Health in the People's Republic of China encompasses the country's health status, health-care system, major public health issues, and health policy. Since the establishment of the People's Republic of China (PRC) in 1949, China has experienced substantial improvements in public health and life expectancy alongside the expansion of public health programmes, changes to the health-care system, and economic development. At the same time, the country continues to face health challenges, including non-communicable diseases such as diabetes and cardiovascular disease, infectious diseases, widespread smoking, air pollution, food safety concerns, regional disparities in access to care, and population ageing.
Health care services in China are primarily provided by state-owned hospitals, while health insurance is mainly administered by local governments. In the 21st century, the Chinese government has expanded health insurance coverage, invested in primary health care, and implemented national public health initiatives, including the Healthy China 2030 programme.
The history of health care in China includes the barefoot doctor programme, the post-1978 health-care reforms, the response to the SARS outbreak, and subsequent reforms. A major related topic is demographic change, including the effects of the One-child policy.
History
Prior to the founding the PRC
Estimates of infant mortality in the PRC put infant mortality as high as 250 deaths per 1,000 live births, often due to tetanus and sepsis.
During the Republic of China era, western-style medicine was mostly not present in the Chinese countryside, although there was some western-style medicine available via missionary-run institutions.
In 1943, scientist Tang Feifan led a team in Kunming which produced China's first batch of penicillin. In 1944, the Communist Party of China began manufacturing penicillin in the Yan'an Soviet.
1949–1976 The PRC government sought to improve the health of the people through a nationwide effort focused on preventive care and the incorporation of biomedicine via traditional Chinese medicine.
In the early People's Republic of China, the pharmaceutical industry was shaped by geopolitical pressures, such as the Korean War and the United States embargo against China, including the U.S. embargo's prohibition on exporting penicillin to China.
An emphasis on public health and preventive treatment characterized health policy from the beginning of the 1950s. At that time, the Chinese Communist Party (CCP) began to mobilize the population to engage in mass "patriotic health campaigns" aimed at improving the low level of environmental sanitation and hygiene and attacking certain diseases. These public health measures contributed to a major decrease in mortality.
Western-style medicine first made significant inroads in rural China via the PRC efforts to increase immunization by vaccinating people against smallpox, tuberculosis, and typhoid fever.
In 1952, the Central Committee of the Chinese Communist Party began the Patriotic Health Campaign to mobilize millions of urban Chinese to clean up streets, catch vermin, and destroy insects. In rural areas, the campaign focused on toilet sanitation (including covering excrement pits), hand washing, and encouraging people not to drink unboiled water.
In 1956, China began a public health campaign to eliminate schistosoma-carrying snails. Beginning in 1958, the "Four Pests campaign" sought to eliminate rats, sparrows, flies, and mosquitoes, which accounted for a nearly 20 percent drop in crop production, leading to the deaths of two million people. Particular efforts were devoted in the health campaigns to improving water quality through such measures as deep-well construction and human-waste treatment. Only in the larger cities had human waste been centrally disposed of. In the countryside, where "night soil" has always been collected and applied to the fields as fertilizer, it was a major source of disease. Since the 1950s, rudimentary treatments such as storage in pits, composting, and mixture with chemicals have been implemented. As a result of preventive efforts, such epidemic diseases as cholera, bubonic plague, typhoid fever, and scarlet fever have almost been eradicated. The mass mobilization approach proved particularly successful in the fight against syphilis, which was reportedly eliminated by the 1960s. The incidence of other infectious and parasitic diseases was reduced and controlled.
Political turmoil and famine following the failure of the Great Leap Forward and the Great Chinese Famine led to the largest or second-largest famine in human history. Beginning in 1961, the recovery had more moderate policies inaugurated by President Liu Shaoqi ended starvation and improved nutrition. The coming of the Cultural Revolution weakened epidemic control, causing a rebound in epidemic diseases and malnutrition in some areas.
