Proposition 1

The Covid-19 pandemic has accelerated the timeline by which China will surpass the United States to become the world’s leading economic power. 

Friday, November 19, 2021, 9:00 am – 10:15 am ET

FOR: Dr. Yao Yang
Professor, China Center for Economic Research and the National School of Development
Peking University

AGAINST: Mr. Gerard DiPippo
Senior Fellow, Economics Program
Center for Strategic and International Studies

Watch the event here.

Keynote Remarks

Keynote Remarks by the Hon. Christine Wormuth, Secretary of the U.S. Army

Wednesday, December 1, 2021, 9:30 am – 10:15 am ET

Watch the event here.

Proposition 2

Beijing’s crackdown on tech firms will significantly stifle Chinese technological and scientific innovation.

Monday, December 6, 2021, 4:00 pm – 5:15 pm ET

FOR: Mr. Matt Sheehan
Fellow, Asia Program
Carnegie Endowment for International Peace

AGAINST: Ms. Rui Ma
China Tech Analyst; Main Writer and Co-Host
Tech Buzz China

Watch the event here.

Proposition 3 and Keynote Remarks

Within the next two years, China will establish itself as the most influential external power within Afghanistan. 

Tuesday, December 14, 2021, 8:45 am – 10:00 am ET

FOR: Sr. Col. Zhou Bo
Senior Fellow, Center of Strategy and Security
Tsinghua University

AGAINST: Dr. Seth Jones
Senior Vice President; Harold Brown Chair; and Director, International Security Program
Center for Strategic and International Studies

Keynote Remarks by U.S. Senator Steve Daines (R-Montana), Commissioner, Congressional-Executive Commission on China; Co-Chair, Senate U.S.-China Working Group

Tuesday, December 14, 2021, 10:15 am – 10:45 am

Watch the event here.

Proposition 4

Given China’s growing power, China will have a sphere of influence in the Indo-Pacific by 2027. 

Friday, December 17, 2021, 1:00 pm – 2:15 pm ET

FOR: Dr. Graham Allison
Douglas Dillon Professor of Government
Harvard University

AGAINST: Hon. David Stilwell
Former Assistant Secretary of State, East Asian and Pacific Affairs, US Department of State

Watch the event here.

The post China’s Power: Up for Debate 2021 appeared first on ChinaPower Project.

Proposition 1

The U.S.-China relationship can best be described as a “new Cold War.”

November 19, 3:00 pm – 4:15 pm EST

FOR: Hal Brands
Henry A. Kissinger Distinguished Professor of Global Affairs
Johns Hopkins School of Advanced International Studies (SAIS)

AGAINST: Melvyn Leffler 
Edward Stettinius Professor of History Emeritus 
University of Virginia

Watch the debate here.

Proposition 2

“One country, two systems” in Hong Kong is dead.

November 24, 9:00 am – 10:15 am EST

FOR: Daniel Russel
Vice President, International Security and Diplomacy, Asia Society Policy Institute (ASPI); former Assistant Secretary of State for East Asian and Pacific Affairs

AGAINST: Regina Ip
Legislator and Member of Hong Kong’s Executive Council

Watch the debate here.

Proposition 3

China will exploit the COVID-19 pandemic to shift the geopolitical balance of power in its favor.

December 3, 9:00 am – 10:15 am EST

FOR: Yan Xuetong
Dean, Institute of Modern International Relations
Tsinghua University

AGAINST: Aaron Friedberg
Professor of Politics and International Affairs
Princeton University

Watch the debate here.

Proposition 4

Within the next five years, China will use significant military force against a country on its periphery.

December 9, 4:00 pm – 5:15 pm EST

FOR: Oriana Skylar Mastro
Center Fellow, Freeman Spogli Institute for International Studies, Stanford University
Foreign and Defense Policy Fellow, American Enterprise Institute (AEI)

AGAINST: M. Taylor Fravel
Arthur and Ruth Sloan Professor of Political Science, and Director, Security Studies Program
Massachusetts Institute of Technology

Watch the debate here.

Keynote Remarks and Proposition 5

Keynote Remarks by Rep. Rick Larsen

December 15, 10:30 am – 11:00 am EST

Proposition 5: Selective U.S.-China economic decoupling will set back China’s emergence as a global high-tech leader.

December 15, 11:00 am – 12:15 pm EST

FOR: Matthew Turpin
Visiting Fellow
The Hoover Institution

AGAINST: Rebecca Fannin
Founder
Silicon Dragon Ventures

Watch the keynote remarks and debate here.

The post China’s Power: Up for Debate 2020 appeared first on ChinaPower Project.

Measuring China’s Progress on Poverty

Alleviating poverty has long been an enduring challenge for the global community. People living in extreme poverty suffer from severe deprivation of basic human needs, including food, safe drinking water, sanitation, health, shelter, and education. While poverty is a multidimensional issue, it is generally measured by income level. The current international extreme poverty line, established by the World Bank, is set at $1.90 per day (2011 PPP).¹

Using the $1.90 per day extreme poverty line, the global poverty rate has declined significantly since 1990, when it stood at 36.2 percent of the global population (1.9 billion people), to about 8.7 percent (roughly 668.7 million people) in 2018. China was responsible for just over 60 percent of this decrease. Decades of rapid economic growth in China helped to lift 748.5 million people out of extreme poverty, dropping the country’s poverty rate from 66.3 percent to just 0.3 percent.

Among the world’s 15 most populous developing countries, China has seen the greatest drop in poverty rates. However, China’s massive contribution to global poverty alleviation is largely a function of its size. Vietnam succeeded in reducing its extreme poverty rate from 61.3 percent to 1.9 percent from 1990 to 2018, putting it roughly on par with China. Yet, because Vietnam’s population is a small fraction of China’s, the Southeast Asian country’s successes have only accounted for about 3.2 percent of global poverty declines since 1990. 

Evaluating extreme poverty only tells part of the story. In addition to the international extreme poverty line of $1.90 per day, the World Bank recommends using $3.20 and $5.50 per day as benchmarks to assess poverty in lower-middle and upper-middle income countries, respectively. Comparing progress across these three international poverty lines provides a more detailed picture of poverty alleviation. The animation below shows how poverty rates have changed in China from 1990 to 2018.

When the $5.50 per day poverty line is applied to China, an upper-middle income country, 17 percent of the country’s population (237.2 million people) still lived in poverty in 2018. This is noticeably higher than some other major middle-income countries. Turkey’s poverty rate of 8.5 percent, for example, was half that of China’s. Iran (15 percent) also fared slightly better than China. Still, China was ahead of both Brazil (19.8 percent) and Mexico (22.7 percent).

Although China’s poverty alleviation progress has been impressive, it has not been without problems. Poverty has long been more severe in rural regions. In 2018, the extreme poverty rate in rural China was roughly five times higher than in urban areas.

China’s own national poverty line is reflective of this rural-urban divide. Official figures only provide data on poverty in rural areas, rather than the entire national population. China’s current poverty line was established in 2011 and was set at $339.7 (RMB 2,300) per year at constant 2010 prices, which equates to $0.93 (RMB 6.3) per day. However, when adjusted to account for rural-urban price differences, China’s rural poverty line equals about $2.30 a day at 2011 PPP.

China’s rural poverty line is notably higher than the international extreme poverty line of $1.90, and in recent years has tended to show significantly higher rates of rural poverty. In 2015, for example, China’s poverty line indicated 5.7 percent of the rural population was in poverty, while the international line indicated a rural poverty rate of just 1.3 percent.

China’s Push to End Poverty

Poverty alleviation has long been a top priority and central source of legitimacy for the CCP. Under Xi Jinping, the Party has pursued an unprecedented goal of completely ending extreme poverty by the end of 2020. China is set to reach its goals, but questions remain about the sustainability of government measures.

China’s success at alleviating poverty is largely the result of decades of rapid economic growth. Over the last two decades alone, China’s Gross National Income (GNI) per capita grew more than ten-fold from just $940 in 2000 to $10,410 in 2019.² This is twice the rate of increase achieved by Russia, the second-fastest growing BRICS economy.

However, economic growth has been highly uneven, with higher-paying manufacturing jobs clustering in urban areas. The Chinese government began taking steps to address this divide by focusing on rural poverty alleviation. In 1986, the government set up a State Council office to identify impoverished counties, established a national poverty line, and created special funds for poverty reduction.

In 1994, the government introduced the Seven-Year Priority Poverty Alleviation Program, which set a goal of lifting 80 million people out of poverty within seven years. Central authorities also created cooperation mechanisms to allow more urbanized coastal areas to support poorer western regions. Subsequent “Outlines for Poverty Alleviation and Development of China’s Rural Areas” (in 2001 and 2011) eliminated primary school fees for rural students, among other measures.

China also broadened coverage of the dibao program,³ a means-tested, unconditional cash transfer program that serves as the primary safety net for China’s poorest individuals. First piloted in Shanghai in 1993, dibao was expanded to cover all urban areas in 1999 and all rural areas in 2007.

Decades of rapid economic growth in China have allowed millions to enter the middle class. As of 2018, China’s middle class had grown to include more than 700 million people, constituting just over half of the population. Learn more.

Explore More.

Since rising to power in 2012, President Xi Jinping has made eradicating poverty a top policy goal. Under Xi, China has pursued a strategy of “targeted poverty relief” – a concept first put forward by Xi in 2013 during a trip to Hunan Province. In late 2015, the Chinese government officially committed to eradicating poverty by 2020 – in time to mark the centennial of the CCP’s establishment in 2021. The government defined poverty as income levels at or below the rural poverty line of $339.7 (RMB 2,300) or less per year in constant 2010 values.⁴

Chinese leaders also pledged to eliminate the “two worries” (inadequate food and inadequate clothing) and provide “three guarantees” (access to healthcare, education, and housing). In all, the government’s commitments amount to lifting more than 70 million people out of poverty within just five years. These goals are unprecedented in their scope, as previous Chinese administrations generally committed only to alleviating poverty, not to completely eradicating it.

To meet these goals, the government scaled up efforts to track poverty. By 2014, authorities had identified 89.6 million poor people, 29.5 million poor families, and 128,000 impoverished villages. The annual government budget devoted to poverty alleviation also more than doubled from $7.5 billion (RMB 46.8 billion) in 2015 to $18.3 billion (RMB 126.1 billion) in 2019.

In December 2020, at a meeting of the CCP Politburo Standing Committee, Xi announced that “China has accomplished its poverty alleviation target… as scheduled and achieved a significant victory that impresses the world.” Xi added that all counties had been removed from the government’s list of impoverished counties and, under China’s own poverty standards, nearly 100 million people had been lifted out of poverty over the preceding eight years.

Yet questions have been raised about various government measures. One recurring criticism is that there are major gaps in dibao coverage. Dibao is financed by the central government, but local officials determine which households can receive payments. This has led to cases of corruption as well as widespread shortages in coverage. As of mid-2020, the program covered only 3.1 percent of China’s total population, and monthly dibao payments averaged only $92.6 (RMB 651.8) for urban recipients and just $67.2 (RMB 473) for rural recipients.

