Сразу хочу развеять популярный миф о том, что наша система была в каком-то там году признану лучшей. Действительно в одном из докладов ВОЗ имела место фраза, что советсткая система Семашко является самой эффективной ДЛЯ РАЗВИВАЮЩИХСЯ СТРАН. Об этой второй части высказывания как-то умалчивают. Система была признана эффективной для борьбы с инфекционными заболеваниями, для чего она в общем и создавалась. Для борьбы с неинфекционными заболевания система не годится.
Ниже привожу выдержку из доклада ВОЗ 2000 года по российской системе здравоохранения
Russian Federation
The period until 1991
At the end of the nineteenth century, life expectancy in Russia was 32 years,
compared to 47 years in France and the United States. By 1938 the gap had
increased: life expectancy was 43 years in Russia, while in France it had reached 59 years and in the United States over 63 years. In the course of roughly the next 15 years, however, Russia made huge strides and succeeded in closing much of the gap. By 1965, life expectancy for males was 64.3, 67.5 and 66.8 for Russia, France and the United States respectively, and 73.4, 74.7 and 73.7 in the case of females (6). However this progress was not maintained in later years. The factors behind these developments will be outlined below. Following the establishment of the “Semashko” model in 1918, Russia made massive strides in arresting the spread of infectious diseases. Drastic epidemic control measures were implemented, particularly in the cases of tuberculosis, typhoid fever, typhus, malaria and cholera. These involved community prevention approaches, routine check-ups, improvements in urban sanitation and hygiene, quarantines, etc. (For an account of health system conditions related to health status development see the section below Historical background).
Progress in controlling infectious diseases continued to be made throughout
the entire Soviet period, with crude mortality rates from infectious diseases
falling from 87 per 100 000 in 1960 to 21 in 1980 and 12 in 1991 (representing
a fall of 86%) (7). Yet these successes were not reflected in improvements in
the overall health status of the population. Whereas life expectancy in Soviet
Russia (and the entire Soviet Union) showed continuous improvement until
the 1960s, it subsequently stabilized, presaging a growing gap with western
nations that were to experience continuously increasing life expectancies. By
about 1990-91, male life expectancy was roughly at the same levels or lower
than in the 1960s (63.8 years in 1990 compared to 63.0 years in 1959 and 64.3 in 1965), while female life expectancy had improved only slightly over the
30-year period (71.5 years in 1959, 73.4 years in 1965, and 74.3 in 1990). The variation in death rates after 1965 was particularly unfavourable in Russia’s male population (8). By the beginning of the 1980s the gender gap in life expectancy was about 12 years, which is largest of all countries in the world (9). Infant mortality stood in 1971 at 22.9 per 1000, having fallen to less than one tenth of pre-revolutionary Russian figures and roughly one quarter of those of 1950 (although the use of the Soviet definition of a live birth prior to the mid 1990s means that these figures are about 20% lower than they would have been using the WHO definition) (10). However in subsequent years they began to climb, reaching 24.7 in 1972 and 27.4 in 1974. At that time, with the appearance of declining health status indices and widening gaps with the west, the Soviet authorities decided to stop publishing data. The diverging paths of Russia and other industrialized nations with respect to health status from the 1960s onward has been attributed to the failure of the Russian health care system to successfully respond to the epidemiological transition. In a sense, the very factors making for the successes of the early years in curbing the spread of infectious diseases were responsible for the inability to effectively cope with noncommunicable diseases that were becoming increasingly important. The Soviet health care system was based heavily on prevention, consisting of extensive screening measures and check-ups, although with little evidence for their effectiveness, which together with the introduction of antibiotics after the Second World War, contributed to major reductions in infectious diseases. This system of prevention, with its primarily medical orientation, did not evolve into one of population-based health promotion measures necessary for dealing with the new patterns of morbidity (due to noncommunicable diseases). While those in power were aware that an epidemiological transition was occurring, they responded by treating cardiovascular and other noncommunicable diseases as “social diseases”5
requiring a medical solution (7).
Как видно из приведенной статистики проблемы у нас начались еще в 60 годах.