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Does the United States Have the Leverage to Press China to Become a Full Global Health Donor?

by Yanzhong Huang
March 16, 2011

Mexican soldiers unload boxes with medical aid donated by China at the airport in Oaxaca, Mexico on May 5, 2009.

Mexican soldiers unload boxes with medical aid donated by China at the airport in Oaxaca, Mexico on May 5, 2009. (STR New/Courtesy Reuters)

On March 11, I had a debate with Ambassador Jack Chow of Carnegie Mellon University on the question: “Should the United States press China to make the full transition from health aid recipient to global health donor?” The event was hosted by the CSIS Global Health Policy Center as part of its “Fault Lines in Global Health Debate” series. You can listen here to our discussion on China’s status as a recipient of and contributor to global health aid, as well as the prospect for China to make the full transition to a global health donor.

The debate occurred only a few hours after the devastating earthquake and tsunami hit Japan. While I was concerned about the safety of my Japanese friends, I could not help but think of China’s Tangshan earthquake 35 years ago, which resulted in the loss of around 250,000 lives. To the surprise of the international community, China had declined the offer of humanitarian and medical assistance by Japan and other foreign governments. By contrast, China today faces growing pressures to significantly increase its global health aid and other development assistance. Critics find it ridiculous that a country with the largest foreign exchange reserve and the second largest fiscal revenue is still aggressively pursuing grants from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

While I am sympathetic to the critics’ perspectives, I don’t think the United States has very much leverage to press China to become a full global health donor. As indicated by its clumsy handling of the Liu Xiaobo case, Chinese leaders today are increasingly inward-looking when it comes to issues with political legitimacy implications.  According to one senior Chinese health official, for example, China is still a developing nation and given the challenges of social-economic development that it faces, the fact that it is addressing the health problems of its 1.3 billion people should be viewed as a significant contribution to global health. Conflicts and instability in the Middle East only highlights the importance of domestic health issues. Years ago, a study by Ted Gurr, Robert Bates, and others found strong correlation between infant mortality rate (IMR) and political instability (e.g., disruptive regime transitions). China has an IMR of 18, which is close to Egypt (20), the same as Tunisia (18), but higher than Libya (17).

It would also be unrealistic to expect China to significantly increase its financial contribution to global health because some political elites are increasingly viewing the demand for China to shoulder more global responsibilities and obligations as an international conspiracy. One former Politburo member, for example, claimed that these demands were in essence to ask China to take responsibilities “that do not match China’s power status… in an attempt to shirk Western developed countries’ responsibilities while at the same time delaying and containing the speed and space of China’s development, and sow discord between China and a large number of developing countries.” The conspiracy theory may become self-fulfilling given the recent debate on Capitol Hill over the Budget FY12. As my distinguished colleague Laurie Garrett recently wrote, “It is troubling to find the first shots out of Washington’s budget cannons taking aim at foreign assistance.” The GOP is proposing a $1.5 billion cut in Global Health Initiative commitments, including sharp reductions in support of the Global Fund. This occurs when the State Department’s QDDR is calling for leading through “civilian power” in solving global problems. Lack of policy coherence and consistence on our side only reinforces Beijing’s view that our efforts to press for radical change of its foreign aid policy are hypocritical at best.

Post a Comment 4 Comments

  • Posted by miriam

    Making rising powers responsible stakeholders is no pic-nic!
    If “a 21st century power” means- as the US Secretary of State declared – having to accept a share of the burden of solving common problems, and of abiding by a set of rules of the road”, three major questions come about.
    .Who sets the rule. Are the Old Powers prepared to recognize rising powers as rule-makers, not just rule-takers?
    .Why rising powers should accept global responsibilities, if they have half populations under welfare standards?
    .Are those global responsibilities worth the seat at the high table, given rising powers diverse interests, capabilities, and world views?

  • Posted by Yanzhong Huang


    Thank you for your insightful comments. The questions are well thought out. I think they are exactly the ones Chinese decision makers are pondering.

  • Posted by S. Mahmud Ali

    I agree that a country with growing surpluses and increasing clout ought to contribute more to the health of distressed humanity beyond its borders. However, one question I’d like to ask is – have you seen the state of China’s healthcare system in some of the remote western and south-western provinces? Beijing is building up its health-coverage across the country to restore some of the services Chinese nationals took for granted in 1955-1978, but universal health coverage is still many years, possibly decades, off. Charity must begin at home for China.

    Secondly, as for US leverage – well, there is an apparent assumption in the USA and among US allies elsewhere that US influence on foreign governments is substantial enough to effect policy decisions of the ruling elites in those countries. This is clearly true in countries which are dependent on US support and assistance in either economic or security fields. But even among allied countries, governments of such states as Japan (debate over the Futenma Marine Air Station relocation), South Korea (KORUS FTA negotiations) and India (Iran)have sought to pursue a measure of autonomy not always in consonance with stated US policy preferences.

    As readers of Foreign Affairs must know, in 2009, the Obama Administration initiated the implementation of the AirSea Battle operational concept, synergising USAF and USN operations to counteract the Chinese military’s A2/AD capabilities in areas proximate to China’s shores, thereby locating China in the same adversarial station reserved for the Soviet Union in the 1980s (remember AirLand Battle?). AirSea Battle was rolled out in 2010.

    Now, a country which lends the US government much of the funds with which Washington then finances America’s current account deficits and is still treated as the premier ‘peer-rival’ might perhaps be forgiven for not acquiescing to the application of US leverage on its policy priorities, no?

    Obviously, there is some merit to the argument that US hegemony has been a force for good, especially for those who have willingly accepted US primacy as the benign universal norm, and benefited from it. But for others, who have been at the receiving end of America’s unparallelled coercive capacity, the picture must look different. To base all arguments on the assumption that the current order is the only one acceptable may be logical for its beneficiaries, but a cursory study of history shows that empires have risen, expanded and then declined in the past, and unless a universally accepted set-up can be established, empires – however defined, will continue to follow that cyclical sequence in the future, too. Coercion cannot be the instrument of immortality; persuation might.

  • Posted by Yanzhong Huang

    Thanks, Mr. Ali, for your interest in this piece. I agree with you that while the US is overall a benign hegemony, people “at the receiving end” of such power might have a different opinion. But that was not my argument in the debate. For more information about the debate, you may access the video of the event by visiting

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