Academician Chazov has a reputation of the Kremlin’s doctor who has signed more than one medical necrologues for General Secretaries of the Communist Party. One of them, it was Yuri Andropov, asked him once (Mr. Chazov was then the head of the 4th Chief Division of the soviet health ministry) why the percent of those recovering is higher in his elite division. Having been answered that it was due to good prophylactic measures, he wondered how much it would be to spread such experience to the nation-wide scale. Soon the figure was on his desk. Having pondered on where to find so much money, the legendary man from KGB said allegedly “Well, we shall oblige the enterprises to do it”… At Putin such a policy is called “social responsibility of business”. Evgeny Chazov has left ministerial position long ago, yet he is still taken advice from by the young leaders. Novaya Gazeta also asked him for an expertise.
Q: Evgeny Ivanovich, everyone remembers you as the chief of the elite 4th Division at the soviet health care ministry, who imposed general prophylactic medical examination in the country. Does that achievement still exist?
A: I’m going to show you a glossy that is published in Russia, where there is an interview by my American colleague Bernie Lown. To a question which system of the health care is best in the world, he answered “Cuban, of course”. This was said by a Yankee doctor about the country of the winning socialism under their nose! Yes, really life interval is 80 years there. During the initial period after their revolution it was me to be sent there as a consultant for reorganization of the private health care system into the public one. My recommendations were based on so called Alma-Ata declaration by the Soviet Health Care Organization about building up the system in accordance with these principles: arranging the preventive measures, primary health care (district doctor) and high technologies. Today I would add raising qualifications by specialists to those three fundamental principles.
Q: The system was soviet and it won not with us!
A: We also had good results. Just two years after our team began to work in the public health ministry, the life interval in the Soviet Union increased from 68 to 70 years, while infant mortality rate dropped from 26 to 18 cases per thousand of born children. Now let’s see the year of 2005: the general mortality rate (it was with us) of 1,560,000 increased to 2,500,000 deaths per year, while the average life interval came down to 64 years with females and 58 years with males. Why? The matter is that in the 90’s under the slogan “when you will become rich, you will be healthy” everyone just forgot about public healthcare as a system, as a branch. In the USSR there were three thousand preventive departments, today we don’t have any.
Q: Where have they got to?
A: They were just closed down. In England Margaret Thatcher privatized almost anything, except the system of public health care. Being a minister, I asked her why she did not set a finger on that. She answered she thought if she did that she would stop being a Prime Minister after two weeks. Why am I saying all that? Out from 11,361 special soviet clinics remaining now are only some in Gazprom and Russian Railroads agency (whose clinics are often better than the local ones). Annual medical preventive examinations of 130 millions people, prophylactic examinations of 65 millions a year – all that has gone now. Only now, thanks to national projects oriented to the primary level of medicine and to high technologies, two of the three mentioned above fundamental principles are getting to be supported by the state. Well, it’s about time the first one was cared about too. In America and Norway preventive measures are put into collective agreements between employees and trade unions, while with us…
Q: It’s clear that in Soviet Union there was a feasible state-financed medicine. Then the country ran out of money, and other people came to power, who put off all the “loading” socialist obligations. The rich got a quality paid medicine, while the poor had to deal with same doctors and hospitals, but the drugs were not given for free this time. The system cannot work without proper financing. Was that stratification inevitable?
A: The misappropriated billions should have been passed to the public health care. Our poor state was featured with longest life interval!
Q: That was not for long, though. There was a terrible demographic fall after boom.
A: You are right. You know when we had the highest percent of GDP given for public health purposes? It was in 1964, when we had favorable external conjuncture, and so on. Much depends on organization. The health care system provides for 60% of necessary life interval, while the rest of 40% depends on other social factors. Each small factory had its own recreational house, and each public office had its own summer camp for children. When Perestroika began, I wrote a report for Mikhail Gorbachev to be submitted at Politburo. And there I said that most regretful thing was that the capitalist society contributes much more to the public health compared to the socialist society. That was seen from the GDP shares dedicated to it: USSR spent 3.2%, Great Britain 6%, France 9%, FRG 8%. And we formulated then to reach the level of 6% only after new millennium coming.
