Prophylactic Direction (Profilaktika)

Concept and origins

The prophylactic direction is the organizing principle of Soviet healthcare and an orientation of medical policy that places disease prevention and sanitation above treatment as the system's priority. Its roots lie in the zemstvo medicine and social-hygiene tradition of the late imperial period. In June 1918, at the First Congress of Medical-Sanitary Departments, Nikolai Semashko set out the principles of the new system in his report "On the Organization of Soviet Medicine," and with the creation of the People's Commissariat of Health on 11 July 1918 the orientation became state policy. By 1918 the principles were formulated as the state character, unity and planning of healthcare; the medical prophylactic direction; free and universally accessible care; and the unity of medical science and practice.

Dispensarization as the method

Dispensarization (диспансеризация) is the practical method of the prophylactic direction: systematic examination and follow-up that detects disease early and links it to preventive measures, including improvement of working and living conditions. Soviet medicine treated it as the basic method for solving prophylactic tasks, and Semashko summarized the principle in the formula "prophylaxis is the path we follow, dispensarization is the method for solving preventive tasks." Combined with campaigns against social diseases such as tuberculosis and syphilis, sanitary supervision and free care for the whole population, the principle was established as the core of the state health system in the 1920s and 1930s. For the same reason, Soviet medicine is described as a system that gave collective prevention priority over the treatment of individual patients.

Spread and assessment

After the Second World War the principle influenced the health systems of the socialist camp and the public health policies of countries including Cuba and the DPRK. At the same time, some accounts argue that the emphasis on prevention also served to obscure or justify the problems of late Soviet healthcare. A further assessment holds that the reorganization of the 1970s shifted the therapeutic system's weight from the district physician to specialist care, so that the prophylactic direction receded in actual practice.