In 1917, before the revolution, health conditions were significantly behind those of developed countries. As Lenin later noted, "Either the lice will defeat socialism, or socialism will defeat the lice". The Soviet principle of health care was conceived by the People's Commissariat for Health in 1918. Health care was to be controlled by the state and would be provided to its citizens free of charge, a revolutionary concept at the time. Article 42 of the 1977 Soviet Constitution gave all citizens the right to health protection and free access to any health institutions in the USSR. Before Leonid Brezhnev became General Secretary, the Soviet healthcare system was held in high esteem by many foreign specialists. This changed, however, from Brezhnev's accession and Mikhail Gorbachev's tenure as leader, during which the health care system was heavily criticized for many basic faults, such as the quality of service and the unevenness in its provision. Minister of Health Yevgeniy Chazov, during the 19th Congress of the Communist Party of the Soviet Union, while highlighting such successes as having the most doctors and hospitals in the world, recognized the system's areas for improvement and felt that billions of Soviet rubles were squandered.