On the weekend of May 10th 2014, protests erupted in the Yuhang district of Hangzhou over governmental plans to open a waste plant in the city. Thousands of people took to the streets to demonstrate against the incineration. The protest turned violent when the public clashed with police forces. Over thirty cars were damaged and dozens of people got hurt (Bloomberg 2014). Chinese authorities detained sixty people following the protest. The national press tagged the blazing demonstration as the ‘5/10 event’. May 10th is not the first event in its sort; Chinese citizens are increasingly raising their voices by opposing the state on environmental issues. Are they fighting against pollution, or is there more at stake?
Opening the curtains on any smoggy Beijing morning, one can perceive China’s pollution crisis with the eye. At times the smog gets so heavy that even a nearby building can barely be seen from a distance. A quick look at the Air Quality Index shows unhealthy air throughout China. The severe degradation of air quality has caused a 5,5 year decrease in life expectancy in the northern regions (Xu 2014). Pollution of China’s soil, water and air has become a serious risk to China’s public health.
Over the past decade, environmental activism is on the rise in urban and rural China. Although the central government has made efforts to protect the environment, local officials continuously place economic growth before environment (Li et al 2012, 65; Economy 2007). In recent years, demonstrations against the installations of waste or chemical plants have led to confrontations between protestors and police over multiple occasions. Before the escalation of the Yuhang protest in May 2014, there were demonstrations in Maoming (April 2014), Kunming (May 2013), Ningbo (October 2012) and many other places. Environmental activism has become a recurring topic in China’s headlines, especially because these protests involve angry citizens and outbursts of violence.
“Are these kinds of public protests solely driven by worries about (local) environment, or are there more issues involved?”
China has had severe environmental problems for a long time. A 1988 investigation into China’s water quality already found that 436 of 532 rivers were badly polluted (Jun 2003, 209). Environmental problems have actually been ubiquitous in China for centuries (Xu 2014). The recent dramatic increase in protests is undeniably linked to the growing health hazards as a result of pollution, but in the context of the general rise in social protest, environment is not the sole reason Chinese citizens are taking their discontent to the streets.
The occurrence of social protests within China has been on the rise since the 1990s. The country’s rapid industrialization has caused a myriad of problems aside from those linked to environment: the decrease of certain forms of welfare, deterioration of living conditions, the loss of housing or land without compensation, etc. Different grievances have caused frustration amongst citizens. And because of a decline in social control from the central government (due to, amongst others, greater power of local authorities), there is also more opportunity for public protest (Chen 2011,13).
“What is the ‘stench of pollution’ to an outsider may be ‘the sweet smell of money’ to local residents”
So are the demonstrations against (local) pollution just protests for the sake of protesting? Not entirely. To a great extent, they are about the hazards of pollution. The protests for clean water in China’s so-called ‘cancer-villages’ are very real. But there are also many examples where serious pollution has not led to protests, whereas not-so-serious pollution has. This is because there are economic and social factors that determine whether or not citizens take their grievances to the street. “What is the ‘stench of pollution’ to an outsider may be ‘the sweet smell of money’ to local residents” (Deng&Guobin 2013, 322). Local residents may be economically depended on a waste plant for their income- in some cases, the economic benefits come before the health hazards. When one’s own neighbor is the one who causes local pollution through his business, local residents might choose community relations over environmental risks (Deng&Guobin 2013, 323). The studies that have been done on the relation between pollution and protest have shown that they are not necessarily directly connected. In other words, these protests should be placed in their context. Chen (2011) calls them a “‘cross-sector’ phenomenon” (11) – political or economic issues aside from pollution might be the determining factors that lead to the decision whether or not to protest.
