tenth five-years period uniform occupational safety standards system for the countries of SEV is created.
In all industries of the national economy and 3. thanks to close connection of scientific institutions with production the tasks connected with rationing of a time factor of radiation, development special a dignity are solved. legislations, justification of preventive actions and effective control behind observance of requirements and standards of radiation safety during the receiving and use of atomic energy. Due to the expansion of the sphere and volume of use of sources of radiations, with introduction to a system of new nuclear power plants, broad use of the radiation equipment and sources of radiations of effort a gigabyte. sciences and practicians dignity. supervision go to the solution of urgent problems of a physics health (see).
On strictly scientific basis the dignity was created. supervision in the field of a physics health. The first dignity. rules (rules on a radiografirovaniye) were created in 1948, and in 1957 in TsIU the first in the Soviet Union department of a physics health was organized. Besides to the period also creation Leningrad research in-that a physics health belongs. The developed system a gigabyte. standards and dignity. rules guarantees full safety working with sources of ionizing radiation.
On the basis of achievements gigabyte. sciences in the USSR, with participation a dignity. - epid, services a number of nation-wide normative documents is prepared: «Sanitary standards of design of the industrial enterprises», the heads of construction norms and rules establishing taking into account a gigabyte. requirements of norm of construction of auxiliary buildings and premises of the industrial enterprises, norm of design of heating, ventilation and air conditioning, natural and artificial lighting, water supply and sewerage, etc. Tolerance levels of noise, vibration, parameters of a microclimate of production rooms, ionizing radiation, etc. are developed and established. Maximum allowable concentrations of 800 names of substances for air of a working zone of production rooms are defined.
At the industrial enterprises laboratories or their departments as a part of factory laboratories designed to exercise constant control behind observance a dignity are created. - a gigabyte. standards in workshops and on other production sites, and also behind pollution of free air, the soil and reservoirs industrial emissions. As a result of performance of a complex a dignity. - those. the actions developed on a basis a gigabyte. the requirements directed to improvement of working conditions and life of workers, the level of professional incidence in the country decreases. In 1975 in comparison with 1970 it decreased by 24%, and this decrease takes place with a simultaneous growth of industrial production and the number of the people occupied in it.
The CPSU set by the XXV congress on the tenth five-years period the task of acceleration of rates of scientific and technical progress is connected with creation and implementation of essentially new conditions of labor process replacing manual skills, new technological ways with use in the national economy of new materials and chemical substances. It demands from a gigabyte. sciences of problem solving, the workers directed to preservation of the optimum state of health, a high level of their working capacity in difficult conditions of modern production. At the same time industrial and page - x. productions shall pass «from the accident prevention — to the safe equipment» (L. I. Brezhnev, a performance at the XVI congress of labor unions of the USSR 21/III 1977 g). All this significantly changed activity of practical workers of industrial sanitary inspection and introduced certain amendments in subject of scientific institutions a gigabyte. profile.
At the present stage of development any country cannot do without originally scientific recommendations in the field of production of food stuffs for the next years and further perspective. The solution of this problem is connected with searches of the most effective and economically justified production schedules of production and research of new sources of foodstuff, with increase them biol, values, development of rational methods of their preservation, a gigabyte. justifications of norms and power supply systems of the healthy and sick person.
The modern science about food of the person represents a uniform complex of appropriate sections of biochemistry, physiology, hygiene and a wedge, medicine. If in 30 — the 40th criteria of nutritional value of products were only a caloric content and content in food of proteins, fats and carbohydrates, then in the 70th during the development a gigabyte. aspects of food tens of components of foodstuff (amino-acid composition of proteins, zhirnokislotny composition of fats, various carbohydrates, the wide list of vitamins, mineral substances and microelements), and also their balance are considered. Sizes fiziol are established, to need of the person for feedstuffs and energy for various groups of the population living in different klimatogeografichesky zones of our country. The specified recommendations have the state value and to some extent form a scientific basis for planning of production of foodstuff. Basic theoretical researches of the last years in the field of hygiene of food (see) studying of laws of assimilation of food and justification of the concept of the balanced food were directed to detection of value for life activity of an organism of separate substances. These researches were conducted both in the conditions of a complete organism, and at the cellular, subcellular and molecular levels. Development and deployment of the principles of a balanced diet, i.e. the food corresponding to specific features and needs of each person continues to remain one of the important directions in work of bodies and institutions a dignity. - epid, services, and also scientific research institute a gigabyte. profile.
With creation in the country of the large-scale food industry, wide network of catering establishments and trade, significant increase in production of page - x. products, contents, forms and methods of implementation dignity. supervision of food of the population changed. Gradually narrow problems of control only of high quality of foodstuff grew to wide tasks of the organization of a balanced diet of the population. Also control over the implementation on food objects a dignity improved. - a gigabyte. and dignity. - protivoepid, rules and norms.
In 60 — the 70th worldwide use of nutritional supplements — the substances preventing damage of the products improving their quality and safety sharply extended. In the USSR the strict gigabyte is established. control of use of these additives: any substance offered to addition in food cannot be applied without the permission of bodies state a dignity. supervision. The same order extends to the polymeric and other materials contacting to foodstuff.
Implementation of a large number of chemical means of protection of plants and animals in agriculture caused the necessity their gigabyte. studying, development of the system of actions for prevention of pollution by them of foodstuff and control methods of the level of their contents in products. On the basis of scientific research and practice a dignity. supervision the resolution of Council of ministers of the USSR «About actions for public health care in connection with expansion of use in agriculture of chemical means of protection of plants» is accepted. For implementation of measures for prevention of pollution of products pesticides (see) the system of forecasting of residual amounts of pesticides in products of crop production and terms of carrying out sowing processings is developed. Thanks to more strict regulation of use of pesticides and strengthening state a dignity. supervision on control of use of chemical means of protection of plants in the ninth five-years period falloff of impurity is reached by toxic chemicals of foodstuff.
The changes which happened in an educational system and educations of younger generation, reduction of content of training in compliance to requirements of science and culture, change of forms of submission of educational information, a considerable intensification of educational activity, reorganization of system of professional training set the task to improve conditions of education and training of children and teenagers. Activities of M3 of the USSR for approval of educational and labor loading, and also approximate mode of occupations of children are considerably expanded. Together with bodies of national education, professional training, others of mines - you and departments to which the duty is assigned protect health of children and teenagers (see), are implemented a gigabyte. standards of construction of buildings of child care facilities and schools, productions of furniture, stock, textbooks and manuals, objects of children's use, including children's toys. Special attention is paid a gigabyte. to education of children and teenagers, and also gigabyte. to training of personnel of child care facilities. It is provided with teaching in educational institutions of bases of hygiene, training of tutors and program teachers a dignity. minimum etc. Bodies and institution dignity. - epid, services in the work widely rely on results of scientific research on the basis of which are developed a dignity. rules, methodical recommendations and gigabyte. the requirements which are valid the law. Skillful use of achievements gigabyte. sciences, their widespread introduction in practice, a constant dignity. supervision of child care facilities and schools was allowed to create ought a dignity. - a gigabyte. conditions and observance dignity. - protivoepid. the mode in them that provided further strengthening of health, improvement of indicators physical. development of younger generation.
The organization and carrying out measures for prevention of infectious diseases — one of the major tasks a dignity. - epid, services. The wide experience is on this matter accumulated and considerable success are made (see above «Formation and development of the Soviet health care»). In the 70th work on improvement of forms and means of specific prevention, sanitary patrolling was continued (see) etc. Vaccines against diphtheria, measles, rage, flu, etc. are improved; the needleless method of immunization is implemented.
For the first time in the world (1972) the accounting of territories, permanently unsuccessful on a malignant anthrax is made. Actions for prevention of infectious diseases become more differentiated and are held together with others of mines - you and departments.
The system of fight against infectious diseases developed in the USSR gained the world recognition and is widely used in the international practice.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) for further decrease in incidence of acute intestinal infections provided implementation of actions for observance a dignity. and tekhnol. conditions by production, transportation and implementation of food stuffs, and also on a dignity. to improvement of the cities and rural settlements.
System of sanitary education
System dignity. educations is a complex of the organizational, legislative, scientific and practical actions providing systematic a gigabyte. training and education of the population by distribution scientific medical and a gigabyte. knowledge.
Characteristic feature Soviet dignity. educations — its organic communication with problems of communistic education, and also broad participation of the population in it. This participation finds expression in grass-roots people's movements for the communistic attitude towards health, for improvement and a dignity. culture, for carrying out in life of the governmental and public activities on protection of national health, in active work of national high fur boots of health etc.
Being important function Soviet 3., dignity. education plays a significant role in the formation of public consciousness, skills and habits directed to improvement of the environment surrounding the person in preservation and continuous strengthening of health for the benefit of wellbeing of individuals and all about-va, in increase a dignity. cultures of the population, organization of a healthy lifestyle, education of a conscientious attitude to protection of personal and public health.
In the USSR a dignity. education is the obligatory section of activity of all medical institutions and office function of all doctors and average medical workers. In Soviet 3. the principle of organic communication a dignity is provided. educations with to lay down. - professional, and a dignity. - a gigabyte. work of bodies and institutions 3.
Special service dignity. educations St. 500 Houses include a dignity. educations (see. House of sanitary education ), being the coordination and organizational and methodical centers a dignity. - a gleam. works in the territory of the USSR. The general management on a dignity. to education carries out M3 of the USSR. Specialists on a dignity. to education are available in states to lay down. - professional, and a dignity. - protivoepid. institutions. Studying of tasks, forms and methods dignity. educations it is provided by programs of the highest and average medical educational institutions, and also is a subject of special cycles in system of improvement of knowledge of medics.
Growth of efficiency and mass character of promotion medical and gigabyte. knowledge it is connected with wide use of mass media (the press, cinema, radio, television), with participation in work on a dignity. to education industrial, construction and page - x. mines - in and departments, cultural institutions and education, about-in Red the Cross and Red Crescent, trade-union and other public organizations. In this regard since 50th comprehensive plans a gigabyte are developed. training and education of the population of the USSR in which implementation all listed institutions and the organizations take part. For coordination of the organizational and methodical events held interested mines - you, departments and public organizations, at M3 of the USSR the All-Union council of sanitary education which is the member of the International union of sanitary education functions. The scientific and methodical center developing scientific bases a dignity. educations, the in-t of sanitary education of M3 of the USSR is Central research.
Practice dignity. - the gleam, works in the USSR confirms that in the conditions of socialist about-va a gigabyte. training and education assist creative activity of the population in recreational actions, allow to use more widely the social and economic factors which are positively influencing health, working capacity and active longevity.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) provided wider use of mass media on improvement a dignity. - a gigabyte. education of the population, promotion of a healthy lifestyle, physical culture and sport. In the resolution special attention to physical is paid. development of younger generation, health protection of women and children, eradication of unhealthy habits — smoking and an alcohol abuse.
See also Sanitary education .
Resorts, sanatoria and institutions of recreational rest play a large role in prevention and treatment of diseases, in recovery of health of workers. N. A. Semashko, defining the place a dignity. - hens. the help in the general system to lay down. - professional, actions, considered that sanatoria are as if a link between the out-patient, hospital treatment and institutions which are carrying out purely preventive tasks.
System dignity. - hens. the help it is created practically for years of the Soviet power. In imperial Russia there were 36 resorts, 60 sanatoria on 3000 places; rest houses were not. Resorts were unavailable to workers.
In 1975 in the USSR was apprx. 600 resorts and to lay down. areas (see Resorts), 11 697 sanatoria and institutions of rest on 1795 thousand places functioned; in sanatoria, institutions of rest, on tourist routes and bases it was treated and 47 million workers and members of their families had a rest, from them more than 31 million people used prolonged treatment and rest, 7 million — one-two-day rest, 9 million — rest on tourist routes of the day off. Apprx. 21 million children and teenagers during the summer spent vacation at summer and school camps, on excursion tourist centers or left for the summer period to country places with child care facilities.
Practical guidance dignity. - hens. business and the organization of recreational rest of workers in the USSR carries out Central office on management of resorts of labor unions, in federal republics — republican, on places — regional, regional and territorial councils on management of resorts of labor unions. The general management of network of resorts and sanatoria for TB patients, and also children's sanatoria carries out M3 of the USSR, and direct management — min.-va health care of federal republics, their zone managements and bodies 3. on places.
The main type to lay down. institutions in the resorts of the USSR is sanatorium (see). For each sanatorium a certain medical profile is established depending on to lay down. factors of the resort. Lech. procedures are, as a rule, carried out in all-resort balneolechebnitsa (see. Balneary ), mud baths (see), drinking pump rooms and galleries, aero sunbeds, klimatopavilyona to lay down. swimming pools, on beaches. In many resorts, in resort policlinics it is carried out out-patient kursovochnoye treatment of the patients who are not needing a high sanatorium regime. The direction on a dignity. - hens. treatment is performed to lay down. institutions in strict accordance with medical indications (see. Sanatorium selection ). Permits in sanatorium and institutions of rest of labor unions are provided to hl. obr. free of charge or for 30% of cost, in sanatorium of the USSR M3 system — it is free.
Organization and development dignity. - hens. the help in the USSR are based on strictly scientific beginnings. Problems of balneology (see) — in studying of the mechanism of action of resort factors and most effective methods of their use, and also development of the principles of the organization, planning and construction of resorts, sanatoria and institutions of recreational rest — 14 research in-t of balneology and physical therapy in federal republics, separate in-you and Academy of Sciences of the USSR and USSR Academy of Medical Sciences laboratories, a number of departments of medical in-t and in-t of improvement of doctors, the research laboratories of balneology which are under authority of Central office on management of resorts of labor unions are engaged Central research in-t of balneology and physical therapy of M3 of the USSR.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) provided increase in number of beds in children's sanatoria, expansion of network of sanatoria and boarding houses for treatment and rest of parents with children, specialized sanatorium summer camps, institutions of rest for family and treatments of patients with ginekol. diseases.
Organization of the medicinal help
The system of rendering the medicinal help to the population of the country is a component 3. Development plan 3. includes further expansion of pharmacy chain, strengthening of material and technical resources of pharmaceutical economy, completion its highly skilled pharm, shots.
Philosophy Soviet 3 are inherent in the medicinal help in the USSR.: the state character, general availability, planned development on a scientific basis, unity pharm, sciences and practicians, free of charge at hospitalization. At out-patient and polyclinic treatment the population receives drugs according to recipes for a payment. Nek-rym to groups of the patients suffering onkol., gematol. by diseases, tuberculosis, schizophrenia, epilepsy, diabetes, an addisonovy disease, etc., and also to disabled people of the Great Patriotic War, children aged till 1 year of medicine are released free of charge and at out-patient and polyclinic treatment. To merit pensioners of medicine are released on favorable terms — at a discount, the cost making 80%.
At various stages of socialist construction depending on the tasks standing before 3. and the pharmaceutical service, changed and improved organizational forms and methods of the medicinal help to the population, new types of pharmaceutical institutions were created, the organization of their work was improved.
By 1976 in comparison with 1914 the quantity of drugstores increased in the country more than by 5 times, and honor the number of druggists by 15 times.
The medicinal help to the population of the USSR is carried out through wide network of pharmaceutical institutions, includes edges: city and rural drugstores, the central regional drugstores, drugstores to lay down. - professional, institutions and interhospital drugstores, branches of drugstores, pharmaceutical shops and booths, pharmaceutical points (see the Drugstore), pharmaceutical warehouses (see) and bases, control and analytical laboratories, pharm. factories and productions.
For January 1, 1977 only in the USSR M3 system 25 060 drugstores, 89 730 pharmaceutical points, 269 pharmaceutical warehouses, 88 pharm, factories, 283 control and analytical laboratories, etc. functioned.
Development of network of pharmaceutical institutions is carried out systematically.
