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• The central government strengthened its commitment during the past year to address the severe shortage of affordable health care in rural China. Since the collapse of the rural public health infrastructure in the 1980s, the disparity in the availability and affordability of health care between urban and rural areas has increased. As a result, the medical needs of China's rural poor, including the diagnosis and treatment of infectious diseases, often go unaddressed. The government, however, has pledged to accelerate the establishment of rural health cooperatives and invest more than 20 billion yuan (US$2.5 billion) over the next five years to modernize hospitals, clinics, and medical equipment at the village, township, and county levels.

• The central government continued to take steps over the past year to prevent and control the spread of HIV/AIDS. Although the estimated number of HIV/AIDS cases nationwide has decreased, health officials still consider the disease to be a grave problem. Government efforts to prevent and control the transmission of HIV/AIDS continue to face serious challenges, as local implementation of national policy lags far behind central government attention to the problem. Victims of HIV/AIDS and other infectious diseases also continue to face harassment and discrimination, despite legal protections.

• Chinese public health officials have shown increased commitment and responsiveness in their efforts to prevent and control the spread of avian flu, and have taken steps to improve government transparency following the mishandling of the SARS epidemic in 2003. International health experts, however, still consider China to be among the most likely incubators of a potential human influenza pandemic. Central government cooperation in sharing information and virus samples with international health organizations has been inconsistent, and international health organizations and central government officials continue to express concern about the speed and accuracy of local reporting on outbreaks among both humans and poultry.

Rural Poverty and Public Health

The central government strengthened its commitment during the past year to address the severe shortage of affordable healthcare in rural China. Premier Wen Jiabao announced the launching of a Plan for Establishing and Developing a Rural Healthcare Service System in a March 2006 work report to the annual plenary session of the National People's Congress. The Chinese leadership highlighted these goals in their December 2005 Opinion Promoting the Construction of a New Socialist Countryside, a document that enumerated key policy goals related to rural development for 2006.¹

According to the plan, the government will invest more than 20 billion yuan (US$2.5 billion) over the next five years to modernize hospitals, clinics, and medical equipment at the village, township, and county levels.² In an effort to accelerate the establishment of rural health cooperatives, Premier Wen pledged to expand experimental health cooperative coverage from 671 counties to 1,145 counties (over 70 percent of the counties in China) by the end of 2006, and double the healthcare allowances paid to rural residents in the program from 20 yuan (US$2.5) to 40 yuan (US$5).³ Wen also said that central and local governments will build rural health cooperatives across the entire country by 2008.⁴

Since 2002, the central government has encouraged the formation of rural health cooperatives, which receive local government subsidies to cover a portion of the medical expenses for farmers who pay an annual 10 yuan (US$1.25) premium. Despite these improvements, healthcare costs have become one of the greatest financial burdens for those living in rural areas.⁵ The poorest residents in rural areas frequently do not enroll in health cooperatives because of the modest annual fee.⁶ Even for participants, the cooperative plan covers only between 30 and 40 percent of hospitalization costs, leaving many rural families in debt after a serious illness.⁷ Yang Lixiong, a social security expert at Renmin University in Beijing, found that since 2001, the per capita income of those living in rural areas increased 2.4 percent, while the per capita yearly expenditure on healthcare services among rural residents rose 11.8 percent.⁸

Since the dissolution of the commune-based rural public health infrastructure in the 1980s, the disparity between urban and rural areas in the availability and affordability of healthcare has increased.⁹ China's healthcare system underwent privatization beginning in 1978, and by 1999 the central government's share of national healthcare spending fell from 32 percent to 15 percent.¹⁰ From 1977 to 2002, the number of doctors in rural China decreased from 1.8 million to 800,000, and the number of rural healthcare workers decreased from 3.4 million to 800,000.¹¹ Eighty percent of medical resources are now concentrated in cities, and the new rural healthcare system covers less than 23 percent of rural residents.¹² The rural-urban disparity is also apparent in mortality statistics. Residents of large cities in China live 12 years longer than rural residents, and the infant mortality rate in some rural areas is nine times higher than in large cities.¹³

