Article by Yossi Schwartz, Revolutionary Communist International Tendency (RCIT), 27th March 2020, www.thecommunists.net
China did not have hospitals serving the majority of people until the middle of the 20th century. The health care providers were mainly small private clinics, individual healers and religious or charity institutions. Hospitals existed only for the royal family and high-ranking officials and military personnel. Hospitals serving the general public began in China in the eighteen century in the form of missionary hospitals controlled by Western Churches.
The Health Department in China during the Qing Dynasty was established in 1905 and was a department within the Police Agency. It was used as a system for political control (1). The Qing dynasty was the last royal dynasty, It ruled China from 1644 until 1912. It was not ethnic Han Chinese but Manchu that occupied China in the seventeenth century. Under their rule the Han Chinese were forced to adopt the traditional Manchu queue: a male hairstyle in the form of shaved forehead and a long braided ponytail. From the 18th century the population grew fast while the economics based on agriculture lagged behind. The rulers were corrupted and under their rule the population suffered from land shortages, inadequate food production and several famines. The peasants and the workers in the cities suffered from high levels of taxation. These conditions led to the start of the Taiping Rebellion in Guangxi province, southern China, in 1851. The rebellion was suppressed by the imperial government, though it took 12 years and cost about 20 millions of lives.
After 1912, when the dynastic system was abolished, the Chinese Nationalist Party promised to create modernized western-style health service in the area under its direct control. After 1927 the Nationalist Government started to build the healthcare sector. Prior to the 1949 revolution there were 768 hospitals, however only 248 of them were government-funded, the other 520 were private hospitals (2).
After the victory of the Chinese Stalinists in 1949, the Stalinist government led by Mao began to modernize the public health service. It relied on the Soviet Union’s model and by 1965 there existed more than 230 medical educational institutions. The total number of medical professionals was over 200,000. General hospitals were built in the provinces and clinics in the villages. The government opened disease-prevention centers in addition to treatment service. It cultivated so-called barefoot doctors (farmers worked often barefood on the the fields), to improve undeveloped rural health care service. Medical education opportunities were open to nearly everyone. To provide medical care to the villages the medical training was reduced to less than three years. The health care system was based on preventive medical service rather than treatment-based service. Barefoot doctors worked in the underdeveloped rural areas for the purpose of prevention of diseases (3).
Today's Healthcare in China
From the 1980s, when China began its motion toward becoming a capitalist state, all of this changed. Workers who earn these days 300 Dollars a month prepare medicines by themselves to provide their sick parents because cancer medicine in the pharmacy costs 2000 Dollars at least. An article of the New York Times describes a case symbolic for the situation of many poor workers in China: “In July 2017, Mr. Zhang started making WZ4002, yet another drug. It was discovered in 2005 by the Dana-Farber Cancer Institute in Boston but has not been approved by regulators in the United States or China. His mother told Mr. Zhang that it caused dizzy spells. Earlier, she had come down with a severe bout of diarrhea after taking one of the homemade drugs and had to be hospitalized for a month.”(4) But he can still order the raw ingredients for drugs like this online at a fraction of their official prices. So he keeps making them, like many other desperate and poor people.
The following is another account of the health care these days: “The introduction of capitalism and the retreat of the state meant that health care was no longer free. Hospitals became profit-driven. And with limited accountability, they were widely accused of predatory behavior. A culture of mistrust and inequality now plagued the system. Here’s what that looks like today for ordinary Chinese. It’s 5 a.m., and about 100 people have gathered in a line in downtown Shanghai. This isn’t the line to the movies or a holiday sale. It’s the entrance to the Shanghai Cancer Center at Fudan University. Those who were willing to lose a night’s sleep trying to get a spot in line now have one question in their mind: “Will I be able to see a doctor today?” The scalpers are out, and they’re selling spots in line. China’s line scalpers symbolize a greater dysfunction. The chance of seeing a doctor here is directly related to how big your wallet is. Corruption is inherently part of the system. And in rural areas, it’s worse. But leaving your home in the countryside could have a profound impact on what type of care you can get in the city. Despite its rapid modernization, China still uses what is known as the Hukou system. Your Hukou is defined by your birthplace, and you’re only entitled to social services within that region.” (5)
In addition to these examples, the case of Wuhan is of specific interest in order to fully understand the health situation in China. Wuhan is a major manufacturing city with a heavy focus on automobile and medical equipment. The famous German company Bosch has two plants in the city and the French company PSA relocated their China headquarters to Wuhan recently.