There is also concern that cash transfer programs like dibao disincentivize employment, which threatens the long-term sustainability of poverty alleviation. Some local governments have experimented with measures to transition welfare recipients to employment, but there is limited evidence that they are effective. Without more sustainable solutions, China risks allowing its most vulnerable citizens to slip back into extreme poverty.

Vulnerability Below the Surface

Despite years of prioritizing rural poverty alleviation, millions of rural residents continue to struggle with lower standards of living. Even in cities, migrant workers face unsafe working conditions and are excluded from accessing some critical social safety net protections.

One of the most pressing socio-economic challenges facing China is the development gap between rural regions in the west and more urban areas in the east. On average, residents of eastern provinces and municipalities have much higher disposable incomes than those of western regions, allowing them to access a much wider range of consumer goods. In the coastal megacity Shanghai, for example, annual per capita disposable income stood at about $10,052 (RMB 69,442) in 2019. Roughly 2,000 kilometers west of Shanghai, residents of Gansu province lived on per capita disposable incomes of just $2,771 (RMB 19,139).

The rural-urban development gap has major impacts on quality of life, affecting everything from dietary habits to disease mortality. In 2018, urban residents consumed 13.5 percent more meat than their rural counterparts. Conversely, rural residents ate 35 percent more grains, which are cheaper than meat. Research has also shown that rural residents face higher mortality rates from diseases like cancer. One study found that the incidence of cancer (per 100,000 persons) is higher in urban areas, but cancer mortality rates (per 100,000 persons) were higher in rural areas. In 2015, cancer mortality was about 36 percent higher among rural residents.  

There are major inequities within China’s cities as well. In 2019, there were 290.8 million rural migrant workers in China, accounting for about 37.5 percent of the country’s total workforce. Roughly 46 percent of them were employed in manufacturing and construction jobs, which are labor-intensive and carry higher risks of injury.

Many migrant workers are considered to be in “vulnerable employment,” which is characterized by “inadequate earnings, low productivity and difficult conditions of work.” About 43.8 percent of China’s working population was considered to be in vulnerable employment in 2018. While this is much lower than India (76.7 percent), it is higher than the other BRICS economies Brazil (27.6 percent), South Africa (9.7 percent), and Russia (5.3 percent).

Many migrant workers also lack access to social welfare protections as a result of the hukou system, or household registration system. Designed to control the internal migration of Chinese citizens, the hukou system can limit rural migrant workers without urban hukous from accessing public services such as dibao. In 2017, for example, just 22 percent of migrant workers had a basic pension or medical insurance, and only 17 percent were covered by unemployment insurance. The children of migrant workers face challenges as well, as they are often forced to attend separate schools that provide a lower-quality education.

Recent crises like the Covid-19 pandemic have hit these vulnerable populations hard. Researchers at Stanford University and China’s Renmin University found that China’s economy likely lost $100 billion in rural migrant worker wages during just one month of Covid-19 lockdowns. With little or no savings (due to low wages) and limited safety net protections, these wage losses were particularly harmful for migrant workers.

Adding to this, their hardships were systematically underestimated. During the peak of China’s Covid-19 outbreak in February 2020, the country’s official unemployment rate reached a record high of 6.2 percent (roughly 29 million people). However, this figure excludes rural unemployment and undercounts jobless migrant workers, meaning China’s actual unemployment rate likely reached 10 percent (about 80 million people).

“We will adopt a policy to see rural migrant workers have equal access to employment services in the cities where they work.”

2020 Government Work Report

The Chinese government has faced growing pressures to address these gaps and inequalities. In May 2020, Chinese Premier Li Keqiang delivered his annual Government Work Report, in which he stated the government “will adopt a policy to see rural migrant workers have equal access to employment services in the cities where they work.” He also announced that low-income earners would be allowed to postpone payments for social insurance premiums.

While these steps may help to dampen the economic blow to China’s vulnerable populations in the short-run, significant obstacles remain. Rapid and sustained economic growth has long been the primary force fueling poverty alleviation in China. As China’s economic growth slows, the pace of poverty alleviation progress is likely to slow along with it. Transforming China into a “fully developed, rich, and powerful” society by 2049 – the centennial of the country’s founding – will thus remain a major challenge in the years ahead.

The post Is China Succeeding at Eradicating Poverty? appeared first on ChinaPower Project.

Decades of rapid economic development have enhanced China’s ability to defend against infectious diseases, but the outbreak of a novel coronavirus disease (COVID-19) in late 2019 laid bare critical weaknesses.¹ Political leaders in China made costly mistakes that delayed the country’s response and allowed the virus to spread from its origin in Wuhan to other parts of the country, and eventually around the world. Within a few months, millions of people had been infected and hundreds of thousands of individuals had lost their lives.

The global impact of COVID-19 exposed shortcomings in other countries as well. Some of these obstacles were unforeseeable, but others are reflected in the findings of the Global Health Security (GHS) Index. Released in October 2019, the GHS index ranks 195 countries based on their performance across six categories of health security, which are visualized in the below interactive.  

Although the GHS Index concludes that “[n]o country is fully prepared for epidemics or pandemics,” it finds that high-income countries are best positioned to respond. Among the countries in the top 20, all but two are high-income economies. The US ranks first overall, followed closely by the UK, the Netherlands, Australia, and Canada.

At 51^st in the overall rankings, China lags behind not only advanced economies but also several countries in the middle-income band, including fellow BRICS countries Brazil and South Africa. China likewise trails many of its neighbors, including Thailand (6^th), South Korea (9^th), and 11 other Asian countries. Among the index’s six categories, China receives the best marks (30^th) for the ability of its health care system to treat the sick and protect health care workers. This relatively strong performance is overshadowed by a weak commitment to international norms, where China lands at 141^st globally, alongside countries like Yemen and Papua New Guinea.

The GHS Index is not necessarily indicative of how the Chinese government, or any government, will perform during an epidemic or pandemic, but it provides a useful baseline for comparing health security capabilities across different countries. Given China’s standing within the index and Beijing’s continued poor performance in managing infectious diseases, it is clear that serious health security deficiencies remain.

Shoring Up China’s Health Security

A robust public health infrastructure is needed to effectively combat infectious diseases. While China has achieved some success on this front, its public health infrastructure has historically failed to keep pace with the country’s economic development. Pronounced failures during the 2002-2003 severe acute respiratory syndrome (SARS) epidemic exposed a pressing need for widescale reforms.

Ambitious government-driven efforts aimed at specific diseases have helped to improve health outcomes in China. Smallpox was one of the government’s earliest targets. Between 1950 and 1952, more than 85 percent of China’s roughly 600 million people were vaccinated, leading to the full eradication of the disease by the early 1960s. Other far-reaching immunization efforts have brought about significant health improvements and contributed to a jump in average life expectancy from just 49.5 years in 1965 to 76.7 years in 2018.

While many of these initiatives proved successful, Chinese leaders failed to significantly upgrade national disease prevention and control mechanisms. Most major countries instituted modern systems for managing infectious diseases throughout the twentieth century, but China continued to rely on an outdated network of epidemic prevention stations modeled in part after the system used in the Soviet Union. China moved to update its public health infrastructure by establishing a national Center for Disease Control and Prevention (China CDC) in January 2002, but the country still lacked a modern system for monitoring and reporting disease outbreaks.

China was unprepared when the SARS outbreak occurred in the early 2000s. Virologists working at the China CDC incorrectly identified the cause of the disease as chlamydia, which is caused by bacteria rather than a virus. The mistake proved embarrassing for China and slowed attempts to control the disease. Poor coordination and political interference also delayed reporting of the disease to the World Health Organization (WHO) and to the Chinese public. The first case of SARS was documented in mid-November 2002, but Beijing failed to relay pertinent information to the WHO until the following February. Before the epidemic ended, over 5,300 people in mainland China, and more than 2,700 elsewhere, were infected.

The global impact of SARS was limited in scale compared to more deadly diseases, such as the 1957 and 1968 influenza pandemics, which collectively killed more than 2.1 million people around the world. Nevertheless, SARS had a high case fatality rate of about 9.6 percent, and Chinese leaders faced protests at home and immense criticism from abroad for their handling of the outbreak. WHO director-general Gro Harlem Brundtland issued a rare rebuke, asking Chinese leaders to “let us come in as quickly as possible” when new diseases arise in the future.

Beijing subsequently adopted several measures aimed at shoring up the country’s health security, including the establishment of a national, internet-based case reporting system. The system was designed to speed up response times, especially in rural areas. The Chinese constitution was amended in March 2004 to allow central government authorities to declare martial law to manage public health crises and other national threats. The Law on the Prevention and Treatment of Infectious Diseases was likewise revamped to promote greater transparency and facilitate swifter action during future outbreaks.

Additional resources were spent on improving and expanding the broader health care system, which had been underfunded for decades as a result of local officials and hospitals prioritizing profit-driven treatments over more costly preventative measures. Between 2002 and 2018, government spending on health care jumped from just $11 billion to more than $247.9 billion. Overall spending on health care across the country likewise increased, from $70 billion to $893.5 billion over the same period.²

The Chinese government increased investments in combating infectious diseases, including malaria and HIV/AIDS. From 2002 to 2016, annual government spending on malaria increased from just $1.6 million to $17.7 million. Government expenditure on HIV/AIDS jumped from $111.9 million per year to more than $1.1 billion over the same period, propelling China into the ranks of top spenders behind Brazil (1^st) and South Africa (2^nd).

These efforts have produced mixed results. China has not recorded an indigenous case of malaria since August 2016, a remarkable achievement for a country of China’s size. The fight against HIV/AIDS has been less successful. Limited government support for sex education has contributed to rising incidents of HIV/AIDS transmission, and according to Chinese government figures, deaths from the disease have risen sharply from 0.02 per 100,000 persons in 2002 to more than 1.3 deaths per 100,000 in 2018.

Lingering Health Security Challenges

Grappling with the outbreak of a novel disease is a challenge for any country. The reforms undertaken by Chinese leaders in the aftermath of SARS upgraded their ability to manage public health crises, but Beijing’s mishandling of COVID-19 made clear that major shortcomings remain. Political interference played a critical role in furthering the spread of the disease.

COVID-19 likely originated in bats and was transmitted to humans through an unknown intermediary animal. According to the US CDC, roughly three quarters of new or emerging infectious diseases are zoonotic (transmitted from animals to humans). SARS and Middle East Respiratory Syndrome (MERS), which first appeared in 2012, are both coronaviruses that are believed to have originated in bats. The novel H1N1 influenza virus that first emerged in the US in 2009 is linked to avian and swine species.

The transmission of diseases from animals to humans poses a significant problem for China. The GHS index pegs China at 101^st out of 195 countries in preventing zoonotic diseases. After SARS, the Chinese government implemented restrictions on wildlife trade, but the laws were later relaxed. Amid the COVID-19 outbreak, Beijing again passed legislation restricting wildlife trade and the consumption of wild animals, but it remains to be seen if political leaders will enforce these measures.

In contrast to SARS, which was not reported to the WHO until three months after the first known case, Beijing was far more effective at identifying COVID-19 and notifying the WHO. Medical professionals in Wuhan began seeing patients with symptoms of the disease in early December, and by the end of the month officials had alerted the WHO.³ It was initially described as a “pneumonia of unknown etiology,” but Chinese experts soon found it to be a novel coronavirus.

