Public Health Engagement Aff Notes



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Add-Ons

ASEAN add-on

Combatting diseases ensures ASEAN stability and improves U.S.-China relations and relations with the rest of Southeast Asia


Meacham '09 (Karen Meacham, CSIS Smart Power Initiative case scenario, "Hu et al. ' ("Health Care System Reform in China: Issues, Challenges and Options", down.aefweb.net/WorkingPapers/w517.pdf", Center for Strategic and International Studies, March report, www.voltairenet.org/IMG/pdf/Chinese_Soft_Power.pdf, CL)

The global outbreak of severe acute respiratory syndrome (SARS) in 2002-2003 prompted a turning point in China’s approach to multilateralism, transparency on public health issues, and its relationship with ASEAN. Eventual Chinese cooperating with ASEAN on SARS control and surveillance bolstered its image as a participating member of the regional community and demonstrated a new willingness to act constructively with its neighbors in response to a regional public health crisis. The SARS pandemic is considered a key factor in strengthening nonmilitary cooperation between China and ASEAN contributing to China’s improved relations in the region. China-ASEAN relations were at a low point in the mid-1990s when it was discovered that the People’s Liberation Army had erected concrete structures in the resource-rich and border-disputes Spratly Islands in the South China Sea. The perceived militarization of a long-standing territorial dispute among China, Vietnam, the Philippines, Brunei, Malaysia, and Taiwan resulted in regional mistrust of China and increased solidarity among non-China countries. Compounded by weakened Sino-U.S. relations, China was pressured to reconsider its approach or face estrangement and a potential containment strategy from the United States and its allies. Although the territorial dispute was largely restrained from the 2002 signing of the Declaration on the Conduct of Parties in the South China Sea, in 2003 Chinese leader were still searching for ways to increase cooperation with ASEAN. SARS emerged as a transnational, organic threat with the potential to gravely affect the health and economy of all of Southeast Asia. Although China initially attempted to conceal the SARS outbreak within its borders, international and domestic pressures led leaders to ultimately adopt a more open and transparent approach to both the SARS crisis and future public health concerns. Over the course of only a few months in 2003, China and ASEAN held four special meetings over SARS outbreak that yielded a series of agreements. following the first ASEAN + 3 Ministers of Health Special meeting on SARS in Kuala Lumpur in April 2003, China, Japan, and Korea committed to actions to be taken for the prevention of further SARS infections. Other meetings followed that year in Cambodia and Thailand, at which many ASEAN member countries made a point of commending China’s handling of SARS. At the June 10-11 + 3 (to include Japan and South Korea) health ministers meeting, the ministers “congratulated China for its very strong political commitment in containing SARS and its utmost efforts to improve the quality and timeline of surveillance.” In October 2003, ASEAN and China signed the Joint Declaration of the PRC and ASEAN State Leaders: A Strategic Partnership for Peace and Prosperity, a declaration that called for the respect of territory and member sovereignty, China-ASEAN free trade initiatives, and cooperation on issues of regional security. This series of meetings was an early sign that China was willing to work with ASEAN in a serious and meaningful way—a significant advancement from the strained relationship of the late 1990s. China’s cooperation was not lost on the wider public health community,, evidenced by a World Health organization statement in April 2003 commending China and ASEAN on their cooperation. The positive response to China’s handling of the SARS outbreak from neighboring countries and the international community may have contributed to China’s shift to a more soft-power approach to global public health. Whether or not this evolution of events was intentional, it became clear to the Chinese leaders that “enhancing mutual interests and interdependence [was] the best way to erode ASEAN states’ perception of the “China threatMultilateral collaboration and goodwill around public health remains relevant as a number of Southeast Asian countries continue to express concern over communicable diseases such as avian influenza. If the public commitment to a regional balance of power and security is any indication of future Chinese foreign policy, we may see continued transparency in public health-related issues as part of broader diplomatic strategy.

