China: The development of the health system during the Maoist period (1949–76)

Abstract

The Maoist period (1949–76) is considered an outstanding stage in Chinese history for its improvements in public health and welfare. In particular, the decrease in infectious diseases led to reduced mortality rates and increased life expectancy. This success can be attributed to the policies implemented in the health-care system during this period. However, different stages defined this process. The aim of this article is to determine whether health inequality in China was evident and consistent during the whole period. To determine this, provincial data were drawn on to undertake a comparative study in the allocation of health resources in different regions. In order to understand the dynamics of the health system during this period, the article focuses on one province in particular, that of Henan. The findings indicate that there were variations in the distribution of health resources among provinces during the Maoist era. The available figures indicate that there was a general increase in health resources in China. However, this did not prevent Henan province from experiencing a great decline in its health system during the Cultural Revolution (1966–76). Future research must be carried out to determine whether the inequality of health inputs in China during the Maoist period was positively correlated with the inequality of the health outputs nationwide.

Keywords:

• China
• health institutions
• Maoist period
• Henan Province
• Cultural Revolution

Notes

1. Deaton, El Gran Escape. Salud; Li et al. ‘Exposure to the Chinese’; FAO, Nutrition and Consumer Protection; Popkin, ‘The nutrition transition’ and ‘Will China’s nutrition transition’; Popkin and Du, ‘Dynamics of the nutrition transition’. Some of these studies are based on health surveys conducted in China in recent decades such as the China Health and Nutrition Survey (CHNS), which has rich information about individual and household health since the late 1980s.

2. Whyte and Sun, ‘The impact of China’s market’; Kwon and Schafer, ‘Improving but unequal’; Li and Wei, ‘Multidimensional inequality in health’.

3. Zhu, ‘Current approaches to social’; Keidel, ‘Chinese regional inequalities’.

4. Evadrou et al. ‘Individual and province inequalities’; Biao, ‘How far are the left-behind’; Feng et al. ‘An exploratory multilevel analysis’; Yin and Lu, ‘Individual and community factors’; Zhao, ‘Income inequality, unequal health’; Chou and Wang, ‘Regional Inequality in China’s Health’.

5. Li and Wei, ‘Multidimensional inequality in health’; Pan and Shallcross, ‘Geographic distribution of hospital beds’; Zhang, et al. ‘Study on equity and efficiency’; Qin and Hsien, ‘Economic growth and the geographic maldistribution’.

6. Zhu, ‘Current approaches to social protection’.

7. White, ‘From “Barefoot Doctor” to’; Brown et al. ‘Reforming Health Care in China’.

8. White, ‘From “Barefoot Doctor” to’; Hipgrave, ‘Commutable disease control in China’.

9. Huang, Governing Health in Contemporary China.

10. Ibid.

11. Slaff, ‘Mortality decline in People’s Republic’; Mason et al. ‘The decline of infant mortality’; Campbell, ‘Mortality Change and the Epidemiological’; Banister and Zhang, ‘China, Economic Development and Mortality’; Chen and Zhou, ‘The long-term health and economic’; Hipgrave, “Commutable disease control in China’; Song and Burgard, ‘Dynamics of inequality’.

12. Jamison et al., China: the health sector; Babiarz et al. ‘An exploration of China’s mortality’.

13. Andersen et al. Changing the US health care system; Horev et al. ‘Trends in geographic disparities’; World Health Organisation, World health report.

14. Pan and Shallcross, ‘Geographic distribution of hospital’.

15. Yip, ‘Disparities in health care’.

16. Notice that even though the health resources have increased since the economic reforms, the privatisation of the health system has led to unequal access of these resources (Hu et al. ‘Reform of how healthcare is paid’; Wagstaff and Lindelow, ‘Health Reform in Rural China’; Yip and Hsiao, ‘China’s Health Care Reform’; Li and Wei, ‘Multidimensional inequality in health’). On the other hand, for most of the Maoist period, the health system was state-owned, and therefore, the allocation of the health inputs had greater relevance to understand health output and inequality, than the income of households.

17. This new data-set developed by the Stanford University and Central University of Finance and Economics has recently been available to the public. The data-set includes health records at a provincial level from 1950 to 1988. Find additional information at (Babiarz et al. ‘An exploration of China’s mortality’). I kindly thank the authors for giving me direct access to the data-set Mao Mortality Analysis.

18. Henan Xian Difang Zhi – 1985 Nianjian.

19. Alvarez-Klee ‘The Nutritional Status’.

20. Seventy-five per cent of hospital beds and 62 per cent of the senior Western-style physicians were located in urban areas (Huang, 2013: pp. 41). Notice that at this point in history over 90 per cent of the population was located in the rural areas.

21. Perkins and Yusuf, Rural Development in China, 135.

22. Huang, Governing Health in Contemporary China, 44.

23. Hipgrave, ‘Commutable disease control in China’ 225.

24. Xu, ‘Control of communicable diseases’.

25. Huang, Governing Health in Contemporary China, 45; Li Rui, Li Rui ‘zuo’ wenxuan, 276; Perkins and Yusuf, Rural Development in China, 137.

26. Xu Yunbei, Kaizhan weida de renmin weisheng gongzuo, 10).

27. Huang, Governing Health in Contemporary China, 48.

28. Ibid. 50.

29. Other reasons attributed to the famine are natural disasters and the elimination of all sparrows in rural areas, which contributed to locust pest. However, main reasons are contributed to political and institutional setbacks in the GLF.

30. Huang, Governing Health in Contemporary China, 54; Hipgrave, ‘Commutable disease control in China, 226.

31. Ministry of Health, Research of National Health Services.

32. MacFarquhar and Schoenhais, Mao’s Last Revolution, 26.

33. Yu, Counterattack the right-est rehabilitation wind; Li, The private life of Chairman Mao, 419–20.

34. Dobson, ‘Health care in China after Mao’, 43; Huang, Governing Health in Contemporary China, 57.

35. Hu The-wei, ‘The financing and the economic efficiency’.

36. Wu Chieh-ping, Medicine and Health: For Workers, Peasants, 10; Hipgrave, ‘Commutable disease control in China’, 227.

37. Lee, ‘Medicine and Public Health’.

38. Cook, ‘Changing Health in China’; Huang, Governing Health in Contemporary China.

39. Banister, China’s Changing Population; Bien, ‘The Barefoot Doctors’; Hipgrave, ‘Commutable disease control in China’.

40. Song and Burgard, ‘Dynamics of inequality’; Wang and Yang, ‘Age at marriage’, 303; Babiarz et al. ‘An exploration of China’s mortality’ , 5.

41. Department of Comprehensive Statistics of National Bureau of Statistics, Comprehensive Statistical Data and Materials.

42. Huang, Governing Health in Contemporary China.

43. Henan Sheng Zhi.

44. Pan and Shallcross, ‘Geographic distribution of hospital’.