The early response to COVID-19 was, however, marred by mistakes and bureaucratic inefficiencies. Hospital administrators and local officials in Wuhan were slow to utilize the online reporting system that was established after SARS, which handicapped efforts to contain the virus. Health authorities also did not pay sufficient attention to early warning signs of human-to-human transmission of the new disease.

Chinese authorities went so far as to punish medical professionals who attempted to publicly warn others about the virus. One of them, Dr. Li Wenliang, was thrust into the international spotlight when it was revealed that he was detained by public security officials and forced to confess to disturbing public order. When he later died from COVID-19, the Chinese public praised him as a whistleblower and widely criticized the Communist Party for his mistreatment. Before his death, Dr. Li was critical of China’s response to the outbreak, stating that if “officials had disclosed information about the epidemic earlier, I think it would have been a lot better.”

Beijing eventually took steps to control the spread of the virus by locking down Wuhan and other cities in Hubei province on January 23, 2020. These measures included closing all non-essential public venues, banning funerals and weddings, and strictly limiting the number of people from each household allowed outside. Local officials in Zhejiang province later implemented similar restrictions.

A WHO official called these moves “unprecedented in public health history,” but other countries soon instituted their own lockdowns. Officials in Italy initially resisted putting in place restrictions, but eventually instituted regional and then national lockdown measures in early March as the COVID-19 death toll mounted. In the US, the federal government did not enforce a national lockdown, but state governments put in place various social distancing and stay-at-home orders, beginning with California on March 19. Many European countries did the same.

Based on values at 60 days from first reported death.

Some governments were able to limit the spread of COVID-19 without instituting draconian lockdowns. South Korea, Japan, and Taiwan, in particular, were able to largely contain the virus through widescale testing and strict quarantining of infected individuals. In all three instances, the number of deaths per 1 million persons was a fraction of the per capita deaths in the US and several European countries.

According to official figures, China was able to cap the total number of COVID-19 cases and deaths at relatively low levels. It is nonetheless difficult to estimate the full extent of the disease in China, as the actual number of cases is believed to be significantly understated.

Bringing the COVID-19 pandemic to an end may only be possible through the development of a vaccine that provides immunity against the virus. Beijing may mandate vaccination against the coronavirus across China, but it is worth noting that the country has been racked by a number of scandals that have severely eroded public confidence in the safety and quality of Chinese vaccines. A 2016 survey found that only 11 percent of parents in China trusted Chinese vaccines. A major incident in 2018, in which 360,000 substandard vaccines were administered to children, heightened public concern over vaccines and likely encouraged many parents to seek more expensive vaccines produced outside of China.

Limited Contributions to Global Public Health

Chinese leaders are increasingly looking to global health initiatives as means of promoting a positive image of the country abroad. Although China’s overall contributions to global health remain relatively modest given its economic size, Beijing has succeeded in expanding its influence, especially through organizations like the WHO.

In the wake of several major epidemics like H1N1 and SARS, China joined dozens of countries and organizations in participating in the Global Health Security Agenda (GHSA), a multilateral partnership established in 2014 to enhance the capacity of countries to prevent and manage infectious diseases. Most GHSA member countries – including major regional players like the US, Japan, and Australia – have voluntarily completed a Joint External Evaluation (JEE), a process aimed at monitoring commitments to international health security targets. China has not completed a JEE, which is a major reason that it received such poor marks from the GHS Index (141^st globally) for compliance with international norms.

Despite enjoying decades of unprecedented economic growth, China has only recently emerged as a major contributor to global health. Between 2003 and 2014, China received more than $802 million in grants from The Global Fund to Fight AIDS, Tuberculosis and Malaria. It was not until 2014 that China became a net contributor to the Global Fund. As of early 2020, China was the organization’s 20^th largest donor, with cumulative contributions totaling $63 million. The top three donors – the US, France, and the UK – have provided a combined $27.3 billion, more than half of the total amount raised since the Global Fund was founded in 2002.

Beijing has recently begun supporting the Gavi Alliance, which was founded in 2000 by the Bill and Melinda Gates Foundation to expand access to vaccines among the world’s poorest countries. For years, China was on the receiving end of support from the Gavi Alliance in its fight against hepatitis B. China became a donor in 2016, but its current overall contribution of $5 million amounts to just 0.1 percent of the organization’s total receipts from 2016-2020.

Chinese contributions to the WHO are similarly small given the country’s economic size. The WHO is funded through a combination of assessed dues and voluntary funding from member governments, as well as donations from philanthropies and other international organizations. The Chinese government contributed just under $86 million to the WHO in 2018-2019, which amounted to around 1.5 percent of the organization’s total biennial budget. China is the seventh largest financial backer of the WHO among countries, but only the 15^th largest donor when factoring in non-governmental contributors like the Bill and Melinda Gates Foundation.⁴

In response to the global backlash that Beijing has received for its initial handling of the COVID-19 outbreak, China ramped up its funding for the WHO, starting with a $20 million donation in March 2020. China pledged an additional $30 million in April after the Trump administration announced its intention to freeze US funding to the organization. Chinese officials sought to cast the move as “defending the ideals and principle of multilateralism.” At the annual meeting of the World Health Assembly (the decision-making body of the WHO) in May, Chinese President Xi Jinping announced that China would donate a total of $2 billion over two years to support the WHO’s COVID-19 response efforts.

China’s impact on the WHO has been considerable. The election of Margaret Chan as director-general of the WHO in March 2006 marked the first time that a Chinese candidate held the position. When Chan’s term ended in 2017, Chinese leaders supported the candidacy of her successor, Tedros Adhanom Ghebreyesus, who has led the WHO during the COVID-19 pandemic.

Beijing has also succeeded in pressing the organization to exclude Taiwan, leaving the island’s nearly 24 million people without direct access to the world’s preeminent public health organization. China permitted Taiwan to participate as an observer in the World Health Assembly from 2009 to 2016, but it was instrumental in stripping Taiwan of its observer status in the years that followed. Despite Taiwan’s exceptional success in handling COVID-19 and widespread international support for its inclusion in the WHO, Beijing has persisted in shutting out Taiwan.

The post How Robust is China’s Health Security? appeared first on ChinaPower Project.

Source: WHO/UNICEF Joint Monitoring Programme (JMP)

Over the last few decades, access to safe drinking water has expanded dramatically across China. In 2000, more than 245 million people drank water from untreated sources. Less than two decades later that number had dropped to 89 million people. China’s ongoing modernization is largely responsible for this improvement, but economic development presents its own challenges for water security.

Industrial pollution has wreaked havoc on the country’s water supply. Rapid urbanization has made it difficult to provide enough water to major cities. According to Chinese government data, China’s total water use increased 8.8 percent between 2000 and 2015, and wastewater emissions grew by more than 50 percent.

The resulting pressure on water supplies has compounded scarcity issues and outpaced the development of waste-management infrastructure. Even in China’s most-developed cities, many residents continue to boil and filter tap water due to concerns about inadequate water treatment and aging underground pipe networks.

As the Chinese economy continues to mature and millions more flock to cities, leaders in Beijing will face continued water security challenges. Failing to resolve these issues could stymie the country’s economic and social development.

How Pollution Undercuts Water Security in China

Decades of poor water and waste management have left much of China’s surface water and groundwater severely polluted. Beijing has made notable commitments to reducing water pollution, but significant environmental and public health risks remain.

More than 80 percent of China’s water supply comes from surface water, such as rivers and lakes. In 2018, the Ministry of Ecology and Environment (MEE) reported that 6.9 percent of surface water in China’s river basins was “Below Grade V” quality, meaning it was so polluted that it was unfit for any use. Another 18.9 percent was categorized as “Grade IV and V,” indicating it was only suitable for agricultural or industrial use, but not for human consumption.

The Hai River basin, which includes the major industrial areas of Hebei and Tianjin, is the most polluted of all the major basins in China. More than half of the basin’s surface water is unsuitable for drinking. In the nearby Liao River basin, which is the second-most polluted river basin in China, the situation grows more dire every year. Between 2013 and 2018, the share of Below Grade V water in the Liao River basin quadrupled from 5.4 percent to 22.1 percent.

Lakes in China are also heavily polluted. Lake Tai, in eastern China, is the country’s third-largest freshwater lake and one of the most polluted. In 2007, decades of industrial pollution culminated in a major algae bloom that killed off much of the lake’s animal life and forced millions of nearby residents to drink from bottled water. Although RMB 26 billion (nearly $4 billion) has been spent on cleanup efforts, nearly all of the lake’s water remains unsafe for drinking.

Groundwater from underground aquifers supplies most of the remainder of China’s water. According to the MEE, 15.5 percent of China’s groundwater in 2018 was unsuitable for any use. Another 70.7 percent was clean enough for agricultural and industrial purposes and could only be used for drinking water after proper treatment. 

Water pollution carries serious economic and social costs. In the first half of 2017 alone, China spent an estimated RMB 667.4 billion ($100.2 billion) on nearly 8,000 water cleanup projects. Water pollution in heavily industrialized areas has also been linked to higher rates of cancer. A 2012 study found that the deterioration of drinking water by a single grade (on the MEE’s scale) can increase the death rate of digestive cancer by 9.7 percent.

Other countries suffer from similar problems. Some of the most polluted rivers in the world are in India. In 2016, it was revealed that approximately 63 percent of sewage running into India’s rivers was untreated. Even developed countries like the US have struggled with severe water pollution in the past. In 1969, northern Ohio’s Cuyahoga River was so polluted that it caught on fire. The event ignited public anger over water pollution and galvanized support for the Clean Water Act of 1972, which still stands as a cornerstone of US environmental protection laws.

The Chinese government has launched its own efforts to reduce water pollution. In 2015, China’s State Council issued the Water Pollution Prevention and Control Action Plan, which set targets for improving water quality by 2030. The National People’s Congress passed major revisions to the Water Pollution Prevention and Control Law in 2018 – the first update to the law in a decade. A key feature of the legislation was the establishment of a system of “river chiefs” and “lake chiefs” that makes local officials responsible for addressing pollution in specific bodies of water.

A considerable increase in the number of groundwater monitoring stations likely contributed to the significant shift in groundwater quality in 2018.

In January 2020, the MEE announced a five-year plan to restrict farming near major rivers, which is aimed at limiting water pollution from agricultural runoff. Successful implementation of the plan could substantially reduce water pollution, but it is highly ambitious and Chinese authorities may find it difficult to enforce.

Although significant challenges remain, government efforts have led to some notable improvements. In 2001, 44 percent of China’s surface waters were considered unusable due to pollution (Below Grade V), compared to just 6.9 percent in 2018. Groundwater pollution, however, remains largely unchanged. Improving groundwater is far more difficult than treating surface water and will likely remain a long-term challenge for China.

How Scarcity Threatens Water Security in China

Water scarcity is another serious threat facing China. Nearly one-fifth of the world’s population lives in China, yet only about 6 percent of global renewable freshwater resources lie within the country’s borders. The Chinese government has made considerable investments in improving access to water, but urbanization and climate change continue to strain water resources.

