What made the October Revolution a "revolution"?

 

What made the October Revolution a "revolution" in the literal sense of the word was its radical change in people's daily lives, the reorganization of everything that had historically been organized according to the interests of the ruling class, according to the needs of society.

One of the best examples of this is the revolution carried out by the October Revolution in the field of “health”.

PARADIGM CHANGE

Throughout history, the aim of health care has been the "treatment of the sick" and medicine has been organized to equip physicians with the knowledge and skills to diagnose and treat diseases in accordance with this purpose.

In the late 1700s, science revealed that biological factors alone do not determine health, but that the physical environment also has effects on health, and towards the middle of the 1800s, it was understood that social factors (working and living conditions) also had important effects on health.

These developments had a profound impact on the organization of medicine and health care. As medicine turns its eyes from the individual to the physical and social environment, it has been understood that health care should also include measures to improve people's living and working conditions.

At the threshold of the twentieth century, the question of how to organize medicine and health care had become the subject of “class struggle”. While capital argued that medicine and health care should focus on the sick individual, labor argued that it should focus on social factors.

With the October Revolution, the purpose of health care was redefined as “prevention of diseases” and medicine was reorganized on the basis of preventive medicine. Henry E. Sigerist expressed this in the following sentences in his epilogue to his book titled “Socialized Medicine in the Soviet Union” published in 1937:

“And I have come to the conclusion that what is being done in the Soviet Union today is the beginning of a new period in the history of medicine. All that has been achieved so far in five thousand years of medical history represents but a first epoch: the period of curative medicine. Now a new era, the period of preventive medicine, has begun in the Soviet Union”.

Similarly, health, which was accepted as an "individual" problem throughout history, was defined as a "social" problem with the October Revolution, and in 1918, the first Ministry of Health (Narkomzdrav) in the world was organized, leading the state to take responsibility in the field of health.

The October Revolution created a new model of public health under state control, based on the social determinants of health (and disease), prevention and universal access.

SOCIALIST MEDICINE AND HEALTH SERVICES

Socialist medicine and health care is simply the organization of medicine and health care according to the needs of the "society".

The world's first Minister of Health, Nikolay Semashko, listed the goals of Soviet medicine in the field of public health in his article titled "The Tasks of Public Health in Soviet Russia" published in 1919:

“... free and widely accessible medical help, together with an increase in quality, and the elimination of unsanitary and harmful living and working conditions for workers”.

Semashko stated that private property was an obstacle to freeing the urban poor from moldy dungeons and moving them to strong and spacious houses, creating healthy working conditions for workers and being able to truly fight social diseases, and that the Soviet government removed of the barrier of private property.

One of the distinguishing features of socialist medicine and health care was the "rights-based" approach to health, and the other was the emphasis on "prevention". In order to prevent diseases, a dispensary system was organized in which everyone was monitored regularly and continuously in terms of health from the moment of conception to the grave.

In the dispensary system, physicians did not wait for the patients to come in their offices, and regularly and constantly visited the workers at their workplaces, the students at their schools, and the elderly at their homes. Physicians began to devote most of their time to preventive examinations (wellness examinations).

SOCIAL HYGIENE

If the disease is a "social" problem as well as an "individual" problem, health is a "sociological" issue as well as a "biological" one, and physicians should be as knowledgeable about sociology as they are in medicine, and should be as interested in preventive medicine as in curative medicine.

Medical education was reorganized in line with this understanding. The first chair of social hygiene was established in 1922 and the State Institute of Social Hygiene in 1923.

In the first epidemiology book (Osnovy epidemiologiia), published in 1927, the microbe was defined not as a "disease agent" but as a "primum movens", emphasizing the role of the host and the environment in the emergence of the disease. According to social hygienists, social factors that determine health (and disease) played a "primary" rather than a "secondary" role alongside biological factors.

Thus, Soviet medicine turned to the "conditions" in which diseases arose and developed, and to measures to be taken to improve these conditions. In the fight against diseases, emphasis was placed on improving people's living (shelter, nutrition, education, etc.) and working conditions, that is “social and economic measures”.

DEMOCRATIZING MEDICINE AND HEALTHCARE

Semashko emphasized another distinguishing feature of socialist medicine and health care in his article titled "Works of the Ministry of Health" published in 1920:

“… workers should take care of their own health”.

The new health organization was built on a "proletarian" basis, directors of the medical and sanitation departments in the localities were elected by the local Soviets of Workers' and Peasants' Deputies, and factory committees, unions and cooperatives were involved in the planning of service.

The workers, who took part in the Workers' Epidemic War Committees organized in 1918, inspected public spaces (hotels, train stations, prisons, etc.) in terms of hygiene and gave hygiene trainings to the public. The Ministry of Health was organizing the fight against social diseases together with trade unions, women's and youth organizations.

THE DECLINE OF SOCIALIST MEDICINE

The socialist approach that dominated medicine and health care in the Soviet Union was adversely affected by the "rapid industrialization" approach adopted in 1928. After Semashko, the architect of the system, left his duty as the Ministry of Health in 1930, therapeutic medicine gained importance again in Soviet medicine.

Within the framework of rapid industrialization policy, factory health units were reorganized with emphasis on therapeutic medicine. While the share allocated to preventive medicine from the budget decreased, the share of therapeutic medicine was increased.

However, the biggest role in the decline of the socialist medicine approach in the Soviet Union was the reorganization of medical education. Curriculum focused on preventive medicine was applied only to students who chose to specialize early in the field of public health, and therapeutic medicine was emphasized in other fields.

At the end of 1930, the name of the State Institute of Social Hygiene was changed to the Institute of Health Care and Hygiene Organization. This was not only a name change, but also a change of “approach”. Whereas "social and economic measures" were understood before when prevention was mentioned, now "medical measures" such as vaccination - immunization, health screenings, etc. have begun to be understood.

In the 1930s, preventive medicine gradually ceased to be the subject of "all" physicians and became the subject of "public health professionals" by narrowing its content again, as it was before the October Revolution.

Today, when it comes to socialist medicine and health care, many socialists understand the equal and free distribution of medical services. It is forgotten that the essence of the socialist approach to medicine and health care is that social and economic measures should be taken as well as medical measures to create a healthy society.