Source: China News Network
Gao Min: How does China's rural cooperative medical system inspire the current public health system construction?
China News Service, Beijing, November 15 Title: How does China's rural cooperative medical system inspire the current public health system construction?
Author Wen Longjie Xu Xueying
Public health is related to the national economy and people's livelihood. From the prevention and control of schistosomiasis in China in the last century to the current normalization of the prevention and control of the new crown epidemic, it reflects the pivotal role of the public health system. How does China's rural cooperative medical system inspire the current public health system construction? Is there a single, specific model of public health standards? Miriam D. Gross, associate professor of the Department of History and the Department of International Area Studies at the University of Oklahoma, recently gave an exclusive interview to China News Agency's "East and West Question" to analyze the relevant issues in depth.
The interview transcript is summarized below:
China News Service: You have conducted an in-depth investigation of Schistosomiasis control in China and re-evaluated the medical model of New China in the 1950s and 1960s in the English-language book "Sending the Plague God: Chairman Mao's Campaign to Eliminate Schistosomiasis". What do you think is the key to the success of Schistosomiasis control in China?
Gao Min: The success of this famous mass health campaign has benefited from the efforts of the whole society. The most effective strategy of schistosomiasis control campaigns (blood control campaigns) is to treat hosts such as humans and animals. Once the host is healed, it no longer continues to excrete infectious substances into the environment. Large-scale individual therapy is an effective form of prevention at the community level.
However, the treatment of schistosomiasis at the time was complex and dangerous – difficult for most rural doctors to operate safely. Large-scale treatment was achieved because of urban doctors and veterinarians who went to the countryside. Urban specialists working in rural areas require the help of traditional rural doctors and barefoot doctors (the Barefoot Doctor Project only began in 1968). [Because] the latter knows the local people, networks, and other available resources. For example, for frail patients who can't survive dangerous treatment, they know which local herbs can help. They can also provide care and mobilize local people. In addition, in the blood prevention campaign, rural medical workers receive on-the-job training from urban experts, which also has a comprehensive long-term impact on rural health care.
Therefore, the success of China's blood defense movement stems from the fact that urban and rural areas exert their expertise and work together. Regarding the actual operation of the blood defense movement at the grassroots level in China, the Social Science Literature Publishing House is translating and publishing my monograph, which is expected to be published in 2022, and readers who are interested can learn more about it.
Infographic: The picture shows the social security card of the people. China News Service reporter Zhang Bin photographed
China News Service: In your opinion, is there any similarity between China's schistosomiasis prevention and control cause and the current prevention and control of the new crown epidemic?
Gao Min: The common point of the above two epidemic prevention and control work is that both disease control is regarded as an all-out war, and the attention and resources of the whole society need to be mobilized. There are pros and cons to this strategy. On the one hand, it is very effective in dealing with emergencies (such as rapidly escalating epidemics) and major problems. But on the other hand, it does not have continuity. Once the state of emergency is over, all attention and resources are devoted.
Defining disease control as war creates a context in which everyone is involved. In the Blood Prevention Campaign, citizens participate in disease prevention as actors. During the COVID-19 pandemic, citizens have achieved patriotic participation through home isolation, while major grassroots workers have become health care providers, environmental disinfection workers, and party members who solve problems and provide food to those in home isolation.
Another commonality between the two epidemic prevention and control work is the promotion of science. In the 1950s and 1960s and even today, people praised professional science and technology. Both the blood prevention campaign and the prevention and control of the new crown epidemic make full use of traditional Chinese medicine to create a combination of Chinese and Western therapies to achieve the best results in disease treatment.
In the end, its ultimate leadership strategy originated at the highest levels of the country. Before the country paid attention, there was a large lack or limited action to combat schistosomiasis and the COVID-19 pandemic. When the state attaches importance, full-scale, full-scale and comprehensive action is carried out from the top down. Developing a holistic, coherent strategy for the whole country has proven critical to epidemic control.
Infographic: Hospital registration window. Photo by Zhang Tianfu
China News Service: In your opinion, what are the characteristics of China's public health system? How is it different from the West? What are the reasons for the difference?
Gao Min: Over time, China's public health system has undergone fundamental changes. Before the reform and opening up, it was a model. After the reform and opening up, China embarked on a market-driven medical model focusing on scientific medicine. But this is the same problem with medicine in Western capitalist countries: in the West, most of the poor cannot afford medical care. After SARS, especially after the global financial crisis, China reinvested in broader health care, creating a hybrid model.
