By Elizabeth Economy, CFR
Editor's note: Elizabeth Economy is C.V. Starr Senior Fellow and director for Asia Studies at the Council on Foreign Relations. This entry of Asia Unbound originally appeared here. The views expressed are those of the author.
Trying to wrap one’s arms around China today is a significant challenge. It is a global power with a growing economy, rising military, and expanding diplomatic reach. Yet there continues to be a gnawing sense in and outside China that all is not quite right. Whether it is the 180,000 protests annually, the growing flight of capital and people to the West, or the potentially ruinous impact of corruption on the Communist Party’s legitimacy, uncertainty about China and its future is much greater than the country’s impressive global standing might suggest.
In the face of such uncertainty, what we need most is to understand better, issue by issue, what is happening on the ground in the country; and a terrific new book Governing Health in Contemporary China by my CFR colleague and renowned public health expert Huang Yanzhong provides precisely that kind of insight. It details Beijing’s efforts to tackle one critical and politically explosive issue – health care – and helps us understand where and why the country has succeeded and failed, and what more needs to be done.
The statistics are startling. China has one-third of the world’s smokers and suffers around one million tobacco-related deaths annually; the cardiovascular disease death rate is higher in China than in the United States; and close to one hundred million Chinese are believed to suffer from diabetes. Public anger over poor care, rising costs, and corruption in the health care system triggered more than 17,000 violent attacks against hospital doctors and health care workers in 2010. Moreover, horrific stories of tainted food and drugs have further undermined the Chinese people’s faith in their government’s capacity to provide an effective health care regime. As Huang notes, over the past ten years, the Chinese people have come to refer to health care as one of the Three New Mountains –health care, education, and social security – modeled after the old Three Mountains (imperialism, feudalism, and bureaucratic-capitalism) that the Communist Party deployed to bring down the government of Chiang Kai-Shek.
More from CFR: Health security in Southeast Asia
Huang takes the reader on a fascinating journey through the twists and turns of the various efforts by Chinese leaders from Mao Zedong through Hu Jintao to tackle the country’s health care crisis. He explores the political battles surrounding three of the most pressing health care challenges the country faces: provision of good and affordable health care for all Chinese citizens, managing health care crises such as HIV/AIDs and the outbreaks of SARS and Avian flu; and developing an effective regulatory and enforcement system for food and drug safety. In each case, Huang finds evidence that Chinese leaders have learned from experience and from the outside world how to improve their practices. As a result, he can point to a number of advances in areas such as health insurance coverage or the strengthening of grassroots health care providers.
Yet as Huang amply demonstrates, these remain changes at the margin. He quotes a senior official from the Ministry of Health as noting that the most recent set of reforms launched in 2009 have not “solved the fundamental, systematic and structural problems [in China’s health sector].” Even president-elect Xi Jinping’s pledge to bring higher levels of health care to the Chinese people, coupled with increased investment in the health care sector (according to a recent McKinsey & Co. study, Beijing plans to triple its health care investment to $1 trillion by 2020), will not be enough to make the kind of difference in the country’s public health system that China’s leaders desire and its people demand.
Real change needs a far more radical set of political and institutional reforms that address how health care policy is made, financed, delivered, and evaluated. For Huang, that means health care policy “by fiat” cannot continue. What is needed, instead, he proposes, is reform in Beijing’s relations with local governments, greater democratic participation, a robust civil society, the rule of law, and a true market economy. Without such reform, Beijing will never get at the heart of its public health care crisis.
© 2012 Cable News Network. Turner Broadcasting System, Inc. All Rights Reserved.
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Why is there a "health care crisis" in China but we don't call ours a "health care crisis"? Everything that's happening in China is happening here. Our system just sinking more slowly?
It's called propaganda.
One of the crucial differences is that in the US we do not have to bribe our doctors for treatments. Corruptions in the Chinese government trickles down to every facet of Chinese citizen's life and is the grassroot evil that inhibits and destroys any hopes of effective social reform.
I'm always startled by these reports if they are true. As someone who has traveled pretty much everywhere it is clear (but admittedly anecdotal) that the US has the fattest people on earth BY FAR. I do see far more smokers in china but I have seen this drop at least in the big cities.
True, but most most older Amercians have listened to their doctors and either quit smoking or made the decision to simply not start. I smoked for 15 years but quit (thanks to my doctor) 13 years ago. Smoking and tobacco in general is even worse than being obese in many ways, especially as we age. So, if more people in China are smoking than in the US, heart disease and other health issues related to smoking are invariably going to be much worse. Seems like you missed the point of the article, either that, or you're ignorant regarding the health problems that smoking causes.
The population of smoker is going down. I remember when I was younger, all my friends smoked. Now smoking is not fashion any more in China, especially in big cities. Most of my friends including me and my wife quite smoking many years ago. This is the FACT.
