Governing Health in China: State Power, Ideology, and Public Health from Empire to Pandemic

This study traces the historical evolution of China’s public health governance, arguing that healthcare has served as a societal technology for political legitimacy across imperial, socialist, and market-oriented regimes. Through a synthetic analysis of key historical phases—spanning late Qing hygiene reforms, Maoist collectivism, and post-1978 marketization to the SARS crisis and the COVID-19 pandemic—the study demonstrates how public health operates as a biopolitical instrument and a symbolic mechanism for state legitimacy. In the late Qing and Republican eras, Western hygienic norms were appropriated as a project of civilizational advancement aimed at asserting sovereignty and domestic order. Maoist socialism harnessed healthcare for mass mobilization, embedding care within collective structures that linked medical service to political loyalty. Post-1978 marketization, while dramatically expanding the clinical capacity in the country, commodified access and fractured the state-coordinated infrastructure— vulnerabilities catastrophically exposed by the 2003 SARS outbreak. In response, the Communist Party has sought to resolve the tensions between socialist rhetoric and marketized healthcare through authoritarian nationalism, a stateled strategy central to post-SARS restructuring and tested intensely against the COVID-19 pandemic. By situating public health as a site where ideology, governance, and state power converge, this study contributes to debates on how modern states deploy public health not merely as medical rationality but as a strategic extension of political authority.