The increase in life expectancy since World War II has been brought about by a drop in the death rate from 12.2 per 1,000 in 1939 to seven per 1,000 in 1970 for the urban population and from 13.7 per 1,000 in 1939 to 11.4 per 1,000 in 1970 for the rural population. During the same period, infant mortality dropped from 139 per 1,000 live births to twenty-seven per 1,000 live births. In the late 1960s the incidence of infant mortality was 39 percent higher among rural infants than among urban ones. More than one-half of the deaths of children under one year of age were the result of pneumonia. The second major cause of infant mortality was birth trauma, despite the fact that 98 percent of the births took place in a public health facility under medical supervision.
The three major causes of death in 1970 were diseases of the heart and circulatory system, which accounted for 252 per 1,000 deaths; cerebrovascular diseases, which accounted for 206 per 1,000 deaths; and cancer, which accounted for 146 per 1,000 deaths. A program of systematic treatment and prevention of infectious diseases, which were once widespread, has either brought them under control or eradicated them completely. The law requires that all cases of contagious diseases be registered with the public health service. In 1971 the greatest incidence was reported for influenza, mumps, chicken pox, dysentery, infectious hepatitis, and measles.
The public health service, modeled after that of the Soviet Union, is based on the premise that the state has the responsibility to provide free health care for the population and that such care should be uniform and readily available. The health service is financed by the state, supervised by the Ministry of Public Health, and administered by the public health departments of the district people's councils. Free health care is available to all citizens; medicine required for outpatient treatment, however, must be paid for by the patient.
The cornerstone of the health service is the polyclinic, which provides general and specialized outpatient aid and consultation. Polyclinics may be attached to a hospital or may be independent units serving a designated geographic area. A separate network of polyclinics is attached to industrial mining, transport, and construction enterprises to serve their workers. Each polyclinic is divided into departments for the various specialties in medicine, and each department is staffed by one or more doctors and auxiliary personnel. Not all polyclinics, however, have departments for all the major fields of medicine; many have only sections for internal medicine, obstetrics and gynecology, pediatrics, and surgery. Patients needing consultation or treatment by other specialists are referred to the nearest hospital.