The brilliance and poverty of Chinese healthcare. How people are treated in China (myths about free medicine) Visa for those traveling to China for treatment

One of the first Chinese healers, who lived about five thousand years ago, is the mythical Emperor ShenNong, who used all kinds of herbs for treatment. According to legend, he compiled descriptions of about 70 poisons and antidotes, died at the age of 140, and after his death became the deity of pharmacists. He is considered the author of one of the oldest in the world, the “Canon of Roots and Herbs,” containing a description of 365 medicinal plants.

As ancient literary monuments testify, already three thousand years ago there were four sections in Chinese medicine - internal medicine, surgery, diet and veterinary medicine. In the 10th century, much earlier than in other countries of the East and West, Chinese Taoist monks, who lived as hermits in mountain caves, learned to vaccinate against smallpox. The source of the vaccination material was smallpox crusts taken from the nose of a person who had been ill. To prevent illness, they were inserted into the nostrils on a cotton swab. Much later, a method of applying smallpox material to a scratch arose.

Chinese medicine has its roots in the deep past and is associated with the ancient philosophy according to which there is a Great Triad: Heaven-Man-Earth. The unity of two principles - Earth and Sky (yin and yang) is the source of the emergence of all things in the Universe, their combination and interaction determine the alternation of cosmic phenomena.

A person is subject to the same laws as the Universe, therefore his life and health are determined by his relationship with the outside world, in particular, with the seasons. “To establish harmony with yin and yang,” says an ancient Chinese medical treatise, “means to establish harmony with the four seasons. If you argue with them, you will ruin a life; if you live in harmony with them, you will forget about illnesses.” Associated with yin and yang is the idea of two types of diseases - “hot”, resulting from an excess of internal warmth, and “cold”, caused by its lack. Diseases caused by cold were treated with “warm” medicines, and “fever” diseases with cold medicines. Parts of the human body, its internal organs are divided into two groups - yin and yang, in accordance with the Tai Chi symbol.

Five principles of the Universe

Yin and yang are the sources of the five principles of the Universe: “... yang changes and yin is always with it. This is how water, fire, wood, metal and earth arise.” The whole variety of things in the Universe consists of them. Philosophers of Ancient China believed that the elements were constantly in motion and interconnected. So, for example, a tree gives birth to fire and overcomes the earth, water gives birth to a tree and overcomes fire.

The entire system of relationships between man and the Universe was taken into account by Chinese doctors when prescribing methods for treating diseases and making medicines. The system played a major role in this magic numbers, special place among which belongs to the number 5. The five elements corresponded to the doctrine of five categories human character, about the five temperaments. Human strength and health were nourished by five plants: rice, millet, barley, wheat and soybeans. The movements of Chinese gymnastics were likened to the “games of five animals” - lion, deer, bear, monkey and bird. Recipes for preparations from medicinal plants were compiled in such a way that they achieved the right combination five tastes. Chinese lemongrass was called the “fruit of five tastes” and was revered by doctors precisely because all the tastes are contained in the fruits of this plant: its skin is sweet, the flesh is sour, the seeds are bitter and tart, and the tincture from them has a salty taste.

When talking about the philosophical aspect of medicine in Ancient China, one cannot fail to mention the concept of qi.

“All beings,” wrote in the 5th century. BC. the great Chinese philosopher Lao Tzu, “carry yin and yang within themselves, are filled with qi and form harmony.” Qi is the vital force associated with blood and breathing, a characteristic of the rhythmic work of the human body as a whole, the totality of all its systems. Under the influence of yin it moves downward, under the influence of yang it moves upward and is constantly in the process of condensation or dispersion. All things in the world, including humans, are filled with qi. When condensed, it forms visible things; in a state of extreme dispersion, it represents emptiness.

In various philosophical schools of Ancient China, qi meant morality, moral spirit, and the pursuit of truth.

The first needles were made of stone. Later they began to make them from silicon or jasper, from bone and bamboo, from metals: bronze, silver, gold, platinum, stainless steel. There were 9 needle shapes; among them were cylindrical, flat, round, triangular, spear-shaped, needles with a sharp and blunt end.

On active points influenced not only by acupuncture, but also by cauterization. Cauterization was performed using a hot metal stick, lit sulfur powder, and crushed pieces of garlic.

Pulse study.

One of the great achievements of the doctors of Ancient China was the idea of the circular movement of blood. The “Canon of the Internal” says that the heart continuously pumps blood in a circle, and the doctor can judge the movement of blood by the pulse. “Pulse is the inner essence of a hundred parts of the body and the most subtle expression of the inner spirit.” Chinese doctors distinguished more than 20 types of pulse. They came to the conclusion that every organ and every process in the body has its own expression in the pulse, and by changing the pulse at several points, one can not only determine a person’s illness, but also predict its outcome. This teaching is set forth in the “Canon of the Pulse” (III century AD).

Historical parallels: The tradition of carefully studying the patient’s pulse was characteristic of the medical knowledge of different countries, but it was in Chinese medicine that it was developed most deeply. Later, the doctrine of the pulse was developed in the medical writings of the Arabs and from Arab treatises passed into the medicine of medieval Europe.

In Ancient China, a state medical governing body was created for the first time - the Medical Order. For diagnosis, doctors used non-instrumental methods of external examination of the patient. Particular attention was paid to the "windows of the body" - the ears, mouth, nostrils and other natural openings of the body. The doctrine of the pulse played an important role. Varieties of pulse were distinguished by speed, strength, rhythm, and the nature of pauses in the pulse wave. In medical practice, such treatment methods as acupuncture (Zhen Chiu therapy - acupuncture and cauterization), plastic gymnastics, and massage were widely used. The arsenal of medicines consisted of large number substances of plant, animal and mineral origin. A special place was occupied by ginseng, rhubarb, seaweed, sea fish liver, deer antlers, iron, mercury, etc. The development of surgical treatment was constrained by religious prohibitions,

Chinese chronicles report the improvement of ancient cities. The territories of future settlements were subject to sanitary reclamation, squares and streets were paved, neighborhoods were located on illuminated slopes, near sources of good-quality water. Military hygiene was at a high level. To prevent smallpox, variolation was used.

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Subject: Chinese healthcare system

Introduction

1 general characteristics health care of the People's Republic of China

1.1 Dynamics of development

1.2 Transforming the healthcare system - People's Republic of China

1.3 Traditional Chinese medicine and pharmacology

2 Study of health care reform in China

2.1 Reform of the healthcare system in China

2.2 Priority areas for reforming the healthcare system

2.3 Current health issues in China

Conclusion

INTRODUCTION

Everyone is familiar with the incredible richness of the traditions of ancient Chinese medicine. In China, for the first time in the world, a conscious medical concept of health, illness and treatment was formulated, and systematized knowledge about human health was presented in a number of treatises and are the most valuable monuments of ancient thought. It was in China that they began to study diseases and establish their causes by analyzing symptoms.

After the founding of the People's Republic of China in 1949, considering disease prevention, health protection and further development traditional medicine As an important part of the strategy, the Chinese government places great emphasis on the widespread establishment of medical and health care facilities and the training of medical personnel. Hospitals of various levels and medical organizations are available throughout the country, and a comprehensive treatment and preventive network has been formed in cities and rural areas. Health care in the PRC has become the most important state matter. Nowadays, numerous medical personnel work in China, an integral system of educational institutions of medical sciences has been formed, which has given the country a whole galaxy of outstanding specialists in medicine and pharmacology. By the end of 1998, the country had 310 thousand medical organizations (including outpatient clinics), 3.14 million hospital beds (in hospitals and sanitary and epidemiological stations - 2.91 million), 4.42 million medical personnel working in this area ( 1.41 million doctors in hospitals and sanitary and epidemiological stations, 1.07 million nurses), which is 85.6, 36.9 and 8.8 times more, respectively, than in 1949.

