Prevention

PREVENTION (from the Greek prophylatto-I prevent). Prevention in the USSR is the aggregate of preventive health measures aimed at protecting and strengthening the health and physical development of the collective of working people, at preventing the emergence and spread of diseases, and at ensuring the longest possible preservation and improvement of the working capacity and development of labor resources. In the USSR, the concept of 'prevention' in the broad sense of the word includes a whole system of preventive measures for improving the collective life of working people: conditions of labor, nutrition, housing and living conditions, improvement of populated areas, protection and strengthening of the health of the rising generation, and the struggle to reduce morbidity. Naturally, prevention is not exclusively the function of health agencies, but is an organic part of the work of many Soviet state organs and Soviet public organizations, trade unions in the area of rational organization and protection of labor and implementation of social insurance tasks, People's Commissariat of Communal Economy-in the line of communal improvement, People's Commissariat of Education-in the area of upbringing, preschool and school construction, etc. In the USSR, prevention in the indicated sense of the word, closely linked with all socialist construction and constituting an organic part of it, contributes to the improvement of labor and living conditions and the all-round increase in the well-being of the broad masses of working people through the implementation of corresponding socio-economic and socio-hygienic measures. Preventive measures constitute the main content of the work of Soviet health care. In the program of the All-Union Communist Party (Bolsheviks) [VKP(b)], the decisive importance of prevention is especially emphasized: 'As the basis of its activity in the area of population health protection, the VKP(b) places primarily the implementation of broad health-improving and sanitary measures aimed at preventing the development of diseases.' 'In accordance with this,' it is further stated in the program, 'the VKP(b) sets as its immediate task: 1. The decisive implementation of broad sanitary measures in the interests of working people, namely: a) improvement of populated areas, b) the establishment of public nutrition on scientific-hygienic principles, c) organization of measures preventing the development and spread of infectious diseases. 2. Creation of sanitary legislation. 3. Struggle with social diseases (tuberculosis, venereal diseases, alcoholism, etc.)'. In this program we have a whole developed system of prevention. In contrast to capitalist medicine-essentially an individualistic medicine serving primarily the needs of the bourgeoisie and limiting its concern for the health protection of working people only within the limits of the extreme necessity for preserving the labor force through its minor treatment-Soviet medicine from the very beginning of its development placed prevention at the head of all the work of health agencies, carried out in the interests of the proper strengthening of the health of the broad masses of working people on the basis of their own initiative, in full conformity with the tasks of socialist construction. In capitalist countries, prevention is mostly conducted and treated as individual, personal prevention, having the aim of preserving the health of individuals-patients-by means of personal hygiene or corresponding medical intervention, for example, appropriate surgical operations, vaccinations or physical therapy procedures, etc., to prevent this or that disease or complication of the disease. In bourgeois medicine, it is customary to speak only about personal prevention, about prevention in surgery, in therapy, in neuropathology, etc. Problems of prevention in the sense of implementing corresponding socio-hygienic measures in the interests of protecting the health of the millions of exploited masses do not find a place in bourgeois medicine, and if questions of public prevention are touched upon anywhere, then only as systems of measures carried out in the interests of the ruling bourgeois class. The preventive measures carried out in capitalist countries mostly aim at ensuring the improvement of bourgeois quarters, the struggle with arisen or threatening to spread epidemic diseases, and are predominantly of a sanitary character-vaccinations, isolation, sanitary supervision, sanitary-police measures. Under the capitalist system, the question of a rational system of health-improving measures in relation to working-class outskirts, factory enterprises, of a planned intensive struggle with occupational hazards and occupational diseases, of the extensive construction of healthy housing for workers, of the proper organization of public nutrition for working people, of the development of protection of motherhood, infancy and childhood, physical culture, etc., cannot be correctly posed in the interests of working people, because the capitalist state, defending the class interests of the bourgeoisie, cannot go to satisfy even the most basic needs for health protection of the overwhelming majority of wage workers. Even the established sanitary norms in regard to nutrition, clothing, living quarters, etc., which have enormous preventive significance in the matter of preventing diseases, serve in bourgeois countries also predominantly the interests of the bourgeoisie, since all these norms are completely unattainable for the proletariat and the poorly provided majority of the working population. It is interesting to note that even the existing relatively few preventive institutions, such as dispensaries for the struggle with tuberculosis, venereal diseases, etc., mostly organized by all sorts of philanthropic societies, are forced to conduct their work in such a way that a ridiculous distortion of the principles of prevention occurs; for example, in Germany dispensaries have only the right to give advice, but are not entitled to treat, in order to avoid causing damage to the interests of private practicing physicians and insurance physicians who receive remuneration from insurance funds for treatment at their homes of insured persons attached to them (for details see Medical Aid). The presence of enormous achievements in capitalist countries in the field of sanitary technology, which played a significant role in the improvement of populated centers, especially in the struggle with infectious diseases, all the more sharply emphasizes that basic fact that the achievements of medical science are used in the interests of class domination by the bourgeoisie. Marx, Engels, and Lenin showed with extraordinary persuasiveness the influence of capitalism on the class character of morbidity and mortality of the population and on the enormous role in the development of morbidity of such factors as heavy labor, poor housing, inadequate nutrition, etc. Characterizing the conditions of capitalist production, Marx says: 'With its wolfish greed for surplus labor, capital oversteps not only the moral but also the purely physical maximum limits of the working day. It usurps the time necessary for the growth, development, and healthy maintenance of the body. It steals the time necessary for the intake of fresh air and sunlight. It curtails the dinner hour and, as far as possible, includes it in the production process itself, so that food is given to the worker as a mere means of production, just as coal is given to the steam boiler and tallow or oil to the machines. The healthy sleep necessary for the restoration, renewal, and refreshment of vital force, capital reduces to as many hours of torpor as are absolutely necessary to reanimate a body utterly exhausted. Thus, not the normal maintenance of the labor power determines here the limits of the working day, but on the contrary, the greatest possible daily expenditure of labor power, however diseased, compulsory, and painful it may be, sets the limits for the worker's rest. Capital does not ask about the length of life of labor power. It is interested solely in that maximum of labor power which can be set in motion during the working day. It achieves this end by shortening the life of labor power, as every estate owner increases the yield of his land by robbing it of its fertility' ('Capital', Vol. I, pp. 236-37). Like Marx, Engels gave in 'The Condition of the Working Class in England' and 'The Housing Question' an extraordinarily vivid characterization of the living conditions of workers in capitalist society, leading to the conclusion about the possibility of creating favorable conditions for the health of workers only with the elimination of the capitalist system. In 'The Housing Question' Engels wrote: 'modern natural science has shown that the so-called "bad quarters", in which the workers are crowded together, are the foci of all epidemics which periodically visit our cities: cholera, typhus, typhoid fever, smallpox, and all other infectious diseases scatter their germs in the infected air and poisoned water of these working-class quarters; there they almost never disappear, develop as soon as conditions permit it, into epidemic mass diseases and go beyond the limits of their native quarters into the more airy and healthy quarters inhabited by the capitalist masters. The capitalist masters cannot with impunity indulge in the pleasure of spreading epidemic diseases among the working class; the consequences fall upon themselves as well, and death cuts down its victims among capitalists as ruthlessly as among workers'.

