public health Archives - ICS Research Blog

COVID-19 Crisis: Is the Communist Party of China facing a Crisis of Legitimacy?

April 23, 2020June 6, 2020 ICSLeave a comment

Mahesh Kumar Kamtam, Research Intern, ICS

Today the world is witnessing an outbreak of a pandemic ‘COVID-19’, unseen in the recent past, illustrating the fragile nature of a globalized world. As the virus outbreak continues to create global reverberations, the case of ‘COVID-19’ becomes even more relevant to the Communist Party of China (CPC). The pandemic could put the regime in a precarious position, threatening the unwritten social contract between CPC and Chinese people, since the legitimacy of the Party is driven by its ability to deliver economic prosperity to its citizens.

China is more connected to the world today than in the past. According to the World Economic Situation and Prospects Report 2020, released by the United Nations Commission on Trade and Development (UNCTAD), China alone contributed 0.75 percent out of an average 3 percent of the global growth. These indicators not only reflect a major trend in globalization, but also the extent to which China is connected in a globalized world. Global economic integration has driven China’s domestic growth in the past. But with global growth set to slow down significantly due to COVID-19, early predictions show signs of recession. As the IMF rings alarm bells on a possible recession, CPC is set for more challenging times as the world enters an era of instability driven by COVID-19.

Increasing global integration and complex challenges due to globalization have domestic repercussions. The inability to maintain economic growth and rise in inequality fuelled by low growth in future are more immediate threats that could undermine the social contract between the people and the Party causing domestic instability. The rise in ‘uncertainty’ casts a shadow of doubt on the goals set forth by the Party, particularly when China is entering into a “New Era”—where Xi Jinping targets to achieve a “moderately well-off society” (Xiaokang society) by 2021— the hundredth anniversary of the formation of CPC.

What is more worrying for the CPC at the moment is the echoing of the anger from Chinese people themselves against Xi’s rule. Xi has been facing criticism of his handling of the COVID-19 crisis and social stability threatened by a slump in production are one of the biggest challenges that CPC is set to face in the next few years. Although CPC has shown the ability to manage ‘domestic uncertainties’ by delivering economic results, mastering propaganda and controlling the flow of information in the past, these strategies are becoming increasingly ineffective for ensuring legitimacy of the Party and its leadership.

There was mounting discontent among Chinese citizens in the early stages of the outburst of COVID-19 as local officials tried to hide the truth about the outburst. The death of Li Wenliang, the doctor who alerted Chinese local officials during the early stages of the virus outbreak, became a breaking point. Li was forced into silence by local officials who hid the truth about the outburst. This event led to widespread discontent among netizens. Popular social-network sites Sina Weibo and WeChat surfaced with the lyrics of a song, Do you hear the people sing” popularized during the Hong Kong protests in 2019, denoting public anger and failure of early response to COVID-19. CPC blocked the ‘anthem of protest’ in mainland China and subsequently, launched a massive propaganda operation to regain lost legitimacy. Eventually, it was forced to sack Hubei Party chief Jiang Changling and Wuhan mayor Ma Guoqiang in an attempt to calm down public anger and channelize resentment away from the Centre while trying to alleviate growing citizen distrust of the central leadership and Xi, in particular.

The newly appointed Provincial Secretary of Wuhan launched a “gratitude education campaign” during the outbreak, to create a favourable impression of party’s image in fighting COVID-19. However, it backfired as the Party was criticized for placing itself above the hardship endured by Wuhan residents. They were enraged because of poor conditions in hospitals, lack of adequate timely care and soaring food prices. In yet another instance, real estate tycoon and princeling, Ren Zhiqiang penned a powerful article that got circulated on Weibo. He was critical of Xi’s handling of the COVID-19 crisis and called him “a clown with no clothes on who was still determined to play emperor”.

These incidents provide early indications of Xi losing control over the CPC narrative and thereby, his legitimacy to lead. However, Jude Blanchette, Director of China Studies program at the Center for Strategic International and Security Studies argues that the “CPC has reoriented itself from time to time to meet the changing demands in the society and CPC is more focused on ‘long-term threat s’ than the short term disruptions like COVID-19 crisis”.

