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10 John B. Grant: Public Health and State Medicine

Bridie Andrews Indiana University Press ePub

JOHN B. GRANT (1890–1962) was the “spirit of public health” for modern China, said Franklin Ho (1895–1975) when he was interviewed by Mary Bullock on July 22, 1970 (Bullock 1980, 134n2). Ho, former director of the Nankai Institute of Economics, shared with Grant an interest in analyzing statistics and economics of public health.1 Ho’s view was further supported by those who worked with Grant at the Peking Union Medical College (PUMC). Marion Yang (1891–1983) recalled in her memoirs that Grant would talk to anybody and everybody about public health when few paid attention to it during his early days in China (Yan 1990, 143–153). For almost twenty years (1921–1939), Grant worked tirelessly with his Chinese colleagues in training a cadre of public health professionals and in creating a modern public health administrative system under the Nationalist government. His enormous work had a profound impact on China’s modern health system. Recent publications on Grant indicate that his ideas on public health have valuable relevance to the current debate on the efficient delivery of health care (Litsios 2011; Bu 2012a).

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8 The Development of Psychiatric Services in China: Christianity, Communism, and Community

Bridie Andrews Indiana University Press ePub

THE STORY OF the introduction and growth of psychiatric services in China is by no means a linear progression toward the achievement of practices based on science. The narrative is one in which culture, foreign intrusion, economics, familism, and politics (especially politics) all form part of the framework within which the goal of providing accessible, affordable, and effective psychiatric care for all of China’s citizens who require it is pursued. As we shall see, it is a goal that has not yet been achieved, although the efforts to do so continue. The chapter’s content that covers the development of formal institutional care for psychiatric patients from 1898 is built around material from medical missionary sources prior to 1949. For the later periods the discussion is structured using formal policy documents (where available) and published analysis and research, supplemented by the author’s own experiences and observations in China over three decades. We start, however, with a consideration of the question at the core of understanding the development and structure of psychiatric care—epidemiology.

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2 Changing Patterns of Diseases and Longevity: The Evolution of Health in Twentieth-Century Beijing

Bridie Andrews Indiana University Press ePub

WHILE BEIJING, THE capital of China, cannot be said to be typical of the country as a whole, the relatively ample documentation of the health of its citizens will be used in this chapter to provide a window into the process of health modernization in China over the twentieth century.

The process of health modernization in Beijing began during the late Qing reforms, or “New Policies” era (1901–1911). In 1905 the Board of Police, set up under the new Ministry of Police, had three departments, one of which was the Department of Health Services (weisheng shu). The department was divided into four sections:

1. Street Cleaning: cleaning streets, public toilets, garbage disposal, and controlling sewage and litter.

2. Disease Prevention: preventing epidemics by vaccination and surveillance of hospitals, slaughterhouses, and food shops.

3. Medicine: administering medical schools and hospitals, certifying doctors, publishing medical books, and keeping statistics of births and deaths.

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5 Epidemics and Public Health in Twentieth-Century China: Plague, Smallpox, and AIDS

Bridie Andrews Indiana University Press ePub

WHILE EPIDEMICS HAVE occurred throughout Chinese history, the contemporary understanding of public health is a recent import from the West, and these two topics are not necessarily related. But due to the fact that public health and the prevention of epidemics are so closely linked in our modern understanding, it has become common to discuss the two subjects as one in contemporary academic research. Chinese public health came into existence during the intensely rapid changes of the twentieth century, which was also a time rife with epidemics.

This chapter will focus on the relationships between epidemics and the evolution of public health in China, with particular attention to the plague, smallpox, and HIV epidemics. It asserts that the public health and hygienic movements often served the political purposes of the state rather than necessarily addressing the most critical medical problems.

Examined merely on the basis of extant historical records, the frequency of China’s epidemics has seen a constant increase (Zhang 2008, 32–33). Based on statistics from available historical records through the year 1949, the Republican era (1912–1949) experienced the greatest frequency of epidemic outbreaks (Li 2004, 1). Our own statistical analysis of the modern period (1573–1949) also shows that the frequency of epidemics in the Republican era was much greater than in previous times, with 3.08 occurrences per year, while that number was only 1.09 for previous eras (Yu et al. 2004, 24–25). After 1949, owing to the increasing details and completeness of relevant medical records and statistics, there are no years without any reported epidemics. The emergence of this phenomenon in the modern period is certainly related to the fact that the occurrence and spread of disease was facilitated by such aspects of modernity as rapid increases in population, social mobility, and ever-increasing internationalization (Yu 2003, 340–344). More importantly, however, I fear that this apparent trend may also reflect the degree to which there now exists an interest in recording, maintaining, and preserving the most complete possible data. It is only from the twentieth century onward, after the creation of the Public Health Administration, that the practice of recording public health and mortality statistics became one of its key programs. Since then, statistics regarding epidemic diseases have obviously seen a steady increase in both quantity and detail, to the point where it has become impossible to separate the gradual increase in records on epidemics from the increasingly detailed statistics on health and life produced by public health administrations and research departments (Liu 1996 [1937], 441–446).1 In the twentieth century, epidemic diseases—and acute infectious diseases in particular—have been an important factor in threatening the lives of the Chinese people and in influencing both the Chinese psyche and the social order. Both the epidemics themselves and the fact that their danger was ceaselessly recorded and emphasized also hastened and promoted the establishment of public health measures.

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11 The Influence of War on China’s Modern Health Systems

Bridie Andrews Indiana University Press ePub

WHEN THE NATIONALIST government established China’s first Ministry of Health in 1928, high rates of infectious disease, maternal and child mortality, and malnutrition still plagued the Chinese people, particularly in rural areas. The political and scientific reforms that swept Japan into the modern era had barely begun to take root even in China’s larger cities, and the high rates of sickness and death alarmed reformers who longed to improve people’s lives and raise China’s standing in the international medical and political communities. Achieving this aim required the adoption of scientific biomedicine and its application to the needs of 350 million people living in considerable poverty in the countryside. Drawing on reforms initiated in Eastern Europe and the Soviet Union after World War I, reformers and statesmen came up with a low-cost strategy of improving health through public preventive care.

This chapter discusses how the Nationalist government pursued this strategy and with what results, discussing both the general situation in the country and the specific situation of Chongqing, its capital during the War of Resistance against Japan (1937–1945). In the 1930s and ’40s, public health care on a scientific biomedical model was a novel idea in China. Although the outbreak of war in 1937 disrupted much of what had been accomplished in the 1930s, by then China had developed a small but growing cadre of physicians, nurses, modern midwives, and sanitary engineers capable of working within the Nationalist state’s biomedical agenda to improve living conditions in China. Many of them moved to the unoccupied southwestern and northwestern provinces during the war, as did several important health agencies. These included the National Institute of Health, the National Central Hospital, and the Central Epidemic Prevention Bureau, all of which retained branches in western China after the war (Fu and Deng 1989; ABMAC 1946). The National Guiyang Medical College (now Guiyang Medical University) remained in Guiyang, Guizhou, and new agencies were established during the war, including the Chongqing Bureau of Public Health and the Sichuan Provincial Health Administration. Rather than curtail the development of health administration and state medicine, the war moved it west.

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