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With the help of League of Nations (predecessor of the UN) health reformers, the GMD government started in the 1930’s to build a nationwide network of medical institutions in urban and rural areas. Cities have priority but the healthcare is unevenly distributed. Rogaski (2004) gives an example of the city of Tianjin " In certain areas, most residents drank tap water and had adequate nutrition. In other areas, people drank water out of stagnant ponds and faced starvation. In 1949, infectious diseases such as tuberculosis, neonatal tetanus, dysentery, and encephalitis were the most common causes of death in Tianjin, the result of poverty, poor nutrition, inadequate housing, contaminated water supply, and a dearth of obstetric services and infant care. Epidemics still loomed even after Liberation....Tianjin was a city with relatively abundant medical resources. The problem was their unequal distribution. To solve these all-too-familiar public health problems, a great deal of work would have to be done to raise basic standards of living and to build up a public health infrastructure; improvements that would require a tremendous investment of time, money, and personnel from the new government."

After 1949, the medical organization is modeled after the Soviet system with its emphasis on constructing urban hospitals, industrial clinics, trade union sanatoria, and technically advanced central medical research institutes. Medicine is practiced by medical missionaries and Chinese students who studied with them in China or abroad. Both have different goals "The missionaries tended to use medicine and health campaigns instrumentally as opportunities to spread the Word and gain converts. The Chinese doctors viewed medicine as a mechanism to help the development of the new Chinese nation through strengthening the bodies of the populace and bringing them enlightenment through Western science." Gross (2010) also observes "… medical missionaries had extraterritoriality rights, unlike native doctors and Chinese health ministries, made it extremely challenging to develop joint programming. Not only were the medical missionaries and Chinese doctors divided, but the missionaries rarely worked well together either. The missionaries were drawn from many different sects that had originated in a variety of Western nations, each of which had its own medical practices. Thus they were separated both by ideological beliefs and by professional practice." As in other segments of society, the CCP has to rely on GMD staff "...the medical techno–scientific elite, which felt safe enough in the knowing that the Communists had no choice but to fully incorporate the pre-existing Nationalist apparatus of both applied and theoretical medicine, with the exception of a handful of ‘famous physicians who had had close relationships with the “imperialists”.10"

In rural areas most Chinese medicine doctors are from despised landlord families, the only group that could afford to educate their sons. "The few patients who could pay felt vindicated in withholding money from this denigrated group, leading to even smaller revenue streams. 63 The doctors’ families could not help either, because they had lost any resources they previously possessed. Chinese doctors tried to survive by increasing prices above the government-mandated amount, appropriating drugs or campaign materials and selling them on the side, pilfering money from the communal campaign account, or running away to resume private practice. However, due to government pressure and simultaneous efforts to eliminate private practitioners, their participation was often mandatory. 64 " AnElissa (1980) remarks "While many Chinese economic and political decisions in the early 1950s emphasized industrial and urban development in an attempt to achieve Stalin's successes in rapid state-planned industrialization, Chinese national medical policies continued simultaneously to develop many of the organizational experiments started by Chinese medical reformers and administrators in the 1930s. As a consequence, Soviet impact on Chinese medical organization appears to have influenced only selected aspects of Chinese central and urban medical institutions: the development of specialized central research institutes under the Chinese Academy of Sciences and Chinese Academy of Medicine, the development of urban industrial workers' clinics and sanatoria, and the Communist Party's manoeuvres to gain political control over medical professionals by reorganizing their associations, journals, teaching curricula, research institutes and health institutions at all levels.⁵⁷ " Fig. 48.1 Healthcare 1949-1954 Often, very practical measurements are taken to improve the health situation. "Fearful of epidemics, the Military Control Committee decided to act where the Guomindang had only propagandized. During the first eight days of June (1949), the committee had the army remove 38,000 tons of garbage from the city’s streets (in Shanghai)" In 1952, the national health policy can be described as priority for the needs of workers, peasants, and soldiers, prevention, unity of Chinese and Western medicine, and the combination of health work with mass movements. In 1952 two health insurances are introduced. One, which covers all government employees, college students and staff, and employees in political parties and mass organizations. This insurance is subsidized with governmental assets devoted special to this purpose. (See Article 2 for restriction of mobility) The other one is designated for all workers employed by state-owned enterprises. This is funded with the contribution of the firms. See also Article 32 Peasants have to pay for their medical care on a fee-for-service basis. As soon as the agricultural collectivization starts, cooperative health care is introduced. Yet the provision of rural medical services is below par.

