Tackling China's public health crisis
January 3rd, 2013
05:23 AM ET

Tackling China's public health crisis

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.

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Topics: China • Health

soundoff (60 Responses)
  1. Jeff G.

    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.

    January 7, 2013 at 2:08 am | Reply
    • Really???

      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!

      January 8, 2013 at 5:22 pm | Reply
  2. KEVIN

    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.

    January 7, 2013 at 5:52 am | Reply
  3. Alger Dave

    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.

    January 7, 2013 at 2:21 pm | Reply
  4. empresstrudy

    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.

    January 7, 2013 at 6:16 pm | Reply
  5. rightospeak

    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.

    January 8, 2013 at 10:33 am | Reply
  6. Jana

    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

    January 8, 2013 at 12:19 pm | Reply
  7. Nanson Hwa

    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.

    January 8, 2013 at 6:57 pm | Reply
    • lewis

      Do you have proof of this or just your opinion? "Cigarettes made in China are not the same as the cigarettes made in the United States..."

      January 8, 2014 at 1:58 am | Reply
      • Nanson Hwa

        American tobacco company, Philip Morris executives admitted addictive chemicals are added to tobacco and cigarette paper so that the user will require less time to become physically addicted to cigarette smoking. Chinese cigarettes are manufactured without any additives or chemical compounds to improve aroma or taste or increase physical dependency.

        December 5, 2016 at 2:29 am |
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    china health insurance

    January 17, 2013 at 10:28 am | Reply
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