Infectious Diseases and Public Health

Infectious diseases such as tuberculosis and hepatitis B continue to be a major challenge for China's public health system. According to the Ministry of Health (MOH), a total of 4.42 million infectious disease cases were reported in 2005, an increase of 12.7 percent from 2004.¹⁴ Over 13,000 people died from infectious diseases in 2005, and the mortality rate increased more than 80 percent from 2004, according to a MOH report.¹⁵ Among the top killers were tuberculosis, rabies, AIDS, hepatitis B, and neonatal tetanus.¹⁶ Unofficial estimates place the number of hepatitis B carriers in China at 120 million.¹⁷ In an attempt to reduce hepatitis B infection, the MOH issued the "2006-2010 National Plan on Hepatitis B Prevention and Control." The plan's top priority is to strengthen vaccination programs, especially among young children.¹⁸ The plan sets the goal of lowering the infection rate to 1 percent among those five years old and younger, and to less than 7 percent nationwide by 2010. The MOH has acknowledged the limitations of the current public health system in addressing the growing medical needs of hepatitis carriers.¹⁹ A survey conducted by the China Foundation for Hepatitis Prevention and Control (CFHPC) found that a majority of Chinese physicians do not have adequate knowledge of hepatitis B or of ways to prevent and treat the disease.²⁰

Victims of infectious diseases, like hepatitis B, continue to face discrimination in schooling and employment, despite protections in the Law on the Prevention and Control of Infectious Diseases, as amended in 2004.²¹ The amended law prohibits discrimination against people with infectious diseases, people carrying the pathogen of an infectious disease, and people who are suspected of having an infectious disease. A 2005 CFHPC survey, covering 583 hepatitis patients in 18 provinces, found that 52 percent of the respondents had faced discrimination in employment and education.²² Some carriers, however, have become aware of their legal rights and have taken legal action against unfair treatment. In November 2005, university authorities in the Xinjiang Uighur Autonomous Region ordered 156 students, diagnosed as hepatitis B positive in their matriculation health checks, to suspend their schooling "for the sake of public health." Students formed an action group and circulated fliers to protest the unfair treatment, and one student started legal proceedings against university authorities.²³ One student also filed a lawsuit against a university in Henan province alleging that the school denied him admission because he is a carrier of the hepatitis B virus. The university had denied the student admission, despite the fact that he scored above the cut-off point on the entrance examination. His application showed that he had tested positive for hepatitis B.²⁴

HIV/AIDS

The central government continued to take steps over the past year to prevent and control the spread of HIV/AIDS. In January 2006, the State Council issued its most comprehensive HIV/AIDS regulations since the government first adopted guidelines in 1987.²⁵ The new regulations address the dominant modes of HIV/AIDS transmission in China: intravenous drug use and sexual contact. The regulations call for cooperative measures among health authorities to provide treatment for drug addicts, require that local governments organize HIV/AIDS prevention action plans and monitoring systems, and encourage local governments to post material about HIV/AIDS transmission in public places. The new regulations also require that governments at the county level and above provide free anti-HIV/AIDS drugs for rural and poor urban AIDS patients.²⁶ A March 2006 UNAIDS report found that China was only half way to meeting its goal under the UN's "3 by 5" initiative of providing 30,000 HIV/AIDS carriers access to anti-HIV drugs by the end of 2005.²⁷ The new regulations also address discrimination against HIV patients, mandating that "no work unit or individual shall discriminate against HIV carriers, AIDS patients, or their families."²⁸ The regulations, however, do not specify legal redress for victims who face such discrimination.

