Smallpox was prevalent in many parts of the world in the late 1960s, infecting 10-15 million and killing around 2 million every year. "China stamped out smallpox in early 1980s. In eliminating snail fever and poliomyelitis China also took the lead, and that owed much to its public health system at that time," said Wang.

Market crash

China said goodbye to the planned economy era and embraced market-oriented reform in the 1980s, and two decades of booming economic growth followed. While economically the country made leaps and bounds, in healthcare there was little advance. Instead, the nation's healthcare system was overlooked by government at all levels as it pursued economic goals.

Statistics show that China's medical expenditure at present make up 5 percent of its GDP, of which 12 percent is devoted into the public medical field, while in other developed countries, public medical expense makes up 50 percent of their total medical expenditure.

In 2000, WHO evaluated the healthcare systems of 191 countries and regions. China ranked 144th, even below Sudan and Haiti, two countries which have GDP far behind China.

The proportion of China's medical budget spent on public health has been decreasing over the past two decades. In the early years of reform and opening up 36 percent of the budget was spent on public health, but that number had dropped to 25 percent in 1990 and 14.9 percent in 2000.

In order to make up for its medical budget shortfall China's public healthcare system moved to a market forces model. Some of the direct results of this were that healthcare shifted from rural to urban areas, from prevention to treatment and from low-cost to higher. Hospitals began to buy more expensive medical facilities and the cost of medical treatment began to eat away at the income of ordinary Chinese citizens. In 1980 the average person spent 23 percent of their income on medical treatment; in 2000 it had risen to 60.6 percent. In developed countries the proportion is around 27 percent. The high cost of medical treatment has for a long time been a major complaint in China.

China's healthcare system also became distorted due to lack of guidance and regulation, with widening gaps developing between different regions, between urban and rural areas and between social classes. The urban-rural gap is particularly stark.

In 2000, China's overall medical costs reached 476 billion yuan, of which rural costs were 107 billion, or 23 percent. That is to say, two thirds of the country's population used less than one quarter of its medical resources and the other third (urban citizens) enjoyed the other three quarters. This imbalance of medical resource distribution finally pushed China to 188th place in a 191-country evaluation on health services in terms of fairness by the WHO in 2000.

For a long time many local public health institutions have been left starving for capital, with government money making up only one third of their funds. Many medical entities were unable buy new medical equipment and some could not pay their staff due to the lack of financial support. According to an anonymous source from the Ministry of Health, one third of the health clinics at the county-level and below are under normal operation so far, and the other two thirds are either breaking down or just one step from collapsing.

Scarce funds also forced many health clinics to search for profits and as a result their disease prevention and control functions have been diminished.

"The grassroots public health institutions, compared to the market-dominated medical ones, are poorer in medical facilities and lower in staff payment level. The talent drainage is considerable," said Wang.

According to Gao, China doesn't have any major disease prevention and control organs at the township and village level. It's fortunate that the 2003 SARS epidemic didn't spread to rural areas otherwise the situation would have been catastrophic.

Rebuilding

The SARS crisis propelled the Chinese Government to step up its efforts to build a public health emergency response system and also raised public awareness of the importance of such a system.

On May 9, 2003, one month after the SARS breakout, China stipulated and issued a regulation on public health incidents, according to which anyone who makes a false report or covers-up a real epidemic situation should be held responsible and punished. It also said that provincial governments should report to the State Council if there is any epidemic situation.

On May 12 that year, the Ministry of Health issued a SARS related prevention and management regulation, detailing everything including a SARS situation report, publicity, prevention and control, and supervision.

Two days later, the Supreme People's Court and Supreme People's Procuratorate stated that anyone who deliberately disseminates an epidemic pathogenic species and endangers public security should be sentenced.

In July the same year the Chinese Government also endeavored to form up a work team dealing with public emergency incidents.

On January 8, 2006, a national public incidents response plan was enacted, and a public emergency response system was established. The plan makes clear the principles and operation of the State Council in dealing with an emergency and has borrowed much from international experience. For example, the government should let the public know what's going on immediately when there is any emergency situation.

In February 2006, the State Council issued emergency response plans covering public health, medical rescue, animal epidemics and food safety. The Ministry of Health also created a national training scheme between 2006 and 2010 to deal with health emergency responses.

By the end of 2006, 70.3 percent of the nation's township-level health clinics, 95 percent of county-level medical institutions and above, and all disease control and prevention centers had been included in an online direct report network created to monitor infectious diseases and public health incidents.

China is becoming mature in managing public incidents and its citizens are growing calmer in the face of them. There was a bird flu breakout in 2006, which affected 16 provinces and autonomous regions and resulted in a direct loss of 10 billion yuan. The State Council immediately issued a response plan and launched a daily report mechanism to ensure information transparency and let the public know how the situation was progressing. Six months later, the situation was under well control.