China: The Unpopular Winner of the Year in Pandemic Times
Resilience in China under COVID-19
If coronavirus is a game with all the countries as players who were dragged into it involuntarily, China seems to be the unpopular winner of the year (Spross 2021).
Looking back at 2020, COVID-19 unleashed a global pandemic that swept across the world. China, like other countries in the Global South, has severely been hit by the devastating pandemic (Carmody et al. 2021). As a widely used concept, Global South refers not only to a geographic area of the world, but more importantly, to a particularly disadvantaged positionality within an unequal global power structure (Kloß 2017). One facet of this is that in the absence of a well-established health system and strong social security net, people in the Global South tend to be more vulnerable to the effects of COVID-19. Against this background, it was unexpected to see China, the country where COVID-19 hit first, emerge as a winner in this pandemic. Yet, quickly recovered national supply chains and continuously growing export trades could be read as signs of China’s successful resilience against the effects of the pandemic (People’s Daily 2020).
Whenever it came to the role of China, be it in the context of environmental protection, global cooperation, or, as in this case, the COVID-19 pandemic, media coverage has always focused on the country’s economic growth. But is economic growth everything people should be concerned about?
While reviewing recent news and journal articles regarding the perspectives taken in China to evaluate its recovery from COVID-19, I noticed that resilience-related studies have mainly been focusing on economic factors. A large proportion of these works deals with supply chain resilience and the ability of economic recovery (Lan & Zhao 2020, Ouyang & Lu 2020, Song 2020). At the global level, scholarly work on resilience, however, is way more diverse and takes into account a wide array of social factors, among them climate resilience, gender equality, and civil preparedness (Tardy 2020, Nanthini & Nair 2020, IGES 2020, Billon-Galland 2020). Given the current narrow focus on the economic aspects of China’s resilience to COVID-19, in this contribution, I wish to ask more broadly which aspects have helped China to combat the pandemic.
The scientific framing of resilience in China in the context of COVID-19
How we define resilience is an important question, especially in the Global South where more vulnerable populations face the global pandemic without the protection of a strong public health system. Emerging from ecology, the concept of “resilience” has been applied in many other disciplines including social science and psychology (Bollig 2014). Although there is no consensus on one specific definition, many scholars agree that social resilience results from a combination of the degree of exposure, i.e. how much you are exposed to a particular disturbance, and the ability to adapt to the changing circumstances (Keck & Sakdapolrak 2013). In some contexts, resilience is used interchangeably with ‘adaptive capacity’ (Bollig 2014). When it comes to the Chinese definition of resilience, it stays quite unclear. It can be “弹性”(Tánxìng), “韧性”(Rènxìng), or “恢复力”(Huīfù lì), expressions which can be translated as “elasticity” “toughness” and “the power to recover”.
These Chinese definitions can be related to Anderies, Janssen, and Ostrom’s understanding of resilience, i.e. “the maintenance of some desired system characteristics despite fluctuations in the behavior of its component parts or its environment” with an emphasis on the idea of robustness (Anderies et al. 2004). Reviewing Chinese journal articles that were published on resilience in the context of COVID-19 in 2020, Song (2020) stresses the negative impacts on enterprises’ supply chains and calls for flexibility and stabilization in supply chain management. Similarly, the management and elasticity of supply chain risks are discussed in Lan & Zhao’s study on the new retail industry (2020). In another research conducted by Ouyang & Lu (2020), the discussion focuses on the elasticity of small and medium-sized enterprises as they are in a weak position when facing threats of COVID-19 and the need for financial support to build the power to recover. Despite their focus on the economic perspective of resilience, the interpretations concerning the concept of resilience offered in these studies are based on “elasticity” and the “power to recover” rather than the adaptation to a changing environment. As this suggests, we must distinguish between “robustness” and “resilience”. While robustness focuses on maintaining a steady status quo, resilience is geared toward the flexible adaptation to changes of the living conditions.
Which aspects of resilience have helped China to fight the pandemic?
When discussing resilience, the level at which we are analyzing shall be defined first. For the purpose of my analysis of China’s resilience in the context of COVID-19, I adopt a simplified framework of “layers of resilience” (Bollig 2014, Obrist et al. 2010), which distinguishes: a) the societal level: the state and world regions, where adequate policies are required, b) the community level: households, social groups, and communities, where social institutions matter most, and c) the individual-level: where humans learn how to cope with stressors.
