In 1953, Brazilian doctor Raul Ribeiro da Silva was invited to join a delegation to the Soviet Union to study its public health system—one of the first of its kind. His observations were later published in the book Russia Through the Eyes of a Brazilian Doctor.
This account was one of many. Between the 1930s and 1950s, Brazilian doctors documented their experiences with Soviet healthcare. Fiocruz historian Gabriela Alves Miranda analyzed these publications and found a common thread: admiration for Soviet healthcare stemmed from a desire to bring its concepts to Brazil. Ideas such as free public healthcare, integration with education and research, continuous medical training, and state-supported innovation would later become pillars of Brazil’s Unified Health System (SUS).
In an interview with Outra Saúde, Miranda discusses how these reports influenced public health debates in Brazil until the 1950s and helped shape visions for the country’s health system.
The 1930s: a new world
In the 1930s, more than a decade after the Russian Revolution of 1917, the Soviet Union remained largely unknown to much of the world. Isolated by a Western cordon sanitaire to contain its influence, reliable information about the socialist state was scarce.
However, the Great Depression shifted global perceptions. As capitalist economies crumbled, the USSR’s economy enabled significant social improvements—not only in contrast to the imperial era under the Tsars, but also outpacing some of the world’s most prosperous nations. This fueled worldwide interest in the Soviet experience, sparking a surge in travel accounts. Brazil was no exception to this trend. As Miranda explains in her research, the publication of books about Soviet life boomed after the publication of John Reed’s Ten Days That Shook the World. “The accounts of trips to Russia after the socialist revolution presented a new world to readers,” Miranda says.
A significant part of this “new world” was the advancement of public health in the Soviet Union, documented in various accounts. In Brazil, this trend was initiated by the publication of Russia: Travel Notes in 1931 by physician Maurício de Medeiros. Medeiros was not a communist sympathizer, yet, according to Miranda, his perspective remained “critical and moderate” throughout the book. He strongly rejected the negative portrayals of Soviet society that dominated the Western press at the time. Medeiros described reports of social chaos in the USSR as “completely fantastic”—in other words, false—and recognized the remarkable progress being made in healthcare. His book was widely read, reaching 24,000 copies in circulation and going through six reprints, a huge success for the time.
The following year saw the publication of Where the Proletariat Leads by Osório Cesar, a doctor from Paraíba and a communist activist. A psychiatrist at the Juqueri Hospital, he provided a more detailed account than de Medeiros. “In his writing, Osório was particularly impressed by the number of scientific institutions in the Soviet Union. He highlighted the state’s support in establishing these research centers, not only for public health but also for advancements in biomedical research,” explains Gabriela Miranda.
Cláudio Bertolli Filho, cited in Miranda’s work, notes that Soviet medicine attracted interest because “it represented the idea of broad care for citizens and greater participation by doctors in solving national problems”—elements largely absent from the Brazilian context and other countries at the time. For this reason, Miranda explains, these reports were not merely descriptive accounts but served as tools for their authors to influence public health debates in Brazil.
“One of the issues that stands out the most, especially in light of current global discussions, is abortion care,” Miranda explains. “De Medeiros gives significant attention to abortion, which was legalized in the Soviet Union in the 1930s. Motherhood is also a recurring theme, as maternal and child health were highly developed in the USSR at that time.” At the time, she points out, “free abortion in the USSR was a scandal in the capitalist world.” The authors highlight that it had proven to be a successful policy in many ways, particularly from a public health perspective.
Both reports also praise Soviet medicine for its comprehensive approach to disease, considering “the elements that made up the patient’s living conditions, such as home visits, consultations with family members, and analysis of the environment in which they lived,” Miranda writes in her thesis. According to her, “in the 1930s, health and care centers also appeared [in the USSR] in municipalities and neighborhoods,” marking the development of territorialized public health.
This concept became known as the Semashko model, named after Nikolai Semashko, who served as Minister of Public Health in Soviet Russia from 1918 to 1930. Under his leadership, the foundations of the country’s public health system were established.
Other Brazilian travelers, including historian Caio Prado Júnior and engineer Claudio Edmundo, also documented their observations of Soviet medicine. Additionally, books by foreign authors, such as The Fight Against Tuberculosis in the USSR, Sexual life in Russia and Protection of Maternity and Childhood in the Soviet Union, were translated into Portuguese. American physician Henry Sigerist’s 1937 thesis, Socialized Medicine in the Soviet Union, influenced many Brazilian professionals. Much of this literature was published by Editorial Calvino, led by Dr. João Calvino Filho.
