Communicable disease control in China: From Mao to now

Hipgrave, David

The rationale for the introduction of the barefoot doctors, and their impact, has interested recent scholars, and the different perspectives are summarized in Figure 2 . One thesis holds that they were part of Mao' s goal of improving the level of literacy in China, itself the antithesis of the contemporary philosophy that education was bourgeois (17) . In support of this theory is the observation that improvements Figure 1 The rural government and health system in 1960s-1970s China, depicting the three-tier network. in education complemented the public health campaigns in reducing mortality (8) . Another points to three influences: (i) models provided by Guomindang experiments on basic primary health care in the 1930s and 1940s, and the Soviet 'feldshers' (field doctors who provided primary health care at village level, supervised by trained staff at higher levels); (ii) the ideology of self-sufficiency, gender equality and egalitarianism (with the peasants as the agents, not just the beneficiaries of revolution), taken up by the Mao and the Communists in Yan'an in the 1940s (also giving rise to the preference for the traditional Chinese medicine practiced by barefoot doctors) and (iii) the political situation in the mid-1960s, which gave rise to Mao' s contention that the urban elite (including the Ministry of Health) was ignoring the backbone of the Revolution, the rural peasantry (18) , and undermining his reliance on them for his own status. Having failed at commune level during the Great Leap years, self-sufficiency was instead introduced at the more stable village or brigade level, represented in the health sector by the barefoot doctors and the CMS. Whilst benefiting the health status of the population, the benefit for the nation as a whole through collectivization at this lower level was the resulting reliable supply of grain for the cities (6).