Sun, May 25, 2003 page9

• The fear of illness is well-founded in China

  Even at the height of the communist system there was never a national health service; now responsibility for public health rests with inadequate local authorities

  • By Isabel Hilton / GUARDIAN
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  The early morning in any Chinese park is the time and the place to track the private fears of Chinese citizens. Some come to rehearse their enthusiasms -- ballroom dancing, calligraphy or martial arts.

  Others come to ward off misfortune. Even before the SARS outbreak, the fear of ill-health was enacted in these dawn rituals.

  

  ILLUSTRATION: MOUNTAIN PEOPLE

  The fear of illness today is well founded. The provision of health services and social security to the mass of the population was perhaps the Chinese revolution's single most important achievement.

  But even at the height of the communist system there was never a national health service. The provision of medical care derived from a work unit -- a factory, a school, a bureaucratic organ or a people's commune -- that had the responsibility to take care of its workers and their families. It was an arrangement that covered most people, but with Deng Xiaoping's (鄧小平) move to a market economy, the system was doomed.

  Economic liberalization meant the end of most of those work units: state industries are closing down, agricultural communes were disbanded long ago and agriculture has been privatized. Nothing has taken the place of the work units, and the services they used to provide have lapsed. Responsibility for public health rests with local authorities which do not appear to have either the funds or the interest to maintain it. Even in the cities, where two decades of economic reforms have brought a general rise in living standards, the burden of medical care is now largely a private responsibility that many can't afford.

  So despite increased prosperity, public health has declined. A service that boasted in the early years of the Chinese revolution of having eradicated venereal disease and brought tuberculosis under control is now almost non-existent. Rural clinics funded by the disbanded people's communes have shut down. Barefoot doctors -- primary health workers ubiquitous in the countryside in the 1950s and 1960s -- have largely been replaced by mountebanks and witchdoctors who dispense colored water and spells.

  Scaling back on health commitments was seen by China's reformers as a central part of economic liberalization. But, as the government found to its cost, if the state does not provide health security, people turn to any promise of health, however implausible. Falun Gong, the religious sect that exploded on to the national scene four years ago, and which the Chinese government has been trying to suppress ever since, owed much of its mass appeal to the belief that it conferred good health on its practitioners. If practitioners are reluctant to give it up, it is, in part, because the Chinese state still offers them no substitute guarantees.

  For a people who now regard the state as unreliable in matters of health, the handling of the SARS outbreak has brought no reassurance.

  The leadership seems nervous as it tries to recover from the official concealment of the disease in the early months. As a rule of thumb, the more the party's propaganda department reaches for stale revolutionary images, the less people trust it to be acting in good faith. The present crisis scores high on the hoary revolutionary image index: the Canadian doctor Norman Bethune, canonized as a revolutionary hero by Mao, is enjoying an unexpected return to the billboards and the martial imagery of the battle against SARS is creating new revolutionary heroes and martyrs.

  President Hu Jintao (胡錦濤) has threatened that the concealing of SARS cases will be severely punished, but the habit of official secrecy that dictated the initial cover-up, and earned China a humiliating public rebuke from the World Health Organization, is no more guaranteed to respond to exhortation than the parts of the body in a Beijing park.

  The still bizarre pattern of admitted SARS cases suggests that the bureaucracy is embracing transparency with less than wholehearted enthusiasm. Shanghai has admitted very few cases, Guangdong to the south and Beijing to the north have many; some provinces acknowledge that the million migrant workers who have fled Beijing brought SARS with them, others do not.

  Chinese are less likely to believe the official story than the versions they read on the internet or the messages they receive on their mobile phones: unofficial accounts of the extent of the epidemic are rigorously policed and censored.

  The SARS outbreak has reminded the Chinese of what has been lost over more than two decades of sustained economic growth, as they discover that dilapidated public health services are in no shape to fight an epidemic, or even to report one consistently. Until SARS, though, the lack of care for the rural poor was no more important to the government than the appalling safety record of the Chinese mines.

  Even now, it is the fear of international quarantine and the potential economic damage rather than the death rate that has prompted action. As the barriers that local people themselves have erected round their villages and neighborhoods demonstrate, the people know it too.
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