She applied the “Page 99 Test” to her new book, Infectious Change: Reinventing Chinese Public Health After an Epidemic, and reported the following:
Page 99 illustrates one of the central motifs that appears throughout my book: the generational split between the old guard of local Chinese public health bureaucrats who spend most of their time banqueting and doing sanitation inspections of highly questionable efficacy, and the young upstarts who seek to replace them by doing what they referred to as “real science.” It also includes a quite illustrative example of the ill-fated attempts of some of these young upstarts to interfere with the banqueting rituals that their older colleagues insisted on engaging in.Learn more about Infectious Change at the Stanford University Press website.
The story that begins the page actually starts on page 98. A measles vaccination team from a city public health institution in southeastern China is visiting a residents’ committee head at the local level to try to enlist her help in implementing a measles vaccination campaign. Despite the fact that the residents’ committee head is in charge of managing the health primarily of members of the so-called “floating population” of rural-to-urban migrants, who are nearly impossible to keep track of, she nevertheless promises her visitors that she will achieve a 100% vaccination rate. One of the younger members of the city vaccination team, whom I call Dr. Feng, then has the audacity to challenge this claim,. Page 99 begins with what happens afterwards to the unfortunate Dr. Feng:At the banquet that followed, the department head made certain that Feng enthusiastically toasted those who would have to repair the relationship that he had threatened. The young man ended up drinking until he collapsed in the bathroom outside the banquet hall and had to be carried home.This might sound a little extreme, especially for a bunch of officials who are supposed to be setting an example for good public health. But binge drinking was a pretty standard way for public health officials in China to both show their commitment to each other and ultimately to achieve public health goals.
I then go on:Feng had threatened the guanxi ritual by trying to open the black box in which public health projects took place. For any given project, the procedures by which collaborating partners obtained the numbers they did were purposefully obscured. In fact, the nontransparency of the guanxi web was helpful in reaching campaign goals, because if city CDC leaders could not see how the numbers were produced, they could not verify that anything was not ‘true’…This last part gets at the heart of the generational split that is explored in this chapter and throughout the book – the newer, younger public health officials considered themselves to be scientists and were deeply dissatisfied with the seemingly unscientific numbers the old ways of doing things were producing. They were also in some cases deeply uncomfortable with the banqueting rituals that were used to produce these numbers. They instead wanted to establish a new set of professional norms that would do away with banqueting and insist that collaborators produce ‘true’ numbers, even if those numbers were not politically expedient. The book shows how these efforts, at least as of the time I was writing it, had largely failed. Without a new ethical system in place to replace guanxi, public health campaigns seemed to be even less capable of produced the ‘truth’ without banqueting rituals than they were with them.
To carry out any public health projects … my informants had to accept the numbers that the black box spit out and had to act as if they assumed that these numbers reflected what had actually been observed or completed – an assumption that Feng had refused to make. Although the older CDC members did not seem bothered by this disconnect, the younger ones found the obvious unreliability of the numbers immensely frustrating. They took the poor quality of the numbers as a personal affront to their status as scientists and an unethical rejection of their colleagues’ obligation to serve the interests of the professional common.