Erenlai - Items filtered by date: Monday, 26 May 2008
If the modern State has two essential tasks, these are to ensure the education of the largest number and the proper functioning of public health. Two spheres on which the Chinese government laid great emphasis after 1949 and at first produced undeniable successes. The literacy campaigns relieved by the simplification of the ideogram system and the despatch of “barefoot doctors” into rural areas remain the two symbols of this effort carried out on a virtually continental scale. This undertaking was largely reduced to nothing by the turmoil of the Cultural Revolution and the regime’s economic failure until the beginning of the Deng Xiaoping era.

Since the mid-nineties, the situation has to some extent been reversed: even while China’s economic successes are impressing the whole world, while the country has taken so many of its citizens out of absolute poverty and allowed many access to modest comfort, the educational and health tasks of the State have been particularly badly performed.

The health system has undergone de facto privatisation. While before 1980, health expenditure was covered virtually one hundred per cent by the State, today only 16% is covered, the rest of the financing being essentially provided by the patients. Now, 90% of the rural population does not benefit from any health insurance system. Even in a country
as liberal as the United States, the proportion of state cover is 44%, and in most other industrialised countries it is approximately 70%. Privatisation has been accompanied by corruption and malpractice. It is well known that, in most hospitals, it is best to slip an envelope to the surgeon who is operating on you if you want to have his undivided attention. Or again, another fact of everyday life has recently been noted by one Chinese university: half of deliveries of infants are by Caesarean (70% in some hospitals) because a surgical procedure is much better paid, and this practice also allows the doctors to organise their time better. Another finding: as drugs are sold directly by the hospital, their sale accounts for more than half the income of some hospitals.

That being said, we are now entering the third phase of this evolution, where the Chinese government is trying to put together a general system of social protection. The priority is now the construction of an integrated system in the countryside. At the same time, the problem is shifting: if, in the next few years, the health risk will be less directly linked to the system of financing of care, it will be increasingly dependent on the rise of the ecological risk.

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Problems of health and anxieties related to the environment are part of the same equation. The WHO considers that 17% of deaths in the western region of the Pacific – a region where the Chinese population is huge - are linked to one or even more ecological health risks.

The link between social tensions and environmental problems was strikingly illustrated by the demonstrations which occurred in Xiamen in May-June 2007. The people came onto the streets to oppose the construction of a giant petrochemical complex intended to produce parayxlene, a substance used in the manufacture of polyesters and dangerous for the health of those exposed to it without protection. At the end of a mass campaign which saw about a million telephone messages exchanged (and after the closure of the internet sites which denounced this construction), the deputy mayor had declared that the project was suspended temporarily. But the inhabitants continued their pressure to try to ensure that the project would be abandoned for good.

In May-June, 2007, Wuxi, an industrial centre in the Yangtze delta, the urban area of which contains 6 million people, had a water shortage for several days because of the proliferation of algae in Lake Taihu. The heat, combined with continuous discharge of a large part of the town’s sewage into the lake and the pollution from the factories, had contributed to the development of this green slick, which was finally controlled after sixty thousand tonnes of algae had been cleared.(1) There had already been a spectacular illustration of this in the serious incidents of pollution of water courses which occurred in
November and December 2005 at Harbin and close to Canton.(2) And the history of these repeated catastrophes points to structural failure:(3) China’s ecological crisis could not be overestimated.

One can see how the health, environmental and social problems must be grasped as a whole. The “Report on the implementation of the project for national economic and social development” from 2006 and the “Sketch of the 2007 Plan for national economic and social development” describe quite well the overall situation, as perceived by the Party-State:
“The need to save energy and to reduce pollution is extremely urgent because pressures on resources and the environment are continuing to grow. (…) Public opinion is expressing serious concerns as to the lack of accessibility and the excessive cost of medical care and education. There are also serious problems on the subject of the safety of food and drugs, housing, distribution of incomes, public safety and production. Other problems which have a negative impact on people’s interests include restructuring of enterprises, demolition of homes and rehousing in urban sectors, acquisition of lands and expropriations and
protection of the environment”.(4) Amartya Sen, Nobel Prize-winner for Economics, often uses a comparison to indicate the nature of the Chinese problem: “Although Chinese economic growth has been much faster than in India since the economic reforms of 1979, life expectancy in India has increased about three times faster than in China. In 1979, life expectancy for a Chinese was 14 years longer than for an Indian. It is now only seven years longer. Some regions of the country,
like the province of Kerala, now have an advance of four years over China in terms of life expectancy. In 1979, China and Kerala had exactly the same rates of infant mortality – 37 per 1,000. In Kerala today the infant mortality rate has fallen from 37 to 10, while the figure in China has fallen from 37 to 30”.(5)

(1) Xinhua press agency, 15 June 2007.
(2) Note at the same time that the catastrophe which occurred at Harbin was to accelerate the completion of major improvement works carried out along the Songhua river, one of the most polluted rivers in the country.
(3) The case of the River Huai, which provides the entry on the subject in the book by Elizabeth Economy, is particularly striking. Cf. E. Economy, "The River Runs Black", Cornell U.P., 2004.
(5) http://www/ The comparison between Kerala and China has often been repeated by A. Sen on the basis of his work, "Development as Freedom, and other essays on the concept of human development".

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