And further points out that even when rebuilding cities and replanning, the bourgeoisie, by laying out wide streets and eliminating dirty narrow alleys and dead ends in one place, creates them in another. 'Foci of infection, the most outrageous poverty and pits into which the capitalist mode of production daily drives our workers are not destroyed; no, they are simply... transferred to other places. The same economic necessity that created them in the first place creates them in the second as well, so as not to cause any material damage to the interests of the ruling class of the bourgeoisie.' Lenin in his works emphasized the close connection between the sanitary condition of the country, the level of health of the working population, and the development of public P., on the one hand, and socio-economic and political conditions on the other. Lenin devoted much attention to socio-hygienic problems related to improving the position of workers and the working peasantry: he repeatedly dwelt on issues of labor protection and social insurance, on the difficult living conditions of workers, on extremely poor housing conditions, and very meager nutrition. He subjected the tsarist labor law (1897) to merciless criticism ('Proclamation of the Union for the Liberation of the Working Class', vol. I, p. 332, 'Proclamations', pp. 321-322, 327). In a number of works, Lenin depicted the excessively difficult working conditions - the prolonged working day, extremely low wages ('Wages of Workers and Profits of Capitalists in Russia', vol. VIII, part 1, pp. 258-259 and 'Working Day and Working Year of the Moscow Province', vol. XII, pp. 267-271), the life full of deprivations of agricultural workers subjected to incredible exploitation, the vile work of factory inspectors, whom Lenin characterizes as 'servants of the factory owners' and 'factory officials' ('Proclamation', vol. 1, pp. 324, 325, 340), the ruthless exploitation of workers through the application of the Taylor system ('Scientific System of Squeezing Sweat', vol. XII, pp. 50-51), the exceptionally difficult position of the Russian peasantry - famines and constant undernourishment ('Development of Capitalism in Russia', vol. III, p. 215), the consequences of famine and its causes ('Famine', vol. V, pp. 70-71), etc. Lenin, giving a profound Marxist analysis to all facts and data of a socio-hygienic nature, used questions of public P. to mobilize the attention of the working and peasant masses around revolutionary paths and methods of their final liberation from oppression, exploitation, poverty and disenfranchisement. Like Marx and Engels, he explained that while maintaining the feudal-bourgeois system in Russia, there could be no question of improving the living conditions of the broad masses of workers, nor could broad preventive-sanitary measures take place. Famines, and with them famine typhus, often afflicted pre-revolutionary Russia as inevitable companions of the bourgeois-feudal-landlord system. 'Robbed by the landlords, oppressed by the arbitrariness of officials, entangled in the web of police prohibitions, nitpicking and violence, bound by the latest protection of gendarmes, priests, and zemstvo chiefs, peasants are just as helpless against natural disasters and against capital as the savages of Africa. Only in wild countries can one now find such extinction, mass death from famine, as in Russia of the 20th century' ('Famine', vol. XII, part 1) - Lenin wrote regarding the difficult position of the peasants and came to the conclusion that only the overthrow of the tsarist system would show a way out. 'The real struggle against famines,' wrote Ilyich regarding the famine of 1911, 'is impossible without eliminating the peasants' landlessness, without reducing the tax burden on peasants, without raising their cultural level, without a decisive change in their legal position, without confiscating the landlords' lands - without revolution' ('Famine' and 'Black Duma', vol. XII, part 1, p. 58). The path to public P. lay through revolution; 'only in the overthrow of the tsarist monarchy,' says Lenin, 'lies the way to a more or less human life, to liberation from famines, from hopeless poverty' ('Famine', vol. XII, part 1, p. 54). The poor sanitary condition of the country was closely connected with the extreme poverty, unculturedness of the masses of workers, the strong political and economic oppression of the bourgeois-serf tsarist system, and complete disregard for socio-preventive measures. Under pre-revolutionary conditions, in the absence of sanitary organization, an extremely insignificant network of medical-sanitary institutions, complete* disregard for preventive measures, and unbearable working and living conditions for the broad masses of workers and peasants, the improvement of city and countryside was a hopeless matter. The revolutionary situation that arose after the end of the world war in all bourgeois states put all governments before the direct threat of overthrow; saving its power through direct agreement with social democracy, the bourgeoisie at the same time sought through certain socio-preventive reforms - in the organization of medical aid, labor protection, housing construction, social insurance, etc. - to create the appearance of concern for the working class in order to, with the help of social democracy, lull its class consciousness and revolutionary vigilance and divert it from class revolutionary struggle. But as soon as the bourgeoisie somewhat strengthened its power and the direct immediate threat to the liquidation of its class rule passed, a decisive offensive against the working class began to deprive it of its revolutionary conquests - the working day was lengthened, social insurance benefits were reduced, allocations for housing construction, labor protection, organization of medical aid, protection of motherhood and infancy, and all preventive-health measures were sharply decreased. In recent years, there has been a very sharp decrease in social insurance benefits in Germany, France, Austria, England, a significant reduction in subsidies by the English government for the construction of housing for workers, and all the burdens resulting from the heavy, increasingly deepening Crisis are shifted onto workers - a significant reduction in wages, an extraordinary lengthening of the working day, a sharp increase in indirect taxes on items of mass consumption, an extraordinary decrease in state expenditures for socio-cultural services for the working population, etc.; Expenditures for social P. are treated as an unbearable burden for the bourgeois state, and in this respect bourgeois medical science seeks to provide a scientific justification for this negative attitude of the bourgeoisie toward public P. In this connection, one should recall the pronouncements against social insurance by Lika, as well as a number of bourgeois eugenicists, such as Lenz, who speak out against social P. in the interests of natural selection of allegedly the most valuable biological elements, which, in the opinion of bourgeois eugenicists, are the upper bourgeois strata of the population. The action of natural selection should not, in their opinion, be hampered by any socio-preventive measures that can only preserve the viability of unfit contingents of the population, and preventive measures should be carried out only in relation to capitalist groups, selected higher categories of the social ladder - the bourgeoisie, the higher and middle bureaucracy, the kulak groups of the peasantry. Lenz speaks out against the fight against child mortality, as it eliminates the natural biological barrier, which allegedly makes