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From China’s “Barefoot Doctor” to Alma Ata: The Primary Health Care Movement in the Long 1970s

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China, Hong Kong, and the Long 1970s: Global Perspectives

Part of the book series: Cambridge Imperial and Post-Colonial Studies Series ((CIPCSS))

Abstract

This chapter argues that during the Long 1970s, health and medicine played an important role in the politics of the PRC and its relationship with both the First and Third Worlds. It examines the widely acclaimed Barefoot Doctor Campaign in Mao’s China. The Barefoot Doctor Campaign was applied domestically in the PRC in the aftermath of the Great Leap Famine, and then during and immediately after the Cultural Revolution period (1968–1978), partly to redress rural health disparity and health crisis but more importantly as a political tool for the CCP to re-establish its power in the Chinese countryside. In the Long 1970s, the Barefoot Doctor Campaign, referred to in the West as the “Chinese approach to health,” came to hold out the promise of a true alternative to the crumbling single-disease-centered “vertical” health program advocated by the United States and the centralized healthcare structure of the Soviet Union. The World Health Organization (WHO) embraced it as a model of Primary Health Care, adopted to achieve a goal of “Health for All” by the World Health Assembly in 1977, and formally included in the Declaration of Alma Ata the following year. Concurrently, the PRC’s purported success in healthcare delivery also became a useful weapon to those in the West who were prepared to see some good in Maoist China in their criticism of America’s military agression in Vietnam.

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Notes

  1. 1.

    Richard Hottelet, “What New Role for the People’s Republic of China,” Saturday Review (September 18, 1971), 27.

  2. 2.

    John Stewart Service, “Edgar Snow: Some Personal Reminiscences,” China Quarterly 50 (April–June 1972), 217.

  3. 3.

    Epoca (April 25, May 9, 1971).

  4. 4.

    “E. G. Dimond: Obituary,” New York Times (November 17, 2013).

  5. 5.

    “Paul Dudley White and Mainland China,” August 24, 1965, in US Department of State, Foreign Relations of the United States (hereafter FRUS), 1964–1968, Vol. XXX, China (Washington, DC: Government Printing Office, 1998), 195. https://history.state.gov/historicaldocuments/frus1964-68v30/pg_195, accessed May 16, 2016.

  6. 6.

    Mary Clark Dimond, Norman Cousins, and J. Garry Clifford, eds., Memoirs of a Man: Grenville Clark (New York: Norton, 1975), 133–134.

  7. 7.

    “Paul Dudley White and Mainland China,” August 24, 1965, FRUS, 1964–1968, Vol. XXX, China, 195; and Dimond et al., Memoirs of a Man, 24–25.

  8. 8.

    James C. Thomson, “On the Making of U.S. China Policy, 1961–9: A Study in Bureaucratic Politics,” China Quarterly 50 (April 1972), 235.

  9. 9.

    “Paul Dudley White and Mainland China,” August 24, 1965, FRUS, 1964–1968, Vol. XXX, China, 195; and Thomson, “On the Making of U.S. China Policy, 1961–9,” 235.

  10. 10.

    Thomson, “On the Making of U.S. China Policy, 1961–9,” 235.

  11. 11.

    Michael H. Alderman, “Summary Report of White House Conference on Health, November 3–4, 1965, Washington, D.C.,” Public Health Reports 81:2 (February 1966), 118; and Thomson, “On the Making of U.S. China Policy, 1961–9,” 236.

  12. 12.

    Thomson, “On the Making of U.S. China Policy, 1961–9,” 237–238.

  13. 13.

    “Telegram From the Department of State to the Embassy in Poland.” August 13, 1961, in FRUS 1961–1963, Vol. XXII, Northeast Asia (Washington, DC: Government Printing Office, 1996), 119, https://history.state.gov/historicaldocuments/frus1961-63v22/pg_119, accessed May 16, 2016; and “Red China Refuses Entry to N.Y. Surgeon,” Record Journal (December 21, 1964), 8.

  14. 14.