1 GENERAL CHARACTERISTICS OF HEALTH CARE IN THE PRC

1.1 Dynamics of development

In accordance with the state system medical care and labor insurance, created in the 50s. in China, treatment of workers and employees in the event of illness or injury is carried out entirely at the expense of the state. This system has played an active role in protecting the health of workers and employees, stimulating economic development and ensuring social stability. However, as the economy developed and the reform of the country's economic system deepened, its shortcomings became increasingly apparent. Since health care is usually paid for by governments and businesses, costs for these purposes have risen too quickly and have become a burden for state budget. On the other hand, waste of sanitary and hygienic resources is inevitable. Health care in rural areas, with the exception of a small number of wealthy regions where it is provided free of charge, still requires payment. The country's general health care system has not yet reached perfection and its coverage is small, so it is imperative to reform the public health care system.

This reform in cities and towns involves creating a mechanism for reimbursing the costs of medical institutions. This means that the health insurance system must be built taking into account local financial and social conditions; Treatment costs must be borne by both the state and enterprises, as well as the patients themselves. In rural areas, the cooperative health care system under the leadership of local governments, which operates at public expense with financial assistance from the government and on the basis of voluntary participation of the population, should be fully developed and improved. It is planned to create insurance funds mainly through contributions from individuals and support from collectives and local authorities in order to provide peasants with basic health care, fulfill the objectives of disease prevention and avoid poverty due to disease. Expanding the coverage of the health insurance system not only promotes complete and timely service from medical institutions, but also meets the requirements for the sustainable development of medical institutions themselves.

The level of medical science is rapidly improving, and control over medicines and sanitary supervision are constantly strengthening. A health insurance system for workers and employees in cities and towns has been established on the basis of public planning and private contributions, and the scope of this system is gradually expanding. Traditional Chinese medicine and pharmacology, as well as a combination of Chinese and Western medicine, are developing together. The incidence of many infectious diseases has noticeably decreased, epidemics have been localized, the work of medicine and healthcare in rural areas is being strengthened, which has significantly improved the health of the population. In terms of the average life expectancy of the population and the reduction in mortality of infants and women in childbirth, China is in the forefront among developing countries; according to some indicators, it has reached the level of developed Western countries.

1.2 Transforming the healthcare system - People's Republic of China

With the founding of the People's Republic of China in 1949, the country's healthcare system was transformed. And earlier, starting from the 19th century, there were a number of missionary hospitals and outpatient clinics in China. Some were just a few beds in a back room, others were more or less full-fledged establishments. The new government decided that well-staffed hospitals should form the core of China's new healthcare system.

healthcare medicine pharmacology Chinese

Chinese Hospital in Xiamen, Fujian Province, China
Source: Wellcome Images

By 1990, the country had a network of modern hospitals. Originally funded by the government, today hospitals in China no longer receive all their funding from the government alone. As a result of reforms introduced after 1979, hospitals now receive two-thirds of their funding from patients directly, or from insurance companies, as is more common in recent years. Ironically, the new economic policies introduced after 1979 created a new market for traditional Chinese medicine. To reduce the growing imbalance between urban and rural health care, hospitals (including those using traditional Chinese medicine) were built in every region of China. These institutions are intended primarily to provide low-cost medicine to the majority of the country's residents.

The Chinese government continues to improve the healthcare system to make medical care in cities and villages equally high quality and affordable. The efforts of the authorities are supported by millions of rural doctors.

This three-story building is a hospital in the village of Mafu in western Hunan Province, located in central China. Doctor Tian Rui works here. She came to Mafa in 1992, right after graduating from medical school. At first, almost none of the local residents went to the doctor: either there was no money to pay for medical care, or they simply did not believe in medicine. But even under these conditions, Tian Rui was able to cure more than two thousand people over the years. At the very beginning, Tian Rui had to go home to the sick. It took Tian Rui much more time to get to the most remote corners of the village along mountain roads than for the treatment itself.

Tian Rui, physician: “Of course, this is not an easy path. Especially for a woman, and yet I am happy in my own way.”

Few villagers earn more than a few hundred yuan, or $50, a year. Therefore, many simply cannot afford to pay for a doctor's services. Tian Rui says that when a person comes to the clinic, they first treat him, and only then they start talking about money. If they are not there, they ask you to bring payment for treatment later, when the money becomes available. Over 18 years of work, Tian Rui has accumulated several notebooks where she writes down countless debts; she no longer expects to receive the lion's share of them.

Tian Rui says that at first people did not trust doctors, and some were even embarrassed. According to Tian Rui, after the village began holding free gynecological examinations, women's diseases were found in 90% of the village residents. Now this figure has been reduced by half.

Tian Rui, doctor: “Now they come on their own if they feel unwell. “Before, they were shy, it was difficult to persuade them even for a simple examination.”

Gradually, not only trust in doctors appears, problems with money are also solved. Thanks to the health care reform, more and more villagers are beginning to receive preferential health care. Health insurance has covered almost 90% of the country's population, and starting from this year it is planned to increase the maximum amount of insurance payments for rural residents. It is expected that farmers with health insurance will be able to get back 70% of their medical expenses.

Improving the three-stage treatment and preventive network in rural areas

About 75 percent of China's population lives in rural areas, so rural medicine and healthcare are a constant focus of government attention. After 1978, since the implementation of the policy of reform and opening up, the country's medical authorities have set themselves the goal of further developing rural sanitation work and providing farmers with medical care, considering this as one of key points building a new socialist village with Chinese characteristics. Along with this, on the basis of the comprehensive development of medicine in rural areas, general sanitary and hygienic measures have been put in first place. Currently, in rural areas, a three-stage (district, volost and village) treatment and preventive system has mainly been formed. In 1998, in China there were 2,037 county hospitals, 50.6 thousand volost sanitary and epidemiological stations, and 728.8 hospitals or outpatient clinics were created in almost 90 percent of the 730 thousand villages throughout the country. There are 1.328 million doctors and health workers in rural areas, of which rural doctors occupy 74.59 percent. China has laid a good foundation for achieving the World Health Organization's goal of "Achieving health care for all by the year 2000."

Within 50 years after the founding of the People's Republic of China, medical institutions were created in the country, in which the main place is occupied by sanitary and epidemiological stations intended for sanitary surveillance and disease prevention. An all-China sanitary surveillance and epidemic control network has been formed. In 1998, there were 4,018 such institutions in the country, including 1,696 county sanitary and epidemiological stations, 1,889 specialized departments or points of prevention and treatment.

In order to completely eliminate or localize infectious diseases and epidemics, the Chinese government promulgated the “Law on the Prevention and Treatment of Infectious Diseases”, “China’s Action Plan for the Eradication of Poliomyelitis for 1995”, “Theses of the Program for the Elimination of Iodine Deficiency Disease by the Year 2000”. China" and other documents, is actively developing immunization work. Immunological vaccination of children was successfully carried out, which made it possible to significantly reduce the incidence of measles, polio, diphtheria, whooping cough, epidemic encephalitis B and other diseases. Currently, the work on disease prevention and the patriotic movement for sanitation and hygiene are deepening, the health status of the urban and rural population has significantly improved compared to the period preceding 1949. The average life expectancy of the population throughout the country has increased from 35 to 70 years.

The causes of death are mainly malignant tumors, diseases of the blood vessels of the head and cardiovascular diseases. In this respect, the situation in China is similar to developed countries. Research institutions and medical institutions are actively involved in the prevention of cardiovascular and cerebrovascular diseases, cancer and other chronic diseases. non-communicable diseases, monitor outbreaks of infectious diseases both within the country and abroad. Over the past 50 years, China has made remarkable progress in disease prevention and treatment. In 1996, the Disease Control Department of the Ministry of Health of the People's Republic of China received the World Health Organization Award for outstanding achievements in its work.

Protecting the health of women and children. The focus is on protecting the health of women and children. After the founding of the People's Republic of China, the Chinese government began to pay great attention to protecting the health of women and children, declaring it a national strategy. Committees for working with women and children have been established under the State Council of the People's Republic of China and local governments. By the end of 1998, there were already 2,724 medical institutions for women and children throughout the country, including 1,507 county maternal and child health centers, staffed by 73,000 medical specialists.

