Health and welfare

The Chinese government faces a mammoth task in trying to provide medical and welfare services adequate to meet the basic needs of the immense number of citizens spread over a vast area. Although China’s overall affluence has grown dramatically since the mid-1980s—per capita income has increased many times over, and caloric intake has become comparable to that for western Europe—a great many of its people live at socioeconomic levels far below the national average. The medical system, moreover, labors under the tension of whether to stress quality of care or to spread scarce medical resources as widely as possible. In addition, there has been repeated debate over the relative balance that should be struck between the use of Western and traditional Chinese medicine. While the Cultural Revolution pushed the balance toward widespread minimum care with great attention paid to traditional medicine, policy after the late 1970s moved in the other direction on both issues; by the late 1980s the proportion of doctors of Western medicine had exceeded those of traditional practices. The Ministry of Public Health of the State Council oversees the health services system, which includes a substantial rural collective sector but almost no private sector. All the major medical facilities are run by the government.

The health of the Chinese populace has improved considerably since 1949. Average life expectancy has increased by about three decades and now ranks nearly at the level of that in advanced industrial societies. Many communicable diseases, such as plague, smallpox, cholera, and typhus, have either been wiped out or brought under control. In addition, the incidences of malaria and schistosomiasis have declined dramatically since 1949, and in 2021 the World Health Organization declared that malaria had been eliminated in China. However, in 2019, the highly contagious respiratory illness COVID-19 was first detected in Wuhan and rapidly spread throughout China and the world, giving rise to a multiyear pandemic that resulted in millions of deaths worldwide.

As evaluated on a per capita basis, China’s health facilities remain unevenly distributed. Only about half of the country’s medical and health personnel work in rural areas, where approximately three-fifths of the population resides. The doctors of Western medicine, who constitute about one-fourth of the total medical personnel, are even more concentrated in urban areas. Similarly, about two-thirds of the country’s hospital beds are located in the cities.

China has a health insurance system that provides virtually free coverage for people employed in urban state enterprises and relatively inexpensive coverage for their families. The situation for workers in the rural areas or in urban employment outside the state sector is far more varied. There are some cooperative health care programs, but their voluntary nature produced a decline in membership from the late 1970s.

The severest limitation on the availability of health services, however, appears to be an absolute lack of resources, rather than discrimination in access on the basis of the ability of individuals to pay. An extensive system of paramedical care has been fostered as the major medical resource available to most of the rural population, but the care has been of uneven quality. The paramedical system feeds patients into the more-sophisticated commune-level and county-level hospitals when they are available.

Changes in the leading causes of death reflect the longer life span and improved living conditions that have developed in China since 1949. For some time, the major causes have been pulmonary and cerebrovascular diseases, malignant tumors, and cardiac disease. Severe environmental pollution has become a major health hazard in several parts of the country.

Because a large proportion of what in the West would be considered public welfare obligations is in China the responsibility of factories, offices, and rural collectives and families, the real level of “welfare” spending and the strengths and weaknesses of the welfare system are difficult to gauge. However, statistical information gradually has become more available. The state provides pensions for retirees from state enterprises and official service, but this includes only a small percentage of the total workforce. The state’s welfare resources are heavily concentrated in the urban areas, where they include subsidies for housing, medical care, education, and some foods. In the cities the level of subsidized services, though, depends largely on the nature and conditions of the unit in which a person works. Unemployed individuals are typically taken care of by their working relatives, and all Chinese citizens have a legal obligation to care for their elderly parents. There is a small number of old-age homes for the elderly who have no children or other relatives to support them.

In the rural areas much of the responsibility for welfare was left to the local collective units, the resources of which have declined since the late 1970s as the collectives have been disbanded. Thus, the actual level of services now varies greatly depending on both the financial standing of the locality and the inclinations of the villagers. The Chinese government does allocate emergency relief to areas that have suffered from natural disasters (including crop failures). Generally, the Ministry of Civil Affairs of the State Council assumes primary responsibility for administering the government’s portion of China’s welfare system.