Sanitary Minimum

SANITARY MINIMUM, all that mass of the simplest and most accessible sanitary-hygienic measures for implementation, which are brought to life with the direct participation of the broadest groups of the population and with the attraction of additional material and labor resources of the interested organizations and population groups themselves. The idea of the sanitary minimum as a new additional method of sanitary work for the improvement of the working and living conditions of the worker and peasant masses did not appear by chance. The decree on the sanitary minimum was issued by the Council of People's Commissars of the RSFSR on May 20, 1930. These years were, as is known, a period of the deployment of the measures of the first five-year plan and broad socialist planned construction in all areas of the national economy. The deployment of planned measures in the field of public health revealed the necessity of the quickest liquidation of the existing lag of health care in the country from the general economic and cultural upswing; the state of sanitary work turned out to be in a certain contradiction with those demands that were made on sanitary improvement by the growing needs of the national economy and the population itself. This lag in health care was emphasized in the resolution of the Central Committee of the party "On the Medical Service of the Toilers"—December 1929. Subsequently, this lag in the field of communal improvement was also emphasized in the resolution of the June plenum of the party on the development of communal economy (1931). The conditions of the development of the national economy and the growth of the needs of the population in connection with the rapid rates of economic construction of the country therefore required from the population itself wide sanitary work directed to the same goal: the sanitary improvement of the country. The methods of the sanitary minimum put forward by the government decree of May 20, 1930, provided health authorities with the opportunity to use other broad resources and possibilities as well. In its introductory part, the decree precisely formulates these guidelines for the new forms of work of health authorities in the cause of the sanitary upswing of the country. The decree begins with a brief formulation of the provision: "The radical improvement of the conditions of labor and life requires a significant acceleration of the pace of implementation of basic measures for sanitary improvement (planning, installation of water supply systems, sewerage, etc.) outlined by the five-year plan. Along with this, it is necessary for the coming years to consider a very important task the implementation of a minimum of the simplest, mass, accessible sanitary-hygienic measures." Paragraph 1 of this decree established the list of these simplest measures of a sanitary-hygienic character. These include: "a) water supply—installation, sanitary protection, repair, and maintenance in proper condition of water supply sources and structures; b) removal of refuse and sewage; c) simplest improvement measures—combating waterlogging, filling in standing puddles, etc.; d) green spaces—installation, protection, and expansion of green spaces; e) sanitary maintenance of dwellings—daily cleaning and ventilation, combating parasites and rodents, timely routine repairs; f) sanitary maintenance of enterprises and institutions—installation of washbasins and showers, arrangement of locker rooms, allocation of special premises for eating, cleaning and ventilation of premises, combating smoking in public service premises, etc." (para. 1 of the 1930 decree). During the implementation of the sanitary minimum, the following main forms of this work are established: first, the very organization and implementation of the simplest sanitary measures accessible for implementation by the population itself in the person of its most diverse groups; second, the involvement of the broad masses of this population in the implementation of the sanitary minimum in the form of constant systematic work; the main attention here should be paid to the use of mass public organizations of various types; third, the most diverse material resources, obtained both through certain additional allocations of individual institutions and enterprises from various funds and through self-taxation of the population itself, must be drawn upon for the expenses of the sanitary minimum; at the same time, the labor resources of the population itself must have even greater significance here, the mobilization of which is one of the tasks of a correctly understood sanitary minimum. Thus, the implementation of the sanitary minimum must appear not only in its idea as an additional measure to the main planned improvement measures carried out by state bodies, but at the same time the sanitary minimum must also create and utilize additional methods of participation of the masses of the population and its material resources in this matter and on this basis more broadly organize the sanitary education of the population. The decree of May 20, 1930, in its subsequent articles indicates the forms of organization of the sanitary minimum. In this area, the following practical questions are put forward: a) leadership in this work, b) selection of objects for carrying out the sanitary minimum, c) establishment of a work plan, d) precise instructions on persons and institutions that will conduct the planned measures for the sanitary minimum, e) establishment of deadlines and calendar execution of