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China in 2015-A SWOT Analysis

Cantonese Opera in the Park in Guangzhou

Cantonese Opera-in the park in Guangzhou

Robert Heinlein wrote Stranger in a Strange Land in 1961 about Mr. Smith, who emigrates to Earth from Mars. This stranger interacts with and changes his strange new world. We don’t have to make the Mars-Earth jump to see a different world; we can simply visit China. It remains an open question who will be changed by the visit: guest or host?

Stranger in a strange land

I recently played the part of stranger in a strange land, visiting China to lecture in Beijing, attended a scientific meeting in Guangzhou and spent a day in Xian (to see the famed Terracotta Warriors).

Map travelling in China

Traveling in China

In Beijing, I lectured at Peking University (hosted by Dr. Wei Kong) and at the State Key Lab of Cardiovascular disease (hosted by Dr. Zhi-Cheng Jing). In Guangzhou, I participated in the annual international meeting of the Pulmonary Vascular Research Institute (PVRI) (http://www.pvri.info/), a non-profit, global research and knowledge translation (KT) body focused on improving understanding of pulmonary hypertension and enhancing treatment. The PVRI meeting travels around the world exposing its 600 plus members to the medical and scientific realities of the host country. It is an interesting model of KT in that participants learn about the disease in the context of diverse cultures and are challenged to recognize geographic differences in scientific/medical capabilities. In recent years, PVRI has exposed members to far-flung lands, like Brazil, Peru, South Africa and this year, China.

It may be appropriate that an organization trying to revolutionize care of a disease held its meeting in Guangzhou, for Guangzhou has a tradition as being a place where revolutions begin. Guangzhou is in the home province of Sun Yat-Sen, the revolutionary who over threw the Qing dynasty in 1912 and became the first president and founding father of the Republic of China. His philosophy (Three Principles of the People: nationalism, democracy, and the people’s livelihood) espoused a much more democratic view of China than what transpired under the subsequent communist regime. Had he lived longer and established his full vision, things might have been different in China, but he died (of cholangiocarcinoma) in 1929. Sun Yat-Sen remains beloved to Chinese and his life is celebrated by this large memorial building in Guangzhou, the city in which his first uprising against the Qing dynasty took place.

Sun Yat Sen Memorial in Guangzhou

Sun Yat-Sen Memorial in Guangzhou

There are many lessons to be learned from visiting China in 2015. Reading this, keep in mind these are the reflections of a neophyte after a 1 week visit…so really first impressions, rather than expert opinion. Nonetheless let me offer you my SWOT analysis of China (that’s Strengths, Weaknesses, Opportunities and Threats).

Strengths:

 The people: China’s strength is its people. They are warm, funny, intelligent, resilient and joyful. Their capacity for hospitality (or at least willingness to offer hospitality) appears to exceed ours. Reading western newspapers, one could get the impression that Chinese society is a monolith, in which individuals are similar. Observation of people in the universities, in parks, and on the street showed, not surprisingly, that Chinese are rugged individualists, have diverse languages (Cantonese in Guangzhou, Mandarin in Beijing) and subcultures and, in short, display the diversity of the people of any country. I presented a seminar on Mitochondrial Dynamics at Peking University, hosted by Dr. Wei Kong, and was impressed by her large group of impressive young vascular biologists. I walked the streets of Guangzhou for example with Josephine Cheung, a grade 3 English Teacher. Her pride in her city was coupled with an interest in the world outside China…a remarkable person. Indeed pride in China, coupled with interest in the outside world, were two common features of the people that I met.

Guide to Guangzhou Josephine Cheung Our Guide to Guangzhou, Josephine Cheung

Musicians on banks of Pearl River Guangzhou

Musicians on the banks of the Pearl River in Guangzhou

China is investing in science: The Chinese government is pouring funds into science at a time when western governments have lost sight of the value of basic and applied research. China’s research and development expenditures have increased 23% per year for the past decade! According to an article in the journal, Nature, China’s central government of spent US $43.6 billion on research in 2013, far outspending the USA and UK (and Canada). The Ministry of Science and Technology spends about 8% of its total budget of $8.1 billion on basic research (while we in the west face a naive political environment in which research is judged based on its short term deliverables).

