Changing China

“The world needs to understand China as much as China needs to melt into the world,” say Sun Yan and Li Li, editors of the Chinese language edition of this issue of the BMJ. We know that China is changing, but I was surprised by the commitment to change when I visited the Chinese Medical Association in Beijing to coordinate this issue with guest editors Zhang Konglai, Wang Chen, and Li Li. I met doctors who felt that China had much to offer the rest of the world and much to learn from it. “We are not used to this style of writing, where you present both the advantages and disadvantages of a policy and its successes and failures,” said one. “We need change but change must be gradual. We cannot simply copy the West,” cautioned another.

The change from a secretive country to one that welcomes tourists and admits mistakes is refreshing. This change is reflected in this issue. “Honesty is needed,” is the first lesson we learnt from the SARS epidemic, say Nanshan Zhong and Guangqiao Zeng in a candid appraisal of the epidemic (p 389). They admit that regulations were flouted in some research institutions and consider how they might do better with the next epidemic. Tuohong Zhang and Yude Chen say in an editorial that China's community health model is a good way of meeting the needs of elderly people but admit that its implementation in China is unsatisfactory (p 363). Tao Liu also emphasises the need to revitalise community health systems, which were previously equitable and prosperous but have declined since China's economic transition (p 365). Mistakes and poor implementation are not unique to China, but admitting and learning from them is the way forward for all of us.

Arguably China has a cupboard full of skeletons, which it needs to bury decently. For example, its one child policy has come in for intense criticism from the rest of the world. Qu Jian Ding and Therese Hesketh find that since the policy came into force the total birth rate and preferred family size have fallen, but (unfortunately and predictably) the ratio of male to female births has risen (p 371). The authors argue for a relaxation of this policy and hope that this will reduce the gross imbalance in the sex ratio. We also hope it will reduce the atrocities that were attributed to the policy. An editorial by Malcolm Potts from California says the policy produced great pain for one generation but a generation later began to yield significant economic benefits (p 361).

Unfortunately we don't have any original research papers in this issue that have come out of China alone without Western collaboration. Sadly no such papers passed our peer review process, largely because of problems of design. But we hope that future BMJs will have such papers: Chinese researchers are committed to gaining increased visibility internationally and will learn the rules of the game soon.