The key theme of the three talks was how to effectively address the lack of medical care in rural areas
As early as during the war, Mao Zedong pointed out that "the so-called national health care, without the 360 million peasants, is not half empty talk". After the founding of new China on September 9, 1951, Mao Zedong in the name of the central government pointed out that: "We must educate the cadres to make them understand that, in terms of the present situation, each year, the nation's lack of knowledge of hygiene and sanitation caused by diseases and deaths of the people suffered from the loss of manpower, animal power and economic losses, may exceed each year, the nation suffered from the floods, droughts, winds, pests and other calamities suffered from losses, therefore, at least the sanitation work should be done. Therefore, health work should be treated at least on a par with disaster relief and prevention, and should never be trivialized." But after all, the new China had a very weak foundation, poor scientific and educational conditions, and a huge rural population, making it difficult to develop the country's health care program. Mao Zedong emphasized that to solve China's health care difficulties, neither Western nor Soviet rules and regulations could be copied, but only from China's actual situation, and always adhered to the basic policy of facing and serving the workers, peasants, and soldiers, and putting the focus of health care work in the countryside. Based on these ideas, the Ministry of Health made it very clear in the early days of the founding of the country that "the focus of future health construction will be in the countryside." However, after more than a decade of development, the actual situation was not satisfactory. In particular, after the "Seven Thousand People's Conference" in 1962, the State fully implemented the policy of "adjustment, consolidation, enrichment and improvement," which, on the one hand, called for the standardization of medical and health care, and, on the other hand, in the name of alleviating the economic burden, removed many of the health care facilities that had been built during the "Great Leap Forward. On the other hand, in the name of reducing economic burdens, many of the medical and health services developed during the "Great Leap Forward" and "People's Communalization" were removed. In many places, the nascent rural cooperative medical service was also suppressed as a product of the "****-production style" and "egalitarianism". As a result, the lack of medical care and medicines in rural areas throughout the country remained basically unchanged. This was the basic background to Mao's criticism.
Not ignoring the medical needs of the rural masses, who account for more than 85 percent of the country's population
Mao's first talk was published on June 26, 1965, and later became known as the "June 26th Instruction". At the outset, Mao accused the Ministry of Health of neglecting the medical needs of the rural masses, who make up more than 85 percent of the country's population. He said, "Tell the Ministry of Health that it works for only 15 percent of the country's population, and of that 15 percent, it is mainly old men. The masses of peasants have no access to medical care, no doctors and no medicine. The Ministry of Health is not the people's Ministry of Health; it should be changed to the Ministry of Urban Health or the Ministry of Health for Urban Lords." The so-called "work for only 15% of the country's population" refers to the fact that health care resources are mainly concentrated in the cities. The word "master" means official, which refers to officials. This is tantamount to saying that the Ministry of Health not only concentrates its major health care resources in the cities, but also mainly serves those who are officials and lords in the cities. Obviously, the criticism points directly at the tendency to ignore the lack of medical care in rural areas, as well as the specialization of the health care system for officials.
Cultivating rural "affordable" and "stay-at-home" health care professionals
Another important part of the conversation was how to cultivate rural "affordable" and "stay-at-home" health care professionals. Another important part of the talk was how to cultivate rural "affordable" and "retainable" medical and health care personnel. Mao Zedong said, "The present method of examination and treatment is not compatible with the countryside at all, and the method of training doctors is also for the cities, but there are more than 500 million peasants in China." The situation at that time was that there were not many colleges and universities training medical and health care personnel, and due to the requirements of "standardization", the annual enrollment was limited by the number of beds in affiliated hospitals and the student-teacher ratio, etc., and undergraduates generally had to spend five to six years, or even seven years, on their studies. The nationally renowned Sun Yat-sen Medical College, for example, had an annual enrollment of about 400 students. In Mao Zedong's view, this mode of training was simply unable to meet the health care needs of China's more than 500 million peasants. Therefore, he demanded that medical education be adapted to the realities of the national situation, and that medical education be reformed to cultivate a large number of talents applicable to rural health care. The contents include: shortening the school system, lowering the requirement of enrollment qualification, and changing the training method. He said, "medical education does not need to accept what high school students, junior high school students, high school graduates learn three years is enough." "There is no need to read so many books", "mainly in practice to learn and improve". He favored students learning "the treatment of common diseases and some preventive work," and then receiving classes from experienced medical personnel for a period of time, they would be able to meet the basic health care needs of farmers. He said, "Such doctors, even if they are not very competent, are better than fraudulent doctors and witchdoctors, and they are also affordable in the countryside." This idea gave rise to a type of student that came to be known as the "She Lai She Gao," meaning that the students were recruited from the commune and, after completing their studies, returned to the commune to serve the peasants. As for the so-called "three years of study is enough," it was not that Mao did not see the need for medical students to receive a more systematic education, but rather that he was anxious about the lack of medical care in the countryside and the urgent need for a large number of talented people. He asked those who refuted this view: "How many years did Hua Tuo study? How many years did Li Shizhen study in the Ming Dynasty?" This claim is still based on "mainly in the practice of learning to improve".
