Those of you interested in the state of China’s healthcare should scoot over to the Lancet’s current magazine, available for free online (partly, with free registration). The Lancet, one of the world’s top medical journals, has been running an almost-annual series of articles on China’s healthcare. This year’s articles are top notch, and fascinating even to the casual Sinophile. Among the articles are:

• Environmental health in China: progress towards clean air and safe water
• Causes of deaths in children younger than 5 years in China in 2008
• China’s health reforms revisited
• Realignment of incentives for health-care providers in China

Here’s a nice summary quote from their editor:

18 months makes a narrow lens to evaluate health-care reform for 1·3 billion people, but during this period events have tested the Chinese Government’s will and shown how crucial reform is and how well some parts of the health system have responded. The global financial downturn emphasised the catastrophic cost of medical care for people without insurance in many countries, while at the same time showing China’s unique strength in having a resilient economy that can sustain investment in health. Another step forward was the vigorous response to influenza A H1N1 by the Chinese Center for Disease Control and Prevention, which included aggressive case finding, vaccine development, and mass vaccination at a speed and scale unparalleled elsewhere. Areas from the 2008 Series that have already seen improvement are greater recognition of migrant workers’ health and introduction of a national organ-donor scheme. Furthermore, research output has surged and Nan-Shan Zhong’s PEACE study was voted a Lancet paper of the year for 2008.

But inevitably there is unfinished business. Smoking is China’s greatest public health hazard, yet tobacco control efforts are timid and implementation lacks conviction. Ethics, including research conduct and governance, remain a concern. Contamination of infant milk formulas with melamine contributed to continuing disquiet about China’s Food and Drug Administration. And little progress has been seen in human rights or access to general information. The latter point—access to reliable information—is a key determinant for the quality of health care that people in China can expect. Information about health in China is a central theme in today’s Lancet.

While China possesses a marvellously rich indigenous tradition of Confucian ethics, medical ethics in contemporary Chinese hospitals, medical schools, and biotechnology research institutes is still largely an import of Euro-American procedures and protocols, with a key influence from the US National Institutes of Health (NIH). As such, medical ethics is often grudgingly treated as a necessary afterthought for which cosmetic and highly technical responses are sufficient. This delayed development of a concern for values in medicine was, I would suggest, substantially encouraged in China (and in Japan) by the failure to provide justice for the wartime medical atrocities of the Japanese Imperial Army’s extensive biowarfare programme. Instead, the occupying US regime prevented a trial of the doctors and scientists responsible, inter alia, for dropping anthrax bombs on Chinese cities and vivisecting each year, from 1937 to 1945, more than 1000 Chinese research “subjects” in grotesquely inhuman experiments. In return for helping the USA co-opt the Japanese biowarfare expertise, there was no equivalent to the Nuremberg Trials for Nazi doctors. And hence there is no East Asian equivalent of the Nuremberg Code for medical ethics. Lacking that powerful stimulus, medical ethics in China has been anaemic. Yet, there is in this decade deepening interest in professional ethics promoted by both concern for controlling corruption and dangerous and unnecessary medical practices and by a health equivalent to the consumer consciousness movement that is affecting the rest of Chinese society. Students and professionals are drawing on the broadening, society-wide critical reflection on patient—doctor value conflicts and the inadequacy of health and welfare security to build a more robust ethics.