Fixing China's Health Problems

Beijing's tactics keep backfiring. On December 2, Chinese officials announced that the estimated death toll from the melamine scandal doubled from three to six babies and the number hospitalized jumped from 53,000 to 300,000. China's leaders have pledged to overhaul its dairy industry, but their public health record leaves much room for doubt. In one health crisis after another, Beijing has simply fired officials, issued new quality standards, and promised to get it right next time. Meanwhile, the scandals have only continued. As Treasury Secretary Paulson wrapped up his meeting with his Chinese counterpart Wang Qishan on December 5, he said that the U.S. and China had again deepened cooperation on food and product safety. But China's haphazard responses are too often too little, and too late. For the U.S. and the rest of the world, it's critical that China learn this lesson now.

After the string of product scares that began last year, America has gotten its own reality check: a healthy China is integral to a healthy United States. With China as our number two trading partner, America has a large stake in improving China's product safety and public health. China's health blunders are corroding the confidence of consumers both inside and outside of its borders, and shaming its reputation as a rising global player. More importantly, they are increasingly threatening global health.

To end the scandals, China will have to change the way health governance works. China's current health system is so opaque that it breeds chronic disorganization and corruption. About 30 different agencies each claim a role in health governance, including economic planning and construction bodies that prioritize profit over health. Adding to the confusion is the fact that none of the agencies' roles is clearly defined. This makes it tempting for companies and officials to hide their mistakes, and worse, get away with them. Even China's Premier Wen Jiabao recently told Science magazine that the government had been lax in "supervision and management." Misprudence also hinders the control and prevention of infectious disease, like SARS and HIV/AIDS. The SARS outbreak in 2003 was prolonged because central and local governments failed to share information swiftly -- not to mention the attempts to cover up the incident altogether. Little seems to have changed since.

For China, getting it right means more proaction. The government can minimize conflicts of interest by deferring the slew of Chinese ministries' health authorities to one that already has the job, like the Ministry of Health. Equally important is strengthening the rule of law and its enforcement. If Beijing wants to deter government officials and company executives from making poor judgment calls, it should maximize their liability by slapping heavy fines on those guilty of misconduct, and by making the judicial process more transparent and accessible. Chinese civil society groups, moreover, can help the government keep the public alert, open information channels, and hold the appropriate guilty parties accountable. But first, China has to create ample political space for these groups to operate in, and protect them from threats of repression in the name of public stability. Only then will China be able to steward effectively public health.

Of course, reforming health governance won't occur overnight. The United States can help here in two ways. First, the U.S. needs to clean up and strengthen its own monitoring system; in food safety, some 12 different agencies monitor 35 different laws. The U.S. Food and Drug Administration recently announced plans to open three branch offices in China by the end of this year, but only to be run by a meager 13-person staff. This is not enough. The U.S. too, will need to reduce bureaucracy, and boost manpower. Second, the U.S. should help China build the institutions and provide the training necessary to improve oversight in product safety, disease control, and broader public health. The U.S. FDA, the Department of the Treasury and other agencies have already begun forging partnerships with their Chinese counterparts to lay the groundwork for improved safety. International bodies like the World Health Organization and World Bank are also widely involved in improving China's disease surveillance and control.

Still, China will have to take the first step.

China's leadership will have to properly address the root causes of its ailing health system, not just the symptoms. If Beijing continues to launch initiatives and fire officials to solve its health crises, it will continue to see improvements that are only marginal and temporary, not meaningful and lasting. Ultimately, the health scandals will persist, further tainting China's image domestically and overseas. Neither China, nor the world, can afford this.