The 114th Peking University Medical Humanities Forum: Rachel Core--Making Medical Advances Available: Institutional Change and Tuberculosis Control in Mao-Era Shanghai

On the morning of May 15th, Dr. Rachel Core, Associate Professor and Chair of the Department of Sociology and Anthropology at Stetson University, was invited to give a lecture titled "Making Medical Advances Available: Institutional Change and Tuberculosis Control in Mao-Era Shanghai" to the School of Medical Humanities, Peking University. The lecture is organized by the Chinese National Social Science Foundation Major Project of the “Contemporary Historiography and Database Construction of Epidemics”. It was moderated by Associate Professor Su Jingjing and Professor Zhang Daqing served as the discussant.


The content of this lecture is derived from Dr. Core's upcoming book, Tuberculosis Control and Institutional Change in Shanghai, 1911-2011, which will be published by the University of Hong Kong Press in October. This book representsthe first longitudinal examination of the most widespread and deadly infectious disease in China. It seeks to answerwhy after controlling TB successfully from the 1950s to 1990s, did China begin facing TB control challenges at the same time as it was becoming an economic superpower?Those TB control challenges such as undiagnosed cases and growing drug resistance arose between 1990 and 2010.


Firstly, Dr. Core points out that although there was some improvement in the tuberculosis mortality rate during the GMD era, it did not consistently decline. Dr. Core believes that the reasons for this situation are as follows: first, a lack of macro-level funding and control; second, limited treatment methods in the medical field; third, the failure of coordination between public and private institutions at the meso level; fourth, public health interventions mainly focused on individual and related behaviors, lacking implementation at the grassroots level.


Secondly, In the 1950s, a new social organization system called the work unit-system was successfully implemented, which effectively linked the population with the public health and healthcare systems. This system ensured the development of tuberculosis control and benefited both urban and rural populations, ultimately leading to a decrease in tuberculosis mortality and incidence rates during that period. The work unit system was established between 1950 and 1957, and it not only helped stabilize the population but also played a crucial role in transitioning from a temporary responsibility system based on privatization to a centralized state responsibility system. This system not only contributed to population stability but also enabled workers to enjoy a range of workplace benefits, such as wages, food coupons, housing, medical insurance, and primary healthcare. Under the work-unit system, tuberculosis control encompassed not only extensive improvements in living standards, such as providing hot meals in canteens and eliminating overcrowded shantytowns, but also the establishment of a three-tiered tuberculosis control network. Taking the example of the Tuberculosis Prevention and Control Institute in Xuhui District, widespread BCG vaccination campaigns were implemented among children under the age of five, young workers, and students soon after the establishment of the People's Republic of China. Additionally, efforts were made to promote tuberculosis prevention through public education campaigns, Mass radiography, and workplace-built TB treatment rooms.


Finally, regarding tuberculosis cases, Dr. Core points out that the detection rate of tuberculosis remained stagnant at around 20% between 1995 and 2002. This means that only a small portion of the potential affected population was identified. Alongside this challenge, China experienced other trends during this period, including the privatization of state-owned enterprises and the emergence of a large number of temporary workers, which contributed to rapid population growth in Shanghai. However, these temporary workers had limited access to healthcare services. Dr. Core suggests that this highlights the need for more flexible healthcare plans that reflect the realities of China's current situation.


Dr. Core's excellent lecture received unanimous praise from the attending professors and students. Following the lecture, Professor Zhang Daqing, Dr. Su Jingjing, and the students engaged in a discussion with Dr. Core on topics such as the role of workplace-built TB treatment rooms, the role of the work-unit system in other infectious disease control efforts, and tuberculosis control in rural areas.


Wang Cong