it possible for biologically incomplete children of workers and peasants to survive. One should fight, in his opinion, only against the decline in birth rate in the upper strata of capitalist society. Lenz also speaks out against the fight against tbc, which interferes with the normal course of natural selection. Infectious diseases - diseases predominantly of the proletariat, such as tbc-also, in the opinion of a representative of bourgeois eugenics, lead to the improvement of the race at the expense of the death of worthless elements. Prof. Koltsov, reflecting the views of the bourgeois eugenic school, says that 'the race', taken as a whole, after a period of severe epidemics turns out to be healthier. On the other hand, venereal diseases, according to Lenz, are not a selective factor, since they also affect the wealthy strata of the population. All the major eugenicists of Germany, England, America (Lenz, Schallmaier, Gruber, Galton, Grant, etc.) with their reactionary theory of the determination of the class structure of capitalist society by natural selection seek to provide a scientific justification for the necessity of the rule of a handful of capitalists on the one hand, and the subjection to them of millions of proletarians on the other. They all speak out against social P. and in every way justify the extremely limited practical activity of bourgeois states in the field of social hygiene and all the social policy they carry out, aimed at deepening poverty and worsening the difficult working conditions, nutrition, housing conditions of the broad masses of workers. This frenzied offensive of the bourgeoisie against the working class has intensified in recent years (since 1930) in connection with the unprecedented deepening of the world economic crisis, which has dealt an unusually heavy blow to the capitalist economy. The intensification of the pressure of the bourgeoisie on the working class is accompanied by a sharp reduction in preventive measures, and those already very limited.

Published in September 1932, the League of Nations article 'La crise economique et la sante publique', while clearly tending to sharply underestimate the harmful effects of the economic crisis on the health of the working masses, presents a number of data indicating a significant deterioration in the health of the working population and a sharp reduction in all health measures, and especially in the area of Prevention. Only under the dictatorship of the proletariat does Prevention become not only an organic part, but the fundamental basis of all work for the protection and strengthening of the health of the working people, and the preventive orientation of all medical activity is a characteristic defining feature of Soviet medicine, which is called upon for the broad development of preventive health measures in the interests of the vast majority of the population—workers and collective farmers. In this case, the tasks of socialist construction determine the content and direction of all preventive activity, which in the conditions of the Soviet state has a class proletarian character. It is expressed in the preferential service in the area of Prevention for the proletariat and the peasant masses of collective farmers, in the concentration of attention primarily on the key sectors of socialist construction—main industrial areas, new construction sites, mining, metallurgical, chemical industries, state farms, etc. 549

On all decisive sectors of socialist construction in the city and countryside, preventive measures are carried out with the aim of a radical improvement and health improvement of all living conditions—along the line of improving the production environment, extensive housing construction, intensive improvement of municipal services and the sanitary condition of the entire area, proper organization of public catering and organization of all types of socio-cultural services and medical-sanitary assistance on a preventive basis. Socio-preventive measures are carried out on a class principle, taking into account the social significance for socialist construction of the corresponding contingents of the population and areas: factory districts, factory enterprises, state farms, collective farms—shock workers are served by all types of socio-preventive assistance; adolescent workers are under special medical-sanitary supervision and special protection of labor protection legislation (annual medical examinations, reduced working day). Women workers receive longer leave for pregnancy and childbirth than employees. A number of preventive measures are carried out according to age and gender characteristics (protection of motherhood, infancy and childhood). But even here, class affiliation and the role of the corresponding contingents in socialist construction and the nature of the functions performed naturally determine the degree of provision with the corresponding types of socio-preventive assistance. A large number of maternity beds, nurseries, consultations are developed in industrial areas, collective farms and state farms, which makes it possible to involve women in production. Rational service with preventive assistance for the indicated contingents through early detection of diseases and timely therapeutic-preventive intervention makes it possible to completely prevent or significantly reduce the loss of working capacity, and in case of its loss—ensure a more rapid and stable restoration of lost working capacity. Only the October Revolution created all the prerequisites for the implementation of a whole system of practical measures in the field of improving and raising the living standard of the working masses and organizing planned preventive health work for the systematic protection of their health and strengthening of working capacity—and all this on the basis of developed successful socialist construction. Already within 1¹/^ months after taking power, the Soviet government began broad preventive measures to improve the living conditions of the working people by issuing a decree on social insurance in case of illness on December 22, 1917; the law on social insurance covered all hired workers; the intensive development of medical-preventive institutions and the intensified struggle for sanitary culture began. Epidemics, which in the pre-revolutionary years were closely associated with capitalist production relations, continued to exist after October on the basis of still preserved落后的 living conditions and still not eliminated cultural and technical backwardness—on the one hand, the civil war, devastation—on the other. ;a

