Lao Tian: What kind of "dead bureaucrats"
did Teacher Mao[1]
encounter - Today and June 26[2]
27/06/2021
(Translator’s Preface: This article was written by
Chinese Marxist-Leninist Lao Tian on the anniversary of Chairman Mao’s June 26,
1965 Directive on Public Health. It not only praises the reliance on the masses
that gave birth to the “barefoot doctor”[3]
movement, but criticizes the capitalist heath system operating in today’s
capitalist China. I have added some footnotes
to assist readers. Any inaccuracies or
clumsiness of translation are mine alone.)
One
In 1949, the Communist Party led the people to win the
War of Liberation, overthrowing the old ruling class that led the trend towards
a high degree of internalisation. At that time, life expectancy per capita was
only 35 years. Infectious diseases of all kinds were the number one cause of
death and the number one threat to the health and survival of the nation's
population.
In order to change this poor situation, the "most
economical" path had to be chosen in order to look to the future, as
industry was not developed and modern technology was not widespread. To this
end, the guidelines for medical and health work in the new China were:
orientation towards workers, peasants and soldiers, unity between Chinese and
Western medicine, prevention as the main focus, and a combination of
professional and technical staff and mass movements. It goes without saying
that this approach encompasses how to make full and effective use of the stock
of traditional technologies to improve the basic living conditions and health
environment of the largest part of the population, but also to improve the
living conditions of the population in general and to mobilise the efforts and
potential of the population.
When the war against the United States broke out in
1951 and the United States resorted to genocidal bacteriological warfare in
Korea, the country launched a patriotic health campaign in conjunction with the
propaganda against the war of aggression, focusing on how to improve the
environmental health of the general public.
In 1955-1956, when the agricultural co-operative
movement was advancing at a rapid pace, and in the context of the progress of
the grassroots organisations in the countryside, Mao began to envisage the
integration of the "eradication of pests and diseases" into the
efforts of the grassroots organisations, and thus, from the perspective of the
"non-experts", he proposed the goal of "eliminating the four
pests"[4],
which was to eliminate common infectious diseases after a period of time in
order to improve the health of the people. This demand for the elimination of
the four pests had not received the least attention from officials and experts
in the medical and health system, apart from the show-like response from the
"non-experts" in the party and government system.
In 1963-65, when the socialist education movement in
urban and rural areas was launched on a large scale, professionals from the
health system were forced to go to the countryside in large numbers. After
seeing the poor conditions of the peasants' living environment, thousands of
professionals began to have a systematic understanding and distilled their
experience into a set of "professional coping solutions" based on big
data - "two controls and five changes" - control of manure and water;
change of wells, toilets, animal pens, cookers and the environment. In this
way, a valuable example of "combining professional and technical teams
with mass movements" was created after a period of time when a large
number of professionals in the field of health care were "involuntarily
going to the countryside".
Thanks to
the "two controls and five reforms" and the effective control of
common diseases in the countryside through cooperative medical care, life
expectancy in China started at 83% of the global average and reached 105% of
the global average within ten years of the Cultural Revolution (a figure that
was deliberately reduced by the World Bank after subtracting three years from
the life expectancy figure). This figure of progress between decades is a
miracle in the history of mankind and is probably unlikely to be surpassed a
second time by any country.
Two
In modern societies, there is a widespread belief that
organised control and the corporate mobilisation and use of resources, in line
with the division of labour and the need for rapid accumulation of experience
and progressive power, are the basis and key to all social progress. Both the
government and the capitalist enterprise potentially fit into the imagination
of people based on the rapid progress made possible by specialisation,
underpinning this widespread belief in modernity. This is why there is a great
deal of subconscious feeling that "the market has abused me a thousand
times, but I treat the market as if it were my first love"; the government
is criticised more, but the critics tend to use the ideal "good government
model" to criticise the bad government performance in reality. Rarely do
they question the government itself.
However, Teacher Mao obviously had different
circumstances and experiences. His judgment of "dead bureaucracy" and
"the potential for degeneration" directly questioned the basic
beliefs of modernity that people today rarely reflect on.
