Field Report: Chronic disease management and multi-sector solutions for health-induced poverty are working, but China’s big hospitals are holding back primary care

Professor Winnie Yip relaunches Harvard’s health policy dialogue in Yunnan Province together with Tsinghua-Lancet Commission

Winnie Yip, Professor of the Practice of Global Health Policy and Economics at the Harvard TH Chan School of Public Health, has been working for several decades on healthcare reform in some of China’s most remote, impoverished areas. And so once the pandemic-related travel restrictions were lifted, she quickly made plans to return to China to resume her academic engagement with Chinese scientists, doctors, and health officials. In April, Yip traveled to China for the third meeting of the Tsinghua-Lancet Commission on Health and Poverty Alleviation in China in Yunnan Province. The meeting was organized by Tsinghua University’s Vanke School of Public Health, a longstanding partner institution of the Harvard China Health Partnership, of which Yip is the director.

In the context of increasingly tense U.S.-China relations, scholarly trips like this take on additional import, because they underscore that people-to-people exchange is still possible, and that experts in the two nations can still work together to solve shared challenges. “It feels great to get back to meeting in person with Chinese health experts, many of whom have become my friends over the years,” says Yip. “It’s so important for us to keep talking. When it comes to healthcare, we have much to learn from each other. They were so grateful that I came.”

“It’s so important for us to keep talking. When it comes to healthcare, we have much to learn from each other. “

Winnie Yip speaking at a conference in Yunnan

Yip speaking at the recent conference in Yunnan

Professor Yip and other commissioners also conducted field visits in Yunnan Province’s Huize County. They spoke in-depth with rural households, village doctors, and other medical staff. In Huize, Yip visited a former farmer who had been bankrupted when his wife fell seriously ill with Schizophrenia. He explained that the local government’s poverty relief and healthcare programs provided subsidies for care, enabled them to move to a new house with safe structure and clean water supply, and also helped him start a small business selling fruits and vegetables in the county seat.

A local clinic doctor speaks with Prof. Winnie Yip — *Yip, here with a clinic doctor, is impressed by China’s multi-sectoral approach to fighting health-related poverty*

The provincial leaders with whom Yip met, including the Governor, the Party Secretary, and officials from the Medical Insurance Bureau, the Health Bureau, the Rural Revitalization Bureau, and the Civil Affairs Bureau shared their perspectives on efforts to eliminate poverty induced by poor health and/or low healthcare payments. “I am quite impressed with the multi-sectoral approach that China has adopted to eliminate health-related poverty,” says Yip. “It’s not just paying for healthcare, but also improving housing conditions and ensuring clean water supply, nutrition, and education.” A key challenge is to sustain the achievements made so far.

While Yip is also impressed with improvements that she observed at the village clinics, including better detection and management of common chronic disease such as hypertension and diabetes, she is also concerned about the big and bigger hospitals (with 8,000 to 10,000 beds) springing up across China. “This will draw most of the resources toward large hospitals,” Yip says, “and limit the growth of primary care, which is really what China needs to build up.”