The EconomistDecember 14th 2019 China 492 Such views lead to discrimination. The civ-
il service refuses to hire people with diabe-
tes. Official guidelines allow universities
to do so, too. This is more likely to affect
type-1 diabetics, because their form of the
condition is more common in the age
group applying for university places or ju-
nior government jobs. But the rules make
no distinction between the types.
Managing patients with diabetes re-
quires a health-care system that can help
them understand their condition, adhere
to prescribed treatments and encourage
regular check-ups. This is costly. In recent
years the number of people with state
health-insurance has grown hugely. This
has reduced out-of-pocket spending on
health from 60% of the total in 2001 to
around 30% today. It has made it more af-
fordable for many diabetics to get the treat-
ment they need. But the government’s in-
surance still does not cover some
essentials, such as blood-sugar test strips
and injection devices.
In July the government published a list
of priorities for health-care reform in the
coming decade. They include a pledge to
improve support for diabetics. The plan
says officials must nudge Chinese into
leading healthier lives.
The single best medicine for type-2 dia-
betes would be more investment in prim-
ary health care. Many people do not have
easy access to family doctors or specialist
nurses, who are best able to provide the
kind of regular advice and check-ups that
type-2 patients need. Even if they do, Chi-
nese patients often prefer to use big-city
hospitals, believing that specialists there
will do a better job because of their greater
expertise. Such hospitals account for near-
ly 55% of health-care spending in China,
compared with less than 40% in rich coun-
tries. But in China they are neither
equipped nor inclined to co-ordinate the
education, screening and monitoring re-
quired to deal with chronic conditions
such as diabetes. Building a primary-care
structure that patients trust will require
enormous effort, including finding doc-
tors willing to work as general practition-
ers (who have fewer money-making oppor-
tunities than hospital doctors) and
devising better incentives for gps to pro-
mote preventive measures, such as healthy
diets and physical exercise.
Without an overhaul, China’s health-
care system will be crushed by the burden
of coping with the chronic diseases that
will burgeon as the population ages. In re-
cent years annual increases in total health-
care spending have been 5-10 percentage
points higher than gdpgrowth. About 13%
of China’s health spending goes toward
treating diabetes, and perhaps four-fifths
of that is spent treating complications that
could be avoided. China has an opportuni-
ty to save both money and lives. 7
C
hina usuallymarks the un’s human-
rights day on December 10th with angry
rebuttals of foreign criticism rather than
announcements of improvements in its re-
cord. So it was perhaps coincidental that an
official this week updated the world on the
most egregious of China’s current abuses:
the incarceration of hundreds of thou-
sands of Uighurs and other mostly Muslim
minorities in the vast western region of
Xinjiang. Shohrat Zakir, chairman of the re-
gional government, told a press conference
in Beijing that the “trainees” in detention
had all “graduated”. Since then, he said,
they “have achieved stable employment,
improved their quality of life and have
been living a happy life.”
Mr Zakir said foreign reports that train-
ees numbered 1m-2m were groundless, but
did not give his own total. China describes
what outsiders see as vast prison camps
(one is pictured, near the city of Hotan) as
“vocational training” centres, teaching
Chinese, occupational skills and “deradi-
calisation”. The camps were set up in re-
sponse to sporadic outbreaks of Islamist
and anti-Chinese violence. The mass de-
tentions amount to a preventive internal-
security operation of almost unimagin-
able—and unmeasurable—proportions.
Divided families fear to speak about dis-
appeared members. A Uighur activist
based in Canada says his grandfather died
this year soon after being freed from one ofthe camps, where his diabetes and heart
condition had been untreated. The activist
is loth to contact his family. A phone call to
his bereaved grandmother prompted a
warning text to her from the authorities.
So the fate of the detainees remains un-
clear. Mr Zakir did not say they had been
freed. The activist thinks a mass release
“pretty unlikely”. But some observers think
that China might be moving to a more sub-
tle form of repression: in the community.
They point to Tibet, a neighbouring region
with its own history of protest, where a re-
sentful local population has been subdued
without mass incarceration (though plenty
of malcontents remain locked up). The
Communist Party chief in Xinjiang, Chen
Quanguo, served in the same post in Tibet.
His skills in containing unrest have been
bolstered by extensive deployment of sur-
veillance technology.
For Tibetans, December 10th did mark
an important and poignant anniversary: 30
years to the day since their exiled spiritual
leader, the 14th Dalai Lama, was in Oslo to
receive the Nobel peace prize. Tibetans en-
joy no more freedom than they did then.
But few mass protests have been reported
since an outbreak of anti-Chinese violence
in Lhasa and protests across the Tibetan
plateau in 2008.
The “Tibet model” of repression relies
on four tactics. The first is to deflect any in-
ternational pressure. In Tibet’s case this
has meant curtailing the influence of the
Dalai Lama. At 84, he is not the tireless
globe-trotter he once was. And China is it-
self tireless in browbeating (and even im-
posing sanctions on) any country whose
leaders dare to meet him.
Second is to limit foreign contact. Tibet
remains cut off. Individual foreign tour-
ists—never mind journalists or human-
rights investigators—are banned, and the
stream of exiles escaping to India has been
cut to a trickle. Third is to swamp the terri-
tory’s native majority by promoting eco-
nomic development that encourages mi-
gration from elsewhere in China. Thanks to
tourism and investment in infrastructure,
Tibet’s economy last year grew by 9%, fast-
er than all but one Chinese province. The
growth brings both jobs and an influx of
Han Chinese, whose presence sparked the
resentment that exploded in 2008.
Last, blanket the region with security
mechanisms and personnel. This includes
stationing “work teams” in villages and
sensitive spots such as monasteries, and
dividing cities into “grids” in which resi-
dents have to spy on each other.
Tibet shows how effective and sustain-
able mass repression can be. But China still
has to weather the eventual passing and re-
incarnation of the Dalai Lama, a powerful
and moderate restraining figure. Where the
Tibet model fails is in offering a future of
reconciliation and harmony. 7BEIJING
Xinjiang’s detainees “graduate”Xinjiang and TibetMissing their
vocations
A stunning campus with excellent security