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Philanthropy for Health in China

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Drawing on the expertise of Chinese and Western academics and practitioners, the contributors to this volume aim to advance the understanding of philanthropy for health in China in the 20th century and to identify future challenges and opportunities. Considering government, NGO leaders, domestic philanthropists, and foreign foundations, the volume examines the historical roots and distinct stages of philanthropy and charity in China, the health challenges philanthropy must address, and the role of the Chinese government, including its support for Government Organized Non-Governmental Organizations (GONGOs). The editors discuss strategies and practices of international philanthropy for health; the role of philanthropy in China’s evolving health system; and the prospects for philanthropy in a country beginning to engage with civil society.

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1 The Collapse and Reemergence of Private Philanthropy in China, 1949–2012

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Wang Zhenyao and Zhao Yanhui

In order to better understand the opportunities and challenges for contemporary health philanthropy in China, this chapter aims to provide a brief overview of the evolving relationship between health care, philanthropy, and the state since the founding of the People’s Republic of China in 1949. It first considers the period 1949–1977, which saw the creation of a state health care system, as well as an increasingly antagonistic governmental stance toward philanthropy, which was perceived as antithetical to the socialist project. Next it discusses the rehabilitation of health philanthropy from 1978 to 2003. This period was characterized by the recognition that health philanthropy could play a crucial role in compensating for an increasingly insufficient state health care system. Various laws were enacted that facilitated the gradual revitalization of health philanthropy, with nongovernmental organizations developing alongside governmental ones, and international involvement increasing throughout the period. The overview is completed by a summary of developments since 2004, the year in which the Fourth Plenary Session of the 16th CCP Central Committee explicitly recognized the importance of the development of philanthropy to the state social security system. The chapter then concludes by identifying certain significant challenges for the current development of health philanthropy in China and offering some predictions for the future.

 

2 The Shifting Balance of Philanthropic Policies and Regulations in China

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Mark Sidel

AS OTHER CHAPTERS in this volume show clearly, the philanthropic arena is developing with extraordinary speed in China. There are now several thousand Chinese foundations, both private foundations and the so-called public fundraising foundations (most more closely associated with the government than the newer private foundations), and a rapidly increasing community of wealthy and middle-class donors. Health care and medicine are one of the interests of these new donors and their institutions, and a strong interest of the growing community of foreign foundations and other donors in China. At the same time, philanthropy and giving have received a great deal of the media’s attention as well, for both positive and negative reasons. Philanthropy and charitable giving played a major role in the public response to the Wenchuan earthquake in Sichuan in 2008, while recent scandals in the charitable sector have brought negative attention as well to problems of accountability, transparency, and disclosure. And as this volume is being completed in December 2013, charitable giving—now primarily to nonstate nonprofit organizations directly—has been playing a significant role in relief from yet other Chinese natural disasters as well.1

 

3 Changing Health Problems and Health Systems: Challenges for Philanthropy in China

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Vivian Lin and Bronwyn Carter

The World Health Organization (WHO) defines health as not merely the absence of disease, but also physical and mental well-being (WHO 1948). It also recognizes the importance of social and economic factors in shaping population health status (WHO 2008). Definitions of public health further recognize that the protection and improvement of health requires an organized effort by society (Lin et al. 2007). Thus, the health of a country or a community reveals not only the array of factors that determine the pattern of health and illness, but also the nature of the collective societal effort at improving the health of the population.

Between the 1940s and the late 1990s, life expectancy in China more than doubled, from 35 to 73 (Lin et al. 2010). The major burden of disease has also shifted from infectious to noncommunicable diseases (NCDs). The positive results reflect in part a more equitable path of social and economic development, and in part a shift from a highly chaotic health system to one with a strong degree of organization. In the past three decades, however, market-based economic reforms have led to the collapse of universal health care coverage, rising health inequities, and, ultimately, new comprehensive health system reforms announced in 2009. During this period of tremendous social and economic change, challenges and opportunities have emerged for the development of China’s health system. The sector’s actors, including health professionals, government policymakers, and development partners, are vital to the successful development of the system. Those concerned with health in civil society—both from within and outside China—also have critical roles to play in service provision and shaping the direction of change.

