I am writing this column from the inner city of Beijing, living in a hutong—one of the traditional houses that used to line the small streets and narrow alleyways of the city—and studying Mandarin. The hutong we are renting has been upgraded to include indoor plumbing, a couple of air-conditioning units, a washing machine and a microwave oven. But next door are the very basic units. My wife, Wendy, and I are living in the midst of a Chinese lifestyle that is sadly disappearing to make way for skyscrapers and luxury condos.
The hutong lifestyle is simple, with all the necessities located within a few steps of our door. There are many restaurants (we have had wonderful meals for four, with beer, costing less than $10). There are small shops selling fresh fruits and vegetables, barbershops, laundry and tailor services, shoe repair and, most important for us, a bicycle repairman.
Since my first trip here in 1994, when the only cars were government vehicles of an aging vintage, today the parking lots are filled with Audis, BMWs, large VWs and other luxury vehicles. The pollution and traffic are horrendous and getting worse as Western-style suburbs are built seemingly overnight. We are commuting by bicycle 40 minutes each way to and from our Mandarin classes. Some days you cannot see the tops of skyscrapers 20 yards away.
The driving is challenging, too. There are bike lanes on most streets, but the bike traffic may be two-way, cars and buses frequently use the lanes, and there are lots of pedestrians. You learn not to make eye contact with cars; if you do, you lose all rights of way open to you. We are exhausted by the end of the day from our commuting, but it is a great way to explore the city.
The bicycle repairman, Mr. Yang, is our best friend and life-support system. He works on bicycles right on the sidewalk and is found at his station seven days a week, 12 hours a day. He is as good a diagnostician as the best Hopkins internist and as manually adept as a top professor of surgery. Nearly each day we need some adjustment (air in the tires, brake adjustments, etc.). We often get thunderstorms in the evening, and the rain falling on the bikes quickly changes to rust, freezing up something—hence the need to see Mr. Yang for an urgent clinic visit.
During this trip I have thought about an observation made by an economist named Roemer many years ago—that certain entities generate their own “demand.” Roemer pointed out that the more hospital beds there are per capita, the higher the utilization of hospital services. I think the same holds for roads as well. When a road is built—generally when the economy is robust—developers will buy up land made accessible and construct houses or factories that require people to commute longer distances, hence filling up the new roads. Since new roads allow the addition of more automobiles, one can never get ahead of the power curve. Beijing today illustrates how the large supply of four-lane boulevards and wide ring roads has generated a “demand” for more cars. When your family lived in the hutong, there was no need for any transportation, save perhaps a bicycle or a small motor-driven vehicle to haul cargo for your vegetable market.
Another important point to consider about China: While right now it has a relatively young population, it is quickly aging, and by 2030, because of the country’s one-child policy, it will have the same inverted age distribution that Western Europe, the United States and Japan will have. How China will pay for medical services is an issue now but is likely to emerge more importantly in the future.
While the demand for high-quality Western medical services is growing and could present some opportunities for Johns Hopkins, one should not overlook the fact that a focus on public health will likely make the most dramatic improvements in the health of the country over the next few decades.
The only books I am reading these days are Chinese-language instruction books, so, somewhat apologetically, I have none of my usual summer reading recommendations. For now, have a good summer, and zai jian. Till we meet again.
