In rural China’s Duan Yao county, David Wei, 60, found himself carrying his nephew, who had suffered a heart attack, for three kilometers down a rough, under-construction road. Despite a 90-minute wait for an ambulance, his nephew narrowly survived. However, when the 53-year-old man had a second heart attack last year, delays in calling for help meant the ambulance was once again too late.
“If we’d lived in the city, he might have had a chance,” Wei said from his two-story home, perched in the mountainous region of southern Guangxi.
Wei’s story reflects a broader issue faced by aging rural communities in China. With about 120 million people aged 60 or older, access to healthcare is becoming a growing challenge, and one that will only intensify in the years to come. Experts warn that the nation’s economic model is at a crossroads, with a need for a balance between investing in healthcare and pursuing urbanization and industrial upgrades, which Beijing views as essential for economic growth.
At a key meeting last year, the ruling Communist Party of China promised to prioritize both. However, some government advisors argue that large-scale spending on rural healthcare may not be a feasible option in the current economic climate.
“High-quality doctors are unwilling to work in rural areas, and those who do lack the skills to provide effective care,” said an anonymous government advisor, who emphasized that the solution lies in improving townships—a process that remains far behind.
While China’s National Health Commission and the State Council did not immediately comment on the matter, the debate over rural healthcare funding has sparked concern. Critics believe that focusing resources on industrial growth rather than rural welfare may undermine long-term prosperity by aggravating factory overcapacity, stalling domestic consumption, and worsening China’s demographic crisis.
According to Jundai Liu, an expert at the University of Michigan, policies that prioritize economic development over social welfare have contributed to the nation’s declining birth rate. “The irony is that these policy choices are now accelerating the ‘hollowing out’ of rural China,” Liu noted.
For people like Wei, relocating to urban centers is not an option. “We don’t have land there. We would need money for food,” he explained.
Neglecting the healthcare needs of rural communities could lead to greater poverty and lower life expectancy, warned Sasha Han, an assistant professor at the Chinese Academy of Medical Sciences. “Rural residents unable to relocate may feel marginalized and left behind.”
Though China has made notable progress in rural healthcare over the past few decades, challenges remain. In the era of Mao Zedong, villagers had little more than “barefoot doctors”—farmers with minimal medical training. Today, some rural hospitals, like one in the southwestern district of Chongqing, boast sophisticated equipment and a wide range of medical departments. Yet, these facilities struggle to meet the needs of their populations.
One doctor in the region, who asked to remain anonymous, described how their hospital’s medical staff, numbering between 120 and 130, are often overwhelmed by the demands of serving around 60,000 people. “Sometimes I don’t even have time to drink water,” the doctor said.
Attracting qualified medical personnel to rural areas remains a formidable challenge. According to Shenglan Tang, a global health professor at Duke-Kunshan University, many doctors and medical students are deterred by low wages, heavy workloads, and the lack of amenities for their families.
Over the last decade, while the number of doctors in urban areas nearly doubled to 4.1 million, the number of rural doctors fell by 42 percent, leaving rural populations increasingly underserved. A Chengdu-based physician explained how urban hospitals often “extract” the best doctors from smaller cities and rural areas, exacerbating the talent drain.
Shirley Yang, a postgraduate medical student from Zhuhai, explained that in cities like Guangzhou, doctors can earn monthly salaries of over 20,000 yuan (S$3,733), far more than their rural counterparts, who struggle to make ends meet.
In Wei’s remote community, where the nearest clinic is 10 kilometers away, healthcare access is limited. The local clinic is frequently closed, and staff are often only able to treat basic ailments. A nurse there explained that it typically only handles colds and fevers. Nearby, a village doctor in Hunan province described how her clinic is equipped with only basic tools like a stethoscope and thermometer. Despite the challenges, she spends her own money to buy additional equipment, like a blood sugar monitor.
“I provide medical care, grow vegetables, and even take on side jobs just to support my family,” said the village doctor, whose monthly salary is only 1,000 yuan.
Despite the challenges, China continues to allocate resources toward healthcare. In 2023, the country spent 7.2 percent of its GDP on healthcare, lower than the OECD average for industrialized countries like Japan and South Korea, where health expenditure accounts for 11.5 and 9.7 percent of GDP, respectively.
However, local government debt remains a significant barrier to further healthcare investments. To address the rural-urban healthcare gap, a policy initiative introduced in 2023 proposes waiving tuition fees for medical students in exchange for a commitment to work in rural areas during their studies or after graduation.
One student who accepted a placement in a village clinic in central China explained that she plans to return to urban centers after her contract ends if the employment conditions do not improve. “If the environment doesn’t improve, I will likely look for work elsewhere,” she said.
In conclusion, as China faces the dual challenge of an aging rural population and economic pressures, the future of rural healthcare hangs in the balance. Addressing these issues will require a careful balance between industrial development and the growing welfare needs of its aging rural population.
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