The important theme of the third talk is how to effectively solve the problem of lack of medical care and medicine in rural areas.
As early as during the war, Mao Zedong pointed out that "the so-called national health, without 360 million farmers, would probably not be empty talk". After the founding of New China 195 1 on September 9, Mao Zedong pointed out in the name of the Central Committee: "Cadres must be educated to understand that, as far as the current situation is concerned, the losses of manpower, animal power and economy caused by diseases and deaths caused by people's lack of health knowledge and health work may exceed the losses caused by floods, droughts, windstorms and insect disasters every year, so at least, after all, Mao Zedong stressed that to solve the medical and health problems in China, we can neither copy the western rules and regulations nor the Soviet rules and regulations. We can only proceed from the reality of China, always adhere to the basic policy of facing and serving workers, peasants and soldiers, and focus medical and health work on rural areas. According to these ideas, the Ministry of Health was very clear in the early days of the founding of the People's Republic of China: "The focus of health construction in the future will be in the countryside. "However, after more than ten years of development, the actual situation is not ideal. Especially after the 1962 "7,000-person conference", the state has fully implemented the policy of "adjustment, consolidation, enrichment and improvement". On the one hand, it requires standardization of medical and health work, and on the other hand, it cancels many medical and health undertakings developed during the Great Leap Forward and People's Communization in the name of reducing economic burden. The new rural cooperative medical system in many places has also been suppressed into the product of "* * *" and "egalitarianism". As a result, the situation of lack of medical care and medicine in rural areas has not changed much. This is the basic background of Mao Zedong's criticism.
We can't ignore the medical needs of the rural population, which accounts for more than 85% of the national population.
Mao Zedong's first talk was published in1June 26th, 965, and was later called "June 26th instruction". At the beginning of the conversation, Mao Zedong pointed out that the Ministry of Health neglected the medical needs of the rural population, which accounts for more than 85% of the national population. He said: "Tell the Ministry of Health that the Ministry of Health only provides jobs for 65,438+05% of the country's population, and most of these 65,438+05% are elderly people. The vast number of farmers have no medicine, no medicine and no medicine. The Ministry of Health is not the Ministry of Health of the people, but the Ministry of Health of the city or the Ministry of Health of the city. " The so-called "working only for the whole country 15% of the population" here means that medical and health resources are mainly concentrated in cities. The so-called "master" means being an official and being a master, which means an official. This means that the Ministry of Health not only concentrates the main medical and health resources in cities, but also mainly serves those who are officials and masters in cities. Obviously, the criticism is aimed at the tendency to ignore the lack of medical care and medicine in rural areas, and also at the professional medical system of officials.
Cultivate medical and health personnel who can afford and stay in rural areas.
Another important content of the conversation is how to cultivate medical and health talents who can "afford" and "stay" in rural areas. Mao Zedong said: "The current set of examination and treatment methods simply does not meet the rural conditions. The method of training doctors is also for the city, but there are more than 500 million farmers in China. " At that time, there were not many universities in China to train medical and health talents, and because of the requirement of "standardization", the annual enrollment was limited by the number of beds in affiliated hospitals and the ratio of students to teachers, and the learning cycle of undergraduates generally took five to six or even seven years. Take Sun Yat-sen Medical College, a well-known medical college in China, for example, with an annual enrollment of about 400 students. In Mao Zedong's view, this training mode cannot meet the medical needs of more than 500 million farmers in China. Therefore, he demanded that medical education should proceed from the reality of national conditions, reform medical education, and train a large number of applicable talents for rural medical and health undertakings. The contents include: shortening the educational system, lowering the requirements of enrollment qualifications and changing the training methods. He said: "There is no need to receive medical education from high school students and junior high school students. Three years of high school graduation is enough. " "There is no need to read so many books at all" and "learning and improving mainly through practice". He is in favor of students learning "the treatment of common diseases and some preventive work", and then accepting experienced medical staff to attend classes for a period of time to meet the basic medical and health needs of farmers. He said, "such a doctor, even if he is not very skilled, is better than a deceptive doctor or a witch doctor, and the countryside can afford it." This idea directly gave birth to the student type that was later called "coming to the commune and entering the commune", which means to recruit students from the commune and then return to the commune to serve the farmers after learning. As for the so-called "three years' study is enough", it's not that Mao Zedong can't see the necessity for medical students to receive a more systematic education, but that he is anxious about the reality that there is a shortage of doctors and medicines in rural areas and a large number of talents are urgently needed. He asked the person who refuted this view: "How many years did Hua Tuo study? How many years did Li Shizhen study in the Ming Dynasty? "The foothold of this proposition is still' learning and improving mainly through practice'.