Indeed, it is true to some extent that COVID-19 may be a short-term disruption rather than a long-term threat to the stability of the Party and Xi’s leadership. The mounting discontent against the state is a sporadic outburst of anger rather than a sustained and coordinated movement challenging the ‘Party’s mandate to rule’. However, we can still expect that it could bring more democratic order in Party though not necessarily democracy, by furthering “intraparty regulations”, promoting information disclosure particularly by local party offices at the time of emergency crisis like COVID-19, thus pushing for more transparency in the Party.

This article was earlier published in The WION under the title ‘Communist Party of China and the crisis of social contract in a globalised world’ on 13 April 2020.

Eye on Labour amidst Lockdown: Taking a China lens

The images of migrants on roads across India should perhaps help us re-evaluate the often romanticised images of the massive movement of workers annually in China

April 5, 2020June 3, 2020 ICSLeave a comment

P.K. Anand, Research Associate, ICS

The nationwide 21-day lockdown announced by Prime Minister Narendra Modi to contain the spread of the COVID-19 pandemic in India has completed 10 days. Being the second-most populous country in the world, India’s lockdown has been a massive exercise involving stopping all forms of public transport, closing down educational institutions, and recreational facilities, and all other avenues of gatherings/congregations across the vast territorial swathes of the country.

The lockdown has generated considerable debate not only on its viability and necessity, but also on its implementation and the resulting effects.

The incrementalism adopted in India’s approach ever since the outbreak in China occupied news space in mid-January — from airport screenings, to visa restrictions and later tracing of contacts and travels of infected people — has also been subjected to scrutiny by public health scholars and experts. The reasons for reluctance of the government to scale up testing at a mass level, even as cases spiked across India, appears to be twin-fold — to avoid a panic and chaos on one hand, and reckoning with the reality of a creaky health infrastructure, amplified by the lack of requisite resources, personnel and equipment, on the other. Even now calls for mass testing than just mere lockdown continues to go unheeded.

Even though Italy was the first country to impose a nation-wide lockdown, the playbook has emerged from China in its complete shutdown of Hubei province (while allowing other provincial and sub-provincial administrations to calibrate measures as deemed necessary in their jurisdictional regions). However, there has been enough reams and ink spent on explaining the impossibility of replication of the Chinese model — which has been undergirded by the authoritarian one-party state system that is decentralised, possessing extensive reach and high-organisational capacity — in democratic, diverse political systems. Further, the party-state massively employed technology to ensure social and political discipline. The party-state’s efforts to ramp up testing and large-scale mobilisation of resources have acted as force multipliers in its combat against the contagion even though the initial cover up, censorship and failure to track it in the first place have come in for criticism.

Nowhere has the planning and viability of the lockdown been questioned than by the heart-wrenching images of displaced migrant workers and their families, fleeing cities to their native places in the Indian hinterland on foot, riven with fears and anxieties of lost livelihoods and absent State support. In fact, these images and stories have generated significant traction to the argument of privileging the middle classes and urban elite in India, who have the wherewithal and space to practice social distancing as well as be able to exercise the option of work from home. Unlike them, the poor and daily wage, low-paid workers who constitute the informal sector and are at the frontlines in keeping essential services thriving, have a hand-to-mouth existence.

The images of migrants on the road also engages us to perhaps re-evaluate the often romanticised images of the massive movement of workers annually in China, for Chunyun, or the 40-day period with the onset of the Lunar New Year holiday, cramping through trains and other public transport (incidentally that movement this year was termed to have accentuated the spread of the virus).

That China’s migrant workers, often termed as floating population, have to traverse great distances to work in manufacturing and services, mostly in coastal regions or bigger cities, reflects the failure to develop viable regional economies. This is line with the high level of inequality prevalent in China, both regional and income related. The obduracy and rigidity of the country’s urban registration system — or, Hukou — that excludes the low-paid migrants from accessing rights and services in Chinese cities, also finds echoes in how ‘invisible’ the migrant workers have become in Indian scenario.