The 1950s: protecting workers’ health
After the Second World War, Soviet prestige grew worldwide, particularly due to the USSR’s central role in defeating Nazism. However, its influence extended beyond military achievements. The country was undergoing another period of economic growth, strengthening its welfare state and expanding public health and scientific institutions.
This led to a new wave of interest in the Soviet Union during the 1950s and led to the publication of new books by Brazilian doctors familiar with Soviet healthcare. Two notable works—Russia Through the Eyes of a Brazilian Doctor by Raul Ribeiro da Silva and Brazilian Doctors in the USSR by Milton Lobato and Reinaldo Machado—were analyzed in Miranda’s research. However, the overall number of publications is significantly larger. According to historian Raquel Torres, 33 accounts from 54 Brazilian travelers to the Soviet Union were published between 1951 and 1963.
Compared to the 1930s, the Soviet Union had developed a more structured approach to hosting and attracting foreign visitors. Institutional itineraries were established by the state tourist agency VOKS, guiding professionals through model public health and scientific institutions, including maternity hospitals and research centers.
“In the reports from the 1950s, there is a noticeable emphasis on the organization of pediatric care and health institutions,” Miranda says. “When Osório César, Maurício de Medeiros, and even Caio Prado Júnior—who was not a doctor—visited, they had more freedom to explore independently. It’s not that later visitors were ‘restricted,’ but the Soviet authorities had become more intentional in organizing travel itineraries, aiming to present socialism to Westerners in a structured manner.”
Read more: A brutal system replaced socialist health care in Europe
In a broader political context, the international communist movement sought to persuade doctors—as well as other professionals and technicians, including architects and lawyers—that only socialism would allow them to fully develop their professions in a world of peace and justice. The world peace movement served as a key platform for communists to rally intellectuals and artists in opposition to imperialist conflicts and the increasing threat of Western aggression against the Soviet Union.
“That period marked the rise of the Soviet Union’s international profile, as it engaged in cultural diplomacy following a phase of isolation. The influx of Latin Americans to the USSR increased significantly from the 1950s through the 1970s, particularly after the establishment of the Patrice Lumumba Peoples’ Friendship University in 1960, which was designed to serve the peoples of the Third World,” she explains.
One of the key tools of such cultural diplomacy was the organization of international congresses that brought together communists, professionals of different ideological backgrounds, and even those considered “apolitical.” These events focused on causes such as peace and the fight against poverty. One such event was the International Congress of Medicine, held in Vienna in 1953, which included the authors of both books mentioned by Miranda.
The historian notes that the debates held at the Congress introduced themes that would later be more fully developed. “It is the duty of doctors, wherever they practice, to defend peace and advocate for better living conditions. At that time, the concept of social determinants of health had not yet been fully established, but discussions were already addressing the impact of living conditions on people’s well-being. As early as 1953, there was an understanding that health encompassed much more than just the absence of illness.”
More significant, however, was what followed the event. As they had hoped and anticipated, the delegation members received an invitation from the Soviet Ministry of Public Health to travel to the USSR and observe its healthcare system firsthand. Their travel accounts stem from this experience.
“You don’t find the terms ‘universal health’ or ‘integral health’ in the reports. But the concept of free and open access to healthcare is very much present,” she explains. “There is also a clear emphasis on preventive rather than curative medicine, with health examinations conducted in factories and workplaces. Brazilian doctors were highly impressed by this approach to prevention.”
The USSR was seen as a pioneer in workers’ health. “In his report, Raul Ribeiro notes that factory workers were required to undergo tuberculosis prevention tests every six months. Non-workers were encouraged to do the same through what he referred to as ‘sanitary propaganda.’ This concept closely resembles what we now call health education,” explains Miranda. “Health campaigns are a recurring theme in Ribeiro’s account, but they appear even more prominently in Milton Lobato’s observations.”
Another key area of focus was rural health. “Doctors working in rural areas were highly valued by the state, and it was mandatory for them to complete internships in underserved regions of the Soviet Union,” she adds. “However, it’s important to note that Brazilian doctors primarily visited designated sites and did not venture much into these rural areas.”
Finally, Miranda explains, “the travelers were impressed not only by the good salaries but also by the high level of respect doctors enjoyed in Soviet society. At that time, their accounts were directed primarily at their peers in Brazil. In the 1950s, discussions about the political role of doctors were gaining traction, and there were even a few strikes by medical professionals in the country.”