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Mao Zedong called at the 1st National health conference (August 7-18,1950) : “Our nation's health work teams are large. They have to concern themselves with over five hundred million people [including the] young, old and ill. This is a huge enterprise, and one that is extremely important. Thus our responsibility weighs heavily . . . At present, doctors of Western medicine are few, and [thus] the broad masses of the people, and in particular the peasants, rely on Chinese medicine to treat illness. Therefore, we must strive for the complete unification of Chinese medicine.” At the same conference , Vice Minister of Health says "Among health workers, as among other workers, a widespread political study and ideological rectification should be carried out in order to correct the misunderstanding that medical and pharmaceutical personnel have little to do with politics. Revolutionary humanitarianism must be promoted (among them)’ Chinese medicine has to absorb scientific theory. Western medicine needed to learn from Chinese medicine, to better approach the masses. ‘the distance between Chinese and Western medicines would day by day grow smaller, and the differences between Chinese and Western medicines would day by day disappear’, until they ‘open-heartedly and inseparably unite’" After the conference, several measures are taken. For example, every Chinese doctor has to obtain a certificate from the Ministry of Health. The purpose of this measure is to gain control on private traditional medical care. In December 1951, the Ministry of Health started “school for further training of doctors”. The initial design of these schools, which are a bridge to the final unification of both (Western and Chinese) medical systems, was to improve the traditional treatments and skills of the Chinese doctors. In October 1952, an exam system is introduced, the examination is largely concerned with Western medicine. Most Chinese doctors fail the exam and are no longer allowed to practice medicine. Those who passed the exam were not allowed to work in Western hospitals. This resulted in an even bigger shortage of doctors and the unification completely failed. Taylor (2005) mentions the main reason "Prior to 1954, there were no directives issued from the Central Committee regarding the path of the development of Chinese medicine. Only the most general statements from Mao made it clear that Chinese medicine was to be maintained and fostered through the use of the slogan ‘unification of Chinese and Western medicines (... )’. Just how such a concept of ‘unification’ was to be carried out, never mind achieved, was the responsibility of the Ministry of Health. "

A second reason for this failure is the composition of the Ministry of Health. The management of the ministry is for the most part in the hands of Western educated personnel. (, He Cheng, , , the 4 vice ministers are all Western educated and the minister was not educated in medicine) They are urban and Western orientated and they only provide lip service to the CCP policy. Part of the scarce budget is spent on diseases, such as tumors and cancer, subjects that at that time in China are rather irrelevant, instead of researching diseases such as typhoid fever, cholera, malaria and smallpox. This attitude provokes a lot of criticism and in 1953 Bai Xueguang 白学光(1913-2017 ), starts an inspection tour. His rapport of March 27, 1953, contains a sharp criticism of the bureaucratic conduct of the Ministry of Health. "Leadership is not centralized, there exists a number of unresolved treatment issues as well as tremendous wastage of resources. There’s confusion among the many sub-departments, and many cadres are discontent within the ranks of the Ministry of Health." In October 1953 Mao Zedong states The most serious one is that [the Ministry] is short on politics, short on political work. There is too little Marxism-Leninism and socialism there. The Party must exercise overall leadership; On June 1954, the decision is made to establish a research institute for traditional Chinese medicine. Lu Zhijun (1911-1999), a western educated doctor but a promoter of TCM, becomes the director. The task of the institute is to systematically organize the Chinese medicine knowledge, to compile textbooks, and to educate teachers. On December 19, 1955, the institute is opened.

TCM is essential to many minority groups. Often they have their own methods and systems for healing. Especially Mongols, Tibetans, Uygurs and Dai. The government tries to bring modern medical and health care, but these efforts are frequently frustrated due to local differences, language problems, and lack of sensitivity by Han medical personnel to the local practices.

Acupuncture and Qigong

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During the Qing dynasty, acupuncture is considered ineffective. Therefore, it was no longer state-sponsored and the elite turned away from this typical Chinese medicine. From then on, acupuncture was only practiced among rural areas and lower classes. The use of herbs increased. In 1930, an acupuncture research center is founded. During the Japanese war, and the civil war the institute closed. In 1951, the school is reopened. Between 1949 and 1953, several publications are printed. At the above-mentioned school for further training of doctors, acupuncture is a minor subject. The so-called 'new acupuncture' had little effect. Taylor (2005) concludes: "Science might have replaced the theory of disease, altered the presentation of the body, changed hand techniques, and reformed the description of individual acupuncture points, but in the ‘new acupuncture’ it did little in the role of diagnostics, and even less in the selection of acupuncture points. ...although such simplified forms of acupuncture were to accompany the barefoot doctor into rural China just over a decade later." Qigong therapy is also a traditional medical practice. Previously, qigong had been used mainly in martial arts. It is the use of body, breath, and mind to cure illnesses. It is recognized by the Ministry of Health as a medical treatment, after the abandonment of so-called ‘feudal’, superstitious, or religious elements and the introduction of scientific methods. The work of was invoked to provide a ‘modern’ and ‘scientific’ basis for qigong. "For example, the Ministry of Health (Zhongyang weishengbu) and the Chinese Academy of Sciences (Zhongguo kexueyuan) sponsored a 35-day Pavlovian theory study workshop (Ministry of Health, Pavlov Theory Study Association) in Beijing in fall 1953 for twenty-two professors, researchers, and doctors of physiology, psychology, and clinical medicine. It proclaimed Pavlovian theory to be a “great and materialist physiology and the only right theory leading the development of medical science in the New China” (Ministry of Health 1954)."

