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Binging and Purging as Online Trend: From China’s “Big Stomach Stars” to “Vomit Bars”

China’s ‘Big Stomach Stars’ are all the rage – but is it really just harmless entertainment?

Manya Koetse

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Skinny girls that eat a week’s worth of food in one sitting: Chinese binge-eating vloggers are all the rage recently. But behind their cute image and happy fans, there are darker online discussions tying them to self-induced vomiting – something that is promoted in China’s so-called ‘vomit bars.’ How innocuous is this social media extreme-eating trend?

Mimi Zhang (aka Mizi Jun 密子君) has over seven million fans on her Weibo page. She regularly hits the top trending lists on Chinese social media, and even has her own online fanclubs.

Unlike previous rising Chinese social media stars such as Papi Jiang, the 26-year-old Mimi from Chongqing did not become an online celebrity because of her comic skills or acting talent, nor for her singing voice or dance moves. Mimi Zhang became famous for eating 8 lb (4 kg) of rice in one sitting, during an eating challenge in 2016.

Mimi eating 8lb (4 kg) of rice in one sitting.

By now, Mimi is one of China’s most successful ‘Eating Broadcasting’ hosts. Also called ‘Big Stomach Star Eating Livestream’ (大胃王吃播) or ‘Livestream Eating Vlogging’ (吃播女博主) in China, it is an online video genre in which hosts will consume extremely large amounts of food.

BJ The Diva during one of her livestreams.

In South Korea, it is known as the ‘mukbang‘ phenomenon, and the craze started there some years earlier, peaking in 2016. ‘Eating Broadcasting’ stars such as Kinoshita Yuka (video) and BJ The Diva (video) already had their moments of fame on the internet in South Korea, Japan, and beyond, but the genre only recently has become a real hype on Chinese social media.

 

Binging on Camera

 

Looking at the number of views and subscribers from YouTube to Twitch, or on platforms such as Kuaishou or Douyin, the ‘Eating Broadcasting’ genre obviously has millions of fans worldwide.

This online movement is innocuous in many ways. According to experts, people enjoy watching others eat because they feel a social connection, or want to stimulate their own appetite – it is one of the reasons why the craze is also dubbed ‘social eating.’

For many, the genre is simply entertaining; hosts often eat unconventional dishes, they are descriptive with taste, play around with their expressions, take on challenges, talk, and make funny sounds while eating.

Chinese food vlogger Duoyi (大胃王朵一) eats some skewers…

But what if ‘social eating’ becomes ‘binge eating’? How harmless is the genre if it shows skinny women eating excessive amounts of food, inadvertently promoting unhealthy eating habits and unrealistic standards?

Extreme binging on camera: eating noodles- not from a bowl, but from the back of a delivery car.

Along with Mimi Zhang, ‘Big Stomach Mini'(@大胃mini) is one other among many Chinese livestreamers that has achieved online stardom by eating large amounts of food. The 24-year-old reportedly is 1,70 m. tall and only weights 47 kilograms (103lbs), yet recently managed to eat a staggering 17 kg (35 pounds) of meat (video).

‘Big Stomach Mimi’

More and more, netizens are starting to connect these live-streamers to a habit of purging. Ongoing rumors suggest a supposed connection between binge streaming and vomiting.

Recently, various accounts claimed that Mimi Zhang used to have an account (using the name ‘Little Mi 360’ 小密360) on an online forum where people, mainly women, encourage each other to binge and purge.

 

China’s “Vomit Bar” (催吐吧) Community

 

China’s so-called “Vomit Bars” (催吐吧), online forums focused on binging and purging, have formed a hidden community on Chinese internet for years.

The phenomenon already came to light in 2012, and started to receive news media attention within China in 2015 and 2016. Most of the bigger online forums got shut down in 2017, however, after rumors circulated that a member of a ‘Vomit Bar’ had reached such a low weight that her organs failed and she passed away.

Example post from a ‘vomit bar’: 158 cm tall and 37 kg weight, but still wanting to lose.

