Statistics

STATISTICS. 1. Brief history, subject, and fundamental concepts of general statistics. The subject of statistics is the study of internally related yet externally isolated elements. The internal regularity of the latter finds its manifestation only in their aggregate mass (statistical regularities). Sanitary statistics in the modern sense of the word, i.e., as an independent branch of knowledge, is a relatively recent phenomenon. Its origin is usually attributed to the publication in 1835 of Adolphe Quetelet's work Of Man and the Development of His Faculties, or Essays on Social Physics. The content, scope, character, and scientific value of statistics have changed historically, reflecting the existing characteristics of given phases of national-economic formations in various countries. The word "statistics" was used to designate numerical material on the state of the country, its territory, population, armed forces, income, expenditures, economic activity, production, quantity of agricultural and industrial products, trade, and the well-being and education of citizens, etc. In this sense, the beginnings of statistics date back to ancient times. Already from the 16th century in individual cities and small states, such as the canton of Zurich (1567), regular population censuses are encountered. The first general decree on the proper keeping of population movement registers was issued by the Council of Trent for Catholic countries (1563); for Protestant states, the obligation to keep vital statistics books was established by the Synod of Séez in 1524. From the 17th century they became more general and periodic (French censuses from Louis XIV to Napoleon I, the introduction of calculations in England in 1701, Prussia in 1733, etc.). In Russia, church books for Orthodox parishes were introduced under Peter I, supervised by the Holy Synod. The first periodic publications of materials contained in church books (metrics) begin in the final years of the 16th century in England, in London. These materials served as the basis for the first and most important strictly statistical works. The rise of capitalism and the interests of newly emerging classes necessitated practical measures to protect their interests, which led to the creation of economic, financial, military, and general political statistics (finance, trade, mining and coinage, police, matters of church, civil and internal administration, military affairs, etc.). Fear of and the desire to protect oneself from numerous epidemic diseases led to the appearance of mortality records (mortality registers were introduced in London in 1592 on the occasion of the plague). Statistics received its true theoretical and methodological development with the onset and development of the era of merchant capitalism (late 17th and early 18th centuries). Historically conditioned circumstances led to the emergence of two trends: descriptive statistics and "political arithmetic." Descriptive statistics (Conring, Achenwall, Schlözer) did not seek regularities or connections in the collected material; its main task was to assist state science by compiling numerical characteristics. The "political arithmetic" trend introduced the idea of discovering connections and internal regularities in externally disjointed, "random" numerical expressions of mass phenomena, i.e., it outlined what constitutes the essence of statistics. Among the works forming the first contribution to statistics as a science, one should include: John Graunt's Natural and Political Observations Mentioned in a Following Index, and Made Upon the Bills of Mortality; Petty's Political Arithmetic; Halley's An Estimate of the Degrees of the Mortality of Mankind; Süssmilch's The Divine Order in the Changes of the Human Race (abbreviated title). In Russia, Euler closely adhered to this trend, giving a systematic formulation of the question of the order of extinction based on Halley's mortality tables (1704). The elemental nature of exchange relations on the market, the intensification of competition, and the struggle of individual capitalists—creating an interest in determining the chances of winning and losing in this struggle for individuals and groups—contributed greatly to providing statistics with a mathematical basis in the form of probability theory. Statistics, both in theory and in the sphere of practical activity, is in the immediate sense a numerical coverage of phenomena of a spontaneous order not regulated by social will. The "law of large numbers" was placed at the base of statistics, with the task set of finding stable types and revealing regularities inherent in these spontaneous phenomena. In the first half of the 19th century, as mentioned above, Quetelet generalized the statistical works of his predecessors, predominantly political arithmeticians, into a system and published A Treatise on Social Physics and Letters on the Theory of Probabilities, which formed the basis of philosophical and mathematical constructions in bourgeois statistics. Quetelet is especially famous for his theory of the "average man," "normal" in all respects, with other people being merely deviations from this average norm. Quetelet was the first to "establish the constancy" of a number of processes occurring in the capitalist system (crime, convictions, etc.). Quetelet developed the questions of the practical application of probability theory to social sciences in the spirit of the apologetics of bourgeois society. The "inviolability" and "eternity" of the capitalist system and the "divine" order and "stability" of its laws form the core of all theoretical calculations in statistics. Numerous theoreticians of bourgeois statistics until recently proclaimed the theory of dispersion or stability as the crown of statistical thought. The "degree of stability," according to Lexis, is determined not by the absolute significance or insignificance of fluctuations observed in reality, but by the degree of their correspondence to numbers calculated a priori, in accordance with the law of "normal deviations" (Chuprov). The comparison of the results of actual and abstract data, expressed in mathematical constructions, provides, in the opinion of the creators of this theory, a solid foundation for judging the nature of the phenomena themselves. The mathematical expression of theoretical dispersion is the so-called coefficient of dispersion or scatter, the constructions of which are based on the application of the law of large numbers (Bernoulli's and Poisson's theorems) to the subjects studied. Thoroughly imbued with an idealistic conception, the dispersion theory assumes, apart from the existing figures measuring reality, the existence of laws of which these given numbers are merely distorted reflections. The applied measure of stability for all subjects, regardless of their material nature, gives it a formal mathematical character with a metaphysical tint. The analysis of only figures, rather than concrete reality, engenders the establishment of stability in the spirit of Machist views. Similarly, the major Russian theoretician A. A. Chuprov believed that "the theory of statistics considers all kinds of statistical numbers provided by observations as a reflection of underlying a priori values distorted more or less by reality" (Messenger of Statistics, nos. 10–12, 1924). The application of many statistical methods and techniques in the official statistics of the bourgeois state leads to a distortion of correct proportions in many areas of the national economy. Thus, the incorrect calculation of the price index for workers' consumer goods (the budget index), wage calculations based only on employed workers—i.e., without taking into account the increase in unemployment and family burden—and many others, are favorite techniques for embellishing the actual situation of the working masses. Bourgeois statistics glosses over the class nature of capitalist society, striving to dissolve classes in the published statistical tables. In studying all aspects of the life of the human collective, the absence of grouping by social attributes is extremely characteristic. Thus, the consumption of the main food products in statistical sources is given in gross figures for the entire population as a whole. Mortality and morbidity with loss of working capacity are not combined with attributes that reveal the true essence of the influence of social conditions on the wear and tear of the collective, etc. Brilliant examples of the application of Marxist theory to statistics are provided by the works of Lenin. The current state of the general theory of statistics relies on the mathematical theory of probability and gives reason to consider statistics a mathematical science. Sometimes a contrast is made between the theory of statistics and the theory of mathematical statistics (an incorrectly applied term, "variational statistics"), which is absolutely incorrect, because the non-application of mathematical methods disarms modern statistics and makes it technically helpless. Statistics cannot fail to use mathematical methods of measurement, but unlike mathematics, which deals with counting and the study of quantity abstracted from the material content of the measured object, it sets itself the task of studying material phenomena in all their qualitative diversity. The counting unit for a mathematician has only a quantitative expression, abstracting from quality, whereas the statistician always studies counting units only of qualitatively homogeneous aggregates, and the statistical method of study is inapplicable to qualitatively diverse aggregates.