We should put a lot of manpower and material resources into the prevention and treatment of common diseases and frequently-occurring diseases.
This talk also criticized the tendency that medical research is divorced from the needs of the masses and is keen on studying high, deep and difficult diseases. He said: "divorced from the masses, we put a lot of manpower and material resources into the study of high, deep and difficult diseases. The so-called cutting-edge, how to prevent and improve the treatment of some common diseases, frequently-occurring diseases and common diseases, regardless of or put little effort. The frontier problem is not unnecessary, but it is necessary to invest a small amount of manpower and material resources and put a lot of manpower and material resources on the problems that the masses need to solve most. " This actually raises the question of the choice of values in medical scientific research. As a leader in governing the country, facing the reality that the overall medical level in China is not high, he earnestly hopes that medical research should first be based on the needs of the country and the public, and put a lot of manpower and material resources on the prevention and improvement of common diseases, frequently-occurring diseases and common diseases. Especially after the founding of New China, the state brought all medical and health institutions and their staff into the scope of public institutions and public officials supported by the state finance, which responded to the needs of the country and the people. Naturally, it should be the responsibility of medical institutions and personnel with the identity of public institutions and public officials. Generally speaking, improving the medical and health level of the country and people really depends on the improvement of the prevention, diagnosis and treatment of such common and frequently-occurring diseases. Of course, the study of so-called "frontier" topics such as "high, deep and difficult diseases" will attract more academic attention than the study of "common diseases" and "frequently-occurring diseases", and it is easier to enhance the academic status of individuals. There are practical problems in the choice of scientific research values of scientific researchers. However, for the Ministry of Health, which is in charge of national medical and health work, Mao Zedong hopes that it will strengthen the orientation and layout of medical research nationwide, and "put a lot of manpower and material resources on the problems that the masses need to solve most". Only in this way can we provide practical and effective medical and health care services for the broad masses of the people in countries with low overall medical standards, and only in this way can we be the "People's Ministry of Health" that truly cares for the people.
We can't regard serving the countryside as a training ground for novices.
This talk also involves how urban hospitals support rural medical and health undertakings. The conversation put forward a seemingly biased proposition: "Hospitals in cities should keep some doctors with little skills for one or two years after graduation, and the rest will go to the countryside", "Focus on the countryside!" To end it. In fact, the so-called "doctors with no skills" have all stayed in the city, and the rest have all gone to the countryside, that is, to tour the countryside. Its original intention is that people who travel to the countryside should be knowledgeable and not regard serving the countryside as a training ground for novices. In fact, no matter then or now, some units regard rural medical service as an extra burden, and send some "manpower" not "talents" that are not needed by urban hospitals to the countryside to perfunctory things. Therefore, putting forward this point reflects Mao Zedong's good intentions and sincere feelings for the rural people.
Health care cannot be regarded as a profitable industry.
The "June 26th" talk touched on a series of important issues of medical and health work in China at that time with a very sharp emotional tone, which caused great repercussions, so there were two conversations on July 19 and August 2nd. The two conversations were aimed at officials of the Ministry of Health, and the theme was how to implement the spirit of the "June 26th" conversation. Here, Mao Zedong further talked about his views on medical and health work.
First of all, Mao Zedong affirmed the idea of "training full-time health personnel for rural production teams" put forward by the Ministry of Health, and further put forward "Why not set up full-time health personnel in factories?" Small factories can set up health workers and large factories can set up clinics. "Later, a large number of barefoot doctors and factory and mine health workers in rural areas actually benefited from this measure. They have indeed played a very active role in strengthening the primary medical care for workers and farmers.
