- Public Health and the Modernization of China, 1865–2015 by Liping Bu
Modern China, Public Health, Imperialism, Global Health, Chinese Medicine
In Public Health and the Modernization of China, Liping Bu offers the most comprehensive overview available of the history of public health in modern China. Its five chronologically ordered chapters show how the political vicissitudes of the past century and a half shaped China’s public-health institutions and initiatives. By specifying Chinese characters for important terms and names, but also including basic historical background, the book strives to be both useful to those with specialized knowledge and accessible to those without.
Chapter One discusses changes from the mid-nineteenth century through the first decade of the twentieth, when public-health programs emerged in the shadow of Western and Japanese imperialism. Until the late 1800s, foreigners living in Chinese treaty ports arranged for sanitary services in their own settlements, but not in the areas where Chinese residents lived. Ironically, the industrialization that the foreigners had brought to the treaty ports had created the conditions—pollution, slums full of impoverished workers—that fostered disease in the first place. After putting down the Boxer Rebellion of 1898-1901, foreign powers demanded that the Qing government establish modern public health measures in Beijing and Tianjin as one condition for regaining authority there. Public health initiatives in the early twentieth century, such as the North Manchurian Plague Prevention Service, likewise served to reassert Chinese sovereignty against Western and Japanese claims.
Chapters Two and Three focus on the 1910s through the 1940s, when Chinese modernizers and Western philanthropists saw state medicine as a way to revive China from its abjection. Not all agreed, however, on what that should look like in practice. Some interpreted state medicine as creating a modern medical bureaucracy, while others understood it as making effective health care universally accessible. The Nationalist government and the Rockefeller Foundation, two of the most important actors in this period, concentrated on the former goal, despite supporting a few [End Page 230] individuals and pilot programs geared toward the latter. While the Nationalists built a mostly urban health-care system that excluded Chinese medicine, their antagonists in the Chinese Communist Party (CCP) strove to improve hygiene and living standards in the countryside, deploying Chinese as well as Western medicine. Wars in the 1930s and 1940s, which brought deprivation and disease and disrupted data collection, make it difficult to assess how either approach affected public health. But Bu suggests that the Communists at least had their priorities straight.
Chapter Four turns to the early People’s Republic of China (PRC), from 1949 through the late 1970s. Intra-Party struggles dominated the 1950s: over whether and how Chinese medicine should be incorporated into the national health system, and over the urgency of tackling public health in rural areas. By the end of the decade Chinese medicine’s status had been resolved; the government would sponsor Western medicine, Chinese medicine, and a new amalgam, combined Chinese-Western medicine. Rural health, however, remained a conundrum, worsened by the horrors of collectivization-induced famine. It was not until transformations in the 1960s, epitomized by the “barefoot doctors,” who administered basic interventions with minimal training, that the health needs of Chinese farmers finally received attention and funding proportional to their gravity. The result was impressive: despite the violence and disorder of the Cultural Revolution (1966-1976), infectious disease rates dwindled and average lifespan increased. By 1980 Chinese life expectancy was thirty years greater than it had been in 1949 (p.249). Moreover, the PRC government achieved this with essentially no international help: it was excluded from the World Health Organization until 1971, and from 1960 also lacked Soviet support.
If the Mao years featured remarkably effective public health intervention despite political chaos and economic deterioration, the past four decades have featured remarkably poor public health provision despite political stability and rising incomes. That is the story of Chapter Five, which indicts post-socialist regression. Many medical services were privatized and public...