The medical model before the reform and opening up and the current hybrid model have obvious advantages over the market-driven model. The former is based on social medicine or national medicine. Proponents of social medicine argue that disease is rooted in poor, underdeveloped, disorderly communities, and that the way to defeat disease is to develop community economies, education, etc., so that primary health care, public sanitation, and pest clean-up are an integral part of community building. Social medicine focuses on training a large number of skilled health workers at the primary level to maximize rural development. In contrast, the prevailing model of scientific medicine in the West, which treats pathogens as the origin of diseases, produces a small group of trained doctors who gather in urban medical centers to provide top-notch medical services to a very small number of urban residents.
The second advantage of China's pre-reform healthcare model lies in innovative fundraising strategies. Most developing countries have never tried to provide primary health care services to society as a whole. And China is really outstanding in this regard. Faced with a lack of resources, China has developed a model of self-reliance. Medical institutions at all levels enjoy corresponding subsidies and financial support. At the same time, China has trained grassroots health workers. After 1968, barefoot doctors were paid for their work and had to return to their communities, and their salaries were severely reduced, and these doctors had to use acupuncture and local Chinese herbs to save costs. These strategies have allowed developing countries like China to afford large-scale primary health care services.
Before the reform and opening up, China's medical care achieved the availability, accessibility and affordability of drugs or herbs for all people to the greatest extent. After the devastation of the war during the Republic of China, China really needed basic medical care, maternity and public health services, so the limited training of rural medical personnel was only a small defect.
China News Service: What enlightenment has the mass public health movement in New China brought to the current institutionalization of public health in China?
Gao Min: In the early days of reform and opening up, China turned to a scientific medical model, and the medical market was almost completely liberalized. Today, China is returning to a hybrid model, combining social medicine, scientific medicine, market-driven and state-subsidized care. The launch of the new rural cooperative medical system after 2009 is a big step in the right direction.
Before the reform and opening up, the core of China's medical model was to have truly accessible and affordable primary medical services. At present, the Chinese government should consider investing in and vigorously subsidizing a new generation of rural doctors to provide them with continuing medical education, medical malpractice insurance and good pension insurance. Perhaps, the Government could also make participation in rural services for a certain number of years a requirement for obtaining a medical degree, thus providing new avenues for the transfer of urban expertise to the countryside.
The Chinese government can carry on the legacy of its early healthcare system: better enforcement of quality control regulations; substantial state-level funding to provide basic health care support to all citizens; and new strategies to continuously inject urban healthcare expertise into rural areas.
Infographic: People swipe their cards at the hospital window to pay. Photo by Zhang Tianfu
China News Service: Is there a single, specific standard model for the public health system? What characteristics do you think an effective public health system should have?
Gao Min: I don't think there is a universal standard or a single model. However, providing equitable, affordable and accessible quality care to all citizens should be the goal of every Government. Ultimately, one of the most distinguishing features of China's pre-reform and opening-up health care model is its desire to provide basic health care and effective public health services to the whole society, rich and poor. China's early visionary leaders realized that a healthy population was critical to economic development and national security.
Frankly, the key to the public health system is not so much related to a particular model as it is to the government's continued commitment of adequate national resources. As countries have learned from the COVID-19 pandemic, effective surveillance systems and basic health systems that provide care for infectious diseases are critical to national and global security. Public health departments in many countries have long faced underinvestment and staffing, as is the case in the United States. Health systems will not be able to respond to emergencies if they are limp in the first place.
However, it is extremely difficult to secure sustained, long-term investments in public health and basic health care. First, public health is often associated with caring for the poor, some cities and the wealthy are reluctant to spend their taxes on them; second, many of the benefits of public health are only visible in the long term, but politicians like to fund short-term needs; and third, the main function of public health is to prevent disease, requiring politicians to use scarce resources to solve uncertain problems. In fact, governments tend to invest in public health and universal health care only after an emergency. Once the memory of an emergency fades, the financial support is weakened. Therefore, good government should recognize that health is a public good, which is essential for the long-term economic development, harmony and stability of the whole society and national security, and investing in health is investing in the future of the whole society. (End)
Respondent Profiles:
Miriam D. Gross is an associate professor in the Department of History and the Department of International Regional Studies at the University of Oklahoma, usa, whose research interests include contemporary Chinese history, Asian history, and global public health history. He received his master's and doctoral degrees from Columbia University and the University of California, San Diego. His scholarly credits are Farewell to the God of Plague: Chairman Mao's Campaign to Deworm China, University of California Press, 2016, and has written in Public Health Reviews, Twentieth Century China (2016) Twentieth Century China), medical history and other journals have published several academic papers.