An important characteristic of resilience is the ability to adapt. Although it was originally developed in the context of archaeological long-term observations (Bollig 2014, Rosen & Rivera-Collazo 2012), the idea behind the concept can be productively applied to the case of China’s epidemic history of the past decades. From resilience to transformation, the so-called “8-shaped adaptive cycle” was first introduced by Holling and used in the study of ecological resilience (Holling 1986). Dearing’s study (2008) uses the adaptive cycle to measure landscape system resilience in Southwest China. When the landscape system collapses under the intensified land use impacts and soil erosion (the exploitation stage), the soil accumulates nutrients (the conservation stage). While the expansion of agriculture leads to destabilization (the release stage), the cessation of agricultural activities allows reorganization of the vegetation-soil system and forms a new stabilization (the reorganization stage). This adaptive cycle concept has been widely accepted not only in ecosystem studies but has also been extended to measure personal behavior patterns and social systems (Sundstrom & Allen 2019, Randle, Stroink, & Nelson 2015, Fath, Dean & Katzmair 2015). Analogous to how the concept has been used in ecosystem resilience, resilience in a social system is the capacity to grow, develop, survive and renew (Fath, Dean & Katzmair 2015). Assuming the system has resources to grow and develop when extreme disturbance or collapse happens, does it have the capacity to survive? After survival, does it have the ability to reorganize and re-gain its functionality?
At the societal level, the structure of the “8-shaped adaptive cycle” might make sense in regard to China’s success in the current COVID-19 pandemic. China had experienced the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002. As a recent UN report and some news articles have pointed out, the experience of fighting against SARS in 2002 might have helped China (and other states affected by SARS) combat COVID-19 (UN 2020, Graham-Harrison 2020, Cooper 2020). The outbreak of SARS had a direct and severe impact especially on Mainland China, Hong Kong, and Taiwan, with 5327, 1755, and 671 cases respectively (WHO 2015). The capacity of these regions’ medical systems was challenged. Although the numbers might not look significant compared to today’s COVID-19 cases, there was no doubt about the amount of pressure that had been put on the health system back then. From the first case in 2002 in South China, the disease spread rapidly, and no immediate actions were taken. The response was delayed by a lack of cooperation and information transparency from Chinese governments and limited resources for infectious disease control.
Although the Chinese government started with denying and rejecting in the beginning of COVID-19, when it finally realized the seriousness of the uncontrolled situation, immediate and strict policies were implemented, with cities locked down and millions of people under tight quarantine. Drawing on its lessons from SARS, the Chinese government enforced draconian measures in the current COVID-19 pandemic. Compared with SARS in 2002, the overall response time was significantly shorter (Wu & McGoogan 2020).
In how far did the SARS-related destabilization in 2002 lead to a new stabilization in terms of higher societal resilience to the current COVID-19 epidemic? The answer is not yet clear but one can see that China benefited from its previous experience with SARS in its fight against COVID-19. In Hong Kong as one of the epicenters of the 2002-2003 SARS outbreak, robust public health policy was adopted and hospital capacity was enhanced. Similarly, Taiwan had established a Central Epidemic Command Center when combating the SARS outbreak (Lewis & Mayer 2020). These previous adjustments had enabled them to take care of more patients and react more swiftly and effectively in the context of COVID-19.
If speaking from personal experience, the memory from SARS has equally helped me to adjust faster when it comes to COVID-19. Neither the lockdown nor the shift to online teaching was new for me. When the SARS outbreak happened in 2002, I had to stop going to school and stay at home with my parents. There was no Zoom or Skype back then, but students would sit in front of the TV and watch their lectures at the same time every day. Having dinner in front of the “Sky School” (空中课堂 Kōngzhōng kètáng) for a few months is one of the most vivid memories I have of my childhood.
At the community-level, the communist structure of society has to be mentioned as a decisive factor in mitigating the effects of the pandemic. In what way health institutions and bureaucracies collaborate with other actors in the network, and how well the groups or communities help bring individuals together can significantly affect the ability of the community to fight back health threats and other disturbances (Adger 2000). The resilience of a society depends not only on formal structures of law or governance but also on socialized behaviors that are shaped in the communities, how inclusive they are and how much trust their members have in each other.
