Chen Zhu: from Barefoot Doctor to China’S Minister of Health

Perspectives

Pro le Chen Zhu: from barefoot doctor to China’s Minister of Health

Even by thestandardsof theconstruction sitethat is21st- Most controversiallyhehopesto buybackcontrol of major century China, Chen Zhu has embarked on an ambitious public hospitals. These institutionshave becomedependent architecturalproject.By2010,thecountry’snon-communist on revenues generated by their 15% extra commission on Minister of Health aimsto havelaid, supported bytheState drug sales. Chen says this system encourages hospitals to Council, the foundations of a stronger public health-care unnecessarily prescribe and sell expensive drugs. “This is system for China’s 1·3 billion people. Not only does this definitely something we must get rid of. But it isn’t easy”, meaninvestingbillionsininfrastructure,trainingmillionsof he says. Hospital directors have so much independence healthworkers, and new medical-insuranceschemes, it also that they can decide by themselveswhat equipment to buy involves the di? cult task of persuading hospital directors, and whether to acquire land for new facilities. Chen wants pharmacists, and bureaucrats that health-care services are to establish a system of management boards and regional primarilypublicgoodsratherthan markets. planning. An infusion of publicmoney iscrucial. “If wedon’t PublishedOnline Giventhescaleof theundertakingandthevestedinterests invest, how can we have control?Thisisa very complicated October 20, 2008 DOI:10.1016/S0140- that must beovercome,thetask isrevolutionary,which may issuebut webelievethisisamust”,hesays.Chenalsoplansto 6736(08)61561-5 lift thestateshareof hospital budgetsfrom6–8%to25–30%. explainwhyPrimeMinisterWenJiabaochoseChen,apolitical SeeCommentpage 1441 Apilot project willbeginnext year.Theministryisindiscussion outsider, to take it on. The Shanghai-born academic isonly SeeOnline for webaudio thesecond non-communist in 35yearsto hold such asenior with local authorities, medical bodies, and the directors of post. Hisrouteto thetop isunorthodox. DuringtheCultural hospitals. “We must be very prudent, very careful because Revolution,hewassent tothecountrysidefor 5years,where thisisavery sensitivearea. So wewon’t do it immediately in he taught himself basic medicine and became a “barefoot Shanghai or Beijing. Wewill chooseamedium sizecity with doctor”. He later specialised in haematology, gene cloning, relatively good economic and social development because and DNA sequencing. After taking his doctorate in Paris, youneedmoney,hugemoney”,heexplains. France, at theHôpital Saint-Louis, hereturnedtoChina, later Chen denies that this shift away from the free market is becomingVice-President of theChineseAcademyof Science. turning back the clock. While the past 30 years of change Chen has a track record of establishing institutions, unleashedentrepreneurial initiative,hesaysit isnowtimeto including a biomedical research institute in Guangzhou, a promotejusticeand equality in basichealth care: “What we biomass energy centre in Tianjin, and several institutes for aregoingtotakeisarevolutionaryconcept,but inpracticewe the Shanghai Institutes of Biological Sciences. But nothing areusing theapproach of reform.You cannot makeheaven compares to his current task of rebuilding China’s health overnight.Youneedtohaveastep-by-stepapproach.” system. A fluent English speaker, Chen is candid about the Philosophically, Chen is advocating a whole new way of challengescaused bytheshift towardsmarket economicsin thinking about health care. “We should enlargeour vision”, the 1980s: “People didn’t realisethere could be a failure of hesays.Aswell astreatment anddiseaseprevention,“health themarket mechanism in certain social areas, such ashealth care should cover essential areas like food safety, clean care”. For Chen, the2003 severeacuterespiratory syndrome drinking water, environmental protection, and occupational crisiswasaturning point: “For sometime, the medical care safety in acountry with very rapid economicgrowth. These systemwasgivenmoreattention—bighospitalsandmedical thingsarefundamental andnot easy.” centres. Of coursethesearenecessary. But in themeantime, Chen’s task is formidable. In China’s political structure, a the importance of public health was a little weakened. The HealthMinisterranksequaltoaprovincialgovernorandChen issuebecameveryacuteduringtheSARSoutbreak.” faces the challenge of coordinating the 17 other ministries But Chen emphasises that economic reforms have also and agencies that have a say in health policy. Hospital had health benefits. In thepast 30 years, lifeexpectancy has directors and pharmaceutical executiveswill not easily give increasedfrom 68 yearsto 73years,andinfant andmaternal up lucrative lines of business. With the global economic mortality rates are at the lowest levels among developing downturn, the finance ministry may think twice about nations. With a growing economy, the government budget providing the huge sums that “health for all” will require. has surged to US$700 billion, which means more cash for But Chen isleading an overdueshift from wealth to health. health care. Extracash islong overdue.Thefinancial burden Clearly a committed, brilliant academic with experience in of medical treatment in China has been disproportionately bothChina’spoor countrysideandeliteoverseasinstitutions, borne by individuals. Chen istrying to changethat through henowfaceshisgreatest test. medical-insurance schemesto cover 90%of the population by2010,introductionof theconcept of “essentialmedicines”, JonathanWatts andgreater investment ingrassrootshealthservices. [email protected]