While democracy versus one-party state value judgements have often tended to dominate India-China comparatives, ideally the metric to test the State has to be State capacity; the ability of the State to provide goods and services to its citizens, especially during times of crises and distress. Herein, in spite of its authoritarian State system, with censorship and restrictions on freedom, China has a higher State capacity compared to India. That in turn, means a more formalised economy, with even social protections built into employment contracts (even if the implementation on the ground has been tardy).

Rome was not built in a day, and that applies for State capacity as well. Perhaps this pandemic and the lockdown, and the stark images left in its wake, will finally activate the Indian State to unlearn and learn, and reshape itself as a provider than remain only as an enforcer.

Originally Published as ‘Labour, lockdown and the State’s predicament’ in Moneycontrol.com, 3 April 2020

Fang Fang: Literary Voice of Dissent Amid China’s Coronavirus Disaster

The party’s ill-governance of the deadly virus has given birth to a new critical voice: Fang Fang’s Wuhan Diary.

March 31, 2020April 2, 2020 ICSLeave a comment

Hemant Adlakha, Ph.D., Honorary Fellow, ICS and Professor of Chinese at Jawaharlal Nehru University in New Delhi.

Fang Fang is definitely not the most famous living writer in China, but she is revered by hundreds and thousands of Chinese as the literary voice of COVID19-stricken China. Even before the outbreak, Fang had published widely in different genres and won several literary awards, including China’s most prestigious Lu Xun Literary Prize in 2010. Until recently, she served as vice president of the Hubei Writer’s Association. Having spent her early and late childhood during the tumultuous Great Leap Forward years and adolescent years in the cataclysmic decade of the Cultural Revolution (1966-76), she worked as a porter for four years to support her family before entering Wuhan University to study literature in her early 20s in the 1970s. Fang Fang’s early works, mostly short stories, concentrated mainly on poor Wuhanese – from urban factory workers to the city’s middle-class intellectuals – part of China’s “new realism” literature. Born into a literati family in 1955, she inherited the legacy of the May Fourth socialist realism and her own experiences of a struggling life made her remain committed to social consciousness. According to well-known Chinese literary critic Han Shaogong, “the secret of Fang Fang’s success is that she can capture the complexities of an ever-changing life without losing its thread.”

Now, she is famous for another reason: her Wuhan Diary posted on social media. Also called the Quarantine Diary, the daily account of the locked down city’s millions of inhabitants’ untold sufferings during the ongoing health crisis has recast Fang Fang from a well-known literary figure into China’s most revered living literary voice of dissent. Her fans in China are already proclaiming her to be the conscience of Wuhan.

On the night of February 7, Dr. Li Wenliang, who was reprimanded for warning about the coronavirus on social media, lay dead in the quarantine ward of the Wuhan Central Hospital. The same day, the first page of the Wuhan Diary was put up on Fang Fang’s WeChat account, and disappeared within hours. But before being taken down by China’s cyber censors, her Wuhan Diary had gone viral with thousands of re-posts. Fang Fang already enjoyed 3.5 million followers on social media even before she began chronicling her life during Wuhan’s quarantine. Wuhan Diary first appeared on day 14 of Wuhan’s lockdown. The latest page of the diary (as of this writing), entitled “Let’s see if you scare me!” was put up on March 20, on Day 57. “Dear internet censors, you should let Wuhan people speak,” Fang wrote recently, as quoted by Kiki Zhao in the New York Times.“If you don’t allow us to express our anguish or complaints or reflections, do you want us to go really mad?”

Interestingly, throughout nearly two months of lockdown and three months since the central authorities confirmed and publicly announced the coronavirus outbreak, each entry in Fang’s Wuhan Diary has been consistently deleted by Beijing’s censors within an hour or so of it being posted on Fang’s social media page. Yet each post has gone viral before being struck down, being shared by millions of WeChatters within China and abroad. More committed fans of Fang Fang are happily and with great enthusiasm sharing the entire series. Some of Fang Fang’s censored posts are being archived by China Digital Times (CDT) in Chinese, and Fang Fang’s Caixin blog is one of the multitudes of sources being preserved on the nCoVMemory Github, a repository of personal narratives from the outbreak in China.

