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Posted on April 3rd, 2012, by

The objective of this essay is to compare and contrast the health care systems in Russia and Germany in the second part of the 19th century and the beginning of 20th century, and to evaluate the impact on social and political structures on public health system. The thesis of this work is the following: public health systems in Russia and Germany were almost similar in certain period but the social and political changes in both countries caused the specific features of health care systems in both countries.Ā  Two articles were used as the base of this research: “The expert and the state in Russian public health”¯ by Susan Solomon[1] and “Public health in Germany”¯ by Paul Wendling[2].

The comparison of public health systems

Russia and Germany were closely related in the historical and cultural context. The last Russian empress Alexandra, who reined with her husband emperor Nicola II at the beginning of the 20th century, was a German princess. For this reason the most prominent German ideas were widely adopted in Russia at that time. Among these adoptions was the structure of state medicine system with its advantages and disadvantages. The development of state medicine system in Russia started later than in Germany. Wendling mentions, that the first guidelines for state medical officials appeared in Germany in 1776 in times of Frederick of Prussia[3]. During the first half of 19th century the state medicine in Germany developed intensively, in particular under the influence of Scottish and English reformers. It is worth mentioning that England was the first country who experienced “the catastrophe of communicable disease in the industrial city[4]”¯, and that is why Britain authorities provided the reform of public health care system with the aim to orient it on the infectious diseases.Ā  The rest European countries including Germany followed the British example. On this time Germany has specific laws “giving the state extensive power regarding sickness registration, isolation and disinfection. (Wendling, 122)”¯ These laws appeared in German after the cholera epidemics in 1831-1832, and they became the fertile soil for the further democratic reforms in health care system. In particular, due to reform the popularization of hygiene started in Germany.

Approximately at this time the development of public health care in Russia came up with the German health care system. The real reason of such delay was in political system in Russia. Up to 1861 the serfdom existed in Russia and it prevented the development of almost all social systems including the public health care. After the abolition of the serfdom the fast development started; the influence of autocracy, which prevented the development, was decreased and the power was partly decentralized. In every region appeared the regional power institutions called zemstvos, and the governing on state physicians were shifted to the regional authorities. According the book of Nancy Frieden quoted in Solomon’s article, “physicians wager on the zemstvos turned out to have been well-placed[5]”¯ this structural reform allowed Russian physicians to emulate the patterns of their European colleagues.

Thus, it can be concludes that the development of public health care in Russia was hold back with the autocracy and serfdom, but after the serfdom abolishmentĀ  it came in line with the average European level. At the end of the 19th century Russian and German public health care systems had at least two common features: the powerful bureaucracy slowed their development in both country, and the system wasn’t headed by doctor or other medicine professional.Ā  The main difference was in the development of corporate group. While in Germany the National Association of Scientists and Doctors existed as well as its subdivisions like National Society for Public Health[6], the medical professional in Russia failed to develop the corporative group. This failure, according the opinion of John Hutchinson, cited in Solomon’s article, was the result of opposition to autocracy. The success of their German colleagues was related to the influence of common European democratic trends.

However, the reforms in the second part of 19th century brought the positive result for public health care in both countries. In the Russia appeared the concept of community physicians. In Germany were established semi-official intermediary agencies. It was, probably, the earliest initiative in these countries against alcoholism, infant mortality, tuberculosis and sexually transmitted diseases. The theoretic in both countries provided the researches in the surgery, bacteriology, sanitary engineering and social medicine. However, the information about the Russian health care system in this period is insufficient because of the absence of serious researches in this field.

The First Words War changed the situation: the health care system in German became more centralized, though the centralization in Russia was problem.Ā  It is known, that after the fall of czarism in Russia and the collapse of German Empire new authorities tried to implement the most prominent idea of their forerunners in both countries.


The autocracy in Russia always prevented the development of its public health care. Meantime Germany always stayed in line with other European countries. In the short period of the autocracy weakening in the second part of the 19th century Russian health care system came up with the German system, but the further autocracy strengthening slowed the development of public health care again.

[1] Solomon, Susan Gross. ““The expert and the state in Russian public health: continuities and changes across the revolutionary divide”¯.

[2] Wendling, Paul. Ā “Public health in Germany”¯

[3] Ā Wendling, 122.

[4] Ā Hamlin, Cristopher. “State medicine in Great Britain”¯, p. 132)

[5] Ā Solomon, 187.

[6] Ā Wendling, 123.

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