David Wei’s harrowing experience carrying his nephew 3 km to safety after a heart attack highlights the severe challenges of accessing medical care in China’s rural areas. Even as roads and infrastructure improve, delays in emergency response times and the lack of nearby medical facilities have dire consequences for rural communities.
Wei’s nephew, who passed away during his second cardiac arrest last year, is among the millions of rural residents affected by China’s healthcare disparities. As China grapples with an aging population—120 million people in rural areas are already 60 or older—the need for better healthcare access in remote regions has become increasingly urgent.
The Urban-Rural Divide
China’s development model faces a critical crossroads. Experts argue that prioritizing industrial and urban development over social spending could worsen long-term economic and demographic issues. Critics warn that neglecting rural healthcare needs could deepen poverty, lower life expectancy, and accelerate rural depopulation as young professionals migrate to cities for better opportunities.
Despite significant progress since the Mao era, when healthcare was provided by minimally trained “barefoot doctors,” rural areas remain underserved. The number of rural doctors has dropped 42% in the past decade, even as urban doctor numbers nearly doubled. Rural hospitals struggle to attract qualified medical staff due to low pay, limited resources, and a lack of family-friendly amenities.
Structural Challenges and Local Realities
The challenges are particularly stark in remote areas like Wei’s mountainous Duan Yao county. With the nearest clinic 10 km away and offering only basic care for colds and fevers, many villagers must travel to cities for treatment. Village doctors, like Xiang in Hunan province, face overwhelming workloads and lack basic medical equipment. Xiang, who earns just 1,000 yuan ($140) a month, supplements her income by growing vegetables and working a side job.
The urban-rural healthcare gap is exacerbated by China’s talent pipeline. Cities like Guangzhou offer salaries 10 times higher than rural hospitals, making rural postings unattractive to young medical professionals. Efforts to narrow this gap, such as waiving tuition fees for medical students who agree to work in rural clinics, face skepticism from students wary of low pay and limited career growth.
The Way Forward
China’s healthcare spending, at 7.2% of GDP, lags behind aging neighbors like Japan and South Korea, which allocate 11.5% and 9.7%, respectively. While Beijing aims to “markedly narrow” the healthcare gap by 2035, high local government debt and systemic issues pose significant obstacles.
Without immediate action, rural residents like Wei may continue to face life-or-death situations due to inadequate healthcare access. For many, the prospect of better healthcare feels like a distant hope as China struggles to balance its urbanization goals with the needs of its aging rural population.
