La santé et la révolution : Russie soviétique, 1917 – 1924 (Health and Revolution in Soviet Russia, 1917-24)

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On Friday 5 May, the World Health Organisation (WHO) declared that "Covid-19 is no longer a public health emergency of international concern" and pronounced "the return to normality".

With "at least 20 million deaths" according to the Director General of the WHO[1], the Covid-19 pandemic starkly revealed the decrepitude of global capitalism, as well as the carelessness and cynicism with which states and governments "managed" the situation. Faced with the dilapidation of healthcare systems around the world, the result of decades of economic crisis and massive attacks, the ruling class in every country had only lies, theft and the arbitrary imposition of "protective measures" such as drastic confinements straight out of the Middle Ages. And while the major powers were boasting in the Spring of 2021 that they had produced vaccines in record time, it remains true that no coherent, widespread vaccination policy has been put in place on a global scale.

"What's the point?" will be the response from government officials and international organisations. Because Covid-19 can now be considered "in the same way as we consider seasonal flu: a threat to health, a virus that will continue to kill, but one that does not disrupt our society or our hospital systems", as Michael Ryan, the WHO's head of emergency programmes, said several weeks ago. This statement alone illustrates the state of mind of the global bourgeoisie when faced with the macabre effects of capitalism. “Seasonal" Covid may well cause hundreds of thousands of deaths around the world every year, but as long as it "does not disrupt" the functioning of capitalist society, let's live with it! This is what all states and governments are now openly advocating: total indifference to the health of human populations, prioritising only the sole interests of the bourgeoisie. This class can only use the most perfidious and underhand methods to try to hide from the world that its own system is constantly plunging humanity into the abyss.

Quite different was the method employed by the soviets during the Russian Revolution, when the working class was forced to face the ravages of Spanish flu, typhus and cholera. We began to address this question in the International Review when we published an article on the evolution of the health situation in Soviet Russia in July 1919, a year after the creation of the Commissariat of Public Hygiene[2].

We extend our discussion here with a review of the book Health and Revolution written by a group of authors. While, as we shall see, the authors cannot help but end their studies with a thinly veiled plea for state capitalism, this little book has the merit of highlighting the central role played by the organised working class in facing up to the health challenges in the midst of the revolutionary process and in the face of the counter-revolutionary assaults led by the White armies and the great European capitalist powers, "And yet, in some of the most difficult material conditions imaginable, the method then used by the proletariat, our method, in every way opposed to that of the bourgeoisie today faced with the coronavirus pandemic, achieved results which, at the time, constituted a considerable step forward"[3].

So what was this method? In what way was it a considerable step forward and an invaluable experience for the future?

Faced with health emergencies and epidemics, the reaction of the working class organised in soviets

The day after the seizure of power, Russia found itself in a disastrous situation. Three years of war had wreaked havoc on society and exacerbated the scourges that were already well known: poverty, famine, shortages and the deterioration of health and transport infrastructures. But there were also numerous epidemics such as typhus, cholera, smallpox, diphtheria, and tuberculosis.

The revolution in Russia was already facing enormous challenges, especially as its rapid isolation had prevented it from gaining the support of the world proletariat. But as the book makes clear, the working class in Russia drew its strength from its collective and centralised organisation, since the soviets were at the heart of the takeover of health policy. As soon as the Winter Palace was taken, the revolutionary committee set up medical detachments in Petrograd and Moscow to help the wounded. These "first aiders of the insurrection" were initially made up of ambulance drivers, nurses and military nurses who had rallied to the Bolsheviks, as well as women workers who supported the doctors. The soviets then extended the detachments' prerogatives to cover all civilian health care. A major step forward was taken when the Soviet government set up a People's Commissariat for Health. From then on, the policy for dealing with both the victims of the war still in progress and epidemics was the task of the workers themselves.

Already we see that this universalised policy is already in stark contrast to the one implemented by the various states during the Covid-19 pandemic, which consisted of imposing on the population measures aimed above all at penalising capitalist production as little as possible. As the authors of the book point out, "there was never any question of taking measures that were nevertheless common sense, such as the massive production of medical equipment by governments or the lifting of patents on vaccines so that everyone could have access to them. Not only would this have cut into their profits, it would also have undermined the sacrosanct right of the bourgeoisie to use its capital as it pleases. This is yet another demonstration of the fact that the private property of capitalists always takes precedence over the interests of the community, and in this case, of humanity as a whole".

To combat epidemics, mobilisation and awareness-raising for all

While governments have not hesitated to make abundant use of lies "to conceal the shortages of masks, care workers, resuscitation beds and vaccines, and their responsibility in this situation", at no time has there been any question of mobilising the population in the fight against the pandemic, with governments preferring to impose health measures (confinement, wearing masks, etc.) by coercion.