Before the Cultural Revolution, the Ministry of Health focused on the delivery of health care in urban hospitals. Mao criticized Minister of Health Qian Xinzhong for promoting this health care model, arguing that an urban hospital-focused health care model failed to treat peasants and focused on cure rather than preventative medicine. Mao also criticized the Ministry itself as the Ministry "of urban overlords". Contentions within the CCP on the health care disparity between urban and rural areas became a significant focus of the intra-party "struggle between two lines in the mid-1960s. With the Cultural Revolution, Mao Zedong introduced a new approach to public health, especially in rural areas. In his June 26 Directive, Mao prioritized healthcare and medicine for rural people throughout the country. As a result, clinics and hospitals sent their staff on medical tours of rural areas. Rural cooperative medical systems provided subsidized health care to rural residents. One aspect of this system was barefoot doctors, who received some training and then delivered primary care medicine to those who needed it.
1976–2003
By the late 1970s, China's national health system covered almost the entire urban population and 85% of the rural population. The World Bank described this success as "an unrivaled achievement among low-income countries."
The "barefoot doctor system" was based in the people's communes. In the 1980s, with the disappearance of the people's communes and the rural cooperative medical system, the barefoot doctor system lost its base and funding. The Chinese government began to push for privatization of health care and, as a result, stopped providing necessary funding. Instead, according to Blumenthal et al. (2005), individual towns were now responsible for ensuring that people were receiving adequate health care, which caused disparities between wealthier and poorer regions. Additionally, the de-collectivization of agriculture resulted in a decreased desire on the part of the rural populations to support the collective welfare system, of which health care was a part. In 1984 surveys showed that only 40 to 45 percent of the rural population was covered by an organized cooperative medical system, as compared with 80 to 90 percent in 1979.
This shift entailed a number of important consequences for rural health care. The lack of financial resources for the cooperatives resulted in a decrease in the number of barefoot doctors, which meant that health education and primary and home care suffered and that in some villages sanitation and water supplies were checked less frequently. Also, the failure of the cooperative health care system limited the funds available for continuing education for barefoot doctors, thereby hindering their ability to provide adequate preventive and curative services. The costs of medical treatment increased, deterring some patients from obtaining necessary medical attention. If the patients could not pay for services received, then the financial responsibility fell on the hospitals and commune health centers, in some cases creating large debts.
Consequently, in the post-Mao era of modernization, the rural areas were forced to adapt to a changing health care environment. Many barefoot doctors went into private practice, operating on a fee-for-service basis and charging for medication. But soon farmers demanded better medical services as their incomes increased, bypassing the barefoot doctors and going straight to the commune health centers or county hospitals. A number of barefoot doctors left the medical profession after discovering that they could earn a better living from farming, and their services were not replaced. The leaders of brigades, through which local health care was administered, also found farming to be more lucrative than their salaried positions, and many of them left their jobs. Many of the cooperative medical programs collapsed. Farmers in some brigades established voluntary health-insurance programs but had difficulty organizing and administering them.
Their income for many basic medical services limited by regulations, Chinese grassroots health care providers has supported themselves by charging for giving injections and selling medicines. This has led to a serious problem of disease spread through health care as patients received too many injections and injections by unsterilized needles. Corruption and disregard for the rights of patients have become serious problems in the Chinese health care system.
The Chinese economist, Yang Fan, wrote in 2001 that lip service being given to the old socialist health care system and deliberately ignoring and failing to regulate the actual private health care system is a serious failing of the Chinese health care system. "The old argument that "health is a kind of welfare to save lives and assist the injured" is so far removed from reality that things are really more like its opposite. The welfare health system supported by public funds essentially exists in name only. People have to pay for most medical services on their own. Considering health to be still a "welfare activity" has for some time been a major obstacle to the development of proper physician - patient relationship and to the law applicable to that relationship.""What Limits to Corruption in Health Care?" in April 2001 Viewpoint Voice of China translated on the U.S. Embassy Beijing website. Accessed 7 February 2007
Despite the decline of the public health care system during the first decade of the reform era, Chinese health improved sharply as a result of greatly improved nutrition, especially in rural areas, and the recovery of the epidemic control system, which had been neglected during the Cultural Revolution.
2003–present