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Offline: Revolution—a prescription for health?
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Offline: Revolution—a prescription for health?
Popperfoto/Getty Images
Universal History Archive/Getty Images
On Feb 19, 1917, amid bread shortages and sub-zero temperatures, Petrograd officials announced the imposition of food rationing. A slowly lengthening crack in Russian society now turned into a deep fracture. 4 days later, 100 000 workers took to the streets, shouting “Down with the Tsar!” A general strike soon followed. By Feb 26, amid mounting fear and anarchy, the police and army shot and killed 50 demonstrators. Mutiny ensued. The Revolution was set on an irreversible course. Government imploded. Tsar Nicholas II abdicated on March 2. A Provisional Government was established. Lenin returned to Petrograd on April 3. By October, the government had been overthrown. Bolsheviks took the Winter Palace on Oct 26. Lenin had won full control of the country. As John Reed wrote in Ten Days That Shook The World, “Adventure it was, and one of the most marvellous mankind ever embarked upon”. And for the citizens of the time, it was indeed a year full of hope. The poet, Mikhail Kuzmin, saw only possibility: “The Russian Revolution is youthful, chaste, and good…it struts down the pavement, plain and simple, like an angel in a workman’s smock.” *
Mikhail Svetlov/Getty Images
Universal History Archive/Getty Images
Have revolutions been good for health? There is ample evidence available. The short-term answer is surely no. Fundamental changes of political power, accompanied by violent and bloody upheavals to economies and cultures, must inevitably destabilise and damage, even destroy, health systems. The delicate infrastructures and networks of surveillance and care that control disease and protect health are all too easily disrupted by civil war and mass terror, whatever the claims revolutionaries might make for emancipation and freedom. But the longer term answer is more complex. The widespread political unrest and public protests of 1848 (which some historians call revolutions) across France, Germany, and England certainly helped to trigger new national movements for public health, new public health institutions and laws, new disciplines (social medicine and epidemiology), and new shifts in medical philosophy towards prevention. It is the philosophical transformations ushered in by revolution that may have the most influential effects of all on health. As Olivier Nay and his colleagues pointed out last year in a Lancet Series on France, the principles of universalism and equality that 586
underpin the French health system today can be traced back directly to the ideals of the French Revolution. * But it is easy to romanticise. Russia’s healthy life expectancy in 2016 was 58 years for men and 66 years for women; the comparable figures in the US were 67 and 70 years, respectively. Still, there is more to health than health metrics. As Andrew Steptoe and others have argued, wellbeing has multiple dimensions—life satisfaction, feelings of happiness, sadness, anger, stress, and pain, and a sense of purpose or meaning to one’s life. Historians and health scientists don’t take these aspects of wellbeing seriously enough. In Orlando Figes’ history of the Russian Revolution, he concludes that Russians today have a “troubling attitude to the revolution’s violence”. Two- thirds of Russians, he reports, believe that Stalin had been positive for the country, despite the deaths of 10 to 30 million people under his repressive rule. Figes does not consider that those “troubling attitudes” may serve a valuable purpose. Perhaps positive and admiring beliefs in Russia’s past (and its murderously flawed leaders), pride in the nation’s ambiguous achievements, and justification of their government’s dubious actions have substantial and important pro-health effects. To vilify the history through which the lives and values of Russian (or Cuban, Iranian, or Chinese) citizens today have been shaped, as critics sometimes do, may only weaken still further prospects for the resilience and health of Russia’s people. By instilling a sense of historical purpose and meaning to lives that may otherwise face considerable physical, mental, and social hardship, post-revolutionary governments, no matter how much we may disagree with their politics, may be doing something right to protect the health of their citizens. Perhaps the mythical narrative of revolution (more than the actual revolution itself) is a powerful prescription for human wellbeing. Since we have no counter-factual for comparison, we are likely never to know for sure. But it is at least possible that revolutions have had profound, long-lasting, and immeasurably beneficial therapeutic effects. Revolution, to use Kuzmin’s metaphor, as an angel of health. Richard Horton [email protected]
www.thelancet.com Vol 389 February 11, 2017
Offline: Revolution—a prescription for health?