To put a lot of human and material resources on the prevention and improvement of treatment of common and frequent diseases
The talk also criticized the tendency of medical research to be detached from the needs of the masses and to be keen on the study of high, deep and difficult diseases. He said: "detached from the masses, put a lot of manpower and material resources on the study of high, deep, difficult diseases, the so-called cutting-edge, for some common diseases, frequent diseases, ordinary existence of the disease, how to prevent, how to improve the treatment, no matter or put very little power. Cutting-edge problems are not to be avoided, but only a small amount of manpower and material resources should be put, and a large amount of manpower and material resources should be put on the problems that the masses need to solve the most." This actually raises the question of the choice of values for medical research work. As a leader in governing the country, faced with the reality that the overall medical standard in China was not high, he eagerly hoped that medical scientific research work should be oriented first and foremost to the needs of the country and the masses, and that a large amount of manpower and material resources should be put into attacking the prevention and improving the treatment of common, frequent, and ordinary existential diseases. Especially after the founding of New China, the state has included all medical and health institutions and personnel into the scope of public institutions and public officials supported by the state treasury, and responding to the needs of the state and the public should be the responsibility of medical institutions and personnel with the status of public institutions and public officials. From the perspective of overall improvement of the country's health care and the public's health care level, it is also true that it depends on the improvement of the prevention and treatment level of this kind of common and frequent diseases. Of course, the study of "high, deep and difficult diseases" and such so-called "cutting-edge" topics than the study of "common diseases" and "multiple diseases" will be more popular among the academics. "will be more concerned by the academic community, more likely to enhance the individual's academic status. This is a real problem of the choice of scientific research values of researchers. However, for the Ministry of Health, which was in charge of national health care, Mao hoped that it would strengthen the orientation and layout of medical research throughout the country, and that "a great deal of manpower and material resources should be put into the problems that the masses most need to solve". Only in this way will it be possible to provide effective medical care for the masses in a country where the overall level of medical care is not high, and only in this way will it be a "people's health ministry" that really cares about the people.
Not to serve the countryside as a training ground for novices
The talk also touched on the question of how urban hospitals can support rural health care. The conversation put forward a seemingly biased proposition: "urban hospitals should leave some graduates one or two years of the ability of the doctor is not big, the rest of the rural areas," and to "put the focus of health care to the rural areas to go!" and ended with "Put the focus of health care in the countryside!". In fact, the so-called leaving only "doctors with little ability" in the city and sending the rest to the countryside refers to going to the countryside to provide services on an itinerant basis. The intention was that those who went to the countryside to provide services should have real skills, and that the rural areas should not be used as a training ground for novices. In fact, both then and now, there are some units that take the rural medical tour as an extra burden, and send "manpower" rather than "talent" that cannot be used in city hospitals to the countryside to perform perfunctory work. So this point reflects Mao's good intentions and his sincere feelings for the rural people," he said.
Can't take health care as a money-making business
The "June 26" talk touched on a series of important issues in China's health care work at the time in a very sharp and emotional tone, causing a great deal of repercussions, which led to two talks on July 19 and Aug. 2 immediately afterward. Both talks were directed at officials of the Ministry of Health, and the theme was how to carry out and implement the spirit of the "June 26th" talks. Here Mao further discussed his views on health care.
First of all, Mao Zedong affirmed the Ministry of Health's idea of "planning to train non-scheduled health workers for the rural production teams," and further asked, "Why don't we set up non-scheduled health workers in factories? Small factories can set up hygienists, and large factories can set up medical clinics". Subsequently, the large number of barefoot doctors in the countryside and the large number of factory and mine hygienists were actually trained thanks to the implementation of this measure. They did play a very positive role in strengthening primary medical care for the masses of workers and peasants.