During the opening of new drugstores first of all perspectives of development of settlements, districts, existence in the settlement or the district of medical institutions (policlinics, consultations, BC, clinics etc.), population density and other factors are taken into account; availability of pharmaceutical institutions to all segments of the population both in the city, and in the village is provided.
Design, construction and the equipment of drugstores and other pharmaceutical institutions is carried out on strictly scientific basis. The developed and accepted construction norms and rules (Construction Norms and Regulations) of drugstores and pharmaceutical institutions provide the most optimal planning solution of structure, the sizes and interrelation of rooms, at the same time technological process of preparation of drugs, safety of pharmaceuticals at their storage, high quality of the medicinal help to the population according to achievements pharm, sciences and practicians is provided (see. Pharmacy ) and requirements of the State pharmacopeia of the USSR (see. Pharmacopoeia ).
The main supplier in pharmacy chain of pharmaceuticals and other products of the pharmaceutical range are the enterprises of the Ministry of the medical industry (see); besides, products of the enterprises of Min-va of the chemical industry, Min-va of the meat and milk industry, Min-va of light industry and others, and also pharm, factories of pharmaceutical managements and purchased abroad come to pharmacy chain.
In pharmaceutical system specialists with the highest and average pharm, education work. Preparation and improvement of shots are carried out by uniform curricula and programs (see. Pharmaceutical education ). Certification of specialists pharmacists is carried out.
The pharmaceutical service of the USSR is headed by the Head pharmaceutical department of the USSR (GAPU). In federal republics the organization of the medicinal help is carried out by the head pharmaceutical departments of mines - in health care of the republics, and in areas, edges, autonomous republics and the large cities — pharmaceutical managements which direct the network of pharmaceutical institutions subordinated to them (see. Pharmaceutical management ).
For rendering the medicinal help to workers of the separate industries of the national economy at medical - a dignity. to service of a number of mines - in and departments there are drugstores and other pharmaceutical institutions and operating controls them which will organize work on the basis of the orders M3 of the USSR, methodical instructions and special provisions, the published mines-vom under which authority they are.
Control of quality of the medicines produced in our country and which are purchased abroad is carried out in the course of their studying and implementation in practice through the state inspectorate for control of quality of pharmaceuticals and products of the medical USSR M3 equipment, management for implementation of new pharmaceuticals and the medical USSR M3 equipment, pharmacological committee (see) and other organizations. At the enterprises producing medicines, inspection departments are given large powers, they carry out check of a feed stock, control of observance of technological process and quality of finished goods. In pharmaceutical system control of drugs is made by control and analytical laboratories and drugstores. The harmonious control system created in the USSR behind quality ensures high performance and safety of the pharmaceuticals applied in the country.
Development of problems of the medicinal help to the population is carried out All-Union research by in-t of pharmacy, research in-you are Min-va of the medical industry, pharm, in-you and pharm, f-you, etc.
Coordination of their activity in the field of scientific research is assigned to the problem commission of the USSR Academy of Medical Sciences «Pharmacy». The big role in improvement of the medicinal help to the population and implementation of achievements of science in practice belongs All-Union scientific about-vu druggists (VNOF), republican, regional and regional scientific about - to you druggists.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) provided a number of the measures directed to full satisfaction of need of the population for pharmaceuticals and products of medical appointment, including a measure for rational distribution and use of pharmaceuticals and dressing materials for operational information of doctors about new pharmaceuticals, to expansion of construction of pharmaceutical warehouses etc.
the Medical industry
the Medical industry — the industry of the national economy which is engaged in development and industrial production of pharmaceuticals, different types of the medical equipment and products of medical appointment from glass and plasts.
In structure of the medical industry (see) enter: the enterprises which are releasing chemical - pharm, drugs, including synthetic medicines, antibiotics, vitamins, endocrine and hormonal drugs, enzymes and coenzymes of medical appointment, blood substitutes, drugs from medicinal vegetable raw materials, etc.; the enterprises for production of products of the medical equipment — medical tools, devices, devices and the equipment; the enterprises making medical glassware, porcelain and polymeric materials; state farms on cultivation of medicinal plants.
The domestic medical industry was created in essence for years of the Soviet power. In pre-revolutionary Russia there were only small semi-handicraft works belonging to generally private owners who produced the elementary pharmaceuticals and separate types of medical tools. The hl based in 18 century at Peter I z-d military-medical preparations, making was the only «state» enterprise. obr. for needs of army surgical instruments, dressing materials and some drugs from medicinal vegetable raw materials.
Almost all medical devices, the main part of medical tools, St. 80% of the pharmaceuticals consumed in imperial Russia were imported from abroad in spite of the fact that the country had big resources of raw materials for their production.
Only after the victory of the Great October socialist revolution which laid the foundation socialist 3., the enterprises and the research organizations for development and production of pharmaceuticals and other medical products began to be created and develop.
In 1918 in the Soviet Russia 22 enterprises for production of medicines at which worked apprx. only 3 thousand people during this period, and also z-d military-medical preparations in Leningrad and the small enterprise for production of medical tools in Vorsm's settlement of the Nizhny Novgorod province were nationalized (nowadays Mr. Vorsma of Gorky area). The state enterprises for production of medicines in Ukraine, in Belarus, Transcaucasia began to be organized. It laid the foundation for creation of the domestic medical industry.
In the same 1918 for the management chemical - pharm. the enterprises at the Supreme Soviet of the National Economy of RSFSR Pharmtsentr reorganized in 1919 into Head department chemical - pharm, by the plants, and then in 1925 — to Gosmedtorgprom was formed.
Understanding importance of ensuring first-priority needs Soviet 3. minimum necessary range of pharmaceuticals and other medical products, the Communist Party and the Soviet government, despite all difficulties of that time, found opportunities for development of the enterprises for production of medical appointment, allocating for this purpose the corresponding capital investments.
Bodies 3., employees of the industrial enterprises made all efforts for bystreyshy construction and reconstruction of the plants, development and the organization of production of the medicines and other medical products which are earlier purchased abroad.
For years of the first Soviet five-years periods were put into operation in the settlement of Kupavna of the Moscow region chemical - pharm. z-d «Quinacrine», products to-rogo was important for elimination in the country of malaria, Kiev chemical - pharm, z-d of M. V. Lomonosov, Kharkiv chemical - pharm, z-d «A red star», etc. On Moscow chemical - pharm, z-de of L. Ya. Karpov and Moscow chemical - pharm, z-de of N. A. Semashko new cases, and on reconstructed Leningrad chemical - pharm were constructed, z-de of Pharmakon is organized production of such synthetic drugs, complex on that time, as pyramidon, acetphenetidiene, etc. Enlargement and specialization of production was at the same time carried out.
The scientific base of the medical industry was created and extended. Played an important role in development of synthetic pharmaceuticals and development of their industrial production organized in 1920 in Moscow research chemical - pharm, in-t (nowadays All-Union research chemical - pharm, in-t of S. Ordzhonikidze) and Kharkiv research chemical - pharm. in-t. Later, in 1931 in-t of medicinal and aromatic plants (nowadays All-Union research in-t of medicinal plants) and in 1936 were formed All-Union. All-Union research vitamin in-t.
Staff of these scientific organizations in a short space of time carried out a lot of work on development chemical - pharm. drugs therefore already in the first five-years period the production of St. 40 new medicines was mastered, and the total production of products on chemical - pharm, the enterprises for 1928 — 1932 increased almost twice.
In development of the domestic medico-tool industry the leading place belonged to the plant of military-medical preparations which became in essence the firstborn of production of the medical equipment in the country and grew today in the largest enterprise — the Orders of Lenin and Awards of the October Revolution the Leningrad production association «Krasnogvardeets» specializing in release of the narcotic and respiratory equipment, endoscopic devices and other difficult medical technique. The small handicraft plant on production of medical tools in Vorsm's settlement for years of the Soviet power turned into one of the largest enterprises for release of medical tools — Awards of the Labour Red Banner medico-tool z-d of V. I. Lenin. On the basis of local production in the settlement of Tumbotino it is created medico-tool z-d of M. Gorky. Some other the enterprises for production of products of the medical equipment is created.
In 1937 the Central research laboratory of medical tools which was one of the first scientific institutions will be organized, on a cut problems of creation of new medical tools and the equipment, the organization of their serial release and development of the progressive production technology of the medical equipment were assigned.
Thus, on the eve of the Great Patriotic War the medical industry which was under authority Narkomzdrava of the USSR was already presented by two subsectors — chemical and pharmaceutical, combining 15 enterprises, and medico-tool, in structure a cut there were 11 plants.
By this time the range of the released drugs, medical tools and devices extended, and the total production of medical products in comparison with the pre-revolutionary period increased more than by 7 times. Chemical - pharm, the enterprises developed St. 570 names of pharmaceuticals, including quinacrine, pyramidon, aspirin, acetphenetidiene, validol, novocaine, luminal, anaesthesin, santonin, caffeine, etc. Most of them was issued in the form of ready dosage forms (tablets, a dragee, ointments, tinctures, injection solutions in ampoules, etc.). Production of wounded sulfanamide drugs, effective at treatment — streptocide, Sulfidinum was mastered. The enterprises of the medico-tool industry issued St. 600 names of medical devices, devices, tools, including it is a lot of difficult medical products, such as cystoscopes, thoracoscopes, bronchoscopes, gastroscopes, various surgical instruments, etc.
A considerable part of synthetic and galenovy drugs, and also dressing means was produced at the enterprises which were under authority of narkomzdrav Ukrainian, Belarusian, Uzbek and the Transcaucasian federal republics.
In days of the Great Patriotic War primary activity of the enterprises of the medical industry, as well as 3. in general, it was aimed at providing needs of the front and back for pharmaceuticals, medical devices, devices, surgical instruments and other medical products. War made considerable changes to work of the industry in connection with destruction and evacuation of most of leaders of the plants. Workers of the medical industry took all measures providing production of necessary medical products both on transferred on the East z-dakh, and at the new enterprises created in incredibly short time in the Urals, in Siberia, Central Asia. In 1942 — 1943 these enterprises began to deliver products a dignity. to service of army, bodies 3. and to the population, and by 1945 the volume of production of medical appointment exceeded pre-war level.
After the termination of the Great Patriotic War before Soviet 3. there were new tasks connected with need of recovery and expansion of network to lay down. institutions, the organization of fight with epid, diseases, especially in the districts freed from fascist occupation. All this demanded to increase considerably production of medicines, surgical instruments, various devices, devices and other medical products. In short terms destroyed were recovered and the new enterprises of the medical industry were under construction, research extended, wide scope was accepted by the movement for early performance of plan targets. As a result the medical industry implemented the plan of the first post-war five-years period (1946 — 1950) successfully. Production of sulfanamide drugs in 1950 in comparison with 1945 increased more than twice.
Even during the war in the country works on development of release of antibiotics began. However development and deployment of the industrial production technology of antibiotics, in particular deep fermentation, and creation of the specialized plants on their release were carried out in 1945 — 1947. Played a big role in it created in 1946. All-Union research in-t of antibiotics, combined efforts of the scientists and practicians working in this direction. In the 50th antibiotics took the important place among the pharmaceuticals applied to treatment of many diseases. Therefore on questions of further development of production of antibiotics, creations of new antibiotic drugs the attention of the enterprises and research establishments of the medical industry concentrates. Their release continuously grows. If in 1950 in the total production of pharmaceuticals 5,6%, then in 1965 — 22,4% fell to the share of antibiotics. Now the medical industry releases for needs 3. generally all major antibiotics, including semi-synthetic.
The beginning of broad industrial production of vitamins belongs to the end of the 50th. During 1960 — 1970 production of vitamins A was organized, In 1 , In 2 , In 3 , In 6 , In 12 , In 15 , D 2 , D 3 , E, P, PP, folic to - you, etc. The total amount of production of vitamins during this time increased by 4 times.
Along with expansion of release chemical - pharm, drugs in post-war years in high gear developed and production of the medical equipment was continuously improved. The big contribution brought in the solution of this task organized in 1944. All-Union research in-t of medical tools and the equipment (since 1966. All-Union research in-t of medical instrument making). Together with the industrial enterprises of in-t developed many types of products of the medical equipment, and also technology of their industrial production.
For the purpose of acceleration of creation of new technical means in the field of surgery in 1951 Ying t of the experimental surgical equipment and tools is organized (since 1971. All-Union research and test in-t of the medical USSR M3 equipment) which improved and finished to industrial and a wedge, implementations the cardiopulmonary bypasses, devices sewing vessels and fabrics, and some other products of the medical equipment.
In the 50th strong bases of scientific development and production of endoscopic devices, the electronic therapeutic and diagnostic package, devices for an inhalation anesthesia and artificial ventilation of the lungs, the aerosol and electroaerosol equipment, surgical lamps and therapeutic irradiators, and also equipments for radio isotope diagnosis are laid, ultrasonic to lay down. and diagnostic equipment.
The Central design and technological bureau «Mekhanization» dealt with issues of improvement of the medical equipment (since 1973. Medoborudovaniye scientific and production association), on the basis of developments to-rogo the enterprise of the industry mastered serial release of operating and orthopedic tables of the improved design, functional beds, various chairs, the sterilizing and disinfection equipment, x-ray equipment for fluorography and panoramic exposures, mobile laboratories and offices, and also the devices facilitating work of medical staff.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR of January 14, 1960 was important for development of the medical industry. «About measures for further improvement of medical care and public health care of the USSR». Performance of the actions planned by it promoted strengthening of research and experimental base of the medical industry, expansion of production capacities, increase in production of medical prescription for needs 3. New production capacities due to reconstruction and expansion of many enterprises were in a short space of time created, are opened up the first stage Novokuznetsk chemical - pharm, z-yes, Bolokhovsky chemical plant of synthetic semi-products and vitamins and the Belgorod vitamin plant of a name of the 50 anniversary of the USSR, some z-dy medical supplies, Tuymazinsky z-d medical glasses of a name of the 50 anniversary of the USSR, large workshops on release of finished pharmaceutical products on a row chemical - pharm, z-dov. A lot of work on training for scientific institutions and the industrial enterprises is carried out. As a result the output of pharmaceuticals in 1965 in comparison with 1960 increased more than by 2,5 times. It was during this time mastered St. 200 new pharmaceuticals. Considerably the range of the released medical tools, devices, devices extended and the total production of the medical equipment grew.
Thus, the medical industry turned into the large industry of the national economy of the country.
For further improvement of the leadership in the medical industry, accelerations of modernization of the enterprises and increase in technological level of production, further expansion of development and increase in production of medicines and products of the medical equipment by the resolution of the Central Committee of the CPSU and Council of ministers of the USSR in April, 1967 the medical industry was allocated in the independent industry of the national economy and the all-union Ministry of the medical industry is formed (see). From 1967 to 1975 the ministry was headed by P. V. Gusenkov, and since 1975 — A. K. Melnichenko.
Creation of the ministry of the medical industry promoted considerable acceleration of rates of development of the medical industry, implementation of uniform technical policy in the industry and to increase in technical and economic indicators of production. Over the last 10 years a lot of work on specialization and enlargement of production, construction and modernization of the enterprises, implementation of more perfect technology, development of scientific base, development of new standards on products of medical appointment with high requirements to quality of these products is carried out to the industries. Tens of the enterprises are reconstructed and are considerably expanded, including. Kurgan plant of medical drugs and products «Synthesis», Penza z-d medical drugs. Awards of the Labour Red Banner medico-tool z-d of V. I. Lenina, Kazan Awards of the Labour Red Banner medico-tool z-d, Mozhaisk medico-tool z-d of P. V. Gusenkov, the Belgorod vitamin plant of a name of the 50 anniversary of the USSR, Yerevan z-d vitamin drugs, the Award of the Labour Red Banner chemical - pharm, z-d «Quinacrine», Leningrad chemical - pharm. z-d Pharmakon, Kharkiv z-d medical plastic and dental materials, etc. On a row z-dov are built experienced razrabotochnye workshops and experimental and laboratory cases. The new research and design organizations, among them Novokuznetsk research chemical - pharm, by in-t, All-Union research in in-t of technology of blood substitutes and hormonal drugs, All-Union research and design in in-t of the radio-electronic medical equipment in Lviv, All-Union research in in-t of medical tools in Kazan, etc. are created.
