Editor’s note: Medical and health work constitutes the prerequisite to protection of the people’s right to safety of lives and health. Over the past decades, the Chinese Government has spared no effort in this regard and, as a result, the Chinese people’s health

has significantly improved. In the nationwide fight against the SARS (severe acute respiratory syndrome) epidemic in the first half of 2003, the Government placed the health of the Chinese people and the safety of their lives above everything else. With a huge input of human, financial and material resources, the country won a decisive victory over the epidemic.

Following is the full text of an interview by Human Rights with Gao Qiang, executive vice-minister of the Ministry of Health, on China’s medical and health work and how it is related to protection of human rights.
Question: In fighting the SARS epidemic, the Chinese government vowed to attach the utmost importance to protecting the health of the Chinese people and the safety of their lives. In our opinion, this highlights its resolve to protect, as always, the right of the Chinese people to safety of lives and health. Would you elaborate on that?

Answer: The SARS epidemic that hit many parts of China in the first half of this year developed in three phases. The first phase covered the first quarter, when SARS affected some parts of Guangdong Province in south China. The epidemic peaked around the Spring Festival in early February and then began declining. In April, the epidemic spread to other parts of China, with Beijing, Shanxi, Inner Mongolia, Hebei and Tianjin bearing the brunt of the onslaught. By the end of April, an aggregate total of 3,460 SARS cases had been identified across the country. The third phase began in May, during which the number of confirmed and suspected cases kept dropping while fluctuating, and the epidemic was brought under control. By 10:00 hours of June 24, an aggregated total of 5,326 SARS cases had been reported, including 4,901 that had been cured and discharged from hospital and 347 deaths. In the afternoon of the same day, the World Health Organization (WHO) removed Beijing from the list of SARS-affected areas, indicating that we had won a decisive victory over the epidemic.

The outbreak of the epidemic came all of a sudden. Even though unprepared, the current Chinese government, with a high sense of responsibility for the health of the Chinese people and the safety of their lives, decided to attach utmost importance to prevention and treatment of the infectious disease. The very first executive meeting of the State Council on March 19 was devoted to ways of fighting the epidemic. The State Council so far has held eight executive meetings since its current cabinet came into being in early March, and the fight against SARS was discussed at six. Here are the major measures taken by the Chinese government to combat the SARS epidemic:
　　　　　
Improvement of legislation has made it possible for prevention and treatment of SARS to be done in accordance with the law. SARS has been listed as a statutory infectious disease, suggesting that the disease now comes under the jurisdiction of the Law on Prevention and Treatment of Infectious Diseases. The State Council published the Regulations Concerning Emergency Handling of Unexpected Public Health Incidents, and the Ministry of Health, Methods for Managing the Prevention and Treatment of Infectious Atypical Pneumonia. Meanwhile, the National Command for Prevention and Treatment of SARS was set up under the State Council, with Vice Premier Wu Yi taking charge. As its name suggests, the command was responsible for leading and coordinating the nationwide fight against the SARS epidemic. Local governments at all levels, too, pooled resources at their disposal to ensure unison of the fight in areas under their respective jurisdiction. Moreover, integrated use of available medical resources increased the effectiveness of the fight.

In the countryside, the entire population was organized for involvement in prevention and control of the disease. This ensured effective medical surveillance over those who had returned home, mostly students studying in cities and farmers working there. By June 24, 316 confirmed SARS cases had been reported all over rural China, without massive spreading of the epidemic over the vast rural areas.

Quarantine was strengthened. At the same time, a mechanism was set up whereby to track down identified and suspected SARS patients and people who had had close contacts with them. Coordination was ensured between various provinces, municipalities and autonomous regions, and the county was united as one in fighting the epidemic.

Resources were pooled to ensure timely and effective treatment of SARS patients. Clinics special for diagnosis of fever cases were set up in hospitals capable of performing the task, and SARS patients were treated at SARS-specific hospitals. Thanks to these and other measures, cross infection was avoided in hospitals.

Combined use of methods and drugs of traditional Chinese and Western medicines was encouraged. This yielded better results of treatment and raised the cure rate.

Financial resources were earmarked for helping SARS patients and their families tide over the difficulties. The central and local governments have so far transferred a total of 10 billion yuan (8.27 yuan against the U.S. dollar) to accounts special for purchase of medical equipment, drugs and protective articles and for renovation of hospitals to make them SARS-specific. More will be earmarked to improve the system for prevention and treatment of diseases, the public health information system and the system of medical assistance. Free treatment and hospitalization were allowed to SARS patients in the countryside and SARS patients in cities who were registered as living below the poverty line.

