China’s Healthcare Revolution: A Three-Part Series -- Chinese Healthcare Pushes Abroad

Healthcare is part of China’s expanding global footprint of influence and power. Part One of this series explored how China transformed its domestic system. This Part Two looks outward at how China is growing and reshaping global healthcare norms. Part Three will examine the control mechanisms embedded in the Chinese model.

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China and Global Health

China is a force to be reckoned with in global healthcare. Being active in global health deepens and enhances China’s ongoing Belt and Road Initiative to increase its economic and political clout beyond its shores. The emphasis is in the Global South, principally Africa, Latin America, and large swaths of Asia -- South and Southeast, which is home to more than 85% of the world’s population!

At a time when the United States has slashed foreign aid, withdrawn from international organizations, and radically reoriented its health efforts worldwide, China has adopted a broader, collegial face as part of its soft power push. In the words of the Executive Director of UNAID, China is positively engaged in “…multilateralism and advancing South-South cooperation, through sharing of technology, innovation, and grant funding in our pursuit of universal health coverage,….”

It is easy to say that as America pulls back, China is stepping in. Dr. Ruby Wang, of LINTRIS, who I introduced in Part One, believes that this zero-sum formulation is catchy, but superficial. I confess that I am guilty of using this very shorthand and that it is indeed too facile.

China is not just filling a vacuum. No, China is pursuing a long-term, selective strategy to expand its global influence by reshaping the system itself with Chinese interests, norms, and technology as primary. It has found a receptive audience where it counts, becoming the partner of choice for more and more countries. Though America’s lack of interest certainly helps, it is not the principal cause of China’s growth.

A New Approach to Global Healthcare

Since the end of World War II, governmental institutions and nongovernmental organizations, funded by wealthy Western nations, have principally coordinated international health aid. This aid was viewed, at least nominally, as a public good. That world is gone.

In pivoting away from its preeminent role in the prior system, the American government has issued a new call to arms with the America First Global Health Strategy. This new health strategy, which is being rolled out in kind throughout America’s new system of foreign relations, is a bilateral, transactional philosophy that mimics China’s approach of folding health “into trade, infrastructure, diplomacy and power, delivered through a mix of public and private mechanisms” (Wang).

Optics matter:

• The stated aim of the American policy is to implement a “comprehensive vision to make America safer, stronger, and more prosperous.”

  
  

• China’s stated aim is to create a “global community of health for all.”

  
  

Each wants to change the existing system. America is a bull in a china shop; China is water seeking the path of least resistance. Both can break; the latter can also nourish.

China on the Ground in Africa

So what does China’s global health footprint look like? In Africa, China has long been deeply embedded providing care and training. Chinese Medical Teams of doctors, nurses, and support staff have been operating in successive waves throughout many countries in Africa since the year President John F. Kennedy was assassinated (1963).

Today, Chinese involvement in Africa’s healthcare is extensive. The Chinese government is funding AIDS prevention in South Africa. Chinese-made insulin is set to be produced in Nigeria. A Chinese pharmaceutical company is building an enormous, multi-phased facility to manufacture antimalarial and antibacterial drugs in the Ivory Coast. Chinese medicines, technology, and know-how are being deployed in more than 130 physical hospitals and clinics the Chinese have built in Africa, while digital, remote-first care is also expanding.

The above has been accompanied by a sea change in technology. China now develops, builds, and supplies many cutting edge nuts and bolts for global healthcare. Zak Dychtwald of the Young China Group notes that Chinese firms are not only competing with Western medical device companies. They are setting standards in developing markets. In setting standards, China is shaping the future.

The United States wants to remain involved in Africa for strategic and economic reasons and has announced new, targeted healthcare investments on the continent. It remains an open question whether America can shift the momentum. Color me skeptical. The Chinese are on the ground, building relationships and trust improving the lives of Africans. In the process, they are cementing China as a growing leader in Africa more broadly.

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A realignment in global health is well underway. The old architecture has shattered. The new system is being assembled through global institutions as well as bilateral relationships, local investment, strategic alignment, and infrastructure that appeals to countries weary of the West and who welcome China’s help and in the process adopt China’s systems.

If the U.S. wants to remain a potent force in this arena, the government needs to prove it. China is showing up. China is committing. Its efforts are not universally successful nor free of criticism; however, the message is clear. China is a friend to the Global South. This helps China strengthen its power and influence around the world in meaningful ways that bring practical benefits to billions of people.