Healthcare

This chapter investigates and summarizes reforms in healthcare and considers

how these have impacted on delivery of important public health services. It also

looks in detail at one related area of public health, the emergence of sexually

transmitted diseases (STDs). The number and kinds of STDs in China have

grown dramatically since reforms started. Their dramatic re-emergence, particu-

larly since the mid-1990s, is also linked to the weaknesses now found in China’s

healthcare system. There are a number of further reasons why exploring the

nature and trends of STD infections is important. First, evidence on STD infec-

tions provides insights into how heterosexual transmission networks are evol-

ving. As more HIV infections are via sexual transmission, as most evidence

suggests is the case, this mode of infection has become an ever more important

component of the epidemic. In fact, widespread generalized epidemics (exceed-

ing 1 percent of the adult population), require widespread heterosexual transmis-

sion within the general population. As such, gaining further insights into the

forces driving heterosexual transmission dynamics is important. Second, by

focusing on the epidemiological evidence we have on STDs, we may also be

able to better understand the particular groups in society that are most affected,

as well as the factors that place them at risk. Third, this may help put together a

more comprehensive picture of the particular forces, or undercurrents that are

currently and in future will drive the epidemic forward. Examination of the evi-

dence on STD infections may therefore help us better understand the economic

and social determinants of sexual transmission networks. The epidemiological

and medical evidence, in this regard, may provide some useful insights.