Fruitful results were reported in SARS-related research. China’s SARS-related cooperation with WHO and foreign countries has proved a complete success. Scientists and medical experts on the Chinese mainland have held several meetings with their counterparts in Hong Kong, Macao and Taiwan for sharing of SARS-related information and expertise.
Q: The victory over SARS should certainly be attributed to those emergency measures taken to bring the epidemic under control. But we have to admit that the great achievements made by new China since its founding had prepared the country for the victory. Would you give us an account of these achievements?

A: Great changes have taken place in China’s medical and health work since 1949. China is still a developing country, with an annual GDP averaging about US$800 for each of the 1.3 billion Chinese, just 2.7% of the corresponding figure for the United States. With so limited an amount of resources at its disposal, the country has succeeded in providing its population, 22% of the world’s total, with basic medical and health care. In terms of the general level of public health, China ranks one of the best among developing countries and is better than the average for countries with medium-level incomes. Life expectancy is one of the three major indicators used internationally to measure the general health level of a country. Life expectancy for the Chinese now averages 71.4 years, up from 35 years before the People’s Republic of China was founded in 1949. The mortality rate for women in pregnancy and labor has dropped from 15,000 per 100,000 to 50.2 per 100,000, a 30-fold decrease. Infant mortality now stands at 28.4 per thousand, down from 200 per thousand. Huge cuts have also been reported for the death rates of infectious, parasitic and endemic diseases.

A fairly complete medical and health system is now in place. In the early-post liberation years, China had 3,670 medical institutions, mostly in cities and towns. These together had 84,600 hospital beds and employed 505,000 medical workers. Divided by the Chinese population, which was then about 400 million, for every 1,000 people, there were 0.15 hospital beds, 0.67 doctors, 0.06 nurses and 0.93 health workers. In contrast, the country now has 306,000 medical institutions with a total of 3.1361 million hospital beds and 5.238 million doctors and nurses. Divided by the current Chinese population of 1.3 billion, for every 1,000 people there are 2.32 hospital beds, 1.47 doctors, one nurse and 3.41 health workers.

Q: China stresses prevention and control of diseases in its medical and health work. Would you elaborate on that?

A: China has always followed the principle summarized as “prevention first” in its medical and health work. The country has by and large built up a complete system for prevention and control of infectious, endemic and chronic diseases, which has proved highly efficient in protecting the health and lives of the Chinese people. The worst flooding in 100 years hit China in 1998 and 1999 in succession, during which no major outbreak of infectious and contagious diseases was reported, with the incidence of major diseases remaining roughly the same as the average for the five years prior to 1998. The incidence of acute infectious and contagious diseases has dropped from 20,000 per 100,000 to 180.14 since the early post-liberation years, and these have been reduced to a place lower than the tenth on the list of killer diseases. Far back in the early 1960s, China wiped out smallpox, ten years earlier than the entire world. Snail fever and leprosy were basically eliminated in the following years. By dint of hard work over the past decades, China has attained the targeting of vaccinating 85% of the infants and babies against measles, whooping cough, diphtheria and polio. Moreover, the country has brought the plague, kala-azar and typhoid under control, and greatly reduced the incidence of major endemic diseases, the likes of Keshan, Kaschin-Beck and iodine deficiency diseases. Good progress has also been reported in the prevention and treatment of cardiac-cerebral vascular diseases, cancers and diabetes.
Q: The bulk of the Chinese population lives in the countryside. Would you say something about the medical and health work in rural China? A: Development of primary medical and health care and effective protection of the rural people’s health have always been a basic target and a long-term task for the country’s medical and health work. The government has spared no effort to build up a rural medical and health system operating at the county, township (rural town) and village levels. In 2002, 2,037 county-level hospitals were counted across the country, along with 44,992 hospitals at the township (town) level, and clinics were found in 637,000 or nearly 90% of the rural villages across the country. County-level hospitals together had 1.918 million doctors and nurses. Working at village clinics were 1.29 million doctors and medics, averaging 1.8 for each clinic. Back in 1990, the government launched a national program designed to enable the entire rural population to enjoy primary medical and health care by the year 2002. By the end of 2000, a total of 30 billion yuan had been spent on the program. Some 41,118 rural township hospitals had been renovated, accounting for 82.36% of the total designated for renovation under the program. Also renovated were 2,371 county-level sanitation and anti-epidemic stations, 81% of the national total, and 2,114 county-level maternity and child-care centers, 85% of the national total. These institutions were revamped and on-job training was provided to medical and health professionals there. A nationwide campaign to help the rural population enhance their health awareness has been going on since 1994. Of the 31 provinces, municipalities and autonomous regions on the Chinese mainland, 25 have since 1999 benefited from medical and health work done by young volunteers as a way of alleviating poverty.
Q: The rural cooperative medical system once won worldwide recognition for its efficiency despite a low input. But the system has kept going downhill since the 1980s. How did that happen?

