Co-Producing Public Health Authoritarianism: State - Citizen Interactions in Rural Gaomi, China

This study has both academic and policy-oriented objectives. The academic goal is to examine how public health authoritarianism in China is co-produced through everyday interactions between the state and citizens in rural settings. The policy objective is to explore strategies for strengthening citizen engagement in public health governance in China and other authoritarian contexts by working with decision-makers at international organizations.

Academic Objectives

The research is structured around three interrelated chapters, each addressing specific questions:

Chapter 1: Co-Producing a Zero-COVID Society in Rural Gaomi

Objective 1-1: Analyze how rural residents in Gaomi responded to COVID-19 restrictions by examining central government policies, local implementation at the village level, and villagers’ interpretations of these measures.

Objective 1-2: Identify the underlying reasons for rural residents' acceptance of COVID-19 restrictions.

Chapter 2: The Mediating Role of the “Third Sphere”

Objective 2-1: Investigate the role of primary care providers in shaping the “third sphere” between the state and society, focusing on their involvement in COVID-19 control and chronic disease management.

Objective 2-2: Examine how their actions, influenced by state directives, local social norms, and economic constraints, contribute to the establishment of public health authoritarianism in rural Chinese communities.

Chapter 3: Divergent Conceptions of Freedom-The Case of a "Fool"

Objective 3-1: Conduct a case study of Jiao Zongbo, a person with Down syndrome, to examine how state governance has medicalized his condition as a public health issue.

Objective 3-2: Explore how different social groups (urban intellectuals versus local villagers) interpret Jiao’s behavior and public health governance, highlighting how contrasting perspectives on freedom (individual autonomy versus collective responsibility) shape attitudes toward public health authoritarianism.

Together, these chapters will contribute to a conceptual model explaining how historical memory, adaptive local governance, and competing understandings of freedom influence the implementation of public health policies in rural China.

Policy and Practice Objectives

This study also seeks to answer a broader question: Given the presence of public health authoritarianism in China, what role can researchers and international organizations in global health and human rights play in strengthening citizen engagement?

As an active member of the Chinese Nonprofit Research Group, a network of emerging scholars studying nonprofit organizations in China, I have been interested in the evolving relationship between international organizations, NGOs, and the Chinese state. Since the 1980s, while the Chinese government has benefited from international nonprofit organizations, it has also actively restricted their influence, particularly when it perceives external actors as a threat to regime security. This dynamic has created a complex and unstable relationship between global NGOs and China as well as limited the ability of these organizations to understand local realities. Fieldwork findings suggest that concepts grounded in universal human rights and democratic principles have not gained traction in rural China, reflecting both long-standing government resistance and local sociopolitical realities. However, as the world’s largest authoritarian state and the second-largest economy, China remains an important actor in global health governance and international policy discussions.

By engaging with the resources available at the Brocher Foundation and collaborating with global institutions based in Geneva, this study aims to develop practical strategies for supporting citizen participation in public health governance in China and other authoritarian contexts. These efforts will contribute to ongoing discussions on the role of international organizations in shaping governance and health policies in restrictive political environments.