Secondly, it is emphasized that medical science cannot aim at making money. He severely criticized some medical units: "I think medical teams that make money are good, and medical teams that don't make money or earn less are not good." Is this the People's Hospital? " He warned cadres at all levels to have a comprehensive view of interests: "You can't look at medicine and medical care by making money or not. A strong worker is ill. It doesn't cost him money to cure him. It seems that he is losing money, but he can carry out agricultural and industrial production. Do you think it is a profit or a loss? ..... Birth control pills don't charge money in Tianjin, which seems to lose money, but it does achieve the purpose of birth control. The birth rate is under control and all aspects of the city are easy to arrange. Is this making money or losing money? " He also said: "in some hospitals, doctors just want to make money, just to make money, so that patients can see them again and again without serious illness or illness." Even using fake drugs to deceive people ... some doctors and fake drugs who make money in hospitals can't cure the disease after spending money. I think it is better to worship the bodhisattva, spend a few coppers and sell incense ashes. Isn't it the same? " At the same time, he advocated that "drugs should be reduced in price", and even patients "can't afford drugs" because "it is cost-effective for the state to pay some money to protect productivity". He has also repeatedly expressed his opinions on free treatment of specialized diseases. For example, on March 12 of the following year, he instructed that "schistosomiasis examination and treatment are free". In his view, the medical and health undertakings in new China should pursue "revolutionary humanitarianism to heal the wounded and rescue the dying" instead of getting rich. This is actually a promotion of the great doctor's way. Of course, not treating medical care as a profitable business does not mean that we can engage in "big pot" and "engage in * * *" in this field. These are two completely different questions.
Doctors must be politically competent and serve the workers, peasants and soldiers wholeheartedly.
Third, it is proposed that "doctors must be politically good". Mao Zedong always believed that "the human problem is a fundamental problem". Doctors are only good at technology. If they have a problem with their outlook on life, they may rely on their skills to blackmail patients. Therefore, without correct political views, there is no soul. With "good politics", we can ensure that medicines and medicines are not aimed at making money, that they are willing to share their worries for the country and the people, and that they serve the workers, peasants and soldiers wholeheartedly, and that they consciously go to the countryside and go to the most difficult places. To this end, he stressed that party committees at all levels should pay more attention to health work, and health management departments should strengthen professional and political leadership to ensure the implementation of the policy of medical and health work serving workers, peasants and soldiers. Here, "good politics" is a real requirement, not empty talk.
The famous teacher hospital should be open to ordinary people.
In the conversation, there is also a problem that affects the vested interests of the upper class, that is, Mao Zedong's criticism of the cadre health care system and the direction of running Beijing hospitals. After the founding of New China, China studied the medical care system of the Soviet Union and provided superior medical care measures for cadres, especially senior cadres. As far as the central government is concerned, the Central Health Bureau was established, and the Beijing Hospital founded by the Germans in 1905 was also designated as a health care hospital in Gao Qian, so ordinary people were refused medical treatment. Mao Zedong has always been dissatisfied with this practice. 1when meeting with Vietnamese friends on June 24th, 964, he pointed out: "China's health care work is based on the Soviet Union." He believes that this practice not only encourages the privileged thinking of cadres, but also is not conducive to the health care of cadres and the improvement of doctors' medical skills. He said: "A person who does not move means eating well, dressing well and living well. If he goes out by car and doesn't walk, he will get sick more easily. Taking care of food, clothing, housing and transportation is too good, which is the four reasons why senior cadres are sick. " For doctors who specialize in medical care, long-term separation from wards and clinics will lead to a decline in the level of diagnosis and treatment, "turning professional doctors into unprofessional doctors", so "it is not good and needs improvement." In August 10 of the same year, when instructing the Ministry of Health's Report on Improving the Health Care of Senior Cadres, it was even more bluntly pointed out that "the Health Care Bureau should be abolished" and "Beijing Hospital is an old hospital with more doctors and fewer patients, so it should