For 1965 — 1975 the fixed business assets of the enterprises of the medical industry increased by 2,7 times, and the volume of production of medical appointment increased more than by 3 times.
Only for years of the ninth five-years period (1971 — 1975) more than 300 new technological processes were implemented in production, the St. 3 thousand units of the high-performance equipment is established, apprx. 200 automatic transfer lines and by that increase in production of medicines and products of the medical equipment by 72% is provided; at the same time 86% of all gain of production are received for the account of growth of labor productivity. For the specified period the industrial release apprx. 180 new pharmaceuticals and nearly 600 names of new products of the medical equipment is mastered. Production of semi-synthobiotics by 1975 in comparison with 1970 increased by 6 times, antineoplastic means — by 1,9 times; the production of vitamins increased almost by 2,5 times, salicylic drugs — by 3 times. The output of products of the medical equipment for the fifth anniversary increased by 1,5 times.
In 1977 the medical industry made St. 1600 names of pharmaceuticals and apprx. 4500 names of medical tools, devices, devices, products from polymeric materials, glass, etc.
The enterprises of the industry make and deliver to bodies 3. in wide assortment almost all basic groups of pharmaceuticals, including sulfanamide, antibiotic, antituberculous remedies, vitamins, the majority of the drugs necessary for treatment of cardiovascular diseases, blood substitutes, anesthetics, antiseptic agents, antineoplastic means, etc., and also many types of products of the medical equipment, in t. h devices for an inhalation anesthesia, artificial ventilation of the lungs, artificial circulation, endoscopic devices, physiotherapeutic devices, operating tables, functional beds, the sterilizing equipment, systems for capture and hemotransfusion, surgical instruments, among them staplers, tool kits for microsurgeries and other products necessary for equipment to lay down. - professional, institutions. Products of the enterprises of Min-va of the medical industry make St. 80% of pharmaceuticals and apprx. 70% of the products of the medical equipment which are released in the country for needs 3.
The largest production associations and the enterprises are: in All-union industrial association on production of synthetic pharmaceuticals (Soyuzleksintez) — Leningrad production chemical - pharm. the association «Pharmakon», Novokuznetsk production chemical - pharm. the association «Organic chemistry», Awards of the Labour Red Banner chemical - pharm, z-d «Quinacrine», Kiev chemical - pharm. z-d of M. V. Lomonosov; in All-union industrial association on production of antibiotics, blood substitutes and organopreparat (Soyuzantibiotiki) — Moscow Awards of the Labour Red Banner production association of medical drugs of Mosmedpreparata of L. Ya. Karpova, Awards of the Labour Red Banner Krasnoyarsk z-d medical drugs, Penza z-d medical drugs, Saransk z-d medical drugs, Kurgan plant of medical drugs and products «Synthesis»; in All-union industrial association on production of vitamins (Soyuzvitamina) — the Belgorod vitamin plant of the 50 anniversary of the USSR and Ufa vitamin z-d; in All-union industrial association on production of finished pharmaceutical products (Soyuzleksredstva) — Moscow production chemical - pharm, merging of Moskhimfarmpreparata, Leningrad the Awards «Sign of Honour» production chemical - pharm, the association «October», Kiev production chemical - pharm, the association «Darnitsa»; in All-union industrial association on production of medical devices and devices (Soyuzmedpribor) — Leningrad the Orders of Lenin and awards of the October Revolution Krasnogvardeets production association, Scientific and production association on the radio-electronic medical REMA equipment (Lviv), the Kiev production association «Medapparatura»; in All-union industrial association on production of medical tools and the equipment (Soyuzmedinstrument) — Awards of the Labour Red Banner medico-tool z-d of V. I. Lenina, Kazan awards of the Labour Red banner medico-tool z-d, Izyumsky the optical-mechanical z-d, Tyumen z-d medical equipment and tools; in All-union industrial association on production of medical glassware, porcelain and polymeric materials (Soyuzmedpolimersteklo) — production association of medical glassware of Tsentrmedsteklo, Klin the awards «Sign of Honour» glass z-d, Tuymazinsky z-d medical glasses of the 50 anniversary of the USSR.
The XXV congress of the CPSU planned the wide social and economic program of further rise in welfare of the Soviet people, protection of their health for the tenth five-years period (1976 — 1980). In this regard the big tasks of ensuring creation and development of production extremely necessary for 3 are set for the medical industry. new highly effective medicines, the automated unified electronic devices and devices for mass medical inspections of the population, improvement of diagnosis of diseases and treatment of patients, significant increase in production of synthetic hormones, insulin, endocrine and X-ray contrast agents, finished pharmaceutical products for children, eyeglass lenses and frames, medical tools, the laboratory medical equipment and means of mechanization of work.
Growth of the output is provided in the industry for 48,6%, and this increase is planned to be reached at the expense of intensive growth factors of labor productivity. It is planned to master serial production of St. 700 new types of products of medical appointment, including St. 200 pharmaceuticals (among them there are new drugs for treatment of cardiovascular and psychological diseases, hormonal, fermental, antimicrobic, antineoplastic and antibacterial drugs, X-ray contrast means), St. 400 names of medical tools, devices, devices, the equipment, including modern radio-electronic devices and devices for mass medical inspections of the population and diagnosis of a number of diseases, overseeing by seriously ill patients, resuscitation; new, more perfect devices for artificial ventilation of the lungs and an inhalation anesthesia; endoscopic devices with a fiber optics; the medical devices and devices based on use of the ultrasonic and cryogenic equipment; more perfect equipment for equipment stomatol, institutions; various medical tools, in t. h applied in microsurgery, and others, and also apprx. 100 products of medical appointment from glass and plasts. The output of the cultivated medicinal plants will increase by 1,6 times.
Also significant increase in production of medical products at the enterprises of other mines - in and departments which according to the developed specialization are developed is planned and make the x-ray equipment, some types of electronic diagnostic installations, the laboratory equipment, medical furniture, a dignity. - tekhn, the equipment, the equipment for milk kitchens, products from rubber and glass, dressing materials, disinfectants, chemical products, endocrine and other drugs.
For 2 years of the tenth five-years period the volume of production of medical appointment at the enterprises of the industry increased for 22,1%, labor productivity increased in 1977 in comparison with 1975 by 18%. The industrial production of St. 80 new medicines and 180 types of medical tools, devices, devices and other products of medical appointment is mastered. But the growing requirements 3. still advance possibilities of the medical industry in pharmaceuticals and products of the medical equipment. In this regard the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) provided large actions for further development of production capacities of the medical industry due to construction new and reconstruction of the operating production plants synthetic chemical - pharm. drugs, antibiotics, finished pharmaceutical products, products of the medical equipment, expansion and strengthening of the research and design organizations in the industry, and also development of production of semi-products, materials and components in other industries of the national economy. It is provided to increase by 1985 at the enterprises of the medical industry in comparison with 1975 production of highly effective medicines for treatment of cardiovascular diseases not less than by 2,8 times, for treatment of oncological diseases, diseases of endocrine system and the drugs used in children's practice — twice, for treatment of psychological diseases — by 1,7 times, semi-synthobiotics of a broad spectrum of activity — not less than by 5 times, steroid hormones — by 2,5 times, sulfanamide drugs of the prolonged action, X-ray contrast and other diagnostic means — twice. The total production of products of the medical equipment taking into account expansion of their release at the plants of other mines - in and departments shall increase for this period by 2,5 times.
Further development is gained by scientific and technical cooperation, specialization and cooperation of production of medical appointment in member countries of SEV.
In creation and development of serial production of new pharmaceuticals and products of the medical equipment the research and design organizations of the medical industry widely use the latest developments of science and technology, work in close contact with M3 scientific institutions of the USSR, the USSR Academy of Medical Sciences, Academy of Sciences of the USSR, others of mines - you and departments. Plans research and construction work on creation and development of industrial release of new types of products of medical appointment are coordinated with M3 of the USSR, and production of medical products is carried out in strict accordance with requirements of GF and technical documentation approved by M3 of the USSR.
Representatives of M3 scientific institutions of the USSR take part in work of scientific and technical council of Min-va of the medical industry, and scientists and workers of the medical industry are a part of Pharmacological and Pharmacopoeian M3 committees of the USSR.
Long-term plans of development of the medical industry, and also annual plans of production and deliveries of products of medical appointment are developed on the basis of the requests M3 of the USSR and other consumers in pro-affairs of the total production approved by the economic plan on the industry.
International value of the Soviet health care
Value Soviet 3. leaves far away from our country. Authority Soviet 3. on the world scene continuously increases. The reasons of it are connected with contents Soviet 3., its influence on world medical science and practice, an enormous methodological and scientific contribution to collective medical and socio-historical experience of fight for protection and strengthening of health of the person, with activity Soviet 3. in the international cooperation
. The USSR became the pioneer in this major and most humane sphere of public life and already six decades highly bear the advanced banner of struggle for life and health of the person. Passed Soviet 3. the way, its today's affairs and plans, experience of the Soviet health care are actively used by many countries in new historical conditions. In the USSR for the first time for all history of mankind the most difficult tasks of protection and strengthening of health of broad masses of the population are solved, the complex system of the governmental, social and economic and medical activities providing continuously growing and changing individual and public needs of the person for preservation and promotion of health is created.
Soviet 3. achieved outstanding progress because it took advantage the Lenin doctrine about social conditionality of pathology of the population, really disclosed all depth of problems 3. and dependence of its forms on social and economic conditions because its basis was made by preventive character of actions for fight against diseases, broad participation of workers of masses in the solution of cardinal problems of public health care. Health of each person and all people in the USSR is recognized as the major public property and inalienable right of each person, and responsibility for real ensuring this right was assumed by the Communist Party and the Soviet state as a component of a majestic task to achieve «... full welfare and free all-round development of all members of society» (V. I. Lenin, Half-N of SOBR. soch., prod. the 5th, t. 6, page 232).
In process of distribution of the ideas Soviet 3. and acquaintance with its practice interest in the organization of protection of national health in the USSR increases. Not accidentally therefore that already first steps Soviet 3. were met with hostility and misunderstanding not only by bourgeois politicians and so-called liberal and charitable numbers of the western countries, but also workers of medical professions and first of all associations of private medical practitioners. Attempts to belittle achievements Soviet 3., do not stop reducing the attractive force of its example and until now, though it is not so rough as earlier.
And when the question of the right to health as well as about other inalienable rights of the human person, gained huge political and social sharpness in all countries, is clear that enormous international interest in Bases of the legislation of USSR and federal republics about health care (see the Legislation on health care) and to the new Constitution of the USSR, in a cut the right of the Soviet person for protection and strengthening of health gained further development. Moreover, in 1970 the XXIII World Assembly of health care in the special resolution «About philosophy of development of national health care» in essence recognized the principles socialist 3.: state character, unity and planned character 3., a preventive orientation, general availability of the qualified medical aid without financial or other restrictions, preparation of national shots, communication of science and practice, a dignity. education and attraction to programs 3. a general population — the most effective and checked on experience of a number of the countries measures also recommended them to all states taking into account their national, historical, social and economic and other conditions.
Socialist 3. in post-war years turned into the international system combined by unity of Marxist-Leninist outlook, the general methodology and the principles of creation, enriched with experience of a number of the socialist states located on different continents of our planet. Example of really effective organization and functioning of services and systems 3. cooperation within SEV and other organizations of the countries of the socialist commonwealth is.
The socialist health care as the international system takes in the modern world the leading place on protection and strengthening of health of the people. It directs the efforts to the comprehensive analysis and research of ways of permission of those national, regional and universal problems 3., which require the most urgent attention and combination of efforts of many states.
The Soviet Union and other socialist countries consider that there is a basic possibility of permission of these problems in historically short terms, but for this purpose it is necessary that all governments really took the responsibility for public health care, improved forms of coordination of activity in this area, developed evidence-based methodology and the strategy of the solution of universal problems 3.
In 1977 the 20-year program of fight against smallpox begun by WHO at the initiative of the USSR entered the final phase. The Soviet Union took active part in its implementation. For the aid to the developing countries of USSR gratuitously directed 1 billion doses of a smallpox vaccine and as a gift delivered to WHO more than 150 million doses. This disinterested aid promoted elimination of the centuries-old centers of smallpox in Latin America, Southeast Asia (including India, Pakistan and Bangladesh) and in Africa. Elimination of smallpox around the world is the first and still only example of successful eradication by coordinate efforts of many states and international organizations of one of the most dangerous to mankind epid, diseases. Experience of this program shall be generalized, studied and used in the most serious way at implementation of other large actions and programs in the field of international 3.
Socialist 3. as the international system strongly not only the orientation on permission of the major problems of health protection of the people, but also the tendency in the future. In June, 1976 the XVII Meeting of Ministers of Health of the socialist countries developed and accepted the major program document «Main Directions and Perspectives of Development of Socialist Health Care» met with great interest in many countries and the international organizations and distributed afterwards as the official document XXX of the World Assembly of health care. In it the characteristic of bases socialist 3 is given. also the results of its development as international system are summed up, the current state 3 is characterized. in the different socialist countries perspectives of its development the forthcoming years are also stated up to 1990 and 2000. In the document it is especially noted that «The socialist countries with understanding treat needs of health care of the developing states of Asia, Africa and Latin America which followed a way of deep social and economic transformations and give to these countries big and versatile help in preparation of national shots and development of public services of health care... will and give further to developing countries help in construction of healthcare institutions and educational institutions, preparation of national medical shots, to direct highly qualified specialists, medicines, inoculative materials and the medical equipment, to help with creation of the enterprises of the medical industry, and also to widely present to their order vast experience of the organization of health care in the socialist states».
Also readiness of the socialist countries «is again confirmed in the document... to cooperate with all other countries in development of medical science and practice, in protection and strengthening of health of the population, considering a community of interests of the people of all countries in this humane sphere of human activity», and also to work in the international organizations, and first of all in World Health Organization, to-ruyu consider... as the important instrument of the international cooperation for the solution of the urgent problems of medicine having the international value for the benefit of all states».
Extremely important aspect of the international importance Soviet and all socialist 3. its active participation in fight for preservation and consolidation of peace and easings of international tension, against development and use thermonuclear, chemical, bacterial is. and others, perhaps, even more dangerous types of weapon of mass destruction, against threat of new war, edge would constitute enormous danger not only to health, but also life of people of the world.
At the initiative of the Soviet Union and other socialist countries, despite objections of representatives of imperialistic powers, the World Assembly of health care adopted a number of resolutions on a role of the doctor in preservation and strengthening of the world in which it, in particular, emphasized that the world is the main condition of maintenance and improvement of health of the people of the planet, expressed deep conviction that achievements of science, and especially medicine and biology — the most humane of all sciences, shall never be used only for the benefit and to the detriment of mankind, called all medical associations, and also all medics to consider a moral and professional duty rendering assistance to the international movement directed to full prohibition chemical and bacterial (biol.) means of warfare, and, at last, appealed to all member states of WHO to support the international efforts directed to easing of international tension and disarmament that will allow to strengthen the help to developing countries in area 3.
In WHO the increasing popularity is gained by the slogan «Health for All by 2000!». Supporting this idea, workers Soviet 3. understand that its implementation is possible only in the conditions of lasting peace, friendship and cooperation between all people. Therefore it is necessary to feel deep responsibility that cooperation in the area 3., in fight for the prevention and elimination of the most dangerous and widespread diseases, for environmental control and rational use of its resources is the integral component of the Soviet Program of the world which is put forward by the XXIV congress of the CPSU expanded and deepened at the XXV congress of the CPSU.