Misunderstanding of this leads to gross methodological errors that make conclusions drawn from "statistical" study practically useless, and sometimes even harmful. It is no accident that the application of abstract mathematical calculations in statistics was used by wreckers in the field of national economic planning (Bazarov, Kondratiev, and others). The generally accepted definition of statistics as a numerical description (quantitative measurement) of spontaneous mass processes occurring in nature and society has always overlooked the fact that statistics, along with quantitative measurements of certain phenomena, must provide the opportunity to uncover the internal development regularities inherent in the studied phenomenon in order to apply the cognized connections and regularities to the practical needs of society. The subject of statistics is not the study of such mass phenomena that are formed by the artificial selection of qualitatively diverse units having no internal connection among themselves, but the study of aggregates (or collectives) of internally connected and externally isolated events, phenomena, acts, and elements, the internal regularity of which finds expression only in their general mass. The most principled and difficult task is the delimitation of the statistical aggregate, i.e., the selection into the statistical aggregate of phenomena that are truly internally connected and truly homogeneous. Statistics by itself is not in a position to resolve this issue. Its solution lies in the special theory of the given field of phenomena, which must establish the quality of the entire aggregate, since it is precisely the general quality that unites all elements of the aggregate into a single whole and is a reflection of their general internal connection, the unity of their general law of development. The question of the qualitative delimitation of the statistical aggregate, while being theoretically extremely important, also has great practical significance, since methodological errors in this area usually lead to incorrect scientific and political conclusions; for example, the famous empirical coefficients of Groman, which supposedly established an invariable ratio between industrial production and agricultural production (with a huge preponderance for the latter)—ratios which were supposedly to remain unchanged for old pre-revolutionary Russia and for the USSR—were obtained by Groman on the basis of the premise of preserving a single law of development of the economy for Russia and the USSR. The statistical basis of this wrecking theory was the incorrect delimitation of the aggregate, the mixing of two qualitatively different aggregates into one. In his famous dispute with the Narodniks at the end of the 19th century regarding the fate of capitalism in Russia, Lenin brilliantly exposed the methodological errors of Narodnik statistics. The main error of the latter consisted in the fact that the Narodniks, studying peasant households in Russia, treated them all as a single statistical aggregate, failing to notice the differences in the economic types of various groups of peasant households, and failing to dismember them into independent aggregates. For an aggregate qualitatively delimited on the basis of a special theory, statistics establishes quantitative ratios. The internal necessity underlying the statistical aggregate is established by statistics only insofar as it has a quantitative expression, in the form of a certain average result for the entire aggregate; random manifestations of this necessity become the object of statistics only from the side of the quantitative significance of individuals; thus, the subject of statistics is the establishment of quantitative ratios for an aggregate of random individuals, externally independent, but internally connected by a single law of development, finding its expression in the general qualitative homogeneity of the individuals of the aggregate. The laws governing the internal connection of individuals, with their great quantitative diversity, can appear only in the general mass. In this mass process of spontaneously random phenomena, a mutual cancellation of individual deviations in one direction or the other from the quantitative characteristic of regularity common to all aggregates occurs. When considering mass phenomena, bourgeois science already formulated the law of large numbers, which boiled down to the assertion that there are laws in nature and society that are incomprehensible and inexplicable to the human mind, the manifestation of which is determinable only by quantitative measurement under the indispensable condition of a large number of observed phenomena. The law of large numbers, surrounded by bourgeois theorists in a theological and metaphysical shell, was applied in its correct understanding by Marx and Lenin. When considering the connection between average price and value, Marx formulates the following proposition: "The possibility of a quantitative incongruity between price and magnitude of value is therefore contained in the price-form itself. This is not a defect of this form, but, on the contrary, makes it the adequate form of a mode of production wherein the rule can make headway only as a blindly acting law of averages." This clearly emphasizes that the specific regularities of capitalist society can appear and do appear only in the shell of statistical regularity, the "law of average values." Marx and Lenin give brilliant examples of the application of the dialectics of the accidental and the necessary in the manifestations of statistical regularity. Statistics, studying spontaneously random processes "characterized by the fact that the individual phenomena of which they consist are random phenomena, i.e., phenomena which occurred, but, generally speaking, could not have occurred or could have occurred not in the form in which they actually occurred" (Engels), obtains statistical aggregates (collectives) as a result of these processes. The further development of the socialist system and the growth of its material and technical base, providing a wide scope for planning national economic life, open up new tasks of theoretical formulation and practical application for statistics in all areas of socialist construction (control over the implementation of the plan, identification of obvious and hidden resources, etc.). The basis of the aggregate is the qualitative homogeneity of all its elements in a certain concrete connection. The main prerequisite for any kind of statistical work is mastering the theory of the given field of phenomena. Only under the condition of sufficient familiarity with the qualitative peculiarity of the studied phenomenon and knowledge of the laws of its development should one proceed to concrete statistical analysis. Gross empiricism and the inevitable search for "normal" values and a formalistic approach are the consequences of artificial concepts of researchers who do not master the material specifics of the studied subject. Equipping oneself with dialectical-materialist methodology and knowledge of the theory of the studied field on the basis of the latest scientific achievements allows for the fruitful use of the methods and techniques of theoretical statistics. Under the conditions of the unfolded socialist offensive during the period of the reconstruction of the national economy, tasks of enormous importance arose before the general theory of statistics: the restructuring of the system of techniques and methods for measuring shifts occurring in national economic life. "No construction work, no state work, no planning work is conceivable without proper accounting, and accounting is inconceivable without statistics" (Stalin). Accounting and planning are the main features distinguishing the socialist economic system. Without a plan, socialism cannot be built; without accounting, planning is impossible. "Accounting is understood as the qualitative-quantitative coverage of the actions consciously outlined by us ourselves and their results" (Osinsky), in contrast to statistics as a set of methods and operations making it possible to account for mass spontaneous phenomena. From this arises the need to build a system of accounting and statistical work and indicators of national economic and socio-cultural development, which are an instrument for fulfilling the plan, serving to control and measure the implementation of the plan. In contrast to previous periods, when the theoretical foundations of statistics were contrasted with its practical application, under the conditions of socialist construction, statistics serves its needs, draws its methodological constructions from the practice of life, and verifies them in the practice of construction. The organizational completion of the reconstruction of statistics was the creation of the Central Administration of National Economic Accounting (TsUNKhU) of the State Planning Commission of the USSR and its local bodies, with a developed network of district inspectorates, replacing the previously existing Central Statistical Administration (TsSU). TsUNKhU became the methodological, guiding, and controlling center for organizing statistics and accounting throughout the country. 2. Techniques and methods of statistical research. The choice of methods of statistical research is entirely determined by the features of the subject of study and the tasks, resp. the target setting of the research. Questions of choosing statistical techniques must be resolved by the plan of research or practical work. The main stages of statistical work: a) Statistical observation.