Popperfoto/Getty Images
Universal History Archive/Getty Images
On Feb 19, 1917, amid bread shortages and sub-zero temperatures, Petrograd officials announced the imposition of food rationing. A slowly lengthening crack in Russian society now turned into a deep fracture. 4 days later, 100 000 workers took to the streets, shouting “Down with the Tsar!” A general strike soon followed. By Feb 26, amid mounting fear and anarchy, the police and army shot and killed 50 demonstrators. Mutiny ensued. The Revolution was set on an irreversible course. Government imploded. Tsar Nicholas II abdicated on March 2. A Provisional Government was established. Lenin returned to Petrograd on April 3. By October, the government had been overthrown. Bolsheviks took the Winter Palace on Oct 26. Lenin had won full control of the country. As John Reed wrote in Ten Days That Shook The World, “Adventure it was, and one of the most marvellous mankind ever embarked upon”. And for the citizens of the time, it was indeed a year full of hope. The poet, Mikhail Kuzmin, saw only possibility: “The Russian Revolution is youthful, chaste, and good…it struts down the pavement, plain and simple, like an angel in a workman’s smock.” *
Mikhail Svetlov/Getty Images
Universal History Archive/Getty Images
Have revolutions been good for health? There is ample evidence available. The short-term answer is surely no. Fundamental changes of political power, accompanied by violent and bloody upheavals to economies and cultures, must inevitably destabilise and damage, even destroy, health systems. The delicate infrastructures and networks of surveillance and care that control disease and protect health are all too easily disrupted by civil war and mass terror, whatever the claims revolutionaries might make for emancipation and freedom. But the longer term answer is more complex. The widespread political unrest and public protests of 1848 (which some historians call revolutions) across France, Germany, and England certainly helped to trigger new national movements for public health, new public health institutions and laws, new disciplines (social medicine and epidemiology), and new shifts in medical philosophy towards prevention. It is the philosophical transformations ushered in by revolution that may have the most influential effects of all on health. As Olivier Nay and his colleagues pointed out last year in a Lancet Series on France, the principles of universalism and equality that 586
underpin the French health system today can be traced back directly to the ideals of the French Revolution. * But it is easy to romanticise. Russia’s healthy life expectancy in 2016 was 58 years for men and 66 years for women; the comparable figures in the US were 67 and 70 years, respectively. Still, there is more to health than health metrics. As Andrew Steptoe and others have argued, wellbeing has multiple dimensions—life satisfaction, feelings of happiness, sadness, anger, stress, and pain, and a sense of purpose or meaning to one’s life. Historians and health scientists don’t take these aspects of wellbeing seriously enough. In Orlando Figes’ history of the Russian Revolution, he concludes that Russians today have a “troubling attitude to the revolution’s violence”. Two- thirds of Russians, he reports, believe that Stalin had been positive for the country, despite the deaths of 10 to 30 million people under his repressive rule. Figes does not consider that those “troubling attitudes” may serve a valuable purpose. Perhaps positive and admiring beliefs in Russia’s past (and its murderously flawed leaders), pride in the nation’s ambiguous achievements, and justification of their government’s dubious actions have substantial and important pro-health effects. To vilify the history through which the lives and values of Russian (or Cuban, Iranian, or Chinese) citizens today have been shaped, as critics sometimes do, may only weaken still further prospects for the resilience and health of Russia’s people. By instilling a sense of historical purpose and meaning to lives that may otherwise face considerable physical, mental, and social hardship, post-revolutionary governments, no matter how much we may disagree with their politics, may be doing something right to protect the health of their citizens. Perhaps the mythical narrative of revolution (more than the actual revolution itself) is a powerful prescription for human wellbeing. Since we have no counter-factual for comparison, we are likely never to know for sure. But it is at least possible that revolutions have had profound, long-lasting, and immeasurably beneficial therapeutic effects. Revolution, to use Kuzmin’s metaphor, as an angel of health. Richard Horton [email protected]
www.thelancet.com Vol 389 February 11, 2017