Taking off or putting on shoes? barefoot doctors, mental-manual labor, and the health revolution in Mao's China

This paper chronologically analyses three sets of dynamic relationships between mental and manual labor in the institutional design, daily practice, and ideological struggle of the barefoot doctor program in Mao's China. The article argues that the institutional design of the barefoot doctor program in the late 1960s was aimed at combining mental and manual labor in agricultural production and medical practice by emphasizing the manual labor of collecting and preparing Chinese herbal medicine to address the cost of delivering medicine and health in rural China. After the early 1970s, the features of medical study and practice, work schedules, and payment methods as well as the integration of Chinese and western medicine in daily practice led barefoot doctors to separate from the manual labor of agricultural production and Chinese herbal medicine. In the middle of the 1970s, the ideological struggles during the Cultural Revolution of 1966–76 interpreted the manual and mental labor of barefoot doctors in terms of a dichotomy between loyalty to a “revolutionary health line” and medical specialization in “the revisionist health line.” The dynamic relations between the manual and mental labor of barefoot doctors disclosed the complex features of the health revolution in Mao's China, including traditional medicine versus modern medicine, deprofessionalization versus professionalization, and political discourse versus distribution practices. This paper contributes to the comparative understanding of medicine and public health in rural China prior to 1949 and to contemporary global approaches to health equity in developed countries and resource shortage in developing countries.