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Public Accountability is not just China’s need

China’s politico-bureaucracy came under a lot of criticism for its handling of the SARS crisis. Even if these criticisms are justified, are they balanced? Seventeen years ago I argued that the criticisms against China’s reluctance to sign the ‘Nuclear Non-Proliferation Treaty’ were similarly unbalanced.¹ The critics were not willing to reduce or abandon their own nuclear weapons.

The recent criticisms are in the final analysis about China’s failure of public accountability, and this criticism is well-founded. It is true that in our globalising world, in which diseases can spread very rapidly, public accountability must be expected of all government, East and West, Chinese or American, Taiwanese or Canadian.² What it overlooks is that the techno-corporate societies of the West are also weak in public accountability, even if they are different in many ways from Chinese centralised politico-bureaucracy. The former can be every bit as unaccountable as the latter.

 

An Eastern public health disaster: SARS

Anthony Saich has said:

“If the spread of the disease is brought under control

soon, the prestige of the new leadership of General Secretary Hu Jintao and

Premier Wen Jiabao will be greatly enhanced. Unlike Jiang Zemin, the outgoing

president, and his supporters, they have appeared business-like, open and

willing to adopt modern management techniques.”¹³

It seems several weeks passed from the outbreak to the public admission of the outbreak.¹⁴ A whistleblowing military doctor revealed that the scale of severe acute respiratory syndrome (SARS) epidemic in Beijing was covered up because it clashed with the annual sitting of China’s parliament and secrecy was supposedly necessary to maintain ‘discipline’ and ‘stability’. While Singapore was already closing schools and enforcing quarantines, China was in denial, with state-controlled media ignoring the growing epidemic. The government hesitated over allowing a WHO team to enter Guangdong Province, the source of the SARS outbreak. At one point, the health ministry said 31 people had become sick with SARS in Beijing, when doctors and nurses were reporting report much higher death toll. Time magazine quoted a nurse at one SARS special hospital in Beijing as saying that there are “at least 100 patients here, if not several hundred”, while the hospital denied it as “impossible”.¹⁵

China was embarrassed when the World Health Organisation announced that the SARS outbreak in Beijing was much worse than the authorities admitted. It discovered that reporting systems were not uniform (e.g. between military and civilian hospitals), or were quite inadequate. Only strong international criticism of China’s lack of accountability in handling of the outbreak led to a more serious response: all domestic airlines were eventually told they must issue face masks and sterile gauze to passengers, and more hospitals were specially prepared for SARS patients.

China’s ideological relations with Taiwan also put at risk a more accountable approach to the epidemic. China did allow a delegation from the World Health Organisation to go to Taiwan for humanitarian reasons, but making sure that this would not lead to Taiwan's gaining WHO observer status. Meanwhile, human rights groups have accused the Chinese Government of using the epidemic as an excuse for cracking down on dissidents, and arresting more Falun Gong members.¹⁶

The WHO team also asked the Chinese government to do report the real situation and to respond properly to rumours and misinformation. This is a matter of accountability.

Eventually China’s Centre for Disease Control issued an apology. “Today, we apologize to everyone,” said the director. “Our medical departments and our mass media suffered poor coordination. We weren’t able to muster our forces in helping to provide everyone with scientific publicity and allowing the masses to get hold of this sort of knowledge.” Then the Beijing Youth Daily newspaper quoted Vice Premier

Wu Yi as calling for “the immediate establishment of a national medical emergency mechanism, with emphasis placed on a public health information and an early warning reporting mechanism.”¹⁷

 

A Western public health disaster: BSE/CJD

It is well known that the UK government’s handling of the ‘Mad Cow Disease’ crisis (Bovine Spongiform Encephalopathy or BSE, and the CJD variant in humans) showed a great lack of public accountability.⁸ The techno-corporate interests of industrial-agriculture, protected by the UK’s Ministry of Agriculture, Fisheries and Food (MAFF), blocked the flow of information and prevented public involvement in decision-making. The result was that many young people died, and some are still dying, of an incurable neurological disease. During this public health disaster, several eminent professionals were disregarded or even victimised. In one case a public veterinary surgeon was dismissed from her job because she refused to sign certificates that cattle were free of infection, because she had insufficient data.⁹

I wrote at the time, that it follows from the very concept of public health that, in a potential epidemic situation,

 

..the balance of risks, costs and benefits is not a matter for scientists, for government, for the beef industry (farmers, abattoir owners, butchers, meat exporters) to battle out in terms of their own interests. What scientists, farmers, government and meat exporters believe and do are also matters of social concern. A social issue should be tackled socially. This means involving open and informed debate across a wide spectrum of the public, occupational groups, professionals and government officials.¹⁰

 

During the crisis an eminent medical microbiologist spoke in a national newspaper of,

 

… the democratic problems that permitted the BSE crisis. As one of the few medics in the field able to speak out (no family, no mortgage), I have been denied information and put down as a crank by MAFF. All the way through it has seemed as if only internal ideas and decisions could be correct and that anything that suggested human risk was invalid. Misinformation was put out from central sources: the Public Health Laboratory Service was kept out from something that was clearly a matter for experts in the human epidemiology of infectious disease, and other governments and advisors were given inadequate data with which to make decisions.¹¹

Soon new NPOs, such as Parents for Safe Food, were being set up to criticise the government’s lack of accountability. In its own study of the BSE problem this NPO wrote,

" Parents for Safe Food is concerned that MAFF’s public relations reflex appears to play down the risks, when it should have acted speedily to cut all possible sources of risk …  MAFF’s actions have been too little, too late.^"12

The handling of the crisis, and in fact the very genesis of the public health problem in the manufacturing press, was riddled with many different failures of communication and public accountability and resulted in many calls for greater government openness and in some improvements.

