Since 1949, the Chinese party-state’s approach to health policy has fluctuated with the vicissitudes of politics, oscillating between neglect and an instrumental use of healthcare to promote state legitimacy. This chapter examines health policy in China from 1949 until the 2000s, with a focus on rural areas. During the Maoist period, two factors hindered the erstwhile Ministry of Health in improving health services: budget constraints and political oscillations that prioritized ideology over expertise. In 1978, Deng Xiaoping initiated market reforms and subordinated healthcare and social policy to economic growth. In the early 2000s, due to pressure from society, shifts in governance style, and encouragement from at home and abroad, the Chinese government initiated a dialogue on healthcare reform that culminated in the 2009 plan to overhaul the health system. But because local government was still primarily responsible for funding health policy and faced budget constraints, legacies of health policy in the second half of the twentieth century continued to impact healthcare in the 2000s.

Chapter 20 of Earthopolis: A Biography of Our Urban Planet continues the book’s exploration of the early Cold War years and the threshold of the Urban Planet’s Greatest Acceleration. It visits imperial capitals like London and Paris as certain types of spaces there became “proto-Third worlds” where young nationalist leaders formed their early ideas of liberation and development, then brought them back to colonial cities to launch struggles for national independence. Mohandas Gandhi’s Satyagraha or non-violent resistance transformed the practice of mass urban protest even as Gandhi fought global urban industrialism, rising sectarian violence, and the British Raj en route to Indian independence. Mao Zedong took a contrasting route to power that also started with villages, in this case as effective military bases to expel far better-armed imperial and bourgeois nationalist forces and then seize China’s great cities. Dozens of other independence movements adopted mixtures of these two strategies, which coalesced above all around development – starting with state or capitalist investment in advanced industrial facilities as well as the housing, educational, health, transport, and planning infrastructure aimed to erase the sheer inequalities of the imperial-era Urban Planet.

As reports of mass famine turned from a trickle to a flood in 1960, the leadership slowly realized that the party had made a mistake of historical proportion. According to Ministry of Public Security data, 675 counties and cities had death rates exceeding 2 percent of population in the early 1960s, compared to the normal 1 percent or so. In forty counties, mainly in Anhui, Sichuan, Henan, Guizhou, and Qinghai, the death rates exceeded 10 percent of the population (Yang et al. 2012: 395). Economists and demographers estimate that the Great Leap Forward caused sixteen to thirty million unnatural deaths in the early 1960s (Kung and Lin 2003). The policy of using confiscated grain to finance a rapid buildup of industrial capacity championed by Mao and his colleagues had led to one of the greatest man-made disasters in the twentieth century.

During his ascent to power in the 1930s, 1940s, and 1950s, Mao had “packed” the CCP upper echelon with people who had sided with him in the many internal power struggles in the party, especially those who had served with him in the First Front Army. Yet even this strategy was insufficient to maintain Mao’s absolute power in the party. When the unexpected shock of the Great Leap Forward led to a precipitous fall of Mao’s prestige within the party, a rival coalition composed of Mao’s former allies emerged to sideline him. Even a formerly loyal protégé such as Deng Xiaoping began to display streaks of independence.

Even at an abstract theoretical level, the power configuration in China after the 1969 9th Party Congress was highly unstable. On the one hand, Mao continued to be an active and powerful chairman of the party. On the other hand, Lin Biao, the anointed successor, had a great deal of control over the military. Without the possibility of other powerful factions in the party to check a potential fight between Mao and Lin, both sides had much temptation to eliminate the other if they believed they had sufficient power to do so (Acemoglu et al. 2008: 162). Fortunately for Mao, he had cultivated two disparate groups to help him govern China in the event of a purge of Lin Biao: the Fourth Front Army (FFA) and the surviving scribblers. Mao’s strategy of cultivating the tainted FFA paid off handsomely. Instead of having to concede to Lin Biao’s reluctance to carry out self-criticism or being forced to rely on Lin’s followers, Mao forced Lin’s hand, knowing that he could credibly threaten Lin with replacing the Lin Biao faction with FFA veterans. After Lin Biao fled, Mao carried out his threat and eradicated close associates of Lin Biao wholesale from the military, replacing them with veterans of the FFA. The Lin Biao incident on September 13, 1971, finally led to the full installation of the coalition of the weak.