Water scarcity occurs when the available amount of renewable freshwater does not meet demand. The UN defines water scarcity as an area having less than 1,000 cubic meters (m³) of freshwater available per person, and “absolute water scarcity” as an area containing less than 500 m³ of water per person. In 2017, there was approximately 2,075 m³ of water per person in China. While this is not considered water-scarce, China’s water resources are far less than the global median (3,776 m³) and roughly one-fifth of the per capita levels in the US (9,459 m³).

Water scarcity can also be measured in terms of “water stress,” which the World Resource Institute (WRI) defines as a ratio of the total amount of water withdrawals to available renewable water supplies. According to the WRI, China suffers from medium-high water stress and is the 56^th most water-stressed country in the world.

As water resources are not evenly distributed across China, national-level comparisons do not tell the full story. Roughly half of the country’s population resides in its northern 15 provinces and municipalities, where only one-fifth of China’s freshwater resources are located.¹ A total of nine provinces and municipalities suffer from absolute water scarcity. All these locations, except Shanghai, are in northern China.

Other countries also struggle with water scarcity. Nine states in India, which are home to over half a billion people, suffer from extremely high levels of water stress.² Most of South Africa does not have high water stress, but Western Cape experiences extremely high water stress. Its provincial capital, Cape Town, faced a severe water shortage crisis in 2017-2018 that brought the city close to shutting down municipal water services. 

Climate plays a major role in water resource disparities. Regions in northern China receive significantly less annual rainfall than elsewhere in the country. In the lower reaches of the Yellow River, which flows through nine northern provinces, annual rainfall averages between just 20-25 inches. In comparison, some areas along China’s southeastern coast receive more than 80 inches of rain per year.

Climate change will likely deepen water scarcity. Rising global temperatures will contribute to the melting of Himalayan glaciers and snowpacks, which are the source of many rivers in China. This will cause greater seasonal volatility of water levels in China’s rivers, and in the long term it will lead to decreased availability of water. Climate change is also expected to increase the occurrence of droughts, flooding, and other extreme weather, which will not just diminish China’s water supply, but also directly threaten lives.

Continued urbanization could further strain water supplies in major cities. By 2050, roughly 80 percent of China’s population is expected to live in urban areas. This shift will place enormous pressure on cities like Tianjin, which already has the lowest per capita water resources (113 m³) in China.

To make its cities more resilient to water scarcity, China launched the “sponge city” initiative in 2015 to capture and re-use more rainfall. The initiative began with just 16 cities, but over the last few years has expanded to include 30 cities. By 2030, participating cities must ensure that 80 percent of their urban areas meet standards for collecting rainfall.

China has taken drastic measures to supply water to parched cities in the north. In 2013 and 2014, the country completed major portions of the South-North Water Diversion Project.³ The herculean effort is designed to transfer water from rivers and reservoirs in the south as far as 1,400 kilometers (km) to northern cities like Beijing and Tianjin. The project already supplies about one-third of all water used in Beijing. Experts have nonetheless criticized it for displacing hundreds of thousands of people and contributing to environmental degradation.  

At the national level, China’s State Council issued country-wide water management objectives in 2012 known as the “Three Red Lines.” These include limiting national water use to 700 billion m³ per year, increasing the efficiency of industrial water use, and expanding the share of major water sources meeting national quality standards by the year 2030. The Three Red Lines amount to some of the most ambitious national water use standards in the world.

China and Global Water Security

Water security issues do not end at national borders. Multiple waterways have been a source of tension between China and its neighbors. The upstream damming of the Brahmaputra River, which flows roughly 2,900 km from China into India and Bangladesh, has sounded alarm bells in India.⁴ Some fear that China could abruptly alter the flow of the river, harming communities downstream.

China’s activity along the Mekong River, which flows from China into Thailand, Laos, Myanmar, Cambodia, and Vietnam, has also come under scrutiny. US Secretary of State Mike Pompeo suggested in August 2019 that China seeks to control the Mekong River through “a spree of upstream dam building.” Similar concerns emerged following the April 2020 release of a US-funded report on the impact of Chinese dams. The report concludes that China’s 11 upstream dams contributed to record-low water levels in the lower Mekong during 2019, even as the Chinese portion of the river received above-average precipitation.

Overseas development projects backed by China stand to significantly impact the Mekong as well. There are over 300 dams planned along the Mekong and its tributaries in lower Mekong countries. In Laos, over half of these dams are believed to be associated with Chinese companies.

Many Chinese-backed dams are connected with the expansive Belt and Road Initiative (BRI), which extends from countries along China’s borders to regions as far away as South America. Since the BRI was launched in 2013, China has been involved in hydropower projects in dozens of countries around the world. While hydroelectric dams may provide renewable energy to areas in need, they also threaten to severely disrupt ecosystems and worsen existing water security issues.

As part of the Belt and Road Initiative, Chinese companies have helped finance and construct hydropower projects around the world. Learn more about the Belt and Road Initiative and its role in China’s overseas ambitions. Learn more.

Explore More.

In Indonesia, the Chinese-constructed Batang Toru hydropower plant has drawn criticism from scientists and activists for endangering the surrounding jungle’s fragile ecological balance. Similar concerns have ignited controversy over projects in largely undeveloped natural habitats like the Amazon and Patagonia. In Brazil, local opposition to the Chinese-financed Belo Monte hydroelectric dam caused significant delays during construction.

Other energy projects likewise tax water resources. China is helping to finance a series of coal-fired power plants in Pakistan that could generate up to 6,600 megawatts of capacity. While these plants would help alleviate energy shortages, they could also use considerable water resources – upwards of 8 million m³ per year combined – in a country already facing severe water stress.

The post How Does Water Security Affect China’s Development? appeared first on ChinaPower Project.

Morning Keynote

Senator David Perdue
(R-Georgia)

Read the transcript of Senator Perdue’s keynote.

Proposition 1

FOR: James Fanell
(Former Director of Intelligence and Information Operations, U.S. Pacific Fleet)
Fellow, Geneva Centre for Security Policy

AGAINST: Timothy R. Heath
Senior International Defense Researcher
RAND Corporation

Watch the debate.

Proposition 2

FOR: Elizabeth Economy
C. V. Starr Senior Fellow and Director for Asia Studies, Council on Foreign Relations
Visiting Distinguished Fellow, Hoover Institution, Stanford University

AGAINST: Wang Huiyao
Founder and President
Center for China and Globalization

Watch the debate.

Proposition 3

FOR: Naomi Wilson
Senior Director of Policy, Asia
Information Technology Industry Council (ITI)

AGAINST: Joy Dantong Ma
Data Scientist
Home Partners of America

Watch the debate.

Proposition 4

FOR: Christopher Balding
Associate Professor
Fulbright University Vietnam

AGAINST: Yi Xiong
Economist, China
Deutsche Bank

Watch the debate.

Proposition 5

FOR: Jude Blanchette
Freeman Chair in China Studies
Center for Strategic and International Studies (CSIS)

AGAINST: Joseph Fewsmith
Professor of International Relations and Political Science
Frederick S. Pardee School of Global Studies, Boston University

Watch the debate.

Afternoon Keynote

Assistant Secretary David R. Stilwell
Bureau of East Asian and Pacific Affairs
U.S. Department of State

Assistant Secretary Stilwell’s keynote was postponed to December 12, 2019. You can watch his speech “U.S.-China Bilateral Relations: The Lessons of History” or read the transcript.

The post China’s Power: Up for Debate 2019 appeared first on ChinaPower Project.

Gauging Corruption in China

The inherent secrecy surrounding corruption makes it almost impossible to measure with complete accuracy. The Corruption Perception Index, published by Transparency International, aggregates a diverse range of surveys to assess the perceived level of corruption within a country.¹ The 2018 CPI ranked China 87 out of 180 countries with a score of 39, placing it in a tie with Serbia.

This level of corruption is far greater than that of most high-income economies. The countries with the least corruption are typically smaller, advanced economies. Denmark and New Zealand, for instance, are ranked 1^st and 2^nd in the 2018 index. Larger developed states also rated well, with Japan (18^th) and the US (22^nd) both near the top of the list. Regarding its developing peers, China outperformed Brazil (105^th) and Russia (138^th) but fell behind South Africa (73^rd) and India (78^th).

Robust democratic institutions are also associated with lower levels of corruption. Full democracies received an average score of 75 in the index, while fully autocratic regimes only averaged a score of 30. Citing “threats to its system of checks and balances” and an “erosion of ethical norms at the highest levels of power,” the US dropped 4 points in the most recent index and fell from 16^th place in 2017 to 22^nd in 2018.

In 2017, the Worldwide Governance Indicators project ranked China in the 47^th percentile globally for the “control of corruption” category.

Perceived corruption in China was at its highest level in 2014, when it ranked 100^th globally in the CPI with a score of 36. This trend marked a significant drop from 80^th place in 2013 and 2012. Between 2015 and 2017, China improved slightly in the CPI, before its score declined by 2 points and its ranking slid from 77^th place in 2017 to 87^th in 2018.

Other indexes reflect a small but positive trend for China. In 2017, the Worldwide Governance Indicators project ranked China in the 47^th percentile globally for the “control of corruption” category, which examines the extent to which public power is leveraged for private gain. While this marked a minor decline from 2016 (49^th percentile), it is overall an improvement from 2012 (40^th percentile). The 2017 Index of Public Integrity likewise reported a slight uptick in all categories measured for China since 2015, except for budget transparency.

Importantly, the nature of corruption varies by country. Transparency International contends that the most prevalent forms of corruption in China are bribery, diversion of public funds, and favoritism by government officials. A 2015 survey conducted by Charney Research revealed that 35 percent of Chinese companies had paid bribes to government officials.

Bribes are pervasive in other areas of Chinese society as well. The 2017 Global Corruption Barometer (GCB) found that when accessing public services — such as those related to education, health care, and the criminal justice system — 26 percent of respondents in China had paid bribes. This level is far below that of some of China’s developing neighbors, with 69 percent of Indian and 65 percent of Vietnamese respondents reporting having paid bribes when accessing public services. Thailand and Myanmar fared better, at 41 percent and 40 percent, respectively. Only 3 percent of South Korean and 0.2 percent of Japanese respondents reported instances of bribery.

Some corruption-related activities in China have declined. The 2017 – 2018 Global Competitiveness Index, which measures country-level economic competitiveness, ranked China 49^th out of 137 countries in the frequency of irregular payments and bribes and 20^th in favoritism by government officials. By both measures, China improved considerably since 2012 when it ranked 67^th in irregular payments and bribes and 34^th in favoritism by government officials.

The Impact of Corruption on China’s Economy

Corruption can impose economic damages both directly, such as in cases of tax evasion, money laundering, and other illicit activities, and indirectly by distorting market mechanisms, increasing the cost of business, and discouraging competition. In a 2018 report, the United Nations suggested that corruption across the world cost at least $2.6 trillion, or 5 percent of the global GDP. The same report also noted that businesses pay more than $1 trillion in bribes every year.

The cost of corruption on a country’s economy is difficult to calculate. A 2016 study of corruption across Europe showed lower levels of economic losses in mature economies like the Netherlands (0.76 percent of GDP) and higher losses in middle-income economies like Romania (15.6 percent of GDP). For China, the picture is less clear. One calculation from 2001 pegged the cost of corruption at 14.5 to 14.9 percent of China’s GDP (annually) between 1999 and 2001. A more recent estimate from 2010 put the financial cost of corruption for China at 10 percent of its GDP.