(A June 26, 1968 article linking Mao's Directive to the "barefoot doctor" movement)
During a visit to rural Zhejiang in 1954, Mao met a
desperate patient suffering from schistosomiasis who was lying on his doorstep
and asked the stranger who visited him, "Can this disease be cured?"
The stranger replied, "Yes," but this did not bring much solace to
the patient. Perhaps it was the desperate face of the patient that completely
touched Teacher Mao. On his return to Beijing, he deployed the health
authorities, but for a long time with little success. There was no doubt that
"charging money to cure the sick" was an ironclad law, and one that
was stubbornly supported by many in the socialist state, especially among the
health authorities, where the dominant ideology prevailed.
Similarly, Teacher Mao's enthusiasm and concern for
"eliminating schistosomiasis"[7] had received a little more
attention among local party and government departments. In 1958, when Yujiang
County in Jiangxi Province reported that schistosomiasis had been eradicated in
the county, Teacher Mao was so pleased that he "could not sleep at
night". He even wrote two poems about it. That this progress, even if
partial, was something to be happy about is beyond doubt.
However, rural areas are vast and do not have the
laboratory conditions for purely thorough, once-eradicated, forever
eradication. According to the Xinzhou County Journal of Hubei Province, on
average, 3.84 complete eradication attempts are required to eliminate the
snails parasitized by schistosomiasis, under natural, small watershed
conditions. In other words, the complete eradication of schistosomes in nature
is much more difficult and requires at least as much as Xinzhou County does:
close to four return trips.
As with other aspects of environmental improvement and
prevention of infectious diseases, the "dead bureaucrats" in the
health sector lacked Teacher Mao’s enthusiasm and commitment to the eradication
of schistosomes. From the point of view of these professionals, there were so
many levels of difficulty in accomplishing this task - one, two, three, four,
five up to one hundred and eleven thousand - that failure to meet the target is
inevitable and failure to complete the task is realistic.
In 1970, the second national conference on blood
control was held in Shanghai, attended by mostly 'lay' PLA officers, whose main
difference from the technocrats of the pre-Cultural Revolution was that they
approached the problem of schistosomiasis eradication with a warlike attitude.
Since orders had already been given, they would find a way to get it done, and
if they lacked highly technical methods, they would work as a team to carry out
the task by indigenous methods; the difficulties that the technocrats were most
familiar with, such as one, two, three, four, five, etc., were seen by the
officers as typical of "surrenderism" - a matter of if the
Nationalist Army had been stronger than the Communist Army in the long run,
would it not have been better to just surrender? You could also say that the
professionalism of military officers is lower than that of technocrats, but
their progress during the ruling period has exceeded that. This contrast is
worthy of careful consideration.
In 1998, after the Yangtze River floods, the
authorities said in a coffin-neutral manner that they would "return the
fields to the lake", and some horseshit experts said that this option
would help to protect the environment and restore the wetlands, and that the benefits
would start from one, two, three, four, five up to eleven million. The results
were unbelievable: after the demolition of 2.44 million rural households, the
quickest recovery in the lake was not any environmental improvement, but the
unhindered expansion of the Oriental vole population, which broke out every 2-3
years in a mega "rat wave". In 2004, the director of the Hunan Water
Resources Department, Du, told a national conference that there were at least
200,000 schistosomes in the Dongting Lake area, with many more potentially
infected.
In this way, it seems that making the best use of the
resources at hand and organising effective inputs in pursuit of possible goals
is often opposed, consciously or unconsciously, by specialists, with the
result, of course, that the best use of resources and the optimisation of
inputs and outputs is not achieved in the long term. The replacement of
professional management teams by non-professional ones occurred during the
Cultural Revolution, leading to an increase in the willingness to act (while
also being repeatedly criticised for a 'decline in professional standards'),
but this increase and the resulting decline also had a significantly different
effect, revealing in stark terms the seemingly justified " modernity"
- that the division of labour and the rise in professionalism are not the only
determining factors - and certainly means that this seemingly justified belief
cannot be fully trusted.
