Politics and Health Care in China: The Barefoot Doctors

On the eve of the establishment of the People's Republic in 1949, China faced some enormous problems in the health area. More than a century of nearly continuous foreign and civil war had drained the country and dislocated the entire society. Economic disruption, malnutrition, and breakdown of health services produced a situation in which, for example, some 30 percent of the children died before the age of 5, and rampant diseases such as smallpox, cholera, tuberculosis, and malaria sapped the strength of the survivors.1 China also lacked adequate resources to deal with these problems. The bare subsistence economy yielded little surplus that could be invested in other areas. What surplus there was had to be divided in response to demands for increasing food and industrial production, developing military strength, and providing a range of social services-of which health care was only one aspect.2 In terms of personnel, China had between 20 and 40 thousand physicians in 1949.3 This small group had to care for a gigantic population while carrying on teaching, research, and other professional work. The problems confronting China were not just material and physical, but intellectual as well. The basic model for a modern health care system was centered around relatively highly trained professionals applying sophisticated technology and often using complex equipment and medicines. This model had many advantages in terms of producing quality medical