Article 48 of the Common Program

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With the help of League of Nations (predecessor of the UN) health reformers, the GMD government started in the 1930’s to build a nationwide network of medical institutions in urban and rural areas. Cities have priority but the healthcare is unevenly distributed. In certain areas of Tianjin, tap water was readily available and residents enjoyed adequate nutrition, while in other areas, people had to resort to drinking water from stagnant ponds and faced starvation. In 1949, infectious diseases such as tuberculosis, neonatal tetanus, dysentery, and encephalitis were the leading causes of death in Tianjin, stemming from factors such as poverty, malnutrition, substandard housing, contaminated water sources, and inadequate maternal and infant healthcare. Even after the take-over, the specter of epidemics persisted. Tianjin boasted a relatively rich array of medical resources, but the challenge lay in their unequal distribution. Addressing these entrenched public health issues required substantial efforts to elevate living standards and establish a robust healthcare infrastructure, necessitating significant investments of time, funding, and personnel from the new government.
Medicine is practiced by medical missionaries and Chinese students who studied with them in China or abroad. Both have different goals.Missionaries often utilized medicine and health campaigns strategically as opportunities to propagate their religious message and garner converts. In contrast, Chinese doctors perceived medicine as a means to contribute to the development of the emerging Chinese nation by enhancing the health of the population and imparting enlightenment through Western science. The extraterritoriality rights granted to medical missionaries, unlike those of native doctors and Chinese health ministries, posed significant challenges in developing collaborative programs. This not only led to a division between medical missionaries and Chinese doctors but also hindered effective collaboration among missionaries themselves. Given that missionaries belonged to diverse sects originating from various Western nations, each with its own medical practices, they were separated both by ideological beliefs and professional approaches.
After 1949, the medical organization is modeled after the Soviet system with its emphasis on constructing urban hospitals, industrial clinics, trade union sanatoria, and technically advanced central medical research institutes. Similar to other sectors of society, the CCP found itself dependent on GMD personnel, particularly in the medical field. The technological and scientific elite within medicine felt secure, knowing that the Communists had little option but to integrate the existing Nationalist infrastructure of both applied and theoretical medicine. This integration excluded only a few renowned physicians who had maintained close ties with the "imperialists."
In rural areas, the majority of Chinese medicine practitioners hailed from despised landlord families, who were among the few able to afford education for their sons. This social stigma resulted in patients withholding payment from this marginalized group, further diminishing their already meager income. Additionally, these doctors' families were unable to provide support as they had lost their previous resources. To survive, Chinese doctors resorted to raising prices above government-set levels, appropriating drugs or campaign materials for personal gain, siphoning funds from communal campaign accounts, or fleeing to resume private practice. However, government pressure and concerted efforts to eradicate private practitioners often compelled their participation.
While numerous economic and political decisions in early 1950s China focused on industrial and urban development, aiming to replicate Stalin's achievements in rapid state-planned industrialization, the country's national medical policies took a different trajectory. During this period, Chinese medical policies continued the organizational experiments initiated by Chinese medical reformers and administrators in the 1930s. Consequently, the Soviet influence on Chinese medical organization appears to have impacted only specific aspects of central and urban medical institutions. These aspects include the establishment of specialized central research institutes under the Chinese Academy of Sciences and Chinese Academy of Medicine, the development of clinics and sanatoria for urban industrial workers, and the Communist Party's efforts to gain political control over medical professionals by restructuring their associations, journals, teaching curricula, research institutes, and health institutions at all levels. Fig. 48.1 Healthcare 1949-1954 Often, very practical measurements are taken to improve the health situation. "Fearful of epidemics, the Military Control Committee decided to act where the Guomindang had only propagandized. During the first eight days of June (1949), the committee had the army remove 38,000 tons of garbage from the city’s streets (in Shanghai)"
In 1952, the national health policy can be described as priority for the needs of workers, peasants, and soldiers, prevention, unity of Chinese and Western medicine, and the combination of health work with mass movements. In 1952 two health insurances are introduced. One, which covers all government employees, college students and staff, and employees in political parties and mass organizations. This insurance is subsidized with governmental assets devoted special to this purpose. (See Article 2 for restriction of mobility) The other one is designated for all workers employed by state-owned enterprises. This is funded with the contribution of the firms. See also Article 32
Peasants have to pay for their medical care on a fee-for-service basis. As soon as the agricultural collectivization starts, cooperative health care is introduced. Yet the provision of rural medical services is below par.
In addressing the severe shortage of healthcare professionals in rural areas, a human resource development strategy was implemented in 1951, comprising three key components. Firstly, a reform in medical education shortened medical degrees to four years of college training and efforts were made to establish a three-year secondary level medical training program. Second, policies and campaigns were enacted to encourage healthcare workers in urban areas to contribute their services in rural regions, including participation in mobile medical teams. The Ministry of Health set a target to allocate at least one-third of health professionals and administrative staff to serve in rural areas. Third, a significant number of educated farmers, referred to as 'barefoot doctors,' were recruited and underwent a three-month training to provide basic primary health care services in rural areas. This initiative began in 1951, with the Chinese government calling for primary school teachers and New Democratic Youth leaders with primary health training to engage in rural health care activities without disrupting their regular work and production activities.
A fourth way to improve the health care system was a tax exemption policy, which was established in 1950, exempting all categories of health facilities from paying taxes. This policy permitted health providers to retain the revenue they generated, encouraging them to reinvest it to eliminate financial barriers to the provision of health services. The policy applied to various providers, including private, collective, or public-private health providers, as well as Chinese medical practitioners. However, this exemption was contingent on their commitment to offering medical services (including free services for the PLA), engaging in epidemic prevention, providing maternal and child health care services, and allocating a portion of inpatient and outpatient services for free. Additionally, providers were obligated to adhere to health service rates established by local health authorities. Experts validating the findings considered this policy crucial for alleviating financial shortages.
Healthcare was essentially free for all, operating under a tiered system of regulation. Urban patients were initially directed to Tier 1 hospitals/clinics, with referrals to Tier 2 and Tier 3 hospitals for more specialized care if necessary. Although this healthcare system was rudimentary and basic, with low-quality care and primitive equipment, its outcomes were remarkable. Significant improvements were observed in key health indicators, such as reduced infant mortality and increased life expectancy. Health financing was predominantly centralized, with strict budgeting and financing allocated to provincial and local hospitals. There was a strong emphasis on cost control and the provision of essential services through public hospitals.
The decentralized system led to variations among provinces in terms of fiscal revenues and consequent investment in local healthcare systems. Evidence indicates that the establishment and development of health institutions were notably limited in Western China, particularly in Qinghai, Ningxia, and Xinjiang provinces. Throughout the entire period, Qinghai and Ningxia provinces failed to reach a 1 percent share of the total healthcare facilities nationwide. A comparable trend is observed for Xinjiang and the southern region of Hainan until the 1960s, with their share remaining below 2 percent even then.

