Solid Foundation or Feet of Clay: Can China’s Public Health System Contain the Novel Coronavirus

02/26/20 • 26 min

Since the first diagnosis of the Novel Coronavirus in December of 2019, the disease, as of February 23rd 2020, has infected 79,561 people and killed 2,619. The disease is rapidly spreading throughout the world, with recent outbreaks in Iran, Italy and South Korea. The Coronavirus is a pandemic moving so fast that it is likely that any podcast I record on the topic will be out of date between my research and the publishing of the podcast. Instead, I wanted to provide context for the current outbreak, by exploring the healthcare system of China, where 97% of all cases of Coronavirus are concentrated. In part one, I will be discussing the public health successes of the 1950s and 1960s and the neglect of the healthcare system in the early reform years. In part two, I will discuss the efforts of the Chinese state the strengthen the provision of healthcare, and the incomplete nature of these reforms. Finally, I will discuss how China has dealt with two prior epidemics, that of SARS and tuberculosis.

The era of Mao Zedong’s rule from 1949 and 1976 was an era of disasters for the Chinese people. The anti-landlord campaign, the Campaign to Suppress Counterrevolutionaries, the Great Leap Forward, and Cultural Revolution lead to the senseless death of an uncountable number of people. One area where this narrative of horrors is not the primary story is in the major improvements in public health saw during this period. In 1980 China had an infant mortality of 48 per 1,000 and a life expectancy and a life expectancy of 67, similar to that of Argentina and Mexico, nations 25 times as wealthy as China in 1980. Starting from 1965, the Chinese government rapidly expanded access to health through the implementation of the Rural Cooperative Medical Scheme (RCMS), which by 1976 covered 92% of the rural population. Each brigade (the basic unit in China’s cooperative farm system) financed a health cooperative that would purchase all medical supplies and pay for doctors. The Chinese government trained 1.8 million barefoot doctors, and 700,000 midwives. Barefoot doctors were usually traditional healers who received three to six months of training in western medicine at a local hospital. Barefoot doctors were paid no more than ordinary farmers, keeping the costs of the system low. The healthcare system offered limited care for the sick, and was instead focused on keeping people from getting sick in the first place. Every county in China had an Epidemic Prevention Station, and the government organized “Patriotic Health Campaigns” for one to two weeks a year focusing on creating sources of clean water, eradicating disease bearing pests such as mice and mosquitos, and latrine construction for human waste disposal.

The healthcare system of China was highly effective given the severe resource constraints (caused by disastrous economic management by Mao) it worked under. However, the collective system which provided the financial basis for the system, collapsed after 1976. Between 1976 and 1981 the percent of people in rural China enrolled in a health cooperative decreased from 92% to 10%. The barefoot doctors became village doctors, who were less well trained than barefoot doctors, and primarily financed themselves by sell...

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A Plague Upon All the Houses: East Africa’s Devastating Locust Infestation

According to the bible, the 8th plague God sent to Egypt, was one of locusts. East Africa, after suffering drought , cyclones, and army worm infestations is set to suffer a plague of locusts of biblical proportions. The current plague of desert locusts originate from the deserts in the interior of Yemen. The 2019 cyclone season was of unprecedented strength, spreading an unusual amount of moisture into the deserts, causing female locusts do go into a breeding frenzy. Locust infestations are terrifying because locust populations can increase 20 fold per generation, and each generation being less than five months. The largest swarm in Kenya is 37 miles long and 25 miles wide, and there are scores of such swarms that can travel up to 100 miles in a day. These swarms have traveled through Somalia, northern Kenya and southwest Ethiopia. It is expected that Tanzania, Uganda and South Sudan will soon be severely effected as well. Massive plagues have also infested huge regions in Pakistan and India. It is likely that infestations will continue to spread until June

The only effective means of controlling locust swarms is to douse them from the sky using small airplanes. However, the countries of the region suffered from severe shortages of the equipment necessary. Kenya has only five planes, and Ethiopia only three to combat the swarms of locusts. East African nations did plea for aid during earlier stages of the infestation. The government of Kenya requested $2 million in September, and $6 in November. Ethiopia is currently requesting $70 million for containment. One of the most important lessons from the last major infestation of a scale similar to the current one, which occurred in north-west Africa between 2003 and 2005, is that it is essential to control the infestation early. The north-west African locust outbreaks cost $2.5 billion in crop damages, and $600 million to control. The same amount of money could have controlled locusts for a 170 years. Controlling locust swarms is further complicated by the fact that many of the swarms primary breeding grounds are in places like Yemen and Somalia where conflict makes it impossible for preventative measures to occur here.

It is likely that climate change will make locust infestations more common in the coming decades. The locust swarms are especially tragic given that some of the most vulnerable people are effected. Currently 29% of people in Kenya, 21% of people in Ethiopia, 39% of people in Yemen, and 41% of people in Uganda suffer from undernourishment. It is likely that the locust swarms will push more than 10 million into hunger. The people who will suffer the worst will likely be in countries suffering from war such as Yemen, Somalia and South Sudan. However, there are reasons to be optimistic about future outbreaks. The coun...

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Idlib’s Last Stand: Turkey’s Intervention, and the Humanitarian Catastrophe in Syria

Since the beginning of the Syrian Civil War in 2011, 6.3 million refugees have fled the country with 3.6 million alone living in Turkey. We are today at the precipice of another surge in refugees from the war-torn country. Over the last several years, massive Russian and Iranian support of the Assad regime has allowed the regime to claw back control of every part of the country except for Idlib. The Syrian armed forces, as they advanced, laid siege to opposition controlled areas, allowing the most hardcore opponents of Assad to flee to Idlib rather than fight to their death. As a result, there are 3 million people in the governorate of Idlib, half of whom are displaced from elsewhere in Syria. Starting in December of 2019, Syrian, Iranian and Russian forces have coordinated a final offensive to retake Idlib, with the Assad government retaking key towns in recent weeks. The Assad regime has committed horrific atrocities against surrendering civilians in the past, leaving refugees in Idlib little choice but to flee.
During the early stages of the war, Turkey under the Erdogan administration opened its doors to Syrian refugees. Although Erdogan has always been highly sympathetic to the opposition, Syrian refugees have become highly unpopular in Turkey, and opposition to refugees is one of the drivers of the steady dipping of Erdogan’s popularity. Indeed, one of the motivations for Turkey’s invasion of Kurdish controlled territories, alongside Turkish opposition to all Kurdish movements, was to create a safe zone for fleeing refugees. The Turkish government, in order to protect the refugees from Idlib from violence, not have to deal with an influx of refugees, and in response the death of 33 Turkish soldiers upholding the ceasefire has launched a massive military intervention to stop the Syrian forces from advancing. The Turkish military has been especially successful in using drones to slow Assad and allied forces. So far Russian forces have not reacted to Turkish attacks, but it is hard to say how long this wil last.

It is unclear what the future holds for refugees from the Syrian conflict. The Turkish government is using every diplomatic tool in its arsenal to put pressure on Assad’s allies to broker a truce. The Turkish government is threatening to scrap an agreement with the EU to stop the flow of refugees and other migrants. Turkey has for some time been trying to forge closer links to Russia, making large purchases of weapons against the wishes of NATO allies, eventually brokering a truce over Idlib. Turkey is hoping to make Syrian forces feel enough pain that it restores this truce. It is refugees of the conflict who have the most at stake. Refugees are not being allowed to flee to Turkey, European nations have no desire to take any more refugees, civilian casualties in Idlib are high, ...