The PLA officers' management of society, and its
replacement of the pre-Cultural Revolution party bureaucrats, probably cannot
be understood in terms of higher or lower "political virtue" (e.g. a
higher degree of willingness to "serve the people"). However,
empirical observation shows that the officers have a higher degree of consciousness
of action, going beyond the obsession with "professional
understanding" and various "fears" to focus more on how to solve
real problems and use the power of the masses, and this small progress alone
has greatly contributed to the exploitation of the relevant potential and to
its enormous improvement. In a word, the PLA officer community is much less of
a "dead bureaucracy" than the party and government cadres.
There is another situation which is also quite
important: class differences had not been completely eradicated during the Mao
era, and the privileged few had a completely different situation and experience
of survival compared to the general population, and the difficulties and
problems of the masses were not their problems. In this way, a major inconsistency
emerged, as a large number of grassroots cadres in factories and rural areas
were also paid the same low wages, and the difficulties of the masses were also
their difficulties. As the problems and difficulties faced by the lower cadres
at the grassroots level were highly consistent with those faced by the general
population, the efforts to universalise co-operative medical care and primary
education during the Cultural Revolution were quite supported and championed by
the lower-level cadres. Deng Xiaoping's criticism of co-operative medical care
in 1974 as "socialism doing the work of communism"[8] found considerable
"political sympathy" among senior cadres, but the large number of
grassroots cadres who, like the people, were faced with the same problems of no
schooling for their children and poor access to medical treatment, were
unlikely to share much of Deng Xiaoping's views. This also determined the
subsequent situation of Qin Xiangguan: disliked by senior cadres, but supported
by a large number of rural cadres, as seems to be the case to this day.
It may be true, then, that the division of labour and
the specialisation of departmental management have helped to increase the rate
of knowledge accumulation, and it may be argued that this has increased the
potential for social intervention, but will these people become the 'dead
bureaucrats' that Teacher Mao had repeatedly identified - the ones who lack the
minimum compassion and willingness to intervene in the plight of the people? If
this is the case, then the implausibility of the belief in modernity will
become widespread. In terms of contrasting experiences before and after the Mao
era, the same symptoms are evident in a number of areas: for example, the
Ministry of Education's lack of interest in low-cost universal education, the
Ministry of Water Resources and the Ministry of Transport's lack of enthusiasm
for small-scale projects run by the masses, and the long-standing disinterest
of the financial team in the State Council with decision-making powers in the
development of rural social enterprises. These types of conditions are
widespread and repeatedly manifest themselves, all revealing a 'class nature'
rather than the occasional manifestation of individual bad actors.
Three
After the Cultural Revolution, economic development
achieved faster GDP growth, which was said to be conducive to developing
productivity and raising the living standards of the population, and would
promote all progress without discrimination. This was the "absolute
truth" that was packaged with the most propaganda efforts of the new era.
In terms of health care, in 1978 China spent 11
billion yuan on health care, covering more than 90 per cent of the country's population
for common diseases and illnesses, and at that time health care costs accounted
for 3 per cent of GDP. Over the past 40 years, the GDP figure for the health
care sector has increased more than 500 times, and the proportion of GDP has
more than doubled. At the same time, however, the majority of the population
has lost basic health care coverage, and the difficulty of accessing health
care has become one of the "three new mountains"[9] weighing down on the
majority of the population.
Despite this, there are still not enough among the
temple dwellers[10]
to seriously vow to make "education, health care and pensions" the
"triumvirate" to further boost GDP expansion. Some leading experts
are quick to follow up and analyse: compared to 9.9% of GDP in the EU, China
has a huge room for growth of 50%; compared to 18% of GDP in the US, China has
a room for growth of 200%. Therefore, the development of the healthcare sector
as a new growth point has become the "authoritative consensus" that
experts and temple dwellers have been focusing on.
To a certain extent, the "dead bureaucrats"
that Teacher Mao encountered, and the reactionary academic authorities they
relied on, were unenthusiastic about, and indeed incapable of recognising, the
possible scope for progress in people's health. The state of development of the
medical profession in the post-Mao era, and the deregulation of the Putian
system[11] (whose entrepreneurial
spirit of "all money and no concern for healing" is to some extent an
industry-wide phenomenon), is also an inherent inevitability in the progress of
Chinese modernity.