The community services the Chinese neighborhood committees provided in this pandemic serve as an example of how the well-functioning of social groups and communities can increase social resilience. In modern Chinese history after the 1911 collapse of the Qing Dynasty, under the influence of the Soviet Union, China established its communist social structure, as part of which “neighborhood committees” (居委会 Jūwěihuì) were established in every community, village, and neighborhood. To this day, their main function is to assist the governments with public health, youth education, and family planning issues, but they also perform many other community services. During the ongoing COVID-19 pandemic, workers in the “neighborhood committee” carry out many duties including taking people’s temperature, sending food and medicine, keeping records and reports (Tan et al. 2020).
While acknowledging China’s achievements, however, we also have to consider what “costs” these achievements come with, especially when authoritarian-style measures like a strict lockdown and extensive digital surveillance are imposed (Sieren 2021). Are these temporary successes the benefits from China’s massive collectivist network and specific communist social structure? But what about individual freedom? This leads to a debate over individualism and collectivism, which has attracted attention in recent media coverage. As China declared its victory in the pandemic (People’s Daily 2020), a critical question over democracy arose: Are democratic governments more competent in dealing with the pandemic? In German media too, the question of whether COVID-19 is undermining democracy emerged (Witting 2020). As so many of the COVID-19 regulations are decided behind closed doors, who has a voice in decision-making during the pandemic? And how democratic can Germany be under the current circumstances of a global public health emergency?
Whereas in the COVID-19 scenario the benefits of a liberal democratic system including transparent information policies and a high level of global cooperation seem obvious, the achievements of authoritarian countries seem rather less persuasive. However, in comparison to many liberal countries in the world, China’s authoritarian style of disease management with its drastic government actions was successful in bringing the case numbers down in a relatively short period of time. While the strict political system is constantly being criticized by many western media (e.g. Amnesty International 2019) since it restricts civil freedom, in the event of COVID-19, it has more power to quickly enforce pandemic response policies. This is supported by an analyst who points out that the systems where minority governments can easily gain power perform less desirable in the pandemic, since this leads to a narrower representation of the people and a lower level of citizen trust (Kleinfeld 2020). Building on a similar logic, an article in the People’s Daily, the official newspaper of the Central Committee of the Chinese Communist Party, considers democracy – especially the democratic system of the US – a “catastrophic failure” whose results are “inefficient” and “chaos” (People’s Daily 2020). At the end of the article, the author writes, “I advise some American politicians to curb their arrogance and prejudice! Think more about the inherent deficiencies and real crises of American democracy, instead of pointing fingers at others…” (Ren, 2020).
On the individual level, culture and belief might have helped Chinese people to build stronger psychological resilience in the context of COVID-19. Psychologist Bonanno emphasizes that hardiness in human resilience results from three contributing aspects: a) a meaningful purpose in life, b) one’s influence on the social surrounding and the possible trajectory of an event, and c) learning from both positive and negative experiences (Bonanno 2004). This conceptualization overlaps with popular Buddhist and Confucian ideologies in China. In Buddhism, suffering is where the path to happiness starts, and thus people shall not be afraid of suffering (Waikakul 2016). The philosophy of Buddhism imbues Chinese traditional values as the old saying “all sufferings have their rewards” (苦尽甘来 Kǔjìngānlái) reflects. The same applies to Confucianism, in which the meaning of life is placed in the center. As the Chinese proverb “pain and suffering are necessary for us to know experientially that we are alive and well” (Wei-Ming, 1984) indicates, a Confucian believes pain is an essential element of life. The embracement of negative experiences and the pursuance of meaning increase individual hardiness. In an interview from Tibet TV with a Buddhist called Avikrita Vajra Sakya Rinpoche, a leading figure in Tibetan Buddhism (TibetTV 2020), he uses the metaphor of an arrow when talking about COVID-19:
“If a man gets shot by an arrow, that man is not gonna care what metal that arrowhead is made of, what wood that shaft is made from and what bird feathers at the end are [made] of, he just wanna take that arrow out of him and try to survive.”