Secondly, he emphasized that medical care and medicine should not be aimed at making money. He severely criticized some medical units, "Thinking that medical teams that make money are good and those that don't and those that make less are bad, is this the people's hospital?" He cautioned cadres at all levels that they should have a comprehensive view of benefits: "Drugs and medical care cannot be viewed in terms of making money or not. A strong laborer is sick, give him a cure do not pay, it looks like a loss of money, but he can therefore carry out agricultural and industrial production, do you see is earned or lost? ...... in tianjin contraceptives do not charge money, seems to lose money, but it does play the purpose of birth control, the birth rate is under control, the city in all aspects of the work are easy to arrange, this is money or loss of money?" He also said, "Some hospitals, doctors are making money, the patient is not very sick or no disease also want him to see again and again, nothing more than making money. Even with fake drugs to cheat people ...... to engage in some money-making hospitals to make money doctors, fake drugs, spend money to cure the disease, I think it would be better to worship the Bodhisattva, spend a few coins, sell some incense ash to eat, or not the same?" At the same time, he advocated that "drugs should be reduced in price", and even patients "can not afford to take the medicine can not take", because "the country to pay a little money to protect productivity is cost-effective". He also repeatedly expressed his views on the free treatment of specialized diseases. For example, on March 12 of the following year, he instructed that "the examination and treatment of schistosomiasis should be free of charge". In his view, medical and health care in the new China should be practiced as a "revolutionary humanitarianism of saving lives and helping the injured" and should not be a business of getting rich. This is actually a way to promote the great doctor. Of course, not to health care as a money-making business, does not mean that you can in this field to engage in "pot rice" and scrape "**** production wind", which are two completely different nature of the problem.
Doctors must be politically sound in order to serve the workers, peasants and soldiers wholeheartedly
Once again, it was suggested that "doctors must be politically sound". Mao Zedong has always believed that "the human problem is a fundamental problem". Doctors are only good at technology, but if their outlook on life is wrong, they may rely on their technology to extort patients. Therefore, the absence of a correct political outlook was tantamount to the absence of a soul, and only "good politics" could ensure that medicine and pharmaceuticals would not aim at making money, that they would be willing to share the country's commitment to the people, that they would wholeheartedly serve the workers, peasants, and soldiers, and that they would consciously go to the countryside and the most arduous places. For this reason, he emphasized that the Party committees at all levels should pay more attention to health work, and that the health administration should not only strengthen the operational leadership, but also strengthen the political leadership, so as to ensure the implementation of the policy of medical and health care work for the workers, peasants and soldiers. Here, "good politics" is a real requirement, not just empty talk.
The hospitals of the aristocrats should be open to the people
The conversation also touched on the impact on the vested interests of the upper echelons of the community, in the form of Mao Zedong's criticisms of the cadres' health care system and the direction of the Beijing hospitals. After the founding of New China, China learned from the Soviet Union's health-care system, which provided superior health-care measures for cadres, especially senior cadres. In the case of the central government, the Central Health Bureau was established, and the Beijing Hospital, founded by Germans in 1905, was used as the designated health care hospital for senior cadres, thereby denying access to the common people. Mao Zedong had always been dissatisfied with this practice, and on June 24, 1964, in a meeting with his Vietnamese friends, he noted that "China's health care is modeled on that of the Soviet Union." He believed that this practice not only fostered a privileged mindset among cadres, but also was not conducive to their health care, and was not conducive to the improvement of doctors' medical skills. He said, "If a person doesn't move around, just eats well, dresses well, lives well, goes out in a car and doesn't walk, he will get sick more often. Being too well taken care of in terms of food, clothing, housing and transportation are the four reasons why senior cadres get sick." For doctors specializing in health care, prolonged detachment from wards and outpatient clinics and "not seeing more of a wide variety of illnesses" can lead to a degradation of the level of diagnosis and treatment, "turning specialized doctors into unspecialized ones." Therefore, "it is not good and should be improved". On August 10 of the same year, he approved the Ministry of Health on improving the health care of senior cadres report more bluntly pointed out that "the Health Bureau should be canceled", "Beijing Hospital doctors, fewer patients, is a laird's hospital, should be opened". In the two conversations centered around the "June 26th" directive, he directly asked, "How has the Beijing Hospital been