To ensure the protection of women's health, the PRC laws “On the Protection of the Rights and Interests of Women”, “On the Protection of the Health of Mother and Child”, the regulation “On the Labor Protection of Women Workers” and other legal acts were adopted. China is actively working on the use of safe methods of obstetrics; in cities and rural areas mandatory medical checkup pregnant women, care for high-risk pregnant women, hospital births, postpartum care and a number of other measures to ensure the health of mother and child. The implementation of these measures yielded positive results: the mortality rate of women in labor decreased from 1,500 cases per 100 thousand people in 1949 to 61.9 cases in 1995.

Since 1978, the Chinese government has begun to pay special attention to protecting the health and monitoring the development of children. Thus, the law “On the Protection of the Rights of Minors” and the “Program to Encourage Children to Breastfeed” were adopted; 5,890 hospitals have been established throughout the country to care for newborns, thanks to which infant mortality has decreased from 200 cases in 1949 to 31 cases per 1 thousand newborns.

Since 1978, China has introduced nationwide routine vaccination. At the state level, measures are being taken to improve the level of physical development of children, and programs are being created to improve their nutrition.

Since the founding of the People's Republic of China, the Chinese government has paid great attention to protecting the health of women and children. Under the National People's People's Congress and the CPPCC, respectively, an institution has been established to ensure legislative support for the rights and interests of women and children and an institution to supervise the implementation of laws. Committees for working with women and children have been established under the State Council of the People's Republic of China and local governments. By the end of 1998, there were 2,724 medical and health care institutions for women and children throughout the country, including 1,507 district points (stations) for maternal and child health care, and 73 thousand medical personnel. A comprehensive network of institutions for the protection of women's and children's health has been formed, covering the entire country.

In order to effectively ensure the protection of women’s health, the “Law of the People’s Republic of China on the Protection of the Rights and Interests of Women”, the “Law on the Protection of Maternal and Child Health”, “Regulations on the Labor Protection of Women Workers”, “Temporary Regulations on the Protection of the Health of Workers” and other legal acts were adopted. China is actively working on the use of safe methods of obstetrics and measures to protect the health of women during the childbearing period. In cities and rural areas, mandatory medical examination of pregnant women has been introduced, registration premature pregnancy, care for high-risk pregnant women, hospital births, postpartum care and a range of other measures to ensure the health of mother and child. These measures have yielded positive results in protecting maternal and child health in China, for example, the mortality rate of women in childbirth decreased from 1,500 cases per 100 thousand people in 1949 to 61.9 cases in 1995.

Since 1978, the Chinese government has attached special importance to protecting the health and monitoring the development of children. “Theses of a program to improve the welfare of children in China for the 90s” have been developed. and the “Minor Protection Law”, the “Child Feeding Promotion Program” was promulgated mother's milk" At the same time, the movement for caring for infants was widely launched, 5,890 hospitals for the care of newborns were created throughout the country, due to which infant mortality decreased from 200 cases per thousand newborns before 1949 to 31 per thousand. Since 1978, a nationwide routine vaccination has been carried out. The level of physical development of children is constantly increasing and their nutritional status is steadily improving.

1.3 Traditional Chinese medicine and pharmacology

Chinese medicine and pharmacology are important integral part brilliant culture of the Chinese nation. Over several thousand years, they made outstanding contributions to the prosperity and power of China. Chinese traditional medicine, distinguished by its noticeable healing effect, national identity, unique methods of diagnosis and treatment, systematic theoretical principles and rich historical documentation, has its own special place in world medicine and has become the common wealth of the treasury of world medical science. Chinese medicine has a long history, and it still shows great vitality today. It and modern medicine complement each other, which is the specificity and advantage of traditional Chinese medicine.

Chinese medicine and pharmacology arose during the primitive period. Primitive people in their struggle with nature they created the rudiments of medicine. While searching for food, they noticed that certain foods could alleviate or cure diseases, which was the beginning of the discovery and use of Chinese medicines. With the advent of fire, people learned that by warming themselves with hot stones or sand, wrapped in skins or tree bark, they could cure some ailments, then, based on repeated practice, the methods of hot medicinal compress and cauterization were discovered. Using stone products as tools of production, people realized that injections and blows to one part of the human body relieved the pain of another part. This is how a method of treatment with stone and bone needles was created, which later turned into acupuncture, and the doctrine of meridians and collaterals was formed.

The main theoretical views of Chinese medicine consist in the original knowledge of dense and hollow visceral organs, meridians and collaterals, “Qi” and blood, body fluids, the causes of disease and pathogenesis. Treatment methods of Chinese medicine are “four methods of examining the patient” and studying the disease: visual (studying the complexion), auditory (listening to the patient’s voice), oral (finding out by asking the patient’s condition) and palpable (feeling his pulse). Study of disease means the process of knowing the cause of disease through analysis, induction, investigation and judgment based on the symptoms of the disease and physical symptoms, seen through the "four methods of examining the patient." In addition to the main method of treatment based on the use of medicine, Chinese medicine also uses acupuncture, massage, qigong breathing exercises and some other original treatment techniques.

More than 2 thousand years ago, the first Chinese medical treatise “Huangdi Neijing” was published, which laid the theoretical foundation of Chinese medicine. After this, many other classical medical works were published, such as “The Canon on Difficult Questions in Medicine”, “Treatise on Exogenous Febrile and Various Diseases”, “Treatise on the Etiology and Symptomatology of Diseases”. “Shennong Bencaojing” (Shennong Pharmacopoeia) is the oldest special work on pharmacology in China. "Tangbencao" is the first pharmacopoeia in China to be published by the government, it is the world's first government pharmacopoeia. During the Ming Dynasty, Li Shizhen compiled the pharmacopoeia “Bencao Gangmu” (“Compendium of Medicinal Substances”), in which he described 1892 species medicinal herbs and other healing raw materials and provided more than 10 thousand recipes based on them.

Since the founding of the People's Republic of China, the government has attached great importance to Chinese medicine and supported its development. In 1986 it was established Public administration for Traditional Chinese Medicine Affairs. 2 years later, on its basis, the State Administration for Traditional Chinese Medicine and Pharmacology was created, which develops a development strategy, course, policy and regulations in this area. It provides the combination of Chinese medicine and pharmacology in an organized manner and manages their integration.

Education in the field of traditional medicine is developing rapidly, higher and secondary educational institutions teaching Chinese medicine and pharmacology, correspondence institutes, evening institutes, schools have been opened, and an external education system is being implemented. Thanks to all this, the country has trained a large number of Chinese medicine specialists. A holistic system has been formed in the production of Chinese medicines, characterized by a rich assortment and advanced technologies. In China, traditional medicine doctors learn from each other, trying to find a way to combine Chinese and Western medicine, which is new to China. Currently, a situation has developed in the country in which Chinese, Western and Chinese-Western medicine coexist, adopt each other’s positive qualities, and develop together. The system of theoretical views of Chinese medicine has a deep content. Chinese-Western medicine workers, using advanced science and technology and modern methods, have carried out long-term research work on the basic theoretical knowledge of Chinese medicine and its treatment methods. Therefore, they have made progress in scientific commentary on solid and hollow visceral organs, blood stasis and the essence of acupuncture treatment. China is at the forefront in the world in 5 areas of medicine, including replantation of severed limbs, treatment of burns, treatment of fractures, treatment of acute illness abdominal cavity and acupuncture anesthesia. Progress in the last 3 areas has been achieved by combining the methods of traditional Chinese and Western medicine.

In recent years, encouraging successes have been achieved in the treatment of cardiovascular and cerebrovascular diseases, immunological diseases, cancer and fractures using Chinese medicine methods. The discovery and systematization of recipes for traditional folk medicine, the processing and preparation of Chinese medicines, and the modification of the forms of finished medicines have received new development, which has enhanced the ability of Chinese medicine to prevent and treat diseases and expanded its service scope. Chinese medicine has discovered new methods of non-surgical treatment in the treatment of acute abdominal diseases. Traditional Chinese medicine - acupuncture, acupuncture anesthesia and acupuncture pain relief - is now practiced in 120 countries and regions around the world. In 1987, the World Acupuncture Federation was founded in Beijing, in which more than 50 thousand representatives from 100 countries and regions of the world participate. It is the first international scientific organization headquartered in China, and China is its chairman. In 1989, the International Conference of Qigong Therapy was held in Beijing, in which representatives of 29 countries and regions of the world took part. In 1991, the International Conference on Traditional Medicine and Pharmacology was held in China, at which dozens of countries jointly developed and adopted the Beijing Declaration. To date, China has already established relationships with more than 100 countries and regions in the world in the fields of medical services, scientific research and academic exchange.