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Mao Zedong called at the 1st National health conference (August 7-18,1950) : “Our nation's health work teams are large. They have to concern themselves with over five hundred million people [including the] young, old and ill. This is a huge enterprise, and one that is extremely important. Thus our responsibility weighs heavily . . . At present, doctors of Western medicine are few, and [thus] the broad masses of the people, and in particular the peasants, rely on Chinese medicine to treat illness. Therefore, we must strive for the complete unification of Chinese medicine.” At the same conference, He Cheng Vice Minister of Health says "Among health workers, as among other workers, a widespread political study and ideological rectification should be carried out in order to correct the misunderstanding that medical and pharmaceutical personnel have little to do with politics. Revolutionary humanitarianism must be promoted (among them)’ Chinese medicine has to absorb scientific theory. Western medicine needed to learn from Chinese medicine, to better approach the masses. ‘the distance between Chinese and Western medicines would day by day grow smaller, and the differences between Chinese and Western medicines would day by day disappear’, until they ‘open-heartedly and inseparably unite’" After the conference, several measures are taken. For example, every Chinese doctor has to obtain a certificate from the Ministry of Health. The purpose of this measure is to gain control on private traditional medical care. In December 1951, the Ministry of Health started “school for further training of doctors”. The initial design of these schools, which are a bridge to the final unification of both (Western and Chinese) medical systems, was to improve the traditional treatments and skills of the Chinese doctors. In October 1952, an exam system is introduced, the examination is largely concerned with Western medicine. Most Chinese doctors fail the exam and are no longer allowed to practice medicine. Those who passed the exam were not allowed to work in Western hospitals. This resulted in an even bigger shortage of doctors and the unification completely failed. Before 1954, the Central Committee had not issued specific directives regarding the direction of Chinese medicine's development. Mao's vague statements emphasized the importance of maintaining and nurturing Chinese medicine through the slogan "unification of Chinese and Western medicines." However, the implementation and realization of this concept of "unification" fell under the jurisdiction of the Ministry of Health, leaving the specifics of its execution unclear.
A second reason for this failure is the composition of the Ministry of Health. The management of the ministry is for the most part in the hands of Western educated personnel. (Fu Lianzhang, He Cheng, Su Jingguan, Cui Yitian, the 4 vice ministers are all Western educated and the minister Li Dequan was not educated in medicine) They are urban and Western orientated and they only provide lip service to the CCP policy. Part of the scarce budget is spent on diseases, such as tumors and cancer, subjects that at that time in China are rather irrelevant, instead of researching diseases such as typhoid fever, cholera, malaria and smallpox. This attitude provokes a lot of criticism and in 1953 Bai Xueguang 白学光(1913-2017 ), starts an inspection tour. His rapport of March 27, 1953, contains a sharp criticism of the bureaucratic conduct of the Ministry of Health. "Leadership is not centralized, there exists a number of unresolved treatment issues as well as tremendous wastage of resources. There’s confusion among the many sub-departments, and many cadres are discontent within the ranks of the Ministry of Health." In October 1953, Mao Zedong states The most serious one is that [the Ministry] is short on politics, short on political work. There is too little Marxism-Leninism and socialism there. The Party must exercise overall leadership; On June 1954, the decision is made to establish a research institute for traditional Chinese medicine. Lu Zhijun (1911-1999), a western educated doctor but a promoter of TCM, becomes the director. The task of the institute is to systematically organize the Chinese medicine knowledge, to compile textbooks, and to educate teachers. On December 19, 1955, the institute is opened.
TCM is essential to many minority groups. Often they have their own methods and systems for healing. Especially Mongols, Tibetans, Uygurs and Dai. The government tries to bring modern medical and health care, but these efforts are frequently frustrated due to local differences, language problems, and lack of sensitivity by Han medical personnel to the local practices.