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In March 1952, Zhou Enlai is named chairman of a new central epidemic prevention committee. China had only fifty-one thousand doctors in 1950. In most rural places, herbalists, midwives, and Chinese medicine practitioners are active. Their skills range from competence to quackery. Mao Zedong mentions an important obstacle for all health campaigns "Agricultural production is the predominant work in the countryside. In the countryside all other types of work revolve around agricultural production and serve its interests. All so-called work assignments and work methods that may hinder the peasants from carrying out production must be avoided...nor is it possible to interfere too much with the peasants. " Gross (2016) mentions one more obstacle "From whole provinces down to the individual villager, campaign work was determined not by what was most effective but rather by what was affordable."

The promises made by propaganda, which stressed complete eradication of disease and the reality, with outcomes of only 60% or less cure rate, resulted in the patient’s feelings of betrayal and deception. Propaganda methods used include movies, slideshows, plays, children book and posters. See for more posters Hygiene posters Most rural areas lack electricity and ‘old’ techniques are used like opera, theater, story-telling, and songs. These methods are excellent to stir emotions (land reform campaign) but insufficient to transmit scientific information. This use of traditional entertainment subverts CCP ideology of crushing superstitious beliefs and popularization of science. One aspect of these beliefs is Feng Shui, Gross (2016) observes "In the early 1950s, even the location of these theatrical productions and educational shows were often the same as religious festivals, occurring during large markets, fairs, and holidays. Although reaching many people, they turned snail fever campaign education into simply one more sideshow." The failure to transmit scientific knowledge hinders the campaign. This comes at the expense of prevention which should be primary and treatment only as a supplement. In reality, prevention is neglected in favor of treatment. Propaganda for sanitation work meets a big challenge, most people see feces, urine, saliva, garbage, and animal manure as natural and as part of the ecosystem, so managing them seems unnecessary and intrusive. Sanitation work is considered make-work, nonproductive labor, a waste of time. Sanitation work involves interference in the environment. This intervention can prepossess feng shui, but disruption of feng shui can bring repercussions. Women in particular are hard to convince to be treated, they are indispensable in their household duties like cleaning, cooking, tending animals and growing vegetables , caring for children, and attending the elderly. They can and will not afford to leave their homes. The treatment of men is also difficult due to their working on the land. "Whereas a son was their social security system, a woman who would not work around the house or bear children bestowed a bad fate on their new household that would curtail the family line. Nobody wanted to waste family resources on somebody like that. " In the early 1950s, kindergarten teachers helped combating tuberculosis through BCG injections. See Posters "Parents were initially reluctant to vaccinate their children with the experimental drug. But after a school lecture, and promises to pay by school administrators for hospital fees if the children experienced any negative side effects, parents vaccinated not only their kindergarteners, but also the younger siblings in their families."

Patriotic Public Health Movement

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On February 23, 1952, the Renmin Ribao published for the first time about “the appalling crime of the American aggressors in Korea in using bacteriological warfare.” This accusation was the starting signal for a national campaign called 'The Patriotic Hygiene Campaign'. The campaign emphasizes that the health of the individual is just as important as the health of the state. The CCP states that both are inextricably linked, the health of the individual is inseparable from the health of the collective. On March 9, 1952, the CCP issues a directive: "...dividing the nation into four “prevention regions” based on their proximity to the Korean front. It defined Korea as “epidemic region,” the Northeast as an “emergent anti epidemic region,” the northern, eastern, south-central, and coastal areas as “anti-epidemic supervisory regions”, and the south-central interior, north-western, and south-western areas as “anti-epidemic preparation regions.” Each region was assigned with different sets of tasks. The tasks for the “epidemic region,” for instance, included a massive program of injections, elimination of all germ-carrying animals, and designation of special hospitals for inflicted patients and quarantine of the epidemic inflicted areas." The campaign has two major goals. The annihilations of the 5 pests: flies, mosquitoes, mice and rats, lice, and bedbugs. The other goal of the campaign "… women and others who labored inside the home were mobilized to clear, dredge, and sweep the city clean. In Tianjin, hundreds of thousands of housewives, joined by university and high school students, helped to clear miles of the city’s stagnant and odiferous drainage canals. ²⁵ Residents supplied with picks, shovels, and shoulder-poles filled in more than seven hundred cesspools, one bucketful of soil at a time. Neighborhood cleanups removed tons of trash from domestic interiors and from public spaces: old derelict temples, opera halls ,and street corners." This campaign is an example of mass mobilization. Neighborhood committees organize meetings to convince housewives and retirees to take care of domestic hygiene. The purpose is to turn average citizens into an army of volunteer public health and sanitation workers. On the one hand, the participation level was not always high. Rogaski (2004) writes "During the 1952 mobilizations, there was considerable foot dragging and ignoring of the government’s objectives. For every jiji fenzi (activist from local society) who joined a neighborhood domestic hygiene inspection team, there were many more who failed to see any connection whatsoever between sweeping the floor and defending the nation against germs. ²⁷ Apparently fear of biological weapons was not an entirely adequate motivation to compel the masses to become hygienically modern. "