The HEALTH CARE IN FOREIGN COUNTRIES
Health care in the capitalist countries
the Post-war period is characterized by evolution of views of a role and the place 3. in life modern about-va and essential reorganization of organizational forms 3. in the majority of the capitalist countries. During this period in the world there were big socio-political transformations. A general scientific and technological revolution, in particular in the field of medical - biol. sciences, revealed not only positive, but also negative influence of scientific and technical progress on health of the person, an escalating gap between what the modern science can give to the person, and what actually becomes for protection and improvement of health of a general population. At the same time it became obvious, how closely problems 3. are connected with economic efficiency of modern production. It gives to problems 3. special sharpness, does them by a factor of political and social struggle of wide workers of masses.
Generally progress in area 3. in the capitalist countries it is caused by the getting stronger organization and activity of fight of workers for the political and economic rights, including for the right to health protection and full medical aid. As confirmation to that serves, in particular, the fact that legislative registration of the majority of positive changes in area 3. and social insurance it is connected with the periods of a victory of the left forces, first of all communist and labor parties, on arene of political struggle. Achievements of the Communist Party and workers of France where in 1945 the law on the state social insurance which defined considerable improvement of medical aid to the population of the country was developed and adopted are indicative in this respect. Result of a victory of progressive forces, and first of all working class of Great Britain, creation in 1948 of the first in the capitalist world state system 3 was. Workers of Italy, Germany, Sweden and some other the capitalist countries achieved adoption of laws on the state insurance and development public 3., provided more available medical aid by the worker.
Considerable impact on fight of workers of masses for progress 3. rendered positive experience of construction 3. in the USSR and other socialist countries. Crisis of private-capitalist system 3., objective need of failure from the become obsolete organizational forms and searches of ways of improvement public 3. caused close attention of a general population and progressive figures of the capitalist countries to the experience accumulated socialist 3., and attempts of use of a number of the organizational forms and the principles of creation of various services 3 developed in the USSR. It is possible to see it in the analysis of the organization 3. in Great Britain (see), step-by-step regional system of the organization of medical aid in Sweden (see), the principles of creation of service 3. in Finland (see), during the studying of national programs of health care of France (see), Italy (see) and some other countries. Such situation is natural since socialist system 3. fullestly, widely and scientifically reasonably reflects the principles and organizational forms of development modern public 3. On the other hand, ruling numbers of the capitalist countries cannot but in modern conditions show the growing interest in development 3., considering its increasing social, political and economic value.
V. I. Lenin distinguished two forms of capitalist operation. The first more frank, convenient, profitable, consisting in extremely long working day, low wage, insanitary working conditions and life, use of work of juveniles, etc. Another — at a cut domination of the bourgeoisie is fuller, wider and more free. It is shown in a huge intensification of work along with improvement a dignity. conditions of production, reduction of the working day without what any intensification of work and acceleration of its rates would be impossible. These provisions of V. I. Lenin allow to understand more deeply an essence of political combinations which are carried out in the capitalist countries for use 3. both for ideological fight, and for the benefit of an intensification of work and ensuring bigger production efficiency. Ideologists and ruling numbers of the capitalist countries use 3. and the shifts happening in it as the major arguments allegedly testimonial of improvement and improvement of capitalism, about an opportunity within this system to resolve cardinal social problems. At the same time not only economists and heads of services 3., but also politicians are forced to recognize communication of public health care with socio-economic factors, and in particular with rates of economic growth, and also with main objectives of social development. In these conditions it is economically more favorable to spend certain funds for a dignity. - a gigabyte. and medical actions, than to incur substantial damages in connection with the general and professional incidence, traumatism and switching off from labor process of the qualified labor.
A consequence of changes of living conditions and general scientific and technical progress was change of nature of pathology in economically developed countries. The leading place in structure of incidence and causes of death was occupied by cardiovascular, nervous and mental diseases, malignant new growths, operational and household injuries. Effective fight against these diseases is inconceivable without progress of medical science, development of material and technical resources 3., equipment of prophylactics by its powerful arsenal, diagnosis and treatment of diseases, coordination and integration of various services 3., developments of a number of the national programs providing development 3. according to requirements of time. The solution of these tasks demanding considerable economic expenses, a legal regulation, uniform medico-statistical information, the organizational management at various levels defined increase in a role of the state in the management public 3. in all countries.
However extent of participation of the state, legal basis, organizational forms of the management and principles of creation of services 3. in the certain countries have essential distinctions. At the same time it is obviously possible to allocate three main forms 3. in the capitalist countries — private-capitalist, insurance and state though each of them does not exist in a «pure» look, and comprises elements of other forms in various degree.
Private-capitalist health care — the most inhuman in the social basis and conservative system 3 in the organizational plan. — is under construction on the principle proclaiming preservation of health a personal record of each person. The full recovery the population of expenses on rendering medical aid is the cornerstone of it. In the most expressed look this form 3. it is characteristic of the USA where the principle of private business is a basis for all system of medical aid and more than 60% of expenses on medical service make direct payments of the population. In the country there is no comprehensive state system of insurance on a case of a disease, and widely developed voluntary insurance is commercial, the Crimea only the persons having necessary material resources can use.
Private-capitalist character defines also the organizational principles of the management 3. in the USA. The role of the state is limited to financing of expenses on medical aid to certain groups of the population (to the public servants, veterans of war, Indians living in reservations, persons 65 years, mentally sick and poor are more senior), scientific research, separate programs 3. and medical educations, implementation dignity. - protivoepid. and quarantine measures, and also regulation of some other parties of medical practice. Functions of the general management of health care carry out departments 3. states and a local operating controls on the basis of the legislation of states. To lay down. - professional, institutions function generally at the expense of the means received from patients; part of them not only completely ensures financial independence, but also brings in the considerable income to their owners. Extra hospital help is given by preferential private medical practitioners of the general practice and specialists in the offices or in offices of group practice (voluntary association of doctors for collaboration). The sizes of the fee are not regulated by any provisions, and are a prerogative of the doctor or to lay down. institutions. The created public extra hospital centers for patients with mental diseases, tuberculosis, infectious diseases and also which are carrying out preventive maintenance of women and children — are not numerous.
The private-capitalist form practically excludes a possibility of coordination of activity in the area 3., control of cost of medical services, rational placement and use of material and personnel resources. Spontaneity, uncontrollability and inefficiency of a private practice in many respects caused crisis modern capitalist 3. Its main lines: uncontrollable growth of cost of medical aid; a contradiction between opportunities modern 3. and medical sciences and extent of their use for health protection of a wide people at large; danger of use of achievements medical - biol, sciences in the inhuman purposes; poor development of the preventive direction and insufficient efficiency of the ambulatory and hospital care, lack of medical shots; the lack of confidence between the population and doctors; manifestation of racial and property discrimination in medical education and during the rendering medical aid; the distribution of self-treatment connected with high cost of medical aid and uncontrolled use of pharmaceuticals.
The insurance medicine is most characteristic of the Western European economically developed countries. Its basis is the obligatory system of social insurance (see) the population of the country in general or its separate groups, providing full or partial compensation for expenses on medical aid. Despite a variety of the organizational principles and forms of the management 3., the general for all national systems of insurance medicine (see) the fact that social insurance provides creation of the national financial fund spent generally for needs of health protection insured is, and doctors to lay down. institutions act as partners of bodies of social insurance. Social insurance funds consist of special contributions of workers, businessmen, and also the state allocations. Extent of participation of each of the specified parties in the certain countries is various as the volume and a form of compensation for expenses on medical services are various. At the same time in the majority of the countries expenses on medical aid, especially extra hospital, are compensated by insurance companies only partially. Existence in the country of system of social insurance does not exclude a private practice of doctors and activity private to lay down. institutions.
Introduction of social insurance caused strengthening of the state regulation of relationship of the doctor and patient, first of all financial, defined need of creation of the permanent mechanisms providing not only functioning, but also development of system of medical aid that considerably raised a role of the state and local operating controls in planning and the management 3. Development of system 3. in the countries where there is the state social insurance, it is carried out generally at the expense of the state and local budget though use of private and philanthropic means, first of all the religious organizations takes place. In some countries (France, Sweden, Finland) there are plans medical - a dignity. constructions, medical division into districts for creation of regions is carried out, the organization of stage system of rendering the extra hospital and hospital help is provided in each of which. At preservation of the dominating role of individual medical practice in rendering the extra hospital help expansion of out-patient and polyclinic institutions would take place at, creation of the centers 3., various clinics, public laboratories. It leads to involvement of doctors and other medical staff to the sphere public 3.
Noting positive value of insurance medicine in increase in availability of medical aid, it should be noted that it does not provide rational reorganization of organizational structure 3., unities to lay down. and preventive actions, effective use of material and personnel resources 3. and, therefore, does not allow to solve fully modern problems of protection of public health.
The state health care introduced in Great Britain in 1948 for the first time is the most progressive form of the organization 3. in the capitalist countries. Management 3. it is across the nation assigned to Min-in of health care. Financing of public service 3. it is carried out at the expense of the state budget (85%), special contributions working (apprx. 10%) and the means arriving directly from the patients (5%) paying some types of medical services (an extract of the recipe, some types of the dental surgery help, additional payment at the placement to separate chamber).
Till 1973 public service 3. in Great Britain was divided into three substantially the isolated services: the hospital, switching-on fixed network and extra hospital specialized help given in out-patient departments of BC; the general medical service combining general practitioners; local services 3., under which authority the domiciliary care, and also the child care and women's medical facilities which are carrying out scheduled maintenance was. Each service had the administration and organizational structure and carried out the functions without sufficient coordination with other services. Organizational dissociation of services 3., slowing down development of public service 3. nearly a quarter of the century, brought reform of 1973 to life, the purpose the cut is creation of uniform bodies 3., constructed by the administrative-territorial principle (the area, the county, the province). By 1977 reform 3. in Great Britain it is completely not complete.
Specific feature of public service 3. in Great Britain there is a legal status of general practitioners who, unlike hospital doctors, are not public servants, and work at a basis of the labor agreement with appropriate authorities 3. It has serious negative effects since the main sector of medical service remains substantially isolated and is controlled by bodies 3. only it is formal. The aspiration of general practitioners to preservation of the principles of individual activity was the leading reason of non-performance of one of main objectives of the law on public service 3. — creation of the centers 3., the out-patient institutions equipped with necessary diagnostic aids and treatments in which activity of general practitioners and a number of specialists shall be concentrated. Only impossibility to provide with forces of general practitioners the modern level of the extra hospital help led in the 70th 20 century to more intensive construction of the centers of health care in which in 1976 worked apprx. 15% of doctors.
To serious difficulties of public service 3. in Great Britain the constant deficit of financial means which is not allowing to carry out planned modernization of medical institutions which considerable part is built during the premilitary period belongs. As a result of a disproportion in placement of BC the rational profiling of bed fund is complicated, in a number of districts the lack of beds is noted that leads to creation of waiting list for hospitalization. To serious shortcomings of public service 3. also the gap between scheduled and medical maintenance belongs.
Health care in developing countries
Developing countries — group of the national states of Asia, Africa, Latin America and Oceania which received political independence as a result of disintegration of colonial system of an imperialism or exempted from economic and political dependence of imperialistic powers. At all variety of historical destinies, levels of economic development, the political and political system developing countries andmet a number of the general signs, as defines in general idiosyncrasies of all this group of the countries of the so-called third world at the present stage of their historical development.
Process of political release of the most part of developing countries was followed by a certain acceleration of growth rates of their economy in comparison with the colonial or semi-colonial period. However the gap in the level of economic development of developing countries y imperialistic powers does not decrease, and, on the contrary, increases.
Before the young states which achieved national independence there were complex challenges of elimination of the hardest effects of colonial rule. Complex and many-sided process of the national liberation movement led to emergence of the states standing on different steps of social and economic and political development. Among them there are groups of the countries which won political independence and started radical social transformations. There are countries where the national bourgeoisie, and the countries which though formally and gained political independence, but owing to coming to power of puppet governments or participation in imperialistic blocks actually did not become independent came to the power. Political and social and economic distinctions cause specifics of development of this or that country, potentialitys and rates of the solution of the major problems of creation of national economy, 3. and other spheres of public life.
One of the most burning issues of developing countries is the problem of food. Developing countries in which lives apprx. 70% of the population of the globe have only 30% of the world income. By the end of the 70th the average revenue counting on one inhabitant in the developed countries more than by 10 times exceeded the income on one inhabitant in developing countries. Apprx. 1 billion from 2,6 billion zhit. developing countries suffers from malnutrition and hunger, and the day income of 900 million zhit. makes apprx. 30 cents.
From 50 million people who are annually dying on the earth, at least 35 million die of malnutrition (see Hunger as the social phenomenon). The main centers of hunger and hron, malnutritions are extensive regions of Asia, Africa and Latin America. Especially children suffer from hunger. According to FAO of the UN, hunger and malnutrition are experienced by 2/3 children of the globe whose most part lives in developing countries. Some bourgeois theorists, considering a problem of insufficiency of food and an effect of malnutrition and hunger, aim to explain the situation with a population explosion, rough process of reproduction of the population in developing countries. However famous Brazilian specialist Zh. Castro's de on the basis of comprehensive study of the facts came to a conclusion that «at the modern level of the equipment we can support the population by 10 times bigger, than that which inhabits our planet. With progress of the equipment it will be possible to support in 100 times more people».
Despite some distinctions in structure of incidence and mortality of the population of developing countries, in addition to malnutrition, the dominating place is taken infectious, parasitic, went. - kish. diseases and diseases of newborns.
In the period of colonial dependence 3. developing countries functioned only for the benefit of colonialists. Its basic purpose consisted in providing with medical aid troops, colonial administration and a well-founded top of local population. Preventive actions were carried out only for the purpose of protection of colonialists against diseases, first of all from especially dangerous infections.
Having gained national independence, developing countries chose different ways of development 3. Creation of the state systems 3 is characteristic of the countries which followed a noncapitalistic way of development. The countries going on a capitalist way along with state 3. develop private and charitable medical aid. However in general tendencies to creation of the state systems 3 accurately were defined. So, if in Africa in 1962 — 1963 there were only three countries (Mali, Mauritania and Senegal) where all medical institutions were under authority of the state, then by 1966 — 1967 their quantity increased to And, and in 1971 — 1973 — to 16, and the specific weight of public institutions in such countries as Algeria, Ivory Coast, Niger, Sudan, etc., in 1972 made St. 90%. In public institutions the population of Burma and Afghanistan generally receives medical aid.
Public sector 3. the countries of Latin America services preferential the persons having the low income: inhabitants of city slums, country people, Indians. Medical aid in public institutions is received by also separate groups of the population (public servants, workers of the state enterprises, etc.). An important role in medical service of the population of the Latin American countries is played by social insurance. Apprx. 50% of all expenses on medical aid it is the share of payment of doctors of a private practice though rather small contingent of the population uses their services.
In a number of developing countries in rendering medical aid the commercial medical institutions belonging to individuals and the organizations, philanthropic about - to you and religious missions continue to play an important role. E.g., in Zambia in 1972 belonged to group hospitals apprx. 45% of bed fund of the country, in Nigeria — 42%, in Sierra Leone, Cameroon, Uganda — 31 — 32%. Existence of the private sector in 3. developing countries in many respects depends on a lack of the state allocations which actually make (1972) in the countries of Africa from 0,5 to 9 dollars, of the countries of Latin America — from 0,2 to 39 dollars per capita in a year.
