History of Public Health in Russia

1. History of Public Health in Russia From 1800’s to 1917

2. The first medical faculty was established in 1775at the University of Moscow. Main buildings of the university in the Mokhovaya Street, 1798.

3. Modern transportation: cholera epidemic Unfortunately the great strides in modern transportation accelerated the spread of cholera from India in 1816 to the ports of the Philippines, China, Japan, Persian Gulf then north toward the Ottoman and Russian empires killing thousands by 1826.

4. Early 19th Century Russia: Alexander I, Nicholas I, and the birth of revolutionary movement

5. Russia in the 1860’s Great reforms: • Railway • Growth of industry • Commercial ties with the Orient

6. Freeing of serfs (1864) Alexander II of Russia: The great reformer

7. Nikolay Ivanovich Pirogov

8. 1870’s-1880’s • Zemstvo or community physicians –idealistic young people who had studied at Russian Universities during the period of relative liberalism which marked the early years of the reign of Alexander II

9. Zemstvo Medicine • A system of primary rural medical and sanitary services which was funded out of government subsidies and zemstvo taxation (available on no fee basis)

10. Who was a zemstvo physician? In modern terms, the best equivalent would be primary care provider.

11. Formation of Pirogov Society of Russian Physicians

12. 1880’s • S.P. Botkin recommended that Russia set up a powerful central administrative agency to direct public health affairs.

13. Bacteriological revolution (1880’s) History of I.I. Mechnikov Diphtheria serum-1893/94 Bacteriology was now championed by community physicians who saw it a s tool to be used for the benefit of the people

14. Alexander III • Famine of 1891-92 • Cholera epidemic 1892-93

15. From the memo of Professor N. A. Veliaminov, 1901 What is the sanitary state of Russia?-In comparison with the states of Western Europe, and even with our own Finland, it has to be admitted that it is dismal in the extreme: the percentage mortality of the population is high, the average life expectancy is short, and there is a great amount of contagious, epidemic and endemic disease

16. 1905 “Making Russia Healthy”—the slogan of community physicians Cholera congress

17. The opportunity for developing preventive education work in connection with such a system is practically unlimited… We may therefore look in the future, as zemstvo and municipal medicine develop and acquire the educational and preventive quality which is in accord with modern progress, for unprecedented successes in the control of preventable diseases in the great sister Republic.. From the report of Charles Edward Amory Winslow, APHA, 1917

18. Community Medicine in Dissaray 1907-1914 Stolypin and his reforms

19. 1918 Establishment of Narkomzdrav, Centralized public health/medical system

20. What was happening after 1917? In 1925, the Pirogov Society was forced to disband and the Hippocratic Oath was abandoned

21. Summary • Historically, Russian medical system was intertwined with the political situation in the county • At the end of the 19th century, Russia’s system of zemstvo medicine provided a very good foundation for preventive care • Zemstvo physicians became a powerful force in the early 20th century • With the revolution of 1917, Russian medical system started to change rapidly with different theories existing about the fate of zemstvo medicine