Most people do not see the connection between bacteria, insects, and diseases. Diseases are only seen as a phenomenon of nature. In rural areas, the peasants notice that the harvest has not been affected. They also rely on old habits instead of modern tools. "...,local religious groups, which had been perceived by the party as residues of the old society, were now using the movement to seek legitimacy and expansion of influence, ironically becoming a strong force to resist the state penetration to the grassroots society." Smith (2006b) cites a report of a public security bureau in Hebei "As a general rule, before people start to seek holy medicine many rumours circulate, and female spirit mediums (…) and immortals-come-to-earth become active, enticing the minority of the masses who are sick to seek holy medicine. If a person whose illness is not serious fully recovers, then rumours run wild and the masses, seeing what has happened, start to believe. At this point the numbers seeking medicine rise sharply" Therefore, newspapers and radio broadcasts stopped giving only medical information but stressed germ warfare descriptions with reports about its victims. On the other hand, Yang (2004) notices "...false alarms and overreactions also increased, 34 indicating that fear, instead of indifference or neglect, was becoming a common reaction. Political propaganda shifted towards transforming popular fear into social reform and national mobilization." This campaign aims at 2 goals. The first is to get the whole nation involved in the disease prevention movement. The second goal is to accustom the people to accept massive political campaigns which influence their daily life. Lynteris (2013) characterizes "The Patriotic Hygiene Campaign, ...was a means of challenging the significance of medical expertise and promoting the model of ‘people’s war’, or mass mobilisation, as the correct way of constructing socialism in China. "

Schistosomiasis health campaign

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One of the most outstanding health campaigns is the schistosomiasis health campaign. The disease affected 10.6 million people, with another 100 million at risk in the southern part of China (mainly in areas along the Yangtze River and to the south of the river basin. These areas include 348 counties in 10 provinces, the Shanghai Municipality and Guangxi Region). Schistosomiasis threatens the productivity of farmland, labor, and capital (draft animals). In the 1950s, the endemic situation of schistosomiasis was extremely serious in various endemic areas of Jiangxi province. Average infection rate for inhabitants was above 10%. Regional distribution of schistosomiasis before the 1950s in China

"Based on reasons of military and economic security, the new Communist regime designated the campaign as a political, rather than a health campaign and promoted it as one of its earliest efforts at transformation of the rural environment. Although the campaign was hindered by lack of funding, material resources, technical and medical skills, and the recalcitrance of the putative participants- both villagers and local cadre; the Party was still able to use the campaign to realize beneficial goals and build positive connections at the bottom level. To understand the complex dynamics of resistance, assimilation, and attempts to assert authority played out against a background of impoverished resources and power struggles within the new regime" See also Article 2. The new regime can rely on personnel, infrastructure, and knowledge from the GMD administration, but it lacks resources. The CCP faces several problems in combatting the disease. Most doctors have employment in the cities and are reluctant to work in inhospitable rural areas. In the early 1950s, rural health bureaus lacked personnel to conduct a treatment campaign to promote ideas about sanitation and public health, and the power to mandate altered behavior. The inhabitants of the newly ‘liberated’ areas have little trust in the new government. During the Sanfan (see Article 18), the local health services get disintegrated "Medical workers unhappy at being posted in the countryside took advantage of the chaos to return home. In some places, the Three-Anti Campaign affected both the quality and the quantity of public health work for up to a year afterward. " "The Chinese government saw medicine as one of the easiest ways to demonstrate the scientific nature of CCP rule that would guide the population to a new scientific socialist future. This future was always juxtaposed against the backwards, superstitious past that had supposedly remained unchanged for the last 5,000 years. " Between 1949 and 1954, the number of research papers on schistosomiasis nearly doubled over what it had been in the previous 40 years. At the end of the 1950’s, despite all difficulties, the endemic disease were to some extent eliminated. Treatment of the disease is successful, prevention of the disease is not. True elimination occurs in most places during the late seventies and eighties. Anti-malaria campaign

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The aim of the anti-malaria campaign in 1952 is to reduce the cases of malaria and the death rate. Several ministries join their efforts to make this campaign a success. In addition, organizations like the Red Cross, the ACFDW, and the ACFTU participate in this campaign. Besides these organizations, urban communities, work units, and rural villages are mobilized. "The campaign attempted to turn the masses from passive recipients of medicine and health care into active fighters against diseases and masters of their own health. This approach to combatting diseases was dubbed ‘the mass mobilization model’ in the study of malaria.¹⁹" The lack of medicines, health professionals, special in the countryside, makes a real breakthrough very difficult. The posters do not promote anti-malaria drugs, which are not available, but focusses on prevention. Lu (2014) remarks "... the campaign would only have disappointed its target population and decreased their enthusiasm for health work. It could even have undermined the credibility of the government itself." Traditional methods of moxibustion and burning mosquito repellent are promoted alongside with modern techniques of spraying insecticides. This mixed use of Western and Chinese medicine is endorsed by the government. In Yunnan, cinchona trees are cultivated to provide a reliable supply of quinine.