In recent years, as treatment methods have spread homeopathic remedies and treatment without the use of drugs, Chinese medicine has attracted close attention from all over the world. The framework for international cooperation in the field of medicine is expanding. Japan, the USA and Germany have established cooperative relations with China. The World Health Organization has established 7 cooperative centers for traditional medicine and pharmacology in China. Among all international students and trainees studying in China natural Sciences, the largest part are Chinese medicine specialists. The joint teaching of Chinese medicine by the Beijing Institute of Traditional Chinese Medicine and a public university in England served as a precedent for the opening of a Chinese medicine specialty in other universities in England and Europe. There are schools of Chinese medicine in Japan and the Republic of Korea; in France, the USA, Italy, Australia and other countries - institutes of Chinese medicine and acupuncture institutes; in Germany at the University of Munich - an institute for the study of theoretical knowledge of Chinese medicine.

Today, Chinese medicine and pharmacology are important components of the culture of the Chinese nation and occupy a special place in the world medical science. Having a centuries-old history, traditional Chinese medicine still exists today, complementing modern medicine. After the founding of the People's Republic of China, the government began to attach great importance to medicine and support its development. In 1986, the State Administration of Traditional Chinese Medicine was established. 2 years later, on its basis, the State Administration for Traditional Chinese Medicine and Pharmacology was created, which develops a development strategy, course, policy and bills in this area. This management ensures the interaction and integration of Chinese medicine and pharmacology.

However, no matter what the achievements of Chinese medicine were, they remained accessible only to the emperor and a limited number of people close to him. Ordinary citizens for many centuries did not have access to medical care, and their average life expectancy was just over 35 years.

The situation changed dramatically with the beginning of the reign of Mao Zedong. It was he who, in the middle of the last century, created an extensive system of primary care, modeled on the Soviet one. medical care, which became accessible to ordinary people, primarily peasants. Semashko’s healthcare model then turned out to be the only correct way to organize medical care in a country in which millions of people live over a vast territory. And today the question arises again: what should it be? efficient system healthcare designed for a population exceeding 1/5 of the world's inhabitants?

The emergence of new Chinese medicine. After the founding of the People's Republic of China in 1949, the Chinese government began to pay great attention to the widespread creation of medical and health care institutions and the training of medical personnel. Today, there are hospitals of various levels and medical organizations throughout the country, and an integrated treatment and preventive network has been formed in cities and rural areas. In large cities there are large specialized clinics, including traditional medicine hospitals. There are also comprehensive and specialized hospitals with modern equipment in medium-sized cities in all provinces and autonomous regions. In most rural areas, a three-stage treatment and preventive network has been introduced at the county, volost and village levels; Central district hospitals were created in the districts, volost outpatient clinics were created in the volosts, and first aid stations were created in the administrative villages.

Healthcare in China has become one of the most important areas of state development. Qualified medical personnel began to work in China, an integrated system of medical educational institutions was formed, which produced a galaxy of outstanding specialists in medicine and pharmacology. If several decades ago in China there were 1.48 doctors and 2.34 hospital beds per 1000 people, then by the end of 1998 the country already had 310 thousand medical organizations, including outpatient clinics; 3.14 million hospital beds; 4.42 million medical personnel, of which 1.41 million are doctors in hospitals and sanitary and epidemiological stations and 1.07 million nurses, which is tens of times higher than similar figures after World War II.

Medical science in China today is actively developing, control over the use of medicines and sanitary supervision are being strengthened. A health insurance system for workers and employees in cities and towns has been established on the basis of public planning and private contributions, and the scope of this system is gradually expanding. The incidence of many infectious diseases has noticeably decreased, and epidemics have been effectively contained. In order to completely eliminate infectious diseases and epidemics, the Chinese government has adopted the Law on the Prevention and Treatment of Infectious Diseases and other documents, and is actively carrying out immunization work. Immunological vaccination of children has been successfully completed, which has significantly reduced the incidence of measles, polio, diphtheria, whooping cough, epidemic encephalitis and other diseases.

At present, the health status of China's urban and rural population has significantly improved compared to the period before 1949. The average life expectancy of the population throughout the country has doubled. With about 75% of China's population living in rural areas, provincial medicine and public health are the focus of the government's ongoing commitment to preventive medicine, which has greatly improved the health status of the population.

2 STUDY OF HEALTH CARE REFORM IN THE PRC

2.1 Rreformatione healthcare systems in China

Healthcare is an integral part of the social sphere of the PRC, the state of which, in many respects, can be considered as a key indicator characterizing the entire social policy the country's leadership and the general level of development of Chinese society.

The current situation in the field of public health in China has every reason to be considered a crisis. This was a natural result of the accelerated economic development of the PRC to the detriment of the balanced development of all spheres of the country’s life.

It is obvious that without such a huge strain of all resources - primarily human - China would not have become one of the regional and world economic giants in such a short time. However, already beginning of XXI century showed that the existing health care system is experiencing most of the serious problems that shook the entire Chinese society at that time, including the ever-increasing social stratification, the gap between city and countryside, etc. In 2000, medical expenses per rural resident were 188.6 yuan versus 710.2 yuan for an urban resident, i.e., 3.8 times lower. During 1991-2000, total expenditures on this item increased by almost 50.7 billion yuan, of which only 6.3 billion yuan fell on the villages, i.e. 12.4% of the total increase, and this despite the fact that The rural population was almost twice as large as the urban population. By the early 2000s, only 10% of villages retained cooperative medical services. More than 80% of peasants are forced to receive treatment at their own expense. The share of public health expenditures in total state budget expenditures decreased from 4% in 1980 to 1.71% in 2000, which placed China in one of the last places in the world in terms of this indicator. Africa's poorest countries spend twice as much on healthcare per capita as China.

It cannot be said that Chinese healthcare was in complete decline during the period of the “reform and opening up” policy. For example, the increase in life expectancy in China is quite an impressive achievement these years (see Figure 1).

Thus, the average life expectancy in China in 2006 exceeded the global average by 5 years, and the same indicator in low-income countries by 13-14 years.

Figure 1 - Life expectancy at birth in China (life years)

Quote by: BergerI. » Domestic notes» No. 3, 2008,. Thus, the average life expectancy in China in 2006 exceeded the global average by 5 years, and the same indicator in low-income countries by 13-14 years. However, it should be noted that the pace of economic development of the country clearly exceeded the growth rate of allocations for healthcare and the income of ordinary citizens of the PRC, which led to extreme serious consequences. The main crisis trends in this area are as follows:

- Low level of government funding for the healthcare sector. As for the level of state subsidies for healthcare, as can be seen from Table 1, specific gravity government spending on health care in China amounted to only 38.8% in 2005, while in the world as a whole it reaches 56%. Only 1% of the state budget goes to health care in China, while in total in low-income countries around the world 4.6% of public funds are spent on these purposes, and the global figure in 2005 reached 8.3%.

Table 1 - Health care costs

	Total health expenditure as % of GDP	Government share of total health expenditure (%)	Health care share of total government expenditure (%)


Low income countries
Low-middle income countries
Middle-high income countries
High income countries
The world at large

Quote. By: I. Berger. Chinese healthcare. Reference//» Domestic notes» No. 3, 2008,http://www.strana-oz.ru/?numid=44&article=1682. This ultimately results in China's per capita health care spending being extremely low. Without going into comparison with similar indicators of countries with developed economies, even a comparison of these expenses with the global level of health care spending is more than indicative (see Table 2).

Table 2 - Health care expenditures per capita

	Total costs at average official exchange rate (USD)	Total PPP Costs (International Dollars)	Government spending at average official exchange rate (USD)	Government spending on PPP (international dollars)


High income countries
The world at large

Quote. By: I. Berger. Chinese healthcare. Reference//» Domestic notes» No. 3, 2008,http://www.strana-oz.ru/?numid=44&article=1682. However, changes in this area can still be traced. After the decision was made on the need to reform health care, the growth of health care costs intensified significantly (see Table 3).

