This chapter introduces the interlocking issues of health, demography, and environmental factors in China’s modernization. Mao-era mass health campaigns achieved some successes despite being interrupted by the Great Leap Forward and Cultural Revolution. Barefoot doctors and medical care were based on one’s collective. After the end of collectivization, health care deteriorated; once eradicated diseases returned. Prosperity created new problems, since people are smoking, drinking, and eating more unhealthy food. Current efforts aim to provide basic health care insurance for all, but the PRC’s health care is nonetheless rated among the least equitably distributed in the world.
By the late 1970s, it was realized that Confucian notions about large families, and Marx’s idea that under socialism there would be enough for all, were not serving China well. A one-child policy was instituted and often draconically enforced. An unintended consequence was severe gender imbalance, since most parents preferred that their one child be male. That and the end of China’s demographic dividend of young workers have resulted in a relaxation of family planning restrictions.
Rapid modernization led to rapid deterioration of the PRC’s environment: China is the world’s leading emitter of greenhouse gases and home to nine out of ten of the world’s most polluted cities. Belatedly addressing the problem, the government is attempting to introduce less smog-producing forms of energy and plans to build “green cities.”