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In December 1952, the People's Republic of China declares to be a ‘drug-free nation’. In 1949, there were estimated more than 20 million opium addicts. From 1950 onwards, an anti-drug campaign is held. On September 12, 1950, the directive states a strict prohibition of drug taking. Peng Zhen coordinates the campaign, many ministries (ministries of railroads, communications, interior, and public health) and organizations (postal service, customs, courts, and procuratorate) are involved. Trade unions, mass organizations, and the CCP hold large education forums and anti-drug gatherings. During these rallies, drug users are publicly shamed (and subject to detention for coercive rehabilitation) and drug traffickers are sentenced. Offenders, who turn themselves in, confess and show remorse, are treated leniently. Persistent offenders (e.g., drug kingpins and drug lords) are confronted with economic sanctions (fines, confiscating of property) or imprisonment or death penalty. These anti-drug campaign is mainly carried out in urban regions and are combined with the Sanfan (see Article 18 ) and Wufan (Chapter 4 ) campaigns. Many corruption cases were related to drug trafficking. The campaign is carried out in silence, there are no newspaper reports, pamphlets, or radio bulletins. The reason for this is the accusation of the US that the People's Republic of China are still smuggling narcotics. The Chinese government assumes that the US will use news and information about drug producing and trafficking to prove its accusations. Therefore, the campaign is carried out orally. The local cadres have to mobilize the masses by holding propaganda meetings. (some are especially for youth, senior citizens, women, and students) Propaganda trucks with loudspeakers broadcast the anti-drug campaign slogans and directives. Sometimes drug offenders are placed on the circling trucks. Operas, comic dialogues, and folk dances are used to spread the campaign’s policy. During the Korea War, the anti-drug campaign is linked with patriotic behavior and related with the “Resist Amerika Aid Korea”. In one area, the southwest of China, the major drug-producing region, the campaign starts in 1956. The production of drugs in the southwest part of China is located in isolated and mountainous regions occupied by minorities. Zhou (1999) remarks "The authorities clearly realized that in some areas, opium was still the main source of income for many ordinary households. Without full control of that area and without replacing poppies with crops, the Communists knew that conducting opium suppression would have provoked strong resistance, even riots ,…" In some areas an allowance as compensation for the lost income is paid, in some cases debtors are allowed to grow poppies until they have paid of their debts. Sometimes even compensation is paid for the loss of income for former employees of the opium traffickers. Bale (2017) states "In reality, however, the situation was much more complicated and variegated, since both the GMD and the Communist regimes - like later Qing Dynasty rulers and various regional warlords - vacillated between adopting harsh anti-opium rhetoric and periodic eradication campaigns, on the one hand, and secretly regulating and taxing the domestic production and sale of opium, which provided them with an important source of revenue in lean times, on the other."

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The new government starts almost immediately with health campaigns, giving information about the improvement of hygiene. The administration takes measures to limit the effects of natural disasters (floods and droughts resulting in famines) by an effective central administration, improved flood control, transport, food distribution, and health services. These actions cause a lower rate of death and mortality rates and growth of the population. (The birthrate is between 1949 and 1954 annually more than 37‰. In 1949 in Guangzhou the birthrate was 27 per thousand, at the end of 1954 it had risen to 44 per thousand population) Hershatter (2011) explains "Soon after Liberation, the Communist Party-state took up the effort to retrain oldstyle midwives and train new-style midwives.⁴⁵ The main difference between the Nationalists and the Communist Party here was not ideological, but practical: the Communist Party had a far more extensive and effective rural presence, and the scope of its efforts to reform rural midwifery accordingly affected many more people.⁴⁶" Fig. 48.2 Birth and Death Rates in China, 1949 to 1984
Child mortality is partly caused by incapable midwives. "In the early 1950s, the new Communist regime in China endowed rural women who occasionally attended births with new techniques as well as political and social identities. The Party viewed these women as old-style practitioners whose childbirth techniques needed to be improved, as newly liberated women whose political consciousness needed to be raised, and as traditional women in an agricultural society whose habitual behaviours needed to be disciplined. Chinese medical classics portrayed these traditional rural midwives as ignorant, coarse, perverse and dangerous; " At the end of 1951, the Ministry of Health declares that there should be at least one trained midwife per district, especially in rural areas, midwifery is quite random, the distribution is uneven, and the quality is often low. Training programs of two weeks are started for those with the right political background (oppressed and/or exploited). "...the two-week format proved to be the most popular as it enabled the greatest number of traditional rural midwives to be trained within the shortest time, maximizing the highly limited budget allocated for this purpose by the provincial department of public health " On September 16, 1949, Mao Zedong speaks out about birth control: "Each time the Chinese people overthrew a feudal dynasty it was because of the oppression and exploitation of the people by that feudal dynasty, and not because of any over-population… It is a very good thing that China has a big population. Even if China’s population multiplies many times, she is fully capable of finding a solution; the solution is production. The absurd argument of Western bourgeois economists like Malthus 3 that increases in food cannot keep pace with increases in population was not only thoroughly refuted in theory by Marxists long ago, but has also been completely exploded by the realities in the Soviet Union and the Liberated Areas of China after their revolutions." Fig. 48.3 Population development in the cities, 1949-1998