Nevertheless, the online community consists of thousands of people, mainly women aged 14-40. A previously well-known forum on Baidu (now shutdown) had around 50,000 members called ‘rabbits’ (兔子) and over 5,5 million posts.

A “Vomit Bar” forum.

Since then, there are still some scattered forums, and a special Android app called ‘Meet Like Rabbits’ (相识于吐), where users can share their experiences and tips on message boards. On WeChat’s group chats, members of the community have more freedom to talk in private with less risk of being shut down.

The app for online purging community.

Members of the online ‘purging community’ are called ‘rabbits’ since the Chinese word for rabbit, tuzi (兔子), sounds similar to the word for ‘purging’ (tu 吐), and also because they eat all day, just like rabbits.

The main goal of these online forums is to share tips and tricks on how to lose weight by purging, while still binging on food. People also post photos of their binges or body, and share their hopes and fears in losing weight. “The way it is now, I could maintain a weight of around 46 kilograms,” one ‘rabbit’ writes: “I think it’s fat. My heart is filled with panic. I can only vomit.”

Netizens taking part in the ‘vomit bar’ community sharing photos of their binge food.

Newcomers ask others about best ways to vomit, and some people who say they’ve been binging and purging for years share experiences about their painful stomach and tooth decay.

Doctor Ma Yongchun (马永春) from Zhejiang Tongde Hospital since long has been warning people that these kind of online forums are harmful. She told iFeng news that the so-called ‘rabbits’ get caught up in a vicious cycle of binging and purging, and in doing so are developing serious eating disorders that can become life-threatening.

 

Eating Disorders in China

 

The Chinese ‘rabbit’ community could perhaps be compared to the Western ‘pro-ana‘ phenomenon, an online movement where people promote the behavior related to the eating disorder anorexia nervosa.

But there is one major difference; the ‘pro-ana’ community is connected to the term ‘anorexia’, suggesting that users of such forums are somewhat aware their behaviors are a sign of an actual eating disorder.

In these Chinese online communities, however, there seems to be a lesser acknowledgment that the cycle of binging and purging is one that belongs in the realm of a psychological disorder. Although people do complain that they feel they can no longer stop their irregular eating pattern, they talk more about their stomach aches and ulcers than they actually talk about suffering from an eating disorder.

This perhaps relates to the fact that there is little general awareness about eating disorders (ED) in China. Although there are no official statistics on the occurrence of bulimia, anorexia, or other ED in China, previous studies have found levels similar to Western countries (Tong et al 2014).

What various studies over the past years have also established is that there are major differences between Western countries and China in how eating disorders manifest themselves, suggesting they are not culture-bound but culture-reactive (Getz 2014, 749; Pike & Dunne 2015).

Because EDs are (1) traditionally conceptualized as a “Western mental health issue,” because (2) there is a social stigma attached to mental health issues in general in Chinese society, because (3) there is little general awareness on EDs, because (4) there is a lack in Chinese healthcare facilities specialized in EDs, and because of (5) various cultural factors (e.g. a very strong food culture), Chinese patients are more prone to talk about their problems in the form of somatic symptoms such as an extreme (dis)taste for food or abdominal problems, than in the form of a psychological problem (Getz 2014, 746-750).

 

Growing Awareness?

 

Recently, Chinese media slowly seem to be promoting more awareness on eating disorders. The American video “I became Anorexic for Instagram” has gone viral on Chinese social media over the past month, as it was posted by various state media channels on Weibo.

Among thousands of reactions, many said: “It seems that this kind of disease doesn’t occur much in China – we have too many tasty food!” Others said: “I want to lose weight too – I want an eating disorder like this!”

But there are also more and more people who are tying the rise of China’s online unhealthy eating trends to more serious issues. “These girls who eat so much [on camera] do not just have big stomachs, they actually puke in order to eat so much. I don’t find it entertaining to watch them anymore,” one netizen (@有兔劳劳) says.

