HEALTH-CHINA: SARS May Yet Lead to Review of Public Health System

By IPS Correspondents Reprint | | Print |

Antonaeta Bezlova

BEIJING, May 25 2003 (IPS) - As the SARS outbreak here appears to ease a bit, hopes are growing that China’s tardy tackling of the epidemic might have a positive side effect – and force its leaders to confront the country’s lopsided reforms in public health.

By taking too long to reveal the real dimensions of a health crisis that had the potential to travel around the globe, China set in motion a chain of negative reactions – from the loss of its international standing in the region and beyond, to economic losses and social tensions across the country.

The global number of SARS cases stands at 8,141 cases as of the weekend. China, where the virus is believed to have originated, is the worst hit country, with 2,491 cases and 163 deaths.

To prevent a repetition of a SARS scenario in the future when an infectious disease becomes a major social, economic and political problem, experts say that China would have to initiate genuine reform of its neglected and underfunded public health system.

"SARS is perfect in a way of showing to the whole world the entrenched problems in China’s public health sector," says Han Deqiang, professor of politics and management at the Beijing University of Aeronautics.

"Medical care in China, especially in the rural areas, has been weakened greatly. The peasants and the laid-off workers have no place to have their disease checked and treated,” Han explains. ”What is more, they have no money. Families of laid-off workers are having problems feeding themselves, not to speak of putting money aside for health care."

World Health Organisation (WHO) experts contend that the government is drawing lessons from the crisis. "We are really seeing an increased level of cooperation and mobilisation on many levels," says Dr Keiji Fukuda, a WHO expert in Beijing. "I hope this is the beginning of rebuilding of the public health sector in China."

Daniel Chin, the head of WHO’s Beijing team of experts, is even more positive. "I believe Vice Premier and Acting Health Minister Wu Yi sees the SARS outbreak as an opportunity to launch reforms in the health system," he asserts. "One can even say she believes the change in the health care system is her mandate."

The collapse of China’s rural communes in the early 1980s brought to an end the era of free preventive health care and universal medical treatment.

Under the collective system, 90 percent of the rural population had access to free health services. Today only 10 percent of rural residents are insured, leaving some 700 million Chinese having to pay out-of-pocket for all of their health care.

The worst affected by the government’s withdrawal from its role as free provider of medical services in the early 1980s have been public health services such as preventive care, disease surveillance and medical control.

Fiscal decentralisation has meant that poor local governments have less to spend on health than their wealthier counterparts. As a consequence, there has been less investment in hospitals and drugs, and lower pay for medical staff has led to lower standards of health care.

Single-minded economic growth should now cease to be the government’s only priority, argues Mao Shoulong, a professor of public administration at People’s University. In an article in the ‘Nanfengchuan’ magazine, he criticised the government for overlooking the public interest in favour of economic growth and social stability.

This is a harsh accusation against a government that was installed early this year with widely proclaimed goals of building "a well-off society".

Chinese officials had played down SARS outbreak and concealed information about it for months, aiding the spread of the killer virus from southern Guangdong to Beijing and other parts of the country as well as nearly 30 other countries.

Shocked by worldwide criticism of China’s slow response to the crisis, the authorities have promulgated a set of regulations for emergency public measures. They cover outbreaks of infectious diseases, mass food poisoning and other serious threats to public health.

Unveiled by Premier Wen Jiabao in mid-May, the new regulations lay the basis for the establishment of a new Emergency Response Bureau expected to coordinate the country’s efforts in combating new outbreaks.

The new rules require local officials to report epidemics to Beijing immediately, and demand that local governments set up reserve funds to tackle future outbreaks.

The central government has also begun pumping funds and resources into a rural health care system that for decades has been drained of funds.

Beijing has already allocated 1.5 billion yuan (180 million U.S. dollars) for the construction of a nationwide disease prevention and control network and an additional 800 million yuan (96 million dollars) to improve infrastructure.

Officials also said they are extending another 2 billion yuan (241 million dollars) to improve standards for rural medical and health care. "The focus of the funding would be to support the central and western rural regions," says Liu Jian, head of the task force for rural affairs at the National SARS Prevention and Control Headquarters.

Yet there are those who doubt that these new measures amount to a real change of government policy. "Social spending can’t sustain economic growth and the Chinese government is well aware of it," says Robert Ross, a political scientist at Boston College, who was in town recently.

He adds: "China’s strategy so far has been a race – pumping money into infrastructure and hoping to close the gap between rural and urban areas before any serious social crisis erupts. I believe it would stick to this."