Mao Zedong follows with his statement the SU, which favors an ‘anti-Malthusian’ viewpoint. A characteristic point of view is ‘strength lies in numbers’. The People’s Daily hails the 600 million mainlanders as the most precious of all categories of capital. A second reason for this pro-natalist opinion lies in the agriculture need for numerous children to uphold ancestor worship and to facilitate land cultivation. In contrast to the SU, a pro-natalist policy is not applied. There are no ‘Orders of the Glory of Motherhood’. However, there are likewise no institutions for birth control. The CCP had forbidden abortion between 1931-1948 despite liberal marriage laws experiments in this period. See Article 6 . A reason for this attitude is to offset the effects of disease, infant mortality, and high death rates in the base areas during the Japanese war and the civil war. At the same time, the party had encouraged young people to delay marriage and childbirth so that they could devote all their energies to the work of the revolution. In reality, the CCP maintains a two-track policy—allowing urban, educated women to practice birth control while encouraging childbearing among peasant women. "In 1952, the Ministry of Health mandated that all parties involved in the manufacturing and sale of birth control register with the authorities. At the local level, the Shanghai government took this mandate even further, ordering that street vendors no longer sell condoms. Those who still possessed unsold condoms in stock could sell out their inventory under the guidance of local health authorities, but no new supplies of condoms might be sold." Fig. 48.4 Population development in rural areas, 1949-1998

"In April 1950 rules for army and government personnel in the Beijing region made abortion contingent on medical indications, plus the written consent of husbands, superiors and doctors. …Moreover, all cadres in central government and Party organs had to obtain the personal endorsement of the Minister of Health himself." A third reason that can be mentioned is the fact that healthcare is "Dominated by Western-trained medical professionals inclined by tradition and training to be conservative on contraception, the ministry (of health) drew up regulations that imposed severe restrictions on access to contraception, abortion, and sterilization." In May 1952, the Ministry of Health issues a regulation which stipulates the conditions for abortion: In cases of severe illness or threat to the woman. In addition, no woman was eligible for sterilization unless she was thirty-five years old, had six or more children, and had one child aged 10 or above. The import of contraceptives is forbidden in January 1953. This policy causes major irritation among women. "...,women in the party’s senior ranks began to press for a change in policy, linking access to birth control to the larger movement for women’s liberation that was already under way." Their plea is heard by the (party) leaders (in particular Deng Xiaoping, Liu Shaoqi and and in July 1954 the ban on contraceptives is lifted and the promotion of birth control starts. There were no provisions for male sterilization, the argument being men could not afford to be temporarily incapacitated from surgery, so therefore women must instead bear the physical burden of sterilization. However, it is not only this plea that makes this change possibly. The economic reality also plays an important role. "By 1953, it became clear to many Chinese leaders that the country’s large population was directly contributing to the ongoing food shortages. Although the government maintained that this was untrue, an editorial published in April in People’s Daily declared that the problem of food scarcity would continue due to the increasing demands of a growing population, bringing the issue to widespread public attention for the first time. In this context, Mao and other high-ranking party leaders began to acknowledge the need for birth control measures, though these discussions happened behind closed doors."" White (2018) notices "In practice, birth control remained extremely controversial, medical personnel remained generally hostile to disseminating information, cadres delayed giving the necessary approvals, and contraceptives were extremely scarce and of poor quality; abortion and sterilization remained the primary methods of birth control. In short, access for many people was more theoretical than real." Goldstein (1998) concludes: "...the Chinese state’s promotion of prenatal health care and new birthing methods could be seen as intruding into women’s social spaces, eroding their agency or autonomy, and redefining how their gender and physiology was conceived to make them more available to the state as both a reproductive and productive force…. these campaign contributed to saving millions of lives and in many ways opened new possibilities to the women involved with them. But at the same time these campaigns were a form of bio-power which integrated women and the birth process into a new ideological and political order of controlling and at times repressive state management " "...in 1949, the CCP set in place a series of programmes designed to cure an estimated 10 million people of venereal diseases (VD); and, in 1964, the acting director of the Research Institute of Dermatosis of the Chinese School of Medicine and Sciences announced to the world, on behalf of the communist government, that China had basically eliminated VD (Hershatter 1997: 348–9)."