Table 3 - Increase in expenditures of the Ministry of Health for the provision of medical services per capita in% compared to last year

- Insufficient level of accessibility of medical services for the population of the People's Republic of China. The low level of government funding for the development of the healthcare system in China is exacerbated by the fact that for the majority of the country's population, obtaining quality medical care is an almost unaffordable luxury. On average in China, spending on these services amounts to about 11.8% of the family budget, second only to spending on food and education. In 2003, a peasant's net annual income averaged 2,622 yuan, and the average cost of his hospital stay reached 2,236 yuan.

Another significant problem is that the increasingly worsening social inequality in the PRC is also projected onto access to medical care. In this regard, the most protected and comfortable group of the Chinese population are government officials and party functionaries. According to some reports, up to 80% of government subsidies for medicine go to serving this group. The least benefits, respectively, are for low-income rural residents and migrant workers who have not received health insurance.

Problem health insurance exacerbates the inability of some population groups to receive basic health services. The fact is that, as with pension insurance, the most free access to this species Only the working urban population receives services, provided that these people work in government agencies. After the introduction of a law obliging the employer to enter into an employment contract with all employees, regardless of the type of enterprise, this situation began to improve, since under the contract the employer is obliged to provide employees with health insurance. However, the process is moving extremely slowly, and the practice of oral contract (especially with rural migrant workers) is still very strong.

As for the rural population, only a small percentage was involved in the compulsory health insurance system. And the introduction of a cooperative health insurance system in rural areas is proceeding extremely slowly and with very limited funds.

Closely related to the above problem is also the question of the discrepancy between the quality of medical services in the PRC and the requirements of modern development of the state.

The duality of the problem also lies in the fact that obtaining medical care in China is inaccessible to a fairly large group of the population, not only due to the fact that they do not have enough funds to pay for it, but also due to the fact that the level and number of medical institutions and medical personnel also do not meet the requirements of society.

Concerning medical personnel , then, 4kStrangely enough, in China in 2006 there were 15 doctors and only 10 paramedical personnel per 10 thousand people (the global figure is 13 and 28, respectively). In general, this level of medical personnel availability (see Table 4) is considered insufficient by international standards. If we compare similar indicators in the PRC and the Republic of Kazakhstan, then in 2006 in Kazakhstan there were 37.6 doctors of all specialties and 125.2 paramedical personnel per 10 thousand people.

Table 4 - Medical personnel in the PRC in 2006-2007. million people



Medical specialists
Of which: doctors and residents

Auxiliary nursing staff
Pharmacists
Medical controllers
Other health workers
Management personnel
Technical staff

Another important indicator characterizing the level of quality of medical care in the country is number of medical facilities and hospital beds . In this regard, it is important to note the following. Firstly, over the period since the start of the “reform and opening up” policy, these indicators have not undergone fundamental changes (see Figure 2).

Secondly, this indicator itself also lags behind similar indicators in other countries. So in Kazakhstan in 2006, the number of hospital beds per 1 thousand people was 7.73, which exceeded the Chinese figure by almost 3 times.

Figure 2 - Dynamics of changes in the number of hospital beds per 1 thousand population in China during the period of the policy of “reform and openness”

In general, over the past two years this indicator has remained relatively stable and no significant qualitative improvements have been observed in this area, and given the continued high rate of natural increase, one can raise the question of a deterioration in the situation. Particularly alarming is the fact that the number of medical institutions in rural areas, as well as the number of research preventive institutions, which is especially dangerous, given the frequency of various types of epidemics in China.

The problem is also that bO Most of the government subsidies for the development of healthcare have recently been directed to the development of social health insurance and to increasing the population’s access to medical services, but not to improving the quality of medicine itself.

Table 5 - Number of medical institutions and hospital beds in China in 2006-2007.

	Medical institutions	Hospital beds

Total
Hospitals
Multidisciplinary
Chinese medicine hospitals
Specialized hospitals
District medical care centers
Health centers
Rural health centers
Outpatient clinics
Clinics
Donor centers
Maternal and Child Health Centers
Specialized scientific institutes for disease prevention
Centers for Disease Prevention and Control

In addition, other indicators characterizing the state of not only the quality of medical services in the state, but also the overall socio-economic development of the country are infant mortality rates . In general, in China there is a positive trend in this indicator (see Table 6), however, in comparison with other countries, comparison of some data seems downright scary.

Thus, the infant mortality rate in China in 2006 was 17.2‰, while in Kazakhstan it reached 13.9‰. However, the infant mortality rate under 5 years of age in the same year in Kazakhstan was 1.29‰, and in China - 20.6‰ (and in rural areas 23.6‰)! At the same time, the World Health Organization (WHO), speaking about child mortality rates in China as of August 2008, provides data that the infant mortality rate in China is 23‰, and the child mortality rate under 5 years is 30 ‰.

Table 6 - Regional mortality rates for mothers and children in China for 2006-2007.

This speaks of both the low level of pediatrics and the general low standard of living of the population, including the absence in most settlements necessary sanitary and hygienic conditions, nutrition level, vaccination, etc. Thus, according to WHO, in 2006, 81% of the rural and 98% of the urban population had sustainable access to potable water, and only 59% of the rural and 74% of the urban population of China were provided with normal sanitation conditions.

Another problematic trend in the development of the modern Chinese healthcare system is uncertainty in the priorities of its development. Due to the focus on introducing market relations in the healthcare sector and the withdrawal of the state from this area, the situation in this sector has approached critical. This is due to the fact that the role state support decreased significantly, but at the same time, conditions were not created for the full arrival of private capital in the field of medicine. In fact, over more than two decades of reforms, conditions for the creation of non-state hospitals have not emerged. Prices for medical services and medications are still controlled by the state. They are not installed by hospitals, but by relevant government departments.

In addition, the vast majority of hospital beds, equipment and medical personnel are concentrated in public medical institutions. Relying on long-term government support, a few hospitals have concentrated the best resources and achieved a monopoly position with which non-governmental medical institutions cannot compete.

The flip side of the problem is that in public, non-profit medical institutions wage and employee bonuses, as well as the running costs of institutions, are mainly financed from their own commercial activities. This is where doctors strive to prescribe a lot of expensive medications to patients and prescribe expensive examinations and procedures. The state controls the prices of approximately 20% of drugs traded on the pharmaceutical market and has repeatedly reduced prices in recent years. However, market-regulated drug prices are rising, sometimes manifold. In the vast majority of medical institutions, markups on the price of dispensed drugs reach 30-40%, far exceeding the state standard of 15%.

Thus, the above crisis trends demonstrate the urgent need for large-scale reform of the healthcare system in China. In the middle of this decade, the fourth generation of Chinese leaders began a gradual transition to a policy aimed at improving the quality of life of the population and developing the social sphere of society. Final design This strategy was received at the XVII CPC Congress in the fall of 2007. Hu Jintao's report at the congress placed more emphasis on the government's responsibility for healthcare reforms. They spoke about the need to strengthen the generally beneficial nature of healthcare and increase the state's investment activity in this segment.

At the meetings held after the congress, it was decided, on the basis of existing independent developments, to prepare a new consolidated draft of health care reform “with Chinese characteristics” and present it to the public. The project was supposed to provide for the creation by 2020 of a system that would guarantee the provision of basic medical services to all residents of cities and villages.

The Health Development Program in the 11th Five-Year Plan (2006-2010) sets a goal for the formation of a universally accessible basic health care system. Strengthening the leading role of the government, increasing its responsibility, reforming the management of public medical institutions, strengthening their generally beneficial nature, preventing the blind pursuit of profit, and easing the burden borne by the population are highlighted. The parallel development of Chinese and Western medicine and the use of Chinese and Western medicines are proclaimed. Particular importance is attached to healthcare in the countryside and at the community level in cities. The creation of non-state medical institutions is also encouraged.

The government intends to use the increase in health care spending primarily through subsidies to the population covered by the insurance system, rather than increasing investment in public health care institutions. Thus, a course towards the development of the medical services market was proclaimed.

Problem reforming the health insurance system Also, in recent years, a period of major decisions has passed.