Wuhan Tianhe International Airport is the only airport in the mid-China region to have direct flights to five different continents, 109 destinations and 20 countries. Last but not least the high-speed railway lines Beijing to Guangzhou (which is from North to South) and Shanghai to Chengdu (from East to West) operate in Wuhan in addition to the usual train services (6). It is therefore not an exaggeration to characterize Wuhan as one of the many industrial strongholds in China, eventhough the region has struggled in the early past. It is also an example how insufficient health care services have been an issue for China — even before the outbreak.
At the end of 2018 the occupancy rate of hospital beds in Wuhan was already at 94% and the city’s medical institutions had a total staff of 136,300 according to Wuhan’s health commission (7). The population of Wuhan in 2020 is 8,365,000 which means an increase by 1.2% since last year (8). The government of China allocated to them additional 10,000 hospital beds since the Coronavirus pandemie started, which means that even now there is one bed for every 836 people which is in average still less than 1.2 beds for every 1,000 people. One has to bare in mind that the rural areas, which represent a big part of the country, have far less healthcare facilities than cities like Wuhan. An epidemic becomes immediately a catastrophic situation for a major part of the population!
COVID-19, Pollution and the Wuhan Protests
It seems that while the outbreak of the new coronavirus increased the health crisis for the people in Wuhan and the whole of China, at least the pollution was reduced. “There’s been a dramatic drop in pollution across China as the country tries to contain COVID-19, the disease caused by the novel coronavirus. New maps using data collected from NASA and European Space Agency satellites show how nitrogen dioxide, a dangerous gas released by burning fuel, has dissipated since the outbreak (…) Maps depicting nitrogen dioxide levels in Wuhan, China from January 1st through February 25th of last year show the region blanketed in fiery colors, with parts in a deeper red signifying high concentrations of the pollutant. Fast forward to this year, and maps of the same region show a stark difference: they’re nearly all blue, showing lower concentrations.” (9)
The pollution in China is mainly a problem in the working class cities. The rich and the political echelons live in relatively non-polluted cities. The top 20 of the worst cities in China concerning air pollution are all located in the central or western regions except of the city Xuzhou, which is in the wealthy east coast province Jiangsu (10).
Wuhan is of specific interest here: “When world leaders arrive in Beijing, the city typically lays on beautiful blue skies. It's a sign of the Chinese capital's ability to control its notorious smog when it needs to. It's also indicative of the progress China has made in tackling air pollution in recent years, both by shutting down and upgrading elderly factories and passing new restrictions to tackle emissions. That's seen Beijing fall out of the top 100 most-polluted cities in Asia in recent years, with overall pollution levels 10% lower across Chinese cities between 2017 and 2018, according to a report by Greenpeace and AirVisual. Shanghai, the country's largest city and financial capital, has also made environmental advances, such as adopting stringent recycling regulations. At 146 globally on the AirVisual list, Wuhan, in northeastern China, is not among China's most polluted cities, but residents aren't taking any chances. Recent weeks have seen major protests there -- in themselves a rarity in China -- over plans for a new garbage incineration plant.” (11) This protests happened from June to July 2019 and surprised the government both in the region and the whole country. The protesters rallied against the planned project to build a new garbage incineration plant in Wuhan.
