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Performance and the Chinese Political System: A Preliminary Assessment of Education and Health Policies

Published online by Cambridge University Press:  17 February 2009

David M. Lampton
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Extract

Having a number of studies on what Kenneth Dolbeare has called “fundamental policies” in the education and health fields, we are now able to make a preliminary assessment of how the Chinese political system has performed along three important dimensions. With what degree of equity have services been provided across provinces? What have been the aggregate growth trends in education and health and what have been the long- and short-term costs of these patterns? Finally, what impact have the programmes had on the problems they were designed to overcome?

Type
Research Article
Information
The China Quarterly , Volume 75 , September 1978 , pp. 509 - 539
Copyright
Copyright © The China Quarterly 1978

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References

* I would like to thank Mr. Keun Sang Lee for his help in collecting statistical data. In addition, I have profited from the collective comments of many colleagues at Ohio State University and the University of Michigan's Center for Chinese Studies. Special thanks are due to Professors Ted Gurr, Joel Glassman and Lawrence Baum. The generous funding of the Graduate School of Ohio State University has been important to this enterprise. For those errors of fact or interpretation which may remain, I am responsible.

1. Dolbeare, Kenneth M., “The impact of public policy,” Cornelius, Cotter (ed.), Political Science Annual, Vol. 5 (Indianapolis: Bobbs-Merrill, 1974).Google Scholar

2. G. William Skinner has further separated the system into marketing areas. See his, “Marketing and social structure in rural China.” Parts I–III appear in The Journal of Asian Studies, running for three successive numbers, starting with, Vol. 24, No. 1 (11 1964), pp. 3–43.CrossRefGoogle Scholar

3. Hsiao, I-chou, Kwangsi Daily, 5 10 1955.Google Scholar

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8. For example, see Seybolt, Peter J., Revolutionary Education in China (New York: International Arts and Sciences Press, 1973)Google Scholar; Stewart, Fraser, Chinese Communist Education (Nashville: Vanderbilt University Press, 1965)Google Scholar; Sidel, Victor W. and Ruth, Sidel, Serve the People (New York: The Josiah Macy, Jr. Foundation, 1973).Google Scholar

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12. This is a slightly different kind of output indicator than will be used in the analysis of health policy. We are measuring the clients of institutions, rather than the institutions themselves. This is necessary because more direct institutional measures, like teachers and schools, are such variable commodities. Sharkansky uses enrolments as his output measure as well.Google Scholar

13. For example, see: Gardner, John, “Educated youth and urban-rural inequalities, 1958–66”, in Lewis, John W. (ed.), The City in Communist China (Stanford: Stanford University Press, 1971), pp. 235–86;Google Scholar see also, “Recent developments in school education In China,” China Topics, YB 567 (06 1971), p. 2.Google Scholar

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15. National level aggregate hospital bed data are available for both the 1950s and the 1970s.Google Scholar

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21. We have used grain output per capita as our index of provincial wealth for 1949 because, at this time, education was funded largely through revenue derived from the agricultural base. By the mid-1950s, the industrial base carried most of the burden; we therefore switched our measure of provincial wealth to gross value of industrial output per capita.Google Scholar

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23. We chose 1949 for the obvious reason that it was the starting point for the regime. 1955 was selected because relatively complete data were available for this year and it was the year in which major programmes of agricultural co-operation were forging ahead. 1957 was selected because it was the last year before the statistical system broke down because of “the Great Leap Forward.”Google Scholar

24. Statistical techniques to determine relative degrees of dispersion are of dubious reliability with such skewed data sets and such slight overlap between provinces for which we have data. However, I have run standard deviation tests for all relevant tables. The results of those tests are not at variance with the conclusions presented.Google Scholar

25. Professor Joel Glassman points out that the percentage of school-age children enrolled would be a preferable output indicator for all time periods. This is true, only if one assumes there are significant differences in the age structures of the various provincial-level units. More to the point, we have no systematic data on the percentage of school-age children enrolled by province for the 1950s.Google Scholar

26. For more see Oksenberg, Michel C., “The Chinese policy process and the public health issue: an arena approach,” Studies in Comparative Communism, Vol. 7, No. 4 (1974), pp. 375–408;CrossRefGoogle Scholar See also, Lampton, David M., “Policy arenas and the study of Chinese politics,” Studies in Comparative Communism, Vol. 7, No. 4 (1974), pp. 409–13.CrossRefGoogle Scholar

