(August 2, 1965)
(August 2:
Qian Xinzhong and Zhang Kai reported to Mao Zedong on matters related to health work.)
Qian Xinzhong and Zhang Kai (hereafter referred to as Qian and Zhang): The Chairman’s instructions and comments on health work are very pertinent and entirely correct. We have conducted a review in accordance with the Chairman’s directives. May we request further guidance from the Chairman?
Mao Zedong (hereafter referred to as Mao): I have already said everything I intended to say. What are your plans now?
Qian and Zhang: Recently, based on the Chairman’s and the Central Committee’s instructions, we have held discussions and plan to organize urban health personnel to go to the countryside to carry out several tasks. First, in addition to providing medical treatment for farmers, we intend to train part-time health workers for rural production teams.
Mao: Training—how long will it take?
Qian and Zhang: About half a month.
Mao: Isn’t half a month too short?
Qian and Zhang: They will mainly learn acupuncture, the treatment of common diseases, and certain preventive measures. After the training, they will also be taken into the field to practice.
Mao: Field practice is very important. How long should that last?
[ I]
Qian Xinzhong
(1911–2009),
from Baoshan, Jiangsu (now part of Shanghai), was at the time Minister of Public Health of the People’s Republic of China. Zhang Kai
(1912–1996),
from Liuyang, Hunan, was then Vice Minister of Public Health.
I IO

Qian and Zhang: The urban medical teams could remain in the countryside throughout the entire period of field practice, roughly three to four months.
Mao: That sounds reasonable—three to four months, during which they can learn to treat a dozen or so ailments.
(When reporting on the establishment of some semi-agricultural, semi-educational training classes)
Qian and Zhang: We have also set up a number of such semi-agricultural, semi-educational training classes in the countryside.
Mao: How exactly are these semi-agricultural, semi-educational classes organized?
Qian and Zhang: During the busy farming season, there is no study; during the slack season, more study takes place.
Mao: For how long?
Qian and Zhang: Two years, or three years.
Mao: Two years means one year of schooling, and three years means a year and a half. This approach is good.
(When reporting on the inspection carried out in accordance with the Central Committee’s and the Chairman’s instructions)
Mao: How many health technicians are there currently?
Qian and Zhang: There are over 1.4 million health technicians in total—600,000 employed by commune and doctor joint collectives, and more than 800,000 receiving state salaries.
Mao: That’s quite a large contingent! Qian and Zhang: The Chairman criticized us for serving only the urban population, and he was right. Currently, eighty percent of senior medical personnel are located in cities, seventy percent of whom are in large cities and twenty percent in county seats, while only ten percent are in rural areas. As for funding, even including counties, only twenty-five percent goes to rural areas, with seventy-five percent allocated to urban areas.
Mao: You have deployed so many personnel and spent so much money to serve such a small portion of the population.
Qian and Zhang: It was only after the Chairman’s instructions that we became fully aware of this issue.
Mao: Have you studied “divine doctors”?
Qian and Zhang: We have not.
Mao: There are three advantages to “divine doctors”: their medicines are safe, do not harm people, and are non-toxic; secondly, they are cost-effective—often costing just a few copper coins; and thirdly, they provide psychological comfort to patients, which can contribute to recovery.
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Qian and Zhang: Many illnesses can heal on their own without treatment.
Mao: That’s better than being deceived by charlatans.
Qian and Zhang: Through the Four Cleansings Campaign and the dispatch of medical teams to the countryside, we have come to realize that the rural health workforce is quite complex.
Mao: In what way is it complex?
Qian and Zhang: Many individuals who were never formally trained as doctors simply read some medical texts and joined the ranks of healthcare workers.
Mao: What kind of books did they read?
Qian and Zhang: Primarily traditional Chinese medicine texts and prescriptions. Approximately forty percent of the rural healthcare workforce consists of personnel with complicated political backgrounds and low technical proficiency.
Mao: Surely there aren’t many bad actors among them?
Qian and Zhang: Truly malicious elements account for only about five percent, but those with poor political awareness and technical skills make up around forty percent. Without a steady influx of new talent, it would be difficult to effectively reform this group.
Qian and Zhang: We are currently holding a conference on medical education to discuss the Chairman’s and Premier’s instructions regarding the establishment of three-year health schools aimed at training doctors for rural areas.
Mao: Higher education typically requires five years of study. It would be worthwhile to explore whether such an extended period of schooling is necessary.
Qian and Zhang: We are considering a two-pronged approach—establishing these three-year programs primarily in rural areas and recruiting students directly from rural regions.
Mao: Who would be eligible to enroll?
Qian and Zhang: Mostly high school graduates.
Mao: Wouldn’t junior high school graduates also qualify?
Qian and Zhang: There are still quite a few high school students in rural areas at present.
Mao: Couldn’t you recruit junior high school students as well? Aren’t you already recruiting in urban areas?