Graph Spending China

China, in contrast, has begun building Key State Laboratories, which are centres that focus and coordinate research into major diseases (respiratory, cardiovascular etc.). They offer scientists from around the country the chance to collaborate, share resources and techniques and advance the field. These centers have enviable levels of annual core funding and are staffed by talented faculty and have superb instrumentation-on par with anything in Canada or the USA. They are very open to collaboration with Western scientists. With their huge bio banks and talented faculty they are promising partners for collaboration. I was hosted at the Key State Lab for Cardiovascular Science by Dr. ZC Jing (decked in Queen’s colours in the photo below). Dr Jing is also Vice President of Dept of Internal Medicine at Fu Wai hospital (where they perform 10,000 angioplasties and 10,000 open heart operations per year). In addition to his brand new, state-of- the-art research centre, he has a building devoted to biobanking which currently contains 3 million patient samples and will ultimately hold 30 million samples…most impressive. One is impressed by the size and scope of practice in Chinese laboratories and hospitals. They have the centralized planned distribution of resources that Canada has but, with a billion inhabitants, the scale of the scientific enterprise is impressive.

National Center for Cardiovascular Diseases

Dr. Jing and I hope to collaborate on understanding mitochondrial metabolic problems in pulmonary hypertension and this exchange, as so many do, began with a simple visit. As a result of the visit a postdoctoral trainee from his group comes to Queen’s University… a human bridge from East to West.
Prof Zhi Cheng Jing and Xiaojian Wang

Prof. Zhi-Cheng Jing (left) and Dr Xiaojian Wang (right)

However, Chinese researchers share problems with Canadian researchers. Muming Poo, director of the CAS Institute of Neuroscience in Shanghai, says that Chinese science “suffers from excessive bureaucratic interference and a culture of jigong jinli — seeking quick success and short-term gain”. Officials often demand the demonstration of productivity on an almost yearly basis, and grants can be slashed by 50% if researchers fail in this task. This may sound familiar to Canadian scientists who also suffer from jigong jinli (but have no name for it).

China is building modern cities. The cores of many Chinese cities have architectural innovation that is world class. The country has a pride in these curved towering glass creations that reminds me of my time in Chicago, one of the few North American cities where many citizens can name more than one architect (think Frank Lloyd Wright, I.M. Pei). The architecture of modern China is stunning, witness the new downtown core of Guangzhou and the national Arts Centre in Beijing (below). On a more mundane level, there are 20-storey high rises spouting from empty fields around all China’s major cities. Note to Canadian government-the cities are connected by a high-speed train (280k/hour). That said, there is a less flattering back-story, on how the government appropriated land from people in the downtown cores to quickly reinvent the city.

Downtown Guangzhou

 Downtown Guangzhou                   

                                       

 

 

 

Beijings Performing Arts Centre

Beijing’s Performing Arts Centre

The youth of China: China has a generation of young people (18-30 years old) that is hungry for knowledge, interested in the world and committed to learning English. Indeed, facility with English is a major criterion for their university placement. Young Chinese are pursuing education with a vengeance. Their future opportunities are determined by standardized exams and they study hard to ensure they score well, thereby opening the door to the elite universities in Beijing. I spent time with undergraduates and MDs and their interest in advancing themselves and creating new knowledge was humbling. They are open to mentorship and hungry for knowledge. They respect education and are not cynical about achievement. Somewhere in Daoism there must be an admonition about a life unexamined…their focus on self-improvement is admirable. 

