Yi Hu

The Double Meaning of “the Sick Man of East Asia” and China’s Politics

China, a country of ancient civilization, possessing vast territory, abundant resources, a large population, thriving economy and trade, and intelligent culture and institutions, has long demonstrated a sense of superiority. The nation was vainly convinced that it was the center of the world, which justified its being an excellent model for neighboring barbarian countries to follow. The meaning of “China” in Chinese characters (Zhongguo) suggests a sense of pride and narcissism. When Western explorers, merchants, and missionaries first flooded into China during and after the Age of Discovery, they were amazed with the alien culture they found and wrote abundantly of their expectations and longings. Those texts, which lavished praise and adoration on China, infused Western people with an immensely romantic notion of the Orient. However, when attacked by an advanced fleet with sophisticated weapons, and defeated in the Sino-Japanese War of 1894–1895 specifically, China bid farewell to prosperity, wealth, balance, and confidence that it had once enjoyed and moved gradually towards the humiliation of the colonial and semicolonial era. When the situation worsened, China, a country that claims a 5,000-year civilization and that took the lead among the countries in the world for most of the time, was permeated with the degrading image of “the Sick Man of East Asia,” a characteristic expression of prejudice, contempt, and even insult.

A Risk Society

“Risk society” is a concept that was first framed by the German sociologist Ulrich Beck in Risk Society in 1986. In Beck’s view, the modern society had deviated from (Karl Marx’s) class society or (Max Weber’s) industrial society and had developed into a social form that is highly modern, known as the “risk society.” Social theories based on unequal distribution of wealth (the functional theory, Marxism, and various kinds of postindustrial or postmodern theories that derived from it) have lost their interpretability when it comes to the crisis and inequality in the distribution of risks. Therefore, there needs to be a turn in social theories, that is to say, “risk sociology” needs to be advanced with problem awareness being “how to avoid, minimize, and direct risks or hazards systematically created as a part of modernization.”

A Public Country and Its Expansion

While low voluntariness and low participation ratio in the implementation of the NCMS exposed the defects of the system design (lack of motivation of the organizers owing to the high cost of organization, low beneficial range of people owing to the orientation in the reimbursement of serious illnesses only, the increasing openness and state of flux of the communities), another problem that underlies at a deeper level does not arouse adequate notice or concern. We have to pursue the basic ideal behind the system design. When they are with the correct ideal, the policies can still be modified to solve the emergent problems or to increase the applicability; when the ideal is problematic, however, the policy cannot be expected to fulfill the designers’ original plan, or to solve the problems effectively, or to reveal the crux of the matter, even with considerable technological modifications.

The Logic of Disease Politics

When he cast his eyes on the present medical problems, the author of the book was at once attracted by the “curious” phenomena, such as a newfound of disputes over Chinese and the Western medicine: Which is the superior medicine? Which should be abolished? Should they both be adopted? These familiar words, and largely the same standpoint, reminded him of a time long ago when and in which there was another similar dispute and controversy. It was the similarity between the historical scenes and the recurrent phenomena that forced me to reflect upon and to meditate a feasible interpretation: Do they belong to the same category? Are they of the same nature? What logic exists behind the controversy?Guided by Lenin’s principle, the author believes to have found a key or an interpretation as well, after conducting investigations into the political medical history in modern China.

The Patriotic Hygiene Campaign and the Construction of Clean New People

Triggered by the American germ warfare, continuing the line of thought of “cleaning” a country, the Patriotic Hygiene Campaign was upgraded to a level that was unparallel in depth and amplitude. In the struggle to defend one’s home and country, one’s personal hygiene was given a deeper meaning at the state level and became a basic prerequisite to maintaining the “cleanness” of the country. Governed by such discourse, the populace underwent a subtle “deterritorialization” process during which they were reconstructed.

The Structure and the Content of This Book

This book intends to seek an approach to understanding and interpreting China’s politics by researching disease politics. In the Western countries, the research and curing of diseases is driven heavily by money. A construction process based on citizenship would generally start when the civil conflicts were alleviated. In modern China, disease politics was mainly a response to a nation facing a survival crisis. It accompanied the process of the social transition of China and its building of a modern state.

National Defense and Hygiene

The term epidemic refers to those communicable diseases caused by the invasion and multiplication of pathogenic microorganisms or pathogens. In the long process of historical development, such diseases brought misery and countless disasters to society. Sometimes, these epidemics even changed history. The frequent outbreaks of epidemics were a serious problem. According to the statistics of some scholars, during the 267 years of the Qing Dynasty (from 1644 to 1911), as many as 134 years (or almost every other year) saw the spread of epidemics on either a massive or a modest scale (Zhang Jianguang 1998). After 1840, the traditionally stable small peasant economy was disrupted owing to multiple factors: the invasion and exploitation by Western powers, the Western powers’ selling the peasant economy’s products at a dumping price, the corruption of the Qing government, and so on. This led to social unrest, a meager living standard of the people, and more outbreaks of epidemics.

Rural Health Care Delivery and State Building

The interpretation and construction work of the theory and practice of disease politics are enormous and cannot be expected to be finished in a day. What this book pursues is something preliminary; it proposes a search for an approach to understanding and interpreting modern China’s politics by way of researching disease politics. With a view to this, the book offers an analysis within the framework of state building, circling around the shaping of the nation, and of the people based on the incident of rural health care delivery. The internal logic is expected to be exposed by comparing the different stages and forms of rural health care delivery and by revealing the state-people relationship behind the comparison.

“China’s Road”: The Cooperative Medical Services as a “Paradigm”

The establishment and development of the CMS effectively changed the long-term situation of the shortage of medicine in China’s rural areas and provided basic medical and health protection for the majority of rural residents. By the late 1970s, China had become a country that had the most comprehensive medical care system. This could be said to be a very significant “health revolution” (World Bank 1994). The CMS had solved the initial health care of rural residents accounting for 80 % of the country’s total population with only 20 % of total health expenses. The “China miracle” was created, a “model to address the problem of the health funds in the developing countries,” “a China mode” in which “the greatest health benefits with minimum investment” was achieved. Health experts also regarded it a rational choice for the then-Chinese government to give priority to prevention, basic medical services, and low-cost promotion of health technology (Culls and West 1979). In 1983, the World Health Organization held the Forum for Cooperative Medical Services, and China was selected to serve as a model of “a backward country achieving the health care level of the most advanced countries, in particular.”

Presentation, Discourse, and Absence

Susan Sontag, held to be the most prominent among modern female intellectuals, said in her book Illness as Metaphor, “Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place” (Sontag 2003). An old Chinese saying also states, “Everyone eats all sorts of grain and will have to experience birth, aging, diseases, and death.” Diseases and health have always been believed to be something that is integrally related to people’s daily lives and experiences. Diseases and the medical treatment of diseases can be said to be both the oldest and the most modern social phenomena, and contracting diseases and receiving treatment necessarily haunt people’s daily life.