Rather than complaining about pain and suffering, Buddhism advocates personal hardiness. As Mencius, one of the best known Confucian philosophers, said, “all men have the mind which cannot bear to see the suffering of others” (Lau 2004). According to the Confucian philosophy, one has the responsibility to look after one another. In a recent article, researchers found countries with many adherents of Confucianism have a better outcome in COVID-19 management (Mayer, Schintler & Bledsoe 2020).
What perspectives shall we look at considering resilience?
During the past few decades, resilience-related research has grown significantly, with an increasing number of publications responding to a wide variety of medical, economic, and political disturbances (Janssen et al. 2006). Why does this matter to us? As the current global COVID-19 pandemic painfully reminds us, we all live under the permanent threat of our political systems and ecological environments being disrupted. Under these circumstances, learning how to adjust to different sorts of plights and emergency situations is absolutely crucial. Therefore, I wonder how Chinese scholars are measuring resilience in the sight of COVID-19. Using the searching keywords “弹性 Tánxìng ”/“韧性 Rènxìng” (resilience) “新冠 Xīnguàn” (COVID-19) in the CNKI (Chinese literature database), the result is heavily focusing on economic factors including supply chain, cycling-economy, medical resources, small size business, export-goods, etc. Although we cannot find a general set of parameters applicable for every case, as resilience assessments are highly case-specific depending on their geographic and cultural background, it appears that economic aspects draw more attention from the Chinese researchers than others. As the finding signals the lack of diversity in current resilience studies in China, many other perspectives shall be taken into consideration when discussing the country’s fight against COVID-19. How we define resilience is the first issue to address, as social resilience does not have a defined translation in Chinese and the current focus is rather narrow. Researchers are supposed to start from a broader base, especially when trying to focus on societal factors. When asking the question of what aspects of resilience have helped China to fight the pandemic, one should not be limited to the range of economics, but have a broader look on the historical, social, cultural, and political aspects. Drawing on its experience with SARS, for instance, China has learned to develop a faster response to COVID-19 and to quickly enhance hospital capacities. Moreover, social communities have been strengthened significantly through the neighborhood committees that assist in providing health services. Also, the current political system enables China to fight against COVID-19 faster and more powerfully compared with western democratic systems. And finally, religious, philosophical, and cultural ideologies like Buddhism and Confucianism contribute to individuals’ resilience inasmuch as they help them to embrace the involved suffering and make sense of the pandemic.
It should be noted that the concept of resilience has been criticized for its functionalist and narrow systems-based perspective (Bollig 2014). The question of whether the engineering of the communities towards a greater resilience is possible remains open due to the complexity of the social system, and it is extremely difficult to find universally applicable indicators of social resilience. Despite these conceptual shortcomings, resilience is still useful in helping us to understand the condition for communities to withstand pandemics and other fundamental disturbances and sustain their capacity to maintain their core functions in such crisis scenarios.
Written on 22 January 2021. Revised version submitted on 15 March 2021.
Mengyi Zhang is a Master’s student in the International Master of Environmental Sciences at the University of Cologne. She was born and raised in China. She holds a Bachelor’s degree in Forestry from the University of British Columbia in Canada. She can be reached at email@example.com.
This article was simultaneously published on Blog Medical Anthropology / Medizinethnologie. Witnessing Corona is a joint blog series by the , Curare: Journal of Medical Anthropology, the Global South Studies Center Cologne, and boasblogs.
Adger, W. Neil. 2000. Social and ecological resilience: Are they related? In: Progress in Human Geography 24(3), 347–364. https://doi.org/10.1191/030913200701540465
Amnesty International, 2019, Everything You Need To Know About Human Rights In China. https://www.amnesty.org/en/countries/asia-and-the-pacific/china/report-china/. Last access: 11/03/2021
Anderies, John M., Janssen, Marco A., & Ostrom, Elinor. 2004. A Framework to Analyze the Robustness of Social-ecological Systems from an Institutional Perspective. In: Ecology and Society, 9(1). https://doi.org/10.5751/es-00610-090118
Billon-Galland, Alice. 2020. COVID-19 and the defence policies of European states. In: NATO Defense College, 1-4. doi:10.2307/resrep26865
Bollig, Michael. 2014. Resilience – Analytical Tool, Bridging Concept or Development Goal? Anthropological Perspectives on the Use of a Border Object. In: Zeitschrift Für Ethnologie, 139(2), 253-279.