55» In the report of the Council of People's Commissars at the VIII Congress of Soviets in 1919 (Vol. XVI, p. 422), Lenin, speaking about the conditions for the elimination of typhus, describes it as "the result of unculturedness, poverty, darkness and ignorance," pointing out that "typhus turns into the most formidable danger," since "either lice will defeat socialism or socialism must defeat the lice." Lenin called for the most energetic struggle against typhus. Lenin attached great importance to the issues of improving living conditions; in sanitary improvement he saw a great evil, which must be eliminated by a whole system of sanitary and hygienic measures. For example, in his "Speech at a meeting of the Moscow Soviet" (Vol. XVII, p. 49), Lenin said: "First of all, here we have the task of cleaning Moscow of the dirt and neglect into which it has fallen. We must carry this out, in order to set an example for the entire country, into which this dirt, carrying with it epidemics and diseases, is increasingly penetrating. We must give this example here in Moscow—an example which Moscow has more than once given." Only after the liquidation of intervention, fronts, famine, and economic collapse did broad, systematic preventive activity begin. Along with the expansion and improvement of medical care for the working people and the gradual introduction of the therapeutic network into work, there began in parallel the process of growth and strengthening of sanitary organs, the organization of a whole network of preventive institutions. A number of sanitary decrees were issued. Great work was undertaken in organizing dispensaries to combat social diseases; a large number of institutions for the protection of motherhood, infancy, and childhood were created: day nurseries, consultations, milk kitchens, preventive outpatient clinics, sanatoriums, etc. Work in sanitary education received an unprecedented scale; attention to physical culture was also drawn to the broad masses of workers. First aid posts (health posts) began to be organized in enterprises; their main tasks included, in addition to providing first aid in accidents and sudden illnesses, the struggle to reduce morbidity and injury, active participation in the protection of labor, in carrying out measures to improve sanitary-hygienic conditions in enterprises, in workers' housing, in the rational organization of production processes, in improving the organization of affairs in factory canteens and day nurseries at the workplace, etc. On factories and plants, health cells, commissions for promoting healthcare were organized, which aimed to mobilize the initiative of workers in the area of protecting their health. First aid posts (health posts) gradually became centers of preventive work in enterprises. Before rural medical districts, the number of which increased sharply from year to year (see Medical District), the task was set—to become centers of preventive work in the countryside: to study and take into account the sanitary condition of the district; to take preventive health measures against the spread of infectious and social-domestic diseases; to organize systematic protection of motherhood and infancy—consultations and day nurseries; to combat unsanitary habits of the population; to raise sanitary education to a proper level, by organizing the initiative of the working population around the issues of the struggle for cleanliness, for healthy labor and living conditions, for broad public P. The period of restoration of the national economy, accompanied by a significant improvement in the material position of workers and the working peasantry, improvement in the sanitary condition of the country, and a sharp reduction in morbidity and mortality, was marked by a huge growth of preventive institutions and measures and an intensification of preventive work in all areas of public health protection. During the period of reconstruction of the national economy on socialist principles, preventive measures occupy a prominent place in all socialist construction, since the issues of organizing socialist labor and strengthening and expanding labor resources are closely connected with a whole series of preventive health measures. The issues of construction of new enterprises in accordance with sanitary-hygienic and sanitary-technical requirements, selection of the workforce and its proper use, issues related to increasing labor productivity and its rational protection, with the organization of a new way of life, public catering, with the improvement of municipal improvement, broad workers' housing construction, with the proper organization of labor and improvement of living conditions in collective farms, and with the preparation of the labor reserve (education and physical culture)—are closely connected with the problems of P. The development of preventive work proceeds along the line of resolving the basic problems of collective life (housing, nutrition, labor, education, social-preventive assistance, etc.), and health authorities carry out their preventive health work, linking the tasks of protecting public health with the tasks of social construction, and resolve them, relying on the initiative of the working people. The directives of the Central Committee of the All-Union Communist Party (Bolsheviks) "on medical service for workers and peasants" ("Pravda" of December 23, 1929), "on the ways of further construction of healthcare on the basis of broad P., with the active involvement of all public in the matter of healthcare and with strict consideration of the main tasks of socialist construction in all work on the protection of public health, requiring the elimination of the lag in the rate of development of healthcare from the growth of the entire national economy of the country and the needs of the working class and peasantry" and the clear implementation of the class proletarian line, had a decisive significance for all the activities of health authorities. The enormous importance of P. for the country building socialism becomes especially obvious if one considers what great losses the national economy suffers from high morbidity and mortality and what significant benefit it derives from reducing morbidity and strengthening labor capacity, from extending the life expectancy of the broad masses of workers. Data published by Tsustrakh show high figures for days lost due to illness. In 1931, per 100 insured persons for temporary disability (excluding childbirth) 840.9 days were paid for due to illness (in 1929—884.6); in 1931, epidemic and infectious diseases still constituted 24.3% of the total number of days lost due to temporary disability, and industrial and domestic injuries—23.9%. The proportion of "preventable" diseases in the total losses of the national economy from diseases of the working population is very large. Since the path of general health measures for the broad masses of workers fully corresponds to the class nature of Soviet medicine, P. became the dominant, basic link in the matter of protecting the health of workers; the measure of achievements in the field of healthcare became the successes in the field of P., since at this stage of the socialist reconstruction of the national economy in the field of healthcare, the tasks of the struggle to reduce morbidity and increase labor productivity through the implementation of broad preventive measures to improve labor and living conditions come to the forefront. Preventive measures closely approach the workshop, the machine, the collective farm, the housing of workers and collective farmers, their nutrition, and rest. To in every way assist health measures in fulfilling the industrial and financial plans, helping to better organize labor and strengthen the capacity for work of the millions of builders of socialism—this is the task that defines the main content, forms, and methods of work in the field of P. in those years when the foundation of the socialist economy has already been built and "we have already entered the period of socialism, since the socialist sector holds in its hands all the economic levers of the entire national economy" (Stalin). Among the problems of prevention, covering all the diversity of collective life, the problem of improving labor and increasing its productivity occupies a very prominent place. The October Revolution gave rise to a new area of P., of enormous importance under the conditions of industrialization of the USSR—the prevention of the effects of harmful conditions of professional labor and the improvement of the latter, which is achieved by the entire system of preventive measures aimed at combating the hazards and dangers of production and the rational organization of the entire production process in accordance with the requirements of sanitation and hygiene. In this respect, sanitary-hygienic and sanitary-technical surveys of enterprises (lighting, heating, ventilation, water supply, cubic capacity, specific hazards: high temperature, humidity, poisons, etc.), the systematic implementation of general sanitary and sanitary-technical supervision, examination of the health status and working conditions of workers, regular mandatory medical examinations of certain categories of workers, mandatory reporting of professional poisonings and diseases (see