The problem of development of network of medical institutions is one of the most complex problems 3. in developing countries. Security of the population of the majority of the countries of Africa with hospital beds is extremely low and made in 1972 in Mauritania, Ethiopia, Niger, Mali, Sudan, Upper Volta less than 10 beds on 10 thousand zhit.; in Chad, Benin, Ghana, Guinea, Tsentralnoafrikansky Empire, etc. — from 10 to 20 beds on 10 thousand zhit. Security with hospital beds of the population of the countries of Latin America fluctuates from 6 (Haiti) to 63 (Argentina) on 10 thousand zhit. Specialized medical aid is developed insufficiently, the number of specialized institutions is very small. Low power of BC is characteristic. E.g., in the countries of Latin America in 1972 more than 50% of BC had less than 50 beds; 35% — 50 — 200 beds; 10% — 200-400 beds and only apprx. 5% of BC — St. 400 beds. Irregularity is sharply expressed in distribution of bed fund for various regions of the country. E.g. * in 1972 on average across Tunisia security with hospital beds made 24,7 on 10 thousand zhit., at the same time in some governorships this indicator made from 7,0 to 11,8. In Tanzania in 1972 on average it was the share of one bed 800 zhit., however in various districts of the country it is a ratio there was from 400 to 3500.
The extra hospital help in developing countries is based on creation of the centers 3., staffed by two or more average medics (see. Treatment-and-prophylactic, institutions, abroad), diagnosis and treatment of patients, fight against the infectious diseases designed to carry out, obstetric aid, scheduled maintenance. The number of the population serviced by the centers, and radius of their service it is various. In Kenya, e.g., most the centers services 15 — 20 thousand people living in radius of 8 — 16 km, in Tanzania the centers are created on each 50 — 100 thousand population, and in a number of districts of other African countries the number of the population serviced by one center reaches 100 — 250 thousand persons. Load of personnel of the centers is extremely big. For the vast majority of country people of developing countries the centers 3. are the only institutions where the diseased can receive medical aid. Existing in the large cities-tsy are unavailable to most of the population in connection with their remoteness, and in a number of the countries — with the high cost of service. Primary medical aid in the majority of developing countries appears in the so-called clinics having, as a rule, one worker who received nek-ry preparation in the field of medicine (from several weeks to 1 — 2 years).
The problem of security of the population with medical, and first of all medical, shots is one of the most acute in 3. developing countries. During the colonial period preparation of medical shots from indigenous people, especially in the countries of Africa, was almost not carried out; in some countries (Senegal, Madagascar) to graduates from among local population so-called African diplomas were issued, with to-rymi they had the right to practice only on the African continent. In 1972 in the countries of Africa security with doctors averaged apprx. 0,6 on 10 thousand zhit.; there are countries (e.g., Upper Volta) where an indicator of security with doctors below an average on the continent by 4 — 5 times. Slightly higher security with doctors in the developing countries of Asia, however this indicator in the certain countries fluctuates in very wide limits. So, e.g., in Sri Lanka 1 doctor fell on 3,2 thousand people (1972), in India — on 4,2 thousand people (1973), in Indonesia — on 20 thousand people (1973), irregularity of distribution of doctors in each country, in particular concentration of specialists in the large cities Is characteristic.
For 1965 — 1975 the number of doctors considerably increased, however many countries of Africa are not able to provide medical aid to the population with own forces yet and continue to attract the most part of doctors from other countries. Considerably brakes the solution of a personnel problem in developing countries emigration of doctors. The problem of providing the population with average and support medical staff is difficult. For the countries of Africa in the conditions of insufficient quantity of the qualified medical shots this problem gains special sharpness, and the future 3 in many respects depends on degree of its permission., since average medics of the majority of the African countries not only carry out medical appointments, but also often independently resolve issues of diagnosis and treatment of diseases. Security with average personnel in a number of the countries is extremely low. E.g., in 1972 in Algeria, Chad, Ethiopia security with nurses made less than one on 10 thousand zhit. The big lack of an average and support medical staff is felt in the countries of Asia and Latin America. Coverage of youth the general primary and secondary education, creation of the highest medical educational institutions training qualified specialists, and also educational institutions on preparation of an average and support medical staff are an important stage on a solution of a problem of medical shots.
The analysis of the problems existing in developing countries shows that still radical social and economic restructurings and years of persistent work will be required to liquidate diseases and poverty and to provide prosperity, health and long life to each citizen. In this regard great interest causes experience of the Soviet Union which for years of the Soviet power from the country, backward in the past, with beggarly suburbs turned into the mighty multinational state which achieved the greatest progress not only in development of the industry, science and culture but also in the field of health protection of the people, into elimination of a row heavy epid, diseases, in providing the population with the free, public and qualified medical aid in the people of developing countries.
The Soviet Union in return gives to developing countries direct help, sending for work to these countries of doctors and other specialists, preparing national shots in the medical educational institutions, projecting and building various objects 3., delivering the medical equipment, tools, pharmaceuticals etc. (see below the International cooperation in health care).
Social and economic transformations in the socialist countries caused progress in all fields of economy, science, culture, steady rise in living standards of the population. From the first days of public authority in the countries of national democracy 3. began to be under construction on the socialist principles checked by long-term practice of construction 3. in the USSR (see above «Philosophy of the Soviet health care»). Creative use of experience Soviet 3. and direct help of the USSR in development of medical science and practice 3. had essential value for formation and development of the state system of health protection in the socialist countries.
Problems of protection and strengthening of health of the people become the most important function of the state and legally are enshrined in constitutions of the socialist countries, and also in a number of special acts, resolutions and other documents regulating and directing to activity to areas 3., including in the socialist countries accepted in the 70th in the majority laws on health care (see the Legislation on health care).
The unity of the theoretical and organizational principles caused a community of basic elements of structure of national services 3. majority of the socialist countries. The management and coordination of all to lay down. - professional, and a dignity. - protivoepid, works provide min.-va health care. They carry out development of acts on questions 3., the consolidating economic and budget plan, statistical and epidemiol, information, development of the higher medical education, the international cooperation, etc. Besides, is carried out by them control of work of territorial authorities 3., who bear responsibility for the organization and the management to lay down. - professional, activity of all services and institutions located in the territory subordinated to them. A basis of the organization to lay down. - the help the territorial and production principle of rendering medical aid is professional. Territorial to lay down. - professional, institutions (-tsy, policlinics, etc.) render main types of medical aid to the population living or working around their activity. The extra hospital help is constructed by local territorially principle. The main type of stationary establishment — multi-profile-tsa, in most cases integrated with policlinic. The leading role in the organization of specialized medical aid belongs large multi-profile and specialized-tsam in which the scientific and methodical centers for separate types of medical aid are created. For patients with malignant new growths, psychological, skin and venereal diseases and tuberculosis the network of specialized clinics and dispensary departments, functions and which methods of work are identical to the Soviet clinics is developed (see the Clinic). Under constant dispensary observation there are also persons playing physical culture and sports.
It is created and effectively the service of fast and acute medical aid functions. Its main institutions are the stations of emergency medical service staffed by the specialists who had special training, and equipped a dignity. transport.
In the large cities of a number of the countries would will be organized multi-profile emergency medical service, having intensive care units and an intensive care, and also specialized departments (surgical, traumatologic, urological, burn, etc.).
Community of the theoretical and organizational principles 3. in the socialist countries does not exclude specifics in the organization of national services 3. the certain socialist countries, caused by an originality of development, national traditions, etc. It is expressed, in particular, in various extent of functional and organizational merging of separate services and institutions 3. in the territorial scale, decentralization of management, association of the medical and social help, etc. E.g., in SFRYu responsibility for public health care lies on appropriate authorities of communities, districts, republics and federation, and institution 3., directly engaged to lay down. - prof. work, function as independent links.
Steady and systematic carrying out in life of the principles socialist 3. caused progress of the socialist countries in health protection of the people. So, thanks to purposeful scheduled maintenance incidence of the population of infectious and parasitic diseases considerably decreased, and some of them are completely liquidated. Sharply changedexpert structure of pathology: among causes of death cardiovascular diseases, malignant new growths and injuries began to take the leading place. The general and child mortality decreased, average life expectancy increased.
Important achievement 3. the socialist countries creation of step-by-step system of medical aid to country people is. Main types of medical aid would provide to country people also policlinics (out-patient clinic); rendering the specialized help is assigned on territorial regional, regional (district, regional) multi-profile-tsy and specialized clinics. Considerable volume to lay down. - the prof. of the help the country people receive also in city institutions 3.
The number of medical institutions considerably increased in all socialist countries in 1965 — 1975, the accurate tendency to reduction of number of low-power BCs and increase in number of large BCs was outlined. Security with beds increased in the majority of the countries by 1,5 — 2 times and made in the 70th of 80 — 100 beds on 10 thousand zhit. At the same time the general tendency for all socialist countries is growth of security of the population with specialized beds. Most high level of security of the population with therapeutic, surgical, obstetric and gynecologic, children's beds. Further development of the stationary help is defined by decisions of the X meeting of Ministers of Health of the socialist countries (1969) which recognized reasonable construction: 1) the general BCs on 300 — 400 beds with 4 — 8 departments for rendering stationary medical aid to the population within the district, a part of the large city or the town on the main and a nek-eye to narrow specialties; 2) the general multi-profile BCs on 400 — 600 beds for rendering the stationary help with 8 — 12 specialties in the city and several rural districts with the population of 50 — 60 thousand people; 3) multi-profile a wedge, BC on 600 — 1000 beds not less than with 10 — 12 specialized departments; 4) specialized BCs power not less than on 300 beds.
Important achievement 3. the socialist countries — creation of wide network of the city and rural out-patient and polyclinic institutions providing the free and public qualified extra hospital help to the population. Treat the main types of institutions of the extra hospital help: policlinics, out-patient clinics, specialized clinics, medical, medical assistant's and sisterly points. The central link of extra hospital medical service are policlinics in which help is given to the coming patients and at home on all main specialties. In wide scales scheduled maintenance and medical examination of the corresponding contingents is carried out. The local system of the organization of the extra hospital help provides synthesis to lay down. and preventive medicine. On this system therapists, pediatricians, and in a number of the countries and other specialists work. Doctors of policlinics study also living conditions of patients, a dignity. the state and incidence of the population in the territory of the site, are developed and carry out system of recreational actions. Development of network of extra medical institutions in the socialist countries, improvement of their activity and growth of number of medical staff promoted upgrading of the polyclinic help, expansion of its volume, general availability and consequently, and to significant increase in negotiability.
For health protection of women and children in the socialist countries the social and economic and medical actions providing to female mothers an opportunity actively to participate in labor and public work, and also harmonious development of children and teenagers are widely carried out. The state provides legal guarantees on labor protection of the pregnant woman, nursing mother, education of children in preschool institutions; besides, material and moral encouragement of motherhood and full medical aid of mother and to the child is carried out. For providing optimal conditions of health protection of women and children it is created and the wide network special is improved to lay down. - professional, and recreational institutions.
The important place in activity of bodies and institutions 3. the socialist countries the system of measures for health protection of the working industrial enterprises consisting in carrying out a dignity borrows. - recreational actions on production, planned implementation of mechanization and automation tekhnol. processes, especially at the enterprises where are available professional harm, it is applied heavy physical. work; in preferential medical - a dignity. service of workers of the industry, construction and transport; in the organization of wide network to lay down. - professional, institutions at the industrial enterprises, etc.
Large achievement of the socialist countries was creation national chemical - pharm, the industries. In the majority of the socialist countries domestic production of medicines almost a floor satisfies with a nost requirements 3., and products chemical - pharm, the industries of NRB, VNR, GDR, SRR, the Party of Russian Taxpayers, SFRYu, ChSSR are widely exported to many countries of the world. For providing the population and medical institutions with drugs and the medical equipment the wide network of pharmaceutical and other institutions, and also the state control system behind quality of pharmaceuticals and the medical equipment which is an integral part of system 3 is created.
The special place in socialist 3. occupies a dignity. - epid, the service which is carrying out the state dignity. supervision and complex dignity. - recreational and protivoepid, actions. Competences, structure and forms of activity national dignity. - epid. services are regulated by special acts, and in a number of the countries laws on health care (NRB, VNR, ChSSR. SFRYu). Personnel basis dignity. - epid, services of the socialist countries health officers who, as a rule, have specialization in the field of epidemiology, occupational health, hygiene of food, utility hygiene, etc., and specialists a dignity make. a profile with secondary medical education. To work in a dignity. bodies also engineers, chemists, biologists, architects and other specialists are involved.
Thanks to snowballing of the higher and secondary medical education (see) in the socialist countries the problem of medical shots is successfully solved. E.g., growth of number of doctors of all specialties is characteristic of all socialist countries. From 1950 for 1974 security with doctors in NRB increased by 2,5 times, in GDR — twice, in VNR — by 2,2 times, in the Party of Russian Taxpayers — almost by 5 times, in SRR — by 1,6 times. In the majority of the socialist countries in the 70th the indicator of security with doctors makes 20 — 25 doctors on 10 thousand zhit.
Development of health care of the socialist countries is inseparably linked with wide use of achievements of medical science. For years of socialist construction the wide network of the research establishments equipped with modern appliances is created, shots of the highly qualified specialists capable to effectively solve urgent problems of modern medicine are prepared, it developed and successfully the state system of the management, planning and coordination of a scientific medical research functions. Scientific potential, and from here and the volume of scientific research in various socialist countries is not identical. Specifics of the organization of scientific network and scope of scientific research reflect national traditions, the developed directions and schools of sciences, and also the tasks standing before 3. each of the countries at the present stage.
In acceleration of rates of development 3. and medical sciences further expansion and deepening of cooperation between bodies and institutions 3 is of great importance. socialist countries. In 50 — the 70th this cooperation underwent a certain evolution, there were also multilateral forms of cooperation. Experience showed that cooperation exerted positive impact on development of urgent problems of medicine and 3. both in each country separately, and in the countries of the socialist commonwealth in general. The tasks standing before 3. the socialist countries, demand collective development of ways of further development socialist 3. Important stage of collective development of the theory and organization socialist 3. acceptance was the XXVII meeting of Ministers of Health of the socialist countries (1976) of the document «Main Directions and Perspectives of Development of Socialist Health Care». The getting stronger cooperation of the brotherly socialist countries opens new perspectives of further development in the field of health care and the medical science designed to provide harmonious development of the personality, protection and strengthening of health of the population, increase in its creative activity and increase in life expectancy.
See also articles about the certain countries (e.g., Austria, Bulgaria, India, etc.).
The INTERNATIONAL COOPERATION in HEALTH CARE
At different historical stages international relations and cooperation in the area 3. developed according to objective requirements of medical science and practice. They were generated by humanistic character of the medicine realized by the international danger epid, and other mass diseases and need medical - a dignity. providing the interstate economic, political, military, commercial and cultural ties developing throughout a number of centuries. The levels of development of medical science and practice and character of the interstate relations inherent in each historical era caused also certain forms and rates of development of international relations in the field of medicine.
Originally «international» bonds had character of sporadic contacts between doctors of Ancient Egypt, Mesopotamia, Persia, India, China and a classical antiquity; they promoted transfer from a civilization to a civilization of medical knowledge.
Crusades and regular trade contacts between the countries of Europe and Asia were the involuntary reason of a drift and a wide spread occurance on the European continent heavy epid, diseases, fight with to-rymi demanded carrying out protivoepid, measures of the state character. National experience of implementation of such measures depending on degree of efficiency was implemented other states. E.g., the system of a quarantine introduced for the first time in Venice (1348) already by the end of 14 century gained distribution in all Western Europe. Creation and growth of high fur boots in Europe and gradual formation of schools of sciences caused expansion of contacts between scientists. In the beginning exchange of the ideas, observations, results of researches was carried out in the form of personal correspondence between certain scientists, then with emergence and development of publishing — in the form of the edition of the original or generalizing works and, at last, from the second half of 17 century — by means of medical periodicals.
In 19 century the first interstate agreements devoted to hl are signed. obr. dignity. - to quarantine measures, the international medical organizations (both public professional associations, and intergovernmental) are created, the international congresses on various medical specialties which are a new form of exchange of information between scientists and practical 3 are carried out., and also will be organized international medical about-va (see. Medical congresses, International medical organizations).