27. See Tables 5, 6, and 7. Standard deviation tests were run on these secondary enrolment figures, but the results were contradictory, depending on whether or not the analyst calculated the deviation on just those provinces which appeared only in all three tables (5, 6, and 7), or on all provinces appearing in each table.Google Scholar

28. Peking's position in Tables 5 and 6 would seem to argue against this generalization. This anomaly is accounted for by the fact that a 1957 population figure was used to calculate the 1955 enrolment percentage, thereby under-estimating Peking's progress.Google Scholar

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30. See China Topics, p. 4.Google Scholar

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32. In 1950 5·2 per cent of China's population was in primary school, while 6·9 per cent of Indonesia's population and 5·1 per cent of India's were so enrolled. By 1972 14·4 per cent of China's population was in elementary school while 11 per cent of Indonesia's was so enrolled in 1970. In 1973 India had an enrolment percentage of 11·9 per cent. For documentation, see Statistical Yearbook 1970 (Belgium: UNESCO, 1971), p. 190;Google ScholarWorld Survey of Education, Vol. II (New York: UNESCO, 1958), p. 544;Google Scholar India: A Statistical Outline, 1973 (Calcutta: Oxford and IBH Publishing Company, 1973), p. 134; Statistical Yearbook 1972 (Belgium: UNESCO, 1973), p. 141Google Scholar. The percentage of population enrolled in school was derived from population figures in Demographic Yearbook (New York: United Nations), years 1961 (pp. 132–33), 1970 (p. 129) and 1973 (p. 103). One should note that the population and enrolment data are of questionable exactitude and that, in both China and India, primary education is of variable duration.Google Scholar

33. Professor Daniel Tretiak has raised an important question. Is it not possible that while the percentage of population enrolled in higher education is small that the absolute numbers are sufficient to meet China's present needs? There is really no way to say, without an accepted evaluation of China's needs. Suffice it to say, there are many in China who feel such enrolment levels represent an under-investment in higher education.Google Scholar

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35. The absence of homogeneity in sample composition makes statistical measures of dispersion difficult to use reliably.Google Scholar

36. It is quite likely that with such a small sample of provincial-level units that we have not fully tapped the range of variation for 1949.Google Scholar

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39. Ibid. p. 32.

40. In 1973 the Chinese reported, “The number of hospital beds in the countryside has increased to 59 per cent of the total throughout the country as against 37 per cent in 1965,” Foreign Broadcast Information Service: Daily Report, People's Republic of China (FBIS), No. 133 (1973), p. B 7.Google Scholar

41. New China News Agency (NCNA), 8 04 1972. In Survey of China Mainland Press (SCMP), No. 5117, p. 165.Google Scholar

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43. Sidel and Sidel, Serve the People, pp. 65–66. The Sidels note that there were 10 hospitals with over 500 beds (assume 550 each), 13 municipal hospitals (assume 250 beds each), 20 district hospitals (assume 200 beds each), and three “others” (with a total of 1,200 beds, let us assume from the fragmentary data provided). This gives a combined total of 13,950 beds, not including sanatoria beds. With Peking's 1972 population of around 7 million, this would give a bed to population rato of 1.84 per thousand. My feeling is that the actual figure is higher than this.Google Scholar

44. For a detailed explanation of these plans see, Lampton, David M., The Politics of Medicine in ChinaGoogle Scholar. For more on the percentage of production brigades with co-operative health plans see, Lampton, David M., “Economics, politics, and the determinants of policy outcomes in China,” Australian and New Zealand Journal of Sociology, Vol. 12, No. 1 (1976), p. 44.CrossRefGoogle Scholar

45. For detailed analysis of the factors determining the stability of co-operative health programmes see, Lampton, David M., “Economics, politics, and the determinants of policy outcomes in China,” pp. 43–49.Google Scholar

46. Chin, Wei; Hupeh Provincial Service, 18 11 1972, SWB, FE/W701/A/1, 29 November 1972 noted that there had been difficulties with barefoot doctors and shortages of medicine, both of which contributed to the financial problems of some co-operative health programmes; Hainan Island Service, 19 August 1972, SWB, FE/4075/BII/7, 24 August 1972, noted, “Some communes and brigades have not sufficiently consolidated and perfected the system after putting it into effect, because they have not carried out regular checks and supervision.”Google Scholar