Labor, occupational diseases) and especially the activities of health posts, which take the initiative in carrying out corresponding preventive health measures in close connection with labor protection agencies and with the broad involvement of worker self-activity—in relation to enterprises, and medical-prophylactic measures—in relation to workers in need of appropriate assistance (preventive leave, shortened working day, appropriate work regimen, transfer to lighter work, placement in rest homes, sanatoriums, improvement of housing and living conditions, etc.) (see Health Protection). In the field of combating occupational diseases, labor protection agencies along the lines of the People's Commissariat of Labor and trade unions carry out extensive preventive work. Our labor legislation, which provides comprehensive protection for the health of workers (see Labor—Labor Protection) and large expenditures for improving working conditions in industry, has enormous preventive significance. The transition of all industry, transport, communications, and municipal services to a 7-hour working day, the granting of annual vacations to workers, etc., represents a preventive measure of enormous importance for protecting the health of workers. Our sanitary legislation, which regulates labor and living conditions from a hygienic standpoint, is a very important instrument of P. The preventive significance of sanitary legislation in the USSR lies in the fact that it not only covers general sanitary measures and standards, but, taken in a broad sense, it includes a whole range of socio-hygienic measures—for the protection of motherhood and infancy, for labor protection, for social insurance, for worker housing construction, for public nutrition. It actively, through systematic and planned intervention by Soviet authorities, seeks to promote the creation of healthy labor and living conditions, in contrast to the sanitary legislation of bourgeois countries, which does not set itself these tasks of social P. due to existing capitalist relations, which assign to sanitary legislation primarily a narrow role—to provide legal norms for administrative and police functions and actions in the matter of sanitation. Sanitary legislation in the USSR regulates the corresponding forms and types of preventive activity. Sanitary supervision agencies, carrying out their sanitary-prophylactic functions within the general system of health agencies as part of it and according to a general plan linked to the economy of the relevant regions and the prospects of their economic development, carry out extensive preventive health work through a series of practical instructions and prescriptions, usually regulated by local special mandatory sanitary regulations. General sanitary measures are closely related to sanitary-technical measures, the preventive significance of which is constantly increasing as our technology advances in connection with the industrialization of the country. And in industrial construction and in the construction of new cities and in the entire matter of improving the amenities of populated areas, sanitary and sanitary-technical measures aim to create healthy living and working conditions, i.e., in essence, they pursue the goals of P. This includes questions of choosing sites for the construction of industrial enterprises, worker settlements, new cities, rural settlements, questions of rational planning of settlements with consideration for health protection interests, questions of water supply, sewerage, sanitation, garbage incineration, green spaces, questions of housing construction (types, building structures, building materials, observance of sanitary-hygienic norms in terms of air volume, heating, lighting, ventilation, etc.) and external improvements (drainage, paving of streets, fight against dust, air pollution by smoke, gases, etc.), the establishment of public hygiene institutions, bathhouses, laundries, sports grounds, etc. The resolution of the June plenum of the CC VKP(b) of 1931 marks an important stage in the improvement of urban amenities; it decisively set before all party, professional, and economic organizations the task of improving cities, developing urban economy, which has basically completed the restoration period and entered the reconstruction period, and comprehensively improving municipal amenities in accordance with the 'rapid pace of industrialization, increase in urban population, growth of domestic and cultural needs of the broad working masses' [from the resolution of the CC VKP(b) plenum of 15/VI 1931]. In connection with the rapid industrial construction, new industrial centers, new socialist cities are emerging; settlements of semi-urban and semi-rural type are being rebuilt into cities; in rural areas, in connection with the collectivization and mechanization of agriculture, the organization of large state farms, collective farms, machine-tractor stations, many villages are turning into cities; a large number of villages, in connection with the abolition of the district system of administration, have become district centers, which, like urban settlements, are turning into socialist cities, which 'must ensure the cultural rise and protection of the health of the broad working masses, increase labor productivity and free the working woman from the shackles of domestic economy' (from the cited resolution). All this construction must be developed on the basis of maximum attention to the requirements of P., without which the task of transforming current cities into 'cultural, technically and economically developed proletarian centers' and creating new socialist cities cannot be successfully solved. The significance of P. for socialist construction is vividly emphasized in the above-mentioned landmark resolution of the CC VKP(b) 'On the Development of Urban Economy in the USSR' (in June 1931): 'In the struggle for the five-year plan, for the further success of socialist construction, for the prosperity of socialist enterprises, for the improvement of material and living conditions of the working masses, for their cultural rise and protection of their health, for the steady growth of real wages—questions of urban economy (housing, water supply, lighting, heating, sewerage, urban transport, external improvements, bathhouses, laundries, public nutrition) acquire the utmost importance'. All these preventive measures are of great significance for creating a new way of life; the great successes in the industrialization and collectivization of the country 'have created all the necessary conditions for a decisive improvement of urban economy—this most important base for restructuring the way of life on new socialist principles' [from the cited resolution of the CC VKP(b)]. In the complex of preventive measures for restructuring the way of life and for health protection, measures to improve housing conditions play a major role, since the latter have great etiological significance (admittedly, in connection with other factors—nutrition, working conditions) in the occurrence of a