In countries like South Korea, corruption has yielded mix results. Although corruption can compromise government effectiveness, it has also been shown to spur growth and promote the formation of multinational conglomerates like Samsung. The relationship between economic growth and corruption in China is difficult to assess. Throughout the 1990s and 2000s, China enjoyed rapid GDP growth despite widespread corruption. This is, in part, a result of what Transparency International refers to as a “profit sharing” model of corruption, whereby government officials are evaluated based on their ability to hit growth targets set by Beijing. As a result, officials are incentivized to support economic development even if corruption is pervasive.

The outflow of capital due to tax evasion, smuggling, and other illicit activities provides additional insight into the economic consequences of corruption. In 2014, illicit financial flows to and from developing countries reached upwards of $3.5 trillion.² Illicit flows to and from China topped $1.1 trillion in that year, significantly more than Russia ($299 billion), India ($122 billion), and Brazil ($76 billion).

Bribery likewise imposes significant challenges for China. Official government figures show that of the officials arrested in 2018 for corruption, 17 people received bribes of at least $1.47 million (10 million yuan) and five had taken bribes of $14.7 million (100 million yuan) or more. In one instance, the vice chairman of the Hebei People’s Congress, Yang Chongyong, was found guilty of accepting bribes totaling roughly $30 million (206 million yuan) in September 2018 and sentenced to life in prison.

Bribes have also been shown to find their way into the hands of tax collectors, which has made eliminating tax evasion a challenge for Beijing. According to the World Institute for Development Economics Research, tax evasion costs China $66.8 billion annually. To help root out evaders, China implemented the OECD’s common reporting standard that provides Beijing with information on assets stored overseas. China has also begun targeting the entertainment industry, where fake contracts have been used to evade taxes. In a recent high-profile case, Chinese actress Fan Bingbing and her companies received fines of $127 million in back taxes and penalties.

Some sectors are more affected by corruption than others. Charney Research reported in 2015 that 41 percent of respondents in the real estate and construction sector paid bribes. A separate study of over 7,300 corruption cases from 2014 to 2015 discovered that a notable portion of real estate corruption occurs on a village level, where bribery and embezzlement can take place during land development projects and other activities.

Prevalent corruption can hinder economic competitiveness and disincentivize foreign investment. Smaller firms operating in China have been shown to be less profitable and productive when competing against larger peers that can allocate more toward “entertainment expenses,” which in some cases has been linked with bribes and other forms of corruption. A 2017 survey of over 16,000 business executives across 140 countries showed that corruption was one of the biggest challenges for conducting business in China, behind inefficient government bureaucracy, inflation, and policy instability.

Chinese citizens have consistently ranked corruption among their top concerns in various surveys. The 2013 China General Social Survey, for instance, stated that over 71 percent of respondents felt corruption was “extremely serious” or “very serious.” A 2016 Pew Research Center survey noted that 49 percent of respondents reported that corrupt officials are a “very big problem,” significantly higher than other concerns, such as the country’s wealth gap (33 percent) and crime (23 percent). Results from earlier Pew studies show that this concern is persistent, with 50 percent of respondents in 2012 reporting that corruption is a “very big problem.”

Efforts to Combat Corruption in China

Beijing first criminalized corruption in 1952, but it was not until 1979 with the adoption of the Criminal Law of the People’s Republic of China that anti-corruption laws were officially codified. This process stipulated that “taking advantage of [one’s] position” was a crime and made key distinctions between bribery and embezzlement.

New laws were introduced in the 1990s to further combat corruption. These included the Civil Procedure Law in 1991, the Arbitration Law in 1994, and revisions to the existing anti-corruption laws in 1997. Collectively, these laws (among others) refined the definitions of and expanded the punishments for corruption.

As the Chinese legal system evolved to tackle corruption, the number of high-level officials prosecuted and the amount of money involved in corruption cases surged. In 1994, 1,915 high-level officials were charged with corruption, and the total amount of money involved in these cases totaled $395 million (3.4 billion yuan).  In 2007, the number of high-level officials prosecuted had jumped to 2,706, and the assets involved had roughly doubled to $882 million (6.7 billion yuan).

To further enhance Beijing’s anti-corruption efforts, then-President Hu Jintao established the now-defunct National Bureau of Corruption Prevention (NBCP) in 2007. The NBCP was charged with preventing corruption, improving government transparency, and building an online forum through which citizens could issue complaints. It also cooperated with international counterparts on multilateral initiatives. For instance, a 2016 agreement between Beijing and Islamabad facilitated the NBCP working with Pakistan’s National Accountability Bureau to combat corruption along the China-Pakistan Economic Corridor.

At the opening of the 18^th Party Congress in November 2012 — just days before the end of his second term as president — Hu warned that failing to handle corruption could “prove fatal to the party and even cause the collapse of the party and the fall of the state.” Soon thereafter, newly-elected President Xi Jinping launched a comprehensive anti-corruption campaign and called on the party to “resolutely investigat[e] law-breaking cases of leading officials.” By October 2018, Chinese authorities were reported to have investigated 2.7 million officials and disciplined over 1.5 million individuals, including seven national-level leaders and two dozen high-ranking generals. Around 58,000 officials have been brought to trial, with two ultimately being sentenced to death.

Xi Jinping also launched Operation Fox Hunt in 2014 and Operation Skynet in 2015 to locate and extradite corrupt officials and other criminals who had fled overseas. In 2015, the CCDI issued over 100 Interpol Red Notices on Chinese individuals living abroad. By January 2019, roughly 5,000 suspects had been arrested and returned to China.

In addition to strengthening anti-corruption measures, Xi also widened the scope of government supervision. In 2018, China established its highest-ranking anti-corruption agency, the National Supervisory Commission (NSC). The NSC took over some of the duties of the CCDI, replaced the Ministry of Supervision and the NBCP, and is reported to have tripled the number of individuals monitored by the government. Individuals of interest include not only party members and government officials, but also numerous state employees, such as management-level public servants in hospitals, cultural and educational institutions, and sports organizations.

Xi’s anti-corruption campaign has recovered a significant amount of assets lost to corruption, although the exact amount is unknown. Xinhua reports that Beijing recovered $1.48 billion between 2012-2017. NBC claims that another $519 million was recovered in 2018. Chinese authorities are reported to have seized over $14.5 billion in assets from Zhou Yongkang and his associates alone. Zhou, a member of the Politburo Standing Committee from 2007 to 2012, pleaded guilty to taking bribes and leaking state secrets. He was sentenced to life in prison in 2015.

Although Xi announced in a 2018 speech that the “anti-corruption campaign [had] delivered a crushing victory,” it is unclear how effective his efforts have been at reducing corruption-related activities. China’s CPI score has remained below the global average since Xi came to power. When asked about the change in the level of corruption over the last three years, 73 percent of Chinese respondents in the 2017 Global Corruption Barometer answered that corruption had increased. Some observers have suggested that comprehensive structural reforms may be needed to truly root out corruption.

The post How Does Corruption Hinder China’s Development? appeared first on ChinaPower Project.

As the world’s largest emitter of greenhouse gases, China has faced widespread criticism from the international community. Beijing also faces domestic pressure to address environmental concerns while maintaining economic growth. Having pledged to reduce its emissions intensity by 60 to 65 percent as part of the Paris Agreement, how China manages these challenges affects both its ability to emerge as a leader in sustainable development and the broader fight against climate change.

Carbon Dioxide Emissions from Industry

China’s economic growth has primarily been powered by coal, which constituted an average of 69.9 percent of the country’s energy consumption between 1985 and 2016. Burning coal comes at a steep environmental cost, as it produces up to twice the amount of carbon dioxide (CO2) as other fossil fuels. While nationwide coal usage increase has slowed down since 2008, China still consumed more coal than the rest of the world combined in 2018. From 2008 to 2018, China’s coal consumption maintained around 1854.5 million tonnes oil. As of 2018, coal represented 59 percent of the country’s total energy use.

Between 2000 to 2018, roughly 75.5 percent of China’s CO2 emissions – which is more than those from all European, African, and Latin American countries combined – results from this heavy dependence on coal. An additional 14 percent of its CO2 emissions come from oil. This high concentration of coal-based emissions differs from that of other major economies. While Japan leans on coal for a quarter of its generated electricity, coal only constitutes 34.6 percent of Japan’s CO2 emissions. Instead, oil contributes the greatest share of Japan’s emissions (45.1 percent). Oil is also the main source (41.7 percent) of CO2 emissions in the US, followed by coal (33.1 percent).

The industrial sector is China’s primary coal consumer. Manufacturing, agriculture, mining, and construction collectively made up 62.5 percent of China’s energy use and 49 percent of China’s coal use in 2017. Notably, this does not include power production activities, which were responsible for 46.5 percent of coal consumption.

Construction-related activities are among the main sources of carbon dioxide emissions. China’s extraordinary urbanization boom has intensified these activities. The production of cement and steel, which have undergirded China’s infrastructure development, both emit a large amount of CO2 during the refining process.

Between 2011 and 2013, more cement was consumed in China than what was used across the entire US over the course of the 20th century. Given that cement production releases 1.25 tons of CO2 per ton of cement created, it comes as little surprise that cement alone accounted for 7.8 percent of China’s carbon dioxide emissions in 2018. These emissions totaled 782 million tons of CO2, roughly 6 times more than India.

China manufactures half of the world’s steel, producing roughly five times more than the European Union. Similar to cement, steel production is a coal and coke-intensive process.¹ Each ton of steel produces two tons of carbon dioxide. Some estimates peg steel processing as the source of more than 10 percent of China’s CO2 emissions.²

While most of these materials are consumed domestically, a notable portion is used overseas. In 2017, around 25 percent of the cement and 7.2 percent of the steel produced in China were exported. Given the scale of its production capacity, these moderate export figures have propelled China to become the world’s largest supplier of steel and cement.

Lessening the Emissions from Fossil Fuels

China has made a concerted effort to reduce industrial emissions. In 2018, Beijing introduced an action plan that requires 480 million tons of carbon capacity from steel production to meet “ultra-low emission” standards by 2020. China is likewise upgrading its power grid with more efficient “ultra-supercritical” plants, which produce more energy with less coal. This push will raise standards well past those currently in place in the US. According to the Center for American Progress, by 2020, “every coal plant operating in the United States would be illegal to operate in China.” Other state-driven measures include the 2013 introduction of carbon capture and storage (CCS)³, which remains in the early phases of development.

Other changes may further help China reduce its carbon dioxide emissions. According to the US Energy Information Administration, China is ramping up its use of natural gas. Compared to coal, natural gas emits 50 to 60 percent less carbon during the combustion process.

As of 2018, China was the world’s third-largest consumer of natural gas after the US and Russia. China was also the second-largest importer of liquid natural gas (LNG) that year and accounted for around half of the global increase in natural gas imports. China is also the third-largest purchaser of LNG from the US.

