Posted by C3W Admin on July 28 2022
In the midst of the COVID-19 pandemic, Dr Xun Zhou published a book The People’s Health: Health Intervention and Delivery in Mao’s China, 1949-1983 (McGill-Queen University Press, 2020). Through two of the most prominent examples of Maoist health care – the anti-schistosomiasis campaign and the ‘Barefoot Doctor’ programme – Dr Zhou provides a critical analysis of the health policy of China under Mao Zedong’s reign. Her book draws on evidence from archives across different provinces, including Zhejiang, Jiangsu, Sichuan, Yunnan, Guizhou, and cities of Beijing and Shanghai, as well as oral testimonies from experts, local cadres and villagers who participated in or were impacted by the schistosomiasis campaign and the ‘barefoot doctor’ programme. Dr Zhou argues that the contradictory political demands by the central government driven by the revolutionary zeal and urgency to control the disease caused a fragmented and often contradictory local response.
Dr Xun Zhou is a Reader of Modern History at the University of Essex. As a historian working at the boundaries of health, medicine, science, religion and everyday life in modern China, her research interests lies at the intersection of history of public health in modern China, history of nutrition and social and cultural history of food, narcotics, and more broadly the political history of the People’s Republic of China (PRC) as well as questions of race and ethnicity. From September 2021 to July 2022, she was the fellow at the Institute for Advanced Study in Berlin (Wissenschaftskolleg zu Berlin, Wiko) working on a new project: a social history of everyday health and food practices in twentieth-century China. Dr Zhou is author or co-author of numerous ground-breaking works that have helped to reshape our understanding of modern Chinese history, including Disease, Religion and Healing in Asia: Convergence and Collisions (2015), Forgotten Voices of Mao’s Great Famine, 1958-1961: An Oral History (2014), and The Great Famine in China, 1958-1962: A Documentary History (2012).
Image 2. Dr Xun Zhou
On a sunny afternoon in May, I had a conversation with Dr Xun Zhou at the Institute for Advanced Study in Berlin (Wissenschaftskolleg zu Berlin, Wiko) about her new book and her opinions regarding the Chinese government’s response to the Covid-19 pandemic, especially the pursuing of zero covid and extreme measures in the recent outbreak in Shanghai. We started our conversation by discussing the diminishing attention towards the covid pandemic. “Forgetting about the damage caused by a pandemic is a repeating phenomenon,” Dr Zhou said. “People have collective memories of wars, with the reminder of visible damages to our living environment, while the covid pandemic hardly leaves any visible marks.” Despite the fact that the virus continues to smoulder in the population, people are tired of the restrictions and eager to ‘return to normal.’ The world’s attention has shifted to predicting how the COVID pandemic will end. However, no matter how or when the pandemic ends, the individual and collective trauma caused by a pandemic has long-lasting effects.
Image 3. Gate of the Institute for Advanced Study in Berlin (Wissenschaftskolleg zu Berlin, Wiko)
Drawing on an example from her new research on the famine resulting from the ‘Great Leap Forward’, which was recognised as a politically sensitive topic by the Chinese government, she points out that, “the official amnesia meant people who experienced such traumatic event could not speak about it. Although unspoken, the trauma continues to structure the famine survivors’ everyday life.” In China, the traumatic experience of individuals has often been embedded in uniform state narrative. The promises of healing and health from the state were tools of introducing socialist cultural revolution and a powerful form of propaganda. However, mass media propaganda about the state’s success in improving people’s health concealed the reality of poor and mismanaged healthcare. In the case of the schistosomiasis eradication campaign, despite much of the evidence indicating a rise in cases and the collapse of the rural health system, the Chinese Communist Party (CCP) claimed it was a success. The narrative of the victory against schistosomiasis has also been used as an example of government leadership in improving public health during Covid-19, which, she says, “continues to create a false sense of security and cohesion – one they require to ensure the stability needed to remain in power.”
From Dr Zhou’s point of view, public health work became one of the central means by which to influence the masses, and public health campaigns were simultaneously political campaigns during Mao’s era. Since the onset of the Chinese revolution in the early 20th century, public health objectives have been an integral part of the CCP ideology. Such ideology was derived from the shame of the label ‘sick man of east Asia’, which linked China’s overwhelming poverty to the poor hygiene and overall health of the Chinese population, particularly those living in the countryside, signalling China’s backwardness in the world. The CCP believed that the improving of rural health would open door for modernisation so that China could compete on the world stage. From 1949, the Communist Party of China pledged that its approach to health care would differ markedly from that of the former Nationalist government and the ‘imperialist’ West. For the next thirty years under Mao’s leadership, the People’s Republic of China made improving the health of the entire population a central pillar of its policy.
The People’s Health shifts our gaze away from official statistics. Instead, the book draws on hundreds of files from rarely seen records of local institutions and oral testimonies from experts, local cadres, and villagers across China, and gives voice to the lived experiences of Chinese people and the health care under communism. Through the cases of the anti-schistosomiasis campaign and the Barefoot Doctor programme, two internationally acclaimed public health initiatives of Mao’s China, Dr Zhou provides a thorough and politically neutral analysis of the social, historical and political context, as well as the delivery, conflicts, repercussions and international influence of the Chinese approach to improving public health. Her book opens a window to the readers on the individual experience of the mass public health campaigns under communism.
Image 4. Dr Xun Zhou
According to Dr Zhou, the launching of the campaign against schistosomiasis was firstly driven by the military desiderata during the war against Nationalist government. Following the founding of the People’s Republic of China, the economic burden of the disease became a major concern. In addition, the newly established communist government was eager to prove the superiority of socialism by eradicating schistosomiasis, an accomplishment which ‘Western Imperialists’ had failed to achieve in Egypt. In 1955 the communist government launched a mass movement to eradicate schistosomiasis within 7 years, the same year when the first Five-Year Plan for the development of the national economy was formulated. After the eradication of schistosomiasis became a state policy, the technocrats were replaced by party officials to lead the campaign.
