THE EXPANSION OF THE HEALTHCARE SYSTEM IN SURKHANDARYA PROVINCE, THE ECOLOGICAL-MEDICAL CONSEQUENCES OF COTTON MONOCULTURE, AND THE CRISIS OF THE SOVIET SYSTEM (1965–1991)

Abstract

This article examines the development of the healthcare system in Surkhandarya province during the late Soviet period (1965–1991), the ecological and medical consequences of cotton monoculture, and the way these problems became entangled with the wider crisis of the Soviet system. In these decades the region’s health network expanded quantitatively — with more hospitals, rural medical points and specialist services — yet suffered from chronic underfunding, a preoccupation with gross indicators, and declining quality, especially in the countryside. At the same time, the intensification of irrigated cotton cultivation and the heavy use of pesticides and defoliants degraded soil, water and air and contributed to rising infant and maternal ill-health across the republic. Under glasnost these consequences, together with the falsification of cotton figures exposed in the “Cotton Affair,” fed a growing critique of Soviet rule that helped shape Uzbekistan’s path to independence in 1991.