From this perspective, if we look back at Mao's
"June 26th Instruction", we can see that the deepening of the cause
of people's liberation cannot be accomplished simply by winning the war against
the old ruling class. How to transform and avoid the reproduction and
re-creation of the "dead bureaucrats" and their erosion of the
possibilities and potentials of modernity is an integral part of the cause of
the people's liberation.
May this be a tribute to and remembrance of the
primary school teacher who spent his life fighting for the liberation and
progress of the people!
June 26, 2021
[1] During the Cultural
Revolution, Chairman Mao was often referred to as “Great Teacher, Great Leader,
Great Commander-in-Chief, Great Helmsman”. Mao, who originally worked as a
primary school teacher, said he wanted to be referred to by only one of these,
“great teacher”.
[2] This refers to Mao
Zedong’s Directive on Public Health,
issued on June 26, 1965. See: Directive
On Public Health (marxists.org)
[3] Although Mao’s June 26 directive did not mention “barefoot doctors”, it is credited with inspiring four-month semester crash courses in the treatment of basic illnesses for rural youths who provided first-aid to the villagers with whom they lived. That, and cooperative health, were hugely successful and internationally acknowledged, but on January 25, 1985, the People's Daily published the article "No longer use the name "Barefoot Doctor" to consolidate the development of the rural doctor teams". "Barefoot doctors" no longer exist, and co-operative medicine that coexisted with it has collapsed.
[4] This refers to a campaign launched during the Great Leap Forward to eliminate rats, flies, mosquitoes and sparrows.
[5] Qin Xiangguan was born on the 26th day of the 9th month of the
lunar calendar in 1933 in Dujia Village, Haping Town, Changyang County. He was
one of the founders of cooperative medical care in China, known as the
"father of cooperative medical care in rural China", and a deputy to
the Fourth Provincial People's Congress. In October 1976, he was promoted to
the provincial health department as deputy director, and in 1977, he resigned
from his post and returned to his hometown to practice medicine at the Paradise
Commune Health Centre. He was later elected as a member of the Standing
Committee of the Changyang County Committee, a member of the Yichang District
Committee and a member of the Chinese People's Political Consultative
Conference. He died at 2.50am on 23 October 2008 at the age of 76 in Paradise,
Hamptons Township due to illness.
[6] The “four clean-ups”
was a campaign initiated by Chairman Mao in 1963 and aimed at revisionists
within the bureaucracy, encompassing politics, the economy, the organization
and ideology. Intellectuals were sent to the countryside to be re-educated by
the peasants.
[7] Schistosomiasis, also known as snail fever is a disease caused by parasitic flatworms called schistosomes. The disease is spread by contact with fresh water contaminated with the parasites. These parasites are released from infected freshwater snails. The campaign is covered in chapter 10 of Joshua Horn’s “Away with all pests…” An English surgeon in People’s China
[8] A criticism meaning that it was in advance of it time, that it was an initiative reflecting the communist principle of “to each according to need” rather than the socialist principle of “to each according to work”.
[9] Health care, education
and aged care.
[10] "If you live in a temple, you will worry about the people, and
if you live far away, you will worry about your monarch." It is a sentence
from Fan Zhongyan's "The Story of Yueyang Tower". It means that when
you are a high-ranking official in the court, you should care about the people;
even in remote rivers and lakes, you should not forget to pay attention to the
safety of the country.
[11] The Putian system
refers to the spread of privately-owned hospitals and pharmaceutical companies
throughout China under the control of four big families: Zhan, Lin, Chen and
Huang. According to media reports, they control 80% of China’s 113,000 private
hospitals. Chinese netizens say that the Putian system “doesn’t really help you
cure the disease, but cheats patients of their money”; “those with no disease
may get sick, a small disease may become a big disease”; “They're business
people, they're not medical workers, they're not hospitals, they're bureaus,
they're the product of semi-market-oriented malformations in the medical
industry,” and so on.
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