The propaganda machinery in China might explain the reasons for the anti-pollution protests in Wuhan the same way as usual: “Teams led by ministerial-level officials are completing inspections of environmental protection efforts across China, with the results having already affected the promotion prospects of thousands of officials (...) Some 18,000 polluting companies have been punished so far, with fines totalling more than 870 million yuan (US$132.2 million) handed out, and more than 12,000 officials disciplined (...) The scope and severity of the crackdown on lax enforcement of environmental standards has been unprecedented, as has been the response from local governments, who have traditionally turned a blind eye to environmental violations as long as they contributed to local economic growth.” (12)
It doesn't come by surprise that the stalinist-capitalist regime in China uses the same tactic when it comes to pollution that its used after the new coronavirus spread in Wuhan: Blame it on the local and regional governments and their bureaucrats. However, the protests in Wuhan have been met with full force by the imperialist regime. Police was mobilised at a large scale, a big number of protesters were arrested and even after the protests came to halt the repression apparatus remained their heavy police presence in the city. Just few months later the coronavirus pandemic started in Wuhan.
Not long ago we were told that the Coronavirus has been suppressed in Wuhan and that “life returned to normal”. Thus pollution is back again and so may protests by the residents in Wuhan. Only this time, the militarisation of the city is well developed and the regime as well as its local bureaucrats can easily prevent any mobilisations with the argument that the virus is still a threat.
The healthcare system in China is not providing the resources that are needed although it managed to build a hospital in short time after the epidemic started. Pollution is worsening the living standard of the working class and poor. A recession similar to 1929 is happening in the era of crisis of capitalism.
However, China seems well prepared to deal with all of it and might become the model for many other imperialist countries. The developments of the last 9 months in Wuhan have shown this. And they have shown us the important lesson about the correlation between the threat of epidemics and the realisation of anti-democratic measures.
(1) “American Doctors in Canton: Modernization in China, 1835-1935”, by Guangqui Xu, Trunsaction Publisher, New Brunswick, New Jersey (2011), p.265
(2) “Historical Evolution of Chinese Healthcare System: a brief overview”, by John Dudovskiy, Research Methodology, 24 March 2014, https://research-methodology.net/historical-evolution-of-chinese-healthcare-system-a-brief-overview/
(3) “The Turning Point of China’s Rural Public Health during the Cultural Revolution Period: Barefoot Doctors: A Narrative”, by Youngsub LEE and Hyoungsup KIM, Iranian Journal of Public Health, July 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124148/
(4) “In China, Desperate Patients Smuggle Drugs. Or Make Their Own”, by Sui-Lee Wee, New York Times, 11 November 2018, https://www.nytimes.com/2018/11/11/business/china-drugs-smuggled-homemade.html
(5) “China’s Health Care Crisis: Lines Before Dawn, Violence and ‘No Trust’”, by Sui-Lee Wee, New York Times, 30 September 2018, https://www.nytimes.com/2018/09/30/business/china-health-care-doctors.html
(6) “Wuhan is a London-sized city”, by Maggie Hiufu Wong, CNN World Coronavirus Newsticker, 23 January 2020, https://edition.cnn.com/asia/live-news/coronavirus-outbreak-intl-hnk/index.html
(7) “China’s health care system under pressure as coronavirus continues to spread”, by Wendy Ye, CNBC, 25 February 2020, https://www.cnbc.com/2020/02/26/coronavirus-china-health-care-system-under-pressure-in-wuhan.html
(8) “Wuhan, China Population 1950-2020”, macrotrends, https://www.macrotrends.net/cities/20712/wuhan/population
(9) “Maps show drastic drop in China’s air pollution after coronavirus quarantine”, by Justine Calma, The Verge, 2 March 2020, https://www.theverge.com/2020/3/2/21161324/coronavirus-quarantine-china-maps-air-pollution
(10) “World most polluted cities 2019”, IQAir, https://www.iqair.com/world-most-polluted-cities?continent=59af92b13e70001c1bd78e53&country=E9SBuvnZmqijthYog&state=&page=1&perPage=50&cities=
(11) “China has made major progress on air pollution. Wuhan protests show there's still a long way to go”, by James Griffiths, CNN, 11 July 2020, https://edition.cnn.com/2019/07/10/asia/china-wuhan-pollution-problems-intl-hnk/index.html
(12) “12,000 officials disciplined and 18,000 companies punished in China’s sweeping crackdown against pollution”, by Nectar Gan, South China Morning Post, 2 September 2017, https://www.scmp.com/news/china/policies-politics/article/2109342/top-level-china-pollution-inspections-wrapping