In addition to environmental considerations, China may be seeking to boost LNG imports to help offset its trade surplus with the US. In early 2018, the China National Petroleum Corporation signed a 25-year contract with the US firm Cheniere Energy to purchase up to 1.2 million tons of LNG annually. While LNG has yet been untouched by the ongoing trade dispute between the world’s two biggest economies, escalating tensions could put it in the crosshairs.

In late 2017, China’s National Resources Defense Council launched the Plan for the Establishment of National Carbon Credit Trading Market, a nationwide emissions trading scheme (ETS) that incentivizes companies to cut emissions by putting a “price” on CO₂. The scheme’s 2011 pilot program, conducted in five cities within Hubei and Guangdong, was included in China’s 12^th Five Year Plan (2011-2015). The program has achieved some early success. Since its launch, approximately 38 million tons of CO₂ have been traded in regional carbon markets.

Household Carbon Dioxide Emissions

For decades, coal has been a key source of domestic energy consumption. Over 72 percent of the electrical power generated in China in 2015 came from coal-powered plants, making coal a primary contributor to household CO₂ emissions. Notably, household coal use is representative of China’s urban-rural divide. In 2015, urban household CO₂ emissions predominantly resulted from natural gas (33.2 percent) and liquefied petroleum gas (26.1 percent). This is a similar breakdown to the developed countries of Europe and North America, where most household emissions come from these alternative fossil fuels. In contrast, coal contributes over 65 percent of China’s rural household emissions.

The Chinese government has taken steps to reduce household reliance on coal by hastening the transition to natural gas. In 2017, China’s Ministry of Ecology and the Environment (MEE) subsidized local officials to install electric or gas heaters in 3 million homes throughout villages and cities in Hebei, Shandong, Henan and Shanxi provinces. At the same time, the use of coal-fired stoves was banned. A lack of coordination between local and national governments, however, hampered this transition.

Beijing is also working to cultivate public support for energy conservation and environmental awareness. Events such as the “Annual Nationwide Energy-Saving Publicity Week” or “Nationwide Decrease Carbon Day” represent efforts taken by China’s MEE to educate the public on environmental goals stipulated in the 13^th Five Year Plan and the Paris Agreement.

The Chinese government aims to have 5 million electric cars on the roads by 2020.

Motor vehicles represent another major source of emissions. There are more than 300 million motor vehicles on the road in China, over 30 million more than in the US. In addition to sheer volume, Chinese vehicles are often less efficient than those produced in Japan, Europe, or the US.

The Chinese government has taken measures to address this issue. In 2016, the Chinese Ministry of Industry and Information Technology proposed limits on fuel consumption for new motorcycles and mopeds.⁴ Two years later, production was suspended for over 500 car models that did not meet strict fuel standards.

Additionally, the government has implemented multiple incentives to encourage the transition to electric vehicles (EVs). As of 2018, there were 2.3 million EVs on the road in China, totaling 45 percent of the world total. Europe and the US accounted for another 24 percent (1.24 million) and 22 percent (1.12 million), respectively. The already impressive fleet of electric vehicles in China is set to expand as well. The Chinese government aims to have 5 million EVs on the roads by 2020.

Given that China’s electric grid runs primarily on coal, this transition to EVs is not as green as it seems. When accounting for emissions from electrical consumption, Greenpeace notes that both electric cars and traditional cars in China have similar “CO₂ emissions and PM2.5 levels per kilometer driven.” Furthermore, the lithium-ion batteries used to power EVs require enormous amounts of energy to produce, up to twice as much as is needed for manufacturing a standard combustion vehicle.

Other Types of Greenhouse Gas Emissions

Like all countries, China’s greenhouse gas emissions are not limited to carbon dioxide. Methane (CH4), nitrous oxide (N2O), and fluorinated gases collectively account for nearly 17.5 percent of the country’s total emissions in 2018. This breakdown roughly corresponds to global emission averages.

These greenhouse gases have the potential to compound the environmental stress created by carbon dioxide. Methane is capable of trapping 25 times more heat in the atmosphere than carbon dioxide. One pound of nitrous oxide has 300 times the warming effect of one pound of carbon dioxide.

As China has developed, its emissions of nitrous oxide and methane have skyrocketed. According to the PBL Netherlands Environmental Assessment Agency (PBL NEAA), China was responsible for 16.2 percent of global methane emissions (1.6 billion tons) and 14.5 percent of N2O emissions (410 million tons) in 2018. On both fronts, China’s emissions surpassed those of India, France, Germany, and Russia combined.

CH4 is mainly produced by transporting and distributing energy sources, raising livestock, and managing wastewater and landfills. In 2018, 30 percent of China’s CH4 emissions came from its energy sectors, such as coal mining and the transportation of gases. Although Beijing enacted new regulations in 2010 to curb methane emissions from coal mines, a 2019 study found that China’s total CH4 emissions continued to increase between 2010 and 2015. In addition to the energy sector, 38.2 percent of the methane emissions resulted from agricultural activities. In the US, energy-related industries contributed to 43.7 percent of the country’s methane emissions in 2016, and agriculture contributed 34.9 percent.

China’s agriculture-related emissions are largely a byproduct of rice cultivation, which made up 22 percent of its agricultural methane emissions in 2018.⁵ Rice cultivation in Japan is likewise responsible for one-third of these emissions. As the world’s largest producer of beef, most of the agricultural methane released in the US comes from livestock instead.

The agricultural and energy sectors are also the primary sources of N2O emissions. Nitrous oxide is mainly a consequence of agricultural soil management, such as fertilizer, as well as other industrial activities. In 2017, the agricultural industry is the leading emitter of N2O in China, making up 73.7 percent of its emissions. By comparison, agricultural activities in India are responsible for 76.9 percent of its N2O emissions. 

A Leader in Tackling Global Emissions

In recent years, China has taken a more active role in tackling global emissions. Beginning with its participation in the non-binding 2009 Copenhagen Accord and continuing to its ratification of the 2016 Paris Agreement, China is now positioned to help lead the charge against climate change. China’s ongoing commitment stands in contrast to that of the US, which announced its withdrawal from the Paris Agreement in August 2017. President Xi Jinping has since emphasized that China is now “guiding international cooperation to respond to climate change.” Shortly after commencing his second term as president, Xi created the Ministry of Ecological Environment. The new ministry replaced the Ministry of Environmental Protection and was charged with leading the country’s battle against emissions.

It is important to note that China has pledged to reduce carbon emission intensity, not impose a firm emissions ceiling. Carbon intensity measures the amount of carbon released per dollar of economic activity. As such, total emission levels could continue to climb if economic growth outpaces emissions. This has been the case with many OECD countries, where their emissions intensity has dropped but overall emission levels have either continued to grow or plateaued.

The Chinese government announced in March 2018 that it had achieved its Copenhagen emission reduction targets for 2020, which included reducing carbon intensity by 40 to 45 percent and raising the share of non-fossil fuel energy sources to 15 percent. According to Beijing, this achievement was largely due to the success of the carbon emissions trading system that was formalized in 2011. While undoubtedly a milestone, China’s carbon trading system is far from complete. The scheme is currently localized to the energy sector. Efforts to establish a national emissions cap and trade system have been delayed due to multiple technical problems, including a lack of reliable emissions data.

As China looks to reduce its emissions, it has actively pursued developing renewable energy sources. Learn more about China’s current energy make-up and its transition away from fossil fuels.

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In order to boost alternative energy usage, Beijing pledged to install “340 gigawatts (GW) of hydropower capacity, 210 GW of wind and 110 GW of solar by 2020.” Nuclear energy is also part of China’s plan to reduce greenhouse emissions. The 13th Five-Year Plan stipulates a 16.5 percent annual increase in nuclear power capacity between 2015 and 2020. In 2018, China accounted for 45 percent of the global growth in renewable power generation, more than the entire OECD combined. As China continues to increase the share of renewable energy, it is expected to surpass the 15 percent target set in the Copenhagen accord.⁶

An additional push may be needed if China is going to hit the targets set by the Paris Agreement. One of the goals of the agreement is to keep the global temperature rise in the 21^st century under two degrees Celsius above pre-industrial levels. It is estimated that China will need to increase its target for non-fossil fuel consumption from its current target of 15 percent to 26 percent by 2020 to meet this goal.

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Overview of China’s health care coverage

China has made significant strides toward providing universal health care coverage to its citizens. At the turn of the century, only one in every five Chinese had some form of health care coverage. A little over a decade later, nearly 95 percent of the population – around 1.25 billion people – was covered. While China does not have universal coverage, it has a lower uninsured rate than the United States, where almost 9 percent of people are without coverage.

China’s centralized health care system has undergone several transitions, including the introduction of “barefoot doctors” in the 1960s. Largely composed of peasants that received short but intensive medical training, these doctors traveled throughout rural China and provided virtually free basic medical services to much of the country’s population. Care provided by the barefoot doctors contributed to a significant rise in life expectancy and a drop in the infant mortality rate.

During the economic reforms of the late 1970s and 1980s, barefoot doctors were abandoned in favor of a market-based health care system. The new system was stymied by financial constraints and ultimately resulted in declining health coverage and widespread public frustration. The 2003 Severe Acute Respiratory Syndrome Virus (SARS) outbreak further exposed the weaknesses of the existing system and galvanized Beijing to initiate much-needed health care reforms.

Reforms began in earnest in 2006, when then-President Hu Jintao declared his vision “for everyone to enjoy basic health care services.” Three years later, health care coverage had greatly expanded as reforms were launched nationwide in accordance with the Guidelines for Deepening the Reform of the Healthcare System. While these reforms have significantly improved access to quality health care, systemic issues continue to plague health care in China.

The outbreak of the novel coronavirus in 2019-2020 exposed additional shortcomings in China’s health care system. Hospitals in Wuhan, the epicenter of the outbreak, were quickly overwhelmed with cases. China was forced to build emergency hospitals to handle the flood of patients, and will likely need to consider making significant changes to its healthcare system to better prepare the country for future crises. China is not alone in this regard. In the wake of the coronavirus pandemic, many countries around the world will need to upgrade their capacity to prevent and manage future large-scale outbreaks.

Currently, there are three public health insurance options available to Chinese citizens. Two of the plans – the Urban Employee Basic Medical Insurance and the Urban Resident Basic Medical Insurance – cover urban dwellers. A third scheme, the New Cooperative Medical Service, applies to rural residents.

Affordability of China’s health care systems

The existing public plans available to Chinese only reimburse a portion of medical fees, which often leaves individuals saddled with a significant amount of out-of-pocket (OOP) payments. High OOP expenses have been shown to financially stress households, which can result in impoverishment and negatively affect health outcomes.

Roughly 29 percent of health care expenses in China were paid by individuals in 2018.¹ A combination of government funding (28 percent), as well as public and private insurance (44 percent), covers the rest. Although the proportion of OOP fees in China has declined since the early 2000s, when they made up 60 percent of total health care expenses, it is still higher than those paid by some of China’s wealthy neighbors. For example, individuals in Japan paid only 12.8 percent of the health care fees in 2018. OOP costs are also generally lower among developed European economies. In Germany and France, citizens paid only 12.3 and 9.3 percent, respectively.

