Congressional-Executive Commission on China,
"Dangerous Secret: SARS and China's Health Care System"
May 12, 2003

Why China's health matters to the world

By Bates Gill and Andrew Thompson

South China Morning Post, April 16, 2003

The unstoppable march of severe acute respiratory syndrome (Sars) from Guangdong to Hong Kong and beyond demonstrates the mainland's increasing economic and social interdependence with the region and the entire planet. Since the mainland has globalised and become East Asia's engine of growth, maintaining the health of its economy and society is in the world's best interests and will present a significant challenge to China's partners in the region and around the world.

The notion of the mainland as a closed society needs to be seriously reconsidered. Domestically, more Chinese enjoy freedom of movement then ever before. Internationally, millions of travellers from all over the world visit the mainland while millions of Chinese travel abroad in increasing numbers every year. As the most important transit point for commerce throughout East Asia, Hong Kong has reaped great benefits from its strategic position. Now Hong Kong, and to a lesser degree the rest of East Asia and the world in general, are paying a price for the mainland's underdeveloped and opaque public health system.

The mainland's formerly admirable public health system has not fared well in the years of gaige kaifang (reform and opening up), with government spending unable to keep pace with a changing society and integration with the rest of the world. The public health system has proven itself ill-prepared to cope with rapidly emerging diseases such as Sars, hepatitis and HIV/Aids.

The mainland's initial denial and slow response to the Sars outbreak characterises a political environment where individual initiative is discouraged and social stability is protected above other interests. Additionally, the initial slow reaction by medical authorities can be explained by outdated laws that prevent effective communication about emerging epidemics. The State Secrets Law prevents local authorities from discussing an emerging outbreak until the Ministry of Health in Beijing has announced the existence of an epidemic. In the case of Sars, the silence of the bureaucracy, coupled with an increasingly mobile population, virtually guaranteed that an infectious disease would quickly spread well beyond Guangdong to the rest of the world.

Even if the bureaucratic delay did not occur, it is unlikely that the mainland's health-care system would have been able to prevent the spread of Sars. The rapid spread of other emerging infectious diseases throughout the mainland demonstrates the inability of the public health system to deal adequately with the complex nature of infectious diseases in a modern, globalised China. In urban areas, public health is adequate for those who can afford it or are still employed in the state sector, where insurance and company clinics can provide primary care. However, in rural areas, where the majority of the population resides, social services are inadequate to non-existent. The ability to diagnose and treat emerging diseases competently does not exist throughout most of China.

While Sars has had an immense, immediate economic impact on the economy of the region, there will be a much greater impact in the long term, as other infectious diseases emerge and spread. Blood-borne and sexually transmitted infections have posed a particular challenge to health authorities in China.

HIV/Aids infects over one million Chinese, while similarly transmitted diseases including hepatitis B and C infect over a hundred million more. The capacity of China's health-care system is so stretched that hepatitis B, a disease for which there is a vaccine, still affects an estimated 170 million Chinese, accounting for two-thirds of the world's cases. The inability to prevent the spread of infectious diseases within China will have serious long-term economic impacts globally.

The mainland will have to bolster its medical capacity if it is to maintain steep economic growth rates and continue to play the role of "factory to the world". The central government must create a more effective, transparent and capable public health management system that is able to communicate quickly both nationally and internationally. Vice-Premier Wu Yi toured the Chinese Centres for Disease Control and Prevention this month and insisted they establish an emergency response mechanism that includes an early warning and reporting function. The outcry over Sars might motivate the central government to improve the country's health system, but that remains to be seen.

As the Sars outbreak demonstrates, the mainland's health matters to the world. Global co-operation to quickly identify, treat and prevent the spread of new, emerging diseases will help the mainland and the world maintain its economic and medical health.

 Bates Gill holds the Freeman Chair in China Studies and Andrew Thompson is a research associate, at the Centre for Strategic and International Studies in Washington.

Published in the South China Morning Post. Copyright © 2003. All rights reserved