 

The political setting of accountability?

Commentators such as Saich also pointed out that China needed to learn a lesson in more open and accountable government in order to deal with such public health threats. However, it has been argued by some people (in response to Saich) that although a coercive bureaucracy covered up the crisis, the same top-down approach made it easier to deal effectively with the SARS crisis in China, and that such a fast and effective approach could not have been adopted in USA, for example. Could a democracy so easily cancel a public holiday, and restrict the freedom of assembly and of movement? The suggestion is that constitutional democracy, or accountable government, would be less effective at dealing with a public health crisis. I think this is a wrong idea. Accountable government can have open and accountable procedures for dealing with social crises.

            Of course, the USA is not a democracy, but a techno-corporate plutocracy in which the wealthiest interest groups, many of them corporations, have tremendous lobbying powers in Washington, and have blocked many initiatives that public accountability would demand. As it is, it is doubtful whether the USA, or other Western countries, would have been inhibited from draconian and undemocratic action by constitutional constraints. Such constraints have not stopped successive USA governments behaving undemocratically or against the welfare of its people, whether over domestic matters of race equality or its foreign wars and subversive activity¹⁸ The so-called ‘executive privilege’ of the President’s office, for example has been widely abused.¹⁹

It is also doubtful whether Western countries would have been as open and accountable as the critics have been demanding of China. Toronto too was not well prepared, and although it was on the whole more open and accountable than China (perhaps because it was at a late stage in the epidemic), the mayor and business interests reacted strongly and unreasonably to the WHO’s advisory. In the USA too a state senator, Edith Prague, complained that there was too much secrecy. When there were four suspected cases in Connecticut, state health officials refused to name the towns where cases were, supposedly because of patient confidentiality.²⁰

Conclusion

The broad lessons from these two historical episodes are clear. Public health threats force upon us the realities of a closely interconnected and globalising world, and the urgency of public accountability values, processes and instruments. They also force us to think about what constitutes such policies in the different philosophical and political frameworks of societies, East and West , past, present and future.

As organic communities breakdown and bureaucratic solutions no longer work, we need a new framework for humanising our organisations. ‘Public accountability’ could be such a framework.⁶ Technological innovations may continue, but social ones that are an alternative to hierarchical domination are now essential. Practical experience in the public health field has shown us that new systems of production, distribution, communications, etc. are not enough.⁷ Experience shows us that we must examine our human relations. Can we learn from our experience if we are looking in the wrong direction; if we are looking at our experience from an unhelpful perspective?

 

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References

1  Hunt, G. (1986) ‘China’s Case Against the Nuclear Non-Proliferation Treaty: Rationality & Morality’, Journal of Applied Philosophy, III: 2, pp. 183-199.

2  Prof. Richard Tedder, a virologist at the University College London,

emphasised:: “What Sars has done is rekindle the concept of  the global village. Somebody’s problem on a peninsula in South East Asia is Toronto’s problem a few days later.” BBC News Online, 2 May 2003.

3  I will not discuss Confucius and bureaucracy here, since it is a very large subject and controversial. See Hsu, Shie L. The Political Philosophy of Confucianism. American Classical College Press, Albuquerque, 1992.

6  Hunt, G (ed) Whistleblowing in the Social Services: Public Accountability & Professional Practice, Arnold, 1998; Hunt, G.  ‘Public accountability: We’re the Ones we have been waiting for’, Royal Society of Arts Journal, 3/6 2002, p. 10; and Freedom to Care, ‘The Charter of Public Accountability’, online at <www.freedomtocare.org>.

7  Draper P (ed). Health through public policy. London: Green Print, 1991:

8  Hunt, G (1996) ‘Some Ethical Ground Rules for BSE and other Public Health Threats’, Nursing Ethics 3(3) 263-65.

9 Erlichman J. Vet sacked in ‘BSE-free’ cattle clash. The Guardian (UK) 1994 14 Dec; p. 3.

10 Hunt, G (1996) op. cit., p. 264.

11 Letter from Dr S Dealler, The Independent (UK newspaper), 19th November 1996. Also reprinted at: <www.freedomtocare.org/page56.htm>.

12 Parents for Safe Food, Briefing on BSE, May 1990. (Parents for Safe Food, Britannia House, 1-11 Glenthorne Rd, Hammersmith, London, W6 0LF.) Also reprinted at: <www.freedomtocare.org/page56.htm>.

13  Saich, Anthony. ‘The real fallout from China's Chernobyl’, Financial Times (UK), May 27 2003.

14  BBC News online, various articles and news items, accessed at: <www.bbc.co.uk>, including Francis Markus, ‘China’s secrecy over Sars’, 20 April, 2003.

15  Time magazine, 2003.

16  BBC News Online, 5 June 2003.

17 Reported at <www.crosswalk.com>.

18 See for example, Findley, P. They Dare to Speak Out: People and Institutions Confront Israel’s Lobby. Lawrence Hill Books, Chicago, 1985, and 2003; Blum, W. Rogue State: A Guide to the World’s Only Superpower. Zen Books, London, 2001, and 2002.

19 Hunt, G. ‘Self-righteousness or Self-examination?’ The Whistle, No. 21, April 2003, pp. 5-6; Rozell, M.J. Executive Privilege: Presidential Power, Secrecy, and Accountability. 2^nd edn. revised. University Press of Kansas, 2002.

20 Hartford-Associated Press Apr. 10, 2003.

 

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