Infectious Change: Reinventing Chinese Public Health After an Epidemic

by Katherine Mason

In February 2003, a Chinese physician crossed the border between mainland China and Hong Kong, spreading Severe Acute Respiratory Syndrome (SARS)―a novel flu-like virus―to over a dozen international hotel guests. SARS went on to kill about 800 people and sicken 8,000 worldwide. By the time it disappeared in July 2003 the Chinese public health system, once famous for its grassroots, low-technology approach, was transformed into a globally-oriented, research-based, scientific endeavor. In Infectious Change , Katherine A. Mason investigates local Chinese public health institutions in Southeastern China, examining how the outbreak of SARS re-imagined public health as a professionalized, biomedicalized, and technological machine―one that frequently failed to serve the Chinese people. Mason grapples with how public health in China was reinvented into a prestigious profession in which global recognition took precedent over service to vulnerable local communities. This book lays bare the common elements of a global pandemic that too often get overlooked, all of which are being thrown into sharp relief during the present COVID-19 blame of "exotic" customs from the country of origin and the poor bearing the most severe consequences. Mason's argument resonates profoundly with our current crisis, making the case that we can only consider ourselves truly prepared for the next crisis once public health policies, and social welfare more generally, are made more inclusive.

268 pages, Paperback

Published May 4, 2016

Reviews

[Ietrio · Rating 1 out of 5]

Another small time bureaucrat making his useless plans and studies in hope the boss will give him more tax money to spend.

[Andrew]

So far I'm enjoying this book. What it's mainly about is a generational tension in Chinese public health. Between the old guard of public health workers who concentrate on building guanxi within the social networks of their local community, and a new generation of university educated public health workers, who see public health in a much more scientific, professionalized and depersonalized way.

Anyway, I'm about half way through this book, and I've been struck by a quotation which for me betrays one of the central flaws of contemporary anthropology - the practice of viewing everything in terms of distinct epistemes or belief systems...

Feng had threatened the guanxi ritual by trying to open the black box in which public health projects took place. For any given project, the procedures by which collaborating partners obtained the numbers they did were purposefully obscured. In fact, the nontransparency of the guanxi web was helpful in reaching campaign goals, because if city CDC leaders could not see how the numbers were produced, they could not verify that anything was not “true.” Latour (1999) argues that black boxes are at the heart of scientific production; they reflect “the way scientific and technical work is made invisible by its own success. When a machine runs efficiently, when a matter of fact is settled, one need focus only on its inputs and outputs and not on its internal complexity” (304). To my young informants, however, the black boxes that guanxi produced were not the essence of science but the antithesis. Black boxes were precisely what needed to be broken down to reveal the “reality” within: a neutral reality that existed independently of human actions, a denetworked reality that science studies scholars would say does not exist but in which Tianmai’s young public health professionals firmly believed.

To me, this is a terrible way to use Latour. It seems to me that these young public health professionals are far better at being good Latourians than the author of this book is. They clearly understand that scientific reality is produced by networks, because their concern is to overcome the "non-transparency" of the guanxi web... They are not satisfied with leaving the black boxes be, and they instead want to follow the actors, to see how the numbers are being produced on the ground in local practices.
Being "networked" isn't a belief system, it is a chain of observances. And the nodes of the network are not necessarily human relationships, they also include the numbers on the report, the testing equipment that produces the numbered results, the human bodies, etc. Tianmai’s young public health professionals do not believe in a "denetworked reality" they believe fervently in the way science produces its particular networks, and this means they believe in striving towards a transparent, visible network at the expense of one where links and nodes are obscured for the sake of interpersonal relationships. Of course the world is too complex for the this transparency and visibility to every be completely observed, which is what Latour is getting at with his comments about "black boxes".

[Carrie · Rating 5 out of 5]

Incredibly timely ethnographic analysis of the transition in China's public health system from Mao's 'barefoot doctors' to a US informed CDC model.

Sarah ... this is the book I was telling you about. Here are my lecture notes.

Infectious Change is written by a US based medical anthropologist, using ethnography to chart the ways in which the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 facilitated an ongoing shift to China’s public heath system and provision. Mason historicizes this shift first in Mao Zedong’s low technology approach to health care rooted in the barefoot doctors that is credited with a number of improvements in health, such as life expectancy, that are frequently used as a barometer of a nation’s health status. After his death and with the focus on economic development, public health posts in China crumbled and were re-envisioned as Centers for Disease Control and Prevention, named specifically after the CDC in the US. Mason’s argument is that in the process public health in China became “geared toward the protection of global, rather than local interests and toward the protection of a cosmopolitan middle-class dream rather than toward the betterment of the poor” (3). She further argues that Chinese public health professionals governed local populations on the basis of an idealized notion of modernity, science and professional trust such that it was often global public health that was being served instead of local populations. Mason argues that this is a problem for any profession that serves an aggregate rather than individuals, and thus has consequences for most of what goes under the banner of global health today – much of which has been focused on securitizing ‘the west’. The chapter you are reading is about how the development of the CDC approach to infectious disease following SARS was deployed in the context of H1N1, which developed in the United States. China was condemned for using the techniques used with SARS, specifically quarantine, to stop transmissions coming from people travelling into China.

[Kaxing Leung · Rating 4 out of 5]

Rather than the change of the PH system after an epidemic，the author put more effort to depict the daily lives of a PH Pro who deals with infectious diseases. 从速度城市的建造神话起底，勾勒出公卫专业人士身份建构、事业期望与职业伦理的边界，既展现本地中期望与现实的冲突，又折射出世界性的学术伦理标准在摇摆。爆发叙事对人群的区隔污名歧视依旧，防疫在全球本地都是政治实作，who do you serve问到最后，还是一个政治问题。作者赞许专业者与真实的人接触理解的超越尝试，但我怀疑对人群制度化的区别对待，能否单靠专业者的努力去改变。

[Sela]

Guanxi and Governance pg. 71