China's Rural Health System and Environment-Related Health Risks

Abstract

This paper presents a chronology of the development of the Chinese rural health system and its responses to environment-related health problems. During the early years of the People's Republic, the health system was very successful in reducing the transmission of infectious diseases through environmental improvements. Since the transition to a market economy, environment-related preventive programmes have been given less priority and a variety of new environment-related health problems and risks have emerged. More recently, the Chinese government has made strong commitments to improve the performance of the health system and increase access by all. Its focus has been on strengthening medical care and developing new forms of health finance. It has paid little attention to environment-related problems. However, as the pace of health reform accelerates, it will be important to ensure that it take environment-related problems into account.

Notes

^1. A. Pruss-Ustun and C. Corvalan, Preventing Disease through Healthy Environments: Towards an Estimate of the Environmental Burden of Disease (World Health Organisation, 2006), available at: http://www.who.int/quantifying_ehimpacts/publications/preventingdisease/en/index.html/.

^2. Y. Zhao, ‘National actions in China’, presentation at the Third Ministerial Regional Forum on Environment and Health in Southeast and East Asian Countries, Bangkok, Thailand, 2007, available at: www.environment-health.asia/ event/HL2/EH_HL2_MR.doc (accessed 9 February 2009).

^3. X. Lu and B. Gill, ‘Assessing China's response to the challenge of environmental health’, China Environment Series no. 9, (2007).

^*Jing Fang is a Professor at the Institute for Health Sciences, Kunming Medical College, China and EcoHealth specialist at the International Centre for Integrated Mountain Development (ICIMOD), an inter-governmental organisation working in eight countries in the Himalayan region. She has been working in health system research and reproductive health for more than 20 years and in the last few years has expanded her work to the arena of environment and health with a focus on ecosystem approaches to human health (EcoHealth). Gerald Bloom is a health policy analyst based in the Knowledge, Technology and Society Team at the Institute of Development Studies in the UK. He convenes the health domain for the STEPS Centre, which is exploring environment and health linkages (http://www.steps-centre.org/). He has been involved in a number of studies of the impact of the transition to a market economy on China's health system and the policy responses that have emerged.

^4. G. Bloom, ‘Health policy during China's transition to a market economy’, in R. Gualt, ed., Comparative Health Policy in Asia–Pacific (Maidenhead: Open University Press, 2005); B. Meessen and G. Bloom, ‘Economic transition, institutional changes and the health system: some lessons from rural China’, Journal of Economic Policy Reform 10(3), (2007), pp. 209–232.

^5. K. Eggleston, L. Li, Q. Meng, M. Lindelow and A. Wagstaff, ‘Health service delivery in China: a literature review’, Working Paper 3978 (Washington, DC: World Bank Policy Research, 2006).

^6. B. Shu and J. Yao, ‘Preventive health care services in poor rural areas of China: two case studies’, IDS Bulletin 28(1), (1997), pp. 39–47.

^7. J. Fang, ‘The Chinese health care regulatory institutions in an era of transition’, Social Science & Medicine 66, (2008), pp. 952–962.

^8. Ministry of Health, PRC, World Bank and DFID, Health VIII External Evaluation Final Report: Foreign Loan Office (Beijing: Foreign Loan Office, 2007).

^9. Y. Wang, ‘The development of rural health policy in China: the case of the new cooperative medical scheme and medical assistance’, in B. Meessen, X. Pei, B. Criel and G. Bloom, eds, Health and Social Protection: Experiences from China, Cambodia and Lao PDR (Antwerp: Institute of Tropical Medicine, 2008), available at: http://www.povill.com/enjkw/emeetcont.aspx?id = 5.

^10. See Jennifer Holdaway, ‘Environment and health in China: an introduction to an emerging research field’; and Benjamin van Rooij, ‘The people vs. pollution: understanding citizen action against pollution in China’, in this special issue.

^11. L. Ellis and J. Turner, ‘Surf and turf, environmental and food safety concerns of China's aquaculture and animal husbandry’, China Environment Series no. 9, (2007).

^12. See Anna Lora-Wainwright, ‘An anthropology of “cancer villages”: villagers’ perspectives and the politics of responsibility', in this special issue.

^13. Y. Liu and G. Bloom, ‘Rural health system reform in poverty areas’, in V. Lin, Y. Guo, D. Legge and Q. Wu, eds, Health Policy in Transition: The Challenges for China (Peking University Medical Press, 2008); G. Bloom, Y. Liu and J. Qiao, Partnerships for Development—Lessons from a Health Project in China, Policy Brief (Beijing: DFID, 2008).