Revolutions Brought Gains in Education and Health Care


Following is the third chapter of a new pamphlet by Paul Siegel on the theory and practice of socialism. It is available from Socialist Action Books for $3.

It is noteworthy that the Soviet Union, China, and Vietnam all made great strides forward after their revolutions in the vital fields of health care and education but swiftly retrogressed on turning in the direction of capitalism. However, Cuba, which made even greater strides forward, was able to retain and even extend its gains while permitting carefully controlled foreign investment in the last 10 years.

“By international standards, the Soviet Union,” says the United Nations Human Development Report for 1996, “achieved many impressive advances in basic human development over much of the 20th century.”

This refers, although the report does not explicitly say so, to the achievements of the Russian Revolution in free education and health care, full employment, and guaranteed subsistence needs, which persisted, although attenuated and overwhelmed, under the brutal Stalinist reaction.

Since the break-up of the Soviet Union, however, continues the report, “Russia’s growth and human development have plummeted. Deep recession and hyperinflation sharply increased unemployment and poverty and exacerbated income inequality. Life expectancy, mortality, and morbidity have worsened dramatically.”1 There has been little if any improvement since then.

The Chinese Communist Party, trained in the school of Stalinism and militarized in the process of coming to power at the head of a peasant army, established a regime that was bureaucratically authoritarian from the beginning. The revolution nevertheless freed China from imperialist domination and transformed society, smashing the power of the feudal landlords and the agents of foreign capital and beginning the process of industrialization.

In doing so, despite the errors and crimes of the Mao government that resulted in famine during the Great Leap Forward period and social turmoil during the Cultural Revolution, it brought much longer and much improved lives for the Chinese masses.

The improvement was so great that the World Health Organization representative in China stated in 1991 that with regard to life expectancy and infant mortality China far surpassed other developing countries. So too the New York Times of March 30, 1991, reported, “China has made enormous strides in medical care in the four decades since the Communist Revolution. … The World Bank lists life expectancy among Chinese at 70 years, compared with 76 in the United States and 58 in India.” Similarly, the revolution brought China a great advance in mass education.2

The era of “market socialism” brought rapid economic growth, but at the same time many losses of the revolution’s accomplishments. The New York Times reporter who commented in 1991 on the remarkable advances in medical care since the revolution added that “the gains in health care have slowed in the last dozen years. … The main reason … appears to be the collapse of the commune system, which used to provide rudimentary health care, usually free of charge, throughout rural China.”3

The story is the same in education. Han Dongping, a Chinese expatriate scholar living in the United States, returned to his home country for the purpose of research. In his 1992 study he found that peasant access to education had declined markedly since his time.

“The village education system supported by the collective fund before,” he stated, “had suffered a great deal. Without financial help from the collective, village schools have had to charge the villagers a high price for the education they offered to survive. Many farmers did not want to pay the price.”4

Vietnam suffered a similar experience. After 30 years of an immensely destructive war against French colonialists, the Japanese invaders, the Americans, Pol Pot’s Khmer Rouge, and the Chinese, it was subjected to a punishing embargo by the United States and its allies.

In these desperate circumstances the Communist Party turned in 1986 to the “free market” as a way of breaking out of the embargo.

It was able to effect this change in policy without opposition because, overwhelmingly supported by the peasantry though it was in its resistance to foreign imperialism, its leadership was not democratically accountable to either its members or the people.

As elsewhere, “structural reform” and “privatization” brought a great increase in wealth for a few, the growth of poverty among the many, and the drastic reduction of social welfare provisions. According to a UN Development Program report, North Vietnam had once been among the first in life expectancy and among the last in infant mortality among the countries of the “developing world.”5 Now, a 1993 World Bank report stated, “despite its impressive performance in the past, the Vietnamese health sector is currently languishing.”6

From 1954 to 1972, the number of elementary and secondary school pupils in North Vietnam increased from 700,000 to nearly 5 million. UNESCO in 1980 estimated that it had a literacy rate of 90 percent and a school enrollment that was among the highest in Asia and the Third World generally. By 1992, with the privatization of education, there were 750,000 children less in the schools although the number of school-age children had grown.7

The Cuban Revolution was different than the Chinese and Vietnamese revolutions in that it was made under a leadership that was not Stalinist. The Cuban revolutionary leaders began by seeking only radical reforms but found that in doing so they were confronted by U.S. imperialism, which wished to retain Cuba as its vassal state. In the struggle that ensued, the expropriation of American property and the logic of events drove the revolution in the direction of socialism.

Committed to the welfare of the masses, the Cuban revolutionaries transformed a society in which health care and education had been confined to the rich and well-to-do in a comparatively short time.

A Reuter’s report from Havana in the London Times of Dec. 30, 1983, describes the changes: “Official statistics, backed by United Nations specialists working here, illustrate the transformation that has taken place. … The average life expectancy of a Cuban born in the 1950s was around 50 compared with 75 today, while infant mortality has been slashed from about 60 per 1000 births to 16. … Cradle-to-grave benefits ensure … equal access to medical treatment and schooling.”8

The Cuban revolutionaries had the immense advantage of their nation not having undergone the years of devastating war that the Soviet Union, China, and Vietnam had undergone. Although subjected almost from its inception to a strangulating U.S. embargo, revolutionary Cuba was sustained by its trade with the Soviet Union and Eastern Europe. This, however, had its downside in that it suffered various pressures from the Stalinist bureaucracy.

