General historical overview
After the fall of the Qing Dynasty in the early 1900s, there was an explosion of Western education, as wealthier families sent their children to be educated abroad (mostly in Japan which by then was fairly Westernized, but some went to the US/UK too). The old traditional Chinese medicine practices began to be sidelined in favor of modern ones. However, Communist policies had an erratic effect that led to a deterioration in both quality of care and general medical knowledge. Even today, modern China continues to struggle with the spread of infectious diseases because both the medical profession and its population continue to embrace non-scientific practices and are uneducated in basic safe practices.
Quick timeline of political history:
- May 5, 1918: May Fifth Movement: after the Versailles Treaty, Chinese felt betrayed by their supposed allies and the promise of a liberal world order because Shandong province was awarded to Japan in the treaty, instead of colonialism in China ending.
- pre & post-WW2: Jiang Jieshi (Wade-Giles: Chiang Kai-Shek) had mostly unified China and severely weakened the surviving communists, but as the war went on they increasingly fought on two fronts. Meanwhile, the early communists, after almost being wiped out and walking thousands of kilometers in the cold and with little food, finally established themselves and were able to grow in strength in a region away from the front lines. They later overpowered the Republic forces and drove them to Taiwan.
- CCP history under Mao Zedong had two major traumatic periods:
- The Great Leap Forward (1958-1962): complete overhaul of society and the economy, was absolutely devastating and plunged the country into hunger and poverty for multiple generations.
- Cultural Revolution (1966-1976): things were sort of starting to get better economically, but instead of stabilizing, the government began massive political purges where neighbors were reporting on neighbors. This is when most of the Western cultural and scientific links were destroyed because anti-elitist and anti-specialist attitudes dominated.
How political turmoil affected medical care in China
The medical profession in China was taking off in the early century, then under the Republic pre-WW2 it flourished and Westernized greatly, but much of that was destroyed in the early days of CCP rule and during the GLF as hospitals and institutions were pretty much done away with in favor of mass-movements. Medical care during the GLF became more community focused, since society was sub-divided into “mass-societies” which were basically huge communes organized around work-groups. However, the government had limited resources, and only 1-2.6% of expenditures were devoted to medical care. Additionally, mass-mobilization techniques often backfired. For example, a campaign mandating that people kill rats to improve sanitation instead led people to breed rats in order to meet their quotas. Ultimately, some progress was made, but the top-down approach of mass campaigns meant the progress would often only be temporary, since the government would eventually shift focus to something else and medical and sanitation problems would reemerge.
Despite the modest success of medical movements after the CCP took power and during the GLF, the Cultural Revolution was deeply damaging to the practice of medicine in China. This time not just hospital systems, but Western medicine in general was eradicated. Mao issued a statement saying that the 500 million Chinese peasants of China’s rural countryside were floundering while medical “gentlemen” lived in luxury in cities, so doctors trained in foreign medicine were sent to the countryside for “reeducation.” At the same time, traditional Chinese Medicine (TCM) was elevated and determined to be scientific, despite it having no scientific basis (not just no double blind trials etc., but even beyond that, it’s largely rooted in superstition).
During the countryside exodus of doctors, there was a bright point: Western-trained doctors began educating some illiterate peasants on medicine, so they could go around and spread awareness of good hygiene, help with delivering babies, treat basic colds, etc. This was successful because the “barefoot doctors” as they were called were able to serve as communal medical care (i.e. not be shut down by the CCP), since they were clearly uneducated and rural. So that type of knowledge, even in a basic and inconsistent form, survived. As time went on and China became less hostile to private endeavors in the 1980s, some of the barefoot doctors began to set up locales where patients visited them, in essence starting an early form of private medical practice in China. However, many people complained to the government that these early private practices were giving out unqualified advice and fake medicines, which led to a clampdown on unofficial medical practice.
Modern medical practice in China:
Even in the 21st century, China continues to place TCM at the same level, or sometimes above Western medicine (depending on political and nationalist climate). TCM is officially considered scientific and effective by the government, and doctors and academics who criticize that position face severe penalties. As a result, many people, especially the older generation (40+), are suspicious of Western medicine. For example, many women don’t use birth control because they think it harms their bodies, and people take herbal pills instead of fever-reducing medicines if they get sick because they think Tylenol, Advil, etc. are bad for them.
The lack of knowledge about Western medicine and medical science extends to the issue of how diseases are transmitted. People cough, sneeze, etc. without covering their mouth. If you go to meat markets and restaurant kitchens, sanitation is usually not just lacking but totally nonexistant. Cross-contamination is everywhere, butchers don’t use gloves, they’ll smoke cigars while handling meats, use the same cutting boards and knives for everything, etc. All over the country, soap is missing in critical places. Toilets don’t have toilet paper or soap because if they did, people would steal it to take home. People carry tissue with them. A very small minority carry hand-disinfectant.
In addition, China’s medical system, though much improved, still has stark downsides. Most notably, although the cost for basic care is fairly low, complicated and life-saving procedures are usually prohibitively expensive: the CCP has focused on trying to make hospitals more financially self-reliant, and as a result, costs of procedures have risen dramatically in the past several decades. Almost half of all Chinese living below the poverty line are that poor because they had to pay exorbitant medical expenses. In addition, around 20% of China’s population is composed of migrant workers, who live in cramped quarters, move often, and tend to perform dirty manual labor, all of which contribute to the spread of diseases both within the migrant community and externally to the people they interact with.
In essence, neither the infrastructure nor people’s knowledge is geared toward containing infectious diseases. Now faced with the novel coronavirus, the government has released information instructing people to wash their hands, not touch their face, etc., but to a lot of people, that’s brand new information. They don’t understand why they shouldn’t do those things. The country is, in some ways, one of the least medically educated in the world. Even as they aspire to be a global leader, they’re still lacking in basic knowledge that a lot of Western countries have taken for granted for decades if not centuries. That’s what makes China so susceptible to the emergence of contagious diseases, and what makes the containment of COVID-19 so difficult even with the massive lockdowns and emergency procedures being enacted by the government.
Much of this info is from June T. Dreyer’s book, China’s Political System: Modernization and Tradition, and from her class at the University of Miami on internal Chinese politics.