主题：【The Economist】China's growing pains -- jlanu

Leaders: China's growing pains - The pains of rapid growing; China

The dark side of China's stunning boom includes pollution and a collapsing state health-care system

IN THE old days, 25 years ago, life was straightforward in China. If you lived in a town, you worked in a state-owned factory or office. If you lived in the countryside, you worked on a collective farm. You didn't earn much, but that didn't really matter because there wasn't much to buy. Clothing options were largely limited to a choice of a dark grey Mao suit or a dark blue Mao suit. Only party officials got to use cars. For everyone else, private transport meant waiting months for the chance to buy a scarce Flying Pigeon bicycle.

In return for living a life of fathomless drabness, people's basic needs were reasonably well looked after. Health care (though it was, in truth, often seriously basic) was provided across the country by the state. Adequate pensions were provided in the same way. Housing was heavily subsidised, schooling was free. Of course, there were dramatic perturbations to contend with (the famine-inducing Great Leap Forward, the Cultural Revolution), but the arrangement had some clear benefits. China's performance on literacy, life expectancy and infant mortality was more characteristic of a middle-income country than a developing one, and hugely better than that recorded by similar-sized but democratic India. The system was sometimes called the iron rice-bowl, which sounded reassuring. The trouble is that most people want something a bit more exciting to eat than rice.

Those days, of course, are long gone. Since Deng Xiaoping launched his "open door" policy in 1978, China has witnessed probably the most dramatic burst of wealth creation in human history. Its income per head has increased sevenfold in that time: more than 400m people have been lifted out of severe poverty. Along its seaboard, and down the length of the Yangtze river, a middle class, perhaps 100m strong, has been created, where none at all existed before. Visit Shanghai, and you are visiting one of the most dynamic and cosmopolitan cities on earth. "To get rich is glorious," Deng said, and everywhere people are doing just that.

The price of progress

But as with any vast transformation, there has been a price to pay. The state has retreated not just from agriculture--over 60% of China's population still live in the countryside--but from great swathes of industry and commerce, too. Inevitably, this has led to unemployment on a staggering scale. Reliable numbers are hard to come by, and the official ones are certainly gross underestimates. But there are perhaps as many as 15m unemployed in China's cities, and ten times that number in the countryside who have little or nothing to do. Still, this is at least a problem that rapid economic growth can be expected to chip away at fast. China's economy is clearly starting to slow, but an Economist poll of forecasts puts growth this year at 9.2%, and at a still-stellar 7.9% next. Other kinds of problem, however, will need imaginative policy changes to correct. This week, we look in detail at two of them.

As we report on pages 22-24, one casualty of the freeing up of China's economy has been its state health-care system, which has in effect collapsed. This threatens to undo one of the genuine achievements of which the Communist Party can boast: life-expectancy in parts of the country, particularly in the west, may actually now be falling. Diseases like tuberculosis and measles, which had been thought tamed, are making their return. Burdened by the costs of modernising its economy, but receiving only a modest tax take (it has risen from 12% to 18% of GDP a year, but that is not enough), the government's deficit has been increasing. The health system has been a victim. Over the last 20 years, the share of health spending picked up by central government has roughly halved. Hospitals and clinics have been forced to up their fees, and most people no longer have state-owned work units able to pick up the tab. Health insurance barely exists outside the cities, so even a minor illness can easily push a family into appalling debt. This means that in some areas poverty is growing.

Pollution (see pages 63-65) is an invariable consequence of development everywhere, but in China it is reaching scandalous proportions. The World Bank reckons that China is home to 16 of the world's 20 most polluted cities, and calculates that pollution and environmental degradation together cost China as much as $170 billion annually. Pollution is hardly new: Mao's drive for industrialisation created environmental catastrophes all over the country. But with the acceleration of economic growth, the problem has hugely worsened. Some of the forces at play have even served to undermine the state's efforts at curbing pollution. Local authorities now operate on a much freer rein than they used to, though without any sort of popular oversight. They have little incentive to make life difficult for employment-generating companies in their bailiwicks merely on the say-so of Beijing.

These, of course, are only two of the growing pains that afflict China as it continues its breakneck growth. A properly funded pensions system is sorely needed, with the withering-away of the state-owned enterprises that used to provide one. Cleaning up the banks could easily cost several hundred billion dollars. Yet look back at the industrial western nations of, say, 150 years ago, and it is worth remembering that none of these had pension systems, or state health care, and most of them had appalling pollution too--London's "pea-souper" fogs spring to mind. What enabled them to change was growth, coupled with muscular policymaking.

In China, the growth is plainly available, and there are clear signs that the government is starting to shoulder its new responsibilities too. As well as the grim tidings, there is good news in the battle against pollution. The courts have more teeth than they used to, and ordinary citizens are starting to make use of them. Spending on environmental protection has increased sharply, and foreign firms are being invited in to help the clean-up. Besides, as countries get richer, they tend to pollute less, building more chip plants and fewer steel mills. As for health, the respiratory disease SARS alerted the authorities to the dangers of a run-down health service, and various forms of health insurance are now being tested. The market, too, is stepping in, offering better and cheaper alternatives to the state-owned hospitals.

Still, solving these problems cannot be fast, easy or free of cost. One way or another, the government needs to claw back some of the gains that people have made in the boom years. Instinctively, people do appear to understand that in the new China, the ability to get rich carries greater individual responsibilities: the savings ratio has shot up to over 40%, one of the highest in the world. But as they are increasingly asked to pay--through higher taxes, medical fees and insurance premiums--for things the state used to provide, citizens will surely want a greater say in how their money is spent. China's Communist leaders may be on the way to tackling health care and pollution, but how they cope with growing calls for accountability remains to be seen. The courts, and increasingly-assertive media, can do a certain amount. But of democracy--the best form of accountability--there is so far not the slightest sign. Booming China has $470 billion of foreign reserves stashed away, and cash can soothe a lot of growing pain. But the demand for votes will grow.