The basic health insurance system today covers mainly urban population of China . In 2007, 223.11 million people participated in the basic health insurance program. urban population, which is 65.79 million more people than in 2006. However, despite this impressive growth rate, this figure represents only 37.6% of China's total urban population in 2007.

An experiment is currently underway to introduce a basic health insurance system for the unemployed urban population. Under this program, it is expected to allocate at least 40 yuan per year per person.

Regarding health insurance rural population , then this aspect deserves special attention. During the entire period of the “reform and opening up” policy, the rural population ( most of which was more than limited in funds) had practically no equal access to medical services with urban residents.

In order to eliminate this state of affairs, China began an experiment in 2003 to introduce a cooperative health insurance system in rural areas. By new system, each peasant pays 10 yuan to the medical care fund. The central and local authorities contribute the same amount for it. When a peasant is forced to seek medical help, part of the cost of treatment is paid from the fund. Since 2008 this system officially applies to all villages in China.

The number of rural population covered by the basic health insurance system in 2007 was 31.31 million people, which is an increase of 7.64 million people. more than in 2006. This is only 4.3% of total number rural population. At the same time, by the end of 2007, the cooperative health care system covered 730 million people, or almost 90% of the rural population. However, the system suffers from a lack of funds and is unable to support villagers in cases of serious illness that require hospital treatment. Within the framework of the new five-year plan (2006-2010), it is planned to create a “socialist village” in the PRC. 30 billion yuan ($3.8 billion) will be allocated for rural healthcare needs.

Battlefield

In China, it is rare for a patient to come to the hospital alone: the support of relatives is required even when the patient has no physical limitations. In addition to moral support, chaperones perform two important functions. Firstly, they take care of registration and payment for services. For example, the doctor gave a referral for a blood test, but first you need to pay for it. And while the patient is in line at the laboratory, his wife/sister/brother-in-law pays for the service at the cash desk. Also, despite electronic queues, an independent “live” often gathers near the doctor’s office, where the patient’s “punching” abilities increase his chances of getting an appointment before others.

Source: l99.com

Secondly, support is necessary to monitor the doctor’s activities. When instead of one sufferer you have several healthy and aggressive people in your office, the doctor’s attentiveness increases significantly. Unsuccessful treatment can also become a reason for violence against the physician. It is not surprising that in China doctors do not want to be left alone with the patient and his relatives and prefer to keep the doors open. After all, a patient upset by the diagnosis or relatives upset by the result of treatment causes injuries to the doctor, even incompatible with life.

Medicine has ceased to be a prestigious specialty in China, and many end up as medical university students if they don’t get enough points to enroll in engineering faculties, some are forced by their parents. According to the All-China Doctors Association, in 2011, only 7% of doctors in China would like their children to continue their professional dynasty.

Also in China, the traditions of a professional medical community that could regulate the standards of behavior of doctors and, if necessary, revoke a license to practice, have not yet developed. Of course, in China there are specialists who value their reputation and are truly professionals, but in general, the existing system does not reward compliance with the “Hippocratic Oath.”

The situation is aggravated by the huge flow of patients, sometimes up to a hundred per day. Having 5-7 minutes at his disposal for one appointment, the doctor does not physically have time to delve into the medical history; he is in a hurry to write out a referral for examination or prescribe treatment.

However, if the doctor’s decisions do not meet the expectations of the patient and his relatives, then this is a reason to doubt his qualifications. For example, Chinese doctors understand that intravenous drips are not the most preferred method of administering the drug, but are unlikely to be understood by those suffering from high temperature. The same applies to large doses of antibiotics: Chinese patients expect immediate results from modern pharmacology, and doctors try to meet their expectations.

Material incentives

The bulk of hospital revenue comes from tests, other technical procedures and prescribed medications. Thus, both the hospital and each individual doctor have an incentive to prescribe more medications and make referrals for additional tests.

4. Features of medicine in Ancient China. Methods of prevention and diagnosis.

About the emergence of medicine in Ancient China in the middle of the 3rd millennium BC. legends and chronicles tell. Treatment methods developed by Chinese doctors influenced the medicine of Japan and Korea, Tibet and India. The doctrine of vital channels and active points on the surface of the human body is one of the foundations of reflexology - a modern method of diagnosing and treating diseases. The art of healing in Ancient China, as in other countries, included knowledge of a variety of medicines of plant and animal origin. One of the first Chinese healers, who lived about five thousand years ago, is the mythical Emperor ShenNong, who used all kinds of herbs for treatment. According to legend, he compiled descriptions of about 70 poisons and antidotes, died at the age of 140, and after his death became the deity of pharmacists. He is considered the author of one of the oldest in the world, the “Canon of Roots and Herbs,” containing a description of 365 medicinal plants. As ancient literary monuments testify, already three thousand years ago there were four sections in Chinese medicine - internal medicine, surgery, diet and veterinary medicine. In the 10th century, much earlier than in other countries of the East and West, Chinese Taoist monks, who lived as hermits in mountain caves, learned to vaccinate against smallpox. The source of the vaccination material was smallpox crusts taken from the nose of a person who had been ill. To prevent illness, they were inserted into the nostrils on a cotton swab. Much later, a method of applying smallpox material to a scratch arose. Chinese medicine has its roots in the deep past and is associated with the ancient philosophy according to which there is a Great Triad: Heaven-Man-Earth. The unity of two principles - Earth and Sky (yin and yang) is the source of the emergence of all things in the Universe, their combination and interaction determine the alternation of cosmic phenomena. A person is subject to the same laws as the Universe, therefore his life and health are determined by his relationship with the outside world, in particular, with the seasons. “To establish harmony with yin and yang,” says an ancient Chinese medical treatise, “means to establish harmony with the four seasons. If you argue with them, you will ruin a life; if you live in harmony with them, you will forget about illnesses.” Associated with yin and yang is the idea of two types of diseases - “hot”, resulting from an excess of internal warmth, and “cold”, caused by its lack. Diseases caused by cold were treated with “warm” medicines, and “fever” diseases with cold medicines. Parts of the human body, its internal organs are divided into two groups - yin and yang, in accordance with the Tai Chi symbol. The five principles of the Universe Yin and Yang are the sources of the five principles of the Universe: “... yang changes and yin is always with it. This is how water, fire, wood, metal and earth arise.” The whole variety of things in the Universe consists of them. Philosophers of Ancient China believed that the elements were constantly in motion and interconnected. So, for example, a tree gives birth to fire and overcomes the earth, water gives birth to a tree and overcomes fire.

The entire system of relationships between man and the Universe was taken into account by Chinese doctors when prescribing methods for treating diseases and making medicines. A large role in this was played by the system of magical numbers, a special place among which belongs to the number 5. The five elements corresponded to the doctrine of the five categories of human character, the five temperaments. Human strength and health were nourished by five plants: rice, millet, barley, wheat and soybeans. The movements of Chinese gymnastics were likened to the “games of five animals” - lion, deer, bear, monkey and bird. Recipes for preparations from medicinal plants were compiled in such a way that they achieved the correct combination of five tastes. Chinese lemongrass was called the “fruit of five tastes” and was revered by doctors precisely because all the tastes are contained in the fruits of this plant: its skin is sweet, the flesh is sour, the seeds are bitter and tart, and the tincture from them has a salty taste. When talking about the philosophical aspect of medicine in Ancient China, one cannot fail to mention the concept of qi.

