User:SSchlhmr/sandbox

Lead

Beginning in 1905, the Chinese government established its first Department of Health. With a more centralized body to manage health care, the Chinese Nationalist Party attempted to move toward Western method of healthcare delivery up until 1949. However, China's health system has undergone a number of changes since the Chinese Communist Revolution and subsequent declaration of the People's Republic of China in 1949. Mainly, from 1949 until 1976 China's

Environment and Health

China's rapid development has led to numerous environmental problems which all have a direct impact on health. According to Kan (2009) the environmental issues include "outdoor and indoor air pollution, water shortages and pollution, desertification, and soil pollution". Of these, Kan (2009) states that the most detrimental one is the outdoor air pollution for which China has become known. In Liu et. al's research (2018) on this issue specifically, the major health effects are listed as "including adverse cardiovascular, respiratory, pulmonary, and other health-related outcomes". The air pollution is not limited to industrial cities. In fact, due to the fact that rural Chinese people still use fuels such as coal for cooking, the World Health Organization attributes more premature deaths to that sort of air pollution than to China's ambient air pollution. In addition, many factories are located in the countryside, which exacerbates rural air pollution. Despite China's notoriously poor air quality, Matus et. al. (2011) have found that the severity of China's air pollution has been declining over the years.

Finally, as described by Kan (2018) and Wu, et. al. (1999) another major contributor to adverse health effects related to environmental issues is water pollution. In rural areas, this is once again due to factories located nearby. In urban areas on the other hand, China's water sanitation systems have not yet caught up with the needs of the population. As a result, the water is often contaminated with human waste and is not considered potable. Ingestion of contaminated water has caused diseases such as cholera.

Proposal

Wikipedia Proposal: Health in China

Need for Revision: My topic is health in China and the article I plan to work on is already extant and named “Health in China” (HiC). The article and sources are a good start, but there are many more sources on the topic which could help to provide readers with a richer understanding of the topic. The topic is very relevant to public health in developing countries, especially with the current coronavirus outbreak. Improving the topic’s Wikipedia article is critical for the information within to be further disseminated.  The subsections are a good start, but the information in each subsection is often not enough, or sometimes too much. I propose a reorganization and expansion of the information. There is also a lack of citations. For example, a 500-word section (Post-1949 History Section) has only one sentence cited. I want to work on that section in particular and break it down into smaller sections, as well as ensure that the information grounded in literature is cited, while the other information will be tagged with “citation needed”. In addition, I want to add a section on post-One Child Policy China and expand many of the subsections under “Medical Issues in China”.

Good Article Comparison: I found only one related article above C-Class that, which was “Health in Ghana” (HiG) (rated B-Class). The HiG section has a much better organized history of health in Ghana section, whereas HiC’s analogous section is long and unwieldy. The HiG article uses many subsections under the history subsection which make the information much more easily digestible. I want to emulate this in HiC’s history section. In addition, the HiG article has way more pictures, which makes it look nicer. The HiC article has just 1 picture, and I plan to add more. I’d also like to make HiC’s “hygiene and sanitation” section more specific, like that of the HiG article. Finally, the HiG article is just better written and doesn’t have stub-like subsections. I aim to emulate this in the BD article.

Track Changes:

1.    History (new)

a.    Post-1949-1976 History

b.    1976-2003 History

c.    Post-2003

2.    Health Indicators

a.    One-Child Policy (expand)

b.    Dependency Ratio

3.    Medical Issues in China

a.    Smoking

b.    Sex education, contraception, and women’s health

c.    SARS (expand)

d.    Hepatitis B (expand)

e.    HIV and AIDS

f.      Tuberculosis

g.    Leprosy

h.    Mental Health (expand)

i.      Nutrition

j.      Malnutrition among rural children

k.    Epidemiological studies

l.      Iodine deficiency

m.  Infection from animals

n.    Coronavirus (new)

4.    Coexistence of Traditional Chinese and Western medicine (new)

5.    Hygiene and Sanitation

6.     Environment and Health (new)

7.    WHO in China

8.    See also

9.    References

10.External Links

a.    Resources

Sections:

Post-1949 History: I’d like to break this section down into smaller ones and add citations. Specifically into 1949-1976, which is when the rural cooperative medical scheme ended. Then the other section will be 1980-about 2003, and then a post-SARS section for after 2003 that includes information about Healthy China 2020 and 2030 .

References:

Hesketh T, Wei XZ. Health in China. From Mao to market reform. BMJ. 1997;314(7093):1543–1545.