Zhang Chunqiao helped Mao launch the Cultural Revolution and became a core member of the Central Cultural Revolution Group (CCRG). At the 10th Party Congress in 1973, Mao promoted him into the most powerful institution in the Chinese Communist Party, the Politburo Standing Committee, a rarely seen leap for a pre–Cultural Revolution vice-provincial-level official in the space of seven years. When his daughter asked him right after the congress whether he felt a sense of triumph, Zhang responded, “I don’t feel much. Which revolutionary base area did I build? Which army did I lead? Which battle did I win?” (Zheng 2017: ix) Despite his formal power, Zhang knew that since he was a writer and an ideologue instead of someone with faction followers throughout the party and the military, he had very little informal power. Given their limited political experience and narrow political networks in the party, why did Mao elevate Zhang and others in the scribblers mafia (笔杆子) into senior offices during the Cultural Revolution?

After Mao’s passing in September 1976, the coalition that Mao had put in place at the end of his life, which was composed Cultural Revolution radicals with little revolutionary experience, even more junior officials like Wu De and mass representatives, the tainted Fourth Front Army (FFA) group, and a handful of trusted First Front Army veterans like Ye Jianying and Wang Dongxing, took over the People’s Republic of China. An uneasy truce persisted for a very short time before the Gang of Four had alarmed Hua Guofeng by challenging his role as the anointed successor, which compelled him to seek more drastic solutions (Zhang 2008b: 263). In this decisive moment, the FFA swung behind Hua, thus sealing the Gang of Four’s fate, but Hua also became very dependent on FFA veterans. His dependence on military veterans with vastly more experience and greater networks ultimately also brought about his downfall. Within two years of Mao’s death, none of the potential successors Mao had put into place just prior to his death survived as powerful figures in the party. The Gang of Four had ended in jail, while Hua was sidelined at the third plenum in 1978. Even FFA veteran Li Desheng, who had served as vice chairman of the party for a short while, ended his career in the 1980s as the head of the National Defense University (Zhu 2007: 425). Except for key members of the FFA group, the vast majority of Mao’s coalition of the weak had ended in jail or in retirement by the early 1980s. His legacy of continuous revolution also was completely expunged from the party ideology in favor of a single-minded focus on economic development.

Authoritarian regimes must grapple with a fundamental source of instability that a significant redistribution of power, often unseen or only partially observed, can radically alter the incentives of regime insiders and overturn initially stable equilibria (Acemoglu et al. 2008). Although institutional features such as authoritarian legislatures and a ruling party can alleviate the incentives to usurp the incumbent leader to some extent, especially among lower-level officials (Gandhi 2008; Svolik 2012), they cannot fundamentally remove the incentives to grab power forcefully in the top echelon of these regimes. For one, one-party states by design entrust enormous power in the hands of the top few officials or even in the hands of one person. For ambitious officials just one layer below the very top facing a low probability of ordinary promotion, the reward for achieving an extra step upward can be enormous and can justify a risky gamble, especially if an external shock leads to a significant redistribution of power. Even for those who are already in the top echelon of the ruling party, a gamble to break the existing power-sharing equilibrium can reap enormous rewards as the power and resources of authoritarian colleagues are consolidated into one’s hands. Knowing the dangers of these possibilities, authoritarian leaders also have the incentives to preempt potentially threatening colleagues by removing them from power with coercive measures. In the absence of credible constitutional frameworks or electoral pressure to stop the actions of the top leadership, the stable façade of authoritarian politics can quickly descend into coups, purges, and assassinations.

