Sick Man of the East

There is little coordination among China’s 64,000 public hospitals, which are controlled separately on the national, provincial, and county level. There are also hospitals overseen by the People’s Liberation Army (PLA) and police force, whose records are considered confidential national secrets, as well as a few that are managed by private companies. These hospitals are basically competing against each other for patients, which produces an inefficient vertical line of communication and control. As a result, there are duplicated facilities and excess capacity. All of this contributes to the problematic lack of a consolidated and coordinated public health surveillance system that incorporates both curative and preventative care. Preventative care should be a high priority in anticipation of the epidemiological shift China will undergo from infectious to non-communicable and chronic diseases like cancer and obesity as a result of its improving living standards. Furthermore, a public health surveillance system is especially important in light of the threat stemming from the SARS epidemic as well as AIDS/ HIV, which is projected to afflict 10 million Chinese by 2010 if countermeasures are not instituted. Prompted by the SARS outbreak earlier this year, the government designated two billion renminbi (RMB) to improve the rural healthcare system in addition to two earlier allotments totaling RMB 2.3 billion. With more commitment and planning, the state can accomplish better referral systems at little expense.

In some ways, the SARS outbreak serves as a case study of China’s struggle to control the influences of globalization— as well as greater democratization of both information and politics—without thwarting the economic development that comes along with it. Over the past two decades, China has become much more globalized; since 1978, its exports have grown at an average of 17 percent each year, and it has become the fourth largest economy in the world, after the United States, the European Union, and Japan. Culturally speaking, US or global influences through music, movies, and other consumer products have touched many parts of China, especially its urban regions. Yet the SARS outbreak has proven that the economic progress China has made thus far has not translated to the full openness of politics or to the faster, greater exchange of information that go hand in hand with globalization. Instead, the government has resorted to its usual tactics of secrecy and denial. Nevertheless, after SARS was exposed and handled effectively earlier this year, some experts are optimistic that the new leadership of the Party, headed by Hu Jintao, is warming up to a less authoritarian, less intrusive government.

Severe Acute Responsibility Syndrome

SARS emerged in November 2002 in Guangdong Province, and by the time it was contained in June over 8,500 people had been infected and 811 had died. As news and rumors of people seriously ill with fl u-like symptoms circulated, the Chinese government downplayed the situation by under-reporting the number of SARS cases. It was not until retired PLA doctor Jiang Yanyong tipped off the international media in early April 2003 that the public became aware of the Chinese Ministry of Health’s cover up. Finally, on April 20, about five months after the first case of SARS, the government finally disclosed its number of SARS patients, and fired Beijing Mayor Meng Xuenong and the national Health Minister Zhang Wenkang. In that one day, the SARS caseload in Beijing shot up from 37 to 339, further tripling by the week’s end. Once the government got past its initial denial of SARS, it effectively contained it with help from the World Health Organization. Nearly overnight, 60 fever clinics were constructed in Beijing. In rural areas where healthcare infrastructures were clearly lacking, people were extremely vigilant about keeping SARS out. Jiangsu Province had only seven probable SARS cases, but at one point more than 10,000 people were under quarantine. During this containment period, the state allowed the press freer rein to report on SARS. Television stations broadcasted hourly updates, while newspapers such as the People’s Daily were permitted to openly criticize the government missteps.

Greater freedom of the press, coupled with the dismissal of Beijing Mayor Meng Xuenong and Health Minister Zhang Wenkang, created optimism that the government was moving toward a less totalitarian attitude. Because Zhang had been former President Jiang Zemin’s personal physician, and Meng was considered a protégé of President Hu’s their sacking was evidence of a concerted effort by the government to turn over a new leaf. But the willingness of offi cials to break with the past practices may have been acts of desperation in its war against the disease. Since SARS has died down, there has been a conservative backlash. The Beijing New Times, which is run by the large government newspaper company Worker’s Daily Group, was closed after it published an essay in its June 4, 2003, issue placing the National People’s Congress on its list of “China’s Seven Disgusting Things.” The June 20, 2003, edition of China’s Caijing economic journal was also censored because of articles on the SARS outbreak and a high-profile Shanghai real estate scandal. Furthermore, the government has dismissed criticism that it was slow to respond to the SARS crisis and has denied any cover-up, claiming that it disclosed warnings about SARS to the world in early February 2003.

This manipulation of the news was regarded as the “noble heirloom” of the Communist Party. The SARS epidemic exposed the contradictions of the Party’s attempts to adapt to global standards of free press and transparency while at the same time retaining the legacy of secrecy. President Hu and Politburo Standing Committee member Li Changchun introduced media reforms earlier this year instructing China’s provinces and municipalities to cooperate with reporters under their jurisdiction in covering potentially damaging news such as mining and industrial accidents. However, most editors of China’s news sources still owe their jobs to political patronage, mitigating the actual effectiveness of the new reforms. Li was the party boss of Guangdong province, the locus of the original SARS cases from 1998 until late 2002, when he was promoted to the Politburo. Interestingly, while Meng and Zhang were sacked because of their improper handling of the SARS epidemic, Li, as the de facto head of the media and propaganda machinery, escaped relatively unscathed. Recently, the New China Agency reported that Li publicly praised Chinese journalists for their effort in combating SARS and touted the Hong Kong media for its “historic mission” of safeguarding “one country, two systems,” but given the realities of SARS and the press in China, the propaganda merely illustrates the blatant contradictions that reside within the top echelons of Chinese government.