CHINA: SARS exposes looming health crisis



On May 1, a month after they admitted for the first time that they had discovered China's first cases of Severe Acute Respiratory Syndrome (SARS) back in November but had withheld that information from public knowledge, Chinese authorities were still preoccupied with how soon to charge the SARS victims for their treatment.

In a joint statement issued on May 1, four government departments instructed hospitals and other health facilities to charge SARS patients only at the end of their treatments, on credit if necessary, rather than demanding immediate payment as they normally would do.

As of May 26, SARS has already killed 584 people in China (including Hong Kong) and continues to infect more than 7000. These cases account for the bulk of the worldwide total of 725 SARS-related deaths and 8202 infections.

With the virus reaching epidemic proportions, Chinese authorities' preoccupation with recouping the treatment costs rather than achieving the most effective control of the virus seems puzzling. However, such a warped sense of official priorities wouldn't surprise China's common people. They have been forced to make do with an increasingly commercialised health care system since the dismantling of the previous guaranteed system of basic health care.

Since the 1950s, the state- and commune-funded health care infrastructure not only delivered primary care, it also provided effective disease prevention. But that safety net has largely disappeared over the past 10 years, as the Communist Party bureaucracy's drive to restore capitalism has gutted the overall quality of China's health care system and forced patients to pay increasing fees for treatment.

The British-based Institute of Development Studies noted in a December 2002 report that in 1997, 32% of the people referred to hospital declined admission, with 65% of them saying they couldn't afford the cost.

Massive job cuts and erosion of working conditions in recent years has made health care even more inaccessible, especially to the country's 800 million-plus rural residents.

As a result, up to 40% of people in rural areas, where average household income is just US$290 a year, avoid treatment even when faced with a significant medical problem, Dr Ray Yip, a senior health officer with the United Nations Children's Fund in China, told the May 28 San Francisco Chronicle.

At present, health care in China is predominantly privatised, so that quality health care has become the privilege of a wealthy minority.

In the cities, the government has privatised health care by licencing 11 insurance companies to sell managed-care types of plans. "But", as the Chronicle observed, "with annual premiums starting at about $300, only a sliver of China's new upper-middle class can afford such plans."

At least 90% of the country's rural population do not have health insurance. It is now common in China, especially in the countryside, for a whole family to be driven into poverty if a single family member becomes seriously ill.

Even after Beijing ordered that no patients with SARS should be refused treatment, according to the April 25 Washington Post, the country's provincial hospitals were still demanding a down payment before they would treat patients. According to Chinese media reports, SARS patients ran away from health facilities in order to avoid the anticipated hospital bills!

This helps to explain why finance minister Jin Renqing announced on May 21 that rural SARS patients will be entitled to receive treatment free of charge.

Jin, however, failed to explain whether the rural residents working or temporarily residing in the cities will also have their treatment fee waived if they have SARS. If this is not the case, people who are members of this group, which numbers 100 million people, will be discouraged from seeking treatment for SARS, and could spread SARS to their home towns and villages. Prior to Jin's announcement, many of those suspected of having contracted SARS but couldn't afford to pay for treatment have reportedly headed to their rural homes rather than suffer a lonely death in the big cities.

The likelihood that most of those contracting SARS will avoid seeking treatment for financial reasons is a real danger, but one for which Beijing has shown little concern.

In late April, the central government announced a $2.56 billion fund to fight SARS. But surprisingly little of that sum is being made available to help treat existing SARS patients.

While the spread of SARS seems to have slowed down in China, it cannot be ruled out that its spread could accelerate again, especially given Beijing's dubious response strategy so far.

The replacement of the previous socialised health system with a for-profit, user-pays system has already led to many infectious diseases reaching epidemic proportions.

The May 31, 2002, People's Daily admitted that "hepatitis B is endemic in China, causing some 250,000 deaths every year". It added that "these preventable deaths account for almost one third of the global hepatitis B death toll".

Bates Gill of the Freeman Chair in China Studies and Andrew Thompson of the US Centre for Strategic and International Studies wrote in the April 16 South China Morning Post: "The capacity of China's health-care system is so stretched that hepatitis B, a disease for which there is a vaccine, still affects an estimated 170 million Chinese, accounting for two-thirds of the world's cases."

Tuberculosis (TB) ceased to be deadly threat in China after successful eradication efforts in the 1950s. But by 1996, the country's then minister of health had to admit that TB was back in China in an "extremely serious" way. More than 330 million people in China were infected with TB at the time. The Taiwan-based China News Analysis pointed out in June 15, 1996, that the resurgence of TB in China was linked closely to the fact that 80% of TB patients could not afford the cost of treatment.

Things have got worse since. The World Health Organisation (WHO) reported in 2000 that TB was causing 150,000 deaths a year in China and TB topped the list of infectious causes of death in the country. It added that more than 400 million in China were infected with TB — the second highest in the world, after India.

From a handful of HIV-AIDS cases in the 1980s, last year there were up to 1.5 million people with HIV-AIDS in China. In an 89-page report issued on June 28, 2002, the UN warned that China is "on the verge of a catastrophe that could result in unimaginable suffering, economic loss and social devastation".

One of the main causes of China's AIDS epidemic is the country's illegal blood-buying industry and its reckless and unsanitary practices, which have resulted in whole villages becoming infected with HIV in recent years. At a purchasing price of 40 yuan (A$8) per half litre, blood sales provide an attractive income to many rural residents.

"We all sold our blood to make money ... to pay the local taxes, to support our kids to school and to make a living. By working on the farm we can't make money. We actually lose money", a peasant woman was quoted by Beijing's Foreign Correspondence Club as saying on May 13, 2001.

Collectors buy blood from villagers, pool it and extract plasma — the liquid part of the blood sought for medical uses. They then reinject the blood back into the sellers, apparently to limit their blood loss.

Often needles and syringes are reused without proper sterilisation. Unclean needles were reportedly repackaged and sold as "new" to increase profits.

The rising problem of drug addiction in China, especially drug taking by injection, has also contributed significantly to the rapid spread of many blood-borne infections.

In the 1970s and '80s, China's rural health care system was widely praised internationally as exemplary in delivering an inexpensive but effective way to provide primary care. But in the WHO's World Health Report 2000, China slipped to 144th place in terms of effectiveness of its health system (behind India and Bangladesh) and 188th (out of 191) in terms of "fairness of financial contribution" for care.

Professor Victor Sidel of New York's Albert Einstein College of Medicine, who has conducted many studies on China's health system, said in a 2000 public address: "China's current ideology of unrestrained free-market entrepreneurialism, combined at times with political repression, had destroyed the economic and social bases for equitable rural services... Unless a society as a whole is concerned with equity and justice in their broadest meaning, that society will have enormous difficulty developing and sustaining equitable provision of health services to all its people."

From Green Left Weekly, June 4, 2003.
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