The chemical plant in one’s hometown is a curse to some and a blessing in disguise for other social groups who are economically dependent on it. Does this mean that one should not take environmental protests too seriously? On the contrary. But one should look beyond environment to see what other (political, economic, social) issues might be playing a role. Whatever issues are at the root of the protests, they should be addressed. In the end, the environment and the nation at large will only benefit from a better communication between the public, local authorities and the central government. From this perspective, the recent protests against pollution might just be the breath of fresh air China needs.References Bloomberg. 2014. “Protest Against Waste Plant in Hangzhou Turns Violent.” Bloomberg News (May 11) http://www.bloomberg.com/news/2014-05-11/protest-against-waste-plant-in-hangzhou-turns-violent.html (Accessed May 11, 2014). Chen Xi. 2011. Social Protest and Contentious Authoritarianism in China. New York, Cambridge University Press. Deng Yanhua and Guobin Yang. 2013. “Pollution and Protest in China: Environmental Mobilization in Context.” The China Quarterly 214: 321-336. Duggan, Jennifer. 2013. “Kunming pollution protest is tip of rising Chinese environmental activism.” The Guardian (May 16) http://www.theguardian.com/environment/chinas-choice/2013/may/16/kunming-pollution-protest-chinese-environmental-activism (Accessed online May 13, 2014). Economy, Elizabeth C. 2007. “The Great Leap Backward?” Foreign Affairs (Sep/Oct) http://www.foreignaffairs.com/articles/62827/elizabeth-c-economy/the-great-leap-backward (Accessed online May 14, 2014). Jun Jing. 2003. “Environmental Protest in Rural China.” In: Chinese Society: Change, Conflict and Resistance. Social Protest in Contemporary China, Elizabeth Perry and Mark Selden (eds), 197-214. London: Routledge Curzon Press. Li Wanxin, Jieyan Liu and Duoduo Li. 2012. “Getting their Voices Heard: Three Cases of Public Participation in Environmental Protection in China.” Journal of Environmental Management 98: 65-72. Xu, Beina. 2014. “China’s Environmental Crisis.” ISN ETH Zurich (May 2) http://www.isn.ethz.ch/Digital-Library/Articles/Detail/?id=179244&lng=en (Accessed online May 14, 2014). Images: Design You Trust. 2012. http://designyoutrust.com/2012/01/pollution-in-china-the-worlds-worst/. Reuters. The Guardian. 2012. http://www.theguardian.com/world/2012/jul/28/chinese-protesters-industrial-waste-pipeline. Photograph: Carlos Barria/Reuters
About the Author: Manya Koetse is the editor of What’s on Weibo. She’s a Sinologist who splits her time between the Netherlands and China. She earned her bachelor’s degrees in Literary Studies, Japanese & China Studies and completed her MPhil in Asian Studies. Contact: email@example.com, or follow on Twitter.[/box]
©2014 Whatsonweibo. All rights reserved. Do not reproduce our content without permission – you can contact us at firstname.lastname@example.org.
Coronavirus on Chinese Social Media: The 8 Major Trends in Times of the 2019-nCoV Crisis
The 8 main trends defining the online responses to the Wuhan coronavirus on Chinese social media.
From panic to patriotism, the outbreak of the coronavirus has led to a wide range of different responses from Chinese netizens and online media outlets over the past few weeks.
Although the first reports on the emergence of a pneumonia-like illness in the city of Wuhan came out in late December, it wasn’t until mid-January that the new virus, belonging to the coronavirus family, started dominating the top trending lists on social media in China and beyond.
The hashtag “Nationally Confirmed Cases of New Pneumonia” (#全国确诊新型肺炎病例#) became one of the biggest news-related topics we have ever seen on Weibo, receiving eight billion views by January 25, and reaching a staggering 13,5 billion views by February 2.
As of February 6th, approximately 28,200 cases of the new virus were confirmed, with over 170 cases reported in countries outside of China. The death toll also became much higher than days before, rising to 564. With these numbers, the coronavirus has exceeded the scale of the 2003 SARS outbreak in terms of infected patients.
Along with the quick spread of the new coronavirus across the country, the general mood and direction of the discussions and trends in the Chinese online media environment have also been in constant flux.
At What’s on Weibo, we have been glued to our social media screens, but because editor-in-chief Manya Koetse has been flooded with daily media requests we have not been able to update the site with regular updates (meanwhile, @manyapan did post regular updates on Twitter).
Here, we will highlight some of the main social media trends we spotted during the outbreak of the new Chinese coronavirus, now and over the past weeks.
