문화대혁명 시기(1966-1976) 기층 의료 현장의 국가-사회관계 ― 베이징(北京) 교구 농촌의 ‘맨발의 의사[赤脚医生]’를 중심으로 ― (State-society Relationship at the Grassroots Level in the Medical Field during the Cultural Revolution(1966-1976) — Focusing on Barefoot Doctors in the Rural Areas of Beijing Suburbs —)

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초록

This article explores the state-society relationship during ten years of the Cultural Revolution(1966―1976), focusing on the activities of barefoot doctors(赤脚醫生) in the rural areas of Beijing suburbs. Meeting rural residents directly, these doctors practiced disease treatment and prevention either at no cost or for minimal fees supported by the Cooperative Medical Systems(CMS). They contributed to the vital improvement of rural healthcare despite the scarcity of national medical institutions and personnel.
From an institutional view, overall barefoot doctor programs, including the recruitment of barefoot doctors, the administration of medical education, and the provision of remuneration and supervision, were operated by the people's communes and production brigades. To be specific, cadres of production brigades who were non-government officials were responsible for selecting barefoot doctors, and the communes’ health clinics and superior medical institutions took charge of their basic-level medical training. Furthermore, barefoot doctors were paid with workpoints(工分) depending on a year’s production by the production teams and were supervised by CMS management committees organized by cadres, rural representatives, and a handful of barefoot doctors. In other words, the capability and resources of local communities in rural areas, rather than those of the government at large, played a critical role in the operation of the barefoot doctor program. This analysis highlights that the party-state did not completely dominate the grassroots level of society in the pursuit of its objectives, but instead delegated some of its authority and granted a certain level of autonomy to local communities while promoting mutual cooperation, meaning that ‘the cooperative mechanism of the state and society’ was activated at the grassroots level in the medical field.
This article also includes barefoot doctors’ roles and status in a research perspective. They conducted two types of roles at the grassroots level: “an executor of state ideology” and “a practitioner of medical service.” The former was to propagate socialist ideology while providing medical services. This allowed rural residents to recognize the superiority of socialist ideology by comparing it with earlier periods when they hardly received any proper medical treatment. The latter was to provide disease treatment and prevention. Even if the medical services provided by the barefoot doctors were far from being sophisticated, rural residents highly appreciated the medical care they received and extended their gratitude to the doctors for the services. In other words, the medical services that barefoot doctors offered were of high marginal utility.
However, barefoot doctors often deviated from the party-state’s instructions while providing medical services. Although the party-state required them to participate in daily agricultural work and promote the use of Chinese herbal medicines, some of the barefoot doctors tended to flout such directions. This was considered to be in connection with the turbulence of the Cultural Revolution. The central government and the Ministry of Public Health were unable to implement consistent and organized policies for rural healthcare because of the rebels’ seizure of the Ministry of Public Health in the mid-to 1960s as well as the wresting of control of the ministry by a small group of soldiers in the early and mid-1970s. This created an administrative vacuum on the level of the communes and production brigades, leading to a lack of instructions and proper administration for barefoot doctors, thereby permitting them to depart from the party-state’s instructions. In brief, barefoot doctors strove to fulfill the demands of the state and society while belonging to neither side. Within the medical field of rural areas in which the responsibilities of the state and local communities overlapped, they could have room for autonomy, resulting from the deficiency of the state’s effective guidance during the turmoil of the Cultural Revolution.

영어초록

This article explores the state-society relationship during ten years of the Cultural Revolution(1966―1976), focusing on the activities of barefoot doctors(赤脚醫生) in the rural areas of Beijing suburbs. Meeting rural residents directly, these doctors practiced disease treatment and prevention either at no cost or for minimal fees supported by the Cooperative Medical Systems(CMS). They contributed to the vital improvement of rural healthcare despite the scarcity of national medical institutions and personnel.
From an institutional view, overall barefoot doctor programs, including the recruitment of barefoot doctors, the administration of medical education, and the provision of remuneration and supervision, were operated by the people's communes and production brigades. To be specific, cadres of production brigades who were non-government officials were responsible for selecting barefoot doctors, and the communes’ health clinics and superior medical institutions took charge of their basic-level medical training. Furthermore, barefoot doctors were paid with workpoints(工分) depending on a year’s production by the production teams and were supervised by CMS management committees organized by cadres, rural representatives, and a handful of barefoot doctors. In other words, the capability and resources of local communities in rural areas, rather than those of the government at large, played a critical role in the operation of the barefoot doctor program. This analysis highlights that the party-state did not completely dominate the grassroots level of society in the pursuit of its objectives, but instead delegated some of its authority and granted a certain level of autonomy to local communities while promoting mutual cooperation, meaning that ‘the cooperative mechanism of the state and society’ was activated at the grassroots level in the medical field.
This article also includes barefoot doctors’ roles and status in a research perspective. They conducted two types of roles at the grassroots level: “an executor of state ideology” and “a practitioner of medical service.” The former was to propagate socialist ideology while providing medical services. This allowed rural residents to recognize the superiority of socialist ideology by comparing it with earlier periods when they hardly received any proper medical treatment. The latter was to provide disease treatment and prevention. Even if the medical services provided by the barefoot doctors were far from being sophisticated, rural residents highly appreciated the medical care they received and extended their gratitude to the doctors for the services. In other words, the medical services that barefoot doctors offered were of high marginal utility.
However, barefoot doctors often deviated from the party-state’s instructions while providing medical services. Although the party-state required them to participate in daily agricultural work and promote the use of Chinese herbal medicines, some of the barefoot doctors tended to flout such directions. This was considered to be in connection with the turbulence of the Cultural Revolution. The central government and the Ministry of Public Health were unable to implement consistent and organized policies for rural healthcare because of the rebels’ seizure of the Ministry of Public Health in the mid-to 1960s as well as the wresting of control of the ministry by a small group of soldiers in the early and mid-1970s. This created an administrative vacuum on the level of the communes and production brigades, leading to a lack of instructions and proper administration for barefoot doctors, thereby permitting them to depart from the party-state’s instructions. In brief, barefoot doctors strove to fulfill the demands of the state and society while belonging to neither side. Within the medical field of rural areas in which the responsibilities of the state and local communities overlapped, they could have room for autonomy, resulting from the deficiency of the state’s effective guidance during the turmoil of the Cultural Revolution.

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