number of diseases: tuberculosis, rheumatism, childhood diseases, etc. The Soviet authorities had to do enormous work in the field of improving housing conditions for the working population, because in prerevolutionary times for the exploitative policy in urban economy 'the most characteristic feature was the direction of main funds to the improvement of districts populated by bourgeois and well-to-do elements, while worker districts and outskirts sank in mud, were deprived of light, water, sewerage, paved streets, and even the most elementary amenities, despite the fact that the main burden of urban taxes fell on the working masses. The supply of housing to the overwhelming majority of the population was (in bourgeois countries is and still is) in the hands of private entrepreneurs and served as a means of the most unscrupulous exploitation of the broad masses of the working population, especially the least secure strata of the proletariat' [from the resolution of the CC VKP(b) Plenum, June 1931]. The Soviet authorities, having decisively undertaken to eliminate the legacy of the past in housing, besides resettling a huge number of workers from outskirts to centers and to better houses, in recent years have widely developed housing and municipal construction in industrial centers, worker districts, and settlements; the best apartments have been made accessible to workers by establishing rental norms in accordance with the level of earnings. This is a policy based on taking into account the tasks of P., the tasks of protecting the health of the working population. In the USSR, over 3.5 billion rubles have been invested in new housing construction from 1927 to 1931 and 28.5 million m² of living space have been built; about 2 million workers have been resettled in new homes in 5 years. The water supply and sewerage network has been significantly expanded, mainly in worker districts, worker settlements, and new socialist cities (Magnitogorsk, Kuznetsk, Dzerzhinsk, Dneprostroi, etc.). New socialist cities and socialist settlements, which should harmoniously combine all the amenities of cultural centers with the possibility of using fresh air, sun, green spaces, culture and rest parks, sports grounds, etc., will truly become centers of healthy and joyful labor and rest, where health protection is based on a solid foundation of public P.

Sanitary-preventive measures aimed at improving the rural environment are of extremely important significance. Questions of rational planning of rural settlements, improvement of housing, water supply, disposal of waste, etc., in short, questions of improving rural health through widespread preventive measures, acquire particularly great and current significance in connection with the fact that as a result of the first five-year plan 'the historical task of transferring small, individual, fragmented peasant farming onto the rails of large-scale socialist agriculture has been solved, and the USSR has turned from a country of small-scale peasant farming into a country of the most large-scale agriculture' [from the resolution of the joint Plenum of the CC and CCC of the VKP(b) of January 7-12, 1933]. The collectivization of the village creates an economic base for widespread health measures in the countryside. Improvement of rural sanitation, along with raising the general cultural development of the village on the basis of its economic growth on socialist principles, contributes to the successful struggle against domestic diseases—a legacy of the past—and to the introduction of healthy hygienic habits, the organization of a new healthy way of life, and the general improvement of sanitary culture in the village. The collectivized village has enormous prospects in the field of sanitation. The organization in rural areas of well-equipped housing, public dining rooms, laundries, improvement of water supply sources, and sanitation is included in the circle of current national economic tasks to meet the needs of the socialist agricultural sector. In the future, as socialist construction develops and rural districts are drawn into industrial construction, which will lead to the elimination of the opposition between city and village, the lag of the village behind the city in the implementation of preventive measures and sanitary improvements will also be eliminated. Under the conditions of the dictatorship of the proletariat, which has eliminated private property and created conditions for socialist development, the prerequisites for eliminating this opposition are given: 'The opposition between city and village,' says Marx, 'can only exist within the framework of private property. Socialist society, along with the elimination of class interests, must also eliminate the contradiction between city and village. The elimination of the contradiction between city and village is one of the first conditions of collectivism, a condition which in turn depends on a mass of material prerequisites and which, as everyone sees, cannot be realized immediately by will alone (these conditions must still be developed)' (K. Marx, F. Engels, Feuerbach, Archive of Marx and Engels, vol. I, p. 234). These material prerequisites are provided in the conditions of our Soviet economy, which is being intensively and systematically transformed under the firm leadership of the VKP(b) along socialist lines. 'Society capable of harmoniously setting in motion,' says Engels (Anti-Dühring, ed. 1928, art. 263), 'its productive forces according to a single general plan, is able to organize them in such a way that it will be possible to distribute large industrial enterprises throughout the country, bringing factory production closer to agricultural production,' as is necessary for the development and preservation of industrial forces. The elimination of the contradiction between city and village must take place not only in the interests of industrial and agricultural production, but also for the establishment of public hygiene. Only with the union of city and village into one whole is it possible to eliminate the current poisoning of air, water, and soil, and only then can the urban residential masses achieve a situation where their waste, instead of causing diseases among them, will become useful material in the general laboratory of nature and will contribute to the success of agriculture. And in 'The Housing Question' Engels points out that 'only a more even distribution of the population throughout the country, only a close connection of industry with agricultural production along with the inevitable spread of means of communication—after the preliminary abolition of the capitalist mode of production—is able to pull the rural population out of the isolation and dullness in which it has almost invariably vegetated for thousands of years.' And Lenin, long before 1917, in 'The Agrarian Question,' while also subjecting to a steady criticism the assertion of Brentano, Bulgakov, and others about the utopian nature of the idea of eliminating the opposition between city and village, says: 'The decisive recognition of the progressiveness of large cities in capitalist society in no way prevents us from including in our ideal (and in our program of action, for we leave unattainable ideals to Messrs. Struve and Berdyaev) the elimination of the opposition between city and village.' This is necessary, in Lenin's opinion, also in order to make the treasures of science and technology 'accessible to the entire people,' to eliminate that alienation from culture of millions of rural people, which Marx so aptly called 'the idiocy of rural life.' In February 1932, the XVII Party Conference of the