Research Article: China’s Engagement with Global Health Diplomacy: Was SARS a Watershed?

Date Published: April 27, 2010

Publisher: Public Library of Science

Author(s): Lai-Ha Chan, Lucy Chen, Jin Xu, Kelley Lee

Abstract: As part of the PLoS Medicine series on Global Health Diplomacy, Lai-Han Chan and colleagues provide a case study of China’s growing engagement in global health diplomacy following the SARS epidemic.

Partial Text: Severe acute respiratory syndrome (SARS) was the first global epidemic of the 21st century. It not only caused mass panic but also generated a discourse on health insecurity around the world. Table 1 shows a chronological account of the disease outbreaks. Owing to China’s belated response, particularly its obstruction in early 2003 of the entry of World Health Organization (WHO) assessment teams into the country for investigation of the virus, the subsequent mapping of the disease during the outbreak period kept global attention on China. In retrospect, there appear to be valuable lessons China can draw from its experience with SARS and several implications of SARS on China’s engagement in global health diplomacy. This case study examines China’s policy changes in the area of public health since the SARS outbreak. Using literature reviews, personal experience, and informal interviews with Chinese health officials, we provide insight into the extent of China’s increased engagement in public health, at both the domestic and the international levels.

We spoke with three high-ranking health officials in China’s Ministry of Health in August 2009 who admitted that the SARS outbreak had alerted Chinese citizens as well as the government to the danger that public health, particularly infectious diseases, could become a dire threat if not properly controlled. This perceived threat extended beyond their country to the world. In the face of criticism from abroad about China’s handling of the SARS epidemic, the new Hu Jintao–Wen Jiabao leadership, taking office in early 2003, swiftly adopted a more open and proactive attitude to the WHO member countries and southeast Asian nations containing the disease.

At the international level, there have been signs since the SARS outbreak that public health is high on China’s foreign policy agenda. First, Beijing has become more proactive in participating in global health governance. China had for a long time played a passive role in the WHO since gaining its membership in the organization more than three decades ago. The SARS outbreak let China experience the power of the WHO, which has become increasingly more influential while other international organizations, such as the United Nations Security Council, International Monetary Fund, World Bank, G8, and the World Trade Organization, are facing legitimacy, accountability, and representativeness challenges. WHO’s authority in dealing with disease outbreaks is still widely recognized [21]. Without China’s prior consent, the WHO issued a travel advisory against unnecessary travel to Guangdong province, putting China under the global spotlight for spreading infectious disease to other countries. Perhaps this lesson has prompted the Chinese government to realize the political importance of the WHO and to increase its participation in global health governance.

The second sign that China has put public health high on their foreign policy agenda since SARS is their provision of development assistance and global public goods for health. As such, China is now using public health as a means to strengthen its diplomatic relations with the developing world, including African countries. China began in the 1960s to send “angels in white” and “barefoot doctors” to the sub-Saharan region to provide some of the poorest African countries with medical services. However, as argued by Huang Yanzhong of Seton Hall University, China’s health diplomacy was “flimsy, passive, and asymmetric,” at least until the 1980s [3]. After the SARS outbreak, in spite of its own failing health system, the Chinese government reiterated in its China’s African Policy, published in early 2006, the nation’s commitment to improving Africa’s public health service.

Following the Chinese government’s acknowledgement of a SARS outbreak in the country, it began to acknowledge the importance of public health to national development and to accordingly strengthen its multilateral cooperation in combating contagious diseases inside and beyond its borders. For example, in the midst of the recent global economic downturn, the Chinese government announced in 2009 an injection of 850 billion yuan (US$125 billion) into its health care system to improve its operation. Since the SARS outbreak, it has not only deepened its engagement with other nations and international organizations, and cooperated with a variety of actors in dealing with its own fledgling health care system including the problem of HIV/AIDS, but China has also developed a vision for global health diplomacy. A ground-breaking implication of the SARS outbreak for China is that it was struck to realize that public health is not simply a domestic, social issue that can be isolated from foreign-policy and security concerns. In a globalizing world, the Chinese government appears to have learned that its health policy will be scrutinized by the world, and hence, it has become more open to and actively participates in global health governance. The government is now learning from such European countries as the UK, France, and Switzerland in the provision of the global public goods for health. Its substantial health assistance to sub-Saharan Africa in building hospitals and training health practitioners forms part of its health diplomacy and contribution to global health governance. It has also been proactively engaging with both regional and global health institutions since 2003 and set up different health surveillance networks with its ASEAN partners as well as other intergovernmental organizations, such as the Asia-Pacific Economic Cooperation (APEC) forum [12].



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