most severe impact was on the Detroit area. Nearly 130,000 automobile manufacturing jobsmore than one-third of those in existence in the area in May 1950-have disappeared in Detroit during the past 9 years. These losses resulted from a combination of factors such as improving productivity, the increased decentralization of automobile production, and the shutdown of several local plants formerly operated by Hudson and Packard. Also contributing to this decline was a change in the relative market position, over portions of this period, of some makes of cars manufactured in the Detroit area.

One result of these developments has been a considerable reduction in Detroit's share of the industry's production and employment totals. In May 1950, about 40 percent of the country's automotive manufacturing employment was centered in Detroit. This proportion was down to about 35 percent when auto production reached its alltime high in 1955. By May of 1959, it had dropped to 28 percent of the total.

Automobile employment cutbacks about in line with, or somewhat sharper than, the national average for the 1950-59 period were also reported in two other chronic areas-Evansville and

Chart 1. Percent Recovery of Previous Year's Loss in Steel Employment, Selected Labor Surplus Areas and United States, May 1958-May 1959

Muskegon-Muskegon Heights-and in two labor surplus areas with less persistent unemployment problems-Buffalo, N.Y., and Flint, Mich.

STEEL PRODUCING AREAS

In May 1959-2 months prior to the nationwide steel strike-steel production was significantly ahead of prerecession levels. Output during the month totaled 11,600,000 tons-an alltime record and nearly 85 percent above the 6,301,000 tons produced in May 1958. Approximately 9,792,000 tons of steel were produced in May 1957.

The industry's recovery in employment by May 1959 was only slightly less impressive. On a national basis, employment in blast furnaces, steelworks, and rolling mills declined from 650,200 in May 1957 to 508,000 in May 1958-a drop of 142,200. Over 135,000 of these jobs had been recovered by May 1959.

The extent of recovery in steel employment nationally is compared in chart 1 with that in a number of important steel-producing centers classified in the substantial labor surplus category (chronic or nonchronic) in July 1959. The recovery rate has lagged behind the national average in five of the six areas shown-all but Detroit. Among the areas showing a somewhat slower than average rate of recovery, the margin of difference between the area and national figures is relatively slight in Wheeling-Steubenville and comparatively moderate in Pittsburgh, Birmingham, and Buffalo.

Over the 9-year period between May 1950 and May 1959, monthly steel production increased by about 35 percent nationally, while employment has moved up by about 6 percent. Three of the labor surplus areas-Johnstown, Buffalo, and Wheeling-Steubenville-reported steel employment decreases ranging from 4 to about 11 percent during the period. In Pittsburgh, the overall employment increase was about one-third the national average (2.4 percent). The largest rise during the 9-year period was in the Philadelphia area (37.4 percent); the opening of the new Fairless Steel Works plant of U.S. Steel accounted for a large share of this gain.

TEXTILE CENTERS

Textile production in May 1959, as measured by the Federal Reserve Board's index of industrial production (seasonally adjusted), was more than

10 percent above the level reported for May 1950. Employment, however, decreased substantially during the period, from 1,247,000 to 965,500. The drop was equivalent to 22.6 percent of the industry's May 1950 payroll.

New England and Middle Atlantic textile centers bore the brunt of the job decline. Providence lost 24,800 textile jobs during the 9-year period ending in May 1959, a decline of 47.4 percent, while Lawrenc, Mass., lost 15,400-more than 80 percent of those in existence in the area in May 1950. Textile employment was also reduced by more than half in Lowell and New Bedford, Mass., during this period, each area losing about 6,000 to 7,000 jobs. Very substantial declines in textile employment were reported, too, in several other labor surplus areas, including Philadelphia (23,000 workers or 39.6 percent), Paterson, N.J. (15,900 workers or 45.8 percent), New York City (7,900 workers or 16.7 percent), and Utica-Rome, N.Y. (7,600 workers or 82.6 percent). On the other hand, both Chattanooga, Tenn., and Asheville, N.C., showed a slight rise in textile employment since May 1950.

Less than one-third of the industry's aggregate 1950-59 employment decline occurred during the

recent rcession. Industry payroll declines during the year averaged about 8 percent on a nationwide basis, but declines approximately double or more the national average were reported in Lowell, Providence, Paterson, and Utica-Rome. Most of these areas have shown only a minor recovery or a further decline in textile employment during the year ending May 1959.