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In April 1917, Mao Zedong stated "Our nation is wanting in strength. The military spirit has not been encouraged; The physical condition of the population deteriorates daily. This is an extremely disturbing phenomenon." The function of sport has 3 political elements in the PRC.
1)sports serve construction, it is instrument in building a new society.
2)sports serve national defence.
3)Sports serve the people, to make sport and physical education available to the masses rather than only a privileged minority. Physical education became a mandatory part of the education system. Fig. 48.5 The regulation of Physical education Hours in elementary schools from 1952-1954 In the Chinese context, the term ‘Tiyu’ (体育) is often used instead of sport. 'Tiyu' also includes general fitness, traditional exercise and martial arts (e.g., taijiquan and wushu), chess, folk dance, competitive and noncompetitive paramilitary activities, collective games, and various kinds of broadcast calisthenics. At the All-China Sport and Physical Education Congress held on 26-27 October 1949, Zhu De, vice-chairman of the Communist Party, explained: "In the past, sport was alienated from the masses. At present, our sport must serve the people, serve national defence and serve people’s health. [. . .] In order to undertake the hard work of constructing our new country, sport should promote people’s physical and mental health. Students, workers, peasants, citizens, militants and civil servants all have to become involved in sport." In 1952, it is decided to participate in the Olympic games of Helsinki. The motivation of this decision is: "International sport competitions are flourishing worldwide. International friends wish China to participate in these events. Recently, we have announced that China will send an Olympic team to the Helsinki Olympics. However, sport in China has been poorly developed in the past. After participating in some international competitions in recent years, we are well aware of the low performance of China's competitive sports teams, which is incompatible with China’s international status. We must change this situation! Sport must be promoted and the performance in competitive sport must be improved.¹⁹" Only after the more or less predicted failure at the 1952 Helsinki Olympic Games (See Article 11, note 59) ,a separate ministry level is established. It shall have equal status to that of others, such as the Ministry of Education and the Ministry of Finance, He Long becomes the head. the ACSF acted as a ‘semi-state’ sports organisation, despite not being a formal government agency. Having seen the results of the Soviet Union at the Olympic Games proposes: "..that China should adopt the model of the Soviet Union to develop a sports policy and a centralised management system to meet the country’s political and diplomatic requirements. … The ACSF (All China Sport Federation) is only a semi-governmental organisation and it does not have the power to lead the development of sport and physical education in China. Rong argued that Chinese sport policy and practice should follow the model of the Soviet Union as it had been proved to be the most successful one in the world." See Sport posters Shortly after these proposals, the CCP instructs Rong Gaotang:
1) Begin the preparation of the structure of the new Ministry of Sport;
2) Begin to recruit professional full time athletes from the army and society;
3) Start to build an athletic stadium;
4) Begin to establish sports institutes;
5) Hold a National Games next year (1953).