 

4 Medicine with a Mission: Chinese Roots and Foreign Engagement in Health Philanthropy

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Zhang Xiulan and Zhang Lu

THE EARLIEST SUSTAINED foreign philanthropic involvement in China came from a wide array of church-sponsored philanthropies. Although such philanthropies are no longer prominent in China, their legacy has been considerable. Drawing on a range of archival sources, this chapter first briefly sketches the Chinese charitable landscape in which Western church-sponsored initiatives arrived. It then provides examples of the wide variety of projects that developed, considering both how these ventures were funded and their relationship with the state. Finally, it considers their legacy: paving the way for other foreign philanthropic engagement, establishing medical institutions that continue to thrive today (although they are no longer linked to their original church heritage), and, most significantly, acting as an initial point of contact for Western and Chinese health care practices, influencing medical education and management models that have carried through to the present day.

 

5 American Foundations in Twentieth-Century China

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Zi Zhongyun and Mary Brown Bullock

AMERICAN FOUNDATIONS HAVE played a frequently constructive role in China, maintaining cross-cultural engagement amid the political and social upheavals of China’s twentieth century and supporting the quest for modernization and reform. This engagement has significantly though by no means exclusively focused on philanthropy for health, with organizations such as the Rockefeller Foundation (RF) and the China Medical Board (CMB) meaningfully contributing to the spread of scientific medicine and the improvement of public health. As this paper will show, the history of American foundations’ work in China during the twentieth century holds lessons for the twenty-first: as China emerges as a world power, striving to make its ongoing development sustainable and to grow its own philanthropic institutions, American foundations’ successes and setbacks reveal the ability of philanthropic partnerships to transcend international differences and to make both China and the world a better, healthier place.

 

6 Connecting Philanthropy with Innovation: China in the First Half of the Twentieth Century

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Darwin H. Stapleton

THE HISTORICAL RELATIONSHIP between modern American philanthropy and modern technology is deep and multifaceted. By examining that history through case studies in China in the first half of the twentieth century, this chapter will examine that relationship as a means of better understanding how modern philanthropy not only has attempted to realize its goals through technological innovation, but in some cases has also chosen distinct goals incorporating technological innovations.

Modern American philanthropy is rooted in the great wealth created by the American industrialization of the latter nineteenth and early twentieth centuries. The exemplars are Andrew Carnegie and John D. Rockefeller, each of whom accumulated enormous resources rapidly (and in ways that forced the rethinking of government regulation of business), and who believed that with wealth came social responsibility for its disposition. Both men (and others, such as Olivia Sage and Julius Rosenwald) chose the organizational format they were familiar with—the corporation (albeit the nonprofit form of a philanthropic foundation)—as a means of disposing of the greatest portion of their wealth, thus giving us the shape of modern organized philanthropy. Many of those who became the trustees of those first great foundations were schooled in the industrial world, and we should not be surprised that they often displayed a technological bent as they innovated the programmatic means of spending previously unheard of sums of money for philanthropic ends.

 

7 International Philanthropic Engagement in Three Stages of China’s Response to HIV/AIDS

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Ray Yip

Since the start of the first outbreak of the HIV epidemic in 1989, China has come a long way in its response to this global pandemic—from total denial to now a strong response. In many ways, the real response came relatively late, around 2003, but the response was by far one of the strongest among developing countries. Throughout this journey, both from denial to awakening and from a weak to a strong response, international partners have played an important role. The complex nature of the HIV/AIDS epidemic, particularly regarding cultural and behavioral factors that result in intense stigma and discrimination, have made the response very challenging worldwide and even more so in China. Additionally, China’s health system has undergone tremendous changes in the past three decades, which have contributed to challenges in effective HIV prevention and care beyond social and culture factors. The nature of the management structure of the system, exacerbated by inefficient financing mechanisms, has resulted in reduced access to and quality of service, especially for those with challenging or costly conditions. For these reasons, international efforts have played an important role in assisting China in confronting these challenges. The purpose of this chapter is to recount the contributions of international philanthropy, broadly defined, to China’s HIV/AIDS response in the context of sociocultural, political, and health system constraints. This review is not intended to be exhaustive, but rather to highlight the roles of different organizations that, during various time periods, have made significant contributions to addressing specific aspects of the HIV/AIDS epidemic in China.

