Introduction

When introducing the Public Health Act to the British Parliament 135 years ago, Benjamin Disraeli remarked that public health was the foundation for the "happiness of the people and the power of the country" and that "the care of the public health is the first duty of a statesman." Disraeli's advice nonetheless fell on deaf ears in the post-Mao China. As market forces overtook central planning, health became a backburner issue on the government agenda. Jettisoning egalitarianism and universalism in the Maoist social policy structure, the post-Mao leaders pursued a neoliberal approach in the health sector to such an extreme that even the American model seemed too "inferior". Since the mid-1990s, the government's share in total healthcare spending in China has been consistently less than 20 per cent, compared to over 45 per cent in the United States.¹ Despite nearly three decades of eye-popping economic growth, the anticipated trickle-down did not occur. Christina Ho's article reveals that by 2005, it was clear that the post-Mao healthcare transition had failed to achieve any significant improvements in the areas of cost, access and equality. Ding Chunyan argues that low insurance coverage and high cost of healthcare force patients to rely on their families for financial support, which reinforces the distinctive practice of seeking family members' informed consent to medical treatment for patients in China. Making things worse, China is now facing all kinds of microbial threats, including HIV/AIDS, sexually transmitted diseases, tuberculosis, viral hepatitis and endemic schistosomiasis, though chronic conditions such as cancer and cardiovascular disease have become the leading killers in China. The latter trend seems irreversible given the rapidly ageing society and the increasingly unhealthy diet and lifestyle of the average urban Chinese citizen.

Different from the voluminous studies that focus on the malfunction and deterioration of the post-Mao health system, this special issue pinpoints a much more complex dynamic in China's healthcare transition. Martin Whyte and Sun Zhongxin note that the health sector reforms have not resulted in a measurable decline in people's health status (as observed in post-communist Europe), and that the affordability and access problems have not undermined the confidence and optimism of the rural residents and migrants about their health. Also, a neoliberal approach has not permeated the entire health sector. When examining the pharmaceutical industry, Peng Liu found that a developmental state was responsible for the collapse of the Interest Community of Government, Enterprises and Service Units, which in turn fostered greater regulatory power over drug safety. The state's failure to take responsibility for health is coexistent with systematic efforts to assume authority over health. Carole J. Petersen argues that China's population policy continues to reflect eugenic theories that seek to improve "quality" of the Chinese population. Yet, the decline of China's health system has apparently not prevented the state from pursuing robust health diplomacy. According to Jeremy Youde, China has recently geared up its medical assistance to Africa as an instrument of "soft power" to expand its political and economic influence in the continent.

In October 2002, the Chinese government set up a new rural cooperative medical insurance scheme. This, in conjunction with measures to abolish the rural agricultural tax and various poverty-alleviation programmes, represents efforts by the Chinese Communist Party to re-establish its legitimacy in the countryside. By the end of 2008, 833 million rural residents had reportedly joined the scheme.² If we take into account the 318 million urban people already covered by the basic medical insurance scheme, health insurance coverage in China exceeds 86 per cent, which is slightly higher than in the United States (15.4 per cent of its population are not covered by health insurance). In early 2009, China unveiled plans to invest 850 billion yuan (USD124 billion) in healthcare reform. Pitman Potter notes that the healthcare reform plan seeks to establish a basic healthcare system covering all Chinese people by 2020.

Clearly, the state is playing an increasingly prominent role in the health sector. But more needs to be done. Despite the growing coverage...