Besides this founding of a sports commission in June 1952, also other measurements are taken, the magazine issue of Xin Tiyu in July 1950, the start of broadcast calisthenics in late 1951. The gymnastics were broadcast by about 40 radio stations scattered across the different provinces. China sends a delegation to observe the 1st Asian Games from 4 to 11 March 1951. The First National Minority Nationalities Traditional Sports Games are held in Tianjin on November 8-12, 1953, with 13 nationalities and 395 athletes. Other mass tiyu activities are held "...particularly useful for rallying behind national and patriotic goals that would help consolidate the new regime’s power, and no truer was this than for the Resist America Aid Korea campaign that began following China’s entry into the Korean War in October 1950" The National Athletic team is established in 1953; the National Table Tennis, Swimming, Badminton teams in 1954; the National Gymnastics team in 1955. In his speech of June 30, 1953, for an audience of the Youth League, Mao Zedong explains: "Now we must ensure that everybody is in good health; we must ensure that workers, peasants, soldiers, students, and cadres are all in good health. Of course, being in good health doesn't necessarily mean that one will study well; studying [well] requires certain methods…. On the one hand there is study, on the other recreation, rest, and sleep; both aspects must be taken into full consideration. Young workers, young peasants, and young soldiers study as they work; for them, too, work and study [on the one hand] and recreation, rest, and sleep [on the other] must both be taken into full consideration. Both ends must be firmly grasped. Studying and work must be firmly grasped, but sleep, rest, and recreation must be firmly grasped also. In the past we only took hold of one end firmly, and we didn't take a firm hold on the other end, or else didn't take hold of it at all. Now we must develop some [programs for] recreation; there must be time and facilities [for recreation]. At this end too, we must take a firm hold. The Central Committee of the Party has already decided to reduce the number of meetings and the time [required] for study; you must supervise the implementation [of this decision]. If there are people who don't carry it out, [an explanation] should be demanded of them." In November 1953, the authors of a report of the China National Sport Commission still complain that "…many cadres not only did not understand the importance of sports but “have even ignored sports.""⁴³ Partly the reason for this is "Nevertheless, tiyu in this transitional period was far more complex than labels of “new” and “old” indicate because it was built on legacies of the past, plans for the future, modeled on the Soviet system, and was directed by Communist revolutionaries, a variety of experts from the earlier Republican period, and a handful of Soviet tiyu specialists. ...Tiyu workers, experts, professors, and athletes who remained on the mainland after 1949 also played vital roles in the development of “new” tiyu, including training the next generation of athletes and leaders. Some became or remained leaders in national tiyu organizations. In other words, so-called “new” tiyu in the early 1950s retained some of the characteristics of “old” tiyu." In the eyes of some Party leaders the "old" tiyu experts are seen as less trustworthy than fellow cadres and thus requiring supervision. Sport is considered as a weapon against American imperialism, in the 30’s and 40’s, the physical culture is based on the principles of American methods. states "The American imperialists spread their sport not because they were concerned about the health of the Chinese people, but because sport was an ideal tool of cultural imperialism. The American imperialists emphasised to the Chinese people that American sports equipment is the best, their athletes are the fastest and their basketball team is the top one...in the world." Likewise sport is seen as a weapon against feudalist martial arts. It has to be of scientific character and oppose feudal and superstitious ideas. "A particular case was the Chinese martial arts of Wusu, which was seen as a tool of the counter-revolutionaries “who had set up anti-revolutionary organizations which threatened the stability of society, taught young people to be thieves and rapists and provided shelter for the people’s enemies” . Fan’s argument agrees unconditionally with the government’s official claim that these Wusu organizations in the countryside and cities should be banned, and that Wusu groups in schools, factories and government departments should be reorganized by the Youth League and local governments." The sport of bodybuilding had been banned because of its bourgeois vanity in 1953. "In contrast to mass sports, elite sports were not advocated in the"early years of the PRC because they were deemed to be serving only a few people and in particular the wealthy and the bourgeoisie. Some elite sports were modified to be more suited to mass sport development. A special kind of ‘sport’ is dancing. It was encouraged by various parties as a healthy recreational activity. However, from September 1954 onward, all dance and concert halls in Shanghai were closed, and had been changed and replaced with collective dance halls held by various units. This did not solve the problem of 'degeneration' of the youth. "...trade union organizations went to record stores to buy jazz records “brimming with toxins.” A Shanghai Federation of Trade Unions propaganda department investigation also revealed that some factory dance parties went as far as playing “yellow music” and turning the lights down low, which caused participants to “loose vigilance." In August 1950, a sports delegation leaves for Moscow, back in Beijing, they communicate their findings: "...the importance of everyone participating in exercise, as well as the necessity of having a large sports stadium with the capacity for 100,000 and an indoor sports arena with a capacity of 10,000.111 Such advice was taken seriously; a plan from the Beijing Municipal Education Bureau in mid-1952 proposed spending nearly 23 billion yuan to build or renovate sports stadiums, fields, and equipment for children and adults.¹¹²" On December 20, 1950, the first Soviet Union sport delegation visited the PRC. During their stay, the delegation visits 8 cities and 14 meetings are held with Chinese officials. The development of Chinese sports programs and sports exchanges in the first half of the 1950s sought to fulfill the goals of the Common Program, while also adopting Soviet-inspired sports programs in China. "PRC leaders wanted these state-sponsored sports programs to strengthen the masses of Chinese bodies and Chinese athletes for the purposes of national goals. However, they also envisioned Soviet-inspired sports programs as the correct path to becoming a socialist state, within the context of Soviet-led international socialism." Most elite athletes in the 1950s came from schools and universities, which were the first institutional settings for women's sports. "Prior to 1952, the PRC lacked any well-organised national team system or competition system. Except for the national basketball team, the PRC had no national teams prior to 1953. Most teams were simply temporary training classes, representing the PRC to compete in international competitions. After 1952, in support of the policy to ‘learn from Soviet Sports’ and ‘inviting Soviet professionals to China and sending Chinese to the Soviet Union’,³⁹ not only were national teams ⁴⁰ set up in China, but Soviet coaches and experts in elite sports were invited to introduce modern training methods, technology and their experience." Fig. 48.6 Numbers of athletes of national competitions 1953 On February 21, 1954, Zhou Enlai delivers a speech "Building physical fitness for the motherland" in which he defines sport as a political mission for national defence and the construction of the socialist country: "The most urgent mission is to develop industry and the economy and consolidate national defence. This mission requires all of us to have strong bodies. We need modern technology to develop our industry. Modern technology cannot be operated without strong and healthy workers. Our people are not strong enough to be qualified workers. Furthermore, modern weapons, such as tanks and jet planes, also need strong and healthy operators. Thus, the GTO is not only designed for the improvement of an individual’s health, but also for national defence and the construction of a socialist country. It is a political mission." Xu (2008) remarks "the modern physical culture so quickly accepted as tiyu was novel for its systematic” effort to link “individual strength, discipline, and health” with the military, industrial, and diplomatic “strength” of the national body.62 For the Chinese, tiyu not only conveyed a distinct sense of sports, but also the idea that through the forum of sports as public culture, they could articulate Chinese nationalism, the national identity of China, and even the meaning of being Chinese. "

Chapter 5 of Common Program

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