Qian and Zhang: We do recruit some students in cities, but our primary focus remains on rural areas. Based on the Chairman’s view that five years of study may be too lengthy, we believe that emphasizing high school graduation as a prerequisite for admission is not essential.
Qian and Zhang: A physician’s political ideology is crucial; technical skill alone is insufficient.
Mao: That point is very important. Physicians must possess sound political principles. Recruiting politically conscientious junior high school graduates would suffice.
(Qian Xinzhong and Zhang Kai again reported on urban issues)
Mao: Are you providing adequate services to urban residents?
Qian and Zhang: Not really—we are facing increasingly higher demands.
Mao: Why are the demands rising?
Qian and Zhang: Taking Beijing as an example, over 500,000 cadres receive free medical care, more than 800,000 workers are covered by labor insurance, and family members are also included.
Mao: Workers are not “gentlemen”; we still need to serve them.
Qian and Zhang: Medical services within factories are poorly organized, so workers end up going to hospitals for treatment.
Mao: Why don’t you establish part-time health workers in factories? Small factories could have a single health worker, while larger ones could set up infirmaries.
Qian and Zhang: Unofficial medical practitioners cannot issue sick leave certificates; employees must go to a hospital and obtain a doctor’s certification to take time off.
Mao: This involves labor insurance issues and requires careful consideration.
Qian and Zhang: Urban hospitals are under immense pressure. With free medical care provided without any cost-sharing, people seek treatment everywhere.
Mao: Even after receiving treatment and medication, patients often fail to take their prescribed drugs.
Qian and Zhang: Chairman Liu and the Premier have instructed that urban medical personnel should be organized to go to the countryside every year, with half of them rotating each time.
Mao: How would this rotation work? And how long would each assignment last?
Qian and Zhang: We propose a rotational system. However, even after such assignments, the burden on urban healthcare remains heavy. We are considering allowing students in higher medical institutions to work part-time while continuing their studies after completing their three-year program. Similarly, nurses could also continue working while pursuing their education.
Mao: Simply being able to recite textbook knowledge is not enough.
Mao: Have you considered the possibility of war?
Answer:
We have given it thought following instructions from the Central Committee.
Mao: How did you think about it?
Qian and Zhang: We have organized dozens of medical teams, ready to deploy to the front lines at any moment. Current hospitals are not equipped to handle wartime scenarios. Some units have already begun training medical teams in preparation for potential combat situations.
Mao: If war breaks out, will everyone still be able to go to hospitals in Beijing for treatment? We need to factor in wartime conditions. Your current distribution of resources is too fragmented. What will happen when war occurs? Will we still only be able to provide internal medicine services and lack surgical capabilities?
Qian and Zhang: In the past, the military had a younger population, and there may not have been many complex or unfamiliar cases. However, medical science has advanced significantly, and we should maintain a small contingent dedicated to cutting-edge research.
Mao: Do researchers themselves ever seek medical care?
Qian and Zhang: Some do, while others do not.
Mao: Who doesn’t seek medical care?
Qian and Zhang: Those engaged in basic scientific disciplines—such as physiology, pharmacology, and biochemistry—who conduct theoretical research generally do not receive medical treatment.
Mao: Theory must ultimately be grounded in practice!
Qian and Zhang: Comrade Ding suggested that only five percent of our workforce need to be devoted to cutting-edge research. Currently, we have a total of 10,000 researchers, including 5,000 technical personnel.
Mao: We must continue to pursue advancements in science and technology.
(When discussing the need for party committees at all levels to pay more attention to health work)
Mao: That’s a very valid point. Party committees exercise collective leadership and oversee all aspects of work. Since the health sector serves the people, it naturally falls within their purview, and party committees should indeed prioritize health-related matters.
(Qian Xinzhong and Zhang Kai again sought the Chairman’s opinion on the issue of remuneration for rural health workers. According to the Sixty Articles of the People’s Communes, subsidies in the form of work points shall not exceed two percent. While commune members agreed to grant health workers such subsidies, the Sixty Articles did not specify this.)
Mao: There is nothing wrong with doing good deeds for the masses; the farmers will certainly agree. Nowadays, even cadres participate in manual labor, and the two percent limit is often not fully utilized—in some places, only one percent is used. Work points are not a significant issue, and the farmers will approve.
(Qian Xinzhong and Zhang Kai again requested the Chairman’s approval to suggest that the Central Committee convene a national conference on rural health work this year, inviting leaders from provinces and municipalities to attend.)
Mao: That is acceptable.
(When discussing pharmaceuticals)
Mao: Drug prices should be lowered.
Mao: Family planning services in Tianjin are provided free of charge. It appears that although the state bears the costs, it is actually economically viable. Investing a small amount to protect productivity is worthwhile. Those who cannot afford medication need not purchase it. Following your efforts in rural health work, you should promote family planning.
(Finally, Qian Xinzhong and Zhang Kai asked the Chairman if he had any further instructions.)
Mao: No further instructions. Proceed as you have outlined.