VKP(b) in 'directives for the compilation of the second five-year plan of the national economy of the USSR' particularly emphasized the existence in the USSR of prerequisites for eliminating the opposition between city and village: 'The complete collectivization of agriculture, the growth of large state agricultural enterprises, and the arming of sovkhozes and kolkhozes with advanced machine technology, which in fact transforms agricultural labor into a variety of industrial labor, and the significant strengthening of transport connections and commodity turnover between industry and agriculture—create conditions for the complete elimination of the opposition between city and village' (from the resolution of the VII Party Conference). Along with carrying out the main measures for sanitary improvement (planning, water supply, sewerage, bathhouse-laundry business, housing construction, and improvement of working and living conditions), the implementation of the sanitary minimum (see) also plays a significant role. All the above sanitary-preventive measures are of great importance in the fight against infectious diseases, where the task for the near future is the complete elimination of parasitic typhus and smallpox, the maximum reduction in the incidence of malaria, typhoid fever, and childhood infectious diseases, primarily in industrial centers and workers' settlements. In preventive work to reduce morbidity, the main link is sanitary-educational work and the organization of the population's self-activity around the main issues and practical tasks of protecting public health. Among the main national economic measures of enormous preventive significance for improving the health of the broad working masses, for increasing labor productivity, and for ensuring proper physical development of the rising generation, is public catering (see). The enormous growth of the public catering network is combined with the growth of dietary nutrition, which is of great importance for the prevention of diseases and the preservation of the working capacity of those in need of a diet (treatment without leaving production). Measures related to public catering are connected with the organization of factory kitchens, dining rooms, bakeries, canneries, etc. Health authorities play a major role in this essentially preventive work in establishing rational nutrition standards, taking into account working conditions and health status, physical development, and sanitary-hygienic requirements for all links of public catering and the systematic implementation of functions of sanitary-food supervision. An extremely important link in prevention, of enormous national economic significance in ensuring a healthy new generation and in involving new masses of workers in production and protecting the health of the working woman, is the protection of motherhood and infancy (see). In this regard, preventive work for the protection of the health of children and adolescents (see) is also very important. Concerns with physical culture and strengthening the physical development of the working population in the Soviet system of prevention are closely connected with another area of preventive work—psychological hygiene (see) and psycho-prophylaxis. One of the cornerstones of prevention is sanitary education (see). In the system of preventive measures, among which the first place is occupied by measures of public-mass prevention, expressed in broad socio-economic and socio-hygienic measures, preventive measures aimed at preventing specific diseases—tuberculosis, rheumatism, heart diseases, skin-venereal diseases, etc.—play a significant role. These preventive measures, although they often have specific features depending on the nature of the corresponding disease and the ways and routes of its spread, are for the most part closely connected with the measures of public-mass prevention, constituting its integral part. In the fight against these diseases, dispensarization is of great importance. The enormous preventive role in protecting and strengthening health is played by the measures of the Soviet power to improve the cultural and living conditions of the working people.

The material well-being of the working people increased year after year in accordance with the brilliant successes in socialist construction; the average annual wage of a worker rose from 703 rubles in 1928 to 1,356 rubles in 1932. Socialized wages (social insurance, expenditures for improving living conditions, workers' housing construction, etc.) increased from 1.6 billion rubles in 1928 to 4.3 billion in 1932. The average annual wage of workers and employees in large industry grew in 1932 by 67% compared to 1928. The wage fund grew during the first five-year plan from 8,152 million rubles in 1928 to 30,321 million rubles in 1932. The steady growth in the size of the working class in the USSR (increase in the number of workers from 11.2 million in 1928 to 22.3 million in 1932 and complete elimination of unemployment) stands in contrast to the enormous growth of unemployment in capitalist countries (in the USA according to official data at the beginning of 1933 - 12 million unemployed, in England - 3 million, in Germany - 7 million, etc.) and the sharp decline in wages (in Germany wages according to official data were reduced in 1932 by 50% compared to 1928, in the USA - by 35%, in England - by 15%). In the USSR, significant appropriations for improving the living conditions of workers (funds for improving living conditions), for housing construction, and for public catering also play a major role in raising the living standard and strengthening the health of the working people. In raising the living standard and strengthening the health of hired workers, social insurance has great significance as an important link in social prevention, contributing to socialist construction and performing very important functions in the area of strengthening labor resources, increasing labor productivity, and protecting public health, i.e., essentially social-preventive functions. The social insurance budget in 1932 reached 4,120 million rubles compared to 1,050 million rubles in 1928; from social insurance funds, huge sums are allocated for medical-preventive purposes and for improving the working environment: rest homes, sanatoriums, resorts, organization of dietary nutrition, milk kitchens, nurseries, etc. These appropriations increase year after year, as can be seen from the following table (in million rubles): Items of expenditure Expenditures for workers' housing construction and laundry service ................ Service for nurseries .......... Construction of nurseries......... . Therapeutic nutrition.......... . . Preventive measures (sanatoriums, resorts, rest homes) . . Nutrition for schoolchildren........ . . Kindergartens.............. Medical help .......... Hospital construction ....... 