Histories and Ecologies of Health. Pittsburgh, PA: University of Pittsburgh Press, 2021. 312 pp. US$55.00, cloth. ISBN 9780822946625.
Xiaoping Fang’s recent book China and the Cholera Pandemic: Restructuring Society under Mao provides a very informative analysis of political, social, and economic institutions in China in the 1960s. It is a must-read for students interested in the social history of China, the political economy of public health, and China studies in general. Using archive documents, local gazetteers, as well as in-depth interviews, the book provides a detailed and also analytical perspective of the cholera pandemic in Wenzhou prefecture, Zhejiang Province in the 1960s.
The book consists of three parts. The first part (chapters 1 and 2) traces the origins of the outbreak of the El Tor cholera pandemic and how the pandemic was transmitted to China. In short, Chinese diaspora members returning from Indonesia were “suspected carriers” of cholera. In June 1961, infected cases were identified in Yangjiang County, Guangdong Province, one of the major destinations of returning overseas Chinese. The first cholera patient in Wenzhou prefecture in Zhejiang Province was identified in February 1962.
The second and third parts of the book focus on the situation in Wenzhou prefecture during the cholera pandemic. Chapter 3 explores the dichotomies in the pandemic between urban and rural areas, male and female rural residents, as well as the military and civilians. Chapter 4 reports how a quarantine was implemented during the pandemic and how people complied with those quarantine practices. Section 3 opens with chapter 5, which discusses how the state enhanced control over local agents in rural Wenzhou by means of a mass inoculation campaign. Chapter 6 shows how that capacity was topped up with building up the statistical reporting system in Wenzhou. Chapter 6 also discusses how information was censored during the pandemic; in particular, mass media did not cover statistical data in detail during the pandemic and instead focused on political education and epidemic preventive knowledge (216). The concluding chapter (chapter 8) highlights the concept of an “emergency disciplinary state” and argues for the continuity of the role of the state in the PRC regime (the most recent case is the state’s response to the COVID-19 pandemic).
Relying on in-depth interviews and archives, Fang makes an original contribution to the literature of China’s social history and the political economy of public health. This book’s contributions are three-fold. First, this book provides a very detailed and vivid picture of state-building in rural China in the 1960s. The bureaucratic system was enhanced in large-scale public health campaigns by the issuance of inoculation certificates, restructuring of the coordination mechanism between the medical and administrative systems, and the collection of statistics on the rural population. Second, and related, the “emergency disciplinary state,” which is built atop the bureaucratic system, can be a very useful concept in the literature of the political economy of public health. As Fang points out, the Chinese government responses to SARS and COVID-19 replicated what happened during the cholera pandemic in the 1960s (i.e., delayed responses in the earlier outbreak and quick and large-scale mobilization later). Third, using the pandemic as a mirror, this book reveals fundamental social changes in rural China in the 1960s. The regime was highly stratified and the mobility of people was highly controlled. Cadres, overseas returnees, and soldiers had privileges in evading quarantine. People’s mobilization was under very strict control via work unit and the commune system, the household registration system, and the political surveillance system (such as the letter of introduction system, jieshaoxin, required for travellers).
I want to raise three issues that are worth discussing in future research. First, Fang makes a very interesting point: bureaucrats realized the ineffectiveness of quarantine, as it is very difficult to identify atypical cases (140), and inoculation (172). But Fang does not elaborate on the reason why these practices continued until the 1980s. Is the persistence of practices including quarantine and inoculation rooted in the social control model?
Second, the diffusion of cost-effective treatment technology in a regime with strong social control could be another direction of future research. The traditional treatment of cholera relies on health workers to provide saline solutions (122). In rural areas, the treatment was considered to be quite expensive and also required a large supply of health workers. A much cheaper and more effective therapy, oral rehydration, invented by David Nalin and Richard Cash, was used in Bangladesh in the 1960s and promoted by the World Health Organization in the 1970s (Thomas Bollyky, Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways, MIT Press, 2018). In principle, this new technology could reduce workload and save administrative costs for health workers and bureaucrats, given the ineffectiveness of quarantine and inoculation. It would be interesting to know whether and when new medical technologies were imported and diffused in China and what was the role of bureaucracy. Bureaucrats in the 2020s face the same question of whether to use imported medical technologies in the COVID-19 pandemic.
Third, some recent studies carve a nuanced picture of state-society relations in coastal China during the pre-reform era (Philip Thai, China’s War on Smuggling: Law, Economic Life, and the Making of the Modern State, 1842–1965, Columbia University Press, 2018; Qi Zhang and Mingxing Liu, Revolutionary Legacy, Power Structure, and Grassroots Capitalism Under the Red Flag in China, Cambridge University Press, 2019). In these studies, even under tight social control, shadow economic activities were prevailing in coastal areas before China’s opening-up in 1978. It would be interesting for future research to explore how local society has responded to the public health emergency and government intervention.
Jiwei Qian
National University of Singapore, Singapore