China Youth

China did it first: China is a proud nation, for good reason – it has a track record of innovation. Professor Joseph Needham summarized the many things the Chinese have done first in a massive, 24-volume tome, Science and Civilisation in China, that reads like a “Greatest Hits of Planet Earth”. It covers all fields from agriculture and metallurgy to explosives and the arts (including achievements ranging form the sublime (printing presses) to the mundane (toilet paper). I recommend the “Man Who Loved China” by Simon Winchester for those who are interested in the accomplishments of the Chinese. It tells the story of Professor Needham a nudist, communist, biochemist and Cambridge University professor. Dr. Needham had a love affair with a visiting Chinese student (and subsequently, with China itself).

The man who loved China http://simonwinchester.com/books/the-man-who-loved-china/

Science and Civilization in China

Based on this track record I suspect, that with increasing freedom in the new Chinese political environment, we will begin again to see Chinese “firsts” in Science and Medicine.

Made in China: The Chinese are manufacturing for the world. True, the average worker is making less than $6000/year and true, the conditions in the work place are “suboptimal”, but nonetheless, their economy is healthy (as judged by an MD). When I visited, the China News was full of stories about increased demand for minerals as citizens purchase millions of new appliances.   Downtown Guangzhou looks more modern than most North American cities. While we deal with loss of manufacturing jobs and rust belts, China is building (for themselves and for us). If they can figure out how to retain manufacturing capacity, but pay people a liveable wage, they will be a force for years to come. Meanwhile, they appear to be more happy to build everything the world needs, including our hockey sticks and mugs emblazoned with “ I Love Canada”.

Weaknesses:

 Don’t know much about history: Canada has its flaws. Our dealings with First Nations people, our failure to act on the understanding that good stewardship of our water, land and air makes sense (and dollars)….and of course the Maple Leafs! That said, we do know a bit of our history, we talk about our flaws openly and we try and improve the future based on the mistakes of our past. We know about the Battle of the Plains of Abraham, the Expulsion of the Acadians, the Residential Schools, the Chinese railway workers, the incarceration of Ukrainians and Japanese during times of war (and more). In comparison, in modern China the press is censored and the people are self-censored. There is much that needs to be remembered in modern Chinese history. For example, the Cultural Revolution in which Mao, paranoid about contenders, set one faction against the other in a mindless and uncontrolled melee, resulted in the destruction of a generation of China’s best and brightest. Despite gentle probing, I could find no one who had much to say about Mao or the Tiananmen square massacre and those who spoke, felt Mao was “good” and as far as Tiananmen square….there was no massacre.

I am sure that talking to a foreigner understandably makes the Chinese want to minimize criticism of their country. However, This failure to learn from their modern history has consequences. It is widely believed, by the Chinese I encountered, that people can say whatever they want-in the privacy of their homes or in the presence of friends. However, what is not understood is that the private forum is not the one in which truth matters; the Chinese understandably struggle to speak truth to power. Indeed fomenting public unrest is still a crime.

Nonetheless, there are Chinese who have spoken truth to power and they have paid the price for their honesty. I recommend the book, Out of the Mao’s Shadow, by Philip P Pan (Simond and Schuster 2008). 

Out of Mao's Shadow

I refer you to Chapter 8 for a story that exemplifies the consequences (personal and public) of secrecy and failing to learn from history. It tells the story of a courageous military surgeon, Dr Jian Yanyong. He was a military surgeon who operated on those shot while protesting peacefully in and around Tiananmen square in1989. While he cried with the victim’s families, he chose at the time to keep silent, knowing the consequences of speaking up. At age 71, this retired and somewhat isolated physician was thrust into the SARS epidemic. The SARS epidemic began in Guangdong province (the province in which Guangzhou is capital). The government knew something very new and very bad was circulating and explicitly decided to suppress this concern. Dr Yanyong became aware of the disease before it had a name and knew it was much more prevalent than the government was willing to acknowledge. He sent a fateful e-mail to the media, revealing the truth about the nature and prevalence of the SARS outbreak, which blew a hole through the government’s wall of silence and denial of the emerging epidemic. Suddenly the world knew something very bad was going on in China. The government reversed its rhetoric within 2 weeks and true mortality and prevalence data began to emerge; however by then the disease had spread. Once the truth was out, public health measures (in China and elsewhere) were able to shut down SARS fairly quickly. Other relevant stories in this book relate to how downtowns have been rebuilt by forced evictions of thousands of citizens, depriving them of their rights, in violation of existing Chinese law.

