18 Chapters
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6 Schistosomiasis

Bridie Andrews Indiana University Press ePub

Farewell to the God of Plague

Mao Zedong

While reading the June 30th edition of the People’s Daily, I found that Yujiang County has rid itself of schistosoma. With my mind racing, I could not sleep. A light breeze brought its warmth, as the rising sun approached my window. Looking at the southern sky in the distance, I happily set my pen to paper.



Crystal-clear water

And emerald hills

Are many,

But of what use?

So many poplars and willows

Dangle in the spring wind.

The people of China

Number six hundred million,

Even Hua Tuo, the legend,

Was helpless

Before this little bug.

Each one as great as Shun or Yao.

Under our command,

Red rain flows like waves,

In thousands of villages

Bursting with weeds,

Men are dying.

Whirling in the wind.

With great effort, we can turn

Green mountains

Tens of thousands of homes

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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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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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16 The Evolution of the Hospital in Twentieth-Century China

Bridie Andrews Indiana University Press ePub

IN 2010 CHINESE hospitals consumed 76 percent of national health spending, whereas in the United States 31 percent was spent on hospitals and in Australia, 33 percent. The first port of call for most Chinese patients is a hospital outpatient department staffed by specialists, while for 80 percent of Americans and Australians it is a general practice physician. The hospital is so dominant an institution in the Chinese health care system that 90 percent of all in- and outpatient services in the country occur in one—a remarkable feat for an introduced institution with no indigenous counterpart.

Like a successfully introduced plant species, the hospital found its niche in nineteenth-century China and was well-established by the turn of the century. As dramatic changes in the political, economic, medical, and social environment have played out over the past hundred years, the institution has proved remarkably adaptable. It has both outperformed and crowded out potential competitors.

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7 Tuberculosis Control in Shanghai: Bringing Health to the Masses, 1928–Present

Bridie Andrews Indiana University Press ePub

TUBERCULOSIS (TB) WAS one of the most widespread and deadly diseases in China in the early part of the twentieth century. The Chinese people had a saying about turning pale at mention of the disease, which they believed killed nine out of ten of its victims. This may have been an exaggeration; however, in the first half of the twentieth century, China’s TB mortality rates were much higher than those in Europe, North America, and other Asian nations. Throughout the century, scientific discovery advanced TB control efforts worldwide, but given China’s massive population, developing a system to bring scientific advances to the wide population presented a special challenge. In Shanghai, the speed of the city’s urbanization, and the resulting size and heterogeneity of the population, amplified these challenges.

This chapter examines eighty-five years of efforts to control TB by connecting the population to the health and public health system in China’s largest city. The chapter is based upon archival documents and interviews with providers and recipients of health care. The archival documents include clinic reports and numerous documents from government archives such as the Shanghai Municipal Archives (SMA). Interviewees included thirty-five providers of health care, including six retired doctors who attended medical school in the 1950s, and fifty-three recipients of health care, including forty-five TB patients at a municipal-level facility. Health care providers were identified through snowball sampling and care recipients were identified through respondent-driven sampling.

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