ASEAN has transformed to become more centralized and enhanced its credibility—assumes past structural problems defense


Yong '09 (Ong Keng Yong, Singapore diplomat and Secretary General of of the Association of South East Asian Nations, "In Defence of ASEAN", The Diplomat, December 17, thediplomat.com/2009/12/in-defence-of-asean/1/, CL)

The strategic geography of the Association of Southeast Asian Nations–wedged between China and India and straddling key trade and transportation networks–has enabled it to play a prominent role in managing stakeholders’ interests in Southeast Asia and the surrounding neighbourhood. The customised mechanisms put in place by ASEAN have helped to institutionalise habits of consultation and cooperation among regional countries and their partners, while the prestige and recognition accorded to ASEAN have increased a sense of belonging to a region. However, the ‘evolutionary’ approach to leadership has raised doubts about ASEAN’s effectiveness in a rapidly changing world. Slow compliance and decision-making combined with weak institutions and a lack of action in some cases have prompted criticism over ASEAN’s ability to manage regional and international affairs. Yet, ASEAN member states’ leaders have accepted that their respective societies need time and space to connect with outsiders and work with them in mutually beneficial ventures. ASEAN’s mantra of ‘moving step by step, at a pace comfortable to all,’ is therefore rooted in the realities of the diverse cultural, economic, political and social order in Southeast Asia. This time-tested philosophy is not, as some would suggest, a wishy-washy approach. Instead it reflects the thorough preparation of the issues to be discussed and reconciled–policy options and alternatives are considered, discussed and weighed up carefully by all parties with a stake in the outcome. Relying on cooperation, dialogue and political convergence, ASEAN is still very much an inter-governmental body. Although this has led to slow, sometimes tedious progress, it still requires good conciliatory and political judgements– leaders need to think carefully about key issues and decide the best moment to join a consensus based upon their own circumstances. Unfortunately, this consensual method of regional cooperation is not fully understood or widely appreciated. Indeed, the ‘ASEAN way’ has been maligned and dismissed by those in a hurry to achieve their own particular goals. But ASEAN is not alone in adopting this consensual approach–such decision-making processes are the mainstay of every effective, collective discourse. While more established international organisations have formalised precedents and specific rules for reaching a quick decision, ASEAN has just institutionalised this process with the coming-into-force of the ASEAN Charter on December 15, 2008 and the promulgation of blueprints on the building of the ASEAN Community by 2015, based on three pillars-political and security cooperation, economic integration and socio-cultural cooperation. With the coming-into-force of the ASEAN Charter, ASEAN has become a rules-based regime with a legal personality. Coupled with the increase in resources allocated to the ASEAN Secretariat, the establishment of the ASEAN Intergovernmental Commission on Human Rights and several other processes aimed at improving efficiency and effectiveness, ASEAN has indicated its commitment to the transformation of the loose informal grouping into a formal body. The changes should allow ASEAN to become stronger and more able to promote solidarity and cooperation on the regional stage. Maintaining a cohesive Southeast Asian region will ensure peace, security and stability and cooperation in solving common problems, and expanding regional economic integration will also follow. The blueprints laid out for the establishment of the ASEAN Community, meanwhile, will provide timelines and a roadmap (with scorecards) to help ensure the implementation of ASEAN’s intentions and plans. By becoming more predictable and accountable, ASEAN has enhanced its standing and attractiveness as a reliable partner with those wishing to invest in the peace and prosperity of Southeast Asia. It would also be simplistic to accept the conventional argument about the diversity of ASEAN member states and how mutual jealousy and suspicion hampers the implementation of ASEAN accords. In reality, the national ego of bigger countries in ASEAN will be a major factor in keeping ASEAN coherent and cohesive. Historically, ASEAN is most successful when both the small and big countries in the organisation rally around a specific cause, especially if there’s a perceived common external threat, such as during the Cambodian Crisis of the late 1970s to early 1990s, the 1997-1998 Asian financial crisis and the SARS crisis in 2003.