Bonanno, George A. 2004. Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive after Extremely Aversive Events? In: American Psychologist, 59(1), 20–28. https://doi.org/10.1037/0003-066X.59.1.20
Carmody, Pádraig, McCann, Gerard, Colleran, Clodagh, & O’Halloran, Ciara (Eds.). 2020. COVID-19 in the Global South: Impacts and Responses. Bristol University Press.
Cooper, Kelly-Leigh. 2020. China coronavirus: The lessons learned from the Sars outbreak. https://www.bbc.com/news/world-asia-china-51221394. Last access: 25/02/2021
Dearing, J. A. 2008. Landscape change and resilience theory: A palaeoenvironmental assessment from Yunnan, SW China. In: Holocene, 18(1), 117–127. https://doi.org/10.1177/0959683607085601
Fath, Brian D., Dean, Carly A., & Katzmair, Harald. 2015. Navigating the adaptive cycle: an approach to managing the resilience of social systems. In: Ecology and Society, 20(2).
Graham-Harrison, Emma. 2020. Experience of Sars a key factor in countries’ response to coronavirus. https://www.theguardian.com/world/2020/mar/15/experience-of-sars-key-factor-in-response-to-coronavirus. Last access: 25/02/2021
Holling, C.S. 1986. The resilience of terrestrial ecosystems; local surprise and global change. In: Sustainable Development of the Biosphere. 292-317.
IGES. 2020. Implications of COVID-19 for the Environment and Sustainability. In: Institute for Global Environmental Strategies. doi:10.2307/resrep24951
Janssen, Marco A., Schoon, Michael L., Ke, Weimao, & Börner, Katy. 2006. Scholarly networks on resilience, vulnerability and adaptation within the human dimensions of global environmental change. In: Global Environmental Change, 16(3), 240–252. https://doi.org/10.1016/j.gloenvcha.2006.04.001
Keck, Markus, & Sakdapolrak, Patrick. 2013. What is social resilience? lessons learned and ways forward. In: Erdkunde, 67(1), 5–19. https://doi.org/10.3112/erdkunde.2013.01.02
Kleinfeld, Rachel. 2020. Do Authoritarian or Democratic Countries Handle Pandemics Better?. https://carnegieendowment.org/2020/03/31/do-authoritarian-or-democratic-countries-handle-pandemics-better-pub-81404. Last access: 25/02/2021
Kloß, Sinah Theres. 2017. The Global South as Subversive Practice: Challenges and Potentials of a Heuristic Concept. In: The Global South, 11(2), 1-17.
Lan, Hong, & Zhao, Jiawei. 2020. Opportunities, Challenges and Coping Strategies Faced by the Development of New Retail Industry Under the COVID-19 Epidemic Situation. In: SOUTHWEST FINANCE, (7), 3-16.
Lewis, Nancy Davis, & Mayer, Jonathan D. 2020. (Rep.). Challenges and Responses to COVID-19: Experience from Asia, 1-2. In: East-West Center. doi:10.2307/resrep25511
Mayer, Jeremy D., Schintler, Laurie A. & Bledsoe, Scott. 2020, Culture, Freedom, and the Spread of Covid‐19: Do Some Societies and Political Systems Have National Anti‐Bodies?. In: World Medical & Health Policy, 12, 498-511. https://doi.org/10.1002/wmh3.377
Mencius, & Confucius. The works of mencius. UK, Trübner, 1861.
Nanthini, S., & Nair, Tamara. 2020. (Rep.). S. Rajaratnam School of International Studies. doi:10.2307/resrep26875
Obrist, Brigit, Pfeiffer, Constanze, & Henley, Robert. 2010. Multi-layered social resilience: A new approach in mitigation research. In: Progress in Development Studies, 10(4), 283–293. https://doi.org/10.1177/146499340901000402
Ouyang, Wenjie, & Lu, Minfeng. 2020. Study on the Resilience and Elasticity of SMEs under the COVID-19 Epidemic – Based on the Survival Perspective of SMEs under the Background of Force Majeure. In: Journal Of Changchun Finance College, (2), 75-86.