 

8 Gender and Reproductive Health in China: Partnership with Foundations and the United Nations

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Joan Kaufman, Mary Ann Burris, Eve W. Lee, and Susan Jolly

China’s sexual and reproductive health and rights story has a mixed history. On the one hand, huge improvements in basic health care since 1949, including access to and promotion of family planning and facility-based birth delivery and the legalization of abortion since the 1970s, have led to impressive reductions in maternal mortality and child survival (Fang and Kaufman 2008; Xing et al. 2011). On the other hand, the imposition of a strict birth control policy has led to major violations of reproductive rights and a highly distorted sex ratio at birth in favor of boys (Hvistendahl 2009). Activism by women’s groups and human rights advocates on reproductive rights is constrained by the uncompromising nature of the top-down population policy. A large youth population with rapidly changing sexual attitudes, identities, and behaviors (Zheng et al. 2010) has come of age in the last decade. These youth require information and services even while government services continue to focus on married couples and promote youth abstinence. An escalating AIDS epidemic (Ministry of Health, Joint United Nations Programme on HIV/AIDS, and World Health Organization 2010) is challenged by the restrictions on civil society organizations that can best reach groups at risk and affected by the disease, and by continuing stigma.

 

9 Foreign Philanthropic Initiatives for Tobacco Control in China

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Jeffrey P. Koplan and Pamela Redmon

Tobacco has nearly as long a history in China as it does in the West. First introduced from the New World via European trading networks in the late sixteenth century, it quickly entered domestic cultivation in the southeastern coastal areas of Fujian and Guangdong. By the time of its earliest extant reference in 1611—when Yao Lü (d. 1622) wrote of it in his Book of Dew—it had begun to spread throughout the country, from the Lower Yangzi Delta to Manchuria in the northeast (Benedict 2011a, 7). Smoked by everyone from elite literati to poor peasants, tobacco became a prominent part of Chinese culture, serving as both an everyday luxury and—uniquely—as a common token in social reciprocity and exchange (Redmon et al. 2013). It has remained so to the present: China now produces more tobacco, more cigarettes, and more smokers than any other country in the world.

The history of the state’s involvement in tobacco’s cultivation, marketing, and control is also long. Already by the 1630s, the government had issued laws threatening those who cultivated, consumed, or sold tobacco with corporal punishment or stiff fines. Such laws were, however, typically short-lived, and were primarily aimed at asserting state control over a valuable economic resource rather than improving public health (Benedict 2011b, 35). Today, the government-owned China National Tobacco Corporation is the largest tobacco company in the world, with privileged access to China’s more than three hundred million, disproportionately male smokers: 53 percent of Chinese men smoke (Giovino et al. 2012) versus roughly 3 percent of women, and tobacco is considered responsible for 1 in 8 male deaths versus 1 in 33 female deaths (Benedict 2011a, 241). By 2020, it is projected that China will suffer two million deaths annually due to tobacco use (Gan et al. 2007). While the government regards tobacco as an aspect of Chinese culture and tradition and a crucial element of the economy, generating roughly 8 percent of the central government’s total revenues (Benedict 2011a, 253), it increasingly recognizes it as a pernicious health threat exacting an ongoing and increasing toll in diseases and premature deaths.

 

10 GONGOs in the Development of Health Philanthropy in China

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Deng Guosheng and Zhao Xiaoping

In China, the philanthropic and nonprofit sector is unique and distinctive. The nongovernmental organizational (NGO) landscape in China is largely divided into two groups—government-linked and independent NGOs—the latter of which ranges from grassroots to international organizations. The distinction between the two is based on whether government or civil society has started the organization and, thus, controls its governance and operations (Wang and Liu 2004). Government-organized nongovernmental organizations, or GONGOs, dominate China’s NGO and philanthropic landscape.

GONGOs are not unique to China and are found around the world, although they may be more prevalent in socialist countries transitioning to a market economy, like the former Soviet satellite states (Young 2004). Often, they are seen as “extended arms of the government” (Wu 2002) or considered in opposition to “legitimate civil society.” Among some groups, GONGOs may be viewed with suspicion as “nothing but agents of governments that created and funded them” (Moisés 2007). Yet nonsocialist countries also have government-linked bodies that are widely considered to be part of the nonprofit sector, such as the Japan Foundation, the British Council, the International Center for Human Rights and Democratic Development in Canada, and the National Endowment for Democracy (NED) in the United States. These organizations were founded or encouraged by the government, receive government funding, and are usually legally registered as charitable organizations in their home countries.