work, f) establishment of responsible persons, and g) finding material and financial resources. The decree of May 20, 1930, establishes that "direct leadership in all work on the development and implementation of the sanitary minimum is carried out by the People's Commissariat of Health and local health authorities" (art. 2). Thus, given a number of directive instructions from central health authorities, local health authorities and local medical workers must include in their activities direct leadership of all local work in this area. For this purpose, both the health departments themselves and their peripheral organs, and above all the sanitary organs on the spot, must draw up brief plans for the implementation of the sanitary minimum within their territory for each given year. The main thing here is an accurate list of all objects where the implementation of the sanitary minimum is planned and where there are appropriate conditions for this. In full agreement with the latest directives of the government and the party on the predominant importance in the matter of economic construction of the main types of industry and the socialist sector of agriculture, it is necessary first of all to put forward appropriate objects in this direction. Thus, in the plan for the organization of the sanitary minimum in each territory of activity of a particular health department or particular sanitary organs (district, city, city district, precinct, state farm, collective farm, etc.), lists of the most important points for the activity of sanitary supervision must be compiled. These include: 1) industrial enterprises as a whole or in individual workshops and departments, 2) collectivized enterprises and partnerships in agriculture—machine and tractor stations, various types of state farms, etc., 3) trade institutions and enterprises, as well as institutions of an administrative character, shops, warehouses, etc., 4) buildings and institutions of public and communal purpose—baths, laundries, clubs, entertainment institutions, etc., 5) food industry and public catering enterprises, 6) dwellings, both individual and above all collective—dormitories, night shelters, peasant houses, 7) children's and physical culture institutions—schools, nurseries, colonies, 8) medical and sanitary institutions—hospitals, polyclinics, sanatoriums, rest homes. Measures in the field of sanitary improvement of transport routes—railway stations, piers, rolling stock, as well as places of detention—must be singled out in a special way. In each of these objects, a group must be created for the elaboration and further implementation of the sanitary minimum. With appropriate instruction from sanitary and other medical bodies, this group, which includes representatives of the most active public organizations, as well as representatives of the administrative and economic management of these objects, draws up its local sanitary minimum for the given object. This sanitary minimum should include measures both for carrying out measures to maintain the sanitary level of the given institution or enterprise at the proper height and for carrying out small sanitary repairs. Thus, a list of individual measures is compiled that must be carried out in the given premises or enterprise with the aim of raising its sanitary state. Such are measures for the systematic cleaning of premises, for their ventilation and normal illumination, for periodic repairs in the form of whitewashing, painting, etc., for monitoring heating devices, for monitoring the maintenance of auxiliary sanitary-technical installations, for the operation of canteens, kitchens, children's institutions, supervision of the improvement and cleaning of the yard, streets, etc. The participation of public forces, as indicated above, should be manifested not only in the development of this plan of the sanitary minimum, but mainly during its implementation. Therefore, each planned measure must have its physical executors either from the composition of the same active or from specially invited persons. In the latter case, systematic public control must be established over the activities of these persons.

The closest participation in this work must first of all be assumed by public health agencies, i.e., various medical personnel working at the respective facility—attending physicians, intermediate and junior medical and economic personnel, sanitary agencies; further participation in this work is taken by representatives of the factory committee, trade unions, health sections, the Komsomol, the women's department, and various mass societies (Russian Red Cross, Osoavakhim, Friend of Children, etc.). For the success of this work, it is extremely important that there is no depersonalization in the execution of each of the planned measures. Specific individuals are attached to each given measure and are accountable to control bodies for the implementation of the corresponding plans. Of equal importance in the implementation of the sanitary minimum is the establishment of deadlines and procedures for execution. In a number of the simplest sanitary measures that are part of the concept of the sanitary minimum, the success of the cause depends on the timeliness of carrying out sanitary supervision and the sanitary measures themselves. Daily airing of premises at set hours, daily wiping of windows, timely periodic repairs, daily cleaning of certain premises, daily inspection of the operation of sanitary-technical installations, such daily control over this matter—all this creates not only a