In mid-1975, a sickly Mao had one of the last meetings with the Politburo. During the meeting, Mao shook hands with the entire Politburo, probably for the last time in his life. When he greeted alternate Politburo member and Vice Premier Wu Guixian, Mao confessed, “I don’t know who you are.” An embarrassed Wu said, “Chairman, we met in 1964 during the national day parade.” Mao compounded her embarrassment by responding, “I didn’t know that” (Mao 1975).

Chinese foreign relations and foreign trade during the Cultural Revolution’s radical phase (1966–1969) were different than during the period from 1970 to 1976. The radicals’ control of the Foreign Ministry affected the Chinese missions in Switzerland between 1966 and 1969. Because of Switzerland’s function as the Chinese headquarters in Western Europe, Swiss diplomats were among the few foreigners who remained relatively unaffected by Red Guard measures and other events in Beijing. Although diplomatic tensions occurred between Switzerland and China, these did not lead to a rupture of official relations. This preferential treatment changed during the period from 1970 to 1976, when Switzerland lost importance because China established relations with the majority of the Western nations. The anti-capitalist and anti-Western fervour of the Red Guards did not stop trade between China and Switzerland completely. In fact, Sino-Swiss trade continued – albeit haltingly – during the radical phase of the Cultural Revolution. The improvement of political relations between China and Western European countries, however, also increased Western European interest in the Chinese market. The last part of the chapter, therefore, discusses how the Swiss government and Swiss companies tried to stave off this competition in the early to mid-1970s.

This chapter charts the development of frameworks and terminology with which revolutionary memory would be constructed during the republic. It begins with Guomindang efforts to tame May Fourth energies, allying the student movement to party-led workers and peasant movements, and tethering them to the evolving organs of state power. With the formation of the United Front between the Guomindang and Communist Party in 1924, May Fourth’s political groundwork would give way to an era of formal national construction (jianshe) when perceptions of rural society would crystallize within a revolutionary program. Originating in shared communications offices in Canton during the United Front, what began as rhetorical devices tested over 1926 in Mao’s strategic texts, such as lieshen (evil gentry), crystallized within months into class designations. The chapter then turns to the field of political journals based in Shanghai in the late 1920s, focusing on Guomin gonglun (The Citizens' Opinion). The interaction of social-scientific study with political mobilization gave wide currency to shorthand terms for understanding rural communities, one that pitted an evil gentry against a generalized peasantry. Moral language originally used to describe social injustices was refashioned as a tool for policing party discipline.

Chapter 5 gives an overview of the Chinese Communist Party’s many campaigns against corruption throughout its history up to 1990. As with Taiwan and South Korea in previous chapters, authoritarian anti-corruption success in China has depended on a strongly motivated leadership with discretionary power driving reforms and a capable party-state implementing them. This combination of factors allowed Chairman Mao’s Three Antis–Five Antis Campaign (1951–53) to curb corruption and help the new communist regime penetrate and reform China’s complex urban areas. However, the disastrous failure of the Great Leap Forward (1958–62) triggered a rise in bribe-taking and embezzlement, especially among rural cadres, and later campaigns under Mao aimed at controlling corruption ended in failure. After Mao’s death in 1976, Deng Xiaoping prioritized liberalizing economic reforms and proved unwilling to jeopardize these reforms by cracking down on the corruption that had come with them. The party leadership conducted a large-scale purge of allegedly corrupt officials to assuage public discontent after the bloody crackdown in Tiananmen Square, but it ultimately had little effect.