Though the first attempts of the European powers to coordinate quarantine measures belong to the end 18 — the first half is 19 century old (creation so-called international, and on the substance of colonial a dignity. and quarantine councils — in Tangier in 1792, in Constantinople in 1839, etc.), the beginning intergovernmental medical - a dignity. contacts it is considered to be convocation of the I International sanitary conference (Paris, 1851), in a cut 12 European countries participated. At a conference the first was accepted international a dignity. the convention, edges was ratified afterwards by only five countries. At the subsequent five conferences (the sixth — in 1885) it was not succeeded to reach full agreement and to take uniform international orders. the convention (see Conventions the international medical), single questions of quarantine service were agreed up to 1911. In 1902 it is created Pan-American a dignity. the organization, and in 1907 in Paris the International Bureau of Public Hygiene (IBPH) — the first permanent intergovernmental organizations on a dignity is organized. and protivoepid, to questions.
Slightly earlier, in 1856, N. I. Pirogov put forward the idea about creation of the international field military-medical committee, and in 1863 the international conference of representatives of 16 states was convened, edges developed philosophy of the organization national private about-in cares about sick and wounded soldiers and decided to petition before the governments for establishment of the international protection of patients and wounded on the basis of the relevant international agreement. The International committee of the help to wounded renamed in 1876 into the International Committee of the Red Cross was the same year organized (see. International Red Cross). In 1864 the diplomatic conference in Geneva developed several conventions facilitating a fate of wounded during war (see. Geneva conventions). Russia joined the Geneva conventions in 1867, then was created Ob-in about care of wounded and sick soldiers, renamed in 1879 in Russian about-in Red the Cross.
After the end of World War I the international political, economic, scientific and cultural ties began to be reestablished already on a new basis. At external preservation of former forms on their contents decisive impact was exerted by emergence on the international scene essentially new socialist 3. In general the developed historical situation defined gradual strengthening of the international positions of the USSR and Soviet 3., degradation of medicine and 3. in Hitlerite Germany and fascist Italy and, at last, helplessness of medicine and 3. bourgeois states. Attempts to isolate the USSR from participation in the international public life, including from the international cooperation in the area 3., explicit connivance of most the international public and intergovernmental organizations concerning the fascism gaining strength defined some recession in the international medical relations. The section of health care of the League of Nations created in 1920 during the existence did not make attempts to the solution of cardinal problems 3., though continued to be convoked international a dignity. conferences (1926, 1933). Were created new international medical about-va.
After the end of World War II there is an active formation and development of the international system socialist 3., and also transition to interstate cooperation to areas 3 is carried out. and medical sciences. The major factors defining progress in the international cooperation in area 3., were: consistent peace-loving policy of the USSR, its aspiration to a discharge of tension and full cooperation with all people that especially fully was reflected in the Program of the world adopted by the XXIV congress the CPSU; successful development by means of the USSR 3. in the countries of national democracy and its transformation into the international system socialist 3.; crash of colonial system of an imperialism and awareness by the people and governments of scandalous needs and difficulties 3. in the developing countries of Asia, Africa and Latin America; distribution on biology and medicine of a general scientific and technological revolution, etc.
A big role in development of cooperation in medical science and 3. after World War II the World Health Organization plays (see).
In post-war years the number of the carried-out international congresses, conferences and symposiums on various problems of medicine and 3 considerably grew., and also quantity international medical about-in, associations and federations. By the beginning of the 70th from 3 thousand international non-governmental organizations more than 500 — a medical profile. In the international medical relations the Red Cross continued to play a significant role.
The most important forms of the international cooperation in the area 3. became: activity of the international intergovernmental medical and social organizations (World Health Organization, International Agency for Research on Cancer, United Nations Children's Fund, Economic Social Council of the UN, International institute of applied systems analysis, etc.); activity international non-governmental (scientific medical and dignity. - a gleam.) organizations, carrying out the international medical congresses, conferences and meetings; to a sotrudnichastvo between various countries on the basis of bilateral or multilateral intergovernmental or interdepartmental agreements and contracts; international economic cooperation and trade medical and pharm, equipment, medicines, objects of patient care and other materials; the activity of the international public and voluntary organizations of a wide profile raising the questions of protection and strengthening of health of the person (about-va Red the Cross and Red Crescent, about-va friendship with foreign countries, large private funds etc.), and also other forms of cooperation (the edition of medical literature and exchange of information, the international correspondence, illumination of problems 3. mass media etc.).
The sixth long-term program of WHO (1978 — 1983) provides joint development of the following universal problems modern 3.: acceleration of development and the international coordination medical - biol, the scientific research sent to search for basic solutions of the major theoretical and practical problems 3.; coordination of fight with quarantine and others epid, diseases with use of modern methods of global observation and taking into account features of distribution of epidemics in a century of new high-speed means of communication and transport and considerable expansion of mass contacts between people; studying and development of effective methods of prevention, diagnosis and treatment heavy hron, neepid. diseases: cardiovascular, oncological, hereditary, endocrine, mental etc.; medical - a dignity. aspects of protection and improvement of the environment, including establishment of the international standards and maximum allowable concentrations of various substances in air, water and the soil; protection of the World Ocean and air basin; ensuring effective control behind quality, safety, efficiency and side effects of drugs and fight against the free or involuntary abuse of medicinal and other drugs which is a consequence of broad development pharm. and chemical industry and international trade; help to developing countries in creation and development of national systems and services 3. and preparation of national shots; sots. - a gigabyte. aspects of reproduction of the population, changes of its age structure, birth rate and mortality, incidence in various countries and districts of the world for the purpose of development of new strategy for 3. The problem of providing a sufficient and balanced diet of the population and fight against the diseases caused by malnutrition and hunger and also the general question of future dynamics of the population in connection with the shown both positive, and negative effects of scientific and technical progress for health of the person is closely connected with it.
All countries are interested in permission of these problems, and it is natural that combination of efforts will allow to use rationally personnel, technical and financial capabilities of the certain states for progress of medicine and health care.
International cooperation of the USSR in health care. In the first years after Great October socialist revolution international relations of domestic medicine from foreign were actually stopped. Not only the political, but also medical press of the leading capitalist countries was full of slanderous fabrications about the Soviet medicine and the Soviet doctors. Despite attempt of imperialistic powers to isolate the Soviet Russia from participation in the international political and public life, the Soviet government aimed to fulfill the obligations of Russia concerning international a dignity. agreements, humane attitude towards prisoners of war, wounded soldiers and officers of enemy armies etc.
In 1918. Russian about-vu Red the Cross performance of all duties, the rights and prerogatives based on the Geneva convention and other international agreements was entrusted. Only after the Genoa conference and the Treaty of Rapallo separate public and politicians [H. G. Wells, E. Herriot, an amer. doctor Hammer (A. Hummers)] begin to get acquainted with a state and problems Soviet 3. In 1921 at Narkomzdrava the bureau of foreign information was created, and at the Soviet embassy in Berlin the position of the representative Narkomzdrava is founded. In 1924 the same position is established at the Soviet embassy in France. In 1925 in the USA the representation of ROKK was open. Articles of the Soviet scientists and figures 3 begin to be published in a foreign press. E.g., in 1922 in Germany N. A. Semashko's article was published, in 1925 «The Russian-German medical magazine» under the editorial office F began to appear. Krauss and N. A. Semashko, since 1926 in France — «The French-Soviet review of medicine and biology» and in the USSR — «News of the French medicine». Importance for establishment of the international contacts of the USSR in the area 3. had departures of figures Soviet 3. and medical sciences abroad: N. A meeting. Semashko with professors Parisian un-that (1925), participation of delegation in work International a dignity. conferences in Paris (1926), in International a gigabyte. to an exhibition in Dresden (1929 — 1930), carrying out «the international social days» in Paris (1928) on whom the conducting Soviet scientists of I. P. Pavlov, H N. A. Semashko, M. I. Barsukov and V. P. Lebedeva, trips abroad made reports. N. Burdenko, L. A. Tarasevich, etc.
In the late twenties and especially in the 30th interest of foreign specialists in the field of social hygiene and public 3 considerably increases. to basic bases and forms of the organization 3. in the USSR. The monograph of the large historian of medicine G. Sigerist who visited the USSR in 1935 in a cut is published an objective positive assessment is given to the principles Soviet 3. and to a condition of matter of public health care in our country. In general objectively the system Soviet 3 is also kindly described. in the book «Red Medicine» (1936) of the department director 3. New York J. Kingsbury and English hygienist A. Newsholme. To growth of the authority Soviet 3. carrying out in the USSR the large international congresses promoted: The IV International congress on rheumatology (1934) passing under the chairmanship of M. P. Konchalovsky and the IV International congress of physiologists, on Krom I. P. Pavlov was proclaimed by the elder of physiologists of the world. Since 1934 the USSR became the member of the league Natsy and took part in its work. However this participation was short-term in view of an active anti-Soviet position of the representatives of Great Britain, France and some other countries who were the main members of the league Natsy.
In the years of World War II in the USA and Great Britain representations of the Soviet Red Cross through which some medicines, the medical equipment, etc. came to the USSR actively worked. Contacts between the soldier were come. - medical and the soldier. - a dignity. services of the countries of the anti-Hitlerite coalition.
In the first post-war years Soviet 3. turns a maximum of attention to assistance in construction of socialist system 3. in the countries of national democracy. Constantly positions of the USSR in WHO become stronger. Since the end of the 50th interstate cooperation of the USSR with developing countries, and from 60th — with the capitalist countries begins to be carried out. In 1976. The m3 of the USSR carries out cooperation and contacts more than with 80 countries; The USSR is a member of 40 international intergovernmental and non-governmental organizations.
Cooperation of the USSR with the international organizations for health care. The most important for the USSR is cooperation in WHO numbering 150 member states (1978).
The purposeful and active position of delegation of the USSR and delegations of other countries on authorized WHO sessions promoted reception in her members of GDR, DPRK, Guinea-Bissau, SRV, Angola, and also to acceptance of a number of the resolutions having not only medical, but also important political value. With active participation of the Soviet representatives were developed the fifth (for 1973 — 1977) and the sixth (for 1978 — 1983) long-term programs of WHO's activities. The Soviet specialists actively participated in development of such important programs of WHO as prevention of cardiovascular diseases, fight against viral and other infectious diseases, hygiene of the environment, medical education, and also programs onkol, researches, etc.
On the basis of 41 Soviet scientific research institutes 88 scientific divisions cooperating with WHO function. Cooperation on the program of fight against cardiovascular diseases, to the preparation of medical shots, questions concerning quality, safety and efficiency of pharmaceuticals and also in the field of hygiene of the environment extends. Development of the nomenclature and classification of tumors, unification of methods of their diagnosis and treatment continues. With active participation of the Soviet specialists of WHO developed classification of tumors of ovaries and a uterus, classifications of melanomas, a carcinoma of the stomach, a gullet and tumoral fabric are developed. Collecting and studying of the strains of activators of a number of bacterial infections, an arbovirus, enteroviruses, mycoplasmas of influenza viruses allocated in the USSR and received from abroad, etc. continues.
Regularly in our country seminars of WHO are held. It gives the chance to foreign specialists to examine activity of scientific and practical institutions 3., to make use of the wealth of experience accumulated in the USSR.
According to the proposal of delegations of the socialist countries on the world assemblies 3. a number of important resolutions was adopted. So, XXIII World assembly 3. adopted the resolution on philosophy of development national 3., in a cut the wealth of experience socialist 3 is reflected. also recommendations to member countries of WHO on construction 3 are formulated. on the state or national basis. On the XXV World assembly 3. the resolution on strengthening of a role of WHO in development and coordination medical - biol is adopted. researches. WHO pays the increasing attention to development of the program primary medical - a dignity. the help, especially in developing countries.
The Soviet Union is a member 40 international scientific medical about-in and associations. Participation of the Soviet scientists in the international and national congresses and conferences in foreign countries, and also carrying out a number of the international congresses, meetings and seminars in the USSR is an important source of obtaining information urgent scientific medical and exchange of experience, promotes growth of the authority of the Soviet medical science and promotion of its achievements abroad.
The Soviet representatives actively work in governing bodies International about-va surgeons, in the International anticarcinogenic union, the International antitubercular union, the International federation mikrobiol, about-in, the International pediatric association, International and European about - Vakh cardiologists, the International association of gerontologists, the International commission and the International association on radio-gramophones, protection, international about - Vakh hematologists and transfuziolog, and also in some other the international scientific associations. Carrying out the congresses and conferences international medical scientific about-in in the Soviet Union provides not only familiarizing with discussion of urgent problems of modern medicine of wide circles of the Soviet specialists and practical doctors, but also effective promotion of achievements of the Soviet medical science and 3. In 1962 the VIII International congress on oncology, in 1964 — the IX International congress of microbiologists, in 1969 — the IX International congress on hemotransfusion and the XIII International congress on hematology, in 1970 — the IX International congress of anatomists, in 1971 — the XXI International conference on tuberculosis, the XXIV congress International about-va surgeons, the IX International congress on cardiovascular surgery and the congress of the International federation of surgical colleges, in 1972 — the IX International congress on gerontology, in 1973 — the VII International congress of Federation obstetric ginekol was carried successfully out to the USSR. about - century.
According to the available agreements and quotas of exchanges a lot of work on reception of foreign medical delegations and specialists for participation in work of the international and inner-union medical congresses, congresses, conferences and meetings, for acquaintance with experience Soviet 3 is carried out. and medical sciences, lecturing, joint researches, demonstrations of pharmaceuticals, medical equipment etc. Together with the State committee on science and technology of the USSR, the M3 of the USSR and Min-vom of the medical industry of the USSR is carried out scientific and technical cooperation with a number of the largest pharm, firms. An important stage in this work was carrying out in May, 1974 in Moscow of the largest international exhibition of medical tools, devices and pharmaceuticals — «Health care-74», in a cut more than 700 firms and associations from 23 foreign countries, and also apprx. 300 organizations of the Soviet Union took part.
In system of international relations Soviet 3. important work on rendering operational and disinterested aid is carried out by the Soviet Red Cross.
Cooperation in the medical press and exchange of literature and details are also important forms of international relations 3. This work is carried out by Meditsina publishing house, All-Union research in-volume of medical information and the State central scientific medical library M3 of the USSR.
Cooperation with the socialist countries took place a number of the periods of development as a result of which the health care of the USSR and the brotherly states gradually developed in originally international system socialist 3., strong not only achievements of the certain countries, but first of all collective experience and uniform methodology. An important role in collective development of ways of development socialist 3. play annual meetings of Ministers of Health (from 1955 to 1977 18 meetings were held), and also the conclusion of interstate cooperation agreements in area 3.
Agreements were signed by the USSR with ChSSR (on December 4, 1957), GDR (on October 21, 1958), VNR (on April 17, 1959), MNR (on September 21, 1971). With other socialist countries sections on 3. join in intergovernmental agreements on scientific and technical and cultural cooperation.
For implementation of these agreements of min.-va health care of the socialist countries coordinate and sign among themselves annual, two-year or five-year plans of cooperation, carry out broad exchange of delegations and specialists. Also mutual information on the carried-out scientific congresses, conferences and symposiums is adjusted.
Important factor of coordination of cooperation between bodies and institutions 3. the socialist countries of steel the expert committees created according to the solution of a number of meetings of ministers for development of the leading problems 3. and medical sciences. Recommendations of expert committees pursue the aim of improvement of organizational forms 3., definitions of the most perspective directions of development of multilateral bonds. In the 70th specialists of the socialist countries jointly discussed problems of fight against infectious diseases, the principles of the organization of work of the district doctor, a problem of planning and coordination of scientific research, methodology of forecasting in 3. and some other urgent problems. Direct interinstitute cooperation of research and educational institutions of the USSR and the socialist countries developing similar subject extended. In 1976 76 research establishments of the USSR cooperated with 200 research centers of the socialist countries on 348 subjects. Joint researches with NRB (72 subjects), VNR (29 subjects), GDR (87 subjects), the Party of Russian Taxpayers (24 subjects), ChSSR (53 subjects) are most actively conducted.