COAL MINING AREAS

The recession accentuated the long-term downtrend in coal mining which had been under way in most coal centers since 1948. In May 1957, coal mining employment in the United States was 222,000 jobs below the May 1950 level of 479,000. Another 45,000 coal mining jobs were lost in the year ending May 1958.

Production cutbacks were much less severe than employment losses. Coal output declined moderately in the early 1950's, but by May 1957according to the Federal Reserve Board's production index had recovered to a point about 15 percent below the May 1950 figure. A large share of the decline was in anthracite miningreflecting continuing sharp decreases in demand for coal for home-heating purposes. Bituminous coal production in May 1957 also dropped (by about 11 percent between May 1950 and May 1957); over this 7-year interval, however, employment in this sector of the industry had decreased by about 46 percent, largely as a result of increasing mechanization of mine operations. Both anthracite and bituminous production declined markedly during the recession period, with overall coal output slipping by about one-fourth between May 1957 and May 1958.

Eight major labor surplus areas, including five in the chronic grouping, now have or had in May 1950-relatively significant concentrations of coal mining employment. As chart 2 shows, each of these areas reported substantial decreases in mining employment between May 1950 and May 1957, and a continuing net downtrend over the next 2 years. In each, the number of coal mining jobs in May 1959 was less than half those available locally 9 years earlier.

-HAROLD KUPTZIN

Office of Program Review and Analysis Bureau of Employment Security

Occupational Health Services

in the Soviet Union

1

THE WESTERN OBSERVER of the Soviet Union's occupational health services 1 is struck by certain distinctive features in the administration of these services.

One striking feature is the emphasis on preventive medicine. The prophylactic approach, although it is often proclaimed as an outgrowth of Marxist ideology, actually has its roots in Russian history, which has been marked by frequent epidemics. The Soviet State itself was born in the midst of a typhus epidemic which threatened the very existence of the new regime.2

A second characteristic of the system is the preferential treatment given to industrial workers over the rural population. This derives both from the Communist doctrine of the proletariat as the revolutionary class and from the practical necessity of maintaining the allegiance of the city workers, who were the Bolsheviks' main source of support at the time of the revolution. After the revolution, with the growth of industrialization under the Five-Year Plans, the practice of giving industrial workers preferential treatment became more strongly entrenched.

3

The prominent role of the trade unions in Soviet occupational health services is a third distinctive feature of this system. The unions inherited their functions in the fields of social security and labor protection when the Labor Commissariat (or Ministry) was abolished in 1933. Trade unions since then have experienced an uneven development of their authority in these fields, but the tendency since World War II has been toward broadening their authority.

All medical services are financed by the State through the use of tax money. Thus, while the Soviet population does not pay for its medical care directly on a fee-for-services basis, it pays for it through taxation which is reflected in increased prices of consumer goods.

Organization

Occupational health services are administered in the Soviet Union by the Government, by individual establishments, and by the trade unions. These agencies review and inspect each other's

work. At all levels, the Communist Party carries on its continuous controlling activities. Divided responsibility, with multiple checks and controls, is typical of public administration under the Communist regime.

The Role of Government. The U.S.S.R. Ministry of Public Health directly administers only facilities which are of significance to all the Soviet Republics, including several large medical schools and scientific research institutions, the Medical Publishing House, and certain other medical establishments. In addition, it supervises the administration by the ministries of public health of the various Soviet Republics of their networks of facilities which provide medical care for most but not all Soviet workers. The individual Soviet Republics also have a safety inspection function which is carried out by State committees on safety in industry.8

Under the control of a Republic ministry of public health, the authorities of a territory (krai), region (oblast), district (raion), or city (gorod) exercise three kinds of responsibility:

1. These authorities supervise, in descending order of their jurisdiction, the two "networks" of medical care: the "open network," consisting of institutions which primarily serve the general population and also provide medical care for industrial workers, and the "closed network" of medical institutions operated by industrial establishments for their own workers.

1 The term "occupational health services" is taken from the International Labor Organization's Proposed Recommendation Concerning Occupational Health Services in Places of Employment, published in Organization of Occupational Health Services in Places of Employment (Geneva, ILO, 1958). This article has used the resolution's suggested functions of occupstional health services as a framework for this discussion. A more detailed version of this article is presented in a forthcoming issue of the Foreign Labor Information Series of the Bureau of Labor Statistics.