The prerequisite for a correct choice of forms of statistical observation is a preliminary, clear establishment, in accordance with the objectives of the study, of the object of statistical observation. This task boils down to the definition and theoretical substantiation of the content of statistical aggregates subject to description. Simultaneously and in a coordinated manner, the issues of delimiting the aggregate in time and space (establishment of territorial boundaries and the observation period) must be resolved. Following this, the object or phenomenon taken as the unit of observation and counting ("addends" forming the aggregate) is precisely determined. The resolution of these primary issues in the organization of statistical observation is associated with a number of technical conventions that are inevitable in statistical work; for example, in classical population censuses, the object of statistical observation is taken to be the aggregate of people living in a certain territory; the delimitation of this aggregate in time is resolved by establishing the critical day of the census, to which the population count is timed, and every person present in the given locality on that day is taken as the unit of observation. With respect to the chosen unit of observation, a list of characteristics subject to registration must be established (the program of statistical observation). It is necessary that the observation program be brought into strict correspondence with the calculations planned for the future (the program of tabular summary) and thereby ensure the obtaining of the system of characteristics of the statistical aggregate outlined by the development plan. It is necessary to avoid excessive complications in observation programs and to achieve extreme clarity in the editing of statistical questions. According to the degree of completeness of coverage of the studied statistical aggregate, two main types of statistical observations should be distinguished: complete and partial statistical surveys. A complete statistical survey, typical representatives of which are general population censuses (see Census), sets itself the task of an exhaustive registration of all units of the studied aggregate. Methods of incomplete surveys cover the studied aggregate only partially. Among the types of incomplete observation, truly statistical ones are only the forms of sample survey (see Sampling method), the organization of which provides the possibility of assessing the representativeness of the results, i.e., the correspondence of the statistical characteristics obtained with respect to the selected part (sample aggregate) to the characteristics of the whole (general population). The possibility of a more thorough description of the observation units reduces observation errors during sampling, and a smaller volume of the aggregate makes it possible to expand the observation program to some extent. The possibilities of the sampling method are limited. It can provide only average and structural indicators (see below), which makes it inadequate for a number of research tasks. It is also essential to establish the nature of the periodicity of the planned work. Programmatic and organizational possibilities are different for episodic, one-time surveys and current ones designed for observation over a certain period of registration. According to the method of collecting information, a distinction is made between the expeditionary method, i.e., collecting information on the spot by the forces of special statistical agencies, and the correspondent method (sending primary forms to the localities and returning them to the statistical center for processing). In work based on departmental reporting, the recording of primary information is carried out by operational workers, and their further "collection" amounts to pulling the materials into statistical bodies in a planned manner. Among the special forms of statistical observations of interest for sanitary statistics, we note the extremely peculiar in its whole plan anamnestic method, which has the task of a retrospective study of phenomena on the basis of information obtained by questioning about the past. The question of the form of recording observations depends on the organization of the survey and the technique of further computational processing of the collected materials. Technically, the records of statistical observation are drawn up on forms (blanks) of statistical observation. The technique of manual calculation (see below) gave unconditional preference to primary records made in the form of individual sheets (filling out a separate form for each registered unit, for example, primary visit statistical cards). In mechanized processing (see below), the form of a ledger or list is preferable (sequential recording of several observations on one form, for example, a population census family card). b) Statistical summary and grouping. The task of the statistical summary (processing) is the systematization and calculation of the collected observation material. By summarizing the material, the first results of measuring a mass process, expressed in absolute numbers (absolute data), are achieved. At this stage of work, the plan-outlined division (grouping) of the observed phenomena into qualitatively homogeneous aggregates must be realized. Only a theoretically correct grouping (classification) compiled with knowledge of the essence of the matter determines the value of the processing and gives the researcher, during analysis, a clear picture of the state of the studied aggregate and the emerging shifts in its development. Some special statistical classifications achieve significant complexity. An example is the classification (nomenclature of diseases and causes of death). The results of processing are presented in the form of a system of statistical tables. In each statistical table, one should distinguish the statistical subject (the list of aggregates characterized by the table) and the statistical predicate (the list of quantitative characteristics of the described aggregates). The designs of a statistical table can achieve significant complexity. Especially complex are the tables of processing large surveys, which are essentially statistical semi-finished products (e.g., publications of population census results). Tables serving analytical purposes should be as concise as possible in their design and satisfy the requirements of convenience of comparisons and comparisons of the studied aggregates. Simple and complex (group and combinatorial) tables are distinguished. Simple tables do not contain grouping in the subject and usually have an uncomplicated predicate. The significance of simple tables for research purposes is limited. The main importance in statistical research belongs to group and combinatorial tables, which provide a wide opportunity for assessments. A mandatory feature of a group table is the presence of grouping in the subject. The tasks of a group table boil down mainly to isolating partial aggregates within the general one. For example, a group table by population age makes it possible to isolate individual age groups having their own characteristics within the general aggregate (population of working age, school age, etc.). For a deeper study of processes in the aggregate, methods of a combinatorial table are used, which makes it possible to divide the general aggregate into partial aggregates according to the combination of several essential characteristics. In the example given above, a breakdown by sex and age, or by sex, age, and social status, can be produced. Examples of a simple, group, and combinatorial table can serve as the following roughly simplified samples: Simple table. Number of patients Of them: men | women Group table. Social status Men Women Total Combinatorial table. Social status Sex Age under 18 18-20 And so on. Workers .... Employees . . . 1 Men 1 Women 1 Men 1 Women Among the various types of tables, variational series (distribution series) should be specially noted, representing the division of the aggregate by quantitative values of one isolated varying (changeable) trait (see Variational statistics). Among the complex tables for mathematical processing methods, correlation tables are of particular interest, giving the distribution of aggregate units by quantitative values of two traits taken in their combination (see Correlation). The first link in the technique of summarization is the preliminary control (verification) of the quantitative completeness of the material and the quality of its filling. Without this sometimes extremely labor-intensive link, calculations cannot be started, since the possibilities of making corrections to summary tables are extremely limited, if not excluded. When checking the quality of filling in the primary observation material, digital calculations (calculation control) and the correctness of filling out the forms according to content (logical control) must be verified. Following control comes the marking (coding) of the material. During marking, individual registered traits are noted with conventional signs, usually numbers (code). The marking of the material has the task of ensuring uniformity in groupings and facilitating further operations.

Grouping and calculations are carried out in strict sequence according to a special processing scheme, coordinated with the planned system of processing tables. This work can be performed either manually (manual compilation) or mechanically (using calculating and statistical machines). Among the various methods of manual compilation, the most rational method for grouping primary material and performing calculations is the sorting of individual slips into groups. Manual work with lists is extremely difficult; in these undesirable cases, it is most rational to resort to the method of chips (extracting data onto special cards). Mechanized processing, which is becoming widespread in statistical practice, requires the prior transfer of characteristics from the primary observation forms onto special cardboard cards (punched cards). This is achieved by mechanically punching special holes in the punched cards. Subsequent groupings (sorting) and calculations are performed by the machine (statistical automatons) using punched cards with exceptional speed, which compensates for the loss of time and money in preparing the punched cards. Methods of processing the compiled material. The results of completed statistical processing (absolute data) only partially resolve the task of measuring the mass process under study. Knowledge of the measure of the aggregate's volume (the size of the phenomenon) and the absolute characteristics of its elements is extremely essential, but insufficient. A developed system of statistical characteristics, whose task is to give a clear picture of the state of the studied aggregate and the tendency of its development, must contain, alongside absolute characteristics, also statistical derivative values (relative values, average values, indices, coefficients of correlation, etc.). It should be noted that in a detailed statistical study, the task of constructing a system of statistical characteristics is resolved, as a rule, on the basis of the coordinated use of a number of statistical sources. The exhaustive awareness of the researcher regarding the quality of the materials used is a necessary condition for their correct use in computational processing. A vast and diverse class of statistical characteristics according to their tasks is formed by the so-called relative values. The most frequent application in everyday practice is found by relative distribution numbers (extensive coefficients), the task of which is to characterize the composition (structure) of the aggregate, and the usual form of expression of which is simple percentage to the total. It should be emphasized that relative numbers of distribution give only a measure of the specific weight (share) of individual parts of the aggregate in the composition of the whole and say nothing about the relative frequency (intensity) of the phenomenon in the environment in which this phenomenon arises. This task is resolved by relative frequency numbers (intensive coefficients), which have exceptionally important significance in the field of demographic and health statistics (for example, morbidity rates, vital statistics of the population, etc.). For example, the morbidity rate is calculated as the ratio of the number of sick people to the size of the population group in which these diseases occurred. Calculations of coefficients are usually carried out per 100 or 1,000 people of the population (see Coefficients). A special group of relative values is formed by coordination numbers (ratios of the volumes of two compared aggregates), according to the type of which a number of indicators in the field of the national economy and cultural construction are built (for example, indicators of population service by medical care, expressed by the number of residents falling per one physician). A thoughtful system of relative values greatly advances the researcher in their work. In addition to the aforementioned possibilities of structural comparisons and intensity assessments, it also provides simple and valuable means for measuring dynamics (see below). The task of a summary (expressed in a single number) characteristic of the studied aggregate from the side of the quantitative expression of its individual properties is resolved by the method of average values. Marxist statistics theory, categorically rejecting the idealistic theory of stability, at the same time considers it necessary to give a quantitative characteristic of the relative stability of the aggregate within the limits of a single quality. The measure of such relative stability of the aggregate is the average value. Abstracting from the individual values of individual elements of the aggregate, the average value gives in a single number a characteristic of the general measure of the aggregate, and gives a quantitative characteristic of the aggregate as a whole, from the side of the moment of its relative stability. The first practical task of the average value is to compare a given aggregate with another, or an aggregate in a given period with its state in some other period of time (in general, the method of comparison is of great importance in