from Asia Unbound

Does the United States Have the Leverage to Press China to Become a Full Global Health Donor?

March 16, 2011

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Mexican soldiers unload boxes with medical aid donated by China at the airport in Oaxaca, Mexico on May 5, 2009.
Mexican soldiers unload boxes with medical aid donated by China at the airport in Oaxaca, Mexico on May 5, 2009. (STR New/Courtesy Reuters)

On March 11, I had a debate with Ambassador Jack Chow of Carnegie Mellon University on the question: “Should the United States press China to make the full transition from health aid recipient to global health donor?” The event was hosted by the CSIS Global Health Policy Center as part of its “Fault Lines in Global Health Debate” series. You can listen here to our discussion on China’s status as a recipient of and contributor to global health aid, as well as the prospect for China to make the full transition to a global health donor.

The debate occurred only a few hours after the devastating earthquake and tsunami hit Japan. While I was concerned about the safety of my Japanese friends, I could not help but think of China’s Tangshan earthquake 35 years ago, which resulted in the loss of around 250,000 lives. To the surprise of the international community, China had declined the offer of humanitarian and medical assistance by Japan and other foreign governments. By contrast, China today faces growing pressures to significantly increase its global health aid and other development assistance. Critics find it ridiculous that a country with the largest foreign exchange reserve and the second largest fiscal revenue is still aggressively pursuing grants from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

While I am sympathetic to the critics’ perspectives, I don’t think the United States has very much leverage to press China to become a full global health donor. As indicated by its clumsy handling of the Liu Xiaobo case, Chinese leaders today are increasingly inward-looking when it comes to issues with political legitimacy implications.  According to one senior Chinese health official, for example, China is still a developing nation and given the challenges of social-economic development that it faces, the fact that it is addressing the health problems of its 1.3 billion people should be viewed as a significant contribution to global health. Conflicts and instability in the Middle East only highlights the importance of domestic health issues. Years ago, a study by Ted Gurr, Robert Bates, and others found strong correlation between infant mortality rate (IMR) and political instability (e.g., disruptive regime transitions). China has an IMR of 18, which is close to Egypt (20), the same as Tunisia (18), but higher than Libya (17).

It would also be unrealistic to expect China to significantly increase its financial contribution to global health because some political elites are increasingly viewing the demand for China to shoulder more global responsibilities and obligations as an international conspiracy. One former Politburo member, for example, claimed that these demands were in essence to ask China to take responsibilities “that do not match China’s power status… in an attempt to shirk Western developed countries’ responsibilities while at the same time delaying and containing the speed and space of China’s development, and sow discord between China and a large number of developing countries.” The conspiracy theory may become self-fulfilling given the recent debate on Capitol Hill over the Budget FY12. As my distinguished colleague Laurie Garrett recently wrote, “It is troubling to find the first shots out of Washington’s budget cannons taking aim at foreign assistance.” The GOP is proposing a $1.5 billion cut in Global Health Initiative commitments, including sharp reductions in support of the Global Fund. This occurs when the State Department’s QDDR is calling for leading through “civilian power” in solving global problems. Lack of policy coherence and consistence on our side only reinforces Beijing’s view that our efforts to press for radical change of its foreign aid policy are hypocritical at best.