In last year's movie hit, "Reds," Emma Goldman, played by Maureen Stapleton, complained to John Reed that the priorities of the new socialist state in Russia were wrong. "Millions are dying," she said, "not from war, but from hunger and disease. When will the new Soviet government put its people first?"
Sixty years after the revolution, American television viewers could hear the complaint again, this time from Dr. Yevgeny Chazov, deputy minister of health of the U.S.S.R. and a member of the Communist Party Central Committee. The occasion was the first U.S. broadcast last night of a historic discussion between three American and three Soviet physicians detailing the medical consequences of nuclear war -- a discussion broadcast unedited twice on Soviet television last June.
Chazov, a cardiologist who heads the medical care team treating Soviet President Leonid Brezhnev, made no direct criticism of Soviet leaders. But when he spoke of how "the money being spent today on missiles, submarines and aircraft could do much good for the health of the people of the world," it is likely that the people on the top of his mind were his own.
The U.S.S.R. has come a long way from the traumatic post-revolutionary years when typhus and cholera were widespread and life expectancy was 30 years, but today it is in the midst of serious and unprecedented deterioration in the health of its citizens.
During the past decade, infant mortality in the U.S.S.R. increased from 23 deaths for every 1,000 births to nearly 40. For Soviet men, life expectancy fell from 66 to 62, with a smaller decrease for women. Both Soviet men and women now live an average of seven years less than their American counterparts, the largest difference in over 20 years.
When these figures were first brought to Western attention in 1981, there was uncertainty and hestitation in their interpretation. Were the numbers accurate? If so, why, in the absence of war or natural disaster, had there been such a dramatic downturn?
Today there is no longer doubt about the numbers' representing serious health problems. At a Moscow news conference last summer, Soviet health officials acknowledged the trouble, and Brezhnev mentioned it in a major policy address this year. New research suggests further deterioration and places much of the blame on an underfunded and inadequate medical care system.
From 1960 to 1978, Soviet death rates from all cardiovascular diseases increased from 247 deaths for every 100,000 citizens to over 500 -- the reverse of what happened in the United States. Here an aggressive program aimed at detecting and treating hypertension, improving diet and exercise and developing new drugs dropped heart disease-related deaths by 23 percent and the number of strokes even further. Few of these advances, including an organized program of detecting and then modifying risk factors, exist in the U.S.S.R. Hypertension is frequently not detected and often under-treated.
There is also new evidence that Soviet infant mortality rates continue to rise -- unprecedented for an industrialized country. A recent report from California that investigated the reasons behind the United States' steady progress in reducing infant mortality concluded that the specialized hospital care given low-birth- weight infants was a major factor. The United States has 462 neonatal intensive care units, with over 6,000 beds in all. The U.S.S.R. has none.
When Chazov complains of the cost of a new submarine and speaks of the need for "all people on our planet to have good drinking water and hygienic conditions," the initial interpretation is that he is talking only about the Third World. But many of the medical problems traditionally associated with underdeveloped nations, such as malnutrition, kwashiorkor and rickets, are also major causes of disease and death in the U.S.S.R.'s Central Asian republics. Chazov and many of the younger Soviet leaders of his generation surely realize they could eradicate these problems if the Soviet budget for health care, which has increased only 50 percent since 1960, were allowed to grow with the complexity of the challenges.
For too long we have viewed the U.S.S.R. only in political terms, as a powerful aggressor, the mainspring of world communism. We have failed to learn of the diversity of its people and their problems. Much of the blame for this rests on the Soviet government, which limits and controls all contact with foreigners. On television last night, however, we could hear a leading Soviet figure begin to tell the Soviet people of the extraordinarily high price they are now paying for a strong military.