    Anne-Emmanuelle Birn and Theodore M. Brown, eds., Comrades in Health: U.S. Health Internationalists, Abroad and at Home (New Brunswick, NJ: Rutgers University Press, 2013), 120; and “An Interview with Dr. Vic Sidel,” Social Medicine 7:3 (October 2013), 178.

  15. 15.

    E. Grey Dimond, “More than Herbs and Acupuncture,” Saturday Review (December 18, 1971), 17.

  16. 16.

    Birn and Brown, eds., Comrades in Health, 121.

  17. 17.

    洪若诗, “我在新中国十五年,” a lecture given at the University of Hong Kong in 1970, published by 香港文汇报 (November 7, 1974); Joshua Horn, “The Mass Line in Health Care in China,” 1971, included in Health Care in China, Modern China Pamphlet Series No. 8 (London: Anglo-Chinese Educational Institute, 1976), 11; and “Dr. Joshua Horn on Red China” (recorded on April 24, 1971 in New York), Pacific Radio Archive, PRA BB4272.

  18. 18.

    On Hatem, see Edgar Porter, The People’s Doctor: George Hatem and China’s Revolution (Honolulu: University of Hawaii Press, 1997).

  19. 19.

    B. Lown, Prescription for Survival: A Doctor’s Journey to End Nuclear Madness (San Francisco: Berrett–Koehler Publishers, 2008), 335–336.

  20. 20.

    Robin Stott, “Foreword” to Health Care in China, i.

  21. 21.

    P. R. Lee, “Medicine and Public Health in the People’s Republic of China: Observations and Reflections of a Recent Visitor,” Western Journal of Medicine 120:5 (May 1974), 430.

  22. 22.

    G. Paterson, “The CMC Story, 1968–1998,” Contact 161–162 (1998), 3–18.

  23. 23.

    J. H. Bryant, Health and the Developing World (Ithaca, NY: Cornell University Press, 1967), ix–x.

  24. 24.

    For further readings on postcolonial healing in Africa, see Stacey A. Langwick, Bodies, Politics, and African Healing: The Matter of Maladies in Tanzania (Bloomington: University of Indiana Press, 2011).

  25. 25.

    John Iliffe, East African Doctors: A History of the Modern Profession (Cambridge: Cambridge University Press, 1998), 202.

  26. 26.

    Stacey Langwick, “From Non-Aligned Medicines to Market-Based Herbals: China’s Relationship to the Shifting Politics of Traditional Medicine in Tanzania,” Medical Anthropology 29 (February 20, 2010), 20.

  27. 27.

    Interview with Wen Changqing, December 2013; George T. Yu, “China’s Role in Africa,” Annals of the American Academy of Political and Social Science 432 (July 1977), 96–109; and George T. Yu, “China and the Third World,” Asian Survey 17:11 (November 1977), 1036–1048.

  28. 28.

    周恩来年谱, p. 1427.

  29. 29.

    See David Shinn, “Africa, China, and Health Care,” Inside ASIA 3/4 (2006), 15; and Drew Thompson, “China’s Soft Power in Africa: From the ‘Beijing Consensus’ to Health Diplomacy,” China Brief 5 (October 13, 2005), 4.

  30. 30.

    Langwick, “From Non-Aligned Medicines to Market-Based Herbals,” 15–43.

  31. 31.

    Alan Hutchison, China’s African Revolution (Boulder, CO: Westview Press, 1975), 220–221.

  32. 32.

    SHAB 242-3-256: 22–4, 35, 39, 209.

  33. 33.

    George T. Yu, “Africa in Chinese Foreign Policy,” Asian Survey 28:8 (August 1988), 854.

  34. 34.

    Hottelet, “What New Role for the People’s Republic of China,” 29.

  35. 35.

    Ibid., 30.

  36. 36.

    On the politics behind China’s re-entry into the World Health Assembly, see Javed Siddiqi, World Health and World Politics: The World Health Organization and the UN System (London: Hurst, 1995).

  37. 37.

    Socrates Litsios, “The Long and Difficult Road to Alma-Ata: A Personal Reflection,” International Journal of Health Services, 32:4 (October 2002), 710.

  38. 38.

    Birn and Brown, Comrades in Health, 125.

