Offline: Towards a Pax Sinica?

Abstract

One's immediate impression on meeting China's new Minister of Health, Ma Xiaowei, is his sense of humour. Laughter frequently punctuates his sentences. He discusses his love of Agatha Christie. Minister Ma has worked in the National Health Commission (Ministry of Health) for two decades. He knows the job and understands its enormous responsibilities. We met on what he pointed out was his 1-month anniversary in the role. Now is “a very critical period” for the health of the Chinese people. He identified two priorities. First, to improve accessibility to medical services. To meet this objective will require a high-performing primary health-care system, something China currently does not have. Second, to reduce the poverty-inducing health costs caused by expensive medicines. He would like to see closer collaboration between Chinese health experts and their international counterparts. And he welcomed independent external assessment of the progress of China's health reforms. He intends to accelerate the pace of those reforms. Time magazine last week named President Xi Jinping one of its “100 most influential people” in the world. It concluded its citation by arguing that, “Pax Americana is finished, and Xi will have a say in whatever comes next.” Today, there are escalating political and economic tensions between America and China. Yet last week signalled a modest but, in the difficult geopolitical circumstances, a not unimportant historic moment. Peng Gong, who heads the Department of Earth Systems Science at Tsinghua University in Beijing, led a team of 45 scientists in publishing a wholly Chinese-led Lancet Commission on unlocking the power of cities for a healthy China. The Commission set out the challenges for Chinese cities as the foundation for Xi's notion of an ecocivilisation: unprecedented expansion, an epidemic of non-communicable diseases, the threat of newly emerging infections, an ageing population, rising health costs, and growing health inequities. Although most policy makers accept that the health sector alone cannot solve these problems, there are few incentives for intersectoral collaboration. Peng and his team wrote a manifesto for urgent action not only by the Chinese Government but also by Chinese society. In line with President Xi's vision for a Healthy China 2030, health must be incorporated into every government policy. Greater public participation in producing healthy cities is needed. Some cities, such as Shanghai, are already putting health at the centre of their thinking. Fan Wu explained how Shanghai has seen life expectancy rise through multisectoral collaboration, community self-management, employer engagement, healthy schools, better care for the urban elderly, and tobacco-free policies. Ling Li put part of reason for the government's unusual focus on health down to President Xi's experience as a barefoot doctor early in his career. But part of the reason is also fear. In 2003, SARS shocked China out of what had been complacency concerning the state of its health system. Healthy China 2030, inaugurated in 2016, aims to achieve three goals. First, to improve population health. Second, to connect health to the country's broader socioeconomic development, emphasising the quality as well as the quantity of development. And third, to provide a platform for China to take a greater role in global health leadership. Foreign affairs specialists often talk about the Thucydides Trap. They mean the moment when one power threatens to displace another. When Athens rose, Sparta saw danger. War followed. Historians say that of 16 episodes of similar power transitions, 12 have ended in war. As America concedes power to China, is conflict inevitable? China interprets America's initiation of a trade dispute as proof that President Trump seeks to check China's rise. Writing in the China Daily last week, Huang Qunhui from the Chinese Academy of Social Sciences charged that the US, “wants to maintain its hegemony to deprive China's development rights.” President Xi has committed China to a new phase of “opening up”. That is certainly the policy of China's health community. The country's medical scientists crave global engagement. The Thucydides Trap is not inevitable. Indeed, there is every reason to believe that if the cooperative spirit of China's medical community could be replicated across China's Government, the future could be peaceful and productive. A new era of Pax Sinica.