Image of Soviet medicine as a historical memory component and health behavior factor in the modern youth

Introduction

The health condition of citizens determines their attitude towards the environment, their activity in various spheres of life, and their civic consciousness. At the same time, health, as a multifactorial phenomenon, includes numerous components, with both heredity and lifelong health-preserving behavior playing significant roles. An individual’s attitude towards health is shaped by information encountered since childhood, which is derived from various sources throughout life. This information influences and evolves perceptions of health and illness as life experience accumulates [1, 2].

Perception of the surrounding reality is closely tied to images of the past. Studies typically focus on citizens' historical memory of the sociopolitical past, as well as images of statesmen, prominent generals, and war heroes. These images often shape memory policy. However, the images of the past are not confined to these aspects alone. The memories of the older generation regarding their interactions with various Soviet public institutions also play a significant role. When these memories enter the media space, they can become mythologised and influence the younger generation's perception.

One of these images of the past is that of Soviet medicine and healthcare, certain aspects of which shaped citizens' worldviews and influenced their perspectives on the modern healthcare system and levels of trust in medical institutions. In this context, analysing the formation of the image of Soviet medicine is of particular interest, as it represents a potential factor influencing the views of modern youth who lack direct experience with Soviet healthcare.

Material and Methods

In the context of images of the past, the use of the concept of "Soviet medicine" is more accurately understood as the "Soviet healthcare system", embracing the achievements of medical science. Although these achievements were a source of pride in the USSR, no studies have been conducted on their representation in the memory of modern citizens. Nevertheless, certain aspects of the perception of Soviet medicine, such as image of doctors or medical institutions, have become subjects of medical and sociological research [3, 4]. However, the limitations of sample size and representativeness have been noted [5]. Some studies explore the relationship between the image of medical professionals and social expectations, particularly concerning the quality of services provided [6, 7]. Another area of research focuses on the image of doctors in works of art [8].

The image of Soviet medicine is reflected in sociological research, such as studies conducted by the Russian Public Opinion Research Centre (RPORC), as well as in sociopolitical discourse. A unique yet insightful source of information is the comments left by internet users under certain publications on news websites and blog platforms. However, these have not yet been specifically studied.

The image of past medicine is often shaped through the lens of satisfaction with modern medicine and the degree of trust in it, which are influenced by factors such as the quality of medical care and patient-centredness. Publications often critically examine aspects of modern healthcare, such as commercialisation, utilitarianism, and the emphasis on technology, which are seen as reflective of the general moral and ideological state of contemporary society [9]. It is also worth noting that the perception of the Soviet Union in the memory of modern Russians is frequently shaped by narratives that were widely disseminated through both Soviet and modern propaganda.

Principles of Soviet medicine

The principles of Soviet medicine were established in the 1960s and encompassed a fully state-run healthcare system, planned development in line with Five-Year Plans, and the unification of goals, objectives, forms, and methods of work across all healthcare institutions. Universal, free, and high-quality healthcare, as well as community-based coverage, were central to these principles [10]. At the same time, the state-run healthcare model emphasised guardianship rather than state monopoly. In the 1970s, the principle of social humanism was introduced, which incorporated professional ethics and altruism [11]. However, despite significant achievements, a range of unresolved issues adversely affected both the quantity and quality of medical care provided to the population [12].

A specific attitude towards Soviet medicine has been motivated by the fact that, following its collapse along with the regime, it has been subsequently reconstructed based on slightly different principles. The previous guarantees of universal and free medical care have been replaced by systems of obligatory and voluntary medical insurance. Private medical institutions have emerged, offering patients more convenient and client-centred services compared to state-run facilities.

State hospitals, struggling with insufficient funding, have increasingly reduced and regulated doctors’ consultation times, limiting opportunities for doctor-patient communication and moving further away from patient-centred care [13]. As not all citizens currently have access to paid medical services or sufficient free healthcare, the level of satisfaction with the system remains low [14]. This, in turn, brings a low level of trust in it.

As a result, social expectations of the healthcare system, largely determined by the sociocultural context, make up the attitude towards both Soviet and modern medicine, which are often opposed to each other.

Medical services or medical aid

The concepts of “medical service” and “medical aid” in the healthcare system are attractive to scientists and also of interest of the public. For a long time, medical profession has been considered a noble one and closely associated with a vocation. During the Soviet era, medical professionals were held in the highest esteem. One of the key distinctions between Soviet healthcare and the modern Russian system lies in the differing perceptions of the physician's role and purpose. In Soviet medicine, the physician was viewed as a specialist providing aid, whereas in the modern healthcare system, the physician is seen as a specialist delivering medical services. This contrast is reflected in terminology: Soviet medicine emphasized aid, while modern medicine focuses on services.

Many physicians highlight the positive aspects of the Soviet approach, expressing concerns that modern medicine faces risks potentially leading to the loss of the profession's status [15]. Researchers have noted that the transition of healthcare into a service industry has had a negative impact on the prestige of the medical profession [16].

