Diabetes and China’s Modernization: A Three-City Study of the Perspectives of Patients, Providers, and Policymakers

Abstract

China has successfully achieved rapid modernization and development over the past few decades, and is now encountering large and growing epidemics of chronic diseases, including diabetes. The Chinese Ministry of Health has published ambitious plans to combat the epidemic, placing a heavy focus on strengthening primary health care through the development of community health centers (CHCs). I argue that the CHCs represent a shift in Chinese biopolitics from regulating population quantity to regulating population quality. The government has not fully recognized that the top-down enforcement model is no longer viable for regulating population quality. Instead, new biopolitical strategies are needed that gain the trust and cooperation of medical providers and Chinese citizens. This thesis analyzes five different forms of evidence in comparison with each other through the use of a frame analysis: 1) Western scholarly literature and media; 2) Chinese scholarly literature and media; 3) Chinese health care policies and official reports; 4) interviews with medical providers; 5) interviews with patients. I find that all of these stakeholders view the diabetes epidemic through the frame of modernization (xiandaihua). However, each stakeholder understands modernization differently. For policymakers, the CHCs represent modernization. Having developed these systems based on the British health system, they symbolize China’s efforts to adopt Western values and policies. In contrast, patients view modernization as achieving the best standard of living and health care possible and they therefore distrust the CHCs. In addition, modernization means distancing themselves from a past of hardship and restriction. Thus, the idea of restricting their diet connotes such pain that diabetic complications seem preferable. Lastly, for medical providers modernization means being respected and having the income necessary to enjoy the modern lifestyle that has been made possible by China’s economic development. This thesis argues that discrepancies between policymakers’ views of what it means for China to be a modern nation, patients’ views of what it means to live in a modern society, and providers’ views of what it means to work in a modern workplace are hindering China’s efforts to address the diabetes epidemic Ultimately I argue that there are two main obstacles to addressing China’s growing chronic disease epidemics. First, while Chinese policymakers are currently looking to the West in their efforts to reform the health care system and address the chronic disease epidemics, these approaches are unlikely to succeed in China. Instead, Chinese policymakers should turn their attention inward, implementing China-specific solutions that are considerate of China’s unique political and cultural history as well as patients’ and providers’ beliefs and values. Second, China is currently trying to simultaneously embrace Western health systems and health policies while also holding onto traditional top-down political controls and political order. The government has not fully recognized that in shifting from regulation of population quantity to regulation of population quality, the top-down enforcement model is no longer viable. Instead, to be successful, new biopolitical strategies are needed that gain the trust, buy-in, and cooperation of medical providers, as the agents of medical treatment and health education, as well as citizens, as the agents of their own health maintenance.