Online Backlash against the Eating of Wild Game
As an online media panic broke out around January 20, when a third person had died of the new Wuhan virus, one of the main trends to come up on Chinese social media was an online backlash against the eating of wild game (as reported here by Jessica Colwell).
The backlash flooded Weibo after the downtown Wuhan Huanan Seafood Wholesale Market (武汉华南海鲜批发市场), selling a wide range of dead and alive wild animals – anything from snakes and crocodiles to rats, hedgehogs or bats, – was identified as the suspected source of the deadly coronavirus outbreak.
Since Chinese researchers linked the novel coronavirus (nCoV-2019) to bats, videos and images of bat dishes and people eating bat soon made their rounds on social media.
Many of these videos were actually unrelated to Wuhan, but were used in condemning the practice of eating (illegal/unsafe) wild game in general.
Around January 23, hashtags such as “Support the Banning of Wild Game Markets” (#支持禁绝野味市场#), “Refusing Eating of Wild Game Starts with You” (#拒吃野味从我做起#), “Control Your Mouth, Refuse Wild Game” (#管住嘴拒绝吃野味#) went viral on Weibo.
As images or videos of people eating bats or other exotic animals soon also spread to Twitter and other non-Chinese social media, some English-language media labeled them as “xenophobic” or “racist” – ignoring the fact that the anti-wild game storm actually started in the Chinese online media environment.
State media outlets such as People’s Daily, for example, played a role in the online dissemination of information against the eating of wild game and actually hosted some of these hashtag pages on Weibo.
The main argument behind the backlash is that those eating (unsafe, illegal) exotic and/or wild animals could risk their own health and that of their community and that what you eat is also your responsibility in keeping others safe.
The backlash against the eating of wild game and online anger against people hunting or illegally buying wild animals for consumption is still ongoing, with some directing their anger against Wuhan people in specific.
This has also triggered discussions on Weibo about discrimination – not against Chinese people in general, but against Chinese netizens discriminating against Wuhan people or even against people from the Hubei province.
Fake News and Censorship
Chinese social media platforms such as Weibo are tightly controlled online environments. When certain sensitive topics pop up, such as the anniversary of the Tiananmen protests, the Hong Kong demonstrations in their early phases, or big political events, virtually all related posts and news sharing will sometimes be removed by online censors.
In the wake of the coronavirus outbreak, this was not necessarily the case. From the start, there was a lot of reporting, sharing, and discussion of the virus online.
However, there certainly has been ongoing censorship of the topic. This was mainly done in the case of netizens reposting videos of chaotic situations in streets or at hospitals, but also in the case of ‘fake news’ posts (mostly called “starting rumors”).
Posts that could potentially trigger unrest or panic also were censored. One hashtag that made its rounds around January 22 was “Escaping Wuhan” (#逃离武汉#), with people trying to leave Wuhan before the city would go on lockdown. That hashtag page was soon completely removed from Weibo.
The comments sections of some posts reporting on controversial or sensitive news were also completely turned off (such as this report addressing local authorities in Wuhan allegedly taking donated face masks).
Confirmed with my friend that yes she’s been sending me
a video of an alleged Wuhan hospital scene through WeChat, but it’s not coming through in our private #WeChat conversation. pic.twitter.com/UOy5Fhm8Np
— Manya Koetse (@manyapan) January 24, 2020
One Weibo user (@魔女小稀), an alleged nurse, posted a video of people in a hospital hallway on January 24th, claiming that “three [dead] bodies” had been lying in a Wuhan hospital for the entire afternoon covered in white sheets without being removed.
The post and the Weibo user were completely removed from the platform on January 25. By that time, however, the video and allegations were already picked up and reposted internationally.
According to Sina News, the post had been completely false; there were no bodies lying around this Wuhan hospital. If there were people covered in white sheets, it was merely people sleeping in the hallway after waiting for a long time.
This is but one of many examples of ‘fake news’ floating around Chinese social media over the past two weeks, with images and videos being placed in a misleading context, people claiming that patient or deceased numbers were much higher than those reported by the official media, and some even bringing up conspiracy theories about the source of the coronavirus (e.g. that the Americans started it, that it leaked from a biolab in Wuhan, etc).