 

11 The Red Cross Society of China: Past, Present, and Future

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Caroline Reeves

THE RED CROSS Society of China has operated uninterrupted since 1904, outlasting diverse governments and helping millions of Chinese over a more than one-hundred-year history. The organization began as a civic-run Chinese group building on the Chinese tradition of local charity and expanded into a national-level philanthropic organization with international ties. It provides an historic example of a successful Chinese federated charitable organization of autonomous societies with their own fundraising, decision-making, and personnel capabilities.

At the start of the twentieth century, China’s natural and political landscapes were rocked by disaster and civil violence as China’s last dynasty crumbled and China was pushed into the modern world. Internationally, imperialism and geopolitics encroached on China’s sovereign integrity, worsening the domestic situation. Poverty, increased mortality, political instability, and social conflict became the norm for many Chinese, of whom more than 90 percent were rural peasants. China’s elite—and, increasingly, China’s general populace—wanted better for China domestically and in the world comity. Working together, they drew on China’s past and innovated for China’s future to improve the social welfare environment for their nascent nation.

 

12 More than Mercy Money: Private Philanthropy for Special Health Needs

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Li Fan

This chapter examines Chinese innovation in philanthropy for people with disabilities and other special health needs. According to the Second China National Sample Survey on Disability, conducted in 2006, approximately 83 million people in China—around 6 percent of the population—are considered to be disabled. The Chinese term used itself reflects how much has changed for those with special health needs: now called canji, a compound with a literal meaning close to “incomplete and ill,” disabled persons had previously been pejoratively called canfei, or “incomplete and useless.” The change in their standing goes beyond mere semantics, however. Economic development and the rapid growth of private wealth in China over the past five years, and the attendant boom in philanthropy, have made more resources available to support this population than ever before. Newly wealthy families with firsthand experience of the challenges faced by people living with disabilities have started foundations to tackle neglected and marginalized health problems, and, in pursuing such philanthropy, have developed many innovations particularly suited to the Chinese context. This chapter characterizes these developments through six case studies and concludes with a call for continuing public education and advocacy for people with special health needs in China, as well as new approaches to help nonprofit organizations become sustainable and self-sufficient, and thus capable of better serving the special health needs community in the future.

 

13 Charitable Donations for Health and Medical Services from Hong Kong to Mainland China

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David Faure

MEDICAL CHARITIES HAVE historically formed a key component of Chinese philanthropic organizations. Indeed, the linkage between philanthropy and physical well-being predates the advent of modern, scientific medicine; frequently this linkage had a religious cast. Traditional Chinese popular religion posits a spirit world closely integrated with that of the living, with spirits amenable to intercession in the affairs of the living if properly appeased through funeral rites and sacrifices. The exorcism ceremonies that have been held by Buddhist monasteries and village temples for centuries may be interpreted as philanthropy for both living and dead insofar as they ultimately serve the living: when the dead are appeased, the living are sheltered from disease, and appeasing the dead entails charitably satisfying their needs for food, clothing, and money. It is not farfetched to say that beneficence, and especially medical charity, has always been a part of Chinese culture, and recognized as an essential part of social well-being.

 

14 Toward a Healthier Philanthropy: Reforming China’s Philanthropic Sector

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Xu Yongguang

When Deng Xiaoping’s Open Door policy reforms first began to be implemented, the Chinese economy was in a precarious state. In 1978 the national GDP amounted to the equivalent of $148 billion in current value. The next three decades witnessed a remarkable transformation as China progressed from economic stagnation to become the world’s second-largest economy, with a GDP of $7.3 trillion by 2011 (World Bank 2013). This spectacular growth has frequently been hailed as “China’s economic miracle,” or “a miracle with Chinese characteristics” (Wu 2004). But it has not come without huge social upheaval, as the transition to a market economy also saw the disintegration of an already-strained state welfare system, most notably in rural areas, which had previously been organized under the Cooperative Medical System. Against a backdrop of limited state welfare provision and rising wealth inequality, the growth of modern Chinese philanthropy has been both heartening and necessary.

 

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