Contemporary Chinese Public Health: The Confucian Familist Perspective
Keywords:公共衞生, 責任主體, 政府, 家庭
LANGUAGE NOTE | Document text in Chinese; abstract also in English.
基於政府應當在公共衞生中承擔主要責任的立場，筆者強調各責任主體在公共衞生中的合作關係。相比於西方社會，中國缺少第三部門 (或非牟利團體) 的社會現實決定了我們必須找尋適合中國自己的出路。通過對傳統儒家家庭觀的批判繼承，筆者認為應當借鑒指導中國家庭的組織與建構，進一步重塑家庭在當代中國公共衞生中的角色。筆者希望借助家庭作為中國社會傳統資源的優勢，讓其在當代轉型社會中充當連接政府和個人的橋樑。一方面，筆者試圖從傳統儒家思想出發建構其理論基礎，另一方面，筆者亦希望該努力能為中國的公共衞生建設找到一條有效途徑，以期為構建中國自己的公共衞生找尋到一條現實而合理的出路。
The SARS epidemic in China in 2003 highlighted the significant role played by public health in contemporary society. It also stimulated public health research in Chinese academia. Although the area is too complex to be concisely defined, it is widely recognized that public health focuses mainly on prevention, protection, and promotion. In China, we have usually attempted to copy Western models to deal with Chinese problems in general and public health issues in particular. A serious problem, however, is that such models may fit Chinese contexts well. Chinese scholars have engaged in Western theoretical debates without considering China’s unique conditions. I think that this is not an effective way to conduct public health research in China.
China faces three major problems in public health services. First, different kinds of chronic diseases severely affect people’s everyday lives, and there is wide regional disparity in public health. Second, it is very difficult to carry out public health services in many regions in the absence of a decent nation-wide minimum healthcare system and a trust relationship between physicians and patients. Finally, because of the one-child policy, the Chinese population has become old before the nation becomes wealthy.
It is impossible for the government alone to deal with all of these difficult problems. Although public participation has been suggested, little has been done to encourage it. It is high time that China adopted a suitable strategy that is based on its unique traditional resources. The family is the key to public health in China. For more than five thousand years, Chinese society has been family based. Although the structure and functions of the family have greatly changed in contemporary times, the resources of the family cannot be overlooked in addressing public health in China. Confucian ethics, which underlie contemporary Chinese society, stem from ideas of proper family life, relationships, and management. If we seriously consider certain public health areas, including health education, disease prevention, and health promotion, then the role of the family is inevitably highlighted. The various elements of Confucianism, such as human flourishing, harmonious family life, filial duty, and mutual respect among family members, constitute the ethical guidelines for the construction of a theory of Chinese public health services and the practical application of such a theory. In addition, compared with Western countries, China still has a long way to go regarding third parties or nongovernmental organizations (NGOs) contributing to public health work. Perhaps family-based associations, such as traditional family clans, will be able to act as Confucianist NGOs and play a significant role in promoting Chinese public health.
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