One of the most significant drivers of China’s high OOP expenditure is rooted in how Chinese hospitals turn a profit. Traditionally, public hospitals would charge patients for the number of services provided and the amount of prescriptions given. Until 2017, hospitals were also allowed to supplement their revenues by selling drugs with a mark-up of up to 15 percent. As a result of this system, patients were often charged with fees for unnecessary services and prescriptions. By 2015, spending on prescriptions reached 40 percent of total health expenditure in China, significantly higher than the OECD average of 20 percent.

The costs carried by Chinese citizens vary considerably. A 2014 study conducted in the urban and rural communities in Suzhou revealed that residents under the rural plan were only reimbursed for 57 percent of their medical fees – far less than the roughly 70 percent reimbursement rate granted under China’s urban health care plans.

This structural economic barrier has contributed to growing inequality. Citizens insured under the Urban Employee Basic Medical Insurance utilize health care services at a higher rate than their rural counterparts. This has contributed to unbalanced health outcomes between urban and rural populations. For instance, residents of Beijing enjoyed an average life expectancy of 80 years in 2010 – 8 years more than in Xinjiang and 12 years more than in Tibet.

Burdensome health care expenses have been a leading factor in the growing inequality between China’s rich and poor. Between 2005 and 2015, household expenditures on health care contributed to a widening of China’s poverty gap at a rate greater than that of Thailand and South Africa. As a result, some have leaned on medical loans to repay hospital bills. By comparison, nations with world-class health care systems, such as Taiwan, often provide generous support to the underprivileged. Taiwan exempts all co-payments and co-insurance for lower income patients, as well as for those suffering from certain catastrophic illnesses.

Wealthier Chinese are increasingly turning to private insurance, which provides better coverage with lower co-payments than public insurance. Accordingly, the private insurance market in China has witnessed rapid growth. Between just 2014 and 2015, the market size jumped from $220 billion to $349 billion. By 2020, the industry is expected to balloon to $730 billion.

Beijing is looking for ways to curb OOP costs. As part of Healthy China 2030, Beijing has laid out plans to reduce OOP payments from 30 percent of total health care expenditure in 2016 to 25 percent by 2030. Chinese authorities have also recently undertaken initiatives to directly negotiate certain drug prices with international pharmaceutical companies. In addition to instructing public hospitals to end the practice of drug price mark-ups in 2017, China’s State Council announced that public hospitals will become nonprofits by 2020.

Efforts to alleviate OOP payments could experience setbacks, however, as some local governments are already struggling to foot the bill for existing health care plans. In 2016, public insurance plans in 108 out of 225 municipalities (the majority of which are in less-developed regions) were in deficit. This is largely a symptom of rising health care costs. Between 2000 and 2015, annual per capita health care expenditure in China grew from $130 to $762 — a 6-fold increase.  Comparatively, health care costs in the US and Denmark only doubled over the same period.

To better manage public expenditure, Beijing is looking to implement a new system where government health insurance provides only a fixed amount of reimbursement to hospitals per disease. This scheme, known as diagnosis-related groups, could discourage unnecessary services and cap fees. Although this payment structure is widely used in nations such as the US and Japan, the benefits of this structure have not yet been proven in China. The system has been piloted in select hospitals in Beijing and a handful of southern cities since 2017, and the government announced it would expand the pilot to 30 cities in 2020.

Accessing health care in China

In addition to insurance coverage, adequate health care facilities and personnel are equally necessary to ensure positive health outcomes. To that end, Beijing has made significant headway in leveraging  its economic growth toward expanding the availability of medical care.

Hospitals are the main channel through which Chinese citizens receive health care, and hospital-based resources have expanded accordingly. The number of hospital beds per 1,000 residents more than doubled from 1.5 in 1970 to 4.3 by 2017. While this ratio surpasses that of the US (2.8 beds) and Canada (2.5 beds), it is significantly lower than the OECD average of 4.7 beds per 1,000 residents. By comparison, Japan and Korea boast some of the highest ratios in the world, at 13.1 and 12.3 beds per 1,000 people, respectively.

China has also devoted resources toward specific health sectors, such as pre- and postnatal care. The percentage of pregnant women receiving prenatal care in China increased from 69.7 percent in 1992 to 96.2 percent in 2015. This far outstrips the global average of 84.6 percent. Almost 100 percent of births in China were attended by skilled medical personnel, whereas the global average stood at just 80 percent in 2014. Expecting Chinese mothers also receive a maternity leave of 98 days — the same amount of time granted in Japan and Germany.

Aside from maternal care, China has also expanded its capacity in non-western medicine. The number of hospitals specializing in Traditional Chinese Medicine (TCM) increased from 447 in 1978 to 3,977 in 2018. TCM may be primed to become a more integral component of China’s health care landscape; a 2016 white paper touted it as “an important component of economic and social development.”

Paid maternity leave in China typically ranges from 3 to 6 months. Learn more about women’s health and other gender issues in China.

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Health care personnel in China have experienced similar levels of growth.  The number of physicians grew from 0.71 per 1,000 inhabitants in 1980 to 2.01 in 2017. This is lower than the physician-to-population ratio in Germany (4.25) and the US (2.61), but is on par with Turkey (1.87).

Yet, due to stark pay differences between general practitioners and hospital-based specialists, as well as patients’ preference for the latter, many newly-trained physicians become specialists. This has left China with a shortage of general practitioners. There were only 189,000 general practitioners in China in 2015, accounting for only 6.2 percent of all Chinese physicians. This amounts to roughly one general practitioner per 7,200 people, which is significantly below the World Health Organization’s recommendation of one general practitioner per 1,500 to 2,000 people.² As a result, 650 million Chinese were left without access to a general practitioner in 2017.

There are reports of hospital-based specialists being forced to see as many as 200 patients a day, which  not only exacerbates wait times, but has also led to the rise of a black market for appointment bookings. Scalpers have exploited this shortage by illegally selling their appointment slots at a price 10 to 20 times higher than the original booking fee. As a point of comparison, a 2013 survey by the American Academy of Family Physicians revealed that US physicians typically see under 20 patients per day.

Beijing is working to increase the number of general practitioners. As of 2018, there were only 1.5 qualified generalists per 10,000 people, but the government is taking strides to raise this number to 2-3 generalists per 10,000 people by 2020. This number is set to increase to 5 generalists per 10,000 people by 2030. In a move to reduce the current reliance on hospitals, China is also looking to increase the number of family doctors, who can provide health care services to patients in facilities outside of hospitals.  

Financing for China’s health care institutions partially depends on local government funding, which contributes to an uneven distribution of health care resources between richer urban centers and less-developed rural villages. For instance, the number of village health clinics increased by only 21 percent from 2003 to 2019, whereas the number of hospitals grew by 91 percent over the same period.

This disparity has had cascading effects on health outcomes. The mortality rate for many major diseases is higher in rural areas than in urban areas. The mortality rate for heart disease was 162 per 100,000 people in rural areas in 2018, compared to only 146 per 100,000 people in urban centers. Notably, the mortality rate for heart disease in both rural and urban China was still lower than that of the US, which stood at 166 per 100,000 people.

China’s disabled population faces challenges when seeking appropriate care, and the availability of health care services for disabled persons can differ dramatically at the provincial level. The inland province of Guizhou, for instance, does not explicitly stipulate full reimbursement of all rehabilitation service fees for disabled children under six, a health care benefit that is guaranteed in the more developed coastal province of Jiangsu.

Mental health patients experience similar challenges. According to the Chinese National Health and Family Planning Commission, 5.9 million people were registered with severe mental disorders in 2018. In 2015, there were only 24 beds per 100,000 patients in mental hospitals within China. While this is a considerable increase from only 14 beds in 2011 it is still behind the US (30 per 100,000) and far behind South Korea (110 per 100,000).³Figures for the US and South Korea are from 2016, while figures for China are from 2015.[/state]

China’s future health care challenges

As the standard of living and life expectancy have risen, new challenges have emerged. In 2019, there were 176 million people aged 65 years and older, making up 12.6 percent of the population. By 2045, that number is expected to reach 26 percent — as high as in present-day Japan. As a result, the incidence of chronic illness and age-related disease has soared.

While care for the elderly has traditionally been provided by family members, the rapidly aging population accompanied by a lower birth rate has rendered this system increasingly impractical, and China has been slow to provide public alternatives. As of 2018, China’s nursing homes only offered 29.1 beds per 1,000 elderly citizens. There were 51 beds per 1,000 elderly citizens in Australia and 44 per 1,000 in the UK in the same year. In addition, China’s nursing homes are often not designed to give optimal elderly care, as few staff receive regular training.

Diseases associated with aging are also on the rise. In 2017, Alzheimer’s disease was the fifth largest cause of premature death in China, marking an increase from ten years prior when it was the 15th largest cause of premature death. While nearly 1 million Chinese are diagnosed with Alzheimer’s disease every year, twice the rate of the US, there are limited numbers of beds for specialized Alzheimer’s care in China. In 2017, there were only a few hundred beds in all of China. A year later, Shanghai reportedly upgraded nearly 1,200 beds for Alzheimer patients across the city. Still, China is expected to have half of the world’s patients suffering from Alzheimer’s disease by 2050 (45 million people), making Alzheimer’s one of the biggest challenges that the Chinese health system will face in the coming decades.

China must also wrestle with growing challenges from chronic illnesses such as heart disease, cancer, respiratory diseases, and diabetes. Of the 422 million adults with chronic illness globally in 2016, an estimated 129.3 million (31 percent) were Chinese. Due to increased inactivity and growing obesity rates, 30 percent of global adult diabetes cases in 2014 were in China. Cancer rates are also on the rise. In particular, breast cancer diagnoses grew by 3.5 percent per year between 2000 and 2013, compared to a 0.4 percent drop each year over the same period in the US.

China’s population is growing old at a faster rate than almost all other countries. This ongoing demographic shift presents an array of social and economic challenges for China. Learn more about China’s aging population.

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In response to these challenges, China has turned toward technology. Both Tencent and Alibaba have made efforts to invest in digital health platforms, including artificial intelligence (AI)-assisted diagnostic tools and online consultation services. As of 2017, over 38,000 medical facilities in China have WeChat accounts. Additionally, 60 percent of those facilities provide online consultations, with 35 percent supporting the payment of medical bills through WeChat pay. During the outbreak of the novel coronavirus in early 2020, Chinese technology giants – like Alibaba, Baidu, Tencent, and Huawei – launched new AI and cloud-based technologies aimed at tracking and diagnosing cases and finding a vaccine. Other nations have also leaned on IT to enhance health care coverage. Taiwan, for example, uses a cloud-based electronic patient records system, which enables it to track and monitor health care usage and disease outbreaks in near real time.

China is also taking steps to enhance its medical development. As a testament to Beijing’s growing global biomedical manufacturing capabilities, Chinese drug manufacturers received approval from the US Food and Drug Administration (FDA) for 38 generic drugs in 2017, and over 20 new Chinese-made drugs are seeking to gain FDA approval in the next 5 years.

Nonetheless, key limitations persist within the pharmaceutical industry, such as long wait times for domestic drug approval and inconsistent drug coverage in its national reimbursement program.  Events like the recent July 2018 vaccine scandal – during which hundreds of thousands of vaccines for Chinese children were found to be faulty – have caused widespread suspicion about the quality of China’s bio-medical products.

