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May 7, 2018

“Towards a Health Silk Road”: China’s Belt and Road Initiative and Its Impact on International Development Assistance for Health

by Jingyi Xu (L'18)

The Belt and Road Initiative (BRI), launched by the Government of China, provides a robust financing system and resources through which China can facilitate its global health strategy. The BRI spans countries that contain almost two-thirds of the world’s population and account for one-third of the world’s wealth, creating new opportunities for trade, investment, economic activities, technological innovation, and the movement of people.

China recently made public financial commitments towards building a resilient health system at the BRI Forum for Health Cooperation “Towards a Health Silk Road.” They also committed to providing international development assistance for global health; strengthening regional cooperation by establishing joint research centers; providing easy access to medicines for the initiative partners; and improving environmental justice for the betterment of health.

However, with many nations already taking part, the BRI is cause for concern. For example, the South China Sea dispute is having negative impacts on the oceangoing BRI, and the land-based BRI requires infrastructure, whose construction is complicated by territorial disputes, religious diversity, and different legal regimes. There is also mistrust from the West and Asian neighbors over the rise of China, and the linkage between central and local governments is quite poor.

From preliminary readings, I have some policy recommendations to mitigate the risks of the project from a global health perspective

First, a well-developed legal structure is needed. China needs the BRI countries to make institutional arrangements to secure access to trade routes, and to improve understanding among people across countries through cultural, educational, and business exchanges. After enacting the framework successfully, I suggest constantly scrutinizing and examining the balance between the private sector and government regulation. Only then will the BRI achieve its purposes by preventing and resolving cross-border disputes through efficient, practical, and cost-effective schemes, leading to higher confidence in trade.

Second, health information data should be shared, and research collaboration centers should be established in developing countries. The collection, analysis, and usage of health information data is important in creating a strong and self-sufficient healthcare system. In addition, it is necessary to formulate explicit strategies for research and development at country, regional, and international levels on the road to provide international assistance for universal healthcare under the BRI.

Third, health personnel should be exchanged between countries, and international assistance in primary health care should be provided. A long-term strategy to improve efficiency in resource allocation involves building a delivery system based on strong preventive and primary healthcare, which anchors in community health centers in cities and township health centers in rural areas. Primary care doctors, known as “health gatekeepers,” include village doctors and doctors in urban community health centers. They assume the main public health duties like providing immunization, giving prenatal and well-child care, as well as maintaining records of the health condition of all patients. Primary care providers will also eventually serve as “managing referrals” to specialists and hospitals.

As the current literature emphasizes, the BRI is not just for the liberalization of flow of goods, services, capital, and skilled labor, but the liberalization of human capital through mutually accepted college and professional training programs, through joint degree arrangements, and through exchange of students and faculty members. The BRI could provide a platform not only to improve the capability of training health professionals by exchanging health personnel, but also to address the geographical misdistribution of health workers in underserved areas among the BRI partners by providing primary healthcare in those countries.

Fourth, the BRI should promote easy transfer and production of health technologies for the initiative partners. All countries rely to varying degrees on imported goods to provide for the healthcare needs of their populations. Trade policy thus affects the way in which markets for medical technologies are opened to competition from imported goods and services. In most countries, especially in smaller developing countries with little or no local production capacity in medical technologies, such imported goods make a unique contribution to these countries’ national health systems.

Fifth, creating a formal complaint scheme specific for the BRI is crucial. Fair and impartial dispute resolution can mitigate the risk of the BRI. The Investor-State Dispute Settlement is a mechanism that allows foreign individuals and foreign companies to sue host-country governments through ad hoc arbitration proceedings rather than through normal domestic administrative and judicial channels. Foreign investors have also used investment treaties to challenge unfavorable court decisions issued in litigation between the investors and third parties such as industry competitors or tort plaintiffs.

After all, to the extent foreign investors cannot get efficient or fair relief in the legal system of host states, trade and investment treaties can use cooperative institutional mechanisms to identify the gaps and issues in those legal systems and help to address them. Not only will such efforts improve dispute settlement between investors and states, it will also enable foreign investors to enjoy greater legal security when dealing with consumers, suppliers, and competitors, and will more broadly improve the investment climate of the host countries under the BRI.

Jingyi Xu (L'18) is a member of the Global Health Law LL.M. class of 2018 and a student fellow with the Global Health Initiative.