47. Anhwei Provincial Service, 22 August 1973; also, China Reconstructs, Vol. 21, No. 11 (1972), p. 6.Google Scholar

48. In 1950 India had 0·32 beds per 1,000 while China (1949) had 0·15. For Indian data see, Report of the Health Survey and Planning Committee, August 1959–October 1961, Vol. I (New Dehli: Government of India, Ministry of Health, 1961), p. 66Google Scholar. The population figure which was used to calculate the population-to-bed ratio is from Demographic Yearbook 1961, No. 13 (New York: United Nations, 1961), pp. 132–33. Figures include both public and private facilities.Google Scholar

49. We must note that 0·9 beds per thousand population is low by western standards. Even granting that the U.S. has over-built its hospital facilities, in 1968 the U.S. had an average of 13·5 beds per thousand population.Google Scholar

50. For Indonesian hospital bed data see, Statistical Pocketbook of Indonesia (Djakarta: Biro Pusat Statistik, 1958), pp. 34–35. See also Indonesia: Facts and Figures (Nugroho, Teroitan Pertjobaan), p. 195. These sources included both public and private beds.Google Scholar

51. Sharkansky, “Environment, policy, output and impact,” p. 63.Google Scholar

52. Ibid. p. 78.

53. Yen, Ta-k'ai, “Government work report on progress in Hopeh Province,” Hopeh Daily, 23 08 1957Google Scholar; see also, White, D. Gordon, “The politics of hsia-hsiang youth,” CQ, No. 59 (1974), p. 496.Google Scholar

54. Lewis, John W., “Commerce, education, and political development in T'angshan, 1956–69,” in Lewis, John W. (ed.), The City in Communist China (Stanford: Stanford University Press, 1971), pp. 165–73;Google Scholar see also, Richard, Baum, “Elite behaviour under conditions of stress: the lesson of the ‘Tang-ch'üan P'ai’ in the Cultural Revolution,” in Robert, Scalapino (ed.), Elites in the People's Republic of China (Seattle: University of Washington Press, 1972), p. 553.Google Scholar

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56. Schwartz, Benjamin I., “A personal view of some thoughts of Mao Tse-tung,” in Chalmers, Johnson (ed.), Ideology and Politics in Contemporary China (Seattle: University of Washington Press, 1973), pp. 359–60.Google Scholar

57. China News Summary, No. 567 (1975), p. 1.Google Scholar

58. Ch'en, C. C., “Public health in rural reconstruction at Ting Hsien,” Annual Report (01 1934), p. 10Google Scholar; see also, Chung-hua I-hsüeh Tsa-chih (The Chinese Medical Journal), Vol. 1, No. 2 (03 1975), p. 81.Google Scholar

59. Ibid. pp. 12–13.

60. Chung-hua I-hsüeh Tsa-chih (The Chinese Medical Journal), Vol. 1, No. 2 (1975), p. 91.Google Scholar

61. Ibid.

62. NCNA Domestic Service in Chinese, 1 June 1974, FBIS, No. 109 (1974), p. E 6. There is a contradictory figure in SWB, FE/W779/A/2, 12 June 1974. This figure, however, was not used because it was far lower than the rate Peking was claiming.Google Scholar

63. Tien-hsi, Cheng, “Schistosomiasis in Mainland China,” American Journal of Tropical Medicine and Hygiene, Vol. 20, No. 1 (January 1971), p. 48Google Scholar; Ho, E. and Tien, S., “The endemicity and periodicity of cholera in China,” The Chinese Medical Journal, No. 76 (March 1958), p. 274Google Scholar; see also, Sidel, and Sidel, , Serve the People, pp. 22–23.Google Scholar

64. NCNA, 13 October 1971, SWB, FE/W644/A/1, 20 10 1971.Google Scholar

65. Szechwan Provincial Service, 23 September 1972, SWB, FE/W694/A/1, 11 10 1972.Google Scholar

66. Annual Report of the Directorate General of Health Services, 1960 (DelhiCentral Bureau of Health Intelligence, 1960), p. 338. From 1961–72, the seventh pandemic of cholera spread over much of the world, involving India but, apparently, not China.Google Scholar

67. Annual Report of the Directorate General of Health Services, 1959, (Delhi: Central Bureau of Health Intelligence, 1959), p. 257.Google Scholar

68. Statistical Pocketbook of Indonesia 1958, p. 36. These data are from “selected areas,” which are not specified. I presume the data are from Java.Google Scholar

69. Annual Report of the Directorate General of Health Services, 1960, pp. 336–37.Google Scholar

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71. Yang, Ho-t'ing, Sinkiang Daily, 29 05 1960.Google Scholar