  39. 39.

    Kenneth Newell, Health by the People (Geneva: World Health Organization, 1975), ix, 193.

  40. 40.

    V. Djukanovic and E. P. Mach, eds., Alternative Approaches to Meeting Basic Health Needs in Developing Countries (New York and Geneva: World Health Organization and UNICEF, 1975).

  41. 41.

    H. T. Mahler, “Social Perspectives in Health: Address in Presenting His Report for 1975 to the Twenty-Ninth World Health Assembly, Geneva, 4 May 1976,” 1, Mahler Speeches/Lectures, Box 1, WHO Library.

  42. 42.

    David A. Tejada de Rivero, “Alma Ata Revisited,” Perspectives in Health 8:2 (2003), 3–7.

  43. 43.

    Ibid.

  44. 44.

    SHAB 250-1-471: 31–32.

  45. 45.

    M. Cueto, “The Origins of Primary Health Care and Selective Primary Health Care,” American Journal of Public Health 94 (2004), 1886–1887.

  46. 46.

    “Consensus During the Cold War: Back to Alma Ata,” Bulletin of the World Health Organization 86:10 (October 2008), 745; see also Tejada de Rivero,” Alma Ata Revisited.”

  47. 47.

    “Consensus during the Cold War: Back to Alma Ata,” 746; see also Tejada de Rivero, “Alma Ata Revisited.”.

  48. 48.

    On the famine in Kazakhstan, see Niccolò Pianciola, “The Collectivization Famine in Kazakhstan, 1931–1933,” Harvard Ukrainian Studies 25:3/4 (Fall 2001), 237–251.

  49. 49.

    Paula A. Michaels, “Medical Propaganda and Cultural Revolution in Soviet Kazakhstan 1928–41,” Russian Review 59:2 (April 2000), 160.

  50. 50.

    Maksut Kulzhanov and Bernd Rechel, “Kazakhstan: Health System Review,” Health Systems in Transition 9:7 (2007), 1–158.

  51. 51.

    “Primary Health Care Comes Full Circle: An Interview with Dr. Halfdan Mahler,” Bulletin of the World Health Organization 86:10 (October 2008), 737–816, http://www.who.int/bulletin/volumes/86/10/08-041008/en/, accessed May 14, 2016.

  52. 52.

    Tejada de Rivero, “Alma Ata Revisited.”

  53. 53.

    “Primary Health Care Comes Full Circle: An Interview with Dr. Halfdan Mahler,” 737–816.

  54. 54.

    Ibid.

  55. 55.

    SHAB 242-4-555: 1–4.

  56. 56.

    J. Walsh and K. Warren, “Selective Primary Health Care: An Interim Strategy for Disease Control in Developing Countries,” New England Journal of Medicine 301:18 (1979), 967–974.

  57. 57.

    Lown, Prescription for Survival, 333.

  58. 58.

    On Warren and the GND, see Conrad Keating, “Ken Warren and the Rockefeller Foundation’s Great Neglected Diseases Network, 1978–1988: The Transformation of Tropical and Global Medicine,” Molecular Medicine (2014), online at http://www.molmed.org (doi:10.2119/molmed.2014.00221).

  59. 59.

    “Primary Health Care Comes Full Circle: An Interview with Dr. Halfdan Mahler,” 737–816.

  60. 60.

    On PRC health diplomacy, see also Jeremy Youde, “China’s Health Diplomacy in Africa,” China: An International Journal 8:1 (March 2010), 151–163.

  61. 61.

    “Chinese President Xi Jinping Opens the Ministerial Forum of China–Africa Health Development in Beijing” (August 16, 2013), UNAids Website, http://www.unaids.org/en/resources/presscentre/featurestories/2013/august/20130816china, accessed May 14, 2016.

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Zhou, X. (2017). From China’s “Barefoot Doctor” to Alma Ata: The Primary Health Care Movement in the Long 1970s. In: Roberts, P., Westad, O. (eds) China, Hong Kong, and the Long 1970s: Global Perspectives. Cambridge Imperial and Post-Colonial Studies Series. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-51250-1_6

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