The problem in this issue is, of course, when do we call it ‘fake news’ and when do we call it ‘censorship’? Amid the chaos and uncertainty of the coronavirus outbreak, it is not always easy to separate the two.
This is also a contributing factor in the general distrust in official media reports that clearly surfaced on Weibo over the past weeks. “I don’t believe it,” is a sentence popping up everywhere on social media.
Spreading online “rumors” is a crime under China’s Criminal Law and is punishable by up to seven years in prison. Although some foreign media outlets, such as this one, make it seem as though it is illegal to share fake news about the coronavirus in particular, it is actually illegal in China to share fake news in general.
Another trend we noticed on social media during the wake of the coronavirus outbreak is not just a distrust in official media and authorities, but also distrust in fellow citizens.
One clear example that blew up on Weibo is that of a young woman from Wuhan who posted about her traveling to France – and enjoying nice food – despite suffering from a fever and cough. Because she took fever reducers, she claimed to have passed airport temperature monitors without issue.
The post sparked great anger among Chinese netizens and triggered the so-called ‘human flesh search engine,’ with people digging into her personal details.
The incident even led to the Chinese embassy in France investigating the matter. The woman turned out not to have been infected with the virus.
But there are many examples of people exposing and doxing those who allegedly are hindering the collective goal of minimizing the risk of a further spreading of the virus, for example by not self-isolating after visiting Wuhan.
There’s also been widespread online condemnation of people stealing tissue paper from public elevators. Many apartment buildings around China now provide a box of tissue paper for hygienic reasons so that people do not need to touch the elevator buttons.
There’s been an ongoing trend of people being exposed on Chinese social media for stealing the tissue boxes now placed in many Chinese apartment elevators (to minimize bacterial levels on elevator buttons in times of #coronavirus). This is but one of many of these videos. pic.twitter.com/A1HAXNZWfQ
— Manya Koetse (@manyapan) February 4, 2020
Surveillance videos of people stealing these boxes have been making their rounds on Weibo and WeChat, such as this lady in an elevator in Chongqing, with thousands of netizens expressing their anger over their behavior – and sometimes naming and shaming them.
Social Media as a Practical Communication Tool
Soon after the scale of the coronavirus outbreak started to become clear, social media platforms such as Weibo were started to be used as practical communication tools for authorities, (medical) organizations, and individuals to spread information or to ask for help.
Social media is now widely used as a practical communication tool for very general matters in the coronavirus crisis (e.g. providing information on how to avoid getting the virus), but also for more specific issues.
FYI the no 1 trending topic of the day is the news that Wuhan hospitals are running out of supplies (hashtag #武汉多家医院物资紧张, 270 million views), hospitals & media are urgently requesting funds & contributions. pic.twitter.com/bSENdSL3kh
— Manya Koetse (@manyapan) January 25, 2020
Various hospitals in Wuhan, for example, spread digital leaflets online summing up their specific shortages in supplies (face masks, surgical gloves, etc), and how people and organizations can contribute.
How Weibo becomes an important communication tool in the handling of #coronavirus. Harbin Center Disease Control PSA: anyone who was on the 20:33 G1278 train carriage 2 from Hankou to Beijing: 3 Wuhan passengers possibly infected, warning passengers to stay indoors if at home. pic.twitter.com/tLPzBRsB5b
— Manya Koetse (@manyapan) January 24, 2020
Another example is how authorities at various times use social media to search for people who were on board of certain trains or where passengers were later diagnosed with the virus.
But we have also seen individuals reaching out through social media. One woman, for example, reached out to netizens online after she and her husband fell ill and needed someone to look after their children.
Through the help of social media, there are now also local volunteers who help taking care of people’s pets while they are unable to return home to feed them.
One of the hashtags increasingly receiving attention online since early February is “Rescuing the Pets Left Behind in Wuhan Homes” (#武汉滞留家中宠物救援#).
Since January 26, Tencent’s WeChat has also opened a special “epidemic supervision” channel within its app where WeChat users can go to get the latest local information about the virus in their area or ask for medical help.