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During the Qing dynasty, acupuncture is considered ineffective. Therefore, it was no longer state-sponsored and the elite turned away from this typical Chinese medicine. From then on, acupuncture was only practiced among rural areas and lower classes. The use of herbs increased. In 1930, an acupuncture research center is founded. During the Japanese war, and the civil war the institute closed. In 1951, the school is reopened. Between 1949 and 1953, several publications are printed. At the above-mentioned school for further training of doctors, acupuncture is a minor subject. The so-called 'new acupuncture' had little effect. While science has updated the theory of disease, transformed the understanding of the body, revised manual techniques, and updated the description of individual acupuncture points, its impact on diagnostics and the selection of acupuncture points in the "new acupuncture" remains minimal.
Qigong therapy is also a traditional medical practice. Previously, qigong had been used mainly in martial arts. It is the use of body, breath, and mind to cure illnesses. It is recognized by the Ministry of Health as a medical treatment, after the abandonment of so-called ‘feudal’, superstitious, or religious elements and the introduction of scientific methods. The work of Ivan Pavlov was invoked to provide a ‘modern’ and ‘scientific’ basis for qigong. In the autumn of 1953, the Ministry of Health and the Chinese Academy of Sciences organized a 35-day workshop in Beijing focusing on Pavlovian theory. Twenty-two professors, researchers, and doctors specializing in physiology, psychology, and clinical medicine participated. The workshop hailed Pavlovian theory as a pivotal and materialist approach to physiology, asserting its status as the sole theory guiding the advancement of medical science in the New China.

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In March 1952, Zhou Enlai is named chairman of a new central epidemic prevention committee. China had only fifty-one thousand doctors in 1950. In most rural places, herbalists, midwives, and Chinese medicine practitioners are active. Their skills range from competence to quackery. Mao Zedong mentions an important obstacle for all health campaigns "Agricultural production is the predominant work in the countryside. In the countryside all other types of work revolve around agricultural production and serve its interests. All so-called work assignments and work methods that may hinder the peasants from carrying out production must be avoided...nor is it possible to interfere too much with the peasants. " Gross (2016) mentions one more obstacle "From whole provinces down to the individual villager, campaign work was determined not by what was most effective but rather by what was affordable." Health posters

The promises made by propaganda, which stressed complete eradication of disease and the reality, with outcomes of only 60% or less cure rate, resulted in the patient’s feelings of betrayal and deception. Propaganda methods used include movies, slideshows, plays, children book and posters. See for more posters Hygiene posters
Most rural areas lack electricity and ‘old’ techniques are used like opera, theater, story-telling, and songs. These methods are excellent to stir emotions (land reform campaign) but insufficient to transmit scientific information. This use of traditional entertainment subverts CCP ideology of crushing superstitious beliefs and popularization of science. During the early 1950s, theatrical performances and educational presentations often coincided with religious festivals, taking place at bustling markets, fairs, and holidays. While these events reached a wide audience, they often reduced snail fever campaign education to just another attraction. The failure to transmit scientific knowledge hinders the campaign. This comes at the expense of prevention which should be primary and treatment only as a supplement. In reality, prevention is neglected in favor of treatment. Propaganda for sanitation work meets a big challenge, most people see feces, urine, saliva, garbage, and animal manure as natural and as part of the ecosystem, so managing them seems unnecessary and intrusive. Sanitation work is considered make-work, nonproductive labor, a waste of time. Sanitation work involves interference in the environment. This intervention can prepossess feng shui, but disruption of feng shui can bring repercussions.
Women in particular are hard to convince to be treated, they are indispensable in their household duties like cleaning, cooking, tending animals and growing vegetables , caring for children, and attending the elderly. They can and will not afford to leave their homes. The treatment of men is also difficult due to their working on the land. "Whereas a son was their social security system, a woman who would not work around the house or bear children bestowed a bad fate on their new household that would curtail the family line. Nobody wanted to waste family resources on somebody like that. " In the early 1950s, kindergarten teachers helped combating tuberculosis through BCG injections. See Posters "Parents were initially reluctant to vaccinate their children with the experimental drug. But after a school lecture, and promises to pay by school administrators for hospital fees if the children experienced any negative side effects, parents vaccinated not only their kindergarteners, but also the younger siblings in their families."

Prevention

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On February 23, 1952, the Renmin Ribao published for the first time about “the appalling crime of the American aggressors in Korea in using bacteriological warfare.” This accusation was the starting signal for a national campaign called 'The Patriotic Hygiene Campaign'. The campaign emphasizes that the health of the individual is just as important as the health of the state. The CCP states that both are inextricably linked, the health of the individual is inseparable from the health of the collective. On March 9, 1952, the CCP issues a directive: "...dividing the nation into four “prevention Regions” based on their proximity to the Korean front. It defined Korea as “epidemic Region,” the Northeast as an “emergent anti epidemic Region,” the northern, eastern, south-central, and coastal areas as “anti-epidemic supervisory Regions”, and the south-central interior, north-western, and south-western areas as “anti-epidemic preparation Regions.” Each Region was assigned with different sets of tasks. The tasks for the “epidemic Region,” for instance, included a massive program of injections, elimination of all germ-carrying animals, and designation of special hospitals for inflicted patients and quarantine of the epidemic inflicted areas."
The campaign has two major goals. The annihilations of the 5 pests: flies, mosquitoes, mice and rats, lice, and bedbugs. The campaign also aimed to mobilize women and others working inside homes to participate in clearing, dredging, and sweeping the city clean. In Tianjin, hundreds of thousands of housewives, along with university and high school students, joined efforts to clear miles of the city's stagnant and foul-smelling drainage canals. Armed with picks, shovels, and shoulder-poles, residents filled in over seven hundred cesspools, one bucket of soil at a time. Neighborhood cleanups removed tons of trash from both domestic interiors and public spaces, including old derelict temples, opera halls, and street corners. This campaign is an example of mass mobilization. Neighborhood committees organize meetings to convince housewives and retirees to take care of domestic hygiene. The purpose is to turn average citizens into an army of volunteer public health and sanitation workers. On the one hand, the participation level was not always high. During the mobilizations of 1952, there was significant resistance and disregard for the government's goals. While some activists from the local community participated in neighborhood domestic hygiene inspection teams, many others failed to see any connection between mundane tasks like sweeping the floor and the larger objective of defending the nation against germs. Evidently, the fear of biological weapons alone was not enough to motivate the masses to adopt modern hygiene practices. Patriotic Hygienic Movement

