Mechanisms of Accountability for the Realization of the Right to Health in China

Qiu, Shengnan; Macnaughton, Gillian

On August 23, 2016, Philip Alston, the United Nations (UN) Special Rapporteur on extreme poverty and human rights, issued a statement at the end of his mission in China. Alston noted the extraordinary progress that China has made over the past three decades in bringing people out of poverty. In particular, he reported that "[i]n 2003, only 10% of the population had health insurance" whereas " [b] y 2013, some 95% were covered, including most of the rural poor and vulnerable urban groups." 1 Additionally, between 2000 and 2012, the infant mortality rate fell by 60% and the maternal mortality rate fell by 49%, and between 1990 and 2012, life expectancy increased from 69 to 75 years. Alston, accordingly, concluded that there were lessons for other countries to be drawn from China's achievements. Significantly, he declared that "genuine political will to alleviate poverty is arguably the most important ingredient of all." 2 On the other hand, Alston reported a number of challenges for economic and social rights, in particular the lack of genuine accountability mechanisms to enable rights-holders to seek remedies for violations of their human rights. The absence of "effective options for seeking redress or letting steam off," he noted, often leads to violence both by and against petitioners and protesters. 3 Accordingly, the development of effective domestic mechanisms of accountability in China is a crucial issue. In this context, this article provides an overview of accountability mechanisms in China, focusing on the right to health specifically and revealing where such mechanisms are lacking and how they might be improved. Accountability may involve a broad range of mechanisms-such as litigation, elections, public hearings, town meetings, professional oversight, social actions, and media reports-and China is a large and complex country. The article, therefore, does not attempt to provide a comprehensive review and does not examine any particular mechanism in depth. Nonetheless, the overview and analysis have implications for accountability for the right to health and all economic and social rights in China.