Dong Z, Phillips MR (November 2008). "Evolution of China's health-care system". Lancet. 372 (9651): 1715–6

Blumenthal, David; Hsiao, William (2005-09-15). "Privatization and Its Discontents — The Evolving Chinese Health Care System". New England Journal of Medicine. 353(11): 1165–1170.

Shaw, Karen. “The 2003 SARS Outbreak and Its Impact on Infection Control Practices.” Public Health 120, no. 1 (2006): 8–14. https://doi.org/10.1016/j.puhe.2005.10.002.

Health Indicators: this section might need to be renamed, I don’t really understand why it’s called “Health Indicators”. The main thing I want to do is add a bit more information under the “one child policy” section and update it with predicted effects of the two child policy.

References:

Zeng Y, Hesketh T. The effects of China's universal two-child policy. Lancet. 2016;388(10054):1930–1938. doi:10.1016/S0140-6736(16)31405-2

Medical Issues in China: For this section, I’d like to focus on expanding certain sections, including Hepatitis B, mental health, the SARS outbreak, and add at least a stub about the coronavirus outbreak, which can be expanded when more information is available.

References:

Shaw, Karen. “The 2003 SARS Outbreak and Its Impact on Infection Control Practices.” Public Health 120, no. 1 (2006): 8–14.

Wang, H., Men, P., Xiao, Y. et al. Hepatitis B infection in the general population of China: a systematic review and meta-analysis. BMC Infect Dis 19, 811 (2019)

Liu J, Liang W, Jing W, Liu M. Countdown to 2030: eliminating hepatitis B disease, China. Bull World Health Organ. 2019;97(3):230–238.

Environment and Health: The environment in china is known for extreme pollution. This has inevitable effects on human health, especially in terms of respiratory health. That being said, China has also been working to make significant strides, but pollution is still prominent.

References:

Kan, Haidong. “Environment and Health in China: Challenges and Opportunities.” Environmental Health Perspectives 117, no. 12 (2009)

Liu, Wenling, Ziping Xu, and Tianan Yang. “Health Effects of Air Pollution in China.” International Journal of Environmental Research and Public Health 15, no. 7 (December 2018): 1471.

Coexistence of Traditional Chinese Medicine and Western medicine: China is unique in that both traditional and Western medicine are incorporated into all levels of the health care system. Although there is a general move to more Western medicine, TCM is still prevalent, especially in the older generations. I think this is something that should be explored by the Wikipedia article.

References:

Hesketh, Therese, and Wei Xing Zhu. "Health in China: Traditional Chinese Medicine: One Country, Two Systems." BMJ: British Medical Journal 315, no. 7100 (1997): 115-17.

Wang L, Suo S, Li J, et al. An investigation Into Traditional Chinese Medicine Hospitals in China: Development Trend and Medical Service Innovation. Int J Health Policy Manag. 2017;6(1):19–25. Published 2017 Jan 1. doi:10.15171/ijhpm.2016.72

Links to add: The article actually has a lot of links. I think the main ones I can add will be in the history section, about things such as barefoot doctors, as well as the cultural revolution, Mao, the rural cooperative medical scheme system, and the SARS outbreak. In terms of adding links to this article into other articles, I’m planning to add links to the “Barefoot Doctor” article, “Healthcare in China”, and “Healthcare Reform in China”, among others, in order to increase traffic to my own article.

Difficulties: The overall article is pretty broad. In addition, China as a country is pretty protective of its information, so the accuracy of statistics provided by the government may not be accurate. I need to make sure I don’t get lost in my goals because I think giving the whole article an overhaul would be too much. This is why I’ve tried to set specific goals for myself to revamp the article.

Drafting of edits to Barefoot Doctor article

User:SSchlhmr/sandbox

NOTE: Much of the work I added to the Barefoot Doctor article was written straight into the article rather than drafted here. I did this because my citations were being copied and pasted into the article in a weird way when I used my sandbox. Essentially they were being duplicated and I had to constantly delete the doubles and find all the citations that were using a duplicate source. It was a hassle that I easily fixed by just working right in the actual article.