Propaganda, Pride and Patriotism in Times of Crisis
The outbreak of the coronavirus coincided with the most important holiday of the year in China: the Spring Festival. On Friday, January 24, the CCTV broadcasted its annual Spring Festival Gala (Chunwan), a 4-hour long show that has been airing since 1983. The show is the biggest live TV event in the world, with a viewership of one billion.
The show is usually meticulously planned up to every second – with rehearsals starting months before -, but this year, for the first time ever, it included a segment on the Wuhan coronavirus outbreak. It showed scenes from inside a Wuhan hospital, and the show’s main presenters paid their respects to all the medical workers working day and night.
In light of Wuhan coronavirus outbreak, CCTV puts out a performance paying tribute 🙏 to first line healthcare professionals. This is currently trending as “The Only CCTV Spring Festival Gala Program Without Rehearsal”. #央视春晚 pic.twitter.com/6D89UMlsFw
— yz奥奥 (@midnightbliss01) January 24, 2020
The event became trending on Weibo under the hashtag “For the First Time in History, ‘Chunwan’ Includes a Non-Rehearsed Segment” (#春晚历史上首次没有彩排的片段#)
It was during this time, with twenty million people under travel lockdown, that the sentence “Jiayou Wuhan, Jiayou Zhongguo” (“Come on Wuhan, Come on China”) was propagated by state media and became widely used on Chinese social media.
By now, the hashtag “Go Wuhan!” (#武汉加油#, hosted by Party newspaper People’s Daily) has over 12 billion views on Weibo.
Medical staff at the dedicated isolation ward of Wuhan’s People’s Hospital wish everyone a Happy New Year, saying: “We’re here, don’t worry [and celebrate Spring Festival]” – a hashtag that’s now propagated online to ease the #coronavirus panic. #有我们在大家安心过年 pic.twitter.com/byWLd8DJ1i
— Manya Koetse (@manyapan) January 24, 2020
Starting from the Spring Festival weekend, Chinese state media began to propagate more positive, patriotic, and nationalistic messages online during the corona crisis, focusing on the unity of China and the dedication and resilience of common Chinese people, with a specific emphasis on medical and army staff.
It is not uncommon, or actually rather common, for Chinese authorities and state media to propagate nationalism in times of hardship (also see our article on online propaganda during the Hong Kong protests).
Quarantine Boredom: From Panic to Humor
From late January, the first humorous memes and videos starting flooding Chinese social media in light of the coronavirus.
Around January 25, there were over forty confirmed deaths due to the new coronavirus and over 1380 known infected patients. Along with the travel lockdown, most of the major tourist attractions across China had shut down, and driving bans were implemented in the city of Wuhan to restrict people’s movements in efforts to contain the outbreak.
What was supposed to be a time of joy and reunion and entertainment (the Chinese New Year) turned into a time of fear and self-isolation for many families in Wuhan and beyond.
Practically locked up in their homes, some people used humor as a ‘defense mechanism’ in times of coronacrisis.
The videos embedded in the thread below are some examples of people making the most of their times in lockdown.
How to survive staying indoors during #coronavirus lockdown according to these very important videos making their rounds on Chinese social media. Firstly: don’t be afraid to express your feelings and get in touch with your emotions. pic.twitter.com/xd8yj73dtx
— Manya Koetse (@manyapan) January 27, 2020
“What’s the situation in Beijing like now?”
[Posts photo of empty shelves Durex condoms]
— Manya Koetse (@manyapan) January 28, 2020
But besides the creative solutions of people avoiding boredom inside the home, there were also many memes going around WeChat and Weibo making fun of the extreme measures taken by people and authorities, such as this photo below that was allegedly taken at a station in Yiwu, Zhejiang, saying: “Some people got off the train in Yiwu but thought they’d ended up in Saudi Arabia.”
There was also this viral image below of an office canteen where people were self-isolating for safety reasons, saying: “Eating at the cantine of my unit now feels more like taking an exam.”
Videos and images of people using sanitary pads, bras, plastic bags, or even fruit to protect their faces due to a scarcity of face masks also continue to make their rounds on social media, with people sometimes mocking neighbors, their friends or family, or even themselves in the extreme and sometimes silly measures they are taking to avoid getting the coronavirus.