Mark G. Field, Organization of Medical Services in the Soviet Union (Alabama, Maxwell Air Force Base, Human Resources Research Institute, 1954), p. 18.

'Merle Fainsod, How Russia Is Ruled (Cambridge, Mass., Harvard University Press, 1953), p. 86.

4 Isaac Deutscher, Soviet Trade Unions (London, Royal Institute of International Affairs, 1950), pp. 117-119.

'See G. T. Shikov, Organizatsiya meditsinskogo obsluzhivaniya rabochikh promyshlennikh predpriyatii [Organization of Medical Care of Workers in Industrial Enterprises] (Moscow, 1955), on which this section of the article is based in part.

• Bol'shaya sovetskaya entsiklopediya [The Great Soviet Encyclopedia] (Moscow, 1947), p. 1159.

7 Certain sections of the economy, such as transportation, the Armed Forces, and the police, maintain their own health services.

M. I. Aleshin, Okhrana truda i promsaritariya v ugol'noi promyshlen. nosti [Labor Protection and Industrial Sanitation in the Coal Industry] (Moscow, 1958), pp. 4-5.

2. The district or city authorities operate the open network which provides medical care for 70 percent of the workers in the U.S.S.R.

3. The office of the local or city sanitary inspector and the local or city sanitary-antiepidemiological stations, which are organs of the ministry of public health, enforce industrial sanitation regulations.9

The administrators of a district or city hospital also have certain special responsibilities with regard to the health of industrial workers. They are charged with the responsibility of setting up "health stations" (zdravpunkty) in most factories and appointing a shop medical officer (tsekhovoi ordinator) to assist health station personnel in the station's operation. In addition, these hospitals are obliged to provide certain services for workers only, such as periodic physical examinations of workers in dangerous and unhealthful occupations.10

The most recent addition to the jurisdiction of the public health ministries is the system of sanatoriums and rest homes. In 1956, these institutions, with the exception of certain local sanatoriums for 1-day or off-duty care, were transferred to the public health ministries of the Soviet Republics." In 1958, reportedly, 3,362,000 persons were to enter sanatoriums and rest homes.12

The Soviet sanatorium has been officially defined as "a hospital type of medical prophylactic establishment for the treatment of the sick, primarily by natural therapeutic means such as climate, mineral waters, medicinal mud, coupled with medically supervised physiotherapy, dietetic regimen, and special regimens of treatment and rest." The sanatoriums have been set up mostly for the treatment of specific disorders. In 1955, they had 284,000 beds, half of them for tubercular patients.

The rest home is a health resort in which selected workers, during their vacations, may combine relaxation with a medically supervised regimen designed to remedy minor ailments and increase resistance to disease.13 In 1957, there were in the Soviet Union 845 rest homes with 159,000 beds, some of which were reserved for young workers, pregnant women, and mothers with young children.14

The Role of Industrial Establishments. The management of an industrial establishment is responsible for the safety and health of the establishment's workers. In each enterprise, there is usually a division of safety technique, which designates senior engineers to install or inspect safety equipment and to instruct workers in its operation. Every shop with more than 500 workers is required to have its own safety engineer.15

Medical services provided by industrial establishments take the form of medical sanitary divisions (MSD's), factory medical subdivisions, and health stations. MSD's are self-sufficient complexes of medical facilities established in large industrial enterprises, usually with 4,000 or more workers, by the appropriate economic ministry or the regional economic council. They include hospitals, clinics, health stations, and in the larger enterprises, day and night sanatoriums and children's nurseries. For purposes of more efficient medical care of workers, some large enterprises have been subdivided into sections of one or more shops, each serviced by a separate factory medical subdivision.