Health officials still consider HIV/AIDS in China to be a "grave" problem.²⁹ Although the World Health Organization and UNAIDS program decreased the estimated number of HIV/AIDS cases nationwide from 840,000 to 650,000, health officials calculate that there were on average 200 new cases of HIV/AIDS infection in China each day in 2005.³⁰ Government efforts to prevent and control the transmission of HIV/AIDS continue to face serious challenges. Central government officials expressed frustration during 2005 and 2006 with local-level implementation of national HIV/AIDS policy. During a November 29, 2005, meeting of the State Council Work Committee on AIDS Prevention and Treatment, Vice Premier Wu Yi criticized some local officials for failing to recognize the severity of the HIV/AIDS problem, and criticized others for neglecting and, at times, obstructing HIV/AIDS prevention and control efforts.³¹ Wang Longde, Vice Minister of Health, criticized local governments in November 2005 for only providing HIV/AIDS prevention services to urban residents with local residential registration, thus excluding migrant workers who are a high-risk group for HIV/AIDS infection.³² To address this discrimination, the State Council and the Ministry of Health announced a new program in November 2005 that aims to provide more than 65 percent of migrant workers with access to HIV/AIDS prevention information by the end of 2006, and more than 85 percent by 2010.³³

Reports of government harassment of HIV/AIDS carriers continued throughout the year, as some local officials retaliated against AIDS victims who expressed their grievances.³⁴ Local government harassment of Chinese civil society organizations dealing with HIV/AIDS also continued, undermining efforts to combat the disease. Public security officials detained activist Hu Jia, co-founder of the Beijing Aizhixing Institute and of Loving Source, both HIV/AIDS advocacy groups, when he attempted to deliver a petition on behalf of more than 50 AIDS patients to Vice Premier Wu Yi at a November 2005 AIDS conference in Henan province.³⁵ Citing government pressure, Hu subsequently resigned from Loving Source in February 2006.³⁶ [See Section VII(a)--Development of Civil Society.]

Avian Flu

Chinese public health officials have shown increased commitment and responsiveness in their efforts to prevent and control the spread of avian flu, and have taken steps to improve government transparency following the mishandling of the SARS epidemic in 2003.³⁷ Since a series of outbreaks in poultry occurred in the fall of 2005, the central government has appropriated over 2 billion yuan (US$250 million) for the establishment of an avian flu prevention fund, and initiated avian flu emergency management and monitoring plans through the Ministry of Health and the Chinese Center for Disease Control and Prevention.³⁸ Local officials have culled or vaccinated millions of poultry in affected areas.³⁹ International health experts, however, still consider China to be among the most likely incubators of a potential human influenza pandemic.⁴⁰ International health officials have continued to express concern about the effectiveness of animal disease surveillance methods at the local level, as the majority of reported human infections have occurred in regions in which no previous bird infections had been reported.⁴¹

Central government cooperation in sharing avian flu information and virus samples with international health organizations has been inconsistent. Although the Ministry of Health has cooperated with international health organizations, the Ministry of Agriculture has been less forthcoming.⁴² Testifying before a Commission roundtable, one health expert said, "Unfortunately, the lessons learned from SARS by the Ministry of Health do not seem to have translated as well to the Ministry of Agriculture."⁴³ In an attempt to improve the transparency of official reporting on avian flu outbreaks, the State Council issued regulations in November 2005 requiring provincial governments to report "major" animal epidemics to the State Council within four hours of discovering them, and county and city governments to report cases to provincial authorities within two hours.⁴⁴ Officials who are found negligent in reporting outbreaks face removal from office and potential prosecution.⁴⁵ Despite these regulations, international health organizations and central government officials continue to express concern about the speed and accuracy of local reporting of outbreaks among both humans and poultry.⁴⁶ The reporting of domestic outbreaks by Chinese news media sources also has frequently lagged behind that of international news media organizations.⁴⁷ In an October 2005 editorial discussing the government's response to avian flu, Hu Shuli, editor of Caijing, a government-sponsored magazine, wrote that, "if one wants to do things even better, one should admit that announcements of avian influenza outbreaks to the domestic public are still obviously delayed and incomplete. This is inappropriate in every way."⁴⁸