We’ve reached a point where people are starting to wear inflatable costumes on the streets to protect themselves against the #coronavirus. According to Chinese media, a medical expert said this is “unnecessary” and that washing hands and wearing face masks will do 😂😂😂 pic.twitter.com/OvhOD76kum
— Manya Koetse (@manyapan) February 6, 2020
We’ve gotten to a point where I am seriously doubting if this is 100% serious, 100% joke, but I’m going for a bit of both. “We’re out of face masks, so now I use this.” #coronavirus pic.twitter.com/1LVuCFvYUo
— Manya Koetse (@manyapan) February 2, 2020
Anger against Local Authorities and Illegal Lock-Ins
As panic over the spreading coronavirus has become bigger over the past few weeks, the voices criticizing local authorities and organizations for mishandling the situation have also grown louder.
While loud criticism of the central government is usually censored before triggering bigger discussions, there has been ample criticism of provincial, city, and county authorities and organizations – and not without consequence.
In Hubei, local authorities have been criticized for, among others, initially censoring reports of an emerging new illness in December of 2019.
The mayor of Wuhan, Zhou Xianwang, became a major target of netizens’ anger. In late January, Zhou admitted that he had failed in disclosing information in a timely manner and also “did not use effective information” to improve the local government’s work.
The Hubei branch of the Red Cross Society of China (RCSC, 中国红十字会) also received massive criticism online in early February when it turned out that, while the public donated medical supplies and money, most of it remained in the Red Cross warehouse.
On February 4, Chinese state media reported that the Hubei Red Cross deputy director had been removed from office and dismissed from the leading Party members group of the RCSC branch.
On village and prefecture-level, there has also been public condemnation of how authorities are handling the corona crisis.
Some videos going around social media showed how people, seemingly against their will, were locked up inside their own homes by local authorities after returning from Wuhan (“武汉返乡人员”).
China Youth Daily, the official newspaper of the Communist Youth League of China, also condemned these practices as “illegal” and “inhumane” in an article that has since been deleted.
Through a new WeChat function mentioned earlier in this post, Chinese netizens can now also report any mishandlings of the coronavirus situation.
At the time of writing, there seems to have been some increased censorship, but nevertheless, criticism on local authorities keeps flooding Weibo.
“While people are busy helping themselves and each other, what are the leaders of Hubei and Wuhan doing?”, some people wonder: “Supplies in the hospitals are still scarce, there are still people who are unable to receive help!”
Corona Panic Buying
It was around January 21st when the coronavirus panic reached a peak in China; a third infected patient had died of the virus the day before, the first cases were confirmed outside of China, and several big travel platforms had started to offer refunds or change flights via Wuhan.
Similar to the SARS outbreak in 2003, news of the coronavirus led to waves of “scare shopping” – a trend that also became very visible on social media.
Medical face masks soon sold out in Chinese pharmacies and on e-commerce platforms: around 80 million face masks were sold on Alibaba’s Taobao platform alone on January 20 and January 21st. Those (online) shops still offering face masks exploited the shortage of face masks, and would only sell them at exorbitant prices.
Twenty dollars for a face mask?
Although Alibaba soon announced it would remove sales of face masks from shops that were selling them at unstable prices, the sales and availability of (disposable) N95 masks is still an issue across China, with netizens complaining about it on Weibo every single day.
Another example of consumer panic followed the Jan 31st reports by two medical research institutions on the TCM oral medicine Shuanghuanglian, which would allegedly be effective in combating the new coronavirus.
Shortly after the reports came out, the herbal remedy sold out in stores across the country.
Chinese state media now warn people against “irrational purchases,” saying that the effectivity of herbal remedies such as Shuanghuanglian is still unsure.
Panic buying is a trend that is not just visible on Chinese social media, it is a trend that also seems to be triggered through social media, with rumors and reports of existing shortages of certain products leading to panic.
A clear example is the February 5 run on toilet paper in Hong Kong after rumors spread that the coronavirus outbreak would lead to insufficient supplies.