The basic unit of industrial medical service is the health station. There are two types of health station-the medical health station in enterprises employing more than 800 persons and the less well staffed and equipped feldsher (a feldsher is trained at approximately the level of the American public health nurse) health station in enterprises employing 300 to 800 persons. These minimums are lower for the petroleum, chemical, mining, and metallurgical industries. 16

First aid is generally provided by the health station in a factory. In industries where workers are far from a health station, as in mines, workers are given special first-aid instruction.17 The health station also has the responsibility for determining a worker's ability to work in the

event of accident or illness and issues sick leave certificates. After an illness of 10 days or more, the responsibility is passed on to the medical boards described below.18

Enterprises must provide preliminary and periodic examination for workers in two categories. The first category, relating to "the protection of labor," includes workers in heavy or hazardous occupations, workers in a cold climate, juveniles, women, and invalids. The second category, relating to public safety, hygiene, and sanitation, includes employees of the food and transportation industries and in retail establishments, employees who deal with children, and all medical and pharmaceutical personnel.19

After an examination, a worker not in good health may be given treatment or be assigned to a sanatorium, rest home, or special dietary clinic.20 The examining physician may transfer him to light work for a period of up to 10 days, and a medical board may extend this period to 2 months. If his prolonged absence interferes with production, he may be certified as an invalid by a second board composed of physicians and union members. He is then eligible for an invalid's pension.21

Workers between the ages of 14 and 18 must receive a medical examination before beginning their employment or factory training and at least annually thereafter. Doctors for young workers are also responsible for seeing that they have highest priority when protective clothing and equipment are issued, and that each young worker be given only work which he is physically capable of doing.22

The Role of the Trade Unions. Soviet trade unions were given most of the functions of the Commissariat of Labor in 1933, including the administration of social insurance funds and the enforcement of labor legislation on wages, hours, and working conditions.23 The unions use several devices for checking on the provision of the required health services for workers.

The technical inspector, a full-time paid employee with technical training, is appointed by the interunion council at the Republic level and in the case of the Russian Republic, at the regional (oblast) level. His primary duty is to enforce the observance of technological standards for safety and industrial hygiene in the factories under his jurisdiction. In case of managerial

recalcitrance, he may exert pressure through the trade union organization. He has the right to close establishments and to levy fines against managers who are in violation.24

At the factory level, it is primarily the labor protection commission of the factory committee (the executive organ of the trade union local) which checks on occupational health services. The commissions are composed of workers who volunteer their time to inspect facilities such as wardrobes, shower rooms, and ventilation systems, and to check on the presence of guards on machines, the issuance of protective equipment, and other safeguards prescribed by law.25

Among the members of the commission are the social inspectors, each of whom are selected by groups (profgrupy) of about 20 coworkers to check daily on the enforcement of safety and hygiene regulations and the availability of medical services where the group works.26 The trade union's factory committee, acting upon the reports of the labor protection commission and the social inspectors, will if necessary ask management to conform to statutory requirements and to its obligations under the "collective agreement" with the trade union. Reports of defects thus exposed may find their way into the trade union daily Trud or some other publication, particularly when the occurrence is widespread.

The administration of social insurance funds to employees who are sick or retired is carried out by the trade union social insurance council. The trade unions also issue passes to rest homes and sanatoriums. The latter are granted in consultation with physicians. Only one-tenth of the rest home passes and one-fifth of the sanatorium passes are free of charge.27

18 Ibid., p. 16, and Mark G. Field, Doctor and Patient in Soviet Russia (Cambridge, Mass., Harvard University Press, 1957), p. 171.

19 F. A. Artem'ev, Kratkoe posobie po zakonodatel'stvu ob okhrane truda [Brief Textbook on Legislation Concerning the Protection of Labor] (Moscow, 1955), pp. 120-121.

20 Sbornik zakonodatel'nikh aktov o trude [Collection of Legislation Concerning Labor] (Moscow, 1956), pp. 243-244.

21 Ibid., p. 410, and Artem'ev, op. cit., pp. 31 and 41. 22 Shikov, op. cit., pp. 36-37.

23 Lief Bjork, Wages, Prices, and Social Legislation in the Soviet Union (London, Denis Dobson, translated from the Swedish language, 1953), p. 16. 24 Spravochnik profsoiuznogo rabotnika [Handbook of the Trade Union Official] (Moscow, 1959), pp. 255-263.

25 Sbornik polozhenii o komissiyakh FZMK [Collection of Regulations Concerning the Commissions of the Factory Committee] (Moscow, 1951), pp. 12-14.

26 Deutscher, op. cit., p. 125.

27 Trudovoe pravo [Labor Law] (Moscow, 1959), p. 348.