A: The state began developing this rural cooperative medical system far back in the 1950s. The system contributed a great deal to protecting the health of China’s rural people, who account for the majority of the Chinese population. By the end of the 1970s, the system had been instituted in more than 90% of the rural areas.

Things began to change in the early 1980s, when the rural reforms began. Farming came to be done on a household basis under contracts signed with the rural collectives. Under the new system, the farmer was allowed to retain whatever is left after paying taxes and contributing a fixed portion of the harvest to the collective fund. The rural economy received a boost from the new system, but in most rural areas, the rural cooperative medical system lost the support given by the collective economy. In 1998, the rural cooperative medical system was practiced in only 5% of the villages across China.

This state of affairs alerted the Chinese government to the need to improve and perfect rural cooperative medical services. In October 2002, the Chinese Communist Party Central Committee and the State Council jointly issued the Decision on Further Improving Health Services in the Countryside. In January 2003, the General Affairs Office of the State Council approved the circulation of an official document prepared jointly by the health, finance and agriculture ministries, which is entitled Opinions on Establishing a New Rural Cooperative Medical System.
Q: What are the characteristics of the new rural cooperative medical system?

A: New ways of organization and fund-raising are the salient features of the new rural cooperative medical system. Under the new system, the county or the county-level city shall function as the basic unit for rural cooperative medical service, instead of the production brigade or village as under the old system. In other words, the new system places people on larger areas under its protection and still better services are available under it. The new system obliges local governments to earmark no less than ten yuan per person to augment the rural collective medical funds, and governments in relatively developed regions in east China may earmark more than that. Beginning 2003, the central government will earmark, through transfer payments to local governments, an extra ten yuan per person for such funds in relatively underdeveloped western regions.
Q: Care of the woman and child is a key indicator for success or failure of a country’s public health work. What China has done to constantly improve maternity and child-care?

A: Only 89 institutions of maternity and child-care were found across China in the early post-liberation years. By 2002, the number of such institutions had grown to 3,067. Shortly after New China was born, work began to spread a complete set of new methods of midwifery in the countryside, methods that can effectively ensure safety of the mother and baby. In 2002, such methods were used to assist 97.2% of the women in labor. Women across China now benefit from regular medical check-ups for discovery and early treatment of gynecological diseases. Back in the early 1980s, the country instituted a system of responsibility for women’s and children’s health care. As regards child-care, it is a long time since the country instituted a system of preventive vaccination against pediatric diseases. In addition, a nationwide campaign has been launched every year to promote prevention and treatment of infant pneumonia, diarrhea, rickets and iron-deficiency anemia. Breast-feeding is encouraged. A complete range of infant care services is available in the country. To promote the protection and development of women and children, the Chinese government in the early 1990s signed the World Declaration on Children’s Survival, Protection and Development and the Action Plan for the 1990s. It also formulated the Outline Program for the Development of the Chinese Women and the Outline Program for Chinese Children’s Development. The National People’s Congress, the Chinese parliament, has promulgated the Law on Maternal and Infant Health Care. In progress are actions at some of the most poverty-stricken regions to cut the death rate of women during pregnancy and in labor.

Q: Community-based health care is being promoted as a part of the effort to build an urban public health system suiting China’s socialist market system. In fact, it represents the orientation fixed by the Chinese government for developing public health systems in cities. We’d be happy to hear your comment on that.
　　　　　
Vice-Premier Wu Yi, the doubles as Minister of Health, with Gao Qiang.

A: Community-based health centers have the central task of protecting the health of China’s urban residents. In providing such health care, the household is taken as the basic unit and priority is given to women, children, the elderly, the handicapped and low-income families. Community-based health centers combine prevention and treatment of diseases with heath education, family planning and rehabilitation treatment, and aim at providing services that are effective, inexpensive and to the best convenience of local residents. By the end of 2002, 2,406 community-based health centers and 9,726 sub-centers had become operational in 358 cities. We aim at having people suffering from minor diseases treated by their GPs working in their neighborhoods and ensuring that those suffering from more serious diseases can count on full-fledged hospitals for help.
Q: As far as we know, public health inspection has played a big role in protecting the people’s health. Would you elaborate on China’s legislation in this regard?