Most people do not see the connection between bacteria, insects, and diseases. Diseases are only seen as a phenomenon of nature. In rural areas, the peasants notice that the harvest has not been affected. They also rely on old habits instead of modern tools. "...,local religious groups, which had been perceived by the party as residues of the old society, were now using the movement to seek legitimacy and expansion of influence, ironically becoming a strong force to resist the state penetration to the grassroots society." According to a report from a public security bureau in Hebei, there is a common pattern observed before people begin seeking holy medicine. Initially, various rumors circulate, often involving female spirit mediums and individuals claiming to be immortals visiting the earth, who actively engage in enticing the minority of the population who are unwell to seek holy medicine. If someone with a minor illness fully recovers, rumors spread rapidly, leading the masses to believe. Subsequently, there is a significant increase in the number of people seeking this medicine. Therefore, newspapers and radio broadcasts stopped giving only medical information but stressed germ warfare descriptions with reports about its victims. However, there now was a rise in false alarms and exaggerated responses, indicating that fear, rather than apathy or disregard, was becoming a prevalent response. Political propaganda shifted its focus towards channeling popular fear into societal reform and national mobilization. This campaign had two main objectives. Firstly, it aimed to engage the entire nation in the movement for disease prevention. Secondly, it sought to familiarize the populace with extensive political campaigns that impacted their daily lives. The Patriotic Hygiene Campaign served as a method for challenging the importance of medical expertise and advocating for the model of 'people's war', or mass mobilization, as the appropriate approach to building socialism in China.

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One of the most outstanding health campaigns is the schistosomiasis health campaign. The disease affected 10.6 million people, with another 100 million at risk in the southern part of China (mainly in areas along the Yangtze River and to the south of the river basin. These areas include 348 counties in 10 provinces, the Shanghai Municipality and Guangxi Region). Schistosomiasis threatens the productivity of farmland, labor, and capital (draft animals). In the 1950s, the endemic situation of schistosomiasis was extremely serious in various endemic areas of Jiangxi province. Average infection rate for inhabitants was above 10%. Regional distribution of schistosomiasis before the 1950s in China Due to military and economic security concerns, the new government framed the campaign as a political initiative rather than a mere health endeavor, presenting it as one of its earliest efforts to transform rural environments. Despite facing obstacles such as limited funding, scarce material resources, inadequate technical and medical expertise, and resistance from both villagers and local officials, the Party managed to achieve favorable outcomes through the campaign and establish constructive relationships at the grassroots level. Examining the intricate interplay of resistance, integration, and power struggles within the nascent regime against a backdrop of resource scarcity provides insight into the campaign's complex dynamics. See also Article 2. The new regime can rely on personnel, infrastructure, and knowledge from the GMD administration, but it lacks resources. The CCP faces several problems in combatting the disease. Most doctors have employment in the cities and are reluctant to work in inhospitable rural areas. In the early 1950s, rural health bureaus lacked personnel to conduct a treatment campaign to promote ideas about sanitation and public health, and the power to mandate altered behavior. The inhabitants of the newly ‘liberated’ areas have little trust in the new government.
During the Sanfan (see Article 18), the local health services get disintegrated "Medical workers unhappy at being posted in the countryside took advantage of the chaos to return home. In some places, the Three-Anti Campaign affected both the quality and the quantity of public health work for up to a year afterward. "
The Chinese government viewed medicine as a convenient means to showcase the scientific underpinnings of CCP governance, aiming to lead the populace toward a modern socialist future rooted in science. This vision contrasted sharply with the perceived stagnant and superstitious past spanning millennia. Between 1949 and 1954, the number of research papers on schistosomiasis nearly doubled over what it had been in the previous 40 years. At the end of the 1950’s, despite all difficulties, the endemic disease were to some extent eliminated. Treatment of the disease is successful, prevention of the disease is not. True elimination occurs in most places during the late seventies and eighties. Prevention

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The aim of the anti-malaria campaign in 1952 is to reduce the cases of malaria and the death rate. Several ministries join their efforts to make this campaign a success. In addition, organizations like the Red Cross, the ACFDW, and the ACFTU participate in this campaign. Besides these organizations, urban communities, work units, and rural villages are mobilized. "The campaign attempted to turn the masses from passive recipients of medicine and health care into active fighters against diseases and masters of their own health. This approach to combatting diseases was dubbed ‘the mass mobilization model’ in the study of malaria.¹⁹" The scarcity of medicines and healthcare professionals, particularly in rural areas, poses a significant obstacle to achieving a substantial breakthrough. Posters, instead of promoting unavailable anti-malaria drugs, emphasize prevention. Such an approach could have disappointed the intended audience of the campaign and dampened their enthusiasm for health initiatives. It might have even eroded the government's credibility. Traditional methods of moxibustion and burning mosquito repellent are promoted alongside with modern techniques of spraying insecticides. This mixed use of Western and Chinese medicine is endorsed by the government. In Yunnan, cinchona trees are cultivated to provide a reliable supply of quinine.