OK, Hong Kong, I totally get the surgical mask panic. We all do. But pray tell. what’s up with the run on toilet paper? Are y’all really buying this rumour that China will boycott HK for… Toilet paper ? pic.twitter.com/kb9e0flFyd
— Wang Feng 王丰 (@ulywang) February 5, 2020
As there are still many new developments and news reports coming out concerning the coronavirus, we will keep on publishing more on What’s on Weibo about what’s trending on Chinese social media. (Also read: Distrust and despair on WeChat and Weibo after the death of Wuhan whistleblower Li Wenliang).
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‘Good Doctor’, Digital Hospitals: How Mobile Apps Are Alleviating China’s Healthcare Problems
With the rapid digitalization of China’s healthcare, Chinese patients now have more ways than one to receive medical assistance.
This is the “WE…WEI…WHAT?” column by Manya Koetse, originally published in German by Goethe Institut China on Goethe.de: “Good-Doctor Apps und Digitale Krankenhäuser.”
Social Credit System, artificial intelligence, surveillance cameras; these are some of the hottest topics making headlines in mainstream Western media when discussing China-related developments recently.
With the rapid digitalization of Chinese society, these topics certainly have come to play a more important role in social media discussions within the People’s Republic of China (PRC). But if there is one issue that seems to concern Chinese social media users the most, it is not facial recognition nor their ‘Sesame score’: it is the topic of healthcare.
In December of 2017, a photo showing a crying mother kneeling down beside a toddler on the sidewalk in front of a Shanghai hospital went viral overnight. The moment was captured on camera by a reporter who was visiting Shanghai’s Children’s Hospital.
The mother, Guo Yinzhen, is a single parent who had traveled from a remote village to seek medical help for her 3-old-son, who was suffering from congenital hydrocephalus or ‘water on the brain.’ Already having traveled to the city multiple times and spending all her money on medical bills, Guo could not afford the additional 100.000 yuan (€ 12.600) for medical procedures needed to save her son’s life.
Guo’s story struck a chord with Chinese netizens, who continue to share the heartbreaking photo on social media to this day. It has become emblematic of China’s healthcare problems.
Crowded Hospitals and ‘Healthcare Disturbance’
The key to an adequate healthcare system, no matter where in the world, is that there is a right balancing in the “iron triangle” of efficiency/cost containment, high quality care, and patient access. China, however, struggles with all three sides of this triangle.
Guo’s case is an extreme example, but many people in China dealing with less serious health issues and needing basic medical services also struggle to afford and access the healthcare they need.
Over 95% of people in China have health insurance, but people from different regions do not enjoy the same benefits and their out-of-pocket expenses can vary greatly. Uncovered medical costs can sometimes be catastrophic and simply unaffordable for patients and their families.
As more money flows are going to healthcare facilities in China’s cities, there is also the issue of varying levels of providers’ medical education and the overall healthcare quality, with the substantial majority of modern hospitals still existing in urban areas.
Easy access to the right kind of healthcare can be especially problematic for China’s rural population, as people often need to travel long distances and have to go through the lengthy process of registering and waiting for their doctor’s appointment, which sometimes requires them to stay in the city overnight.
For all of these reasons, China’s bigger public hospitals can get super crowded, sometimes resembling shopping malls on an end-of-season sales day. On social media, both patients and medical workers often complain about the stress brought about by the huge crowds and the shortage of doctors in hospitals across the country.
Perhaps it is no wonder that China even has a word to describe outbursts of violence between patients and doctors: ‘Yī nào’ (医闹, literally: “healthcare disturbance”).
One major problem within China’s healthcare conundrum is the lack of local family or primary-care doctors, which often makes bigger hospitals the first stop to any kind of medical treatment for Chinese patients.
The reasons for this issue are manifold. There is a general lack of trust in private and smaller local healthcare clinics, for example, and patients often choose to go directly to a bigger hospital to avoid making extra costs.
This makes it extra difficult for many community health care centers – that are already struggling – to make enough money and to retain qualified staff. In a society that is rapidly aging, the challenges facing China’s healthcare industry are only becoming more pressing.
A Doctor Today, Just an App Away
As China’s online environment is thriving, new innovative online apps are popping up on a daily basis. Some of these apps, that have found their ways into China’s most popular app rankings, are offering solutions to some of the country’s most pressing healthcare problems.