A: Since 1981, China has promulgated nine public health-related laws and 27 public health-related government statutes. Central government departments have published more than 400 sets of rules and regulations to the same effect, as well as 1,250 state standards. Moreover, local people’s congresses and governments have published numerous pieces of legislation by proceeding from local conditions. While effectively protecting people’s health, these constitute the legal basis for enforcement of law on affairs of public health. Under state laws and government statutes, food hygiene has improved markedly, and the incidences of infectious and contagious diseases have kept dropping. Good results have also been achieved in reducing the number of food poisoning cases and cases of industrial dust pollution.
Q: Development of public health work is an important part of the national effort to build socialism with Chinese characteristics. It has always been listed in government plans for economic and social development. Would you give us an account of the decisions taken in the most recent years by the Chinese government to this effect?

A: In 1996, the State Council published the Decision on Reform and Development of the Public Health System. The Decision calls for “focusing health work on the countryside, putting prevention first, attaching equal importance to traditional Chinese and Western medicines, relying on science in promoting public health work and getting the broad masses of people involved in it.”

In December 1998, the State Council published the Decision on Instituting a System of Basic Medical Insurance for Urban Workers, calling for accomplishing the task of building up the system in three to five years. According to the Decision, the system to be built up shall cover all laboring people in cities and urban towns, and shall be complete with basic medical insurance, supplementary medical insurance by enterprises and commercial insurance. A complete set of methods has been published for implementation of the Decision.

In early 2000, the General Affairs Office of the State Council approved the publication of an official document prepared by eight central government departments, which is entitled Opinions of Guidance for Reforming the Urban Medical and Health System. The document further clarifies the basic guiding principles for the reform and its main targets and contents. In July 2002, the general target to be achieved through the reform was fixed at a national work conference called by the State Council. This general target is summarized as “providing good medical and health services to the people at a relative low cost and ensuring the basic needs of the people for such services.” This was followed by publication of 13 documents by the relevant departments of the central governments on ways and means of attaining the general target.

In October 2002, the Chinese Communist Party Central Committee and the State Council jointly published the Decision on Further Strengthening Rural Public Health Work, describing such work as vital to the rural people’s health and to the attainment of China’s long-term economic and social development targets.

All these decisions have one objective-developing a national medical insurance system with distinct Chinese characteristics, fully ensuring the right of the Chinese people to health and effectively protecting the health-related human rights to which the Chinese people are rightfully entitled.
Q: Development of public health work is an important target set by China in striving for an all-round social development and for development of its human rights cause. Would you comment on the prospect of the public health-related human rights in the country?

A: China has won worldwide recognition for its success in promoting and upholding public health-related human rights. In fighting the SARS epidemic over the past months, the Chinese government placed the people’s health and lives above everything else. This came as one more endeavor by the Chinese government to uphold human rights. It highlighted the ultimate objective of the country’s public health undertakings.

Looking back at the fight, we acknowledge the need for a rethinking of China’s medical and health system. When the epidemic began biting, our understanding of its seriousness was far from being adequate. Because of this, and also because of the defects inherent in our medical and health system, we were caught unprepared for the epidemic that came all of a sudden. For a time, we were thrown into passivity. Organization of the fight was poor. The relevant legislation was ineffective, and so were transmission and sharing of information and the pre-warning mechanism.

Nevertheless, we came to realize these problems before it was too late. With a high sense of responsibility for the safety of the people’s health and lives, we took a series of resolute measures to fight back and, thanks to this, we finally emerged victorious from the fight. From now on, we’ll spare no effort to publicize the Regulations Concerning Emergency Handling of Unexpected Public Health Incidents promulgated by the State Council during the fight and the Law on Prevention and Treatment of Infectious Diseases. We aim at enabling all citizens to have an adequate understanding of the law and the regulations so that they will act on their own to safeguard their right to health. The Chinese government will accelerate the building of a mechanism whereby to ensure prompt and effective handling of emergency public health incidents, and improve the public health information network, the system of diseases prevention and control, and the system of medical treatment and assistance. The Ministry of Health will build a system of diseases reporting. This system will cover all levels of administration, from the central down to the village level. Governments at the county and higher levels are obliged to set up centers for prevention and control of diseases. We hope that in case of an unexpected public health incident, governments at all levels and their working departments, medical and health institutions and the general public will know their respective rights, responsibilities and obligations and act accordingly.

We will, as always, proceed from China’s realities in accelerating the reform of China’s medical and health establishment and promoting public health work in the countryside. We believe that the Chinese people’s right to health will enjoy still more adequate and effective protection.