However, the problems and challenges encountered in the early stages of the campaign were not solved. Instead, the zealotry to defeat the disease as the ‘enemy of socialism’ had negative impact on the actual disease prevention work on the ground. Firstly, the campaign was hindered by the lack of health professionals. Local healthcare providers were often underqualified workers chosen more for their social class rather than their educational background. Moreover, the insecticides required for vector control were expensive and difficult to obtain, and eradicating snails made only a limited contribution to overall reduction of the incidence of the disease. The campaign also faced resistance from local populations. In her book, Dr Zhou describes how locals opposed collecting night soil for disease prevention because it was commonly utilised as fertiliser at a time when chemical fertiliser wasn’t widely available. Poor planning and management also led to the increase in infection. In order to simultaneously increase agricultural output and reduce infection, the policy of land reclamation was adopted in attempt to destroy snail habitats. However, failing to provide protection gear for either the workers involved in the campaign or farmers relocated to work on the newly reclaimed lands, led to a large number of schistosomiasis infections. In addition, the Great Leap Forward campaign launched in 1958 to re-organise the rural population into large-scale rural communes, to achieve unrealistic industrial and agricultural development goals, contributed to the three-year Great Famine, which caused tens of millions of deaths and the disruption of the rural health system in China. Malnourished migrants looking for sustenance in contaminated waterways in urban areas further spread the disease. At the end of the 7-year plan, schistosomiasis was not eradicated – on the contrary, both morbidity and mortality rates of the disease were significantly raised. Despite the failure, the party propaganda machine continued to claim victory against the disease by falsifying data, in order to prove the superiority of the party leadership.
Due to the failure to contain the disease and the damage to the ecological system as well as changes in politics at the eve of the Great Proletarian Cultural Revolution – Mao’s attempt to tackle the problem of the bureaucratic institutionalization of the Chinese Revolution and to forestall the rise of a new socialist ruling elite, the 7-year plan of eradicating schistosomiasis was eventually abandoned. In addition, the rural health system had collapsed by the early 1960s, which resulted in the adoption of the “Barefoot Doctors”. Dr Zhou argues that the world-renowned public health initiative was emerged from localized practices, rather than being entirely the creation of the central government. The approach had already been rolled out in rural areas to remedy the failure of public health services after the Great Famine, resulting from the disastrous Great Leap Forward. In the book, Dr Zhou shifts attention away from the utopian rhetoric of the Chinese approach towards universal health care, instead focusing on the reality of poor quality healthcare on the ground and the actual experiences of patients, healthcare providers and local cadres involved in the programme. The Chinese approach toward universal health coverage was exported to other third world countries through its health diplomacy activities. In addition, with the opening up of the country in the 1970s, the country’s healthcare accomplishments became known to the international community, which became the flagship of the PRC in its relationship with the rest of the world.
In his controversial and polemic work Medical Nemesis(1975), Ivan Illich, a philosopher and radical thinker born in Vienna, whose ideas influenced the development in the 1970s of of alternative and self-help health styles, criticised the hegemony of scientific medicine in the 1960s and the 1970s. He argues that “a vast amount of contemporary clinical care is incidental to the curing of disease, but the damage done by medicine to the health of individuals and populations is very significant.” However, he praised the Chinese barefoot doctors as a rare exception to the dominance of the orthodox medical profession. “Only in China—at least, at first sight—does the trend seem to run in the opposite direction:” he said, “Primary care is given by nonprofessional health technicians assisted by health apprentices who leave their regular jobs in the factory when they are called on to assist a member of their brigade. Nutrition, environmental hygiene, and birth control have improved beyond comparison. The achievements in the Chinese health sector during the late sixties have proved, perhaps definitively, a long-debated point: that almost all demonstrably effective technical health devices can be taken over within months and used competently by millions of ordinary people.”
Image 5. Ivan Illich, credit: https://www.manhattan-institute.org/the-genius-of-ivan-illich
However, as Dr Zhou pointed out, Illich, alongside other international health experts who visited China, were misled by carefully selected information and highly embellished propaganda, and blinded by their belief in ‘the mirage of health’ or the utopian model of state solution to provide health care for all which was tainted by their radical polemics. Despite the poor quality of care and many other problems, such as the abuse of antibiotics, the significant improvement in vital statistics of public health, including the life expectancy, maternal death, infectious disease infection rate etc., convinced the international health stakeholders that the Chinese approach had achieved better health outcomes with limited resources. In the late 1960s, increasing criticism regarding the disease eradication model advocated by the WHO starting to reconsider its approach towards the ideals of international health. From 1970 onwards, the organisation turned to Primary Health Care which addressed broader socio-economic determinants of health and advocated for “inter-sectoral” coordination and community participation. The Chinese approach to tackling health problems with limited financial, technological, and human resources was promoted as a prominent model of primary health care globally, and it in turn inspired the Alma-Ata Declaration in 1978 – which seems to Dr Zhou an historical irony.
Illisch, Ivan. Medical Nemesis. 1975
Zhou, Xun. People’s Health: Health Intervention and Delivery in Mao’s China, 1949-1983. Montreal: McGill-Queen University Press. 2020.
Zhou, Xun. “Mao’s China Falsely Claimed It Had Eradicated Schistosomiasis – and It’s Still Celebrating That ‘Success’ in Propaganda Today.” The Conversation. 2020. Accessed https://theconversation.com/maos-china-falsely-claimed-it-had-eradicated-schistosomiasis-and-its-still-celebrating-that-success-in-propaganda-today-144464