CDT has also translated her censored WeChat post entitled “As long as we survive” in which, as CDT puts it,“Fang Fang expresses the frustrations of lockdown, laments the many displaced and affected by the virus, lauds the brave journalists attempting to uncover truth amid propaganda, and demands accountability from those who allowed the situation to develop.” The post begins:

“It is cloudy again and a bit chilly, but not too cold. I walked out to look at the sky. A sky without sunshine is somewhat gloomy and dismal, I thought. The article I posted on WeChat yesterday was deleted again, and my Weibo account has also once again been blocked. I thought I couldn’t post on Weibo anymore, and then found out that they only censored yesterday’s post and that new posts can still be published. It made me instantly happy. Alas, I am like a frightened bird. I no longer know what I can say and what I can’t. When it comes to something as important as this fight against the epidemic, I’m cooperating fully with the government and obeying all their commands. I’m now just short of taking an oath with a fist over my heart – is this still not enough?”

It is no exaggeration to say the ongoing swelling debate over Wuhan Diary on both WeChat and Weibo – China’s main social media platforms – has led to a near vertical split among the country’s educated millions. Viewed in the context of how Charter 08, a manifesto for constitutional reforms issued by Liu Xiaobo and others, jangled the nerves of the Communist Party of China more than a decade ago, Wuhan Diary and the emerging discourse it has triggered have to be understood in the context of political criticism at home during the current health crisis, the critics in China are telling us. Of course, both supporters and opponents of Fang Fang can be found in large numbers.For example, one online group of Fang’s detractors spelled out 20 reasons why Wuhan Diary deserves to be rejected and condemned. Reason 20 for “Why we are opposed to Fang Fang” — as the group is called in English – reads: “Some people are really weird and crazy. The more they have to appear in front of the public, the more they show off. These people easily get excited and go berserk. They fiercely start attacking all those who disagree with them. When provoked, these people will not only bully others. They will even pull out a gun if necessary!” But each Wuhan Diary post has also inspired hundreds of her supporters and eliciting comments from them. One comment reads: “Dr. Li Wenliang and Wuhan Quarantine Diary are ‘flowers of thought’ and ‘flowers of Wuhan’ that bloomed in the blood and tears of Wuhanese people during the epidemic period. Blooming in spring in early February, she is destined to be ‘cold and crystal clear’ and eye-catching. I hope she is always blooming.”

The controversial and at times acrimonious debate over Wuhan Diary touches on a wide range of issues – political, social, cultural. But a fundamentally disturbing aspect of the debate invokes the specter of the Cultural Revolution. A few days ago, an “open letter” written by a 16-year-old boy challenging Fang Fang, not only sent shockwaves through China’s netizens but it shook everyone who had experienced the 10 chaotic years of the Cultural Revolution – including Fang Fang. The reason for the shock, according to Li Yongzhong, China’s leading anti-corruption scholar-expert, is that “our generation, including Fang Fang, always thinks that the Cultural Revolution has gone, at least our generation will never see the Cultural Revolution again.” But the open-letter by the high school student rekindled the memories of the nightmare that teenager Red Guards unleashed to commit violence, especially targeting intellectuals.

Thus readers of Fang Fang, and perhaps even some of her detractors who were wounded during the Cultural Revolution, profusely thanked her for her befitting reply to her teenage provocateur in March 18’s Wuhan Diary entry: “Son, all your doubts will be answered sooner or later. But remember, those will be your answers to yourself.” And hundreds and thousands of Wuhanese and people all over China continue to impatiently wait for her next Wuhan Diary page.

This article was earlier published in The Diplomat under the title ‘Fang Fang: The ‘Conscience of Wuhan’ Amid Coronavirus Quarantine’ on 23 March 2020.

Situating Labour in a Pandemic: Corona Virus Outbreak’s Social Costs

February 20, 2020June 3, 2020 ICSLeave a comment

P.K. Anand, Research Associate, ICS

As the Chinese pick the pieces of the outbreak of the novel Coronavirus, COVID -19, and the much-vaunted State capacity becoming frail, the pandemic has left more than a trail of dead in its wake. The direct or indirect impact on various segments of the polity, economy and society are being seriously felt and some of the cascading and ripple effects may be in the long-term.