definite tone of sanitary activity, but also forms certain habits and skills among the population. From this point of view, the sanitary minimum—when properly conducted—carries within itself certain germs of the development among the population of that sanitary culture, which to a significant extent consists of the daily habits and skills of the population in maintaining bodily cleanliness and surroundings. Special control commissions created by the public to check the sanitary minimum also check this work at set times and report on it at wide mass meetings. It is quite obvious that both at the beginning of the deployment of this work and during the period of the work itself, it is necessary to make wide use of various large meetings of working people, where one could agitate for this method of sanitary improvement of living conditions. With such an arrangement of work, the sanitary minimum cannot by any means proceed everywhere according to a uniform template. It must everywhere be adapted to all local conditions of environment and daily life and be directed toward overcoming precisely those shortcomings of sanitary structure and daily life that are characteristic of the given facility. Along with this, the sanitary minimum should not remain the subject of concern solely for public health agencies. The latter, while taking upon themselves all the initiative and leadership in this matter, are nevertheless only a part of those social forces that carry out the sanitary minimum; therefore, the directive instructions of the People's Commissariat of Public Health of the RSFSR also contain proposals for the appropriate involvement of other departments and first of all economic organs in the cause of the sanitary minimum. In development of this proposal, a series of coordinated decrees was issued in 1930–1931 by many central bodies. Such are the decrees of the People's Commissariat of Public Health and the former People's Commissariat of the Interior on the implementation of the sanitary minimum in the field of communal sanitation; such are also the decrees of the People's Commissariat of Public Health and the People's Commissariat of Agriculture (rural sector); the People's Commissariat of Public Health and the People's Commissariat of Education (schools), as well as similar decrees of central bodies of public organizations (Russian Red Cross, Osoavakhim). The important question of financing measures for the sanitary minimum is resolved in accordance with the instructions of the law. Article 3 of the decree of May 30, 1930, states the following: "Expenses for the implementation of those sanitary-improvement measures whose financing by law is entrusted to the local budget, economic organs, and other organizations are produced in the manner established by law. The mobilization of funds from the working population for the implementation of sanitary-improvement measures must be based exclusively on voluntary principles. General meetings of collectives have the right to issue decisions on the establishment of monetary contributions for the implementation of sanitary-improvement measures planned by them." One of the most convenient forms of raising funds is the inclusion of certain sanitary minimum measures in the industrial-financial plans of enterprises. In view of the fact that the organization of the sanitary minimum on the very wide periphery, where there is often no sufficient contingent of leaders in the form of qualified representatives of sanitary supervision, may encounter great difficulties, the People's Commissariat of Public Health of the RSFSR also carried out extensive instructional work for the active personnel of this periphery. During 1930–1931, the People's Commissariat of Public Health of the RSFSR developed a series of model sanitary minimums for the most important and responsible objects of application of this form of work. Subsequently, all these model minimums were published in the form of a separate collection, which came out in 1933 in a 2nd edition. These developed sanitary minimums of individual facilities included the following: I. Sanitary minimum a) for the improvement of worker settlements, b) for improvement at new construction sites, c) for improvement in collective farms, and d) for improvement in state farms; II. Sanitary minimum in an industrial enterprise; III. Sanitary minimum a) for dwellings in cities and worker settlements, b) for temporary residence dormitories; IV. Sanitary minimum a) for public catering enterprises, b) for bread factories and bakeries, c) for stalls and kiosks, d) for buffets, e) for grocery stores, f) for beverage-producing enterprises, g) for the maintenance of food warehouses and distributors, h) for bazaars; V. Sanitary minimum a) for bathhouses, b) for laundries, c) for barbershops, d) on personal hygiene; VI. Sanitary minimum a) on water transport, b) on rail transport; VII. Sanitary minimum a) for schools, b) in nurseries; VIII. Sanitary minimum a) for workers' clubs, b) for administrative and office institutions, c) for collective farmers' houses and hotels; IX. Sanitary minimum for physical culture institutions; X. Sanitary minimum a) for outpatient-type institutions in cities, b) for the rural medical district, c) for settlement and district hospitals, d) in sanatoriums and rest homes, e) for balneological and mud-bath institutions, beaches, etc.; XI. Sanitary minimum for combating malaria in malarial localities. In the designated sanitary minimums, exact instructions are given, firstly, on all those measures that are