be opened". In these two conversations around the "June 26" instruction, he directly asked "What changes have taken place in Beijing Hospital?" When the reporter explained the situation, Mao Zedong still thought that the matter was "not completely open". He said, "So-and-so, so-and-so can't go to see a doctor, so-and-so can go to see a doctor. This is not a noble master hospital. What is it? " He said categorically, "Open to the people." And said, "Don't be afraid of offending people. This has offended a group of people, but the people are happy. If these people are unhappy, let them be unhappy. What you do will always offend people, depending on who you offend and who you are happy with, as long as the people are happy. " Under the strong position of Mao Zedong, the Central Health Bureau was later revoked, and the Beijing Hospital was renamed "Dongdan Hospital", no longer specializing in medical care in Gao Qian. However, in 1972, many officials at or above the ministerial level suffered misfortune because they failed to see a doctor in time. The main leaders of the State Council believe that "it is impossible without Beijing Hospital", and Beijing Hospital has been restored as a health care hospital in Gao Qian. Originally, Beijing Hospital could be required to be open to the common people objectively, and undertake the medical and health care functions of Gao Qian together with Beijing Hospital. He criticized that hospitals with so many people in Beijing and so well-equipped only serve a few people, alienate themselves from the masses and encourage privileges, which is not conducive to the improvement of medical staff's diagnosis and treatment level. These are all desirable. However, in the extreme "left" ideological atmosphere, the beautiful idea of "opening to the common people" has turned into an "either-or" choice, which has gone to the other extreme. This should not be Mao Zedong's original intention.
China's medical and health model was once world-renowned.
1After Mao Zedong's death on September 9, 976, great changes have taken place in China. Since 1979, the leaders of the Ministry of Health clearly put forward the idea of "managing health undertakings by economic means", the national medical and health work has embarked on a different development path. At that time, people really believed that a better state could be achieved through this road. However, more than 30 years later, people see that the big hospitals in some big cities are bigger and higher, with more complete and advanced equipment, and the overall development of hospitals is more dynamic and advantageous. At the same time, they also see that the allocation of medical resources in urban and rural areas is becoming increasingly polarized, and the grievances of the lower class, especially rural farmers, are almost boiling, and the relationship between doctors and patients is unprecedentedly sharp and antagonistic under the guidance of the development of medical industrialization. Many ugly interest disputes and outrageous cruel events in the medical and health field are also constantly impacting. We have to admit that medical and health incidents are still plaguing and even tormenting many people and governments at all levels in China.
At the same time, the World Health Organization's evaluation of China's medical and health undertakings has also undergone subversive changes. In the early 1980s, the World Health Organization called China's medical and health model, especially the rural cooperative medical care advocated and implemented by Mao Zedong, an example of meeting people's basic medical needs at the lowest cost and achieving the highest benefits, and praised it as "the only example of solving health funds in developing countries". Qian Xinzhong, the former Minister of Health, also proudly said in the book Health Development and Decision-making in China: "Dr. Mahler, former Director-General of the World Health Organization, actively recommended China's rural health work experience to developing countries." In a world development report with the theme of "investing in health", the World Bank also highly praised China's medical system, saying that "this is an unparalleled achievement of low-income developing countries". However, 20 years after the implementation of the new system, in the World Health Report 2000, the World Health Organization ranked China as 1 9188 out of1countries in the world, that is, the fourth from the bottom. Relevant people found that this ranking is only behind two countries widely regarded as far behind our neighbors-Nepal and Vietnam, and ranks at the bottom together with Brazil, Myanmar and Sierra Leone. All these are hurting the self-esteem and conscience of China people.
Today, under the background of diversified social values, people will have different value judgments in the face of Mao Zedong's thoughts and viewpoints. However, in any case, Mao Zedong's high-spirited criticism, thinking and opinions in those years revealed a strong and moving sentiment. If people hold a more peaceful mind, they may get some enlightenment to get out of the quagmire of medical reform in China.