Historical parallels: “In ancient times,” the legend tells, “when China was ruled by Fu-Xi, versed in many sciences, one of his subjects had a headache.” This man became so ill that he could not find peace either day or night. One day, while cultivating a field, he accidentally hit himself on the leg with a hoe and noticed a strange thing: the headache went away after this blow. Since then, local residents began to deliberately hit themselves on the leg with a piece of stone when they had a headache. Having learned about this, the emperor tried to replace the painful blows with a stone with injections of a stone needle, and the results were good. Later it turned out that such injections, applied to certain places on the body, help not only with headaches, but also with other diseases. It has been observed that exposure to certain points of the body leads to relief from pain or illness. For example, squeezing the central fossa of the upper lip helps lift the patient out of a state of fainting, and inserting needles at certain points at the base of the first and second fingers cures insomnia. The first needles were made of stone. Later they began to make them from silicon or jasper, from bone and bamboo, from metals: bronze, silver, gold, platinum, stainless steel. There were 9 needle shapes; among them were cylindrical, flat, round, triangular, spear-shaped, needles with a sharp and blunt end. The active points were affected not only by acupuncture, but also by cauterization. Cauterization was performed using a hot metal stick, lit sulfur powder, and crushed pieces of garlic. Pulse study. One of the great achievements of the doctors of Ancient China was the idea of the circular movement of blood. The “Canon of the Internal” says that the heart continuously pumps blood in a circle, and the doctor can judge the movement of blood by the pulse. “Pulse is the inner essence of a hundred parts of the body and the most subtle expression of the inner spirit.” Chinese doctors distinguished more than 20 types of pulse. They came to the conclusion that every organ and every process in the body has its own expression in the pulse, and by changing the pulse at several points, one can not only determine a person’s illness, but also predict its outcome. This teaching is set forth in the “Canon of the Pulse” (III century AD). Historical parallels: The tradition of carefully studying the patient’s pulse was characteristic of the medical knowledge of different countries, but it was in Chinese medicine that it was developed most deeply. Later, the doctrine of the pulse was developed in the medical writings of the Arabs and from Arab treatises passed into the medicine of medieval Europe.

In Ancient China, a state medical governing body was created for the first time - the Medical Order. For diagnosis, doctors used non-instrumental methods of external examination of the patient. Particular attention was paid to the "windows of the body" - the ears, mouth, nostrils and other natural openings of the body. The doctrine of the pulse played an important role. Varieties of pulse were distinguished by speed, strength, rhythm, and the nature of pauses in the pulse wave. In medical practice, such treatment methods as acupuncture (Zhen Chiu therapy - acupuncture and cauterization), plastic gymnastics, and massage were widely used. The arsenal of medicines consisted of a large number of substances of plant, animal and mineral origin. A special place was occupied by ginseng, rhubarb, seaweed, sea fish liver, deer antlers, iron, mercury, etc. The development of surgical treatment was constrained by religious prohibitions,

Your Excellencies, The Honorable Madam Minister Li Bin, Provincial Leaders, general directors provincial committees for health and planned childbirth, ladies and gentlemen,

In the eyes of the world, China is increasingly seen as a model for development on many levels.

The world's second largest economy demonstrated rapid and, at the same time, sustainable growth. China opened its markets to free trade only when its economy was mature enough to compete internationally. Countries with fragile economies should look to the example of China when considering joining trade agreements.

The most populated country The world has used its robust economic growth to lift millions of its citizens out of poverty. The achievement of the Millennium Development Goal on poverty reduction was largely determined by China's achievements.

China has made impressive progress in reducing public health threats.

Based on professional doctors, community health workers, traditional Chinese medicine practitioners, health inspectors and factory health workers, this vast and populous country was able to eradicate smallpox, two decades ahead of the rest of the world. In the three years leading up to the last case of the disease, more than 500 million people were vaccinated against smallpox in China.

In the face of this achievement, the WHO developed a belief that continues to this day: if China decides to do something, it will do it.

Within one decade, China made significant leaps: in 2003, when the SARS outbreak broke out, the measures taken by China were the subject of serious criticism; several years, during an outbreak bird flu H7N9 China took measures of the highest class, earning gratitude from the international community.

China has built the world's largest electronic real-time epidemiological surveillance system, demonstrating how transparent and comprehensive epidemiological information can be transmitted instantly. Your scientists and epidemiologists promptly published their reports in the most prestigious medical journals, demonstrating that China has world-class scientific capabilities.

The Chinese government's response to the Shandong vaccine scandal was equally swift and effective. The scale of the scandal was colossal: 2 million doses of vaccines, stored in violation of regulations, were administered to children and adults.

Within a month of the scandal breaking, the Vaccine and Immunization Law was amended by China's State Council to address both the immediate and underlying causes of the scandal. Health authorities have also taken steps to restore public confidence in the safety of vaccines and the importance of lifelong protection against disease that comes from vaccination.

Social stability is highly valued in China, and there is an understanding that inclusive social services, including health care, contribute to social cohesion and stability.

Over the past decade, China has embarked on the largest healthcare reform in human history, with the goal of extending healthcare to more than just residents of prosperous megacities.

At the beginning of this century, less than one-third of China's population had access to health insurance. Today health insurance Almost 100% of the population is covered. Such equality in access to health services is an essential condition for social harmony.

Essentially, China has provided its enormous population with social safety nets that protect people from falling into poverty due to high health care costs. This is a tremendous contribution to building a just and prosperous society.

Ladies and Gentlemen,

China has a special status in the development of international health care. Due to China's success at home, its solutions enjoy special prestige when exported to other countries.

For most developing countries, China is a fellow traveler who has recently faced and overcome similar development challenges. This shared experience gives these countries a special relationship with China that not every wealthy development partner can boast.

Centuries ago, the Silk Road was a conduit for the transmission of knowledge about traditional Chinese medicine, which spread along trade routes from China to India, the Middle East and Europe. Today, the Belt and Road Initiative is a continuation of this tradition and a modern tool of economic diplomacy.

This initiative, which is a new type of development strategy, aims to promote international cooperation in the inherent Silk Road the spirit of “peace and cooperation, openness and inclusiveness, mutual learning and mutual benefit.”

In the area of health, in my view, the initiative has very great potential and can be expanded from today's health security issues to issues of broader cooperation, especially on diseases such as heart disease, diabetes and cancer, for which trade solutions and economic policies can have a major impact.

As early as 1963, the work of Chinese medical teams in Africa had become a model program of international health development assistance, including the construction and donation of hundreds of hospitals and clinics that dot the map of sub-Saharan Africa today.

Although some critics believe that this aid was mainly aimed at guaranteeing supplies natural resources, so necessary for the Chinese economy, independent studies have not found any connection between the volume of aid to individual countries and the flow of natural resources.

In 1978, the approach of training local workers in basic health care skills inspired the primary health care movement that began with the Declaration of Alma-Ata and has become the trademark for much of what WHO does.

China's contribution to global health security received international attention during the Ebola outbreak in West Africa, when dedicated Chinese medical teams were among the first to respond to my call to provide medical support on the ground, despite having to work in very dangerous conditions.

China provided well-trained and self-sufficient medical teams, drawing on its experience gained from decades of work in sub-Saharan Africa, where medical teams independently procured the equipment, supplies and medicines they needed.

Most recently, WHO conducted a qualification audit of an emergency medical team from Shanghai Oriental Hospital, which, based on the results of the audit, was issued a certificate of compliance with international qualification standards.

The Shanghai medical team is now listed by the WHO and can be called upon to work when the next regional or global outbreak occurs.

Building on these achievements and successes at home, China has twice taken center stage on the global development stage in the past year.

At the United Nations General Assembly in September 2015, President Xi Jinping announced the creation of a fund, starting at US$2 million and increasing to US$12 million by 2030, to support the least developed countries in the context of the 2030 Agenda for Sustainable Development.

The Chairman also announced that China would write off the debts of the poorest countries and launch 600 specific projects to reduce poverty, improve education and promote better health services.

As many have noted, China's leadership was a critical element in reaching an agreement during the Paris Climate Change Conference, which took place last December.

Air pollution in China is one of the largest public health hazards. The country still produces more than 60% of its energy from coal, especially in the most industrialized parts of the country, and is the world's largest emitter of carbon dioxide. China's commitment to reducing these emissions has greatly facilitated the negotiations.

The government has taken a number of steps, including the creation automatic system real-time air pollution monitoring with warning and warning systems, and has committed large amounts of funding to the transition to nuclear, solar and wind energy in line with commitments made under the Paris Agreement.

Provincial leaders are entrusted with important role in ensuring the relocation of coal-fired thermal power plants and cement factories outside the cities.

If every country took its climate change mitigation commitments so seriously and decisively, we could truly save the planet and its climate.

This year marked another significant milestone in the history of health care reform. In August, health issues were declared an official priority national policy after the Central Committee approved the Healthy China 2030 plan.

