This article by Roxanne Stevenson-Brown was awarded Runner-Up in the “Young China Watchers & Lau China Institute Writing Competition 2023” on the topic of “China: Knowledge Superpower”.
Opinions expressed in this article are those of the author and do not represent the views of Young China Watchers or the Lau China Institute.
In 2016, President Xi Jinping made a pledge to increase the capacity of the Chinese healthcare system as part of “Healthy China 2030” (HC 2030). The four key principles outlined were health prioritisation, innovation, scientific development, and justice. Educational policy focus was largely missing from the overall aims of the pledge, despite the fact that China’s plan will use the number of registered doctors and nurses as a key indicator of success. Further still, missing from this plan and indicator are the number of registered Allied Health Professionals (AHP), including physiotherapists, occupational therapists, and speech and language therapists. A proactive education policy to develop this sector of the healthcare workforce will be necessary if China is to achieve its health goals, and the title of ‘Knowledge Superpower’.
In China, the need for the clinical rehabilitation that therapies specialties provide is growing. An estimated 339 million people required rehabilitation in 2018. This, coupled with the fact that China’s ageing population is growing rapidly, and the number of people over 60 years old are expected to make up 28% of the population by 2040, means the demand for AHP capacity will only increase as we move closer to the HC 2030 deadline. Sun et al. pointed out that the Chinese Ministry of Education’s approval of rehabilitation degrees has steadily increased in recent years. However, the focus has been on physiotherapy, with occupational and speech therapy continuing to lag behind. In addition, the majority of courses on offer in mainland China are at the Junior College level, with only 13 institutions offering doctoral level rehabilitation degrees. This trend can be seen in Figure 1 below. This does not bode well for career progression. As we have learned from the UK’s recent NHS Long-Term workforce plan, without retention initiatives and career progression, the Chinese healthcare system risks losing the few existing qualified AHPs to other industries.
“As we have learned from the UK’s recent NHS Long-Term workforce plan, without retention initiatives and career progression, the Chinese healthcare system risks losing the few existing qualified AHPs to other industries.”
Despite small gains in attention towards physio and sports therapy domestically, China is not a member of World Physiotherapy, a worldwide organisation that aims to further physiotherapy as a profession through advocacy, education, and support. Interestingly, despite limited domestic engagement in occupational therapy, the Chinese Occupational Therapy Association became a full member of the World Federation of Occupational Therapists in 2018. Full membership approval required China to meet certain educational provision requirements, such as having an entry-level occupational therapy programme. With regards to speech and language therapy, the first bachelor’s degree opened for admissions in 2014, supported by the University of Hawaii. In the same year, the Chinese International Speech-Language and Hearing Association was founded. Despite this progress, two years after the opening of this programme, the University of Hawaii has pointed out that there is still only one speech therapist per 300,000 patients.
Without effective educational policy making and strategy development, therapy interventions in Chinese rehabilitation medicine will fail to meet the growing demand. In addition, medical and nursing capacity will continue to be lost, as doctors and nurses will be required to support these patients, as Healthcare Professional and Consultant Leeves points out that in Chinese hospitals, any required therapy is usually carried out by nursing staff. In an environment where this capacity is at its limits, policymakers need to step in to review the skill mix of their healthcare workforce. The World Bank’s data demonstrates this, as the number of physicians per 1,000 people in China falls below almost all developed countries, as well as high number of developing ones.
This has a knock-on effect on the overall delivery of healthcare services across the country. In a system where China is struggling with medical and nursing capacity, and demand for services is continuing to increase, the system will not be able to cope with additional capacity loss. Furthermore, the absence of effective rehabilitation may have social and economic effects, as younger generations leave the workforce to support older members of their families. At a time when the number of working-age adults is already declining, China cannot afford to speed this decline up.
“In a system where China is struggling with medical and nursing capacity, and demand for services is continuing to increase, the system will not be able to cope with additional capacity loss.”
There is an absence of an effective education policy and workforce strategy that aims to address this growing gap. Although China is a knowledge superpower across many sectors, education policy aimed at developing an effective therapies workforce that can deal with the challenges of an ageing population, has fallen behind. Chinese policymakers need to look outwardly at how other countries deliver therapy to their populations and develop an effective strategy with Chinese characteristics.
“Chinese policymakers need to look outwardly at how other countries deliver therapy to their populations and develop an effective strategy with Chinese characteristics.”