One of these apps is Ping’an Good Doctor (平安好医生), which was developed by health insurance provider Ping’an in 2015 and calls itself China’s “one-stop healthcare ecosystem.”
Employing some 1000 medical staff in its in-house team, contracting over 5,200 external doctors, and collaborating with 3000 hospitals and thousands of pharmacy outlets across the country, the app is somewhat of an “online hospital.”
Through the app, users can look through an online database of medical professionals, order medicine at nearby pharmacies, get 24/7 online medical consultancy, search for information about both Western and Chinese Traditional Medicine, etc., but they can also use Ping’an Good Doctor as a fitness app to track their own health.
When looking for a specific doctor for a one-on-one consult, the app first lets users select an area of expertise (e.g. dermatology or gynecology), and then offers a list of different specialists in various price categories.
Doctors from well-known hospitals, for example, or those with excellent ratings, have a one-time consultation fee of 100 yuan (€ 12,60). Other doctors can be consulted starting from 30 yuan (€3,70). All costs can be paid efficiently via online payment apps.
Ping’an Good Doctor uses an AI-driven system to ask patients various questions about their symptoms and to automatically create a user’s medical record to save time. Based on the AI-generated record and the conversation with the patients – files such as photos can also be uploaded to the app -, the doctors can prescribe medicine or refer the patient to a hospital for an offline appointment if needed.
Ping’an recently announced that its number of registered users exceeded 300 million users, with 62 million monthly active users. Because the app keeps building on its AI-driven system, Ping’an Good Doctor can be expected to only become a ‘smarter’ smart health app the more popular it gets.
Although Ping’an is now leading within China’s medical app category, there are many other apps providing similar services, such as Chunyu Yisheng (春雨医生), Haodafu Online (好大夫在线), or DingXiang Doctor (丁香医生).
The emergence of these apps is just one of the many ways in which China’s digital developments, online media, and tech giants are impacting the healthcare industry, profoundly changing how patients receive healthcare information and access medical services now and in the future.
In a way, China’s medical consultation apps fill the void in offline primary care. Patients who would otherwise turn to hospital care as their first stop can now access medical consultations any time, any day, at a relatively low cost. Those who suffer from relatively harmless conditions could be diagnosed by a medical specialist via the app and get the medicine they need within a matter of minutes. With the growing popularity of these kinds of apps, many patients no longer need to visit a hospital at all.
Are smart health apps such as Ping’an Good Doctor the solution to China’s healthcare problems? No, they’re not. Struggling mums like Guo Yinzhen will not find the help they need there. But they do contribute to a more efficient healthcare environment where crowd flows in hospitals can be reduced, and patients do not need to spend a lot of time and money to stand in hour-long queues to get five minutes of their doctor’s time.
Although smart health apps could not help Guo Yinzhen and her son, social media apps could. As soon as their story went viral in late 2017, Shanghai Children’s Welfare Foundation Xiaoxingxin offered to cover medical treatments for the little boy, with a notable pediatric neurosurgeon operating the child. According to the latest updates, the boy’s situation was “looking good.”
Hopefully, the same holds true for the challenging sides of China’s healthcare industry.
 Burns & Liu, 2017: 3-4.
Burns, Lawton Robert, and Gordon G. Liu. 2017. “Introduction.” In China’s Healthcare Industry: A System Perspective, Lawton Robert Burns and Gordon G. Liu (eds), pp-1-116. Cambridge: Cambridge University Press.
Economist, 2017. “China needs many more primary-care doctors.” The Economist, May 11 https://www.economist.com/china/2017/05/11/china-needs-many-more-primary-care-doctors [20.10.19].
Zhou, Viola. 2018. “Does China Have Universal Healthcare? A Long (And Better) Answer.” Inkstone, Oct 10 https://www.inkstonenews.com/health/china-translated-does-china-have-universal-health-care/article/2167579
This text was first published by Goethe-Institut China under a CC-BY-NC-ND-4.0-DE license (Creative Commons) as part of a monthly column in collaboration with What’s On Weibo.
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