President Xi Jinping, in his speech at the National Health Conference, emphasized that without ensuring health for all people, it is impossible to build a prosperous society. He placed the issue of health at the center of the entire policy-making system in the country. As a result, the systematic consideration of health issues in all decision-making has become official government policy.

In his speech, President Xi also emphasized the need to establish a health impact assessment system for all economic and social development plans and policies, as well as major projects.

This formal recognition of the political role of health is inherently unique and will underpin China's leadership role both at home and abroad.

However, in China, as in all regions of the world, new, serious threats are emerging. The difficulties associated with them and their consequences for human health and society are so great that they can slow down or even reverse the achievements recent years. This applies to both China and all other countries.

Ladies and Gentlemen,

All of humanity today is faced with unprecedented speed of change, which poses a threat to human health and causes alarm. Globally, 800 million people continue to suffer from chronic malnutrition. At the same time, there are countries where more than 70% of the adult population suffers from obesity or overweight.

Although obesity is becoming increasingly common worldwide, the epidemiological characteristics of the problem depend on the duration of the epidemic. In North America and Europe, the prevalence of obesity is highest among populations with low level income, often living in urban food deserts densely packed with kiosks and fast food restaurants.

In countries that have experienced an obesity epidemic more recently, such as the Asia-Pacific region, obesity primarily affects the rich in urban areas, followed by the poor in rural areas and peri-urban slums.

In China, as decades of scarce food supply gave way to abundance, the prevalence of obesity and overweight rose, more than doubling in the last decades of the 20th century. Thus, in less than one generation, the country leapt from famine to feast and plenty.

The increase in body weight affecting all categories of the population is an alarming signal, warning us of the big problems ahead. They will not arise immediately, but inevitably, and will appear in the form of a wave associated with lifestyle chronic diseases, including heart disease, diabetes and some diet-related cancers.

Economic growth and modernization, which in the past were associated with improved public health, are now opening the door to the globalization of advertising and trade in unhealthy products such as tobacco, alcohol, highly processed foods, and sugar-sweetened beverages.

While the rapid migration from rural to urban areas has a number of positive consequences, it is also accelerating the transition from active to sedentary lifestyles.

For the first time in history fast growth welfare leads to deterioration in the health of many of yesterday's poor. This occurs in countries where the health system does not have sufficient resources and human resources to take timely action. If current trends continue, diabetes, which accompanies the obesity epidemic and requires such expensive treatment, can negate all the fruits of economic development.

The Asia-Pacific region is widely considered to be the epicenter of the diabetes crisis. People in this region develop the disease earlier, are more severe and die faster than people in richer countries.

In some of the most populous countries in Asia, including China and India, a generation of people who grew up in poor rural areas, where food was always scarce and work was physically demanding, now lives in urban apartment buildings, works in offices, exercises little, and travels in affordable cars. in all cars and eats cheap food from fast food establishments.

Partly as a result of these changes, millions of people who had managed to escape poverty and become part of a rapidly growing middle class now find themselves trapped in the suffering associated with chronic diseases and their complications, which are very costly. Today, China has the world's largest diabetes epidemic, affecting 12% of its adult population, a figure that continues to grow at an alarming rate.

WHO data shows that the prevalence of diabetes, heart disease and cancer among the Chinese population has risen more than nine-fold in a single generation, far outpacing the rest of the world.

This alarming situation is largely a consequence of the shift from traditional diets to Western-style diets rich in fat, sugar and salt, an aging population and rising consumption of alcohol and tobacco.

The rise in the prevalence of non-communicable diseases has very far-reaching consequences. This is a real tectonic shift that requires fundamental changes in fundamental public health attitudes.

In most developing countries, health systems were designed to deal with short-term events such as childbirth or acute infections. These systems were not designed for long-term management of patients with chronic pathologies and their serious complications requiring expensive medications and hospital care.

Public health must shift its focus from treatment to prevention, from short-term to long-term case management, from delivery, vaccination and antibiotics to behavior change, from working alone to coordinated action with multiple sectors and partners.

One of the most forward-thinking ways to ensure this transition is to develop a pipeline of well-trained and motivated doctors general practice. They both treat and prevent. They are also better than others in identifying the disease in the early stages before complications arise that require expensive treatment and lengthy hospital stays.

GPs are the gatekeepers to the healthcare system, tasked with ensuring that patients with relatively minor complaints do not overwhelm emergency departments. General practitioners know that illness has social as well as medical causes, which gives them a great advantage when it comes to primary prevention and improving patient satisfaction with services. They are the ones who can provide services that are truly focused on people's needs.

Many outside observers of China's ambitious reform program have noted that the lack of well-trained medical practitioners is a major obstacle to reducing overuse of hospital care.

Provincial health leaders have a key role to play and direct resources correctly. Investments in primary health care will produce more results and be more cost-effective than investments in building new hospitals and clinics.

The costs of treating these lifestyle diseases are shocking. Prevention is undoubtedly a more effective way to solve a problem, but organizing prevention is a very difficult task to at least for two reasons.

First, the underlying causes of chronic diseases lie outside the health sector. The health sector bears the burden of these diseases but has little leverage over risk factors. Secondly, the activities of powerful economic actors such as tobacco, alcohol, food and soft drink manufacturers are leading to the globalization of unhealthy lifestyles.

Using the WHO Framework Convention on Tobacco Control as a legal instrument, governments, including at the regional level, can enact legislation that will significantly reduce tobacco consumption. We are sure of this, we have a lot of evidence of this.

Beijing's tobacco control measures are among the strictest in the world. Shanghai recently banned smoking in all airport buildings and train stations in the city. The Shanghai Legislative Assembly is considering taking even stricter measures to ban smoking in all public buildings.

If Beijing and Shanghai can do it, with broad public support, every health director in every province can do it.

Unfortunately, the tobacco industry is trying everything it can to undermine the passage of these desperately needed laws. Their goal is to weaken China's national tobacco control legislation, which is currently being drafted.

Don't let industry's notoriously unscrupulous behavior reverse these health gains in China. Health interests must come before protecting the profits of private companies. Every tobacco-related death is a preventable tragedy.

Ladies and Gentlemen,

In a world where there are so many uncertainties, economic, trade and industrial considerations can trump national and international objectives and override public health interests.

Another trend requires close attention. Economic growth and increased prosperity are almost always accompanied by an increase in demand for meat and dairy products.

Over the last decades of the last century, the world food system has made a transition to industrial food production. The result is huge livestock complexes where thousands of pigs, cattle and poultry are kept in cramped and unsanitary conditions.

Thus, in China, giant livestock enterprises have been built, capable of producing more than a million heads of pigs per year. The system of mass housing of livestock makes it possible to satisfy the population's demand for cheap meat, but at a very high price.

This system is not environmentally sustainable. Such livestock farms seriously pollute the environment with animal excrement and chemical waste, as well as methane, which contributes to climate change.

Raising huge numbers of animals in cramped conditions requires the use of enormous amounts of antibiotics. In some countries, more antibiotics are used to produce food than to treat people.

Research from China best demonstrates the direct link between the use of antibiotics in food production and the discovery of drug-resistant pathogens in food, animals and humans.

Around the world, more and more first- and second-line antibiotics, vital to humanity, are becoming useless as a result of the emergence of resistance, which is clearly linked to the abuse of these valuable drugs.

With so few replacement drugs in development today, the world is moving toward an era of antibiotic-free living, in which many common infectious diseases will become deadly again.

As host of the G20 summit in September, China included the issue of antimicrobial resistance on the agenda and final communiqué of the event.

China is very fortunate to have a Chairman who has placed health at the center of all government activities. All measures taken by all agencies must be accompanied by a health impact assessment.

This can help China ensure that, as a result of rapid modernization and economic progress, the population does not lose, but improves its health.

I would like to ask you in the process further development initiative "One Belt and One Road" do not forget that there are so many economic and trade factors that could reverse decades of sustained progress in improving public health.

Recognizing and adjusting these factors is another way to promote peace and cooperation, openness and inclusiveness, mutual learning and mutual benefit.

A world in which there is such an imbalance in income, opportunity, access to healthcare and health levels is neither stable nor safe.

Thank you.

The brilliance and poverty of Chinese healthcare. How people are treated in China (myths about free medicine) Visa for those traveling to China for treatment

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