The tendency to effective integration of efforts of the socialist countries in the field of 3 becomes more and more distinct. In 1973 within SEV the cooperation agreement on nine important problems of oncology and about creation in the USSR Coordination onkol, the center was signed. Big collaboration is carried out on hygiene of the environment, problems of food, and also on the Intercosmos line, etc. the XXIX session of SEV at the level of heads of governments which was taking place in June, 1975 in Budapest made the decision on creation of the Constant commission of SEV on 3. with participation of interested countries — members of SEV. The sessions of this commission took place in 1975 — 1977 in Moscow, Sofia and Peshtyanakh (ChSSR) under the chairmanship of the Minister of Health of the USSR academician B. V. Petrovsky. At the sessions of the commission the plan of scientific and technical cooperation of member countries of SEV in medical science, the equipment and 3 was considered and accepted. for 1976 — 1980 and on more remote perspective on 11 complex problems. Among them methods of complex studying of the state of health of the population, cardiovascular diseases, malignant new growths, viral diseases, and first of all flu, gigabyte. aspects of environmental control, infectious diseases and problems of vaccination, organ and tissue transplantation, etc. Seven of these problems are coordinated by the Soviet scientific institutions, the others — scientific NRB, VNR, Party of Russian Taxpayers, ChSSR institutions.
Cooperation with the capitalist countries also gained considerable development. Systematic scientific exchange and cooperation in the area 3. M3 of the USSR and the USSR Academy of Medical Sciences with France, Finland, the USA, Great Britain, Sweden, Italy, Canada, Belgium, the Netherlands, Denmark, Austria, Japan and other capitalist states are carried out. A legal basis of cooperation are intergovernmental agreements and protocols on 3., signed between the USSR and France (on January 9, 1969), Italy (on February 2, 1970), the USA (on May 22, 1972 and on June 28, 1974), Great Britain (on February 17, 1975), Finland (on March 19, 1976), and also the agreement between the USSR Academy of Medical Sciences and Royal Academy of Sciences of Sweden (on June 6, 1968) and agreements between the USSR and other countries on cultural and scientific and technical cooperation.
There were also main forms of cooperation: exchange of specialists and delegations for carrying out joint researches, lecturing, mutual consultations; participation in scientific meetings and conferences; mutual acquaintance with technical means and medical equipment; coordination of scientific research; exchange of scientific and technical information etc.
Cooperation between the USSR and capitalist states in medical science and 3. is under construction on a mutually advantageous basis, is of great mutual interest. So, with Canada plans of joint studying medical - biol are developed. problems of the North, with Sweden problems of endocrinology, pharmacology, biochemistry, medical radiology, with Belgium, the Netherlands, Austria, Denmark and other countries are studied separate problems of medicine and 3 are developed. The going deep cooperation with France is concentrated on problems of use of the COMPUTER in medical science and 3., and also medical genetics, submicroscopy, organ transplantation and fabrics, wedge, and experimental oncology, studying of new pharmaceuticals, medical equipment, etc. Consistently cooperation develops in areas 3. with Finland on problems of scientific information, a pharmacodynamics, an angiography, flu and other viral diseases, pseudorheumatisms, went. - kish. diseases, vibration disease, lead intoxication, etc. Cooperation with Italy is directed to joint studying of problems of cardiovascular diseases, oncology, pharmacology, biochemistry and social hygiene.
In the 70th the particularly important became cooperation in the area 3. and medical sciences between the USSR and the USA. In 1971 the Soviet-American negotiations as a result of which the agreement on cooperation on problems of cardiovascular diseases, malignant tumors and hygiene of the environment was reached were held. In March, 1972 the first meeting of the Soviet-American working commission on these questions took place, on May 22, 1972 in Moscow «The agreement between the governments of the USSR and the USA on cooperation in medical science and health care», and on June 28, 1974 — «The agreement between the USSR and the USA on cooperation in scientific research and development of artificial heart» which practical implementation was entrusted to the Soviet-American commission on 3 was signed.
Effective cooperation in the area 3 gained development. and with other countries. As a result of signing in Moscow on February 17, 1975 at the level of heads of governments «Agreements on cooperation between the USSR and Great Britain in the field of health care and medical science» the contact with scientists and doctors of Great Britain was come that got broad support of the medical public of both countries. According to
the plan of cooperation signed in September, 1975 in London joint efforts of the Soviet and English specialists concentrate on the solution of three important problems — treatment and the prevention of diseases of eyes, studying of viral infections, in particular flu, the organization of emergency medical service.
The experience of cooperation in medicine with the capitalist countries demonstrates that, despite distinctions of a social system and systems of the organization 3., at the correct understanding of interests of the parties there are all bases and opportunities for mutually advantageous exchange of experience and business cooperation.
Cooperation with the m developing the country and Asia, Africa and other regions is carried out in a number of the established directions: sending of the Soviet specialists for long work to these countries, design and construction to lay down. and scientific institutions, the direction of specialists for rendering protivoepid. help, delivery of the medical equipment and pharmaceuticals. Big groups of the Soviet doctors, teachers and other specialists selflessly work in Algeria, Guinea, Mali, Chad, Nigeria, Congo, Zambia, Mozambique, Afghanistan and other countries. In developing countries more than 20 medical institutions are constructed and equipped (-tsy, maternity homes, policlinics, medical assistant's schools, etc.)? some more objects 3 are under construction or projected.
Many medical institutions constructed by means of the USSR became the important centers of science and practice 3. in developing countries: it hospital of the Soviet Red Cross in Addis Ababa (Ethiopia), Tehran (Iran), Lokhdarye (Algeria),-tsy in Taundzhi (Burma) and to Katmandu (Nepal), in Sheikh and Uodzhida (Somalia), in Sana'a (the Yemen Arab Republic) and Kisumu (Kenya), a maternity home with clinic for women in Brazzaville (Congo), the center of protection of motherhood and the childhood in Bangui (Tsentralnoafrikansky Empire). In many medical institutions constructed by the Soviet Union after their commissioning the Soviet doctors and other specialists work.
Preparation of national shots 3 is more and more widely carried out. for developing countries in medical educational institutions of the USSR. In 1949 — 1975 from among citizens of the foreign states more than 4300 doctors and pharmacists are trained, more than 900 people defended master's theses, passed a training or an internship, hundreds of nurses and paramedics are trained. Many graduates of the Soviet higher education institutions already proved as the highly qualified specialists capable to resolve difficult questions of the organization of national services 3. All of them move forward on important posts of chief physicians of BC and heads of departments 3 more often., are included delegations of the countries on authorized WHO sessions etc. In 1976 — 1977 in the USSR the St. 5 thousand students and interns from 95 states studied. The Soviet specialists gave also direct help in creation medical f-tov in Zambia, Guinea, Algeria, systems of preparation of average medical shots in Mali and other countries.
The m3 of the USSR and the Soviet Red Cross repeatedly gave help to developing countries and at natural disasters and flashes epid, diseases by deliveries of vaccines and serums, medicines, tools and the equipment, and also by the direction of consultants and teams of specialists (mobile groups) for the practical organization protivoepid, actions.
Importance of full cooperation in the field of medicine and 3. it is noted also in the Helsinki final act of the All-European meeting on safety and cooperation, and also in decisions of the Conference of communist and labor parties of Europe.
Soviet scientists-physicians, professors and teachers, doctors, nurses and other workers 3. the active participation in implementation of the international cooperation in protection and strengthening of health of the people together with workers 3. the brotherly socialist states and progressive figures of medicine of all other countries of the world make the feasible contribution to general fight for peace and happiness of the people, for bright future of mankind.
Table 1. EXPENSES ON HEALTH CARE AND PHYSICAL CULTURE UNDER the STATE BUDGET of the USSR And FROM OTHER SOURCES of FINANCING *
Table 2. SOME EXPENSES UNDER the BUDGET of the STATE SOCIAL INSURANCE *
Table 3. The NUMBER of DOCTORS of ALL SPECIALTIES AND SECURITY of the POPULATION with DOCTORS ON FEDERAL REPUBLICS (on &konetsnbsp; years, in one thousand)
Table 4. The NUMBER of DOCTORS of ALL SPECIALTIES In the USSR IN COMPARISON WITH SOME FOREIGN COUNTRIES
Table 5. GROWTH of NUMBER of MEDICAL AND PHARMACEUTICAL SHOTS (on the end of the year, in one thousand).
Table 6. GROWTH of NUMBER of DOCTORS In the USSR ON the MAIN SPECIALTIES (on the end of the year, in one thousand).
Table 7. GROWTH of NUMBER of HOSPITAL BEDS AND SECURITY with THEM of the POPULATION IN FEDERAL REPUBLICS (without hospitals)
Table 8. MAIN INDICATORS of ACTIVITY of INSTITUTIONS of PROTECTION of MOTHERHOOD AND CHILDHOOD (1913 — 1975)
Classics of Marxism-Leninism and the resolution of party and the government on 3. — Marx K. Capital, in book: Marx K. and Engels F. Compositions, 2nd prod., t. 23, hl. 9, M., 1960, t. 25, p.1, hl. 5, M., 1961; Marx K. and Engels F. Manifesto of the Communist Party, in the same place, t. 4, page 419, M., 1955; Engels F. Position of working class in England, in the same place, t. 1, page 507, M., 1955; e of about e, the Origin of a family, a private property and the state, in the same place, t. 21, page 23, M., 1961; Lenin V. P. A great initiative (About heroism of workers in the back. Concerning «communistic community work days»), Half-N of SOBR. soch., 5th prod., t. 39, page 1, M., 1963; e of about e, the VIII congress of RCP(b), on March 18 — 23, 1919, in the same place, t. 38, page 125, M., 1963; it, Second All-Russian congress of Councils of working and soldier's deputies, on October 25 — 26: (on November 7 — 8), 1917, in the same place, t. 35, page 7, M., 1962; e of about e, Persecutors of a zemstvo and An-nibaly of liberalism, in the same place, t. 5, page 388, M., 1959; e of about e, the Meeting of the Petrograd Council of working and soldier's deputies on October 25 (on November 7), 1917, in the same place, t. 35, page 2, M., 1962; e of about e, Materials on review of the party program, in the same place, t. 32, page 135, M., 1962; e of about e, to the aid of the wounded Red Army man!, in the same place, t. 41, page 156, M., 1963; it, Immediate tasks of the Soviet power, in the same place, t. 36, page 165, M., 1962; e of about e, the Speech at the II All-Russian congress of workers of medical and sanitary work on March 1, 1920, Legal record, in the same place, t. 40, page 188, M., 1963; VII All-Russian congress of Councils on December 5 — 9, 1919, in the same place, t. 39, page 385, M., 1963; Brezhnev L. I. Pride of domestic science, the Speech at the Ceremonial meeting in the Kremlin Palace of Congresses, it is devoted. to 250-year anniversary of Academy of Sciences of the USSR, 7 Oct. 1975, M., 1975; e of about e, About the draft constitution of the Union of Soviet Socialist Republics, the Report на^Пленуме the Central Committee of the CPSU on May 24, 1977, M., 1977; it, Report of the Central Committee of the CPSU to the XXIII congress of the Communist Party of the Soviet Union, on March 29, 1966, M., 1966; it, Report of the Central Committee of the CPSU to the XXIV congress of the Communist Party of the Soviet Union, on March 30, 1971, M., 1971; it, the Report of the Central Committee of the CPSU and immediate tasks of party in the field of domestic and foreign policy, the Report to the XXV congress of the CPSU on February 24, 1976, M., 1976; it, the Soviet labor unions — the influential force of our society, the Speech at the XVI congress of labor unions of the USSR on March 21, 1977, M., 1977; Constitution (Fundamental law) of the Union of Soviet Socialist Republics, M., 1977; XXII congress of the Communist Party of the Soviet Union, Stelografichesky report, t. 1 — 3, M., 1962; XXIII congress of the Communist Party of the Soviet Union, Verbatim record, t. 1 — 2, M., 1966; Materials of the XXIV congress of the CPSU, M., 1974; XXV congress of the Communist Party of the Soviet Union, Verbatim record, t. 1 — 3, M., 1976; The Communist Party of the Soviet Union in resolutions and decisions of congresses, conferences and plenums of the Central Committee (1898 — 1971), t. 1 — 10, M., 1970 — 1972; Lenin decrees on health care, 1917 — 1921, M., 1970; About the 60th anniversary of Great October socialist revolution, the Resolution of the Central Committee of the CPSU of January 31, 1977, M., 1977; Bases of the legislation of USSR and federal republics about health care, M., 1970; The resolution of the All-Union Communist Party (bolsheviks) of the Central Committee «About medical care of workers and peasants», December, 1929, Vopr, zdravookhr., No. 1, page 1, 1930; The Resolution of the Central Committee of the CPSU «About measures for further development of biological science and strengthening of its communication with practice», January, 1963, in book: Collection of resolutions of the government of the USSR, No. 2, page 39, 1963; The Resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of health care and development of medical science in the country», July, 1968, in the same place, No. 13, page 82, 1968; The Resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of medical care and public health care of the USSR», January, 1960, in the same place, No. 3, page 63, 1960; The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About actions for further increase in welfare of the Soviet people», September, 1967, in the same place, No. 23, page 558, 1967; Resolutions of the CPSU and Soviet government on health protection of the people, sost. P. I. Kalyyu and H. N. Morozov, M., 1958; The Resolution of the Supreme Council of the USSR «About a condition of medical care to the population and measures for improvement of health care in the USSR», June, 1968, Sheets of the Supreme Council of the USSR, No. 27, page 390, 1968; The Resolution of Council of ministers of the USSR «Questions of development of physical culture and sport», August, 1966, in book: Collection of resolutions of the government of the USSR, K 18, page 363, 1966; The Program of the Communist Party of the Soviet Union, is accepted by the XXII congress of the CPSU, M., 1976; Collection of laws of the USSR and decrees of Presidium of the Supreme Council of the USSR, 1938 — 1975, t. 3, page 177, M., 1975.
History 3. and history 3. in Russia — Varadinov N. V. History of the Ministry of Internal Affairs, p.1 — 3, SPb., 1858 — 1862; Veselovsky B. B. Istoriya of a zemstvo in forty years, t. 1 — 4, SPb., 1909 — 1911; The founded interdepartmental commission on review of the medical and sanitary legislation (chairman G. E. Rein), is most high. m, 1912 — 1914; D. N Zhbank. The collection on matter city medical sanitary in Russia, M., 1915; 3 and l of yj d about in with to and y P. E. History of domestic medicine, the Lecture 2, Development of medicine in the people of the USSR to feudalism and during the feudal period, M., 1955, bibliogr.; it, History of domestic medicine, p.1 — the period till 1917, M., 1960; it, Way of development of public medicine, M., 1970; History of medicine, under the editorship of B. D. Petrov, M., 1964, bibliogr.; To and - the Nevsky L. O., Lotov E. I. and And d e of l h and to X. And. The main lines of development of medicine in Russia in the period of capitalism (1861 — 1917), M., 1956, bibliogr.; Kupriyanov N. G. History of medicine of Russia in Peter the Great's reign, SPb., 1872; L of e in and M. M t. Formation of public medicine in Russia, M., 1974, bibliogr.; Lyubimenko. Medical and medicinal matter in the Moscow state, Russian used up. zhurn., book 3-4, page 3, 1917; Maximov E. D. Orders of public contempt in their past and the present, the Labour help, No. 9, page 532, 1901; Meyer-Shteyneg T. and Zudgof K. Istoriya of medicine, the lane with it., M., 1925; M e N e L. History of medicine, the lane with fr., M. — L., 1926; Nikitin A. The short review of a condition of medicine in Russia in reign of the empress Catherine II, SPb., 1855; Novombergskiyn. Ya. A medical structure in pre-Pertine Russia, Tomsk, 1907; Osipov E. A., Popov I. V. and To at r to and P. I N. Russian territorial medicine, M., 1899; Richter V. M. History of medicine in Russia, t. 1 — 3, M., 1814 — 1820; Russian D. M. Istoriya of general and domestic medicine and health care, Bibliography (996 — 1954), M., 1956; Skorichenkog. G. Gigiyena in prehistoric times, SPb., 1895, bibliogr.; Freyberg N. G. The medical and sanitary legislation in Russia, SPb., 1913; Frenkel 3. G. Sketches of territorial medical and sanitary business, SPb., 1913; H and with t about in and the p Ya. A. Sketches from history of the Russian medical institutions of the 18th century, SPb., 1870; Me Combs of S. E. City health administration, N.Y., 1927, bibliogr.; N e w s h o 1-m e A. Health problems in organized society, L., 1927; it, The story of modern preventive medicine, Baltimore, 1927; Rapmund O. Das offentliche Gesund-heitswesen, Bd 1 — 2, Lpz., 1901 — 1914.
