Page 40 - Genomic Medicine in Emerging Economies

The History and Current Situation of Public Health in China 29

provinces (Hu et al., 2008). Most domestic migrations are due to rural labor
migrants who are almost entirely without any medical benefits in contrast to
most urban residents, and they do not enjoy the state subsidies granted perma-
nent urban residents (Wang and Zuo, 1999). They also tend to live in crowded,
low-quality housing, often at the work site (Feng et al., 2002; Roberts, 1997;
Shen and Huang, 2003). All these factors aggravate the dangers of disease, such
as maternal and infant diseases (Asweto et al., 2016; Hu et al., 2008; Shaokang
et al., 2002; Yang et al., 2005).
China established a “one family, one child” policy in 1979 and a family plan-
ning law in 2002. Under the one-child policy, couples were encouraged to
marry late, usually in their mid-20s, and allowed to have only one child.
This policy brought a conspicuous birth rate decline from 37.88% in 1965 to
18.21% in 1980 (Flaherty et al., 2007). In 1985 the birth rate had rebounded
to 21.04% because of the “1.5 policy” of 1984, which permitted peasants
whose first child was a girl to have a second child after a suitable period. Since
then, the birth rate has been declining gradually. Now, it is under 15%. To
date, China’s one-child policy has contributed 200–400 million less people
to the total growth of world population (King, 2005). The one-child policy,
insofar as it limits couples to have one or two children, leads to more atten-
tion to the diagnosis of birth defects and greater involvement of parents in
child care, which is named “healthy birth and child care” (Short et al., 2001).
The law on maternal and infant health (launched in 1994) requires physicians
to recommend a postponement of marriage if either member of a couple has
a genetic disease. If one spouse has a serious hereditary disease, the couple
may only marry if they agree to use long-term contraception or to undergo
sterilization. If prenatal tests reveal that a fetus has a serious hereditary dis-
ease or serious deformity, the physician must advise the pregnant woman to
have an abortion, and the law states that the pregnant woman is supposed to
follow this recommendation. A survey on genetic research and practice was
done on 402 genetic service providers in China, using a Chinese version of
an internationally circulated survey questionnaire on ethics and genetics. In
all, 255 participants completed the questionnaires (63%). The majority of
respondents (89%) reported that they agreed with current Chinese laws and
regulations on termination of pregnancy for genetic abnormalities on the
basis of considerations of population control and family planning (Mao and
Wertz, 1997).

Public Health Care Structure in China
In 2005 the fund allocated to the health sector was 60,150 million renminbi,
about 1.77% of the total government budgetary expenditure in China. In
2006 there were 308,969 health institutions in urban China and 609,128 vil-
lage clinics in rural China (Health, 2007). There are wide differences in the