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In December 1952, the People's Republic of China declares to be a ‘drug-free nation’. In 1949, there were estimated more than 20 million opium addicts. From 1950 onwards, an anti-drug campaign is held. On September 12, 1950, the directive concerning the strict prohibition of opium and other narcotics. states a strict prohibition of drug taking. Peng Zhen coordinates the campaign, many ministries (ministries of railroads, communications, interior, and public health) and organizations (postal service, customs, courts, and procuratorate) are involved. Trade unions, mass organizations, and the CCP hold large education forums and anti-drug gatherings. During these rallies, drug users are publicly shamed (and subject to detention for coercive rehabilitation) and drug traffickers are sentenced. Offenders, who turn themselves in, confess and show remorse, are treated leniently. Persistent offenders (e.g., drug kingpins and drug lords) are confronted with economic sanctions (fines, confiscating of property) or imprisonment or death penalty. These anti-drug campaign is mainly carried out in urban Regions and are combined with the Sanfan (see Article 18 ) and Wufan (Chapter 4 ) campaigns. Many corruption cases were related to drug trafficking.
The campaign is carried out in silence, there are no newspaper reports, pamphlets, or radio bulletins. The reason for this is the accusation of the US that the People's Republic of China are still smuggling narcotics. The Chinese government assumes that the US will use news and information about drug producing and trafficking to prove its accusations. Therefore, the campaign is carried out orally. The local cadres have to mobilize the masses by holding propaganda meetings. (some are especially for youth, senior citizens, women, and students) Propaganda trucks with loudspeakers broadcast the anti-drug campaign slogans and directives. Sometimes drug offenders are placed on the circling trucks. Operas, comic dialogues, and folk dances are used to spread the campaign’s policy. During the Korea War, the anti-drug campaign is linked with patriotic behavior and related with the “Resist Amerika Aid Korea”. In one area, the southwest of China, the major drug-producing Region, the campaign starts in 1956. The production of drugs in the southwest part of China is located in isolated and mountainous Regions occupied by minorities. The authorities were keenly aware that in certain regions, opium remained the primary source of income for numerous households. Recognizing that attempting to suppress opium without establishing full control over these areas and without providing alternative crops would likely trigger substantial resistance, potentially leading to riots. In some areas an allowance as compensation for the lost income is paid, in some cases debtors are allowed to grow poppies until they have paid of their debts. Sometimes even compensation is paid for the loss of income for former employees of the opium traffickers. In reality, the situation was far more intricate and diverse. Both the GMD and CCP regimes, akin to later Qing Dynasty rulers and various regional warlords, oscillated between employing severe anti-opium rhetoric and launching sporadic eradication campaigns on one hand, and clandestinely regulating and taxing domestic opium production and sales on the other. This clandestine activity served as a significant revenue source during economic downturns.