Q: And what is the figure of today?
A: About 4%. And in soviet times we managed to overcome smallpox and tuberculosis thanks to the preventive measures system.
Q: Tuberculosis came back later?
A: Yes, because the primary social issues were not solved. It’s only now that billions are beginning to be spent on social programs in the public health area. The previous system was built as a vertical, and now it is given to municipalities. While excellent hospitals are built in some parts, in others there are no funds for that. There must exist federal help for development of public health care in poorer provinces.
Q: Why within the frames of the national project the wages were raised for the most mass class – district general practitioners – while single-function doctors were forgotten. Was it done just to attract the medical electorate?
A: This is what I’m talking about: we need the fourth fundamental principle – that’s the qualifications raising program for doctors. At the time being, the specialists from Belgorod, Astrakhan, Penza regions are having a study course at our cardiologic center. We are giving special courses for advanced training. We also hold teleconferences.
Q: Teleconference with a hospital where no one is skilled enough to work with the equipment brought within the frames of the national project? Maybe, the money is spent in the wrong way?
A: You will write it as revelation, but Dmitry Medvedev has already said that. He sat just in this seat when talking to me. What’s the problem now? Nothing good will come out in a situation where governors don’t care about what is going on in their regions. There is no medical vertical: the system of the regional public health care formally is not submitted to the health ministry, as every region has its own health minister. Inter-district hospitals are difficult to be started, as no one wishes to give the best hospital to one’s neighbor. Only good-willed interference by the governor has allowed making such a hospital in the city of Ivanovo, for example.
Q: As an expert for cardio-vascular diseases, could you tell why they do not decrease?
A: We are keeping register of what works how. There is a program of struggle with hypertension. We shot 5-minute clips dedicated to the topic and sent them to the regions so that local TV show that. Almost from anywhere a response came “Please make payment”. Why must we struggle while the TV washes its hands of it and gets money from manufacturers for advertising the nasties?
Q: How many prophylactic medical examinations can the state afford a year?
A: When the wages of district general practitioners were raised, they began to have it as a responsibility. We studied their working in a number of well-developed rich regions, like St Petersburg and Sverdlovsk region. We have found that the reduction of the blood pressure figure to the norm happens only in 52% of cases. The doctor gives a prescription and does not care what happens next. After a year we check the situation to find out that out of those 52% only 5-10% continues receiving the necessary medications, while the others just go on with their hypertension.
Q: You have already referred to the authority of our new president who used to be the curator of the national project for public health care. What has been done for training the personnel at least at your cardiologic research center?
A: We offer a qualification raising program. There are three levels. The first one is people of highest professional level working with us, like academician Akchurin. We conclude a contract with him for 2-3 good surgeons, who come to work with him for a year on the constant basis. After that they go to a foreign clinic for half a year and after that they come back as A1 specialists. Renat Suleimanovich himself used to be a good micro-surgeon, but he had never been engaged in heart surgery. We sent him to my friend Michael Debeiki. He worked with him for some while and became one of the leading cardiac surgeons in Russia. The second level is qualification of a specialist of a middle level. To get it, a person works with us for 2-3 years. Every year we are able to accept about 10 people for this program. The third level is a master class program titled “152 Hours”, where we make highly skilled specialists out of common surgeons.
Q: What else is to be done?
A: Teaching medicine must be changed at medical institutes in favor of medical practice. When I was finishing my fifth year in Kiev in 1953, they added the sixth one. What for? For working in real hospitals and getting the experience of clinical thinking. Today’s students at the 6th year just revise the lectures given to them when they were at 3-4th year. I’m not sure whether people who graduate today from medical institutions have ever held at least forceps in their hands when they studied the course of surgery.