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Public healthcare came late to Russia, and it developed along two paths: a state system and a community medicine system. The state system developed first with a small number of hospitals in Russia’s capitals (Moscow and St. Petersburg) and some army hospitals, leaving healthcare in rural areas mostly to the individual. When, from the 1860s,  zemstvos  as institutions of local self-government were introduced, a public healthcare system (“community medicine”) started to be developed. It coincided with the bacteriological revolution and functioned during the great epidemics of, for example, cholera, typhus, and plague. Infectious diseases affected Russia and were often linked to famines, a social affliction with which the government tried to cope. In the late nineteenth century, epidemics led to the foundation of research institutes and laboratories. Shortly before the outbreak of the First World War, the establishment of a ministry for public health was discussed but was postponed. However, it was the Great War that gave impetus to the modernizing process, although initially there was no centralization. Both the state system and the  zemstvo  systems expanded—for the army as well as for the civilian population. The state and  zemstvo  systems continued to rival one other, but an outstanding coordinating role was played by a member of the royal family. Leaving the First World War after the October Revolution, Russia immediately plunged into the Civil War, which resulted in the complete dissolution of non-governmental healthcare bodies, which had been so significant during the war. In Bolshevik-controlled Russia, all healthcare institutions were subordinated to a centralized ministry of health, thus abolishing the Unions and the Pirogov Society. This article describes the conflict between the pre-First World War state and  zemstvo  healthcare systems, the efforts for improvement during the war, and the centralization after the war.

Russian Public Health during the First World War