reformed?" When the debriefers explained the situation, Mao still thought that it "had not been completely opened". He said, "So-and-so and so-and-so can't go to the doctor, and so-and-so and so-and-so can go to the doctor, so what is this if not a hospital for aristocrats and lords?" He said categorically, "Be open, open to the people." And said, "Don't be afraid of offending people. This offends a group of people, but the people are happy. If this group of people are unhappy, let them be unhappy. You always have to offend people in everything you do, depending on what kind of people you offend and what kind of people you are happy with, as long as the people are happy." Mao Zedong's strong advocacy, later, the Central Health Bureau withdrew, Beijing Hospital was renamed "Dongdan Hospital", and no longer specialize in the health care of the high cadres. However, in 1972, due to the misfortune of several officials above the ministerial level due to untimely medical treatment, the main leaders of the State Council thought that "it would not be possible to do without a Beijing Hospital", and Beijing Hospital was resumed as a health care hospital for senior officials. Originally, objectively speaking, the demand that Beijing hospitals be open to the general public and the assumption by Beijing hospitals of the functions of health care for senior officials could go hand in hand. He criticized the Beijing Hospital for being so crowded and well-equipped, for serving only a few people, for being detached from the masses, for fostering privileges, and for not being conducive to the improvement of the medical staff's standard of treatment, all of which were desirable. However, under the extremely "leftist" ideological atmosphere, the good idea of "opening the hospital to the people" was turned into an "either/or" choice and went to the other extreme. This should not have been Mao's original intention.
China's health care model was once world-renowned
After Mao Zedong's death on Sept. 9, 1976, China underwent a sea change. Beginning in 1979, when the leaders of the Ministry of Health made it clear that they wanted to "use economic means to manage health care," the country's health care took a different path. At the time, there was a sincere belief that this path would lead to a better state of affairs. However, today, after more than 30 years, people see that some big hospitals in big cities have bigger and taller buildings, more complete and advanced equipment, and the overall development of hospitals has become more dynamic and advantageous, but they also see that the allocation of medical resources in urban and rural areas has become more and more polarized, and that the grievances of the people at the lower stratum of the population, especially rural farmers who find it difficult to get medical treatment and expensive to get medical treatment are close to boiling, and that the relationship between doctors and patients is also more acute than ever before, guided by the idea of the development of the health care industry. The doctor-patient relationship has also become more acute than ever under the guidance of the development of medical industrialization and confrontation, and many ugly disputes of interests and heinous cruelty incidents in the field of health care are also impacting the bottom line of people's morality and conscience. We have to admit that the health care of that file is still confusing and even tormenting many Chinese people and governments at all levels.
At the same time, the World Health Organization's evaluation of China's health care has also undergone an upheaval. In the early 1980s, the World Health Organization (WHO), in its report on its visit to China, referred to China's health care model, especially the rural cooperative medical care, which was established under Mao Zedong's initiative and impetus, as an example of obtaining the highest efficiency in meeting people's basic health care needs at the lowest possible cost, and hailed it as the "only model for developing countries in solving the problem of health financing". ". Former Minister of Health Qian Xinzhong, in his book China's Health Development and Policymaking, also proudly said: "Dr. Mahler, the former Director-General of the World Health Organization, has actively recommended China's experience in rural health work to developing countries." The World Bank, in a world development report entitled "Investing in Health", also highly praised China's health care system as "an unparalleled achievement for low-income developing countries". However, 20 years after the introduction of the new system, the World Health Organization (WHO), in its World Health Report 2000, ranked China 188th out of 191 countries, or the fourth from the bottom, in terms of the fairness of the financial burden of health care. Those concerned found this ranking just behind two immediate neighbors recognized as lagging far behind us - Nepal and Vietnam - and at the bottom of the list along with countries like Brazil, Myanmar and Sierra Leone. It all stings the Chinese pride and conscience.
Today, against the backdrop of diversified social values, people are bound to make different value judgments when confronted with Mao's ideas and propositions back then. However, no matter what, the popular sentiment revealed by Mao's spirited criticisms, thoughts and propositions back then is so strong that it is touching. If people hold a more peaceful state of mind, may also be able to get out of the quagmire of China's health care reform of a little inspiration.