Nikolay Semashko: the creator of Soviet healthcare

02  12.2024 The Soviet healthcare system was considered one of the best in the world. Its uniqueness lay in the unified principles of organization and centralization of all healthcare, and the key role was played by free of charge, accessibility and qualification. The creator of the model was Nikolai Aleksandrovich Semashko, the first People's Commissar of Health of the Soviet Union.

Nikolai Aleksandrovich Semashko was born in September 1874 in the village of Livenskoye, which was located in the Yeletsky district of the Oryol province (now in the Zadonsky district of the Lipetsk region). Semashko came from an intelligent family: his father, Alexander Severinovich, was a teacher, and his mother, Maria Valentinovna, came from a noble family and was the sister of the philosopher and Marxist Georgy Plekhanov. Nikolai Aleksandrovich was a student at the Yeletskaya gymnasium, where he studied with the future writer Mikhail Prishvin. Even then, Nikolai understood that in order to change the lives of ordinary people, it was necessary to carry out reforms in the country. In 1891, Nikolai Aleksandrovich graduated from the gymnasium and entered the medical faculty of Moscow University. In 1896, a wave of arrests swept over Moscow University. The gendarmes detained many students for participating in the revolutionary movement. Semashko failed to avoid repression: Nikolai was sent to Yelets, where his actions were monitored by the police. Nikolai discussed Marxist ideas with several teachers and helped with propaganda. Soon, students joined them, and a Marxist circle was formed in Yelets.
But Nikolai Aleksandrovich still wanted more. He was too bored in the small town, it lacked scope. Therefore, in 1898, when the period of eviction ended, Semashko moved to Kazan. The local students greeted Semashko as a real hero, and he began vigorous activity at Kazan University. In a short time, Nikolai managed to put together several political circles, establish cooperation with workers of the largest enterprises in the city.
Nikolai Aleksandrovich wanted to get a diploma, so he cheated: he settled in the suburbs of Kazan, glued on a moustache and beard and attended classes. The teachers, of course, knew about this trick, but no one gave away the agitator and propagandist. Semashko became a certified specialist.
The young doctor worked in the Oryol and Samara provinces. What he had to face only convinced Semashko of the correctness of the revolutionary path. Alexander was depressingly affected by the lack of normal medicines and the fact that the peasants had to be treated according to special instructions. The recommendation "try to eat more butter, eggs, milk", in his opinion, was a real mockery of the starving people. It was necessary to conduct educational work with the peasantry only according to a special leaflet approved by the censors. However, Semashko quickly abandoned the instructions, moreover, he organized illegal political circles, the basis of which was the peasant youth. Of course, it was not possible to hide this from the police, Nikolai once again faced the prospect of arrest. In order not to end up behind bars, he moved to relatives in Nizhny Novgorod, where he got a job as a provincial sanitary doctor.
Here Nikolai continued his political activities. Its crowning glory was participation in numerous workers' protests in the winter of 1905. Semashko led medical teams that helped wounded people on the barricades. However, the uprising quickly petered out, followed by raids and arrests. Nikolai Alexandrovich ended up behind bars, and was released only at the very beginning of 1907.
Understanding that a new arrest was a matter of time, Nikolai emigrated to Switzerland. The young doctor hoped that in a European country he would be able to fearlessly engage in revolutionary agitation, but he was mistaken: he was sent to prison. Unexpectedly, Lenin himself acted as a savior. Vladimir Ilyich hired the best lawyers, who managed to secure the release of Nikolai Alexandrovich. Once free, Semashko, together with Lenin and the Bolsheviks, moved to Paris. A whirlwind of events swirled Nikolai Aleksandrovich: he visited several European countries, where he gave reports, and at the very beginning of 1912, Semashko participated in the VI (Prague) All-Russian Conference of the RSDLP. From the rostrum, he spoke about the need to radically change the approach to workers and working conditions, and it was necessary to start with an insurance reform that should protect people. The party approved Nikolai Aleksandrovich's report.
In 1917, Semashko returned to Russia. He joined the Council of District Dumas and headed the medical department. Nikolai Aleksandrovich's first job was organizing medical care for people who suffered during the October events in Moscow.
In the summer of 1918, the First All-Russian Congress of Representatives of the Medical and Sanitary Departments of the Council of Workers, Soldiers, and Peasants' Deputies took place. The congress was productive: the delegates made an important decision to create a Health Commissariat. Semashko received the post of the first People's Commissar of Health.

