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SARS exposes flaws in China's health
system
By Antoaneta Bezlova
BEIJING - When China's newly inaugurated leaders
pledged last month to devote their energy to helping the
poor and downtrodden, little did they know that they
would run straight into a challenge that would test this
commitment. This is because of the fast-spreading
atypical pneumonia called severe acute respiratory
syndrome (SARS), which is not only active in China and
in many countries around the world but is suspected to
have originated in this country.
But beyond the
growing worries about what some fear may have the
potential to be a global pandemic, SARS has brought to
public attention one carefully concealed failure of
China's development over the past two decades - the
regression of its rural health care, largely
overshadowed by the glare of the country's remarkable
economic achievements.
In truth, this boom has
left hundreds of millions of peasants in the Chinese
countryside without even basic preventive care -
something they enjoyed in the old days of socialism.
After the government withdrew from the role of being the
free provider of medical services in the early 1980s,
when its market-opening measures were stepped up, the
worst affected by this shift have been public health
services - preventive care, disease surveillance and
medical control.
In rural China, the collapse of
public health care has been a disaster waiting to
happen. The current health crisis might well turn out to
be a time bomb that inflames dormant social tensions in
the long-neglected countryside.
SARS has
officially killed at least 65 people and infected 1,445
people in China, which now has nearly half of the
world's cases. Outside of Guangdong, Beijing and
Shanghai, SARS already has spread to southern Guangxi
and Hunan provinces, to Sichuan in the west and Shanxi
in the north. Two more far-flung provinces, Inner
Mongolia and Ningxia, reported this week that they too
had an outbreak.
A visiting team of World Health
Organization (WHO) experts that did their investigations
in Guangdong, southern China, where the first case
emerged in November, reported that it had "found an
urgent need to improve surveillance in the countryside
to head off new outbreak in rural areas".
"The
team observed that many of China's poorer provinces may
not have adequate resources, facilities, [or] equipment
to cope with outbreaks of SARS, and underscored that
Guangdong's capacity was [actually] exceptional among
China's provinces," the report said.
Hospitals
in Guangdong, one of China's wealthiest coastal
provinces, are among the most modern in the country, but
have nevertheless come under enormous strain due to the
outbreak.
WHO experts admit they have scant
information about the level of preparedness and scope of
the epidemic in most of China. "We do not know what is
going on outside Guangdong," said David Heymann, WHO's
head of communicable diseases.
Experts fear that
far away from central government control, hospitals in
some regions might turn away patients with SARS who are
unable to pay for their treatment. "No hospital should
refuse treatment to people infected with SARS," read a
headline on the front page of the Beijing Youth Daily
newspaper this week.
Echoing fears about how
well poor provinces could handle a full-fledged health
crisis, Communist Party chief Hu Jintao warned that if
mishandled, the SARS epidemic could jeopardize not only
social stability but also China's overall economic
development. The emergency meeting of the Standing
Committee of the Communist Party's Politburo, held on
Thursday, follows two other SARS-related meetings
convened by Premier Wen Jiabao.
A matter that
has been taboo for months, SARS and its impact on
China's future have become the most formidable challenge
the country's leaders, who assumed their positions in
the past months, are facing as they try to seek
legitimacy for their rule.
There are plenty of
reasons to worry. Rural residents account for more than
70 percent of China's 1.3 billion population, but
receive just 20 percent of public spending on health.
Urban residents also enjoy disproportionate access to
hospital beds and trained medical personnel.
This week Beijing earmarked 18 more hospitals to
those three already designated as infectious-disease
hospitals to deal with SARS patients. It was not clear
why so many hospitals were needed when official
statistics claimed only 37 people in Beijing had been
affected by SARS, and only four had died.
But
even if Beijing has grossly underreported the scope of
epidemic, as feared by many specialists here, the
capital's preparedness for emergency situations mirrors
a growing disparity in health care between the developed
coastal and urban areas and poorer inland regions.
The collapse of China's rural communes in the
late 1970s and early 1980s brought to an end an era of
free preventive health care and universal medical
treatment. Under the collective system, 90 percent of
the rural population was provided free health services.
Today only 10 percent of rural residents are insured,
leaving some 700 million Chinese having to pay
out-of-pocket for all of their health expenses.
The Chinese government has in effect
relinquished all responsibility for health care in rural
areas, leaving local governments to fend for themselves.
Many regions in China's poorest and underdeveloped
regions have been unable to finance public health
programs on their own.
As a routine, financing
for rural clinics come partly from local governments and
partly from their own revenues. To increase revenues,
clinics are charging fees for injections, antibiotics
and intravenous drips, disregarding less costly
treatment. As a consequence, the neglect of preventive
care in favor of more profitable curative treatments has
led to a precipitous rise in infectious diseases and
epidemics. Tuberculosis and neo-natal tetanus kill more
than 200,000 children in China every year, and
hepatitis, tuberculosis and AIDS are spreading rapidly.
SARS is only the newest health threat to befall
China's neglected countryside.
And even as
Premier Wen Jiabao says the situation is now "grave",
the "golden week" labor holiday that begins on May 1 -
which would see millions of Chinese head for trains,
planes and cars to visit their families and tour
regional resorts - remains on schedule. The government
is still encouraging people to travel and spend, and
live up to the country's growth targets, although this
will also ensure a greater risk of the disease spreading
throughout China.
(Inter Press
Service)
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