Commissioned by the China Medical Board in celebration of its 100th anniversary, “Philanthropy for Health in China” brings together the expertise of over two dozen authors in 14 chapters. Contributors hail from a range of academic fields, and many have long experience as practitioners working in philanthropy. Any volume commissioned by an organization in the field under study runs the risk of producing mostly upbeat, uncritical cheerleading. While there is some of that here, a majority of the chapters are substantive and informative.
The volume tackles a wide range of topics concerning health philanthropy, with most contributors utilising case studies of key organizations to shed light on their particular area of expertise and interest. One consistent theme across many chapters, however, is that the form and nature of philanthropy over the past century have been continuously shaped by larger political dynamics. During the heights of the Cultural Revolution, for example, charity and philanthropy were branded deceptive ploys of capitalists and essentially extinguished. When Deng's reforms began, foreigners and their “culture of giving” were welcomed back, and the state began encouraging domestic philanthropy to tackle newly emerging social problems.
Wang Zhenyao and Zhao Yanhui offer a comprehensive overview of how shifting political priorities and economic reform have impacted the space for philanthropy in the health sector. They do not shy from acknowledging that “for the Chinese government, cooperation with well-resourced international charities helps make up for the shortfall in public investment in the health sector, while ... limiting the opportunities for them to work independently with local NGOs” (p. 32). Zhang Xiulan and Zhang Lu trace the history of philanthropy in China from its indigenous roots in benevolent societies of the Ming and Qing through the arrival of Western medical missionaries in the 19th century. Explicating the roles of church-sponsored hospitals and medical schools, their chapter provides an exemplary account of how the rise and practice of modern medicine in China are inextricably tied to early foreign philanthropy. Caroline Reeves presents a fascinating if brief history of the Chinese Red Cross, identifying a consistent pattern in the way that the Qing, the ROC and the PRC governments all used the Red Cross to shore up favourable international opinion of China.
Distinct from most other chapters, Li Fan focuses on notable domestic NGOs and foundations that are breaking new ground in the areas of rare diseases, mental health concerns, and the rights of disabled people. Mark Sidel recounts the development of NGO and charity regulations in recent years, noting the important and continuing role of local experimentation and piloting of different regulatory frameworks for sector actors. Zi Zhongyun and Mary Brown Bullock's decidedly positive take on US philanthropy in China is developed through case studies of the Rockefeller Foundation, the China Medical Board and the Ford Foundation.
Darwin H. Stapleton draws on examples of X-ray technology and public health “stations” in northern China to argue that many of the early medical programmes supported by the Rockefeller Foundation and other US philanthropies should be understood as part of the rise of industrialization and faith in new technologies. Ray Yip's generally excellent overview of China's HIV/AIDS epidemic details programmes by a number of foreign foundations but, oddly, gives short shrift to the Global Fund, whose US$600 million in contributions made it the largest outside funder of the battle against HIV in China. A chapter by Joan Kaufman, Mary Ann Burris, Eve W. Lee and Susan Jolly (all current or former philanthropy practitioners) serves as a comprehensive account of Ford's engagement in the fields of HIV/AIDS, domestic violence, and reproductive health and sexuality.
Of the volume's many contributors, Jeffrey P. Koplan and Pamela Redmon are perhaps the most ambivalent about the moral foundations and uses of philanthropy, offering a catalogue of tobacco control programmes by foreign philanthropies but also noting how Chinese tobacco companies fund schools and scholarships in China. Deng Guosheng and Zhao Xiaoping's discussion of government-organized NGOs (GONGOs) argues that their close relations with government can be a double-edged sword, at times burdening them with bureaucracy but also allowing opportunities for positive impact on policy. A short chapter by David Faure briefly introduces numerous Hong Kong-based charities that support projects in mainland China.
Vivian Lin and Bronwyn Carter, both public health academicians, offer an outstanding and unique contribution to the volume. They argue that the biggest health challenges for China are demographic changes and an “epidemiological transition” that has led to a rise in non-communicable diseases, chronic disease, suicide and air pollution. Their treatment of these issues and discussion of government health care policy help identify areas where future philanthropic interventions may be most effective. The volume's concluding chapter, by Xu Yongguang, is perhaps also the most critical. Xu argues that contemporary philanthropy is not icing on the cake of the Chinese economic miracle, but rather a necessary intervention to tackle the drop in state welfare provision and the rise of inequality. Xu makes the case that the government needs to step back from dominating the field and allow grassroots groups to rise and grow. By doing so, he argues, government-run charities will learn to become more responsive to actual social needs, and more nimble, smaller NGOs will be able to deliver targeted services to the communities they serve.
Excluding the exceptions noted above, what this volume lacks in analytical edge may be made up for in sheer information and breadth of topics covered. While unlikely to satisfy all readers, it can be commended for drawing a clear picture of the contributions of health philanthropy in China historically and for presenting concise snapshots of recent programmes. Most of the chapters end with some prognostications on their particular topic, a contribution of unique value for those looking to understand what pathways Chinese civil society may take in the future.