The U.S. and China working together on transnational issues through political changes stabilizes ASEAN


Yong '09 (Ong Keng Yong, Singapore diplomat and Secretary General of of the Association of South East Asian Nations, "In Defence of ASEAN", The Diplomat, December 17, thediplomat.com/2009/12/in-defence-of-asean/1/, CL)

So far, the rise of China and India has been positive for ASEAN and the regional interests of China and India intersect with those of the United States, Europe, Japan and Russia. ASEAN has rich experience of managing such stakeholders’ interests and the ‘ASEAN Plus’ processes such as ASEAN Plus Three (the ten ASEAN countries, China, Japan and the Republic of Korea) and the East Asia Summit (ASEAN, China, Japan, the Republic of Korea, India, Australia and New Zealand) have engaged these stakeholders in orderly and mutually rewarding exchanges and transactions. Consequently, ASEAN’s role is recognised as ‘central’ and ASEAN is also acknowledged to be ‘the primary driver’ of regional architecture development. However, if ASEAN wants to ensure its strategic usefulness is maximised it will have to make full use of its persuasive powers. The longer it takes for decisions to be made, the lower the level of efficiency. Some ASEAN member states yearn for faster processes and want to see immediate results, but by its nature ASEAN relies on individual countries finding common interests and working together. This is, of course, time consuming and an issue that will need to be addressed going forward if the rest of the world is to continue to engage productively with ASEAN. Individual member states of ASEAN will also need to have the political will to support the processes and procedures laid down. This key factor will determine the future success of ASEAN and push its ten member states into solidifying its plans for the building of an ASEAN Community. The centrality of ASEAN in regional architecture has placed it in the midst of different proposals for either an East Asia community or an Asia Pacific community, and with a number of countries wanting to take the steering wheel, there’s no certainty of success. The current lack of clarity and consensus on how to move forward, with various countries involved wanting to ensure that their own interests are well served, means a careful step-by-step process that balances national sensitivities must be undertaken. Ultimately, ASEAN must gain from such moves or risk irrelevance. The fumbling and quarrelling that sometimes occurs within ASEAN must not distract from the fact that four decades of skilled management has reaped dividends. The ingenuity of ASEAN has been its skilful use of its strategic geography and engagements with those who matter for the region. This skill has fostered confidence among outside powers who now trust that ASEAN can deliver relevant initiatives in tune with their own interests.

Strong ASEAN key to US influence and trade in Asia, solves pandemics, Korean war, climate change, energy security, and terrorism


THE NATION 11-15-2009 (“US backs central role for Asean,” http://www.nationmultimedia.com/home/2009/11/15/regional/US-backs-central-role-for-Asean-30116623.html)

