Since China is seen globally as a rapidly rising economic power capable of engineering marvels -- from bridges and roads to high speed trains -- some assume Chinese health care is developing just as fast. But as China's delayed, haphazard response to the coronavirus outbreak shows, the reality is that health care has not kept up pace -- and the government is to blame.
Delivery of high quality, effective medical care and public health solutions in China suffers from a variety of problems. One of the most challenging is low levels of human capital in health care systems.
According to one study, China has only 60,000 general practitioners, roughly one per 23,000 people. By comparison, in the U.S. there are 1,500 people per general practitioner.
Nor are many medical professionals well trained. In community health centers, less than one quarter of doctors have a bachelor's degree or higher. Even as recently as a decade ago, only 67% of Chinese doctors had only been educated up to the junior college or secondary school level -- hardly enough under any reasonable standard to be a highly qualified medical professional.
Human capital deficiencies are compounded by government priorities. Buoyed by nationalistic support from President Xi Jinping, traditional Chinese medicine occupies the second largest share of the retail drug market, at 29%, behind chemical pharmaceuticals at 43%.
Leaving aside the weak evidence of traditional Chinese medicine's efficacy in clinical trials, it diverts enormous resources from mainline medical service delivery and research to placate nationalistic sentiment. Addressing major public health challenges is a better target for public spending than boosting nationalist fervor.
While China is good at construction, health centers might be the only market in China to have missed out on the building boom in the past decade. In 2009, China had 917,000 health institutions but by 2018 this had only increased to 997,000, growth of roughly 1% a year.
Instead, there has been a concentration on building larger tertiary hospitals. This has led to wildly divergent health services, with more specialists concentrated in the larger hospitals in big cities. Primary level hospitals, the smaller ones in the smaller cities, have bed occupancy rates of 57%, while third level hospitals, the largest in the biggest cities, registered 98% in 2018.
The low levels of human and medical service resources have become a flash point in China, where the population is used to things improving rapidly. Violence by patients against medical personnel had become so common that China passed a law specifically covering this type of assault.
Numerous studies of the general population have found significant dissatisfaction with various aspects of Chinese medical care, from respect for and communication with patients to institutional problems and doctor interaction. A country of consumers who can now get almost anything delivered within a few hours are frustrated by low levels of doctor competence, regular requests for bribes and a lack of information on their care.
Arguably, the biggest investment the government has made to address the broader public health problems associated with disease outbreaks is the toilet revolution. Started a few years ago to bring flush toilets to rural households and improve public toilets in crowded urban centers, it lifts sanitation standards.
A fundamental problem in Chinese public health is low hygiene standards in toilets, restaurants, hospitals and meat markets. One recent study found 61% of rural health care workers in Inner Mongolia did not use gloves and 40% did not use sanitary hand wash.
Poor refrigeration of food and the availability of all kinds of animals -- from raccoons to snakes and dogs -- remain quite normal throughout China and are also health risks.
Even basic statistics may be misunderstood. Chinese life expectancy has more than doubled from 35 years in 1949 to 77 years in 2018. By one measure, the healthy life expectancy at birth of Chinese people has even surpassed that of the U.S.
Life expectancy, however, is a poor measure of health care quality as it can be significantly impacted by factors that have little to do with doctors, medicines and hospitals. For instance, removing cars, guns and drug deaths significantly alters American life expectancy statistics.
In order to meet GDP growth targets and publicly demonstrate its accomplishments, the Chinese Communist Party has prioritized large infrastructure projects. Latex gloves in medical care and proper refrigeration in food service simply do not grab the headlines or the imagination the way high speed rail does when justifying the possession of political power.
This challenge to improve Chinese health care services and sanitation largely mirrors the broader challenges facing Beijing. To increase GDP, the economy will need to shift away from large-scale construction toward improving productivity with a focus on managing complex organizations and focusing on details.
Grandiose displays of construction make for good headline fodder but they do not help prevent and fight the coronavirus and other similar outbreaks. More attention to the basics -- better scientific training for doctors, more basic supplies like latex gloves and hand wash -- does.
Christopher Balding is an associate professor at the Fulbright School of Public Policy and Management of Fulbright University Vietnam in Ho Chi Minh City and author of an upcoming book on China's economic development tentatively titled "The Great Transformation."