possible in relation to the given facility; secondly, instructions on both the facility itself and its parts in relation to which the measures are applied; thirdly, instructions on which population groups or public bodies are enlisted for each given measure; fourthly, instructions on in what forms and what material resources will be required for the given measure, and fifthly, the priority of execution of these measures. All this material is presented in tabular form. The task of compiling these model sanitary minimums consisted in facilitating the compilation of their local sanitary minimums for peripheral workers and the public, suggesting in a certain sense all those measures that are necessary and possible for implementation in each given area. Thus, for example, regarding the sanitary minimum for housing, a number of measures are detailed according to the following sections: a) use of residential and utility premises for their direct purpose (e.g., prohibition of washing and drying laundry in residential apartments, prohibition of cooking food in living rooms when a kitchen is available, etc.); b) prevention and control of dampness in housing (drying, airing, plastering, drainage, soundness of roofs and downpipes, etc.); c) ensuring the correct thermal regime in housing (maintaining a certain temperature in premises, proper maintenance of under-floor spaces, insulation of exterior doors, insertion of winter window frames, a certain insulation of the attic, supervision of heating devices, cleaning of pipes, etc.); d) ensuring better solar illumination of living rooms (keeping glass window surfaces clean, whitewashing walls in light tones, proper arrangement of greenery in front of house facades, etc.); e) general maintenance of cleanliness in the premises (devices against tracking dirt and dust into rooms, arrangement of cloakrooms, sweeping and cleaning of stairs and entrances to premises, wet cleaning of the latter, systematic washing of floors, removal of dust from furniture and equipment items, sweeping of walls and ceilings, preventing the accumulation of waste in the premises, presence of buckets with lids for dry waste, measures for keeping domestic animals in rooms, installation of spitbusters, etc.). Regarding measures in the field of personal hygiene, the sanitary minimum also envisages detailed individual measures regarding the maintenance of cleanliness of the human body, clothing, footwear, bedding, as well as the simplest forms of personal regimen protecting against the development of infectious diseases, etc. In the very first years after the publication of the decree on the sanitary minimum, this form of work on the sanitary improvement of labor and living conditions became widespread. Local public health authorities, in the struggle to raise the sanitary level, in addition to their broader improvement measures, began everywhere to apply this new method of work. In relation to those plans of work on improvement and public health that were developed by public health authorities as the main type of their work, the implementation of the sanitary minimum acted as a kind of counter-plan coming from the population itself. Proper coordination of both these plans and types of improvement activity yielded the best results. It must be noted, however, that the very implementation of the sanitary minimum locally has had and still has a very motley character.

The reason for this is both a misunderstanding of the very methods of work on the Sanitary Minimum and, frequently, the substitution of the Sanitary Minimum by various shock campaigns, month-long drives, and so on. At the same time, in many places the health authorities themselves do not sufficiently take into account the significance of the Sanitary Minimum and do not draw the population into this work. As a result of this, the practice of implementing the Sanitary Minimum on the periphery has not everywhere yielded and does not yield definite results; alongside a number of successful initiatives in this area, noted both in the periodical press and in reporting data, there are also a number of shortcomings. It must in any case be remembered that the Sanitary Minimum is not a replacement for the daily, systematic sanitary work of health authorities and that this method of activity can and should be only an extremely important subsidiary method, varying in its scope in each given individual case. With a broad, real deployment of sanitary measures in the field of communal improvement and the sanitation of everyday life, the aforementioned application of the Sanitary Minimum will undoubtedly change, but this will happen at the expense of raising the sanitary level and sanitary culture and increasing among the population those habits of personal hygiene and prophylaxis that were spoken of above. Decrees on the Sanitary Minimum were repeated after 1930 in all other union and autonomous republics as well. The practice of their implementation is generally similar to the practice of the RSFSR. In the application of the Sanitary Minimum, there also emerged the major role of designating certain model sectors and model facilities, as well as applying methods of socialist emulation, the formation of shock brigades, the awarding of prizes, and so on. At the same time, all methods of sanitary enlightenment must also be utilized for this purpose. For the creative initiative of the broad worker and peasant masses in the field of raising their sanitary level, the Sanitary Minimum is one of the most fruitful methods of their activity.