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The new administration starts almost immediately with health campaigns, giving information about the improvement of hygiene. The administration takes measures to limit the effects of natural disasters (floods and droughts resulting in famines) by an effective central administration, improved flood control, transport, food distribution, and health services. These actions cause a lower rate of death and mortality rates and growth of the population. (The birthrate is between 1949 and 1954 annually more than 37‰. In 1949 in Guangzhou the birthrate was 27 per thousand, at the end of 1954 it had risen to 44 per thousand population) The state embarked on the task of retraining traditional midwives and educating new midwives. The primary disparity between the Nationalists and the Communist Party in this regard was not ideological but pragmatic: the Communist Party boasted a significantly broader and more efficient rural presence, which consequently impacted a larger populace through its initiatives to modernize rural midwifery. Fig. 48.2 Birth and Death Rates in China, 1949 to 1984
Child mortality partly stems from the inadequacies of midwives. In the early 1950s, the government empowered rural women who occasionally assisted with childbirth by imparting new techniques alongside shaping their political and social roles. The Party perceived these women as practitioners with outdated methods requiring enhancement, as newly emancipated individuals necessitating a boost in political awareness, and as conventional figures in an agrarian community whose customary practices warranted regulation. Classic Chinese medical texts depicted these traditional rural midwives as uneducated, uncouth, obstinate, and hazardous. At the end of 1951, the Ministry of Health declares that there should be at least one trained midwife per district, especially in rural areas, midwifery is quite random, the distribution is uneven, and the quality is often low. Training programs of two weeks are started for those with the right political background (oppressed and/or exploited). The two-week format emerged as the most favored choice, as it allowed the training of a larger number of traditional rural midwives in the shortest duration, optimizing the scarce budget allotted by the provincial public health department for this initiative.
On September 16, 1949, Mao Zedong speaks out about birth control: "It is a very good thing that China has a big population. Even if China’s population multiplies many times, she is fully capable of finding a solution; the solution is production." Fig. 48.3 Population development in the cities, 1949-1998
Mao Zedong follows with his statement the SU, which favors an ‘anti-Malthusian’ viewpoint. A characteristic point of view is ‘strength lies in numbers’. The People’s Daily hails the 600 million mainlanders as the most precious of all categories of capital. A second reason for this pro-natalist opinion lies in the agriculture need for numerous children to uphold ancestor worship and to facilitate land cultivation. In contrast to the SU, a pro-natalist policy is not applied. There are no ‘Orders of the Glory of Motherhood’. However, there are likewise no institutions for birth control.
The CCP had forbidden abortion between 1931-1948 despite liberal marriage laws experiments in this period. See Article 6 . A reason for this attitude is to offset the effects of disease, infant mortality, and high death rates in the base areas during the Japanese war and the civil war. At the same time, the party had encouraged young people to delay marriage and childbirth so that they could devote all their energies to the work of the revolution. In reality, the CCP maintains a two-track policy—allowing urban, educated women to practice birth control while encouraging childbearing among peasant women. "In 1952, the Ministry of Health mandated that all parties involved in the manufacturing and sale of birth control register with the authorities. At the local level, the Shanghai government took this mandate even further, ordering that street vendors no longer sell condoms. Those who still possessed unsold condoms in stock could sell out their inventory under the guidance of local health authorities, but no new supplies of condoms might be sold." Fig. 48.4 Population development in rural areas, 1949-1998
In April 1950, regulations governing army and government personnel in the Beijing Region stipulated that abortion could only be carried out based on medical necessity, alongside written consent from husbands, superiors, and medical professionals. Additionally, all cadres in central government and Party organizations were required to secure personal approval from the Minister of Health. Another factor to consider is the dominance of Western-trained medical professionals in healthcare, who, due to their traditional and conservative training, were hesitant to promote contraception. In response, the Ministry of Health enacted regulations imposing stringent limitations on access to contraception, abortion, and sterilization. In May 1952, the Ministry of Health issues a regulation which stipulates the conditions for abortion: In cases of severe illness or threat to the woman. In addition, no woman was eligible for sterilization unless she was thirty-five years old, had six or more children, and had one child aged 10 or above. The import of contraceptives is forbidden in January 1953. This policy causes major irritation among women. "...,women in the party’s senior ranks began to press for a change in policy, linking access to birth control to the larger movement for women’s liberation that was already under way." Their plea is heard by the (party) leaders (in particular Deng Xiaoping, Liu Shaoqi and Shao Lizi) and in July 1954 the ban on contraceptives is lifted and the promotion of birth control starts. There were no provisions for male sterilization, the argument being men could not afford to be temporarily incapacitated from surgery, so therefore women must instead bear the physical burden of sterilization. However, the potential for this change is not solely based on this appeal. Economic factors also play a significant role. By 1953, it became apparent to many Chinese leaders that the country's large population was directly exacerbating the ongoing food shortages. Although the government denied this assertion, an editorial published in April in the People's Daily asserted that the problem of food scarcity would persist due to the increasing demands of a growing population, bringing widespread public attention to the issue for the first time. In this context, Mao and other senior party leaders began to recognize the necessity of birth control measures, although these discussions took place behind closed doors. In reality, birth control continued to be highly contentious, with medical staff generally resistant to providing information, cadres delaying necessary approvals, and contraceptives being both scarce and of low quality. As a result, abortion and sterilization remained the primary means of birth control. In essence, for many people, access to birth control was more theoretical than practical. The Chinese state's initiatives in promoting prenatal health care and introducing new birthing methods could be interpreted as encroaching upon women's social spheres, diminishing their autonomy, and reshaping societal perceptions of their gender and physiology to render them more compliant as both reproducers and contributors to the state's goals. While these campaigns undoubtedly saved countless lives and presented new opportunities for participating women, they also represented a form of bio-power. This bio-power integrated women and childbirth into a novel ideological and political framework characterized by state control, occasionally manifesting as repression.
Access to information regarding sexual health and birth control varied significantly based on demographic factors such as location, social class, and level of education. Urbanites with higher education were not only more likely to possess knowledge about birth control methods but were also among the first to access legal contraception and abortion services. While state media aimed to propagate norms regarding sexuality and reproduction aligned with national objectives, the ambiguous stance of public policy and discourse on abortion and birth control inadvertently allowed for some flexibility in individual reproductive decisions. This ambiguous landscape, consequently, facilitated diverse approaches to fertility management.
Following the Communist victory in 1949, urban sex workers and ethnic minorities emerged as the primary focal points of an anti-syphilitic campaign. The Ministry of Health orchestrated efforts to assess the epidemiological landscape of the country and develop tactics for preventing and treating sexually transmitted diseases (STDs) (an estimated 10 million people). This initiative led to the establishment of a Central Research Institute of Dermatology and Venereology in 1954. Beyond medical interventions, the campaign also encompassed social and vocational rehabilitation programs for sex workers.