The post Is China’s Health Care Meeting the Needs of its People? appeared first on ChinaPower Project.

China’s constitution guarantees women “equal rights with men in all spheres of life,” and over the last several decades, women in China have enjoyed some notable gains. Life expectancy and literacy rates, for instance, have risen as China’s economy has developed. This progress, however, has been outpaced by the rest of the world. China’s ranking in the index fell sharply from 63^rd out of 115 countries in 2006 to 103^rd out of 149 countries in 2018.

Chinese Women’s Health Prospects

Access to healthcare and positive health outcomes are key measures of gender equality. Similar to other developing countries, as China has grown richer its citizens have enjoyed a higher life expectancy. Chinese women born in 2016 can expect to live 77.8 years, an increase of 4.2 years from 2000 and 9.5 years from 1980. While female life expectancy in China has surpassed the global average since 1970, it still falls short of high-income neighbors like Japan (87.1 years) and South Korea (85.2 years).

Improvements in health outcomes have primarily been driven by government initiatives. Soon after taking power in 1949, the Communist Party created a state-driven health service that was offered at little to no cost for its citizens. These services were transformed into a market-based healthcare system in the 1980s. In 2009, President Hu Jintao initiated comprehensive healthcare reforms to enable “everyone to enjoy basic healthcare services.” This effort has largely succeeded, which is all the more impressive given China’s massive population. As of 2012, 95 percent of Chinese citizens receive a modest level of healthcare coverage.

Beijing has also instituted programs specifically designed for women. These include the National Program for Women’s Development 2001-2010 and the subsequent National Program for Women’s Development 2011-2020 – both of which increased access to preventive screenings, standard reproductive healthcare services, and health and nutritional education. Such measures have delivered tangible gains. A survey issued by the National Bureau of Statistics revealed that in 2013 the number of women undergoing screenings for general diseases rose to 68.7 percent, a 7.5 percentage increase from 2010.

China has made significant strides in improving standards of living and health outcomes. Learn more about how China’s ongoing development compares to other countries around the world.

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Other health indicators, such as the maternal mortality rate, also reflect positive change. According to the World Bank, China has dramatically lowered its maternal mortality ratio from 97 deaths per 100,000 live births in 1990 to only 27 deaths in 2015. This ratio surpasses those found in other large developing economies like Brazil (44:100,000) and India (174:100,000). OECD countries average 14 deaths per 100,000 live births, with Finland’s ratio of 3:100,000 leading the way.

China’s sex ratio at birth is the most imbalanced in the world, with only 87 girls born per 100 boys.

China has also taken strides to improve postnatal care. A law introduced by the State Council in 2012 increased paid maternity leave to 14 weeks, and in some provinces, an entire year. In 2016, China further extended maternity leave by an additional one to three months (depending on province). The length of maternity leave in China is now comparable to the paid leave offered by many wealthy European countries, and it is a significant improvement over the US, which has no federally mandated leave.

While China has achieved a higher life expectancy and better health outcomes for women, it still suffers from an imbalanced sex ratio at birth. The lingering effects of the One-Child Policy and the longstanding cultural “son bias” have contributed to a female-to-male ratio of 87:100 at birth, ranking China last out of 149 countries surveyed by the WEF.

The sex ratio at birth is even more pronounced in rural areas. China’s 2010 census revealed that in Anhui, for instance, the ratio was less than 80 females to 100 males. However, this ratio may not fully capture China’s sex ratio, as some women who were hidden from authorities at birth have been added to official records as they age and require social services, healthcare, and education.

China now faces the challenge of a rising population of young unmarried men. The number of single men is expected to grow to 30 million in 2020. This imbalance has been associated with negative socio-economic consequences, including a declining labor force and an increase in human trafficking. Over time, however, China’s sex ratio is expected to level out. According to the United Nations, China’s sex ratio is projected to reach 106 males per 100 females by 2050.

Chinese Women’s Access to Education

Across the globe, women face significant educational disadvantages. Women often receive less schooling than men, which limits their economic prospects and has been linked with higher rates of early pregnancy.

China has made a concerted effort to boost access to education for its entire population. The 1986 Nine-Year Compulsory Education Law and the 1995 Education Law of the People’s Republic of China established equal access to enrollment, degrees, and study abroad programs. These measures have contributed to a rise in the literacy rate of women from 86.5 percent in 2000 to 92.7 percent in 2017. While noteworthy, this still places China in the lower half of global rankings, well behind highly developed economies where literacy is over 99 percent.

Over time, China’s compulsory education laws are likely to further improve literacy rates. The mean years of schooling for women in China grew from 4.8 years in 1990 to 7.6 in 2017, and primary school enrollment is nearly universal. The vast majority of young Chinese women (95.9 percent) move on to secondary schools. These levels of enrollment are much higher than their respective global averages – 88.3 percent for primary education and 75.9 percent for secondary education.

Since 2008, Chinese women have been more likely than men to continue onto tertiary and postgraduate education. According to the Ministry of Education, women constituted 52.5 percent of undergraduate students in China’s colleges and universities in 2017. The WEF ranks China as number 1 in gender balance for tertiary education.

At China’s top universities, gender ratios still skew toward men. In 2018, the female-to-male ratio at Peking University was 48 to 52, while the ratio at Tsinghua University was lower at 34 to 66. In contrast, female students are more likely to study abroad than their male peers. In 2014, women accounted for 51 percent of Chinese students studying in the US and 63 percent of those in the UK.

China’s urban-rural disparities further affect equal access to education. A 2016 report by the China Social Welfare Foundation found that while 96.1 percent of rural girls had enrolled in primary education, only 79.3 percent moved on to secondary levels. Some note that this drop is due to lower parental expectations and fewer employment opportunities for rural women.

Beijing is working to reduce the gap between rural and urban girls. In Sichuan province, for instance, efforts to elevate the quality of education include providing libraries, multimedia classrooms, and improved school infrastructure to rural elementary schools. Multimedia classrooms have also been utilized in the Ningxia and Gansu provinces, where schools have introduced livestreamed lessons to allow resource-sharing between urban and rural students.

Economic Opportunities for Women in China

China’s economic growth has improved overall prosperity, but Chinese women have benefited less from these gains. Throughout the 1980s, female participation in the labor force was high, averaging around 80 percent. By 2018, however, female workforce participation had dropped to 68.6 percent, only slightly higher than the US (66.1 percent) and roughly equal to Japan (68.7 percent). This decreasing trend runs contrary to other major developing countries, like Brazil and South Africa, which witnessed increased female participation over the same period.

According to Human Rights Watch, 19 percent of the Chinese national civic service jobs posted in 2018 included requirements such as “men only,” “men preferred,” or “suitable for men.”

The reasons for this sharp decline are multifaceted, but China’s changing social structure and economic modernization are commonly cited as primary factors. For instance, the restructuring of China’s state-owned enterprises in the 1990s had particularly negative consequences for women. Although aimed at boosting productivity and efficiency, the privatization process precipitated layoffs of low-skilled, and often female, workers.

China’s development has also disproportionately benefited men. The income gap between urban male and female workers increased from 15 percent in 1990 to 25 percent in 2000. This disparity has persisted over the last two decades. A 2018 poll reported that Chinese women on average earn 22 percent less than their male coworkers.

Given these factors, the WEF unsurprisingly ranks China 74^th globally in wage equality, behind the US at 8^th and the UK at 64^th. South Korea, which has a GNI per capita more than twice that of China, is riddled with even greater wage inequality than China. Ranked in the bottom fifth globally in terms of wage equality, South Korean women earned a shocking $26,725 per capita¹ less than men in 2017. In the same year, Chinese women suffered a wage discrepancy of roughly $6,000.

Other factors are also at work. Around 50 percent of Chinese women work in secretarial, sales, and accounting positions, which typically pay less than the sales, technology, and manufacturing positions that employ 58 percent of Chinese men. The coming wave of  intelligent automation may further divide the labor force. The WEF reported in late 2018 that there is a considerable risk that growing demand for AI skills could “perpetuate — and even widen — the sort of gender and equity gaps that often impact the technology sector.”

The noticeable lack of women in managerial positions further exacerbates this issue. According to the WEF, only 17 percent of senior managers, officials, and legislators in China are women. These factors are not unique to China, as only 29 percent of managerial positions in Germany are held by women. In Japan, it is a meager 13 percent.

Gender Inequality in China: A Conversation with Leta Hong Fincher

Additional roadblocks perpetuate these inequalities. For instance, the official retirement age for Chinese women is at least five years earlier than men, which reduces their potential earnings. Discrimination extends to the hiring process as well. According to Human Rights Watch, 19 percent of the Chinese national civic service jobs posted in 2018 included requirements such as “men only,” “men preferred,” or “suitable for men.”

Entrepreneurship stands as one area where Chinese women take a leading role. A 2017 WEF report noted that women set up 55 percent of new internet companies in China, and more than a quarter of all the entrepreneurs in the country were women. The 2018 Mastercard Index of Women Entrepreneurs also ranks China 29^th out of more than 60 countries surveyed, just behind countries like Germany (23^rd) and France (24^th).

Women’s Political Participation in China

Women continue to face barriers in terms of political empowerment around the world. According to the World Bank, only 23.9 percent of parliamentary seats are held by women globally. Women in China face comparably low levels of representation. The WEF ranks China 78^th in terms of the political involvement of women, below similarly populous India (19^th), but ahead of the US (98^th). Iceland, with 38.1 percent of seats in its parliament occupied by women, ranks first globally.

Since 1949, China has had only six female members on the 25-member Politburo.

While the government officially supports gender equality, large disparities in political representation remain. In 2017, female membership in the CCP was roughly one quarter of total party membership. Similarly, only 24.9 percent of representatives in the 13^th session of the National People’s Congress hosted in 2018 were women. No woman has ever sat on China’s Politburo Standing Committee, nor has any woman ever held the presidency. Since 1949, China has had only six female members on the 25-member Politburo.²

Beijing has introduced some measures to encourage greater political participation among women. With assistance from the United Nations, the All-China Women’s Federation supported training programs on leadership and political participation for rural women from 2011 to 2015.

Such efforts may fall short in facilitating women’s political participation. China’s 2018 ranking in the WEF’s Global Gender Gap report has fallen 26 places since 2006, placing it at 78^th out of 149 countries. Three of the G-7 countries — the US, Japan, and Germany — witnessed a similar decline. In contrast, some countries rose in the rankings, such as Chile, which jumped from 56^th place in 2006 to 31^st in 2018.

Chinese women have become more active in asserting their rights through protest, but outlets for activism are increasingly difficult to find. China’s recent participation in the ‘Me Too’ movement, in which Chinese women campaigned against sexual abuses and exploitation in universities and workplaces, was met with swift censorship. The movement’s hashtag on China’s popular microblogging website, Weibo, was removed by censors shortly after it gained traction online.

Previous instances of activism also faced pushback from the government. The Feminist Five, a group of five Chinese women famous for their social activism, were arrested in 2015 over plans to protest sexual harassment in subways. They are still labeled “criminal suspects” despite their release from prison.

The post Do Women in China Face Greater Inequality than Women Elsewhere? appeared first on ChinaPower Project.