In the aftermath of China’s traumatic Cultural Revolution, Western travelers have searched for the remnants of Chan (Zen) Buddhism. Gretel Ehrlich’s Questions of Heaven documents her unhappy tour of sacred mountains and other religious sites and practices in Sichuan and Yunnan Provinces and her search for traditional arts and music. George Crane’s Bones of the Master depicts a pilgrimage with an exiled Chan monk to find the bones of his spiritual mentor and build a stupa to honor him. Bill Porter’s Road to Heaven recounts his search for Chinese hermits who seem to have abandoned every attachment to a social self. Porter’s Zen Baggage documents a pilgrimage to sites connected to the first six patriarchs of Chan Buddhism and his attempts to discard “baggage,” that is, attachments. Because of Chan’s suspicion of talk about oneself and because these authors focus more on documenting conditions in China than on self-disclosure, they are guarded or discreet about how their journeys affected them. Yet each shows how a Chinese journey initiated a transformed sense of self.

Chapter Three lays out Mao Zedong’s determination to build a revolutionary army. Party policy at the time argued for mobilizing the masses and the party leadership thought that Mao’s approach was too militaristic. Mao and Zhu De came into conflict over the scope of party control, and Mao was voted out. Zhou Enlai backed Mao, and he was restored to his position. The chapter ends with the Gutian Conference, at which Mao asserted his dominance over the military.

In 1976, Chinese Communist Party (CCP) Chairman Mao Zedong died, providing an opportunity for China to change his revolutionary course that led the country to ruin. In the late 1970s, the CCP changed course and began to open China to investment and trade. The democratic countries welcomed the change and engaged with China, hoping that economic development would lead to democratization. Forty years later, the Chinese economy has become the largest in the world, but democracy and the rule of law are still missing. This chapter provides an overview of the book. The author argues that, wielding its absolute and total control, the CCP has made the entire country into a giant corporation. China, Inc. has the agility of a corporation and the resources of a country, making it extremely competitive globally. However, China, Inc. also has its built-in contradiction: its need to close China from the democracies’ influence, and its reliance on the world’s openness to thrive. Based on the China, Inc. perspective, the author makes policy and strategic suggestions for the democracies and multinational corporations dealing with China.

Comparative cross-disciplinary study shows how East Asian thought, theater, and poetry, while situating cultural analogies, helped shape Brecht’s work. The narrative clarity and distancing techniques of Japanese theater undercut superficial naturalism, and comparison with sophisticated, graceful Chinese theater later relativized his own. In Chinese philosophy he encountered witty discrimination, an estranging critique of virtues, dialectical social interrelations, a stimulating flow of things, focus on practical engagement, warnings (apropos Confucius) of accommodation with power and, in his crucial Me-ti, what he intimated to Korsch as an “anti-systematic … epic science” realized through individual productivity, not by a top-down imposed social order. East Asian imagination stimulated an unconventional aesthetics. In ethics, the social paradox of self-love would avoid turning people into “the servants of priests.” Even another global politics once briefly seemed conceivable, when China appeared to confront European Stalinism, but in the end that revolution disappointed as well.

Chapter 5 focuses on the 1967 Cultural Revolution campaign against Wang Guangmei, wife of the disgraced former PRC president Liu Shaoqi. A detailed firsthand account of Wang’s emblematic and theatrical mass struggle session at Tsinghua University introduces the story, followed by background to provide context for her poor treatment, and the larger political developments which led to Wang and Liu’s ultimate downfall. These include Wang’s early elite education as scientist, her work as an interpreter for the Chinese Communist Party’s underground in Beijing, and her eventual reassignment to Yan’an and role in the land-reform movement of 1947. The extreme violence of this earlier period contrasts with leading role in the implementation of the Four Cleans campaign in rural Hebei as part of the larger Socialist Education movement in the early 1960s. Her experience with exposing allegations of cadre malfeasance in the Peach Garden Brigade of Funing County ultimately provided a model for a nationwide anticorruption campaign, with Mao’s encouragement. The chapter concludes with a discussion of the violent backlash against the top-down work-team approach of the Four Cleans, advocated by Liu Shaoqi and Wang, in favor of the more chaotic bottom-up Red Guard approach of the Cultural Revolution that brought them down.