The work ahead was colossal. After the Civil War, the country demanded quick and effective measures. Nikolai Alexandrovich had to solve a difficult task - to overcome the mistrust of medical workers. At that time, no one really understood what the Soviet government was, how long the communists would stay at the helm. The Bolsheviks were perceived as destroyers of the usual way of life, some kind of bandits who had settled in the Kremlin. Semashko, by personal example and authority, proved to doctors that medicine was not an empty phrase for the new government. The People's Commissariat of Health acted as a guarantor that the Bolsheviks cared about the health of the people. By February 1919, Semashko had achieved impressive results. The Commissariat of Health had fully implemented the idea of ​​​​insurance for workers, which in turn made it possible to move on to the next stage - social medical care for all residents of the country, which was indicated in the decree of 1918. One of the most serious problems of the Russian Empire was infant mortality. Thus, according to statistics for 1905, out of every thousand who died, two thirds were children under the age of five. To change the situation, reforms affecting motherhood and childhood began in the country. In a short period of time, the Health Commissariat created a network of children's clinics where qualified doctors worked. A thorough and serious approach allowed for a significant reduction in child mortality in a few years.
Another serious problem inherited from Tsarist Russia by the Soviet state was tuberculosis. Semashko himself called it a "proletarian disease". Nikolai Aleksandrovich considered the main method of combating the disease to be providing people with normal housing conditions. Tuberculosis mainly affected city dwellers who, due to financial problems, lived in basements and barracks where unsanitary conditions reigned.
The second, no less important method was to increase the number of anti-tuberculosis dispensaries and sanatoriums. On Semashko's initiative, the water filtration system in large cities was taken under control. At the same time, medical units began to appear at enterprises; their responsibilities included providing emergency care, preventing and treating occupational diseases. In addition, medical units issued vouchers to health resorts.
In 1923, the Main Resort Administration was created under the People's Commissariat of Health of the RSFSR, construction of new resorts and health resorts began, and a network of specialized institutes developed.
Under the leadership of the first Soviet People's Commissar of Health, sanatoriums and resorts began to appear. For example, in 1925, specialists converted the Livadia Palaces of Crimea into sanatoriums with 500 beds, where peasants rested and received treatment for free.
The introduction of vaccines had a beneficial effect on the general health of the inhabitants of the USSR. Adults and children were vaccinated against the most dangerous and widespread diseases. Many vaccines were developed directly by Soviet scientists, which was a real breakthrough.
The Health Commissariat actively fought epidemics and infections. In 1922, Nikolai Alexandrovich opened the Department of Social Hygiene, which was based at the Medical Faculty of Moscow University.

N. A. Semashko played a great role in the creation of the system of protection of motherhood and childhood. By 1920 (the civil war had just ended!), 567 nurseries, 108 mother and child homes, 197 consultations, 108 milk kitchens, 207 shelters for infants were deployed in the country. At the end of 1922, the State Scientific Institute for the Protection of Motherhood and Infancy was created, headed by Professor G. N. Speransky. Over time, a well-organized state system of protection of mother and child health with an extensive network of medical, preventive and health institutions was formed in the country. Numerous health care reforms led to the emergence of the "Semashko system" - a revolutionary approach to medicine. In just a few years, this model bore impressive fruit. Changes occurred in all areas of medicine, which allowed it to reach a fundamentally new level. N. A. Semashko and his associates form a new (the first in the world!) health care system, the main principles of which were:

• Free and generally accessible medical care
• State character
• Involvement of the broad masses of people in health prevention
• Close connection between science and practice

The system of budget financing of health care, first created in the Soviet Union by the efforts of N. A. Semashko, operates in Great Britain, Sweden, Denmark, Ireland, and Italy.
At the insistence of N. A. Semashko, a number of preventive disciplines (social hygiene, occupational hygiene, hygiene of education) were included in the curriculum of medical universities. At the same time, two-year pharmaceutical schools were created. Paramedic schools were reorganized into paramedic-obstetric schools. Since the early 1920s, the first dental schools were created, short-term courses were opened to train and improve the quality of mid-level medical workers of various profiles.
Semashko's focus on improving the quality of medical education worked. Thanks to the active development of research institutes and universities, the country received a large number of young and qualified specialists. In the 1930s, the Soviet Union became one of the leading countries in the world in the production of various drugs for the mass consumer. A huge leap occurred in the study of diseases and, accordingly, methods of their treatment. As a result, people received high-quality, progressive and, most importantly, free medicine. Nikolai Semashko was directly behind this success. Nikolai Aleksandrovich headed the Institute of School Hygiene of the Academy of Pedagogical Sciences of the RSFSR, the Institute of Health Organization and History of Medicine of the USSR Academy of Medical Sciences. He was the initiator of the creation of the Central Medical Library and the House of Scientists in Moscow. In 1927-1936, he was the editor-in-chief of the Great Medical Encyclopedia. It is clear that Nikolai Aleksandrovich was not the only one who created the system that was named after him. But it was Semashko who clearly implemented the state line, brought to life the boldest and most ambitious ideas. If someone else had been in his place, it is unknown whether such high-quality progress would have occurred in such a short time.

When the Great Patriotic War began, Nikolai Aleksandrovich went to Ufa, where the authorities evacuated his department of healthcare organization. However, in the spring of 1942 he returned and began collecting materials on the work of medical institutions. After the war, Semashko took on the restoration of the healthcare system in the territories damaged during the occupation.
The results of practical work in these responsible positions formed the basis of scientific work. In 1921-1949, N. A. Semashko was a professor, head of the department of social hygiene at the First Moscow Medical Institute. He generously shared his knowledge and enormous experience with young people.
The work of People's Commissar Professor Nikolai Aleksandrovich Semashko was recognized at the scientific (academician of the USSR Academy of Medical Sciences and the Academy of Pedagogical Sciences of the RSFSR) and state levels: he was awarded the Order of Lenin and the Order of the Red Banner of Labor, and many medals. In Moscow, the Federal State Budgetary Scientific Institution "National Research Institute of Public Health", the Private Healthcare Institution "Clinical Hospital "RZhD-Medicine", OJSC "Moskhimfarmpreparaty" and others are named after the outstanding organizer and scientist N. A. Semashko. Until his death in May 1949, Nikolai Aleksandrovich worked in the healthcare system. After himself, Semashko left a colossal legacy in the form of an exemplary system, which was adopted by many countries.