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Changing Medical Models in China: Organizational Options or Obstacles?

Published online by Cambridge University Press:  17 February 2009

AnElissa Lucas
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Extract

No nation begins anew – with or without a political revolution – without building upon and carrying forward selective aspects of an inherited past. Nor for that matter, is any national policy implemented without reference to past experience and accumulated resources. Despite claims of revolutionary transformation and self-sufficiency, no nation has developed a modern medical system either overnight or in isolation.

Type
Research Article
Information
The China Quarterly , Volume 83 , September 1980 , pp. 461 - 489
Copyright
Copyright © The China Quarterly 1980

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References

1. Bank, World, Health: Sector Policy Paper (Washington, D.C.: World Bank, 03 1975), pp. 39–40Google Scholar.

2. “NCNA report notes improved health care in China,” NCNA, Beijing (7 09 1978)Google Scholar in FBIS-PRC (8 September 1978), E 17–18.

3. Figure 1 represents a composite of organizational information drawn from Chinese media reports, see foonote 2 and reports of recent medical visitors to the PRC, e.g. Seah, S. K. K., “Health care in the People's Republic of China,” Canadian Journal of Public Health, 66 (01/02 1975), pp. 56–60Google ScholarPubMed, and Sidel, Victor W. and Sidel, Ruth, Serve the people: Observations on Medicine in the People's Republic of China (Baltimore: Port City Press for the Josiah Macy, Jr, Foundation, 1973)Google Scholar. Figure 1 medical staff designations are defined by this author as: Type 1: Higher medical school graduates in medicine, pharmacology and dentistry; Type 2: Intermediate or secondary medical school graduates; includes doctor's assistants, nurses and most advanced level of midwives with three years' college level professional education; Type 3: Great Leap Forward “peasant doctors” and Cultural Revolution “barefoot doctors” with primarily apprenticeship training; Type 4: Spare-time public health workers and rural midwives trained primarily by apprenticeship during slack agricultural seasons.

4. “Number of national health workers reported,” NCNA, Beijing (26 06 1977)Google Scholar in FBIS-PRC (27 June 1977), E 6; “Gang's fallacy on barefoot doctors criticized,” Guangming Daily (10 December 1977), 1 in FBIS-PRC (19 December 1977), E 10–12; “Progress in health work,” Guangming Daily (7 January 1978), 1 in FBIS-PRC (23 January 1978), E 14–15.

5. “Medical groups discuss modernization in medical science,” NCNA, Beijing (13 06 1978)Google Scholar in FBIS-PRC (14 June 1978), E 7; “People's Daily issues guidelines on health work,” Beijing domestic broadcasting service (16 June 1978) in FBISPRC (20 June 1978), E 6–8.

6. “Red Flag denounces gang's machinations in public health,” Red Flag, 11 (7 11 1977), 43–48Google Scholar in FBIS-PRC (1 December 1977), E 12–19, esp. E 16.

7. “It is necessary to launch the patriot public sanitation campaign in an extensive way,” Renntin ribao (People's Daily) editorial (8 April 1978) in FBISPRC (10 April 1978), E 9–12, esp. E 10.

8. Selden, Mark, The Yenan Way in Revolutionary China (Cambridge: Harvard University Press, 1972)Google Scholar.

9. FB1S-PRC (10 April 1978), op. cit. E 10.

10. FBIS-PRC (10 April 1978), E 7, E 11, E 8.

11. FBIS-PRC (8 September 1978), op. tit. E 18–19.

12. d'Hygiène, Comité, League of Nations, European Health Conference, Warsaw (Geneva: no C.H. document number, 03 20–28, 1922), esp. p. 12Google Scholar; idem, Note on the Present Evolution of Schools of Public Health: Prepared for the Meeting of Directors of Schools of Hygiene, Paris (Geneva: C.H. 866, 2 May 1930), esp. p. 9.

13. d'Hygiène, Comité, League of Nations, Suggested Outline for Report on Public Health Organisation and Report on Public Health Statistics (Geneva: C.H. 117, 06 1923)Google Scholar.

14. Prausnitz, Carl, The Teaching of Preventive Medicine in Europe (London: Oxford University Press, 1933), pp. 86–88, 102–5, 116–18, and 128–33Google Scholar.

15. Stampar, Andrija, Public Health in Yugoslavia (London: School of Slavonic and East European Studies in the University of London, 1938)Google Scholar.

16. Rajchman, Ludwig, Medical Director Comité d'Hygiène, League of Nations, Proposals of the National Government of the Republic of China for Collaboration with the League of Nations on Health Matters (Geneva: C.H. 842, 02 12, 1930)Google Scholar.