Free of charge medicine

The image of free Soviet healthcare plays a key role in the nostalgic sentiments of modern citizens, serving as a foundation for the idea of a just state with extensive social guarantees. This thesis has been reflected in several studies [17].

The availability of free healthcare is one of the key components in the perception of the Soviet past, as confirmed by sociological studies. According to study conducted by the Russian Public Opinion Research Center in 2010, 4% of Russians associated the word “Soviet” with free healthcare [18]. According to a survey conducted by RPORC in 2022, dedicated to the 100th anniversary of the founding of the USSR, free healthcare was listed among the most notable achievements, recognized by 6% of respondents [19]. Although the list was dominated by advancements in science and technology, respondents also highlighted social benefits [19]. Overall, universal access to healthcare has been often regarded as a symbol of national pride.

According to the monitoring survey on social justice conducted by RPORC in February 2024, Russians defined social justice primarily in terms of social guarantees (50%), including accessible and free healthcare (6%) [20]. It is worth noting that the lack of free medical care remains one of the most pressing concerns for citizens. During the first wave of the coronavirus pandemic, RPORC studies showed that fears regarding the unavailability or poor quality of free medical care reached their lowest level in March 2020 (42%) but later almost returned to the levels observed at the beginning of the year (62%) [21].

Criticism of Soviet medicine

Despite several positive aspects, Soviet medicine is subject to criticism in various areas. Such critiques frequently appear in news outlets and on blog platforms aiming to “debunk” long-standing myths about Soviet medicine. These publications often argue that healthcare was only conditionally free, as it often involved giving gifts or offerings to medical professionals [22]. Dental care, for instance, has been described as being “associated with horrifying, torturous dental drills [23]”, with the overall quality of dental treatment and hygiene considered low.

Additional criticism is directed towards the high cost, poor quality, and limited availability of medications [24]. These publications emphasize that the Soviet healthcare system cannot stand comparison with modern healthcare, especially in light of the significant advancements in medical science and clinical practice. Moreover, nostalgic memories of "good Soviet medicine" are often likened to romanticized notions, such as the longing for “Brezhnev-era ice cream [24]”.

Comments on these publications provide valuable insights into perceptions of Soviet healthcare. Some commentators, relying on personal experiences, criticize certain aspects of Soviet medicine, such as tonsil removal without anesthesia, dental procedures and nerve extractions without pain relief, gynecological aid issues, and the general state of medical facilities of that time [25].

Conversely, their opponents highlight the accessibility and free nature of Soviet medicine, the presence of fully staffed medical personnel in peripheral regions, in oppose to the modern Russian medicine. For example, some comments note that “Soviet health and preventive care was patient-oriented, whereas modern healthcare prioritizes the interests of industrial stakeholders” [25]. The high level of professionalism among physicians of that era is also emphasized, often attributed to free medical education, where the acquired knowledge of a future doctor determined his success.

The perspectives of medical professionals who emigrated in the 1990s also deserve attention. While they often expressed dissatisfaction with the instrumental aspects of their work in the Soviet Union, they simultaneously reported a high level of satisfaction with their relationships with colleagues and patients [26].

Overall, the perception of Soviet healthcare aligns with broader trends, where positive sentiments toward the USSR remain dominant in how the Russian population views the past. Russian society continues to show adherence to the Soviet system of ideas and values. Emerging tendencies of re-Sovietization are observed [27].

Conclusion

Thus, the image of Soviet medicine is perceived within two discursive dimensions: as part of the collective memory of the Soviet past and as an element of perception of modern medicine. Considering the image of Soviet medicine as part of the historical memory of the Soviet era, it should be noted that it is not a prior theme, but remains a symbolic one, vividly characterising the bygone era through the concept of social justice. Nostalgic sentiments among Russian citizens are centered around positive emotions associated with the late Soviet period, particularly the era of Brezhnev. The Soviet Union, viewed as a stable state with free healthcare, retains its relevance in contemporary perceptions, with its negative aspects often blurred.

However, when examining the image of Soviet medicine in the context of public attitudes towards the modern healthcare system, the perception becomes more ambivalent. Alongside attributes such as free and accessible medical care, negative impressions related to the quality of services also persist. The largely mythologised image of Soviet medicine, with both its positive and negative interpretations, has percolated public consciousness and become part of everyday culture. This legacy continues to influence young citizens' trust in the modern healthcare system and state health policies, thereby shaping their attitudes towards health maintenance.

Funding

The article was written within the framework of Additional Agreement No. 073-03-2024-060/7 dated 12/09/2024 to Agreement on the subsidy from the federal budget to implement the state assignment for the provision of public services (work execution) No. 073-03-2024-060 dated 01/18/2024, concluded between the Federal State Budgetary Educational Institution of Higher Education "I.N. Ulyanov Ulyanovsk State Pedagogical University" and the Ministry of Education of the Russian Federation.

Conflicts of Interest

The authors declare no conflicts of interest.