US President Barack Obama will today endorse the centrality of Asean in new regional community building and an expansive role for it in global issues, at the inaugural Asean-US Leaders' Meeting in Singapore. Obama, who is scheduled to hold a 90-minute meeting this afternoon with the 10 Asean leaders, will also pronounce the policy of engagement with Asean as a key partner in promoting peace, stability and prosperity in the region. The historic meeting, which is being co-chaired by Prime Minister Abhisit Vejjajiva, marks the first meeting between the leaders of the two sides. It will also be the first time in 43 years that a Burmese prime minister has met a US leader. The draft joint statement, seen by The Nation on Sunday, touches on the whole gamut of Asean and US relations in the past 32 years related to political/security, economic/investment and social development issues. The draft also included Abhisit's proposal of Asean connectivity, which aims at promoting infrastructure and communication links within Asean, including people-to-people contacts. Obama will reaffirm the importance of Asean's centrality in building regional architecture, which must be inclusive, promote shared values and norms and respect the diversity within the region. This is in line with his Tokyo speech on Asia yesterday, when he said: "Asean will remain a catalyst for Southeast Asian dialogue, cooperation and security." The US will also express support for the Asean Inter-government Commission for Human Rights, including the track-two initiatives. Washington will invite members of the AICHR to the US to meet their counterparts. Leaders of Asean and the US are expected to discuss regional and international issues. Topping the agenda will be the situation in Burma - particularly Aung San Suu Kyi's freedom - and North Korea. Various efforts related to transnational issues, such as climate change, energy security, terrorism, pandemics and disaster management, will also be discussed. The outcome of a recent visit to Burma by two senior US officials will be discussed. On Burma, the leaders will stress that the US approach will "contribute to broad political and economic reforms and the process will be enhanced in the future". Obama yesterday called for the release of Suu Kyi ahead of the leaders' meeting. The leaders of Asean and the US will jointly urge the Burmese government to hold free, fair, fully inclusive and transparent elections next year, including a dialogue with all stakeholders. The Asean leaders are expected to support the US call for a nuclear-free world. Together, they will call for North Korea to return to the six-party talks. Despite the US reluctance to call its first meeting with Asean a summit, both sides have agreed to meet next year. At the meeting today, Obama is expected to invite all the Asean leaders to the US next year. US-Asean relations have been bolstered following the new US policy towards Asia. In August, Washington signed the Treaty of Amity and Cooperation, which further strengthened the three-decade relationship. According to the draft statement, both sides have agreed to set up a joint Asean-US Eminent Persons Group to address regional and global issues. This group can work on issues tasked by their leaders, such as the Asean-US Free Trade Agreement. The US has yet to agree to Asean requests on the regular participation of the Asean chair at G-20 summits and Washington's support for non-Apec Asean members. Former US president George W Bush met Asean leaders three times - in October 2002 in Los Cabos, Mexico; in December 2005, in Busan, South Korea; and in September 2007, in Sydney. These meetings were on the sidelines of the Apec leaders' meetings and were limited to seven Asean members. Cambodia, Laos and Burma are not members of the Apec forum. The US plans to open a permanent office in Jakarta with an Asean ambassador before the end of the year. China stated last month it would do the same soon. Before he meets Asean leaders, Obama will hold a separate summit with Indonesian President Susilo Bambang Yudhoyono. Obama, who skipped Indonesia this year, plans to go there next summer with his family. He spent four and half years of his childhood in the country. Last year, bilateral Asean-US trade reached US$178 billion (Bt5.9 trillion), while US investment in Asean amounted to $153 billion. Other key dialogue partners such as China, Japan, South Korea and India have an annual summit with Asean leaders. Russia is planning a second summit next year in Hanoi under the new Asean chair, Vietnam.

CCP Collapse Add-On

Economic decline causes CCP instability


Symonds '15 (Peter Symonds, Asia specialist for the global economy, "China’s Economic Downturn Raises Concerns about Political Instability", Global Research, www.globalresearch.ca/chinas-economic-downturn-raises-concerns-about-political-instability/5472407, CL)