17. Rajchman pp. 5–6; idem, Plan for a Central Field Health Station at Nanking in Conformity with the Request of the Ministry of Health of the National Government of the Republic of China as approved at the First Meeting of the Directors of Schools of Hygiene, held in Paris, May 20–23, 1930 (Geneva: C.H. 876, 12 June 1930), esp. pp. 2–5.

18. The Central Field Health Station departments were: (1) Bacteriology and Epidemic Disease Control; (2) Chemistry and Pharmacology; (3) Parasitology; (4) Sanitary Engineering; (5) Medical Relief and Social Medicine; (6) Maternity and Child Health; (7) Industrial Health; (8) Epidemiology and Vital Statistics; and (9) Health Education. See Liu, J. Heng, NHA and CFHS Director, Comité d'Hygiène, League of Nations, Report on China: Preparatory Paper for the Inter-governmental Conference of Far Eastern Countries on Rural Hygiene (Geneva: C.H. 1235(f), 05 1937), p. 18Google Scholar.

19. Ibid. pp. 18–19. (See Figure 2.)

20. d'Hygiène, Comité, League of Nations, European Conference on Rural Hygiene.Minutes, June 29 to July 7, 1931, Vol. II (Geneva: C.473.M.202.1931, III, 31 07 1931), pp. 10–15Google Scholar.

21. d'Hygiène, Comité, League of Nations, European Conference on Rural Hygiene: Report of the Preparatory Committees on the Principles Governing the Organisation of Medical Assistance, Public Health Services and Sanitation in Rural Districts (Geneva: C.H. 1045, 1 06 1931), esp. pp. 10, 12–13, 15–22, 23–26, 30, 35Google Scholar; idem, European Conference on Rural Hygiene: Recommendations on the Principles Governing the Organization of Medical Assistance, the Public Health Services and Sanitation in Rural Districts, Vol. I (Geneva: C.473.M.202.1931 III, 31 July 1931), pp. 7, 9, 15, 17–18, 20–22, 23–26, 29–33, 35–39.

22. Ibid.

23. Cf. Prausnitz, (1933), op. cit. pp. 128–39Google Scholar; Stampar (1938).

24. Ibid.

25. Stampar, (1938), op. tit. pp. 23–26Google Scholar.

26. Ibid. p. 43.

27. d'Hygiène, Comité, League of Nations, Report of the Medical Director on Work of the Health Organisation Since the Last Session of the Committee, March 1930 to September '930 (Geneva: C.H. 891, 11 09 1930), p. 4Google Scholar.

28. d'Hygifène, Comité, League of Nations, Andrija Stampar, Impressions of Activities of the Health Institutions in the North-West Provinces of China with Recommendations for the Future (Geneva: C.H. 1164, 6 09 1935)Google Scholar; idem Andrija Stampar, Rural Welfare Activities in Kiangsi: Impressions and Remarks (Geneva: C.H. 1168, 23 September 1935); idem, Berislav Borčič, Public Health Activities in China from 1929 to 1935 (Geneva: C.H. 1195, 23 November 1935); idem, Report by Dr A. Stampar on His Mission to China (Geneva: C.H. 1220, 15 October 1936); idem Heng Liu, C.H. 1235(0. May 1937, op. cit. pp. 18–19; idem, Dr C. C. Chen, Head of the Health Department of the Chinese Mass Education Association, Organisation of 29 For footnote, see p. 474. Health and Medical Services: Report to the 1937 Oriental Rural Hygiene Conference (Geneva: C.H. 1253, No. 2, May 1937), pp. 11, 13; idemConference d'Hygiene Rural Orient: Collected Papers from Bandoeng (Java) Conference, August 3 to 13, 1937 (Geneva: OHRO papers 1 to 18, 1937), esp. 8–11,77.

29. * indicates institutes located in Nanjing until December 1937. Figure 2 represents a composite of organizational information drawn from ibid.

30. J. Heng Liu, C.H. 1235(0, May 1937, pp. 9–10, 36.

31. Berislav Borčič, C.H. 1195, 23 November 1935, p. 9.

32. C.H. 842, 12 February 1930, p. 27; d'Hygiène, Comifé, League of Nations, Knub Faber, Report on Medical Schools in China (Geneva: C.H. 961, 31 06 1931), pp. 1–12, 15Google Scholar.

33. Sigerist, Henry, Socialized Medicine in the Soviet Union (New York: W. W. Norton & Co., 1937), pp. 143–4Google Scholar.

34. C.H. 961, 31 June 1931, pp. 1–6, 21.

35. d'Hygiène, Comité, League of Nations, Comments by Chinese Experts on Dr Filberts Report on Medical Education in China (Geneva: C.H. 1009, 2 05 1931)Google Scholar; idem, Informal Discussions of Dr Faber's Report on Medical Education in China, in Shanghai (Geneva: C.H. 1010, 2 May 1931).