Cigarettes companies make their profits in Asia and Africa. As the people in general aren't become sensitised on the risk of lung cancer and other diseases.
They need Obamacare.
Don't worry, in another 10 years or so, both the US and China will have Chinacare.
time the cfr looked at the health crises, crookedness, corruption in the u.s. system.
china will take care of itself
we need to look at cuba, france and copy
Hugo Chavez probably not too happy with the Cuban medical system at this juncture...
Cuba?? France?? Cuba is one of the poorest countries and its healthcare system isnt exactly the best and France's tax rate is enormous partially due to their failed healthcare system
to cnn:
get rid of wolf blitzer. he is sickening and mediocre.
and
an israeli first, last, only.
Wolf is a sweety wife. Some people feel good listening to sweety wives. But yes, he seems to say nothing
They have public health care except the hospitals now want to see money up front before treating the patient. Patient then goes to try to get refund back from insurance which you might or might not get back.
It's far worse in many countries in Asia. North Korea does not have a functioning medical system that's able to treat even the most treatable diseases/conditions. In many countries, if you don't have cash, you don't live if you develop a condition that requires medication to survive.
Are you seriously using North Korea to make a point? It's like complimenting a person's pronunciation by comparing that person to someone who can't speak.
The health system in the States is pretty good never less we have to open the States to Mexican franchisers ad drugs stores that are offering medical prescription for less than 3 dollars buying the medicine, and others. There is much to do if Mexico, Canada and the States worked in an integrated medical services. Health insurance is one of the most costly thing an American family paid.
I am no expert on China's health care, but as an American who lived there for five years, I have experience with both the USA system and the Chinese system. Ours is transparently rotten. The China system is opaquely rotten. Both systems provide inconsistently good care, and at times, both provide deplorably inadequate care. Both need overhauling from top to bottom but it is unlikely anyone reading this will live long enough to see meaningful change, especially if you need to use either system for life-saving care.
Appreciate your post.; Thanks
Naturally, both our health systems are built upon centuries of trial and error. We have the top shelf package which is now bloated and falling apart under its sheer weight. The Chinese are building theirs up from a Third World prototype, and will eventually recapitulate ours.
Almost all of China's smokers are men, and less than 4% of the women in China smoke. So China's health care crisis has a huge gender bias. I'm surprised the article didn't mention that.
you think US healthcare system is any better? the healthcare in this country is getting so expensive and unaffordable, for profit and inefficient, and even worse that everyone will be forced to pay for insurance with Obamacare no matter you can afford it or not.
maybe what you say would be more useful if you analyze US healthcare system and write an article about it.
If we did not allowed the disease in, we will never worry about medicines.
In U.S., some Hitler leftovers brought with them, the UNKNOWN KNOWN and the UNKNOWN UNKNOWN.
Three New Mountains –health care, education, and house,not social security
China and India, India especially, are creating some of the most horrible superbugs ever seen because of their wide overuse, and china's population control methods are already securing their downfall, they will have an ultra massive elderly population with a work force to small to support them, they have destroyed their fertility rate, being half of what is necessary for a nation to stay the same. China is also using up its resources at a crazy rate, when they're gone, resources don't come back. Boom, china's devastating future, the consequence of rising to the top in population and manufacturing to fast
China will, nonetheless, become a superpower later this century, and a healthy word needs several superpowers and a check and balance or each other. Once the elderly die off, there will be a sizeable reduction in the poplulation, more resources for all, and a boom in their growth. I would like to see several Asian superpowers, such as in India and China, and even in Europe such as Turkey. Enough of World War II style politics, and putting down other cultures as inferior to our own; it sickens me and many people.
Clearly squirrels are to blame.
I know, they are always plotting our down fall, they have found ways to alter the stock market and intercept important calls between nations, they are slowly bringing down civilization.
well ... not all peaches and cream in China either
Or lychees and soya milk in this case....
maybe they should adopt a single payer universal health care system like a civilized nation and trade some police jobs for more democracy? privatized insurance is a communist plot, designed to create a caste based system.
Seriously, every modern western nation has universal health care, we have too long been inconvenienced by pathetic privatised insurance, we as a people need to take the next step and demand a more modern system and government, cut the lies, cut the unneeded spending on pathetic programs.
Said the man who's very livelihood depends on the thousands of dirty coal fired power plants in China which create a brown cloud over the whole nation, a fog you can actually see from space.