The economic ill-health has significant bearing for not just China, but also for the rest of the world; in fact, the slowdown of the economy predates the outbreak with surge in inflation, and structural factors complicated by the trade war with the United States. While the Chinese had scaled down from high- to medium-term growth in early 2015, with reference to the term ‘New Normal’, the slowdown reflected that things had veered away from the expectations.

Much before the National Day last year, the surging prices of pork (a staple ingredient in Chinese food), along with other red flags on the economic front, had signalled life becoming harder in China. In fact, the pork prices have continued to rise amid shortages during the lockdown.

The ‘manufacturing centre of the world’ tag has taken a hit, as factories, enterprises and production units across China are either still closed or yet to restart completely, with cases of even an extension of the Lunar New Year holiday. Being the centre of automobile production in China, Wuhan has borne the maximum impact. Further, the ripple effects have in effect ceased production in automobile factories in South Korea and Japan, as closure of factories manufacturing auto parts in China.

The prospects of an extension of the economic recession also carry social costs, with significant consequences for labour in China. The travel of migrant workers — the fulcrum of the Chinese urban manufacturing story — at the onset of the new year from cities to their home provinces was often visually showcased with fascination over the years. While this masks the weaknesses of the regional economies within China by illustrating the inequalities between coastal and inland provinces, the movement also causes apprehension of spread of the virus.

The workers are also confronted with a dilemma while making decisions on returning to the workplaces — the need to make income by selling their labour versus (in)adequacies of health safety. More often than not, circumstances condition the workers to choose the former. The more days the things remain in limbo and cause disruptions including non-availability of transport for workers to reach workplaces, the more rise in workers’ anxieties.

The workers in manufacturing enterprises and their significance have always dominated the discourse on labour in China, and therefore, their absence through closure of workplaces and dilemmas do command news space. However, of equal, if not more, importance are the workers in the services sector — those in essential services such as sanitation workers, security guards, drivers and those on the low-end, not only in China but also in Hong Kong.

Along with them, hundreds of workers employed to power the platform/gig economy are also on the frontlines, especially food delivery workers. Even though extra precautions are exercised through usage of safety equipment, reporting the body temperature of employees to customers and quality checks, the food delivery workers are under added pressure in addition to the need to make deliveries in time, even though heralded as lifeline during the pandemic, and valourised for their selfless service.

However, dig a little deep, and the rosy picture starts turning bleak — workers for platform services are among the most vulnerable and precarious workforces in China without adequate workplace protection, or entitlements, and are also victims of accidents in the rush to ensure speedy deliveries and for customer satisfaction. Moreover, the rating-driven ecosystem where a high number of deliveries become the benchmark for evaluation, frustrations and alienation also set in.

Avowedly, China has national laws to regulate work contracts and to implement social security, but the translation of the same into action on the ground remains lopsided and inadequate. Precarity is intermingled within the system, as tough urban registration system called hukou, that segments and stratifies residents, renders migrant workers in the services sector to the margins, without access to services in the city where they reside.

The (in)capacity of the local-state to come up with problem-solving solutions to properly integrate the workers in the services sector also has echoes in India; even though there is cognisance of the prevalence of informal workforce in the urban system, adequate legal/formal inclusive measures are few and far between. This leaves them exposed to the vagaries of the market, which leads to the glorifying of their ‘resilience’ bringing forth a low-level equilibrium.

Undoubtedly, the social costs of a pandemic are in the long-term and therefore, the need to learn and unlearn.

Originally Published as Coronavirus exposes the brittleness of China’s economic prowess in Moneycontrol.com, 18 February 2020

Health and Wellbeing in the Context of the 19th Congress of the CPC

November 1, 2017 ICSLeave a comment

Madhurima Nundy, PhD, Associate Fellow, Institute of Chinese Studies

The political report delivered by Xi Jinping at the 19^th Congress of the CPC is open to analysis and many interpretations. Indeed, it is a lengthy and comprehensive report where Xi attempts to cover all aspects of development in the last five years and challenges that face China today, apart from his take on socialism entering a new era. Health and wellbeing of the population is an integral component of human development which gets articulated in various sections.

