China’s shocking response to recent Covid-19 outbreaks in Shanghai highlights the country’s deep-rooted challenges around health care. Shanghai dwellers were barred from leaving their residences, and stories of people lacking food and other necessities flooded the internet both behind and beyond the Great Firewall of China. Health care in China is a politically charged topic amid concerns about Beijing’s status as a Great Power and persistent fears of inadequacy and humiliation. During the period starting in the mid-1800s that Chinese leaders now describe as the country’s “Century of Humiliation,” Western missionaries provided health care services to local populations. The Middle Kingdom was reported to have one of the highest death rates in the world, and travelers to China reported atrocious sanitary conditions. In an account published 100 years before Covid-19 reportedly emerged from a Wuhan food market, one missionary, Mary Ninde Gamewell, said: “Food and meat shops, fruit-stalls and markets are centers of infection.… Flies constitute one of China’s gravest perils. In warm weather, meat shops are black with them.” Its history of poor public health left a visible mark on China. To this day, several of China’s leading health care institutions still trace their roots to Western expertise. Enduring reminders of Western contributions to medical care in China are grating for nationalist leaders in Beijing, who wish to see China pursue its own approaches. Three fronts in China’s health care efforts are particularly consequential. One effort has been championing traditional Chinese medicine. President Xi has been a vocal supporter of TCM, consistent with his broader efforts to elevate China to become a great power less dependent on Western influences. State-run media has highlighted the importance of TCM in battling Covid-19 in Shanghai. Yet TCM does not appear to be as influential as President Xi might like. The public-health metrics cited most often, including by Chinese state-run media, focus on Western medicine and especially vaccines, rather than on TCM.A second effort by Beijing to develop a Chinese approach to health care has been intense surveillance and limits on speech and travel. Until a few months ago, international media often portrayed China’s response to the pandemic as a success, and many Western observers pointed to Chinese tech and surveillance as a template for controlling the pandemic. In contrast, throughout 2020, America’s response to the pandemic, with minimal surveillance and almost no restrictions on movement, was widely criticized as ineffective. Now, echoing the “Century of Humiliation,” much of the world perceives the West’s approach to health care — and especially America’s relatively laissez-faire attitude to the pandemic — as far superior to China’s. Once again, Beijing’s sense of inadequacy and failure may fuel long-lasting resentment and ambitions. The third effort is more difficult to monitor but perhaps the most consequential: instilling trust in China’s health care system. Endemic distrust has plagued China’s health care system for years. Chinese patients are known to request over-the-counter medication from Western travelers who carry extra supplies. Similarly, Chinese tourists returning from the United States often bring large quantities of extra medications, both for personal use and to distribute to friends and family. With a Party Congress scheduled for the fall of 2022, expect Beijing to redouble its efforts to showcase an authentically Chinese approach to health care that is free of Western influence. Even if the next six months go smoothly, and Beijing does not become the epicenter of a large-scale outbreak the way Shanghai did, it may be too late to change the minds of Chinese citizens. For those who have seen China’s health care policies in action, an American-style approach may have a lot more appeal than what Beijing has to offer.