1931 1932 357.7 710.0 66.9 22.0 30.0 8.4 32.5 97.9 179.9 5.7 16.0 13.0 33.4 471.8 740.8 29.2 78.0 Measures aimed at improving the social and domestic needs of the working people play a dominant role in the system of Soviet prevention. As a result of colossal achievements in collective farm construction, the stratification of the peasantry into the propertied and the propertyless has been eliminated, and pauperism and destitution in the countryside have been liquidated. Comrade Stalin in his report at the joint plenum of the CC and CCC of the VKP(b) "Results of the First Five-Year Plan" (January 7, 1933) characterized the changes in the position of the poor and the lower strata of the middle peasants as follows: "What did the five-year plan in four years give to the poor and the lower strata of the middle peasants? It undermined and smashed the kulaks as a class, freeing the poor and a good half of the middle peasants from the kulak yoke. It involved them in collective farms and created for them a firm position. It thereby eliminated the possibility of stratifying the peasantry into exploiters-kulaks and the exploited-poor peasants. It raised the poor and the lower strata of the middle peasants in the collective farms to the position of people with secure means, thereby eliminating the process of ruin and impoverishment of the peasantry. Now there are no longer such cases that millions of peasants annually leave their places and go to work in distant regions. In order to draw a peasant to work somewhere outside his own collective farm, it is now necessary to sign a contract with the collective farm, and also to provide the collective farmer with free railway passage. Now there are no longer such cases that hundreds of thousands and millions of peasants are ruined and knock at the doors of factories and plants. This was, but it has long since passed. Now the peasant is a secure owner, a member of a collective farm that has at its disposal tractors, agricultural machines, seed funds, reserve funds, etc., etc., and this at a time when in capitalist countries the agricultural crisis is undermining peasant farming and throwing millions of ruined peasants and farmers out into the world. It is sufficient to point out that in the USA according to official data the annual income of the average farmer fell over the last three years from 847 dollars in 1929 to 187 dollars in 1932." Against the background of the general measures of the Soviet power to maximally improve the material and domestic situation and raise the cultural level of the working people (elimination of illiteracy, universal compulsory 7-year education, intensive training of cadres from the working-peasant environment), the work in the field of health in the area of prevention is only a part of the entire social-preventive activity of the organs of the dictatorship of the proletariat. Under Soviet rule, prevention has as its object the working strata of the population and, first and foremost, the proletariat and collective farmers. In the center of attention in carrying out preventive measures are industrial regions, new construction sites, and the socialist sector of the countryside. In these areas of socialist construction, preventive measures are carried out with the aim of fundamentally improving and improving all living conditions along the lines of improving the production environment, extensive housing construction, intensive improvement of municipal services and sanitary conditions of the entire area, proper organization of public catering and organization of all types of social-cultural service and medical-sanitary assistance on a preventive basis. Social-preventive measures are carried out on a class principle taking into account the social significance for socialist construction. The measures of the Soviet state for the socialist reconstruction of the entire national economy are reflected in the indicators of the sanitary condition of the country, at the level of its sanitary culture in the most favorable way. These results were noted by the XVII Party Conference of the VKP(b): "As a result of the implementation of Bolshevik tempos of socialist construction and the elimination in basic terms of parasitic classes, already in the first five-year plan the foundations and source of the exploitation of man by man are eliminated, the national income grows at a pace unattainable for capitalist countries, unemployment and destitution (pauperism) are eliminated, the 'price scissors' and the opposition between city and countryside are eliminated, the well-being and cultural level of workers and working peasants grow year after year, mortality falls and the population of the USSR rapidly increases."-The reduction in morbidity and mortality is the result of the improvement in the material situation of the working masses, the increase in their cultural level, and extensive preventive health measures. The indicators of physical development of the population have significantly improved, as evidenced by the data of examinations of conscripts in draft commissions and the published results of mass surveys of adolescents (Kurkin and Bogoslovsky). Social-preventive measures played a huge role in the health improvement of small nationalities. In the pre-revolutionary period, they were degenerating and dying from rashes, syphilis, infectious diseases, going blind from trachoma. The socio-economic measures of Soviet power aimed at raising the material well-being and cultural level of national minorities, along with the intensive development of the network of medical-sanitary institutions and preventive measures in national areas and regions, have led not only to the cessation of the process of extinction but have created all the necessary conditions for strengthening the health and further development of small peoples. The general national policy of Soviet power, expressed in a whole system of socio-economic and socio-hygienic health measures in the protection of the health of national minorities, had enormous preventive significance. All these results irrefutably prove that prevention, which has become an integral part of all the work of Soviet power, and the preventive direction determining all the content of the work of health authorities play a huge role in the health improvement of the entire country, strengthening its labor resources and defense capability, contributing to the successful implementation of its socialist reorganization. There remains enormous work for further health improvement of labor and living conditions, for the final elimination of epidemics and reduction of morbidity, for raising the municipal improvement and all sanitary culture, for bringing all health work closer to production and maximizing the pace of its development in accordance with the needs of the national economy, for strengthening the initiative of the working people in the field of health and for training qualified medical personnel capable of playing an active role in socialist construction. On the basis of the general line.

The CPSU(b) will ensure the further successful development of preventive measures in full accordance with the tasks of socialist construction. The further growth of these measures will intensively occur on the basis of the directives of the 17th Party Conference on socialist construction for the second five-year plan. The conference considers that the main political task of the second five-year plan is the final elimination of capitalist elements and classes in general, the complete destruction of the causes that generate class differences and exploitation, and the overcoming of the remnants of capitalism in the economy and in the consciousness of people, the transformation of the entire working population of the country into conscious and active builders of a classless socialist society. On the basis of the elimination of parasitic class elements and the general growth of national income, which entirely goes to the disposal of the working people, a significantly faster rise in the well-being of the working and peasant masses must be achieved, and at the same time, a decisive improvement of all housing and municipal affairs in the USSR. The conference considers that the provision of the population with basic consumer goods, including food items, by the end of the second five-year plan should increase by at least two to three times compared to the end of the first five-year plan.