People’s Daily. 2020. A full victory in the fight against the epidemic – General Secretary Xi Jinping’s speech at the National Commendation Conference for Fighting the COVID-19 Pandemic. http://www.gov.cn/xinwen/2020-09/11/content_5542466.htm [in Chinese] Last access: 25/02/2021
People’s Daily. 2020. The international community praises China’s rapid economic recovery. http://www.gov.cn/xinwen/2020-10/28/content_5555198.htm Last access: 25/02/2021
Randle, Jason M., Stroink, Mirella L., & Nelson, Connie H. 2015. Addiction and the adaptive cycle: A new focus. In: Addiction Research & Theory, 23(1), 81-88.
Ren, Ping. 2020. Epidemic Exposes the Truth of American Democracy. http://paper.people.com.cn/rmrb/html/2020-05/26/nw.D110000renmrb_20200526_2-03.htm Last access: 25/02/2021
Rosen, Arlene M., & Rivera-Collazo, Isabel. 2012. Climate change, adaptive cycles, and the persistence of foraging economies during the late Pleistocene/Holocene transition in the Levant. In: Proceedings of the National Academy of Sciences of the United States of America, 109(10), 3640–3645. https://doi.org/10.1073/pnas.1113931109
Schwartz, Shalom H.. 2006. “A Theory of Cultural Value Orientations: Explication and Applications.” In: Comparative Sociology 5 (2–3), 173–219.
Sieren, Frank. 2021. Sieren’s China: High tech to track the coronavirus pandemic. https://www.dw.com/en/sierens-china-high-tech-to-track-the-coronavirus-pandemic/a-53000740. Last access: 25/02/2021
Song, Hua. 2020. The Implication of the Novel Coronavirus Outbreak to Supply Chain Flexibility Management. China Business And Market, 34(3), 11-16. doi: 10.14089/j.cnki.cn11-3664/f.2020.03.002
Spross, Hans. 2021. China: An unpopular winner in the year of the coronavirus. https://www.dw.com/en/china-an-unpopular-winner-in-the-year-of-the-coronavirus/a-55413717. Last access: 15/02/2021
Sundstrom, Shana M., & Allen, Craig R. 2019. The adaptive cycle: More than a metaphor. In: Ecological Complexity, 39. https://doi.org/10.1016/j.ecocom.2019.100767
Tan, Huibing, Jia, Yunge, Li, Yinhua, & Hou, Wwi. 2020. China Neighborhood and Village Committee confront the COVID-19 Pandemic: Cultural History and Tracking back Review of Relevant Public Health Events in Last Century. Preprints, 19(April), 1–37. https://doi.org/10.20944/preprints202004.0447.v2
Tardy, Thierry (ed). Front Matter. NATO Defense College, 2020, pp. ii-iv, COVID-19: NATO in the Age of Pandemics, doi:10.2307/resrep25148.10
TibetTV. 2020. Coronavirus Pandemic from Buddhist point of view [Video]. https://www.youtube.com/watch?v=um609hufDW8. Last access: 25/02/2021
U.N. 2020. Variations in COVID strategies: Determinants and lessons. https://www.un.org/en/desa/variations-covid-strategies-determinants-and-lessons. Last access: 25/02/2021
Waikakul, Waraporn. & Waikakul, Saranatra. 2016. Pain Perception in Buddhism Perspective. In: Journal of Religion and Health, 55(4), 1336–1344. doi: 10.1007/s10943-015-0080-z
Wei-Ming, Tu. 1984. Pain and suffering in Confucian self-cultivation. In: Philosophy East and West, 34(4), 379-388.
WHO. 2015. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. https://www.who.int/publications/m/item/summary-of-probable-sars-cases-with-onset-of-illness-from-1-november-2002-to-31-july-2003. Last access: 25/02/2021
Witting, Volker. 2020. Is the coronavirus pandemic undermining German democracy?. https://www.dw.com/en/coronavirus-germany-democracy/a-55346478. Last access: 25/02/2021
Wu, Zunyou, & McGoogan, Jennifer M. 2020. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. In Jama, 323(13), pp. 1239-1242.
There was a significant delay from the first signs of an imminent epidemic to the political reaction, which indicates the political complexities that are always involved in the management of epidemics.
 While it provides public services, it also bears a negative reputation under the one-child policy, as the neighborhood committee implements family planning, sometimes involving forced abortions and sterilizations. This ambivalence of communist health and social policy shall be noticed.