With this observation, she returns to what she sees as the primary purpose behind publishing these reports: beyond countering anti-communist propaganda about the USSR, there was a strong interest in introducing the Brazilian public—both general and professional—to the ideas and practices that were observed in Soviet medicine. “At that time, national development projects for Brazil were being discussed, and these ideas were part of the debate—and, in some cases, even implemented—within this political context,” says Miranda. These projects inevitably included discussions on “how to organize public health and medical care in Brazil.”
The interest of Brazilians also extended to medical procedures developed in the Soviet Union. In her thesis, Miranda closely examines issues of the magazine Medical and Biological News, a scientific journal edited by communist doctors Alcedo Coutinho and Irun Sant’Anna from 1951 to 1960. The journal not only documented Soviet medical advancements but also organized seminars and studies on health practices developed in the USSR. Some of these included the “painless childbirth” method popularized by Fernand Lamaze, the human tissue therapies pioneered by ophthalmologist Vladimir Filatov, and the pathophysiology research of Ivan Pavlov.
For Gabriela Miranda, accurately measuring the influence of these reports at the time of their publication is a complex task. While Maurício de Medeiros held the position of Minister of Health during the Kubitschek administration, he did not implement the socialization of Brazilian healthcare. On the other hand, there is photographic evidence of lectures on Soviet medicine that drew hundreds of attendees in Rio de Janeiro and São Paulo during the 1950s. The historian also reveals in her thesis that the police closely monitored the authors, considering them significant enough to keep detailed records of their activities.
Beyond their immediate impact, their reports played a pioneering role in promoting public policies that would later become fundamental pillars of the SUS.
Did Soviet healthcare help shape the SUS?
In the 1970s, the push for universalizing the right to health in Brazil gained momentum within the opposition to the military regime. By the 1988 Constituent Assembly, this social movement secured the creation of the SUS, which today stands as the world’s largest public, free, and universal healthcare system.
Similar to the doctors who wrote about Soviet healthcare, many of the key figures behind this structural reform were communists. The programmatic document “The question of democracy in healthcare,” considered to be the first outline of the SUS proposal, included contributions from members of the Brazilian Communist Party (PCB). However, they were far from alone. Dozens of figures linked to other Marxist-Leninist organizations played crucial roles in the struggle that ultimately helped dismantle the dictatorship and establish the SUS.
Yet Miranda cautions that attributing a direct influence of the reports on Soviet healthcare to the ideas behind health reform would be an overstatement. The 1964 military coup acted as a significant rupture, limiting the exchange of ideas between different generations of activists. Additionally, in the same decades, other public health systems and models emerged, providing alternative sources of inspiration for those advocating for the universalization of healthcare in Brazil.
For key figures involved in the intense debates of that period, such as public health experts Reinaldo Guimarães and Sonia Fleury, other models also played a significant role in shaping discussions on health reform in Brazil. “There were other major influences on the SUS—England, Cuba, Canada, and Italy, both in terms of health reform and mental health,” explains Fleury. She further notes that “today, the SUS, which is an original model, serves as an inspiration for these countries and many others.”
Guimarães, now a professor at Federal University of Rio de Janeiro and vice president of Abrasco, recalls discussions about the feldsher, a mid-level medical professional in the Soviet health system trained to perform select medical procedures. While there was no direct equivalent in the SUS, the concept was part of the broader debate that contributed to the development of the Family Health Strategy, which was implemented in the following decade.
Despite this, both emphasize that various international experiences, not just the Soviet model, influenced the development of the Family Health Strategy (ESF) and community health worker programs in Brazil. “China in the 1960s,” recalls Fleury, referring to the barefoot doctors initiative, was one such influence. Another key model was Cuba’s Family Health system, as highlighted by Odorico Monteiro and Carlille Lavor in 2010 and 2015. Both played a role in the 1980s in successfully implementing methods in Ceará that drew heavily from the Cuban system, as well as from the experience in Planaltina, a process that later helped lay the groundwork for the national expansion of the ESF.
Among other things, Monteiro reflects on the earlier consideration of the Soviet model. “At an earlier stage, there was the proposal of the Soviet model, which was very little discussed in Brazil. It was the first major prospect of universalization that we could have taken as a reference, but for various reasons, it did not become widespread in our country,” he recalled.
So far, no academic dissertation or thesis has explored in greater depth the influence of Soviet medicine on Brazil’s health reforms beyond Gabriela Miranda’s research. However, the researcher sees this as a promising area of study. “The history of medicine and public health, which was once dominated by a very European and North American narrative, is beginning to open up to new perspectives,” she concludes.
Originally written by Guilherme Arruda and published in Portuguese on Outra Saúde. Lightly edited for length.
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