Saturday, April 26, 2003

The dragon wheezes, The Economist Newspaper

Excerpt: China finally wakes up to the SARS epidemic, which may herald much more profound changes ... On roads leading into Beijing’s neighbouring province of Hebei, officials have begun stopping some vehicles to check passengers for signs of SARS to prevent the disease from spreading. But such measures have come too late. Official figures show that SARS has now affected 20 of the country’s 31 provinces and municipalities. Apart from Guangdong, Beijing and the northern province of Shanxi, each has reported only a tiny handful of cases. Tianjin, the port city closest to Beijing, has reported only eight, the whole of Hebei province has declared only six and Shanghai a mere two. But it is safe to assume that the actual number of cases around the country is significantly higher. With the best will in the world, cash-strapped local governments whose health-care and disease-surveillance systems have fallen into disarray in recent years for want of funds would be extremely hard pressed to monitor the spread of a new disease.

Even in Beijing, the official figures still convey only a partial picture. The city has offered free treatment for poor SARS patients. But this is little consolation to the large numbers with no health insurance, particularly the unemployed and the 3m or so ill-paid migrant labourers (about one-fifth of the city’s population) who are too poor to consider hospital treatment in the city. Many with SARS-like symptoms would think twice about any offer of free treatment, since their ailment may well turn out to be something else for which they would have to pay. Compounding this fear is the risk that days of quarantine for themselves and family members could cause a big loss of earnings.

In rural areas, the situation is particularly bleak. The “barefoot-doctor” system established under Mao Zedong to provide basic health care to peasants has broken down. Many township hospitals can now do little more than dispense medicine. As many as 70% of country people cannot afford to pay for medical treatment. On Sunday, the deputy health minister said that if SARS was found to be spreading in the countryside, “the consequences would be extremely serious.” But how will anyone know? On Wednesday the government announced a fund of 2 billion yuan ($240m) to support anti-SARS work in the countryside and among the urban poor. The problem, however, could only be solved by a massive overhaul of the health-care and insurance system that would cost many times more than that.

With their political U-turn, Mr Hu and Mr Wen may help to shore up their image. In Beijing, the party’s legitimacy rests largely on its ability to deliver economic growth. Although a severe downturn could precipitate serious social unrest, China’s SARS crisis (unlike Hong Kong’s) occurs at a time of strong growth. As long as the death toll does not rise (or is not rumoured to rise) dramatically in key urban areas such as Beijing and disruption is short-lived, the new leadership will probably muddle through. But the trust of the rest of the world, which had come to believe that China was beginning to understand the need to play by international rules, could take far longer to repair.

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