statistical practice). The process of abstraction in establishing the average value includes, besides abstracting from the individual values of individual elements of the aggregate, also the moments of abstraction from the diversity of essential attributes in the complex of which the qualitative unity of the elements of the aggregate is manifested. The average characterizes the aggregate by only one attribute (for example, an aggregate of people by height or weight, etc.). For a comprehensive study of the aggregate, it is necessary to calculate a system of average values characterizing the aggregate by all its essential attributes. Finally, the average value calculated for a given attribute requires the establishment of a certain point of view from which the average value should be calculated. Depending on the differently posed task for the same statistical aggregate, according to the same attribute, different forms of average values will be legitimate (arithmetic mean, harmonic mean, quadratic mean, etc.). In the language of statistical theory, this requirement is expressed in the mandatory preservation, during the transition from the individual values of the units of the aggregate to the average value, of a certain property of the aggregates, the so-called determining property. For example, when calculating the average age for an exemplary "aggregate" consisting of 5 people with different ages (19, 20, 23, 24, 24), the arithmetic mean (X) will be: X = (19 + 20 + 23 + 24 + 24) : 5 = 110 : 5 = 22 years. In general form, the formula of the arithmetic mean is such: X = -, where x are the individual values of the members of the series, and n is their number. When calculating the average, we abstracted from the individual differences in ages characteristic of the individual units of the aggregate, and as it were equally distributed among all its members the total sum of lived years. This latter property of the aggregate remained undisturbed (the "determining" property of the average). When calculating average values, it is necessary to take into account the repeatability (weights) of individual values. Every average, as a rule, must be a weighted average. The simple average, calculated "without taking weights into account," is a special case of the weighted average (equality of weights). The purposes of measuring the variability (fluctuation) of studied attributes are served by measures of fluctuation (mean absolute deviation, standard deviation, etc.). The mean deviation is calculated as the quotient of dividing the sum of the absolute values of differences (deviations) of individual values of the aggregate from the arithmetic mean value by the number of members of the series and is a simple and easily accessible elementary technique for assessing the degree of fluctuation of the attribute's values. For the example of five people with different ages, the sum of the absolute values of the deviation will be: (3) + (2) + (1) + (2) + (2) = 10 years, and hence the mean deviation is equal to 2 years (10 : 5). The formula of the mean deviation is d = -, where r is the absolute value of deviations, and n is the number of members of the series. The greatest importance among the measures of fluctuation in statistical practice, due to a number of mathematical considerations, is possessed by the standard deviation (σ), calculated as the square root of the arithmetic mean value of the squares of deviations. For our example we have: [...] where x are the deviations of the series values from the arithmetic mean, and n is the number of members of the series (see Variation statistics). For the purpose of a quantitative description of the nature of variation of an isolated studied attribute, so-called counting descriptive averages (mode, median, etc.) are also important for the study. The mode, or the most frequently encountered numerical value of the attribute for the schematic example considered above, is the value of the 24th year. The median, or the middle value, is called the value of the attribute of the series member standing in the middle of the series if all members of a given aggregate are arranged in order of increasing value of the studied attribute. In our schematic example, the median will be equal to 23 years. Techniques for the quantitative description of the variation of an isolated studied attribute constitute the subject of the doctrine of distribution series (see Variation statistics).

Methods for processing absolute and derivative characteristics of the studied statistical aggregates for the purposes of the main task of the statistical method—measuring the aspects of a process in their mutual interconnection—constitute an extensive section of methods for measuring association. The concrete association of the aspects of a phenomenon can be shown by a number of uncomplicated elementary techniques (the method of parallel comparison of series, the method of repeated groupings, techniques for the elementary analysis of a combination table, etc.). The measurement of association in the precise sense of the word as a task of quantitatively characterizing the dependence between attributes requires a number of complex mathematical techniques for its resolution. Basically, the task of measuring association reduces to: a) establishing a mathematical expression (an equation of association) that provides a characteristic of the change in the value of the studied attribute depending on changes in another (e.g., the change in the average weight of conscripts depending on their height), and b) calculating an average measure of the tightness of association (coefficient of association, in particular the correlation coefficient) (see Correlation). - Necessary and inextricably linked with the measurement of association as an element of comprehensive statistical research is the study of changes (development) of aggregates over time (time series). A number of complex questions of measuring shifts and development trends (measures of velocity, rates, forms of the level of dynamics, etc.) are associated with the analysis of time series. 3. M e d i c a l s t a t i s t i c s i n c a p i t a l i s t c o u n t r i e s. The practice of West European medical statistics has long laid the elements of the natural movement of population as the basis for elucidating issues of public health. Already the first works in this direction (Süssmilch, Graunt, Petty, etc.) are considered in the West to be the primary contribution to medical-statistical literature. The principled foundation of medical statistics was formulated in 1906 by Prinzing as follows: "Medical statistics is a special science that branches off from population statistics. While population statistics extends to all phenomena of human life, medical statistics is restricted to facts and phenomena of a pathological order... It is an exhaustive numerical investigation of the pathological phenomena of human society." The subject matter of medical statistics includes: a) statistics of births, b) statistics of diseases and accidents, and c) statistics of deaths. Birth statistics in the strict sense includes pathological phenomena—premature births, stillbirths. After the war, certain shifts occurred in socio-hygienic thought in the West toward expanding the concept of medical statistics. Thus, Fischer (A. Fischer) believes that the combination of population, social, and medical statistics, insofar as they relate to the state of public health, constitutes the very foundation of "sanitary statistics" (Gesundheitsstatistik). The progress of medical science at the end of the 19th century, especially hygiene associated with the development of capitalist technology, stimulated the use of medical statistics as a method of studying mass pathological phenomena. Utilizing the successes of bacteriology, which considered microbes to be the direct cause of all infectious diseases without connecting them to the surrounding social environment, the medicine of capitalist countries relegated medical statistics to the background. "It led, so to speak, a clandestine existence in the 'News' of medical colleges and sanitary departments, published starting from the 1870s in many states" (Prinzing). The growth of the labor movement caused the development of social hygiene (see) and medical statistics as one of its primary methods. Under the capitalist mode of production, the main purpose of which is the extraction of surplus value through surplus labor, there is not and cannot be any place for the problem of developing the physical and mental powers of the working people. The social order of capitalism consists of something else: utilizing such indicators of shifts in the health of the population that would mask the pathology of capitalism, create the illusion of the possibility of improving the health of working people within the framework of the capitalist system, and claim that such a process of raising the health level is allegedly taking place. Such a role in capitalist practice is played by the mortality rate (see). At the end of the 19th century and the beginning of the 20th century, a number of studies on mortality by occupation appeared (N. Westergaard-Copenhagen, A. Newsholme-London). The further development of medical statistics was manifested in the appearance of a significant number of works of a journal and monograph nature in Germany, England, and the USA. Since 1906, the journal «Zeitschrift für sociale Medicin» has been published in Germany under the editorship of Grotjahn and Kriegel, featuring statistical research, and was renamed in 1914 to «Archiv für sociale Hygiene und Demographie», edited by Dr. E. Roesle. The development of medical statistics in individual countries was far from uniform. Thus, in England and the USA, the basis of medical statistics is causes of death (publications on infectious morbidity began in England in 1912), and the statistical method (especially) found application in a number of disciplines bordering on medicine (e.gugenics, experimental sciences, heredity, microbiology, clinics). In general, what Marx said about social statistics can be fully applied to the sanitary statistics of capitalist countries: "The social statistics of Germany and the rest of the West European continent is in a very wretched state, it lifts the veil just enough to make one suspect a Medusa's head beneath it" (Preface to Volume I of Capital). The lack of data on total morbidity in the West is compensated to a certain extent by the statistics of morbidity of the insured. Insurance data are, first of all, operational and practical for insurance institutions. The appearance of statistical data on the morbidity of fairly large human masses was not only of practical interest, and these materials began to serve as a source for studying the morbidity of the population in general, for assessing the sanitary condition of the population, for investigating working conditions in various industries, and so forth. At the same time, it must be borne in mind that insurance materials reflect first and foremost the features of insurance legislation and the economic conjuncture, and therefore their use requires serious critical analysis. The first attempt to study sick fund materials dates back to 1820 (Scotland). German sick fund statistics has been conducting its processing according to the most simplified program on a nationwide scale since 1885; in 1890, the processing of sick fund materials was introduced in Austria. From a methodological standpoint, the data on morbidity with loss of work capacity from the Leipzig Insurance Funds for 1887–1904 are most thoroughly developed. Under the conditions of private practice, complete registration of diseases is unrealizable, nor is there any genuine interest in capitalist countries in revealing the actual state of health of the working people. Moreover, the concept of disease is insufficiently defined, and therefore morbidity statistics, in the absence of a sufficiently developed methodology, can encompass the most diverse and unequalized visits to a doctor, which does not satisfy the scientific requirements placed on the study of morbidity. The class character of medical statistics in capitalist countries, its incompleteness and imperfection, cannot be denied even by some of its most prominent representatives. Its most essential shortcoming, however, is the study, as a rule, of only those processes that do not make it possible to reveal the true picture of the health of the working masses and to uncover the class nature of differences in the morbidity of individual population groups. A formal approach, a predominantly biological illumination of the phenomena of pathology among working people in isolation from the socio-economic environment and their living conditions, is characteristic of the medical statistics of capitalist countries. The sharp wear and tear of the proletariat is not reflected in capitalist medical statistics in those metrics that are put forward as benchmarks for judging the impact of socio-economic conditions on the state of health. The "racial" theories of fascism, specific indices of constitutional differences, and the like, built on an "exact" mathematical foundation, supplement the "scientific" justification of the numerical data cited in capitalist countries. The oldest organization where both the theory and practice of medical statistics were discussed was the international statistical congresses (9 congresses starting from 1853 and ending in 1878) and international congresses on hygiene and demography (from 1878 to 1912). At present, international statistical work is associated with the International Statistical Institute, which has existed since 1885. At present, the international body that consolidates the acquisition and publication of sanitary-statistical data across a number of states is the Hygiene Section of the League of Nations, which publishes a monthly bulletin on the movement of contagious diseases and the natural movement of population, as well as various yearbooks including data on causes of death and the state of medical-sanitary assistance in individual states (39 states, 1931). At the XIX Session of the International Statistical Institute, a Soviet report was presented revealing the formal and apologetic nature of these publications: "Accroissement de la population en rapport avec les indices de la natalité et de la mortalité par le Dr. B."

