Communicable disease control in China: From Mao to now

China’s progress on communicable disease control (CDC) in the 30 years after establishment of the People’s Republic in 1949 is widely regarded as remarkable. Life expectancy soared by around 30 years, infant mortality plummeted and smallpox, sexually transmitted diseases and many other infections were either eliminated or decreased massively in incidence, largely as a result of CDC. By the mid-1970s, China was already undergoing the epidemiologic transition, years ahead of other nations of similar economic status. These early successes can be attributed to population mobilization, mass campaigns and a focus on sanitation, hygiene, clean water and clean delivery, and occurred despite political instability and slow economic progress. The 10-year Cultural Revolution from 1966 brought many hardships, but also clinical care and continuing public health programs to the masses through community-funded medical schemes and the establishment of community-based health workers. These people-focused approaches broke down with China’s market reforms from 1980. Village doctors turned to private practice as community funding ceased, and the attention paid to rural public health declined. CDC relied on vertical programs, some of them successful (such as elimination of lymphatic filariasis and child immunisation), but others (such as control of schistosomiasis and tuberculosis) demonstrating only intermittent progress due to failed strategies or reliance on support by the poorest governments and health workers, who could not or would not collaborate. In addition, China’s laissez-faire approach to public health placed it at great risk, as evidenced by the outbreak in 2003 of the Severe Acute Respiratory Syndrome. Since then, major changes to disease reporting, the priority given to CDC including through major new domestic resources and reform of China’s health system offer encouragement for CDC. While decentralized funding and varying quality diagnosis, reporting and treatment of infectious diseases remain major challenges, national priority on CDC in China is high.