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In April 1917, Mao Zedong stated "Our nation is wanting in strength. The military spirit has not been encouraged; The physical condition of the population deteriorates daily. This is an extremely disturbing phenomenon." The function of sport has 3 political elements in the PRC.
1) sports serve construction, it is instrument in building a new society.
2) sports serve national defence.
3) Sports serve the people, to make sport and physical education available to the masses rather than only a privileged minority. Physical education became a mandatory part of the education system. Fig. 48.5 The regulation of Physical education Hours in elementary schools from 1952-1954 In the Chinese context, the term ‘Tiyu’ (体育) is often used instead of sport. 'Tiyu' also includes general fitness, traditional exercise and martial arts (e.g., taijiquan and wushu), chess, folk dance, competitive and noncompetitive paramilitary activities, collective games, and various kinds of broadcast calisthenics. At the All-China Sport and Physical Education Congress held on 26-27 October 1949, Zhu De, vice-chairman of the Communist Party, explained: "In the past, sport was alienated from the masses. At present, our sport must serve the people, serve national defence and serve people’s health. [. . .] In order to undertake the hard work of constructing our new country, sport should promote people’s physical and mental health. Students, workers, peasants, citizens, militants and civil servants all have to become involved in sport." A policy document issued by the CCP’s CC and the Central Committee of the Communist Youth League of China: International sport competitions are flourishing worldwide. International friends wish China to participate in these events. Recently, we have announced that China will send an Olympic team to the Helsinki Olympics. However, sport in China has been poorly developed in the past. After participating in some international competitions in recent years, we are well aware of the low performance of China's competitive sports teams, which is incompatible with China’s international status. We must change this situation! Sport must be promoted and the performance in competitive sport must be improved¹⁹" Only after the more or less predicted failure at the 1952 Helsinki Olympic Games (See Article 11, note 59) ,a separate ministry level sports commission is established. It shall have equal status to that of others, such as the Ministry of Education and the Ministry of Finance, He Long becomes the head. the ACSF acted as a ‘semi-state’ sports organisation, despite not being a formal government agency. Having seen the results of the Soviet Union at the Olympic Games Rong Gaotang proposes: "..that China should adopt the model of the Soviet Union to develop a sports policy and a centralised management system to meet the country’s political and diplomatic requirements. … The ACSF (All China Sport Federation) is only a semi-governmental organisation and it does not have the power to lead the development of sport and physical education in China. Rong argued that Chinese sport policy and practice should follow the model of the Soviet Union as it had been proved to be the most successful one in the world." See Sport posters Shortly after these proposals, the CCP instructs Rong Gaotang:
1) Begin the preparation of the structure of the new Ministry of Sport;
2) Begin to recruit professional full time athletes from the army and society;
3) Start to build an athletic stadium;
4) Begin to establish sports institutes;
5) Hold a National Games next year (1953).
Besides this founding of a sports commission in June 1952, also other measurements are taken, the magazine issue of Xin Tiyu in July 1950, and the start of broadcast calisthenics in late 1951. The gymnastics were broadcast by about 40 radio stations scattered across the different provinces. China sends a delegation to observe the 1st Asian Games from 4 to 11 March 1951 in New Delhi, India. The First National Minority Nationalities Traditional Sports Games are held in Tianjin on November 8-12, 1953, with 13 nationalities and 395 athletes. Other mass tiyu activities are held "...particularly useful for rallying behind national and patriotic goals that would help consolidate the new regime’s power, and no truer was this than for the Resist America Aid Korea campaign that began following China’s entry into the Korean War in October 1950" In his speech of June 30, 1953, for an audience of the Youth League, Mao Zedong explains: "Now we must ensure that everybody is in good health; we must ensure that workers, peasants, soldiers, students, and cadres are all in good health. Of course, being in good health doesn't necessarily mean that one will study well; studying [well] requires certain methods…. On the one hand there is study, on the other recreation, rest, and sleep; both aspects must be taken into full consideration. Young workers, young peasants, and young soldiers study as they work; for them, too, work and study [on the one hand] and recreation, rest, and sleep [on the other] must both be taken into full consideration. Both ends must be firmly grasped. Studying and work must be firmly grasped, but sleep, rest, and recreation must be firmly grasped also. In the past we only took hold of one end firmly, and we didn't take a firm hold on the other end, or else didn't take hold of it at all. Now we must develop some [programs for] recreation; there must be time and facilities [for recreation]. At this end too, we must take a firm hold. The Central Committee of the Party has already decided to reduce the number of meetings and the time [required] for study; you must supervise the implementation [of this decision]. If there are people who don't carry it out, [an explanation] should be demanded of them." In November 1953, the authors of a report of the China National Sport Commission still complain that "…many cadres not only did not understand the importance of sports but “have even ignored sports.""⁴³ Part of the reason for this complexity lies in the fact that the concept of tiyu during this transitional phase was far more nuanced than simple categorizations of “new” and “old” would suggest. It was influenced by legacies from the past, aspirations for the future, the Soviet model, and guidance from Communist revolutionaries, along with input from various experts from the pre-Communist Republican era and a few specialists from the Soviet Union. Moreover, individuals such as tiyu workers, experts, professors, and athletes who remained in mainland China after 1949 played crucial roles in shaping the trajectory of “new” tiyu, which included mentoring the next generation of athletes and leaders. Some even assumed leadership positions in national tiyu organizations. In essence, the so-called “new” tiyu of the early 1950s retained certain elements of the “old” tiyu. In the eyes of some Party leaders the "old" tiyu experts are seen as less trustworthy than fellow cadres and thus requiring supervision. Sport