Smouievitch et A. Wolkoff". 4. Sanitary statistics in pre-revolutionary Russia. In pre-revolutionary Russia, sanitary statistics as a method of studying the sanitary condition of the population arose in the 1870s and 1880s. Zemstvo sanitary statistics were a reflection of the liberal-opposition sentiments of certain circles of the petty-bourgeois intelligentsia and developed to a significant extent under the direct influence of Narodnik ideas. This determined its main characteristic features. On the one hand, it sought to identify the mass pathology of the working people (primarily the peasantry and handicraftsmen), while on the other hand, it could not rise to a genuinely class-based analysis of the phenomena being studied. One of the most recognized and characteristic definitions of zemstvo sanitary statistics is that proposed by Yanson (1887): "The totality of data on the state of health of the population, the circumstances adversely affecting it, and the means at the disposal of society to combat these circumstances constitute the field of sanitary statistics," which encompassed the synthetic tasks of socio-hygienic research rather than the immediate content of sanitary statistics as a particular branch of statistics. Since the problem of the struggle for the improvement of the health of the working people under the conditions of the feudal-capitalist system could not be developed, the most prominent theorists of zemstvo sanitary statistics, developing and substantiating the given definition, emphasized that the leading point in this formulation was the task of creating a base for the organization of medical care for the population, for "the planned arrangement of medical care cannot do without the most accurate possible accounting of the development of this care" (P. I. Kurkin). The concrete class policy of the actual masters of zemstvo medicine shattered the naive illusions of the radical zemstvo elements about the possibility of the "planned" construction of medical care within the framework of zemstvo medicine. Therefore, statistics on medical care arose as an independent section of zemstvo sanitary statistics even in the most advanced zemstvo—Moscow—only towards the end of its third decade of existence (1902). Even in the scheme of sanitary-statistical research compiled by one of the theorists and a major practitioner of zemstvo sanitary statistics, P. I. Kurkin, in 1912—a scheme that summarized almost 40 years of experience in the development of zemstvo sanitary statistics—the issues of organizing medical care occupied a secondary place; they were given in isolation, completely unconnected with other elements of the scheme, and neither in the construction of the scheme nor in its foundation was there even a hint of the determining role of this group of issues, of their significance as the target objective of the research. Thus, the practice of zemstvo sanitary statistics introduced a very substantial correction into the ideological formulation of its tasks and content given above: it emasculated from it all operationality and vitality, condemning it to academic "study-mongering." That is why even sanitary-statistical reporting, instead of being an instrument of operational management and activity, turned into a source of accumulation of materials for in-depth "scientific" study—with detailed and cumbersome programs that could not be justified ultimately by the fact that on rare occasions they served as a base for brilliant monographic works of the type of V. S. Lebedev's research on normative issues in the organization of the rural precinct network. What was the actual content of zemstvo sanitary statistics? P. I. Kurkin believed that "it would be most correct to characterize it as a general continuous and uninterrupted determination of the mass morbidity of the population." Thus, of Yanson's tripartite formula, only one link was actually realized—the study of the sanitary condition, or more precisely, one of the elements of this condition, the so-called morbidity of the population. This direction of zemstvo sanitary statistics was not only historically progressive, but also continues to constitute its greatest merit, ensuring it a higher level of development compared to Western European countries. Special note should be made of the so-called individual-family registration created in the Moscow zemstvo, which consisted in recording data on the illnesses of all family members in a single family folder. But even in this direction, the practice of zemstvo sanitary statistics introduced its own serious corrections into the theoretical schemes. Materials from a survey of the activities of zemstvo sanitary bureaus, processed on behalf of the Pirogov Society by D. N. Zhbankov and dating to 1908–1909, show that the "determination of mass morbidity" was neither continuous nor uninterrupted even in those few zemstvo provinces where it was established. But even where it was continuous across the territory, it did not exhaust the phenomenon due to the weak recourse of the population to medical care; this circumstance, making observation of the dynamics of morbidity by its level essentially impossible, limited analytical possibilities to the study of the structure of morbidity. For the same reason, complicated by the lack of methodological unity in processing, which the Pirogov Society attempted to establish (though without sufficient success), it was not always possible to compare morbidity across different territories. Finally, the use of materials for any operational purposes whatsoever was completely excluded, since processing, as a rule, ended 3–5 years after the end of the period to which the materials belonged (e.g., in 1908–1909, according to the aforementioned data of D. N. Zhbankov for the majority of provinces where processing was conducted, it was completed only on materials for 1903–1904). These belated materials were subjected to systematic analysis only in rare cases—with the exception of the Moscow zemstvo. Thus, in this main and almost sole direction of mass observations, the role of zemstvo sanitary statistics was reduced to the accumulation of materials, and consequently, the disproportion between the accumulation of materials and their use, repeatedly pointed out by V. I. Lenin in his criticism of zemstvo statistics as a whole, was a characteristic feature of its sanitary department as well. From this it is clear that the study of morbidity was not only not an operational tool, but not even a "scientific basis for organizing medical care." But even in the part where these data were used, they served primarily the class interests of the landowners and the agricultural bourgeoisie. By constructing the study of the population's morbidity in extreme detail, studying it by sex and age, by months and seasons of the year, etc., zemstvo sanitary statistics not only did not differentiate morbidity in mass processing by class groups, but, on the contrary, took credit for this, contrasting itself with the zemstvo and the class policy of its leadership: "if the Russian zemstvo itself was built on class principles, then public folk medicine in the Russian village was implemented mainly by Narodnik doctors in the famous era of the 1870s on the principles of a non-class orientation," for which "the principle of special groupings of the population... was alien to its spirit, contradicting the fundamental proposition—to serve the needs of the entire mass of the rural population on the principles of zemstvo egalitarianism" (P. I. Kurkin). The naivety and reactionariness of such positions of zemstvo sanitary statistics are completely obvious: instead of showing how the remnants of feudalism and the development of capitalism in the countryside affected the sanitary condition of different class groups, zemstvo sanitary statistics glossed over and obscured the differences in morbidity of the most exploited masses of the peasantry. Thus, the 40-year history of the development of zemstvo sanitary statistics did not justify the content outlined by its founders and in most cases did not correspond to the scheme of sanitary-statistical research that was constructed almost at the end of this period as a generalization of the experience of the most advanced zemstvo organization—the Moscow one. Various variants of partial combinations of individual elements of this scheme represent the monographic sanitary-statistical works of the zemstvo period. Not only in subject matter, but also in construction, these numerous works are extremely diverse, forming a long chain of transitional forms from primitive medico-topographical descriptions to detailed socio-hygienic research. Methodologically, they repeat the main defects of zemstvo statistics. Thus, the methodological task of zemstvo statistics, which consisted in ensuring "that the process of development of capitalism could be traced in all its ramifications and forms" (Lenin), was far from being resolved in sanitary-statistical research. Following the principle of "egalitarianism" of which zemstvo medicine, and after it zemstvo sanitary statistics, were proud, some researchers abandoned any differentiation of the sanitary condition of the peasantry by groups; others, resorting to grouping, repeated Cadet or Narodnik techniques that did not reveal typical differences, but obscured them; the most frequent of such techniques was grouping by land allotment, in which the "rural proletarian" ended up in the same group with representatives of the rural bourgeoisie. The "averages" obtained from such addition glossed over the process of decomposition and "are therefore purely fictitious" (Lenin).

