China's Unhealthy Elites
Food, cigarettes, booze, women—China's traditional power culture takes a toll on the body.
President Xi Jinping is the latest in a long line of Chinese rulers to campaign against corruption—but likely will not be the last.
Xi’s austerity measures aimed at curtailing conspicuous government spending on the lavish banquets that are practically mandatory among Chinese officials—part of a broader anticorruption drive—were met with almost immediate backdoor schemes contrived to perpetuate these culturally and politically ingrained practices in secret. That may take conspicuous spending out of the limelight but will do little to reduce corruption or have much impact on the health of the men who engage in this de rigueur tradition that requires them to constantly eat, drink, smoke and engage in commercial sex.
But what if Xi used his warning to officials to limit themselves to just “four dishes and a soup” as a combined call to fight corruption and improve the general health of China’s populace? After all, the practices he admonishes not only threaten the party’s political health, they also pose serious risks to China’s public health. Even so, many men see the excessive smoking, drinking, eating and after dinner entertainment—including services from sex workers—as a way to climb China’s economic and political ladders, without worrying about the occupational hazards inherent in these practices.
Posing his anticorruption interests in this way can only be a win-win policy that helps Xi preserve party integrity and promote individual well-being that is suffering from rampant epidemics of chronic disease and sexually transmitted infections (STIs). This will also offer important cues to local and global public-health practitioners about the structural causes leading to China’s rapidly emerging epidemic problems.
The figures are staggering. Almost 200 million people suffer from hypertension, many of them part of the 300 million (mostly men) who smoke—a full third of the world’s smokers. One million deaths per annum were attributed to smoking-related illnesses by the turn of the millennium. At the present rate, this could bring death to 100 million men by the year 2050. Rates of syphilis alone also rose by nearly 72 percent each year between 1991 and 2005. Many of these health hazards are found in China’s wealthier urban areas and are associated with evolving lifestyles that follow distinctive Chinese characteristics.
Lavish banquets have long been an entitlement for China’s rich and powerful. The collective practices of eating, drinking, smoking and female entertainment are part of a cultural ritual called yingchou that elite men have used to build loyalty among one another since the tenth century. Today men (and to a lesser extent women) from Beijing down to township and village levels use these practices to create guanxi (personal relations) with officials who control the resources needed for business success in both state-controlled and private enterprises. In the Leninist system that still officially governs China, resources, permits and licenses are controlled by the state and only distributed to those who demonstrate party loyalty, making it difficult to achieve economic growth in a market-driven system that doesn’t always rely on merit.
The implicit loyalty among those who share guanxi ties is used to justify the distribution of resources within that network. But what about all the entrepreneurs outside these trusted networks who also are critical to Chinese prosperity? Yingchou allows them to create a comparable loyalty; accepting a drink and emptying a cup of strong liquor from a partner demonstrates that sense of mutual loyalty and reciprocity. The same dynamic exists in accepting a cigarette, a portion of food or the generous offer of commercial sex.
But yingchou is not a one-time affair; strong guanxi is built and then maintained by repeated engagement. This can keep a man busy five or six days each week, often from morning till night, with a lot of shared revelry. A typical day could start with breakfast, followed by a field trip or factory visit. The first banquet of the day then starts around 11:30. Return to the work of field trips and meetings resumes only after a brief siesta, perhaps including a visit from a sex worker to an out-of-town guest’s hotel room. A dinner banquet may begin about 5:30, leading to entertainment continuing long past midnight—or up to three sustained bouts of heavy drinking in a single day. These deep-rooted cultural practices may have helped China achieve economic growth while preserving its bureaucratic system, but they have also adversely affected the health of those involved.
Combining Xi’s anticorruption effort with a public-health campaign may seem unorthodox to the public-health community, which typically sees disease as the result of discrete types of behavior that individuals themselves can control. But the statistics in China tell us something different. Smoking, for instance, a major cause of premature death, is most prevalent among men; over 52 percent of Chinese men smoke, with the highest rates among those between ages thirty-five and sixty-four, while only 2.5 percent of Chinese women smoke. Working-age men also consume most of the alcohol, making them more vulnerable to stroke, the nation’s leading cause of death. A similar trend can be seen regarding STIs. Statistically, women are more likely than men to have one, but many contract them from husbands or male partners who earn high incomes and frequently socialize for business purposes.
This gender and age imbalance is likely heavily skewed because so many of these high-risk behaviors occur as part of the shared rituals of yingchou intended to build guanxi, rather than at the individual level that normally concerns public-health practitioners. Men offer cigarettes—preferably an expensive brand—to each other whenever they meet and continue doing so until they part. It is disrespectful and counterproductive to one’s guanxi to light up and not offer smokes all around, just as it is equally disrespectful to decline the offer. The same applies to alcohol, for men do not raise their cups individually for a casual sip. Rather, each man at a banquet table is expected to sequentially invite everyone else at the table to drink some of China’s strong traditional liquor if they want to optimize their guanxi (do the math for a table of ten, and then add similar invitations to guests at other tables). The public-health effects are debilitating, but solutions require a local approach that may be found in Xi’s anticorruption efforts.
In coming years, many Chinese men suffering from tobacco-related illnesses will need to visit thoracic surgeons, while alcohol-related illnesses will send others to liver specialists. Those with STIs or HIV may require various courses of antibiotics and anti-retroviral therapies. But while these illnesses require distinct biomedical treatments, they can share a common cause—the practice of yingchou. With his directive intended to curb these practices, President Xi has simultaneously affected profits in three industries that also fuel epidemics of chronic disease. Sexual relations, the fourth high-risk behavior involved, may also be restrained, though these generally are not discussed in public nor mentioned in his anticorruption plan.
At the same time, Xi’s call for only “four dishes and a soup” is driving official banquets underground. This will perpetuate these practices and make it even more difficult to address China’s burgeoning epidemics of chronic disease as officials try to hide the actions that make them sick. Yet if Xi’s campaign could be merged with an effort to protect the health of both party and public, it might have greater success and offer a more effective way of mitigating China’s rapidly emerging epidemic problems.
Elanah Uretsky is an assistant professor of global health, anthropology and international affairs at the The George Washington University.