It is accepted universally, that the determinants of health and wellbeing are not restricted to access to health services alone but includes social, economic, environmental and cultural factors that influence the health of the population. As a prelude to his speech, Xi gave an overview of the overall socio-economic development and that 60 million people have been lifted above poverty. Continue reading “Health and Wellbeing in the Context of the 19th Congress of the CPC” →

China’s 19th CPC Congress: Redefining Economic Growth

October 29, 2017 ICSLeave a comment

Jabin T. Jacob, PhD, Fellow, Institute of Chinese Studies

There are several aspects of the recently concluded 19^th Congress of the Communist Party of China (CPC) that are noteworthy for India.

First, CPC General Secretary Xi Jinping has attempted to redefine what acceptable economic growth is in China. The expression ‘contradiction’ is an important one in the Chinese communist lexicon and until the 19^th Party Congress, the ‘principal contradiction’ was the one between ‘the ever-growing material and cultural needs of the people and backward social production’ or, in other words, China’s inability to provide for the basic material needs of its people. Following nearly 40 years of economic reforms, this challenge has now been met with China eradicating poverty at the most massive scale and at the quickest pace in human history.

This process has, however, also resulted in rising income inequalities between individuals and between regions in China, and massive environmental damage and health crises across the country. Continue reading “China’s 19th CPC Congress: Redefining Economic Growth” →

Elderly Care in India and China: Need for Comprehensive Policy and Planning

April 13, 2017 ICSLeave a comment

Madhurima Nundy, PhD, Associate Fellow, ICS and Prof. Rama V. Baru, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi and Adjunct Fellow, ICS

Demographic transition and population ageing are one of most discussed phenomena of the present times. China and India are at different stages of the demographic transition. In India about 8.6 per cent of the population are elderly while in China it is 16.1 per cent. Given the large population size, in terms of numbers, the elderly population is large.

Change in Family Structure and State Response

While the demographic transition is determined by the economic and social changes in any society, the transition itself has profound social, economic, psychological and ideational consequences for the individual, family and society. In India and China, the changing family structure, living arrangements and support services have created challenges for dealing with the changing needs of the elderly population. Continue reading “Elderly Care in India and China: Need for Comprehensive Policy and Planning” →

Family physicians to play a bigger role in medical care in China

June 21, 2016 ICSLeave a comment

Madhurima Nundy, Associate Fellow, Institute of Chinese Studies.

One of the major programme priorities of China’s health care reforms that was announced in 2009 was strengthening of primary level services and the development of general practice in order to improve accessibility. China recently announced that it plans to expand the family physician services to all its citizens by 2020. The family physician or the general physician (GP) as the gatekeeper to the health service system is the hallmark of the National Health Service (NHS) in the UK where every citizen is assigned a GP. In India, where medical care is highly privatised and unregulated, the GP is a dying breed and is no longer able to stand up to a system now increasingly dominated by specialists. There is no regulated referral system that ensures rational distribution of services and market forces have put demands for more number of specialists thus creating a top-heavy system.

Continue reading “Family physicians to play a bigger role in medical care in China” →

Indian students in professional education abroad: The case of medical education in China

June 7, 2016 ICSLeave a comment

Madhurima Nundy, Associate Fellow, Institute of Chinese Studies.

The commercialisation of medical education in India has led many students to study medicine abroad especially in China. The Indian medical education is in a state of crisis but there is no sense of urgency to address the serious issues of maldistribution of resources, the unregulated growth of the private sector, dearth of faculty, a lack of uniform admission procedures and dated curricula that needs to undergo a review. The commercialisation of medical education has raised concerns over issues of quality, regulation and increasing corruption in selection and recruitment procedures as has been exposed by the Vyapam scandal leading to the ‘criminalisation of medical education’.

Continue reading “Indian students in professional education abroad: The case of medical education in China” →