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

China: Richer, But Not Healthier

By Bates Gill

Far Eastern Economic Review, May 1, 2003

The news about Severe Acute Respiratory Syndrome out of China seems to get worse with each passing week. For, in spite of some recent positive steps by Beijing, the political and socioeconomic conditions are ripe in China for the further spread of infectious disease, including atypical pneumonia, hepatitis and HIV/Aids.

True, Chinese leaders recently have taken greater interest in dealing with Sars. But admitting to problems is only half the battle. There is still a long way to go, not just in dealing with Sars, but with other health-care-related challenges. To begin, even if political and bureaucratic impediments can be overcome, the Chinese health-care system is incapable of adequately addressing the complexities of emergent epidemiological and prevention challenges. Local health-care capacity varies wildly across the country as central government spending in this sector flattens and localities are expected to pick up the difference. As a result, the expertise and capacity to diagnose, prevent and treat the spread of disease--especially new viruses--is limited to nonexistent throughout much of China.

In addition, Beijing and the provinces seem reluctant to fully accept assistance from the international community to deal with their burgeoning public-health quandary. Only after a two-week wait were inspectors from the World Health Organization permitted to travel to the Sars outbreak's epicentre in Guangdong. This same reticence characterizes China's earlier response to its HIV/Aids crisis; political leaders in Beijing and throughout local jurisdictions remain overly cautious in their willingness to accept international intervention and assistance.

China's approach to Sars exposes troubling weaknesses that are reflected in Beijing's overall reaction to deadly disease outbreaks. These are: opaque communication channels--and even deliberate disinformation--from provincial to central authorities; denial and inaction short of international outcry and senior-leadership intervention; weakening public-health-care capacity to monitor, diagnose, prevent and treat emergent disease outbreaks; and early and persistent reticence to collaborate effectively with foreign partners. This must change.

A first priority must be to implement more transparent, accurate and coordinated public-health-care management and communication. As a start, the country should invest even more heavily in its epidemiological and surveillance capacity to accurately detect, monitor and quickly report on disease outbreaks and their progress. Beijing will also need to oversee improved cooperation both between the central and local authorities and across the bureaucracy in a more effective interagency mechanism. But for these kinds of steps to succeed, China's new leadership must commit to raising the political priority of public health on their agenda of socioeconomic challenges.

Second, resources for public health will need to be expanded considerably, both as a part of central and provincial government expenditures. At a basic level, more well-trained professionals will be needed to properly diagnose, treat and care for persons afflicted with emergent epidemics in China. Even more could be gained by promoting greater awareness and preventive messaging, not to alarm people, but to help them take the necessary precautions to protect against infectious diseases prevalent in China.

Finally, China and the international public-health community have a shared interest in scaling up cooperation and assistance programmes. There are numerous international health-related assistance programmes in China, but most operate at a relatively modest scale. Expanding successful programmes will require significant new funding. The World Bank may be one resource that could expand its support for health-related programmes in China, but major donor nations should also consider re-channelling development aid to focus more on public-health programmes. In the end, however, China--as one of the world's largest economies and an aspiring great power--will need to show a greater commitment to working with international partners and to taking its public-health challenges more seriously.

The silver lining to the tragic Sars outbreak may be the attention brought to China's health-care system, and how China's health is a concern to the world. Given China's intensifying interaction with partners around the world, more concerted action will be needed to stem the spread of debilitating and even fatal infections from China, and ameliorate their effects on the economic wellbeing of China, the region and the planet.

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