WHEN Venetian traveller Marco Polo visited China in the 13th century, he was gobsmacked by the country’s wealth and industry, observing canals carrying thousands of trading vessels, iron production dwarfing that of Europe, and “stones” that were burned instead of wood.

Those stones were coal, a substance that still plays a crucial, though possibly declining, role in underpinning the Chinese economy.

More than seven centuries later, Western observers are still prone to awe, and often a certain degree of alarm, when it comes to contemplating China’s industrial might and global ambitions.

The nation’s massive Belt and Road infrastructure project, designed to improve its links to markets in Asia, Europe and Africa through new land and sea routes, has evoked international reactions ranging from the enthusiastic to the “stridently suspicious” according to a briefing paper from the Australian parliament.

Analysis of the ambitious initiative tends to focus on its economic or strategic and military implications, but what of health?

In what is presumably a bid to calm fears about global expansionism, the Chinese plan also includes a vision for a “Health Silk Road” linking the Belt and Road nations.

“We are committed to expanding health and related people-to-people exchanges, safeguarding health security, promoting health development, strengthening cooperation on health related innovation to improve people’s health and well-being, enhancing social cohesion and inclusiveness,” said a communiqué issued by participants in a 2017 Beijing summit on the Health Silk Road, including the World Health Organization (WHO) and the OECD among others.

No small ambitions there, then. As the communiqué went on: “… improving the people’s health quality is our common goal; creating a community with a shared health future for mankind is our common aspiration”.

What do all the fine words mean in practice? The communiqué’s goals are somewhat short on detail, but they include international research cooperation, strengthened infectious disease control, and medical aid to less wealthy countries, with a particular emphasis on projects designed to improve maternal and child health.

They also include the further institutionalisation and strengthening of traditional medicine based on its “long history in the Belt and Road countries [as] an important carrier of fine traditional culture and a key part of our health care”.

The WHO has been enthusiastic about China’s plans, saying the nation has much to teach the rest of us when it comes to health issues.

“President Xi’s proposal for a Health Silk Road, which strengthens and renews ancient links between cultures and people, with health at its core, is indeed visionary,” WHO director-general Dr Tedros Adhanom Ghebreyesus said at the time of the summit.

“The Belt and Road initiative contains the fundamentals to achieve universal health coverage: infrastructure, access to medicines, human resources, and a platform to share experience and promote best practices.”

That’s a lot to lay on a project that, while it may well deliver health benefits, is fundamentally about economic and strategic objectives.

Some outcomes of the Belt and Road initiative may actually be antithetical to public health. An article in Tobacco Asia in 2017, for example, detailed the expected benefits for China’s tobacco industry.

“The countries and regions on the Belt and Road account for 63% of the global population, which means a vast market to be tapped by China’s tobacco industry, helping to solve the problem of possible surplus of tobacco production,” the article said.

“Around the world, there are still cigarette markets to the tune of 22 million cases (110 billion cigarettes) yet to be developed.”

In the language of tobacco marketing, I’m assuming “cigarette markets yet to be developed” means non-smokers.

More broadly, experts interviewed by the BMJ this month saw both potential gains and harms from the Health Silk Road.

On the downside, experts raised concerns about the potential export of hazardous industries or the increased spread of infectious diseases along busier transport routes.

On the plus side, though, improved health and sanitation infrastructure could bring benefits to billions of people across Asia and Africa.

Global expansion of China’s huge pharmaceutical manufacturing capacity could also reduce drug prices, said Dr Joan Kaufman of Harvard Medical School. Provided there was adequate quality control, this could make crucial medications more accessible across low income countries.

Still, it’s worth remembering that powerful nations are fundamentally motivated more by their own interests than the desire to do good.

For China, including health initiatives in its program of expansion has clear public relations benefits, a strategy Dr Kaufman suggests the Chinese have learned from US foreign policy.

“You get a lot of mileage out of foreign aid for health,” she told the BMJ.

Jane McCredie is a health and science writer based in Sydney.


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