Book reveals Maoist China health campaigns were “poor and mismanaged”

A new book by Dr Xun Zhou, using previously unseen oral testimonies, has challenged claims that large-scale health initiatives in Maoist China were successful and revealed that some interventions had a detrimental impact on the environment and the public’s health.

The People’s Health: Health Intervention and Delivery in Mao’s China, 1949-1983 is the first systematic study of healthcare and medicine during the Maoist era. It shows that official statistics and global pronouncements about health improvement often turned out to be failures at the local level. Dr Zhou’s findings also shed light on China’s handling of the current COVID-19 crisis.

Dr Zhou, from our Department of History, reveals that despite political vision and the leadership’s ability to mobilise the masses, large-scale public health campaigns often failed due to a range of local factors and political instability which made them difficult to sustain. The study also shows that health planners in central government and experts involved in designing these campaigns rarely understood how communities at the periphery perceived their health needs.

“By bringing those directly impacted by the campaigns into my account and seeing them as active participants, we can see how great designs on paper often turned into makeshift solutions as soon as they encountered human reality,” Dr Zhou explained.

Using two internationally-acclaimed initiatives, including the anti-schistosomiasis campaign, as case studies, Dr Zhou illustrates the complex interactions between policymakers, national and local administration and those communities affected on the ground.

Despite China’s desire to be the first country to eradicate schistosomiasis - a water-borne disease transmitted by snails which was endemic in rice-growing regions around the Yangtze River – The People’s Health shows how methods employed to control it were not only ineffective but also had unintended long-term consequences that were harmful to human health and the environment.

“The application of molluscicides and use of engineering interventions, such as land reclamation, to kill snails damaged the natural ecosystem contributing to severe flooding that still haunts the region. The intensification of the use of shorter courses of the highly toxic antimony tartrate, a universally accepted intervention of the time, killed many people, while many more were infected when they were sent to infected regions to help with agricultural production in the aftermath of the Great Leap Famine,” explained Dr Zhou.

• Mao’s China falsely claimed it had eradicated schistosomiasis – and it’s still celebrating that ‘success’ in propaganda today. Read Dr Xun Zhou's article in The Conversation.

According to Dr Zhou the anti-schistosomiasis campaign is typical of how centralised health campaigns often failed when rolled out at the local level: “While official reports often biased success and portrayed these campaigns in a heroic light, the oral interviews show that authorities had little control.

“People responded to these campaigns in vastly different ways, ranging from enthusiastic participation and passive conformity, to supplication, manipulation, and stealthy resistance, or even to active opposition.

“The ever-shifting politics of public health trumped the reality of poor and mismanaged health care delivery and eradication. Success had to be the goal. Engage the masses, and the people’s health would improve – and improve it had to, whether supported by the experiences of the people or not.”

Dr Zhou argues the legacy of the utopian goal of turning the Chinese countryside into a ‘disease free socialist garden’ through health improvements can still be seen today: “The Covid-19 crisis has exposed the Chinese authorities’ lack of transparency. This is a reoccurring problem.

“Since the founding of the PRC in 1949 the promise to improve the people’s health has been a central tool utilised by the Chinese Communist Party in establishing political legitimacy. Hence, as with the Maoist campaign to eradicate schistosomiasis, the CCP’s campaign to control Covid-19 is simultaneously a political undertake,” she added.

The People’s Health uses hundreds of files from rarely-seen party archives in impacted provinces across China, as well as freshly collected oral testimonies, some collected by Dr Zhou and others by researchers at the Institute of Health at the Kunming Medical University and Yunnan Health and Development Research Association (YHDRA) between 2000 and 2016. It is published in the UK by McGill-Queen's University Press.