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Welfare and health of China

The Chinese government is tasked with the formidable challenge of delivering medical and welfare services that are sufficient to address the fundamental needs of its vast population, which is dispersed across an extensive geographical expanse. Despite China’s significant economic growth since the mid-1980s—evidenced by a manifold increase in per capita income and a caloric intake on par with Western Europe—there remains a considerable portion of the population living well below the national average in terms of socioeconomic status. The healthcare system is strained by the dilemma of prioritizing either the quality of care or the maximization of limited medical resources across the population. The debate over the emphasis on Western medicine versus traditional Chinese medicine has been ongoing. During the Cultural Revolution, there was a focus on providing basic care with an emphasis on traditional medicine, but policies shifted in the late 1970s towards favoring Western medical practices, which by the late 1980s saw Western-trained doctors outnumbering those trained in traditional methods. The Ministry of Public Health, under the State Council, manages the health services system, which is predominantly government-run with a significant rural collective sector and a minimal private sector presence.

Since 1949, the health of China’s citizens has seen substantial improvements. Life expectancy has risen by approximately thirty years, aligning closely with that of advanced industrial nations. Many infectious diseases, such as plague, smallpox, cholera, and typhus, have been eradicated or controlled. Malaria and schistosomiasis have seen a significant reduction since 1949, and in 2021, the World Health Organization declared China free of malaria. However, the emergence of COVID-19 in Wuhan in 2019 led to a global pandemic, causing millions of deaths worldwide.

Healthcare facilities in China are distributed unevenly when assessed on a per capita basis. Roughly half of the medical and health personnel serve in rural areas, where about three-fifths of the population lives. Western-trained doctors, who represent about a quarter of the total medical workforce, are predominantly found in urban centers, as are approximately two-thirds of the country’s hospital beds.

China’s health insurance system offers nearly free coverage for urban state enterprise employees and affordable coverage for their families. The situation is more complex for rural workers or those employed outside the urban state sector, with some cooperative healthcare programs experiencing a decline in membership since the late 1970s.

The most significant constraint on health services availability is the absolute scarcity of resources rather than discriminatory access based on individuals’ financial capacity. A widespread paramedical care system serves as the primary medical resource for the rural populace, though the quality of care is variable. This system channels patients into more advanced commune-level and county-level hospitals when possible.

The evolution of mortality causes in China since 1949 reflects longer lifespans and improved living conditions, with pulmonary and cerebrovascular diseases, malignant tumors, and cardiac disease now leading. Severe environmental pollution has also emerged as a significant health concern in various regions.

In China, many responsibilities typically associated with public welfare in the West fall on factories, offices, rural collectives, and families, making it challenging to accurately assess the welfare system’s scope and efficacy. Nonetheless, more statistical data has become available over time. The state provides pensions for retirees from state enterprises and official service, which covers a small fraction of the workforce. Welfare resources are concentrated in urban areas, offering subsidies for housing, healthcare, education, and certain foods, with the level of subsidized services largely dependent on one’s place of employment. Unemployment is generally managed through the support of working relatives, and there is a legal duty for all Chinese citizens to care for their elderly parents, with a limited number of old-age homes available for those without family support.

In rural regions, welfare responsibilities previously managed by local collectives have become more varied since the collectives’ dissolution in the late 1970s. The level of services now greatly depends on the financial health of the locality and the community’s disposition. The Chinese government does provide emergency relief for areas affected by natural disasters, including crop failures. The Ministry of Civil Affairs of the State Council is primarily responsible for administering the government’s welfare system.

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