The policy pursued by the "Soviet Republic" on the other hand was driven by an entirely different approach. In all the health battles it had to wage, the first step was to tell the population the truth: to explain as clearly as possible the state of the situation, the protective measures to be adopted, and the recommended organisational methods for dealing with the situation. But it was also a matter of calling for the mobilisation of the working masses. This was the case during the cholera epidemic that struck southern Russia, Moscow and Petrograd in the summer of 1918, the smallpox epidemic in 1919 and the Spanish flu that killed nearly three million people in Russia. This method, which relied on the support and participation of large sections of the population and the centralisation of policy by the Soviet government (through the Health Commissariat), was fully implemented during the typhoid epidemic between 1918 and 1919. As the authors point out, the experience of fighting the epidemic provided "the basis for a new health system based on action by the workers themselves, centralisation, free use and prevention".

After that, with the end of the civil war, significant progress was made in training medical staff, combating tuberculosis, treating addictions, combating prostitution, and improving maternity care. In short, the working class took charge of society, lifting it out of the "backward" conditions in which it had been vegetating.

Faced with the scourge of pandemics, there's nothing to expect from the state!

In the last part of this book, the authors show the extent to which health policy suffered a real regression under Stalinism. The degeneration of the revolution in Russia, expressed above all by the fusion of the party with the state and the total devitalisation of the soviets, gave rise to a new ruling class exploiting the working class under the form of a veritable state capitalism. As a result, the aim of health policy was no longer to contribute to the improvement and emancipation of the human condition, but to enable the state to exploit the workforce more and more. The introduction of "occupational medicine" to study the causes of certain illnesses and workers' ill-health, or to compile a list of pathologies, had no other objective than to enable greater productivity, and therefore greater exploitation of the working class. Similarly, the creation of crèches and childcare facilities for older children in the factories only served to further enchain the workers to their workplace and to the capitalist state.

However, infatuated with leftist catechisms, our group of authors cannot help but find in Stalinist barbarism residues of the revolutionary period: "The Soviet health system, which would last for several decades, was the envy of many [...]. In countries such as the People's Democracies in Eastern Europe and Cuba, which had not experienced a workers' revolution but were trying to overcome their backwardness in the medical and social fields, the Soviet health system was taken as a model. With its advantages, as we have seen, as well as its shortcomings: those of a society dominated and crushed by bureaucracy. But in spite of everything, and even if it never became a socialist health system, this health system long retained some of its popular, innovative and progressive features of a victorious workers' revolution".

The alleged medical prowess of the "Soviet economies" is more of a farce than a historical reality. In the USSR, as in all the satellite countries, people lacked everything. Both food and medicine. The authors here take up an old lie propagated by the scoundrels of the left and extreme left of capital, which consists of presenting a state such as Cuba as the pinnacle of good practice in medicine. The pandemic was a reminder of the real state of health in this other remnant of Stalinism. Even there, health workers had to cope with an influx of patients without sufficient medicine, oxygen, antigens, sanitary gel or syringes, etc.

Behind this nostalgic nod to the supposed survival of the advances of the October Revolution, via Stalinism, lies the credo of considering the USSR as a "degenerate workers' state", perverted by the Stalinist bureaucracy. Today, this error of Trotsky’s, taken up by organisations on the extreme left of capital such as Lutte Ouvrière in France, is used to maintain the illusion that a "well-managed" state could be a tool in the service of the general interest. But while the state may appear to be above social classes, it is always the expression of the domination of a given class in society. In capitalism, the state exists to facilitate the domination of the bourgeoisie. Moreover, since capitalism entered its period of decadence, the general trend towards state capitalism has been one of the dominant features of society. The pandemic has fully confirmed that state capitalism, defended tooth and nail by all the parties of the left and extreme left, is in no way a solution to the contradictions of capitalism. On the contrary, it is a clear expression of them, even if it can delay their effects at the cost of amplifying them in the long term! [4]

If it ever succeeds in overthrowing capitalism, the proletariat will have to lay the foundations of a communist society in a world ravaged by wars, climate and environmental disruption, and huge health problems. This gigantic task will not be carried out with the help of the state, but against it, with a view to its demise and disappearance.

Above all, this task will be the work of the working class itself, organised and aware of its goals. To achieve this, building on the experiences of the past, such as the October 1917 revolution, and knowing how to draw the main lessons from them remains an essential task if we are to build the society of the future!


Vincent, 7 May 2023


[1]At present the official death toll is 7 million

[2] Health Conservation in Soviet Russia, International Review 166



Critique of a new book