Amid continuing global share market volatility, the financial elites around the world have been intently focussed on the movement of Chinese stock markets and more broadly on the state of the Chinese economy. Yesterday’s rise of the benchmark Shanghai Composite Index, after falls in six successive trading sessions, produced an almost audible sigh of relief as share prices responded by rising on major markets internationally. The deluge of media commentary on the Chinese economy reflects the degree to which the world economy as a whole is dependent on continued growth in China. Speaking on the Australian Broadcasting Corporation’s “Lateline” program last night, Ken Courtis, chairman of Starfort Holdings, pointed out that “this year we’re expecting 35 to 40 percent of all the world’s growth to come from China.” If that did not happen, “then we have a real problem.” Concerns in ruling circles that China’s economic slowdown will lead to political instability were evident in an article published in the Financial Times (FT) on Tuesday entitled, “Questions over Li Keqiang’s future amid China market turmoil.” Analysts and party insiders who spoke to the FT suggested that the Chinese premier was “fighting for his political future” after the Shanghai Composite Index plunged by 8.5 percent on Monday—its largest decline since early 2007. Analyst Willy Lam from the Chinese University of Hong Kong told the newspaper: “Premier Li’s position has certainly become more precarious as a result of the current crisis. If the situation worsens and if there comes a point where [President Xi Jinping] really needs a scapegoat, then Li fits the bill.” Li and Vice Premier Ma Kai were closely associated with efforts in early July to stem the falling share markets, including a ban on short selling and new stock offerings and share sales by large investors. According to the FT, state-owned institutions pumped an estimated $200 billion into the share market, only to see it plummet over the past week. The Chinese leadership is more broadly under fire. A lengthy article in the New York Times last weekend reported that Xi had been told by powerful party elders to focus more on restoring economic growth and less on his anti-corruption drive. Xi, however, has exploited high-profile anti-corruption cases to consolidate his grip on power, jail potential rivals or challengers, and intimidate factions critical of his government’s accelerating pro-market reform and further opening up to investment. A shrinking economy will only fuel tensions within the isolated and sclerotic Chinese Communist Party (CCP) regime and open up the prospect of renewed factional infighting. Having all but abandoned its socialistic posturing, the CCP leadership has depended for its legitimacy on continued high levels of economic growth. The fear in Beijing and major financial centres around the globe is that rising unemployment and deepening social inequality will lead to social unrest, particularly in the working class, which is now estimated to number 400 million. The official growth figures have fallen this year to 7 percent—well below the 8 percent level that the CCP long regarded as the minimum required for social stability. Many analysts, however, regard even 7 percent as significantly overstating actual growth. A recent Bloomberg survey of 11 economists put the median estimate of Chinese growth at 6.3 percent. Others put the figure far lower. Analyst Gordon Chang told the Diplomatwebsite that “influential people in Beijing” were “privately saying that the Chinese economy was growing at a 2.2 percent rate.” He pointed to other indicators of declining economic activity: rail freight (down 10.1 percent in the first two quarters of 2015), trade volume (down 6.9 percent), construction starts by area (down 15.8 percent) and electricity usage (up by just 1.3 percent). While the Beijing leadership is under pressure to boost the economy, the slowdown in China is bound up with the broader global crisis of capitalism. The restoration of capitalism in China over the past three decades has transformed the country into a vast cheap labour manufacturing platform that is heavily reliant on exports to the major economies. In highlighting China’s contribution to world growth, Ken Courtis noted on “Lateline” yesterday that “Japan is contracting or in great difficulty still, the US is growing at 2, 2.5 percent, [and] Europe is slugging around at 1.5, 1 percent.” These economies, however, are precisely the markets on which China depends. The latest figures for July showed that exports slumped by 8.3 percent year-on-year, with exports to Europe and Japan down 4 percent, partially compensated by a rise of 7 percent to the US. Following the 2008 global financial crisis, the CCP leadership only maintained economic growth through a massive stimulus package and the expansion of credit. However, with exports and industrial production stagnating, the money flowed into infrastructure spending, property speculation and, more recently, stock market speculation. Notwithstanding occasional rallies in response to government measures to ease credit, falling property prices over the past year, and now plunging share prices, underscore the fact that these speculative bubbles are unsustainable. The Chinese regime is under international pressure to accelerate its pro-market reform agenda, including privatisation of state-owned enterprises (SOEs) and the further liberalisation of the financial sector to open up new profit opportunities for foreign investors. Such measures, however, will only heighten the social gulf between rich and poor and provoke wider social unrest. The last round of privatisations in China resulted in the destruction of tens of millions of jobs. The Beijing regime, which represents the interests of the tiny layer of Chinese millionaires and billionaires, is deeply fearful of the emergence of a movement of the working class. The fact that questions are being raised about the future of Prime Minister Li Keqiang is an indicator of the existing sharp tensions that will only intensify as financial and economic turmoil worsens and impacts on the lives of hundreds of millions of people.