Lead: must be shortened, information within transferred to “Background”

1.    Background

2.    Training and education

3.    Work

a.    Scope of practice

b.    Income

4.    End of barefoot doctors in China (expand)

5.    Historical legacy (expand)

1.   International development with NGOs

6.    See also

7.    References

8.    External links

Underlined sections are ones where I am planning to add new sections

Background

Leading up to the cultural revolution, China's health care system, especially in rural areas, was multifaceted. Different medical practitioners filled different roles for rural citizens, who did not have access to the medical elite because they resided mainly in urban centers. In addition, there was much conflict between those who were loyal to traditional Chinese medicine and those who believed in the more modern Western medicine that was slowly being introduced to China. This all began to change in 1949, when the People's Republic of China was established. The government began to focus more on health care, especially on preventative medicine and incorporating Western medicine into traditional Chinese medicine. Despite the new attention placed on centralized health care and public health, differences between urban and rural public health were significant. This changed with the dawn of the cultural revolution. Mao Zedong himself noted the disparity between the quality of urban and rural healthcare, and eventually this prompted the beginning of the barefoot doctor program. The concept was introduced as policy by the Red Flag journal and soon revolutionized urban healthcare.

Education and Training

People selected to become barefoot doctors were usually native to the village where they would later serve, and often were "young farmers".

Work

Scope of practice

New Section:

The income of the barefoot doctors was calculated as if it were agricultural work; they were paid roughly half of what a classically trained doctor made. This funding came from collective welfare funds as well as from local farmer contributions (from 0.5% to 2% of their annual incomes). This program was successful in part because the doctors were selected and paid by their own villages. By the 1960s, there were Rural Co-operative Medical Schemes (RCMS) programs in 90% of China's rural villages.

Income

Barefoot doctors were primarily compensated by the villages in which they worked, specifically from the "local collective economy". The compensation system was very similar to the way farmers in rural villages were compensated. In fact, perhaps because many of the barefoot doctors previously worked as farmers, they earned their liviing both with their work as barefoot doctors and with agricultural jobs on the side.

Reception and Results

This section still needs to be created and worked on. It had somehow disappeared from my outline above, so I completely forgot that it was part of my plan. It's still coming!! Just a bit delayed.

End of barefoot doctors in China

Current state:

Two-thirds of the village doctors currently practicing in rural China began their training as barefoot doctors. This includes Chen Zhu, China’s former Minister of Health, who practiced as a barefoot doctor for five years before going on to receive additional training.

The barefoot doctor system was abolished in 1981 with the end of the commune system of agricultural cooperatives. The new economic policy in China promoted a shift from collectivism to individual production by the family unit. This shift caused a privatization of the medical system, which marginalized barefoot doctors and their focus on preventive medicine and primary healthcare. The barefoot doctors were given the option to take a national exam, if they passed they became village doctors, if not they would be village health aides. Village doctors began charging patients for their services, and because of the new economic incentives, they began to shift their focus to treatment of chronic conditions rather than preventative care. By 1984, village RCMS coverage had dropped from 90% to 4.8%. Without the public-service oriented work of barefoot doctors, "health-care crises of peasants substantially increased after the system broke down in the 1980s."

In 1989 the Chinese government tried to restore a cooperative health care system in the rural provinces by launching a nationwide primary health care program. This effort increased coverage up to 10% by 1993. In 1994 the government established a program to reestablish primary health care coverage for the rural population, but the efforts remain largely unsuccessful due to the market-oriented nature of healthcare.

In 2003 the Chinese government proposed a new cooperative medical system that is operated and funded by the government. This program is run more like an insurance program. It pays 10 Renminbi per year for each person covered by the program, and ensures coverage for serious diseases. This new program relies heavily on lessons learned from the times of the barefoot doctors, but faces many challenges in providing sufficient, cost-effective care for China’s rural populations. Currently, the rural population in China attempts to migrate to urban areas to seek better healthcare, which is becoming increasingly limited due to growing costs.

Sentences to add: Sentences to add:

The barefoot doctor model officially ended during the Chinese Medical Reformation of 1985, when the term 'barefoot doctor' was removed from the health care system and replaced with the term and concept of 'village doctors'.

Soon after the barefoot doctor system came to an end, in the years between 1977-1989, aims of the health care system in rural areas shifted away from preventative health care to more lucrative treatment-based health care. The new system became financially problematic as insurance was expensive and paying for medical services without insurance was even more expensive. Families struggled to finance health care costs without the economic model of the barefoot doctors in place.

Eventually, the SARS epidemic exposed the struggles of China's healthcare system and drove the government to reinvent the medical system to prevent any future epidemics.