Only in isolated cases, even on the basis of the above-analyzed methodology of work of individual Zemstvo doctors who were able to create a powerful indictment against tsarism on their generalized material, did they grow into documents of great political significance. An example of the few works of this type is "The Dying Village" by A. I. Shingaryov. And only the best of them managed to provide valuable materials and, in a number of cases, generalizing conclusions. These primarily include works on the study of the sanitary conditions of labor of handicraft workers. Quoting one of such works (Mollesson on the felt-boot trade), Lenin says: "Thus, sanitary doctors demand for these handicraft workers the establishment of factories, the prohibition of home work. One cannot but wish for the implementation of this measure, which would push technical progress forward, eliminating a mass of intermediaries, clearing the way for the regulation of the working day and working conditions, in a word, would eliminate the most flagrant abuses in our 'people's' industry." In the same way, a number of works on the survey of the sanitary conditions of labor of agricultural workers led to conclusions of great economic significance, despite the fact that they were not free from Narodnik illusions about the possibility of improving labor through public criticism and control. Criticizing these illusions, Lenin at the same time generally assesses such works favorably (e.g., N. I. Tezyakov) and widely uses their materials and conclusions. One cannot fail to mention the works on the study of morbidity and the construction of the medical-sanitary network by M. M. Gran (Samara Governorate), M. S. Uvarov (Kherson Governorate), Z. G. Frenkel (Kostroma and Vologda Governorates), and V. S. Lebedev. Alongside the existence of Zemstvo sanitary statistics, the minimum of compulsory information on the state of public health and the organization of medical-sanitary assistance was also regulated by the government, but the quality of these materials was significantly worse than that of the Zemstvo ones. The development of legislation on sanitary statistics in Russia is closely connected with the development of legislation on the "fight against contagious and epidemic diseases." The first legislative act obliging the local authorities to provide information on contagious diseases dates back to 1775 ("Senate Decree" of November 7). In 1839 and 1842, Senate decrees laid upon householders and doctors the duty of reporting information on contagious diseases, and the latter decree provided for the delivery by doctors of information on all diseases both in medical institutions and those treated in private practice. In 1845, punitive measures were established for failing to report cases of the appearance of contagious diseases (Articles 1029 and 1037 of the Penal Code). From 1867, compulsory medical registration of the causes of death was introduced in St. Petersburg, extending at the beginning of the 20th century to Warsaw and some Vistula Region cities. The organization of sanitary statistics in cities was in only an embryonic state. According to official materials, in 1912 only 13 provincial cities of Russia had sanitary bureaus, of which by far not all had statistical work set at the proper level. The incompleteness and unsatisfactoriness of the information collected locally depended mainly on the absence of local special statistical bodies and the low level of persons collecting statistical data (lower police ranks, volost elders, and clerks).

5. Sanitary statistics in the USSR in the restoration period. The October Revolution radically changed the paths of development of the health of workers and the organization of public health in the former tsarist Russia. This posed completely new tasks for sanitary statistics: firstly, to reveal shifts in the health of workers under the conditions of socialist construction, to establish their significance for the entire national economy and socio-cultural development, to organize their use for the purposes of socialist construction, and not only for the "organization of medical care"; secondly, to transform accounting and statistics from a "semi-legal position" (Kurkin) of a scientific basis for the organization of medical care into an operational tool of leadership and activity of all branches of the ramified system of Soviet public health. These new tasks, which changed the content of sanitary statistics, required a radical reconstruction of the theoretical and methodological foundations of sanitary statistics, its methodology and organization. However, the theorists and organizers of sanitary statistics in the restoration period...

period did not understand the fundamental, principled new tasks and features of sanitary statistics in the Soviet country, which stem from the tasks of socialist construction under the dictatorship of the proletariat. They saw only the advantages for sanitary statistics created by the Soviet public health system, its organizational unity, the recognition of the role of sanitary statistics, elevating it 'from its former (almost illegal, one might say) position to state heights' (Kurkin), the transformation of statistical work into an obligatory function of health institutions and bodies, the elimination of political obstacles for surveying the working people, and so on. Hence, the conclusion was naturally formed that the theoretical and methodological positions of the Zemstvo sanitary statistics do not require revision, that they must remain 'unshakeable,' since they retain their full significance in the Soviet period as well. Therefore, according to this concept, the new should consist only in expanding the programs of sanitary-statistical research. Numerous responsible statements by theorists and leaders of sanitary statistics in the restoration period in the press, at congresses and conferences, and in textbooks and manuals speak of such positions. This ignoring of the specific features of Soviet sanitary statistics, arising from the socialist character of its tasks, placed sanitary statistics outside the broad road of socialist construction. Such a situation can be traced in the main directions of sanitary statistics during this period. This mechanical continuation of the Zemstvo line in organizing work to monitor the dynamics of morbidity and disease incidence among workers was felt especially acutely and painfully. Proceeding from Zemstvo egalitarianism, which dictated the need for a comprehensive study of morbidity, seeing in the general statistical card, which was the methodological tool of this comprehensive statistical registration, a 'cultural achievement' of Zemstvo sanitary statistics, the leaders of sanitary statistics believed that the organizational capabilities of Soviet public health ensured the implementation of this comprehensive registration across the entire territory of the Soviet Union. It is quite obvious that such a formulation of the problem was organizationally and methodologically incorrect. Such processing of materials on morbidity smoothed over the class orientation of Soviet public health, did not arm health organs in their struggle to reduce morbidity, but turned into an operation of academic significance. Practically, this position led to difficulties, disruption, and even the liquidation of the statistics of morbidity: the compilation of a general statistical card for each case of medical consultation, applied on the scale of the USSR with the high availability of medical care and, consequently, the increased demand for it, generated over the course of a year materials consisting of hundreds of millions of cards, the processing of which annually would have represented a task equal in volume of effort and resources to the processing of the materials of the All-Union Population Census; the realization of the senselessness and aimlessness of such a system, the practical difficulties in expending such efforts and resources in the absence of another system led in a number of cases to the abandonment not only of the processing, but even of the registration of morbidity. Thus, a system that was a 'cultural achievement' on the scale of a single advanced province became a brake on the development of sanitary statistics when it was mechanically applied to the entire country as a whole, relying on organizational capabilities without taking into account the specific tasks and conditions of Soviet public health. An equally striking example is provided by the position of sanitary statistics on the issue of dispensary registration. Viewing dispensary care for working people only formally, from its external organizational side, from the standpoint of the opportunities it opens up for the implementation of the methodological plans of Zemstvo sanitary statistics, rather than the tasks that confront sanitary statistics in connection with the organization of dispensary care, the ideologues and leaders of sanitary statistics saw in this system only opportunities for realizing the old Zemstvo idea of individual-family registration. At the same time, dispensary registration became, according to Zemstvo custom, the 'commanding height' of the dispensary system, shifted the main mass of attention and effort onto itself, replaced the essence of the new method of therapeutic and prophylactic care, became a brake on the restructuring of the work of health institutions on these principles instead of being an instrument and stimulus for this restructuring, and ultimately led in a number of cases—in its most acute forms of distortion—to the discredit of the dispensary method itself. The preservation of the principled foundations of Zemstvo sanitary statistics had the most severe consequences for the organization of accounting and reporting of health institutions and bodies. Deprived of concrete connections with the tasks of operational work, in the Zemstvo period it inevitably found itself captive to Zemstvo statistical formalism with its universalism, aimlessness, and cumbersomeness. In the Soviet period, such reporting could not become an instrument of operational leadership, nor could it meet the requirements of planned public health construction. The new requirements imposed on sanitary statistics were attempted to be resolved along the lines of further mechanical expansion of programs, the layering of new forms and new types of reporting. Already in 1920, on a nationwide scale, the unification of sanitary-statistical reporting forms