Reduced legitimacy causes the CCP to embrace nationalism---that causes existing territorial disputes to escalate to armed conflict


McKnight ‘13 (Tyler McKnight, M.A. student in International Relations at the University of San Diego, B.A. in Political Science from Villanova University, “Regime Legitimacy and the CCP,” Fall 2013, http://www.sandiego.edu/cas/documents/polisci/TylerMcKnightPaper.pdf, CL)

Perhaps the most reasonable and likely path the CCP will pursue to shore up its legitimacy is by embracing nationalism. There is a lot for the Chinese to be proud of these days. They are a country that has risen from the ashes of the Cultural Revolution to become the second largest economy in the world. Most of the people of China no longer live a life of subsistence, but one of material wealth. Many Chinese can now afford things that were once considered luxury items such as televisions and cars. China has firmly established itself as an economic power. China is now not only economically strong, but also politically and militarily strong on the international stage. After many years of subjugation, exploitation, and humiliation at the hands of foreign powers China is now a strong nation. China is powerful enough now to defend its borders against any potential threat. Increasingly, China is also able to flex its muscles beyond its own borders and territorial waters as exemplified by China’s recent establishment of an Air Defense Identification Zone (ADIZ) over the disputed Senkaku/Diaoyu islands in the East China Sea. China’s ability to project power is quickly catching up with potential rivals such as Japan and the United States.¶ The use of nationalism to support regime legitimacy is not a new concept for the CCP. Since the late 1970s the CCP have been cultivating nationalism as a way to compensate for the weaknesses of communist ideology. After the turmoil of the Cultural Revolution and the “sanxin weiji” (three spiritual crises) the CCP started using nationalism as a way to establish a hegemonic order of political values and as a way to rally popular support behind a less popular regime and its policies by creating a sense of community. The CCP double downed on using nationalism as a way to unite the country and reinforce its legitimacy after the Tiananmen Square protests in the spring of 1989. Nationalism was viewed as a way to counter Western liberal ideas and calls for democracy. As the CCP did after the protest of 1989 and continues to do today, the party continues to sell itself as the protector of the Chinese people against foreign aggression. If the CCP were to allow weakness, disunity, and disorder at home it would open a Pandora’s box. Such chaos would weaken China and give foreign aggressors the chance to reassert themselves. With China’s history of foreign exploitation, such an argument can carry a lot of weight in China. China is once again a strong country and it does not want to fall back into a role of subjugation.xxiii¶ The problem with nationalism is it is a fickle beast. If the CCP were to strongly embrace and stoke nationalism, it would be hard to contain it. If the CCP were to define itself as the guardians of Chinese nationalism it would have to work hard to ensure it appeases the concerns of nationalist. China continues to have a number of festering territory disputes with its neighbors: the continued de facto independence of Taiwan, its border with India, and the Senkaku/Diaoyu islands in the East China Sea to name a few. With its history of foreign exploitation, China is acutely sensitive to any territory dispute. The CCP would have a very hard time maintaining its nationalist credentials if it were to allow other countries to assert control over any of the disputed areas. The Chinese leaders ran into this problem in the late 1990s when there was a distinct rise in nationalism in China. The authors of the popular nationalist book The China That Can Say No were openly critical of the Chinese government for taking a stance they viewed as too soft towards the United States and Japan. They endorsed taking action to annex Taiwan at any cost and open confrontation with Japan and the United States. A move such as this would at best be risky considering China was, and still is, dependent on Japan and the United States to ensure its continued economic growth.xxiv¶ As a result of China’s history of humiliation and the CCP’s need to strengthen its nationalist credentials, China is more likely than other countries to use strong-arm tactics or force to assert itself. Such moves are a double-edged sword for the CCP. They could help the CCP to maintain its credentials as the guardians of the Chinese people, but this would be at the expense of hurting its standing in the international community, or worse, sending China on path towards armed conflict. When military units of opposing countries are in close proximity to each other and tensions run high, it can be very difficult to prevent acts of aggression from spilling over into armed conflict. Posturing on one side can be viewed as an imminent intent to attack on the other. China will have to balance a fine line to ensure their actions are not viewed as too soft at home or overly aggressive by the international community. If the CCP relies heavily on nationalism to strengthen its legitimacy and it is viewed too soft at home, it will hurt the staying power of the regime. If China is viewed as too aggressive by its neighbors, it could face reduced foreign investment, sanctions

xt Economic growth and performative legitimacy is key in a world where many Chinese no longer believe in Communism