36. C.H. 1195, 23 November 1935, pp. 6, 8, 9, 11–12.

37. Ibid. pp. 12–13, 15, 21–22, 25–28.

38. Grant, John B., “Rural reconstruction in China,” in Seipp, Conrad, ed., Health Care for the Community: Selected Papers of Dr John Black Grant (Baltimore: The Johns Hopkins Press, 1963), pp. 148–54Google Scholar; Bullock, Mary Hopper Brown, “The Rockefeller Foundation in China: philanthropy, Peking Union Medical College and public health,” Ph.D. dissertation, Stanford University, 1973, pp. 289–390Google Scholar; Chen, C. C., “Scientific medicine as applied in Ting Hsien,” The Milbank Memorial Fund Quarterly Bulletin (hereafter MB), XI (04 1933), 97–129CrossRefGoogle Scholar; idem, “Public health in rural reconstruction at Ting Hsien,” MB, XII (October 1934), 370–8; idem, “ The rural public health experiment in Ting Hsien, China,” MB, XIV (January 1936), 66–80; idem, “Ting Hsien and the Public Health Movement in China,” MB, XV (October 1937), 380–90; Gamble, Sidney D., Ting Hsien: A North China Rural Community (Stanford: Stanford University Press, 1968)Google Scholar.

39. For further information about Dingxian (Ting Hsien) and other Chinese rural health projects and perceptions about their limitations in the 1930s, e.g. Thomson, James C. Jr, While China Faced West: American Reformers in Nationalist China, 1928–37 (Cambridge: Harvard University Press, 1969), esp. pp. 46–123Google Scholar.

40. Regarding British East Africa, e.g. Beck, Ann, A History of the British Medical Administration of East Africa, 1900–1950 (Cambridge: Harvard University Press, 1970), esp. pp. 108–11, 146–7Google Scholar; re: Netherlands India, e.g. d'Hygiène, Comité, League of Nations, Hydrick, J. L., Intensive Rural Hygiene Work and Public Health Education of the Public Health Service of Netherlands India (Geneva: C.H. 1397, 01 1937), pp. 6, 24–27, 31Google Scholar; re: Soviet Russia, e.g. Sigerist (1937), esp. Appendices for Chapter III, pp. 316–32, which provide: translations from Zakonodatel'stvo R.S.F.S.R. po zdravookhraneniyu 1930–34 (Public Health Legislation of the R.S.F.S.R., 1930–34) (Moscow-Leningrad, 1935).

41. C.H. 1010, 2 May 1931, pp. 3, 7.

42. Chinese Medical Journal, 42 (1928), 374–5, 444–6, 448, 591–4, 914–27Google Scholar.

43. Thomson (1969), pp. 70–71.

44. Fu-ch'ing, Yen, “Medicine of the future in China,” Chinese Medical Journal (1936), 155Google Scholar.

45. J. Heng Liu, C.H. 1235(f). May 1937, pp. 16–17, 10–11, 15.

46. Cheng, Chu-yuan, “Health manpower: growth and distribution,” in Wegman, Myron E., Tsung-yi, Lin, and Purcell, Elizabeth F., eds., Public Health in the People's Republic of China (Philadelphia: Wm. F. Fell Co., for the Josiah Macy, Jr, Foundation, 1973), pp. 146, 149Google Scholar; d'Hygiène, Comité, League of Nations, War and Epidemics in China (Geneva: C.H. 1333, 12 05 1938)Google Scholar; idem, Epidemic Control Action in China (Geneva: C.H. 1443, 15 November 1939).

47. See note 3 for distinctions made by this author between medical personnel “types.”

48. J. Heng Liu, C.H. 1235(f), May 1937, p. 34.

49. Sze, Szeming, China's Health Problems (New York: China Institute in America, Inc., 1942), p. 12Google Scholar.

50. Moruo, Guo (Mo-jo, Kuo), “Cultural and Education Work During the Past Year,” NCNA, Beijing (10 19, 1950)Google Scholar in Current Background: 15:2.

51. e.g. Field, Mark, Doctor and Patient in Soviet Russia (Cambridge: Harvard University Press, 1957), pp. 65–66CrossRefGoogle Scholar; Sigerist (1937), pp. 122–7, 132; Semashko, Nikolai A., Health Protection in the U.S.S.R. (London: V. Gollancz, Ltd., 1934), p. 156Google Scholar.

52. Lucas, AnElissa, “NIH post-war expansion: a case study of the incremental processes of legislative oversight,” unpublished Harvard University research paper, 01 1973, esp. Appendixes I–IV, pp. 51–54Google Scholar.

53. Summary of VNRRA Operations for 1943–47 (Washington, D.C.: UNRRA, 04 1948), p. 191Google Scholar.

54. Vinogradov, A. A., Public Health in the Soviet Union, 2nd ed. (Moscow: Foreign Language Publishing House, 1951), p. 123Google Scholar.