was carried out in the form of the 'Rules and Forms of Registration and Reporting.' Sanitary-statistical reporting of the restoration period, reflecting the attitudes of the former grassroots Zemstvo reporting, brought to the central health organs data that had no practical significance, did not arm them for planned and operational work, and at the same time cluttered the reporting. At the same time, in its guidelines, the reporting remained true to Zemstvo egalitarianism, did not reveal the class breakdown of care, and did not signal distortions of the class line. The most characteristic expression of Zemstvo ideas is the scheme of sanitary-statistical research proposed by S. M. Bogoslovsky on the threshold of the reconstruction period (in 1927). It almost does not change the research system of the Zemstvo period, only significantly expanding the list of indicators, arguing for their introduction solely by the possibilities associated with the organizational conditions of the activity of health institutions. Without revealing the specific content and tasks of the new period, without revising the understanding of the basic indicators in relation to their content and scope, without establishing a system of connections between individual elements of the research, this scheme also made no attempt to establish a demarcation of the tasks of mass surveys and special monographic works, the role of sanitary statistics in mobilizing materials for sanitary-statistical research according to this scheme—that is, it essentially ignored the restructuring of the entire accounting and statistical business in the Soviet Union. It completely failed to take into account that as a result of the restructuring and strengthening of state statistics, its synthetic nature corresponding to the interests of socialist construction, the representation of sanitary statistics within it, ensuring its consideration of tasks and requirements in the materials of other branches, the complex nature of sanitary-statistical research became possible on the basis of pooling materials from various branches of national economic and socio-cultural statistics, and thereby went beyond the narrow framework of the monograph, acquiring much broader scales. The falsity of the main paths of development of sanitary statistics in this period was not exposed in a timely manner. Numerous congresses and conferences discussing the issues of the mounting disorder of sanitary statistics were held under the same slogan of the unshakeability and inviolability of the theoretical and methodological grounds of Zemstvo sanitary statistics, and therefore the causes of this disorder were sought in the realm of organizational conditions (the structure of sanitary-statistical bodies, their place in the health apparatus, staff, etc.). 6. Sanitary statistics in the USSR in the reconstruction period. The resolution of the Central Committee of the All-Union Communist Party (Bolsheviks) of December 17, 1929, 'On the medical and sanitary care of workers and peasants,' stated the sharp lag of public health behind the pace of development of the national economy and outlined a concrete action program for the reconstruction of public health. The entire public health system faced the task of eliminating this lag, putting itself at the service of fulfilling the plan of socialist construction, becoming an instrument of this construction, and for this purpose launching a struggle to reduce morbidity and traumatism, to raise the labor productivity of the working class and peasantry of the USSR, to bring public health closer to production, and to improve the quality of medical and sanitary care for working people. Hence the task arises, along with the further quantitative growth of the network, to make wider use of internal resources for expanding and improving care, the organizational and economic strengthening of public health, to master technique and technical equipment, to restructure work on new principles of labor organization—on the principles of socialist competition, shock work, strict discipline and a sensitive attitude towards the patient, reducing the cost of care while improving its qualification and quality.

All this required a fundamental revision and reconstruction of the content of sanitary statistics, its methodology and organization. Sanitary statistics became part of the general national economic accounting in the field of public health, while it goes without saying that statistical work in the proper sense of the word retained serious significance (various censuses, accounting for shifts in the health of the population, studying the physical development of the population, etc.). At the same time, in the reconstruction period, sanitary statistics naturally had to become an instrument of the plan in the field of sanitary measures and public health. Sanitary statistics in its past understanding, not meeting the new content and new requirements, had to be transformed into an independent branch of the national economic accounting of health statistics. The state of health statistics and accounting required the creation of a single methodological center for all departments interacting and working in the field of health care. In 1930, such a center was created in the Central Administration of National Economic Accounting (TsUNKhU) and its local bodies in the form of sections for health accounting and statistics. The organizational weakness of the accounting and statistical apparatus in the departments and the underestimation of the importance of accounting in the health system during the reconstruction period and partially in the restoration period led to very serious defects in the organization of grassroots accounting, in the collection of data and in the methodology of their processing: reporting data came only from part of the institutions, for each reporting period they were collected from a different range of institutions, by virtue of which they turned out to be incomparable either with each other or with planned projections. Thus, they did not give an idea of the dynamics of the network, nor of its capacity and activity, nor of the implementation of the plan. The main task during this period thus consisted in the organization and strengthening of current accounting and reporting. Satisfying the needs of planning could not, however, be postponed until the moment when the system of current accounting and reporting would be established. This raised the issue of conducting special census-type accounting and statistical work. Thus arose the All-Union Health Census, organized in 1930 by the Central Statistical Administration (TsSU) of the USSR, and the census-type survey "Results of the First Five-Year Plan of Health Care," conducted in 1932-33 by the Central Administration of National Economic Accounting of the USSR State Planning Commission (Gosplan). Among the main tasks of sanitary statistics in the reconstruction period, the most important was the development of a system of quantitative and qualitative indicators of accounting. It was constructed from such an angle as to ensure the possibility of concrete operational management and planning, and not the tasks of academic "study." By virtue of this, the range of indicators included in accounting and reporting was extremely limited: 1) the capacity of the network of health institutions and the volume of their actual activity; 2) the degree of utilization of this capacity and the size of internal health resources; 3) the degree of provision and service of the working people, and 4) indicators of the quality of work and public service (indicators of labor productivity, cost of a visit and bed-day, the structure of this cost, technical and production indicators: the number of working days of an office, installation, etc.; load per unit of technical equipment—bed turnover, number of procedures per installation, etc.; average duration of stay of a patient in a medical institution, etc.). In connection with the development of the system of indicators, the need arose to revise the content, volume, and methodology of constructing almost all indicators: to exclude unsuccessful indicators not mastered in the practice of planning and the work of health institutions, replacing them with others, to change the methodology of constructing indicators that had survived in a number of cases from the Zemstvo times and clearly did not meet new conditions, etc. On the basis of the new system of indicators, their new content, and the new methodology for obtaining them, the reconstruction of accounting and reporting was carried out. Reporting in terms of content and volume for different links of the health system was differentiated. The tasks of concrete operational planning and management in the district link required a much more developed system of accounting indicators than in the higher links. On the other hand, the accounting and statistical forces of the district link were such that even a narrowed program of indicators for a short reporting period would be beyond their strength. Therefore, the system of health reporting was constructed as follows: health institutions submitted to the district health inspectorate once a quarter a report necessary for operational management and ensuring concrete operational observation of the implementation of the plan. The district health inspectorate compiled and submitted to the regional (krai) health department a quarterly summary of current accounting and an annual report—according to programs significantly narrower, in accordance with the needs of planning and management in the regional link. To increase the capabilities of the center in the field of concrete operational planning, the direct submission to the People's Commissariat of Health of a quarterly current report according to a more in-depth program from individual industrial centers according to a special list was established. For the same purpose, regional (krai) health departments and the People's Commissariats of Health of the republics were granted the right to receive reports from health institutions of the most important districts after their use in the district. For each department, a reporting schedule was established, regulating the content of accounting, the organization of reporting, its periodicity, and finally those obligations assigned to departments regarding the submission of reporting materials to the bodies of National Economic Accounting. Since a number of departments and organizations