Infectious Change: Reinventing Chinese Public Health after an Epidemic

摘要

China's SARS epidemic was a watershed moment in the story of China's public health system. Before 1949， with rampant infectious diseases and private doctors who only served the urban rich, China was known as the "sick man of Asia," so the reform of the health care system was one of the first orders of business for the triumphant Communists. Syphilis was eradicated and a primary health care system constructed, increasing access to care through barefoot doctors, a basic health insurance system and a "three-tiered" network of clinics and hospitals at county level and below. Greatly improved health status (infant survival, longer life expectancy through control of infectious diseases) resulted in a demographic dividend that was a major factor in China's spectacular economic growth. However, three decades of dismantling a publicly funded system and re-privatizing the medical payment system weakened the rural health system, creating inequity by restricting access to those who could afford the bribes and high fees for drugs and care. With little or no communal funds devoted to "patriotic health campaigns" and the fundamentals of community health efforts, a weakened epidemic control system was unable to address threats like SARS. China had the greatest number of SARS cases and deaths.