3. in the USSR — Artemyev F. A. Labor rights of health workers, M., 1965; Ashurkov E. D., V. I. Lenin and health protection of the people, M., 1965, bibliogr.; Babanovsky I. V. Questions of financing of health care to the USSR, Questions of social hygiene, economy and management of health care, M., 1976; Baroyan R. O. Scientific and technological revolution and health of workers, M., 1976, bibliogr.; M. I badgers. Questions of the organization of health care in Russia during the February bourgeois-democratic revolution, Owls. zdravookhr., No. 4, page 43, 1947; it, Great October socialist revolution and organization of the Soviet health care, M., 1951, bibliogr.; B and t to and with G. A. and L e-karev L. G. Social hygiene and organization of health care, M., 1969; Burgasov P. N. and Impecunious I. S. Scientific bases of the organization of prevention of infectious diseases, M., 1977, bibliogr.; Burgasov P. N., L and d about in I. P. and With t about the h and to And. M Union of Soviet Socialist Republics (USSR), KME, t. 3, page 99, M., 1974; B at ~ r en k S. P. The main directions of the five-year plan for 1971 — 1975 on health care and medical science in the light of directives of the XXIV congress of the CPSU, Owls. zdravookhr., No. 9, page 3, 1971; e of about e, the Main objectives of the Soviet health care in the light of decisions of the XXV congress of the CPSU, Owls. medical, No. 1, page 3, 1977; B at r N and z I am A. I. N and To r and h and and V. I. N of 50 years of the Soviet health care and development of air and space medicine, Tousle. biol, and medical, t. 2, No. 4, page 3, 1968; In e of N of e d and to - t about in D. D. Problems of the scientific organization of work and management of health care in the USSR, Owls. zdravookhr., No. 12, page 3, 1968; it, Forecasting, advance planning and management in health care and medical science, M., 1970, bibliogr.; Vinogradov N. A. Health care in the USSR (1917 — 1957), M., 1957; e of about e, Philosophy of socialist health care, M., 1976; Vinogradov N. A. and With t r and sh at I. D N. Health protection of workers in the Soviet Union (to the 30 anniversary of Great October socialist revolution), M., 1947; Vladimir y M. F. Tasks of bodies of health care and socialist construction, At the front zdravookhr., No. 5-6, page 3., 1930; Doctors Bolsheviks is builders of the Soviet health care, under the editorship of E. I. Lotova and B. D. Petrov, M., 1970, bibliogr.; A. S of St. George. and Gavrilov of O. K. Sotsialno-gigiye-nicheskiye of a problem and effects of wars, M., 1975, bibliogr.; Gerasimov P. I. Tasks and perspectives of development of pharmacy in the 10th five-years period, Pharmacy, No. 3, page 1, 1976; Golovteev V. V. Original positions of the five-year development plan for health care of the USSR for 1971 — 1975, Owls. zdravookhr., No. 1, page 3, 1972; e of about e, the Main results of development of health care for the ninth five-years period (1971 — 1975), in the same place, JSfc 1, page 3, 1976; Golovteev V. V., KA I pour P. I. and Pustova I. V. Bases of the economy of the Soviet health care, M., 1974; About r f and D. V N. Sketches of history of development of rural health care of the USSR (1917 — 1959), M., 1961; At with e of N to about in P. V. The medical industry to the 50 anniversary of formation of the USSR, Chemical - pharm, zhurn., t. 6, No. 12, page 3, 1972; Twenty five years of the Soviet health care (1918 — 1943), under the editorship of G. A. Miterev, M., 1944; 3 and r at and G. P. Sanepidstantion's N at the present stage, M., 1975, bibliogr.; Health resorts of labor unions, under the editorship of I. I. Kozlov, M., 1973; Health care in days of the Great Patriotic War 1941 — 1945, the Collection of documents and materials, under the editorship of M. I. Barsukov and D. D. Kuvshinsky, M., 1977; Health care in the years of recovery and socialist reconstruction of the national economy of the USSR 1925 — 1940, the Collection of documents and materials, under the editorship of M. I. Barsukov, etc., M., 1973; Health care in the Soviet Russia, the Collection of articles to the Congress of Councils, M., 1919; Health care in the USSR (The statistical collection), M., 1960; Health care to the USSR, Methodical materials, M., 1971; Health care in the USSR (Statistical materials), M., 1976; To and-linin M. I. The speech at the 7th All-Russian congress of zdravotdel, Vopr, zdravookhr., No. 5-6, page 124, 1930; Kalyyup. I. Modern problems of management of health care, M., 1975, bibliogr.; To and - the Nevsky L. O. Participation of workers of the USSR in construction of health care, M., 1957, bibliogr.; Kanep V. V., Lipovetskayal. L. V. S ilukyan. The theory and practice of the scientific organization of work in health care - M., 1977, bibliogr.; To and with l I to N. S., V. I. Lenin and health protection of mother and child, Vopr, okhr. mat. also it is put., t. 15, No. 4, page 3, 1970; e e of e, International year of the woman and protection of motherhood and childhood, in the same place, t. 20, No. 12, page 3, 1975; To about l about m and e of c of P. E. Questions of health care in V. I. Lenin's works, the Scientific and bibliographic grant, Kiev, 1971; To at r and sh about in S. V. The Soviet health care in the sixth five-years period, M., 1957; it, the Hospital help at a new stage, M., 1963, bibliogr.; it e, Union of Soviet Socialist Republics, BME, 2nd prod., t. 30, Art. 1030, M., 1963; L and with and c y Yu. P N. Social hygiene and organization of health care, M., 1973; Lotova E. I. and And d e of l h and to X. And. Fight against infectious diseases in the USSR 1917 — 1967, Sketches of history, M., 1967, bibliogr.; M and N and N of N and to about in and N. V. Health protection of children in the USSR, M., 1973, bibliogr.; Mechanization and automation of processing of statistical information in medicine and health care, under the editorship of L. E. Polyakov, L., 1976, bibliogr.; Nesterenko A. I. As the National commissariat of health care of RSFSR, was formed Of history of the Soviet health care (October, 1917 — July, 1918), by M., 1965; The Organization of health care in the USSR, under the editorship of N. A. Vinogradov, M., 1962, bibliogr.; Bases of the organization of the stationary help in the USSR, under red, A. G. Safonov and E. A. Loginova, M., 1976, bibliogr.; Sketches of history of health care of the USSR (1917 — 1956), under the editorship of M. I. Barsukov, M., 1957, bibliogr.; Sketches of history of the preventive direction of the Soviet medicine, under the editorship of B. D. Petrov, M., 1958, bibliogr.; Petrov B. D. Code of health, Klin, medical, t. 48, K 8, page 7, 1970; Petrovsky B. V. Sostoyaniye of medical care to the population and measures for improvement of health care in the USSR, Owls. zdravookhr., No. 10, page 6, 1968; it, Health of the people — the most important property of socialist society, M., 1971; it e, Problems of the Soviet health care and medical science in the light of decisions of the XXIV congress of the CPSU, Owls. zdravookhr., No. 2, page 3, 1972; e of about e, 50 years of formation of the USSR and the Soviet health care, in the same place, No. 12, page 3; e of about e, Achievements in health protection of women and children in 50 years of the USSR, in the same place, No. 3, page 3, 1973; it e, the Soviet health care in 50 years of the USSR, M., 1973; it, the Problem of the Soviet health care in implementation of decisions of the XXV congress of the CPSU, Vestn. USSR Academy of Medical Sciences, Kya 10, page 6, 1976; it, Achievements of the Soviet health care for years of the ninth five-years period, M., 1976; Petrovsky B. V., Burgasov P. N., L and d about in I. P. and A. M. Zdravookhraneniye's Sto-chik, BSE, the 3rd prod., t. 24, book 2, page 271, M., 1977; Petrovsky B. V., T and m and to about in B. D., Burgasov P. N., I. P.'s Leads both With t of au h and to A. M. Medical sciences, in the same place, page 334; Poltoranovv.V. Sanatorium treatment and rest in the USSR, M., 1971, bibliogr.; P about p about in G. A. Ekonomik and planning of health care, M., 1976; Potulov B. M., V. I. Lenin and health protection of the Soviet people, L., 1969, bibliogr.; 50 years of the Soviet health care, 1917 — 1967, glavn. edition B. V. Petrovsky, M., 1967, bibliogr.; The guide to social hygiene and the organization of health care, under the editorship of N. A. Vinogradov, t. 1 — 2, M., 1974; With and - A. G backgrounds. Medical care to the population in RSFSR, M., 1961, bibliogr.; e of about e, the State and ways of development of the specialized help in the USSR, in the same place, KV 2, page 3, 1964; Semashko N. A. Chosen works, M., 1967, bibliogr.; With e p e of N to about A. F., V. I. Lenin and social problems of health care, M., 1969; it, Prevention — fundamentals of socialist health care, Rubbed. arkh., t. 46, No. 1, page 3, 1974; With ER of e of N to about A. F. and With about about l of e in with to and y G. N. Zdravookhraneniye of socialist society, M., 1975, bibliogr.; A. F. Seren-co, Ermakov V. V. ipetra-to about in B. D. Bases of the organization of the polyclinic help to the population, M., 1976, bibliogr.; With l at the h and N to about I. S. and Church G. F. Statistical information in management of healthcare institutions, M., 1976; Sobolevsky G. N., Ermakov V. V. and about l about W of e e in V. V. Bases of financing of healthcare institutions, M., 1974, bibliogr.; Nightingales 3. P. Questions of social hygiene and health care, Chosen works, M., 1970, bibliogr.; 40 years of the Soviet health care, 1917 — 1957, under the editorship of M. D. Kovrigina, M., 1957; Social hygiene and the organization of health care, under the editorship of A. F. Serenko and V. V. Ermakov, M., 1977, bibliogr.; The reference book of the main leading documents on pharmaceutical business, under the editorship of A. K. Melnichenko, M., 1962; Formation and development of health care in the first years of the Soviet power (1917 — 1924), the Collection of documents and materials, under the editorship of M. Y. Barsukov, etc., M., 1966; Stepanov V. S. Organization of operation of the office of bodies of health care, M., 1966, bibliogr.; 100 years of the Red Cross in our country, under the editorship of G. A. Miterev, M., 1967; With y with and A. N N. A sanitary condition of Russia and the USSR, in book: Sots. hygiene, under the editorship of A. V. Molkov, century 1, page 111, M. — JI., 1927; Tentsova A. And., Panchenko E. I. and Semenova T. D. Pharmacy in the USSR, M., 1973, bibliogr.; Theoretical heritage of V. I. Lenin and medicine, under the editorship of G. I. Tsaregorodtsev, M., 1970; T and m and to about in V. D. Chelovek, medicine and scientific and technical progress, M., 1971; it, 250 years of Academy of Sciences of the USSR and Soviet medical science, Zhurn, mikr., epid, and immun., No. 6, page 3, 1974; it, 30 years of the USSR Academy of Medical Sciences, Vestn. USSR Academy of Medical Sciences, No. 11, page. And, 1975; Trofimov V. V. Health care of the Russian Federation in 50 years, M., 1967, bibliogr.; Works of a scientific session of the international courses of organizers of health care, under the editorship of V. N. Booth-rova and N. A. Vinogradov, M., 1970; Philosophical and social and hygienic aspects of the doctrine about health and diseases, under the editorship of G. I. Tsaregorodtsev, M., 1975; X and-chikyan A. S. Experience of the organization of specialized medical care in the central regional hospital, M., 1975, bibliogr.; The p e r N at x A. M. and Safonov A. G. Development of medical science and implementation of its results in to the practician in the tenth five-years period in the light of decisions of the XXV congress of the CPSU, Vestn. USSR Academy of Medical Sciences, No. 12, page 3, 1976; H and to both S. Ya. Zdorovye's N of the person and the social environment, M., 1971; e of about e, the CPSU and health protection of the people, M., 1977; H and to and S. Ya. N and d river the Higher medical school in the USSR, M., 1973, bibliogr.; Shabaylov V. I. Management of health care in the USSR, M., 1968; 60 years of the Soviet health care, glavn. edition B. V. Petrovsky, M., 1977, bibliogr. 3. foreign countries and the international cooperation in the area 3. — Venediktov D. D. International problems of health care, M., 1977, bibliogr.; World Health Organization (History, problems, perspectives), under the editorship of D. D. Venediktov, M., 1975, bibliogr.; Second ten years of World Health Organization (1958 — 1967), M., 1969; Dobrovolsky Yu. A. Health of world's population in the 20th century, M., 1968, bibliogr.; To and l yu P. I. Questions of economy and planning of health care in foreign countries, M., 1971, bibliogr.; it, Management of health care in the USA, M., 1971, bibliogr.; Methods of the economic analysis and planning of health care in the developed capitalist countries, the Scientific review, under the editorship of A. F. Serenko, p.1, M., 1974; The Organization and management of health care in the developed capitalist countries, the Scientific review, under the editorship of A. F. Serenko, p.1, M. * 1975; Problems of economy and planning of hospital service in industrially developed capitalist countries, the Scientific review, under the editorship of A. F. Serenko, M., 1972, bibliogr.; Problems of economy of work in health care of the developed capitalist countries, the Scientific review, under the editorship of A. F. Serenko, M., 1975, bibliogr.; Tarasov V. V. Health care in the countries of Latin America, M., 1976, bibliogr.; Tentsova A. And., Panchenkoye. And. iyankhonene. H. Pharmaceutical matter in the capitalist countries, M., 1976, bibliogr.; Shch e p and O. P. Zdorovye's N of the population and health care of the countries of Africa, M., 1970, bibliogr.; it e, Problems of health care of developing countries (On materials of the African continent), M., 1976, bibliogr.; Economic problems of health care in the developed capitalist countries, the Scientific review, under the editorship of A. F. Serenko, M., 1972, bibliogr.
B. V. Petrovsky; O. A, Alexandrov, B. A. Alekseev, P. N. Burgasov, C. P. Burenkov, D. D. Venediktov, P. I. Gerasimov, V. V. Golovteev, V. A. Dvoryakovsky, Yu. F. Isakov, N. S. Kislyak, M. A. Klyuev, I. P. Leads, Yu. P. Lisitsyn, D. N. Loransky, A. K. Melnichenko, V. V. Poltora - is new, L. N. Pokrovskaya, B. M. Potulov, A. G. Safonov. A. F.Serenko, A. M. Sto-chik, A. I. Tentsova, I. D. Strashun, B. V. Trofimov, O. M. Hromchenko, A. M. Shishova, O. P. Shchepin.