Some of that sounds like the result of a US-style diet taking over from what they traditionally would have eaten. History will remember the 20th century for its failed experiment of putting food additives in food.
first off, china's air quality is soooooooo bad soooooooo ubiquitous and has been for soooooo long that most chinese don't even know what it's like to see a blue sky. they refer to the smog as clouds! SMOG not smoking is to blame for such widespread lung disease.
secondly, corruption in china – how about corruption in america? our government, including the third branch, is corrupt from top to bottom. so please – don't be pointing the finger at china when we're just as corrupt.
thirdly, education and healthcare is not FREE in china – just like in america.
as for reform – it's about as likely in a communist country as it is in a capitalist country. i doubt it will happen here or there.
Chinese are the dirtiest people on this planet. They spread germ(SARS) that caused so many problems and killed many people around the world. Chinese people eat everything that has legs except a table.
People like you are one of the reasons for the US's non stop decline!
Is the US health care system based on true market econamy? The answer is flat no. Get your own house in order before prescribe anything to China with a straight face.
why should americans care about china? they would anniliate us if they could. they want to take over the world and would mow us down if they could. care about americans. they are your neighbors and friends and family first.
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I am an ex-pat living in Shanghai. The medical care here is terrible. The ex-pats here have special medical care centers which are iffy at best. If you are a Chinese citizen you must go to a hospital for treatment and wait many hours to see a doctor. If you are prescribed an antibiotic, most of the time it is given by IV. You must go to the hospital for a number of days, waiting hours each day to get your IV antibiotics. Some of the doctors have their patients leave the IV in their arm for the whole three days.
My husband fell and hurt his back. He could not walk or get up by himself. He was told to do some exercises and when he asked for pain meds he was told the pain was good for him. My daughter takes a daily medication. I could only get this medicine for 14 days at a time. Every time I had to refill it I had to call the doctor and the pharmacy. This meant a had to pay a doctor visit fee every time I had to fill the prescription. Thankfully, iwas able to get a year supply while home in The States.
I am in college, I cannot believe how many of the International Asian Children smoke and how frequently they smoke. Its a dirty and disgusting habit.
No wonder everything they export is so cheap. There is no quality to their society. It even makes ours look good.
As someone who lives there 6 months out of the year I can say the healthcare system is horrifying. My exposure to hospitals there has so far only been brief, but it is like a cross between 1950 and the Civil War. And as with many other things in China, the service and quality is totally inconsistent.
It will not change anytime soon. The Chinese blow off many of the science behind modern medicine as "western" and instead turn to TCM (Traditional Chinese Medicine) where they can choose random causes and cures for anything. Little understanding of modern science helps to keep TCM in full swing, and the government will not tolerate any debunking of the myths. TCM is a huge industry employing millions and it helps the government to point the finger for medical problems in any number of directions other than where the true root cause really lies.
You sound like you have no experience with TCM, and just claiming based on your western perceptions of what is a true medicine that TCM doesn't work, you're not an expat!
And typical American... bring politics into everything, your own health care system is way overpriced, yet you consider Canada socialist, which is a bad word, only in America!
The article forgot the profound concentration of it's population in small geographic areas that cannot support that large population. China is geographicaly huge and they need to spread out their population and industry.
One more good article pointing out what we're beginning to fully understand. China has 'cheated' it's way to the top economically. While most developing countries add social services as they expand their middle and upper classes, China has struggled to do any reasonable safety net improvement over it's growth years. Of course this type of thing costs money, and governments get money by taxing more heavily. This inevitably slows growth. China has been on a 'planned growth' binge for decades now. Planners will now need to bring a balanced approach of growth with more government attention to social safety net issues. This will keep China from bring the driving force in global economic growth it has been for 20 years. Of course the other option is growth leading to revolution, as the masses revolt.
All the liberals need to do is scold the Chinese to dial down their economic progress a century or more and go back to the rural China of the early 20th century before all this capitalism nonsense.
We need to worry about OUR health care crisis which is caused by greed. Because of out censored press, manipulated public opinion the truth never seems to get out. Gore Vidal stated the truth in 1963. He wrote " In public services, we lag behind all the industrialized nations in the West, preferring that the public money go not to the people but to big business.The result is a unique society in which we have free enterprise for the poor and socialism for the rich.
To change that you need to have free expression of opinions which the media does not allow ,except in a few cases like this one. If it were done long ago we would not be in endless wars and in a fiscal abyss.
Überall in Europa gerät das Gesundheitssystem unter Druck. In Deutschland wäre das System zwischen Privater und Gesetzlicher Krankenversicherung ohne die Beamten die sich fast alles sehr günstig in der Privaten Krankenversicherung absichern können längst nicht mehr zu halten. Siehe auch http://www.krankenversicherung-beamte-beamtenanwaerter.de
Many of China's leaders like Mao and Deng smoked heavily and yet they lived into their eighties. Cigarettes made in China are not the same as the cigarettes made in the United States where additive chemicals are added to the tobacco and paper which are carcinogenic. Smoking is known for short term benefits but with possible long term consequences like emphysema.
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