Lack of a free press: The combination of a single party system of government and lack of a free press is one of China’s great weaknesses. There is no vehicle to right wrongs, expose corruption, speak out for conservation, or present views that are in opposition to the government. However, in 2015, there is optimism amongst Chinese people. Many Chinese believe the worst of repression is past and that there is increased freedom under the rule of president Xi Jinping. We will know that they are right and that the long march to freedom of expression has begun when we start seeing headlines about pollution, city planning and limits to growth in the Chinese newspapers. Certainly, while I was there, there were many headlines about government officials being pursued for corruption. In an informal survey of a dozen or so young Chinese, however, there was a limited expressed curiosity in the history of China. If knowledge of history is some immunization against recurrence of insanity, this might be a cause for worry. The campaign against the rightists, the Cultural Revolution, Mao’s laying waste to the flower of academia in China-seem to me to be either forgotten or suppressed. I met only one person who spoke about the Cultural Revolution as China’s “Great disaster”.

 Opportunities:

Go East to go West

When we hear about China it is usually in connection with imprisoned Canadians or cyber terrorism or pollution. New China is not only open for business but it is welcoming of tourism and collaborations between individuals and universities. I recommend a visit for anyone who wants to have their assumptions about China’s challenged. The history is rich, the infrastructure world class, and the people are friendly and welcoming.

Threats:

Pollution:

Pollution of air water and soil is problem 1, 2 and 3 in China. It is estimated that 350,000-400000 people die prematurely each year due to air pollution. Air pollution contributed to 1.2 million premature deaths in China in 2010, making it the 4th leading cause of such deaths in China.

Air Pollution

I visited Xi’an in the west of China. It is a beautiful and historically important city with a historic wall that has successfully defended the city from human marauders for a thousand years. However, that wall is not protecting the citizens of Xi’an from pollution. There are many words we use to describe pollution in the west (annoying and concerning come to mind); in China these words are replaced with harsher terms, like frightening. I felt fear on behalf of the Chinese people that they are experiencing an unfolding environmental catastrophe. While industry and coal fired power plants are important point sources of pollution, the country’s rise in wealth has fuelled a purchasing spree so that most Chinese have an automobile. I won’t need to waste time referring to a scientific study to conclude that air pollution is an imminent threat; in Xi’an at times I could not see buildings a kilometer away. To a person, the people I met noted that the smog was new and had not been a factor when they were young (2 decades ago). My new friends are breathing this nitrogen dioxide, particulate soup and are dying and developing COPD because of it (as did Chairman Mao). In the end, the environment affects all in China and, as the ruling class realizes that wealth cannot immunize them, hopefully actions (which are already underway) will accelerate.

Smog Xian

Smog storming the walls of Xi’an in Jan 2015-01-20

 So are there lessons to be learned from a visit to China?

  1. We need to invest in our science and infrastructure or we will soon be badly outclassed by China.
  2. The Chinese people are every bit as engaging and warm as the people of Canada.
  3. There are opportunities for collaboration with China which Queen’s and other Canadian Universities can benefit from. Some of these opportunities have been tapped-many await a visit!

Archer ChinaArcher Group China

One Response to China in 2015-A SWOT Analysis

  1. Tony Sanfilippo says:

    Thanks for that great review Steve. I would add that a number of Canadian medical schools are developing formal links and exchanges with Chinese universities. In addition to comparing and sharing curricula, the engagement of a diverse culture is, itself, a great learning opportunity for students. The themes you relate in your article (environmental impact on health, engaging minority populations, learning from history) are relevant to learners whatever their nationality.

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Dr. Archer, Dept. Head
Dr. Archer, Dept. Head