^done, all added

Proposal for Barefoot Doctor article revision

The article and sources are a good start, but there are many more sources on the topic which could help to provide readers with a richer understanding of the topic. The topic is not only historically important, but also very relevant to public health in developing countries. It provides one method that could be used even now to help increase medical care in rural areas of developing countries. Improving the topic’s Wikipedia article is critical for the information within to be further disseminated.  The subsections are a good start, but the information in each subsection often relates to things other than the subsection’s titles. I propose a reorganization and expansion of the information. There are also citations needed and so I want to either remove that information or see if I can back it up with one of my academic sources.

Annotated Bibliography

Dong, Zhe and Michael R. Phillips. “Evolution of China’s health-care system.” The Lancet 372, no. 9651 (2008): 1715-1716 https://www.sciencedirect.com/science/article/pii/S0140673608613513?via%3Dihub

Good for general overview from early on in China's healthcare system up until fairly recently (2008). Provides a bit of information on the barefoot doctor period. Especially helpful for figuring out the health care situation after the barefoot doctor situation and how the end of the system affected China's public health.

Gross, Miriam. “Between Party, People, and Profession: The Many Faces of the ‘Doctor’ during the Cultural Revolution.” Medical History 62, no. 3 (2018) https://www.cambridge.org/core/journals/medical-history/article/between-party-people-and-profession-the-many-faces-of-the-doctor-during-the-cultural-revolution/E0852C21E1D5B727674B9C849F5A9DAB

General good info about barefoot doctors in the cultural revolution. Especially important because it covers a time about which information is often supressed

Hu, Dan et al. “Development of village doctors in China: financial compensation and healthy system support.” International Journal for Equity in Health 16, no. 9 (2017)

https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-016-0505-7

Key information for the subsection I'm planning to add about income, details how the doctors were compensated. Pretty critical as the compensation method provide a way to better understand how the barefoot doctor system was instituted.

Lee, Youngsub and Hyoungsup Kim. “The Turning Point of China’s Rural Public Health during the Cultural Revolution Period: Barefoot Doctors: A Narrative.” Iranian Journal of Public Health 47 (2018): 1-8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124148/

Nice positive portrayal of the effects of the barefoot doctor system. Good for results section of my proposed update. I think the effect of the system needs to be emphasized more in the article than it currently is.

Li, Xiuyun et al. “Revisiting current “barefoot doctors” in border areas of China: system of services, financial issue and clinical practice prior to introducing integrated management of childhood illness (IMCI)” BMC Public Health 12, no. 620 (2012) https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-620

Not sure how relevant this will be, but the information provides a nice of the moment update on barefoot doctors. The system has indeed been removed, for quite some time actually, but remnants remain. Because this is specifically about childhood illness it may be hard to gain more generally applicable information.

Wang, Virginia Li. “Training of the Barefoot Doctor in the People’s Republic of China: From Prevention to Curative Service.” International Journal of Health Services (1975) https://journals.sagepub.com/doi/10.2190/F3CA-3XAU-13N2-RL1C

More detailed information on the training of the barefoot doctor. Important for the training section that I want to expand to training and education.

White, Sydney D. “From ‘Barefoot Doctor’ to ‘Village Doctor’ in Tiger Springs Village: A Case Study of Rural Health Care Transformations in Socialist China.” Human Organization 57, no. 4 (1998): 484 https://www.jstor.org/stable/44127544?seq=1#metadata_info_tab_contents

Outlines the transition from barefoot doctor to village doctor, which occurred after the barefoot doctor system was abolished. Important for results section.

Xiaoping, Fang. “From union clinics to barefoot doctors: healers, medical pluralism, and state medicine in Chinese villages, 1950–1970.” Journal of Modern Chinese History 2, no. 2 (2008): 221-237 https://www.tandfonline.com/doi/abs/10.1080/17535650802489518?scroll=top&needAccess=true&journalCode=rmoh20

Overview of the transition into the barefoot doctor system, the only source I could find with such information. Hopefully I can use some of this info in the background section, to set the scene.

Xu, Sanchun and Danian Hu. Barefoot Doctors and the ‘Health Care Revolution’ in Rural China: A Study Centered on Shandong Province.” Endeavour 41, no. 3 (2017): 136-245

https://www.sciencedirect.com/science/article/pii/S0160932717300662?via%3Dihub

Bit of a more specific case study because it focuses on Shandong province. Still, has good example and more detailed real world of how the system worked.

Yang, Le and Hongman Wang. “Medical education: what about the barefoot doctors?” The Lancet 390, no. 10104 (2017) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32416-9/fulltext   

More info for the education and training section! takes a bit of a different perspective than the previous article. In addition, it details how barefoot doctors were then reeducated (or not) after the system was removed.