performed identical functions, in the interests of unifying accounting and reporting for homogeneous types of services for each branch of health care, a standard system was established for the leading department in this branch, obligatory (with some variations arising from the features of their work) for all departments and organizations participating in serving the population in this branch of health care. Obligations for collecting reporting, ensuring it with grassroots accounting, and supplying blanks and forms to their network were borne by the corresponding departments. The bodies of National Economic Accounting exercised systematic control and instruction of departments in this area and compiled summaries on the basis of departmental materials on health care as a single branch. The reconstruction of reporting could not yield positive results without the organization of grassroots primary accounting in health institutions. To an even greater extent, grassroots accounting was necessary for grassroots planning, planning and organizing the work of the institution itself, and its organizational and economic strengthening. And finally, grassroots accounting fundamentally changed the nature of special statistical surveys, turning them into accounting and statistical operations. In the absence of grassroots accounting, a survey, for example, a census of the technical equipment of health institutions, consisted of two moments: the identification of equipment, its inspection and evaluation, on the one hand, and subsequent registration, on the other. Grassroots accounting removed the first task and changed the nature of the second, turning the statistical survey into a single-moment operation consisting in using the data of grassroots accounting from the angle of the targeted setting of the survey. The survey turned from a purely statistical operation into an accounting-statistical work, for which the need to go beyond the materials of grassroots accounting arose very rarely. The problem of studying shifts in the health of working people was also posed in a fundamentally new way in the reconstruction period. Shifts in the health of working people in the USSR constituted a synthetic expression of the effectiveness of all socialist construction and at the same time one of the most serious factors of this construction. Therefore, the study of shifts had to provide not only a picture of the improvement of the health of the working class and peasantry, but also the conditions and factors of this improvement, and its impact on the course of socialist construction. By virtue of this, the mortality rate in the USSR ceased to be the only and main one in characterizing the sanitary state of the population (see Mortality). However, the problem in that formulation dictated by the course of socialist construction was not resolved by the study of morbidity established by the Zemstvo sanitary statistics. Morbidity gave only an idea of new diseases, but did not illuminate the movement of chronic diseases, the dynamics of physical development, ability to work, etc. Therefore, to characterize the shifts in the health of working people, a complex of features synthetically linked into a single characteristic was necessary. However, the features that were used until then and that could be used for such a complex (morbidity, sickness rate, traumatism, disability) bore a negative character. Meanwhile, the entire socio-economic system of the country building socialism, the entire apparatus of the proletarian dictatorship, all forms and types of public health were directed in their content not only at eliminating the remnants of capitalism in the field of health, not only at preventing morbidity, not only at reducing it, but also at the direct and immediate development of the physical and mental forces of the working people.

But in this field, even more than in others, theory lags behind practice! Medical scientific thought has not yet theoretically conceptualized this process, has not sufficiently concretized its content, and has not yet developed the methodology and techniques for its study. Therefore, health statistics still lacks a system of direct positive indicators of population health as a process of physical and mental development of the working people, and is forced to limit itself only to the aforementioned indicators of a negative character. However, under the conditions of socialist construction, these indicators also acquire a different qualitative content, reflecting a trend of positive significance: morbidity, disability, etc., show a continuous downward trend over a number of years (see USSR, Labor, Social Hygiene). Morbidity, which is understood as the relative (per 1,000 population) number of fresh cases of disease, i.e., those that arose in the current year, characterizes the process of the emergence of new diseases in a collective, its level and structure by individual types. By measuring the dynamics and nature of emerging diseases, this indicator thereby reveals the causes and conditions under which diseases arise, and characterizes the trends in the development of these conditions. Thus, this indicator arms public health in the fight against diseases, making it possible to organize their prevention. Morbidity indicators leave unknown the further development of emerged diseases, or in other words, the appearance and decrease of chronic diseases, or more briefly, the movement of chronic diseases. This gap is filled by the study of general morbidity, by which we mean the relative magnitude of all diseases (both newly arisen in a given year and chronic) registered over a certain period of time in the course of seeking medical care. But neither of these indicators gives an idea of how morbidity and general morbidity affect the labor productivity of the population, what losses the national economy suffers from these processes, or for what length of time they deprive the working people of the opportunity to actively participate in socialist construction. The disability indicator provides the answer to this. The unit of account for obtaining morbidity and general morbidity indicators is the initial visit. However, the understanding of this term is not identical in different union republics. In the RSFSR, this was considered for a very long time—and this understanding has not yet been completely eradicated even now—to be a visit registered for a given disease for the first time in life, while in the Ukrainian SSR, it was considered to be the first time in the given year. The content of morbidity in the RSFSR understanding of the initial visit included a wide variety of elements: a) diseases newly arisen in the current period; b) diseases that arose long ago and assumed a chronic course, but had not caused a request for medical care prior to this period and therefore had not previously entered registration. Such a combination of completely heterogeneous elements in a single concept speaks neither of diseases newly arisen in the reporting period, nor of the entire mass of diseases (fresh and chronic), nor of health factors, since they can be judged mainly by the line and pace of development of newly arisen diseases. The Ukrainian interpretation includes in this concept all newly arisen and chronic diseases that caused a visit in the current year, regardless of whether they had already been registered in previous years or not. Although such a concept is insufficient for determining morbidity, morbidity can be isolated within its framework. For this, along with the initial visit in such an understanding, one must also take into account the moment of the onset of the disease. Then initial visits regarding fresh diseases, not only registered but also arising during the reporting year, will characterize morbidity; whereas all initial visits made not only for fresh diseases, but also chronic ones, will speak of general morbidity. At the same time, the first request in the reporting year for medical care regarding a given disease should be considered primary, regardless of whether it was already registered in previous years or not. Registration of initial visits is carried out on individual cards, which are maintained in all outpatient medical and preventive institutions (polyclinics, dispensaries). The study of morbidity and general morbidity is carried out along two lines: firstly, according to a brief compulsory nomenclature of 15–20 forms, most important for identifying shifts in the health of workers—selectively in individual industrial centers, cities, and regions of greatest national economic importance; secondly, for certain particularly important diseases whose list is established by the Central Administration of National Economic Accounting (tuberculosis, venereal diseases, diseases associated with reproduction, cancer, rheumatism, etc.)—in a complete census or in a representative sample. Operational registration remains complete—using the individual patient card, while statistical registration on statistical coupons of individual cards is set up only in those localities where the study of morbidity is planned. The statistical utilization of materials according to the brief compulsory nomenclature for individual industrial points, cities, and regions is organized in such a way that the processing includes cities and regions where there is a sufficiently developed medical network and guarantees of correct registration; among them, first of all, those where general morbidity has not been studied for a long period. The reconstruction of the morbidity study system also included the revision of the international nomenclature of causes of death. Soviet sanitary statistics took part in the international discussion and then in the International Conference in Paris (December 1929), where the USSR delegation unfolded its system of views and proposals on this issue, corresponding to the Soviet understanding of the tasks of studying shifts in the health of workers. Health statistics does not exhaust its content with the aforementioned works included in the system of state accounting and statistics. The study of the productive function of women, morbidity according to hospital data, the application of the clinical-statistical method in scientific branches of medicine, bacteriology, and epidemiology, and the study of causes of death (see Mortality) constitute a broad field of statistical activity for the scientific forces of public health. Biological statistics—see Biometry, Variational statistics.