55. Zarechnak, Galina V., Academy of Medical Sciences of USSR: History and Organization, 1944–59 (Washington, D.C: PHS Monograph No. 63, PHS Publication No. 702, 1960), p. 25Google Scholar.

56. “New China's achievements in health work,” Chinese Medical Journal 71 (04–05 1953), 88Google Scholar.

57. For similarities between specialized medical research institutes of the Chinese Academy of Medical Sciences and Ministry of Public Health and medical research institutes of the Soviet Academy of Sciences and Commissariat of Public Health, cf. Hoover, Institute, Directory of Selected Scientific Institutions in Mainland China (Stanford: Hoover Institute Press, 1970) with Sigerist (1937), pp. 360–1Google Scholar and Vucinich, Alexander, The Soviet Academy of Sciences (Stanford: Stanford University Press, 1956), pp. 125–31Google Scholar. For a discussion of Soviet influence on Chinese science policy in the 1950s, see: Suttmeier, Richard P., “The Chinese Academy of Sciences: institutional change in a research oriented organization” (Ph.D. dissertation, Indiana University, 1969)Google Scholar, esp. Chap. IV. Unfortunately, the published version, idem, Research and Revolution: Science Policy and Societal Change in China (Lexington, Massachusetts: D. C. Heath & Company, 1974) excludes this discussion of Sino-Soviet comparisons. Regarding industrial workers' programmes, see: Zedong, Mao, “A talk Chairman Mao gave at a reception of foreign guests from Vietnam concerning China's health insurance work” (24 Jone 1964) in Xin Ren Wei (New People's Health), Beijing: People's Health Press, 3 06 1967, p. 13Google Scholar in SCMM Supplement, No. 22, 8 04 1968Google Scholar. Also see: Kalgren, Joyce K., Social Welfare and China's Industrial Workers (Berkeley: University of California Center for Chinese Studies, Reprint Series C–10, 1969)Google Scholar and Richman, Barry M., Industrial Society in Communist China (New York: Vintage Books Division of Random House, 1969)Google Scholar. Regarding the reorganization of the Chinese Medical Association's Chinese Medical Journal, see: CMJ 68 (November–December 1950), p. 377.

58. “Rural health work shows gradual development: Borčič organizations of health work are being rapidly restored and built-up,” NCNA, Beijing (20 09 1951)Google Scholar in SCMP: 179:19.

59. e.g. “Medical prevention network shapes up in rural districts,” Renmin ribao (People's Daily), Beijing (21 08 1957) in SCMP: 1607: 25–26Google Scholar.

60. e.g. “Gang's fallacy on barefoot doctors criticized,” Guangming Daily in FBIS-PRC (19 December 1977), E 11, which equates the public health workers who served as doctors and peasants during the Great Leap Forward as the “embryonic form of the barefoot doctor.”

61. Aird, John S., “Recent provincial population figures,” China Quarterly, No. 73 (03 1978), 1–44, esp. Table 4, p. 40CrossRefGoogle Scholar.

62. FBIS-PRC (28 June 1976), E 1.

63. “Society of traditional Chinese medicine to be established,” NCNA, Beijing (12 06 1978)Google Scholar in FBIS-PRC (13 June 1978), E 19.

64. Cf. e.g. ibid. with “Achievements in health work,” NCNA, Beijing in SCMP: 1619: 7 (24 September 1957).

65. FBIS-PRC (28 June 1976), E 1; FBIS-PRC (8 September 1978), E 17.

66. e.g. FBIS-PRC (8 September 1978), E 17; Sidel and Sidel (1973), pp. 88–94. See note 3 for distinctions made by this author between medical personnel “types.” The Dazhai commune, which was lauded during the Cultural Revolution as a model commune, has been implicated in recent criticisms of its former leader, Chen Yonggui.

67. FBIS-PRC (27 June 1977), E 6.

68. e.g. note 11, 1978 policy quote above.

69. Other analyses of Chinese policy shifts have focused more on changes in policy means than the long term continuities in policy goals emphasized in this study. E.g. Lampton, David M., The Politics of Medicine in China: The Policy Process, 1949–1977 (Boulder, Colorado: Westview Special Studies on China and East China, 1977)Google Scholar who analyses PRC health policy in terms of two conflicting Party lines, central coalition politics and bureaucratic interest group politics. For a critique and defence of Amitai Etzioni's cyclic theory of “normative,” “remunerative,” and “coercive,” means to Chinese policy implementation, see Andrew J. Nathan, “Policy Oscillations in the People's Republic of China: A Critique,” and Edwin A. Winckler, “Policy Oscillations in the People's Republic of China: A Reply,” C.Q., No. 68 (1976), pp. 720–50.