When this bureaucracy turned towards the restoration of capitalism, Cuba lost 75 percent of its foreign trade in a year. The shock to the economy was tremendous. Cuba entered an extremely difficult period of great scarcity, from which it has in good part emerged at the price of the development of differences in well-being between those who have access to foreign currency through the flourishing tourist industry and through remittances from the United States and those who do not.

These differences and the penetration of foreign capital are producing distortions in Cuban society. The bureaucratic tendencies against which the Castroists have had to struggle since the inception of the revolution are bound to triumph, as they triumphed in the Stalinist regimes, unless the revolution is extended to other countries, particularly to advanced capitalist countries.

What is remarkable, however, is that even through this period Cuban advances in health care and education have continued. The World Bank’s 2001 edition of “World Development Indicators” states that the infant mortality rate fell from 11 per 1000 births in 1990 to seven in 1999. Cuba now is sixth in the world in this respect, the first five countries being advanced industrial countries. The average for Latin America and the Caribbean was 30 in 1999.

The Cuban mortality rate for children under five fell from 13 to 8 per 1000 over the course of the decade. This is far lower than those who came closest to it in Latin America. The average for the entire region was 38 in 1999.

Cuba’s educational system is as outstanding as its health care system. Jo Ritz, the World Bank’s Vice President for Development Policy and the former education minister in the Netherlands, said of it, “[I]n education performance, Cuba is very much in tune with the developed world, and much higher than schools in, say, Argentina, Brazil, or Chile.”9

The record of Cuba and the other post-capitalist societies demonstrates the potential of socialism. Compare this record to that of underdeveloped countries elsewhere, as given in the “United Nations Human Development Report 1996.” The advance of medical science resulted in significant gains in infant mortality and life expectancy, despite pharmaceutical monopoly prices, and physicians catering to the rich few rather than tending to the poor multitudes, but nevertheless the mortality rate for children under five in underdeveloped countries was nearly six times as much as that of industrialized countries.

Some semi-industrialized countries greatly increased the number in primary and secondary schools, but nevertheless 130 million children at the primary level and 275 million at the secondary level were out of school. The education of those who were in school was impeded by the fact that a third of the children were malnourished.

The gains that had been made, the report went on, were precarious. For one thing, the more than a billion people who live in overcrowded houses with poor sanitation and the 100 million who are homeless are subject to contagious diseases that rapidly become epidemic. These diseases can overwhelm all the gains made through immunization and other health measures and can spread throughout the world.10

“The United Nations Human Development Report 1998” repeated this warning and pointed to the HIV/AIDS epidemic.

In 1996, 22.3 million people were living with HIV; at the end of 1997, nearly 31 million were doing so. Such epidemics, from which rich countries cannot insulate themselves in this era of global travel and mass immigration, threaten “not just the health of the world’s people but the achievements in human development.”11

Yet, stated the report, human development could readily flourish if proper goals were set and the world’s resources were properly allocated. Only $40 billion or 0.1 percent of world income would be needed yearly to bring basic education, clean water and sanitation, and basic health, nutrition, and family-planning services to every one in the world.12

The difference between what could be achieved and the actuality is also great for advanced capitalist countries. This can be seen in the “human poverty” index for industrialized countries of the “UN Human Development Report 1998,” which measures deficiencies in health, education, and other conditions of human welfare.

Ranking 17 industrialized countries, the report finds (p. 29) that, although the other industrialized countries have themselves been cutting social services since the 1970s, “the United States, with the highest average income, has the highest population share experiencing human poverty.”

Thus, among the 17 countries, the United States, with 13 percent of its people not expected to survive to age 60, came in last in this respect. With 20.7 percent of its population between the ages of 16 and 65 functionally illiterate, as measured by an international literacy survey, the United States did more poorly than any other country except Ireland and the United Kingdom. It also had the grossest maldistribution of income.

That the richest country in the world has so large a portion of its population living so poorly in vital respects indicates how far not only the unindustrialized countries but also the industrialized countries are from what could be achieved if we were living in a rational world.

We live, however, in an irrational world in which what looms before us is overwhelming catastrophe. Epidemics are only one form which this catastrophe can take.


1 United Nations Human Development Report 1996, (Oxford University Press, 1996), p. 84.

2 Robert Weil, Red Cat, White Cat: China and the Contradictions of “Market Socialism” (Monthly Review Press, 1996), pp. 241-42, 246.

3 Weil, pp. 241-42.

4 Weil, p. 249.

5 John Pilger, Hidden Agendas (New Press, 1998), pp. 333, 389.

6 Pilger, p. 333.

7 Pilger, pp. 332-333.

8 Ralph Miliband and Marcel Liebman, “Reflections on Anti-Communism,” p. 6.

9 Socialist Action, July 2001.

10 United Nations Human Development Report 1996, pp. 20, 24.

11 United Nations Human Development Report 1998, p. 34.

12 United Nations Human Development Report 1998, p. 37.