“I now find it sad to watch these ‘big stomach stars’ (大胃王),” another person says: “They definitely vomit – it’s impossible for one person’s stomach to hold so much food.”

“What’s up with all these ‘big stomach stars’ recently? It’s not something they were born with, or something they were trained in doing; they are like those ‘rabbits’ and it is a disease, it’s bulimic. I don’t want to support them anymore by watching how they harm themselves,” another commenter writes.

Meanwhile, China’s binge-eating online stars seem to be unaffected by the online rumors that connect them to unhealthy trends and eating disorders.

This week, Mimi Zhang has posted her latest video in which she finishes a total of 15 desserts, while ‘Big Stomach Mini’ has posted a new video in which she eats, amongst others, 250 skewers of meat.

For some commenters, there is no issue at all: “She just has a great appetite.”

Are you suffering from an eating disorder and need help? For information on eating disorders and how to help if you are worried about someone, Beat (UK) or ANAD (US) has advice for sufferers, friends and family.

By Manya Koetse

References (online references linked to in text)

Getz, M.J. 2014. “The Myth of Chinese Barbies: Eating Disorders in China including Hong Kong.” Journal of Psychiatric and Mental Health Nursing 21: 746-754.

Pike, Kathleen M., and Patricia E. Dunne. 2015. “The Rise of Eating Disorders in Asia: a Review.” Journal of Eating Disorders 3:33. Available online https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-015-0070-2 [17.1.18].

Tong, J., Miao, S., Wang, J. et al. 2014. “A Two-stage Epidemiologic Study on Prevalence of Eating Disorders in Female University Students in Wuhan, China.” Social Psychiatry and Psychiatric Epidemiology 49(3): 499-505.


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Manya Koetse is the editor-in-chief of www.whatsonweibo.com. She is a writer and consultant (Sinologist, MPhil) on social trends in China, with a focus on social media and digital developments, popular culture, and gender issues. Contact at manya@whatsonweibo.com, or follow on Twitter.

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Backgrounder

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.

Manya Koetse

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Since the outbreak of the new coronavirus becoming big news in China and around the world, there have been few other topics going trending on Chinese social media than those related to 2019-nCoV. What’s on Weibo gives an overview of the most noteworthy online media trends in China regarding the corona-crisis.

 
By Manya Koetse, further research and news-gathering by Miranda Barnes
 

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.

 

TREND #1:

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.

Image posted by Sina Parenting on February 1st.

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.

Online information leaflet spread by People’s Daily, “Resisting the Consumption of Wild Game Starts with Ourselves”

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.

A news story of a man hunting wild animals for consumption made its rounds on Weibo this week.

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.

 

TREND #2:

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).

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.

 

TREND #3:

Virus Vigilantism

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.

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.

 

TREND #4:

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.

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.

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.

 

TREND #5:

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.

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.

“1.4 billion Chinese salute you”

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).

 

TREND #6:

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.

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.

 

TREND #7:

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!”

 

TREND #8:

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.

 

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).

If it’s quiet here, please also follow us on Twitter here and here.

By Manya Koetse, additional research and news-gathering by Miranda Barnes
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Backgrounder

‘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.

Manya Koetse

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China’s healthcare industry is facing some serious challenges. As Chinese society is rapidly digitalizing, mobile apps now provide innovative solutions to alleviate pressing problems in the country’s health services sector.

 
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 photo of Guo Yinzhen and her son that went viral in China (image via NetEase, source: https://3g.163.com).

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.[1] 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”).

Weibo user ‘Sunscreen’ complains about the crowds at Huashan Hospital.

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.”

“Ping’an Good Doctor” promotional image by Ping’an.

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.

Screenshot of Ping’an app screen, by author.

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.

Doctors to pick from within the app’s various price categories.

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.

List of recommended medical apps in the Tencent app store.

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.

By Manya Koetse
Follow @whatsonweibo

[1] Burns & Liu, 2017: 3-4.

References/Linked Sources

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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