>>China’s Health Infrastructure Problems: Priorities, the Party and Lack of Democracy
China has many, many dedicated health workers who have long been frustrated by obsessive secrecy, idiotic priorities, and poor leadership. While it lacks some modern equipment, China has had great achievements in public health as well such as near universal child vaccination and smallpox eradication. The problem is not so much equipment as it is investment in training and in people. What China lacks is not so much much equipment as a society and government that will reorder its priorities and supports its public health workers and makes public health a top priority.
One side effect of China's headlong rush to development over the past two decades has been a very serious neglect of public goods including public health. Even capitalist countries like the USA can appear socialist in comparison to the kind of dog-eat-dog Chinese society of today. Lu Xun's descriptions of the cruelties and corruptions of 1930s China still seem current today. The problem at bottom is not that China is a poor developing country. Because China is a politically underdeveloped country, its priorities are wrong.
Chinese people often complain that their government is corrupt and incompetent rather than that it is not democratic. The threat to throw the bums out in elections, however, has much to do with whatever success that relatively democratic countries have in reducing corruption and incompetence in government and in reordering priorities to meet the needs of society.
In the first line of the first paragraph above I was tempted to say "health professionals". However China does not have professionals in the sense of an autonomous group that will speak out to maintain standards and enforce standards among its members. The Party does not allow such truly independent groupings. So they are not professionals not for lack of dedication but for the lack of a political environment that permits true professionalism. The physicians who spoke out about the SARS cover-up are a sign that this is changing.
China’s public health system has been very successful in controlling older diseases such as malaria and polio. Public health has improved dramatically over the past two decades thanks to the marked general improvement in nutrition. Why has China’s public health system become so much less effective than it was two decades ago? As He Qinglian pointed out in her “China and the Pitfalls of Modernization” [Zhongguo Xiandaihua de Xianjing], economic reform brought with it galloping decentralization, increased official corruption and even the loss of power of village and local government to clans, especially in southern China. [Several He Qinglian essays are translated on the website of the U.S. – China Economic and Security Review Commission at
http:// www.uscc.gov/works.htm
Politics, the Party and lack of democracy are the fundamental weaknesses of public health in China. The Chinese writer Yu Jie has called China an “Emperor’s New Clothes” sort of society. Everyone knows what the problem is, nearly everyone dares not speak out. In the introduction to his book “The Wings are Willing but the Bird is Weak” [Xiangfeide Chibang, January 2000] Yu Jie wrote:
"China has many scholars, professors and writers. But what China lacks is people who truly express their own inner selves and their true understanding of the world....I am not a scholar or a writer. That is not what is important. The important thing is to express oneself. Why is evil everywhere and so powerful? The root is the monopoly some hold on information and the fear that people feel to express themselves.
The 1998 Nobel Prize Winner in Economics, Cambridge University Professor Amitaya Sen, an Indian, is an expert on famine. His research demonstrates that countries with a democratic system that guarantee freedom of expression and freedom of association are able to avoid famine and economic disaster. Conversely, ancient empires, totalitarian regimes and dictatorships are especially vulnerable to famines. This is because they lack criticism, they lack voices the question and oppose. Information monopolies lock up power within a very small scope. Amitya Sen's "Information Famine" concept holds that closing up against correct information results in much incorrect information. Disasters come because people don't dare to say what they think. Our failure, our fear to express ourselves has become something that has been transformed by oppression into just the ordinary state of our everyday lives. That is why disasters come upon us one after another. ...” wrote Yu Jie.
[For more related Chinese insights on Chinese society today, see
http:// www.usembassy-china.org.cn/sandt/sandsrc.htm#Society
Public health expenditures are unfortunately allocated to be visible things such as fancy equipment such as multi-million dollar CAT scanners in some rural county seat hospitals to make local officials look good rather than things that are lower profile but equally or more important such as training and funding better health care in the villages.
China’s inadequate response to AIDS reflects these problems just as the current SARS epidemic crisis does. AIDS is easier to hide. HIV takes years to produce full-blown AIDS and often afflicts marginalized rural people. The SARS virus takes just a few days to produce SARS and afflicts well-educated professionals in the cities.
For an analysis of AIDS and the shortcomings of China’s public health response.
See “PRC Blood Donors and the Spread of Rural AIDS”
usembassy-china.org.cn
A collection of translations of Chinese language articles on HIV/AIDS in China is available at
usembassy-china.org.cn
See also UNAIDS China Country Profile at
unchina.org
and a translation of a Chinese article on the role of the Henan Provincial Health Bureau in the transmission of HIV to one million people.
usembassy-china.org.cn
It’s the System: Formidable Obstacles to Reform
By pulling together statements at various places of “Grave Concerns” a 1998 book by Chinese Academy of Social Sciences scholar Zheng Yisheng and Qian Yihong on China's environmental problems, one can find an eloquent statement of the obstacles to China’s sustainable development and to the development of its public health system.
Ranking the Obstacles to Sustainable Development in China
"Grave Concerns" provides not just a deep analysis of the problems of sustainable development but also ranks these problems.
Obstacle #1 The biggest obstacles are unrealistic economic goals defined in economic terms (GDP) which are then exaggerated at lower levels. Economic growth goals need to be relaxed, said Zheng. The development ministries such as the State Development Planning Commission, the State Economic and Trade Commission are much more powerful than the protective ministries such as the State Environmental Protection Administration (SEPA), the State Forestry Bureau (although some Chinese experts say that Forestry is more of a forest- exploiting than a forest-protecting agency.)
Obstacle #2 The second greatest obstacle to sustainable development is the private interest group-like behavior of ministries and local governments. This results in conflicting goals as each ministry and local government seeks its private advantage first and prevents a coherent policy from being implemented. This second obstacle is related to the weakness of law and the ineffectiveness of the central government in imposing policy upon different ministries and upon local government.
Obstacles #3 The third obstacle is the widespread corruption of Chinese government officials. This is closely related to obstacle #2 above. The perception of widespread corruption by government (that the government does not obey the law) probably also makes it harder to persuade Chinese people to comply with laws and weakens the authority of government generally.
Obstacle #4 The fourth obstacle is the poor quality of decision-making by Chinese government officials. This fourth obstacle is due to limitations in personal integrity, education and knowledge of many officials [Note: The Chinese term that expresses a person's quality (suzhi) is a blend of personal integrity, education, and general knowledge. End note] but also to the poor quality of the statistics they base their decisions on. Some Chinese academic say that the elimination of the social sciences from university curricula in the early 1950s (but making a comeback today) has resulted in very narrowly educated officials and scientists who don't understand the big picture. Premier Zhu Rongji's government in 1998 launched a campaign still underway to stop the widespread falsification and exaggeration of statistical data that local governments send to the central government.
[See
usembassy-china.org.cn hp.html#Health
and the section immediately above it – a six part summary of “Grave Concerns”. China’s environmental problems and public health problems largely come down to the same political, social and institutional conundrums. So one can borrow analysis from the environmental field and apply it to public health. ]
DC<<
sarswatch.org |
