CHINA: Public Health Education Sorely Missing

By IPS Correspondents Reprint | | Print |

Antoaneta Bezlova

BEIJING, May 15 2007 (IPS) - China’s government is trying to fix its ailing rural health-care system by pouring millions into medical infrastructure for the countryside, but its neglect of basic health education for the public could condemn these efforts to failure, health experts here warn.

After China was caught ill prepared to deal with severe epidemics such as the deadly Severe Acute Respiratory Syndrome (SARS), allowing the virus to spread quickly through several provinces in 2003 because of lack of facilities, the government announced a 252 million US-dollar investment to improve the rural health infrastructure.

Central leaders have also pledged to reverse a long-standing trend of providing health care for towns and cities while neglecting the countryside. Beijing is spending 10 billion yuan (1.2 billion dollars) on rural medical care this year, nearly double the 5.8 billion it spent in 2006.

But health experts and non-governmental (NGO) medical workers in the countryside warn that China’s attempts to mend the dilapidated health system in the villages are skewed towards improving its “hardware” while neglecting public education.

“Not only infrastructure and technology are needed to achieve better health-care, the population needs a better awareness of disease and what causes it,” James Murray, co-ordinator for Plan China, an NGO involved in rural health-programmes in central China, said.

Summing up his seven-year experience of running health-care programmes in China’s rural areas, Murray said one of the main problems was that the country’s health-care system focused on curative rather than preventive care.

In the six counties in the central province of Shaanxi where his organisation works, fewer than 5 percent of mothers and just 1 percent of young people had basic knowledge of HIV/AIDS and other sexually transmitted diseases, he said.

“There is no obligation to provide residents with health education, and the government does not invest funds for this,” Murray told the Foreign Correspondents Club of China in Beijing. There was also little incentive for government health workers to be pro-active in promoting disease prevention.

Poor knowledge about epidemics and infectious diseases, and a lack of government effort to educate the public about prevention, are now threatening to undo some of the progress that China has made in cutting poverty and boosting incomes over the past 25 years.

While health-care provision in towns and cities has improved, rural medical care has collapsed. For instance, in 2005 the infant mortality rate in rural areas was 2.4 times higher than in urban areas, and in poor rural areas, life expectancy was 4 years shorter than the country’s average.

In some parts of the country, particularly in the poorer hinterland, diseases like tuberculosis and measles, which were once thought to have been eradicated, are now making a return. A number of recent health scares, including the SARS outbreak and the avian influenza, have all highlighted the sorry state of China’s health-care system.

The demise of rural health-care began in the late 1970s with the collapse of state communes. While in the first decades of communist rule the government provided health-care for all through its co-operative medical scheme, with the dawn of economic reforms in early 1980s, people in rural China were left to pay out-of-pocket for their treatments.

By 2003, some 90 percent of the country’s rural population, or 800 million, did not have any health-insurance coverage. As the state withdrew from health provision for the countryside, rural doctors who sometimes earn as little as 60 dollars a year, were forced to become businessmen, prescribing costly medicines that earned them commissions.

The government spending cuts on health-care had also forced hospitals and clinics to increase their fees and turn people who can not afford the treatment away.

With poor health-care provision one of the main causes of growing rural unrest across the country, the government is now trying to boost investment in medical infrastructure and arrest the decline in national health.

But the results of this investment push have been mixed. A damning report of the state of the nation’s health, published by the Chinese Academy of Social Sciences last year, said malpractices continued to plague the country’s ailing health system.

The report – the ‘Green Book of Health’ – said hospitals had extravagant infrastructure, including star-rated wards and hi-tech machines, but sick people could not afford to go for treatment.

Government spending on medical care in 2006 was only 5.5 percent of gross domestic product – still low compared to developed countries, which spend around 8 percent of GDP on healthcare.

Outside observers have been equally critical of China’s neglected health-care system. A recent report by the World Health Organisation, which ranked the public-health systems of 191 countries, based on fairness of access to health-care and fairness of contributions to the total cost, placed China 144th. By comparison, India, which has a per capita income of half of China, was at 112th place.