Sport is considered as a weapon against American imperialism, in the 30’s and 40’s, the physical culture is based on the principles of American methods. Feng Wenbin states "The American imperialists spread their sport not because they were concerned about the health of the Chinese people, but because sport was an ideal tool of cultural imperialism. The American imperialists emphasised to the Chinese people that American sports equipment is the best, their athletes are the fastest and their basketball team is the top one...in the world." Likewise sport is seen as a weapon against feudalist martial arts. It has to be of scientific character and oppose feudal and superstitious ideas. A notable example was the Chinese martial art of Wusu, perceived as a tool wielded by counter-revolutionary elements. These individuals established anti-revolutionary organizations that posed a threat to societal stability, imparted criminal behavior to young individuals, and harbored enemies of the state. Consequently, the government asserted that these Wusu organizations, both in rural and urban areas, should be outlawed. Additionally, Wusu groups within educational institutions, workplaces, and government bodies were directed to undergo reorganization by the Youth League and local governmental authorities.
The sport of bodybuilding had been banned because of its bourgeois vanity in 1953. "In contrast to mass sports, elite sports were not advocated in the"early years of the PRC because they were deemed to be serving only a few people and in particular the wealthy and the bourgeoisie. Some elite sports were modified to be more suited to mass sport development.
A special kind of ‘sport’ is dancing. It was encouraged by various parties as a healthy recreational activity. However, from September 1954 onward, all dance and concert halls in Shanghai were closed, and had been changed and replaced with collective dance halls held by various units. This did not solve the problem of 'degeneration' of the youth. Trade union organizations visited record stores to purchase jazz records, which were deemed to be "brimming with toxins." An investigation conducted by the propaganda department of the Shanghai Federation of Trade Unions uncovered instances where factory dance parties featured "yellow music" and dimmed lights, leading participants to "lower their guard."
In August 1950, a sports delegation leaves for Moscow, back in Beijing, they communicate their findings: "...the importance of everyone participating in exercise, as well as the necessity of having a large sports stadium with the capacity for 100,000 and an indoor sports arena with a capacity of 10,000.111 Such advice was taken seriously; a plan from the Beijing Municipal Education Bureau in mid-1952 proposed spending nearly 23 billion yuan to build or renovate sports stadiums, fields, and equipment for children and adults.¹¹²" On December 20, 1950, the first Soviet Union sport delegation visited the PRC. During their stay, the delegation visits 8 cities and 14 meetings are held with Chinese officials.The development of Chinese sports programs and sports exchanges in the first half of the 1950s sought to fulfill the goals of the Common Program, while also adopting Soviet-inspired sports programs in China. PRC leaders aimed for state-sponsored sports programs to enhance the physical fitness of the Chinese populace and develop Chinese athletes to serve national objectives. Additionally, they saw Soviet-inspired sports programs as essential for advancing towards socialism and aligning with the framework of international socialism led by the Soviet Union.
Most elite athletes in the 1950s came from schools and universities, which were the first institutional settings for women's sports. Before 1952, the PRC did not possess a structured national team system or competition framework, aside from the national basketball team, which was the sole exception. Until 1953, most teams functioned as provisional training groups, representing the PRC in international events. Following 1952, aligning with the directives of "learning from Soviet Sports" and "engaging Soviet professionals in China while sending Chinese athletes to the Soviet Union," the country established national teams. Additionally, Soviet coaches and experts in elite sports were invited to introduce modern training techniques, technologies, and share their expertise. Fig. 48.6 Numbers of athletes of national competitions 1953 On February 21, 1954, Zhou Enlai delivers a speech "Building physical fitness for the motherland" in which he defines sport as a political mission for national defence and the construction of the socialist country: "The most urgent mission is to develop industry and the economy and consolidate national defence. This mission requires all of us to have strong bodies. We need modern technology to develop our industry. Modern technology cannot be operated without strong and healthy workers. Our people are not strong enough to be qualified workers. Furthermore, modern weapons, such as tanks and jet planes, also need strong and healthy operators. Thus, the GTO is not only designed for the improvement of an individual’s health, but also for national defence and the construction of a socialist country. It is a political mission." The contemporary physical culture, readily embraced as "tiyu," was groundbreaking due to its systematic approach in associating "individual strength, discipline, and health" with the broader "strength" of the national body encompassing military, industrial, and diplomatic aspects. For the Chinese populace, "tiyu" not only represented sports but also served as a platform for expressing Chinese nationalism, the essence of China's national identity, and even the essence of being Chinese through public cultural activities. Radio Gymnastics

This so called Labour Defence System is based on the Soviet Union “Ready for Labour and Defence” system. Hwang (2002) distinguishes five basic aspects of Chinese physical education "(i) the most basic was exercise—the core of the physical training programme. Participation in a varied set of exercises was viewed as preparation for all other aspects of physical education; (ii) physical education involved both games and dance which were included in the middle school programme; (iii) sports were seen as an extension of basic exercises with competition (iv) physical education involved training for labour and defence....(v) physical education involved complete patriotic and socialist education. " The Labour Defence System is largely confined to schools above middle school level and the upper school physical education program, it has always a military flavor. The National Defense Sports Society (NDSS) is established in 1952. The NDSS is a section of the "Sports Ministry". Its mission is to promote parachute jumping, shooting, camping, sailing, aero modeling, radio sports, motorcycling, aerodonetics, and other military sports in the city. A total of 163 sports grounds are built around the country to serve this goal. Parachute jump towers are given the highest priority. The improvement of the physical is not restricted to scholars and students in 1954 an instruction is issued ‘to Engage in Sports Activities during Breaks’ "Cadres in government departments at all levels were required to undertake physical exercise for ten minutes in the morning and afternoon during working days. In the same year, the All-China Federation of Trade Unions issued its ‘Instruction to Promote Sports in Industrial factories to improve workers health …"

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16-09-1949 Mao Zedong "Bankruptcy of the idealist conception of history"
30-06-1953 Mao Zedong Speech on the Youth League
21-02-1954 Zhou Enlai Building physical fitness for the motherland
April 1912 Mao Zedong "A study on physical education"
03-04-1953 Instruction on Leadership Work of Health Departments of Military Commissions
October 1953 Mao Zedong Criticism of the Ministry of Public Health
27-12 1954 Liu Shaoqi "Encourage birth control"

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26-10-1949 All-China Sport and Physical Education Congress

07-08-1950 - 18-08-1950: 1st national health conference

25-07-1952 - 28-07-1952 national drug prohibition work meeting

01-12-1952 - 04-12-1952: 2nd national health conference

24-12-1953 - 28-12-193: 3rd national health conference

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15-03-1951 Provisional regulations governing the management of hospitals and clinics.
11-04-1951 - 23-04-1951 Ministry of Health convened a national professional conference on epidemic prevention, and formulated a prevention and control plan for 19 infectious diseases such as plague, cholera, and smallpox
18-02-1952 Nie Rongzhen reports to Zhou and Mao on biological warfare
08-03-1952 Zhou makes a statement protesting the US use of bacteriological weapons
14-03-1952 GAC establishes in Beijing the Central Committee of Diseases Prevention
07-04-1952 Chinese investigating commission on biological warfare in Korea reports
15-04-1952 CC “Directive on Eradication of Drug Epidemic”
15-04-1952 CC disease prevention campaign is to improve public health
20-06-1952 the All-China Federation of Physical Culture is established
27-06-1952 Free medical care for workers in government and noncommercial organizations
18-12-1952 End of the campaign to eradicate drugs
03-04-1953 Mao "Instruction on Leadership Work of Health Departments of Military Commissions"
04-06-1954 Mao decides to set up a Research Academy of TCM
December 1954 Meeting of the St. Com. CC traditional Chinese medicine

Chapter 5 of Common Program

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