Mao’s Cold Greeting: Aristotle’s Cold Reply

Healthcare’s role in instigating Chinese Insecurity

This past summer two observations struck me while visiting several Chinese hospitals. First, walking through urban health centers is analogous to a game of hopscotch from the overflow of patients sitting on the floor, and second, rural health centers are eerily empty. Despite improvements in healthcare since the Chinese Communist Revolution, with life expectancy rising from 40.8 to 73.0 between 1950 and 2010, the system has not kept pace with the demographic changes.

Communist China ignored Aristotle’s concept of an individual’s right to health, but the philosopher may have a final say. Demographic challenges like China’s rapidly aging population, predominant rural population, growing economic disparity, and disease rates put a strain on an already crippled system. If healthcare reform to accommodate these trends does not occur, China’s national security will be threatened.

Capability

The capability of a healthcare system is its ability to manage the influx of citizens into the system. Since the 1980’s, the one-child policy has prevented at least 250 million births creating the 4:2:1 problem. As the population ages and healthcare needs increase, children will, by law, be required “to support and assist their parents.” As this scenario develops, so will social and economic insecurity, as society finds itself in a game of tug-of-war between governmental law and job commitments. If China chooses work over care, social insurrection may grow over elderly neglect. Alternatively, time devoted to elderly care would cause great economic loss especially given a declining work force.

By 2050, China’s elderly will make up 35.6% of the population, compared to12.3% currently. China has made no move to accommodate the rapid demand in healthcare needs that this aging population will require; with the number of hospital beds and doctors per 10,000 people stagnating at 23 and 15, respectively, between 1989 and 2003. This system will not accommodate patient load, initially creating structural insecurity that may progress into regime insecurity, as sick people are refused care. Although it is hard to imagine the elderly storming the Great Hall of the People with their pension cards, anger could manifest itself through their already neglected children, a group that has displayed volatility in the past.

Alternatively, increasing GDP expenditure on healthcare from 4.5% to a reformative level will be necessary if China chooses to dramatically increases healthcare supply; this will be at the expense of other spending priorities of the GNP “pie” and could threaten China’s more urgent desires, such as a move to a technologically based military.

Breadth

China must create an insurance program that will provide the poor with an opportunity to receive comprehensive healthcare. Providing care to the 900 million rural inhabitants must also be a forerunner in policy reform if China is to care for its civilians.

Currently, in rural areas, there are 1,116 beds/million people, compared to 5,777 beds/million in urban areas. This, in addition to the fact that the majority of doctors serve in urban areas, suggests a vast disparity between urban and rural coverage.

If the healthcare needs of the rural population are not addressed, this population will be predisposed to disease, malnutrition, and other variables that influence physical and financial loss, instigating risk to the structural security of China. The rural population serves as China’s providers, supplying food and raw materials for production. If the life expectancy of the working, rural population drops, or there is migration out of these areas into cities in order to seek medical attention, China might run the risk of not having a large enough rural workforce to support the needs of its urban citizens. The communist government should take note of its birthplace, a dissatisfied rural population, and realize that if structural security of individuals is not met, regime security may decrease.

Medical costs are the primary blockade to healthcare for the urban poor and rural populations. The healthcare reform of the 1980’s decreased health coverage per capita from 100% to 10%. Despite various insurance programs initiated in the last seven years, which have increased insurance coverage from 190 million to 1.13 billion, many Chinese are still left paying as much as 50-60% of expenses, an access limiting amount.

Despite the government’s efforts to provide insurance, its actions may catalyze further discontent. By reducing the barrier to access, more people have access, yet many will also demand more coverage in order to resolve the more apparent disparity. Such threats to regime security have been seen in the U.S. through the demand for healthcare reform.

Preventative Action

Demographics and epidemiology affect the entire population, not just the extremes, and pose just as strong, if not a stronger threat to China’s security. The increased incidence of cancers and chronic illnesses are trends that impartially attack the population.

Cancer threatens China’s security from multiple angles. Environmental degradation that results in the formation of “cancer villages” can catalyze discontent and anger in rural populations. Other occupational hazards in factories can pose a threat to the working class. A study by Pronk et al., in 2004, concluded that people who work in Chinese factories pose a higher risk of cancer than those who don’t. Demands for a safe workplace and community could pose a threat to Chinese economy if workers take it upon themselves to strike, which has already been seen. With China’s reliance upon its lax environmental standards to keep costs low and attract foreign investment, consequences of such strikes could be severe. Additionally, increased cancer prevalence increases health system burden, since treatment requires extended stays and it is a relatively expensive disease to treat.

Cardiac disease, which is China’s leading killer, primarily inflicts the elderly. Increasing incidences of this disease threaten the capacity of the healthcare system, but more importantly, threaten the economic strength of China. Due to decreased productivity and early death, the total economic loss in 2000 due to cardiac disease was $30 billion U.S. dollars; if this trend continues, cumulative loss between 2005-2015 would be approximately $556 billion dollars.

Healthcare reform shows no sign of attacking China’s growing demographic malignancy. If health trends continue at the current pace, the state will fall victim to not only a declining population, but to a volatile population that expects to be cared for. Addressing healthcare reform through a dynamic approach in the areas of capacity, breadth, and prevention will provide the best means for reducing demographic pressures. If this approach is not followed, China’s national security will be at risk. If the state cannot maintain its structural security expectations, it risks loosing regime security through civil discontent and economic losses.