The Politic '13 (The Politic, "Performance Legitimacy: An Unstable Model for Sustaining Power", The Politic, January 10, thepolitic.org/performance-legitimacy-an-unstable-model-for-sustaining-power/, CL)

Surely, the CCP’s hold on power for the past three decades suggests that performance legitimacy is a workable model for justifying rule. However, China’s economic growth of the past 30 years was unprecedented in magnitude and duration, as the country averaged 10% growth annually.[8] Thus, the effectiveness of China’s performance legitimacy model was perhaps augmented in ways that normal economic growth would not make possible. Therefore, looking into a future in which China expects high, but more ordinary growth rates, performance legitimacy will inherently be a less effective method of justifying power. Moreover, accustomed to rapid economic progress, Chinese citizens will take growth for granted, reducing the effectiveness of performance legitimacy and elevating the importance of alternative justifications of power. Performance-based legitimation is also unstable because the government must reach ever-higher benchmarks of performance to maintain its rule. Improvements in official accountability, a key tenet of performance legitimacy, can actually make future legitimacy harder to achieve.[9] Specifically, by increasing transparency and accountability, the Chinese government makes its mistakes more noticeable to the Chinese citizenry. Thus, China’s achievements are increasingly at risk of being overshadowed by even minor missteps.[10] In this way, as transparency is increased, China’s achievements produce “diminishing marginal gains” to its performance legitimacy. In other words, over time it becomes increasingly difficult to sustain performance legitimacy. The Chinese government must constantly re-legitimate its rule, as achievements and setbacks keep its performance legitimacy in fluctuation. Therefore, sole reliance on performance legitimacy is unstable because it progressively becomes a less effective method of maintaining power. Overreliance on performance legitimacy is also unstable because when a government fails to deliver on its promises, it loses its only source of legitimacy. As University of Chicago Professor of Sociology, Dingxin Zhao, writes, performance legitimacy is “intrinsically unstable because it carries concrete promises and therefore will trigger immediate political crisis when the promises are unfulfilled.”[11] As mentioned, by improving the quality of life of its citizens through rapid economic growth, the Chinese government demonstrated to its people that it is fit to lead. If China’s economic miracle were to suddenly end, its performance legitimacy would be undermined, and the country could find itself in a legitimacy crisis. Although it would be unfair to say that China is solely reliant on performance legitimacy, the country stands on shaky ideological footing, as most citizens no longer believe in Communism.[12] Moreover, the government possesses weak moral grounds to rule, as corruption is rampant and Chinese citizens are well aware of it (recent revelations of the immense wealth of Premier Wen Jiabao’s family is a prime example).[13] Thus, if China’s economic growth were to cease, the country would lack other forms of political justification to compensate for a decline in performance legitimacy. As a result, Chinese citizens might withdraw support of such a government lacking ideological and moral grounds to rule. Some may argue that performance legitimacy alone has enabled the CCP to maintain its rule for the past thirty years; improvements to governing accountability bolstered China’s performance legitimacy and allowed it to sustain power. Surely, the Chinese government has made great strides toward comprehensive governing accountability, as bureaucratic administration has become more “institutionalized, regulated, and disciplined.”[14] However, a system that lacks moral grounds to rule inherently can never fully deliver on governing accountability. Thus, a government cannot maximize its performance legitimacy unless it possesses a moral justification to rule. For example, China’s government is not morally justifiable because corruption is rampant and even shows signs of worsening.[15] If a government were held fully accountable for its actions, its officials could not get away with actions such as misusing public funds and amassing vast private wealth. However, as corruption is rampant in China, the government obviously does not possess governing accountability. Thus, a lack of moral justification to rule indirectly weakens a government’s performance legitimacy by undermining its governing accountability. By contrast, moral legitimacy is a prerequisite of full governing accountability. Therefore, a regime that intertwines both moral and performance legitimacy is inherently more stable than one that is not morally justified. Moreover, a lack of ideological agreement between citizen and state necessarily reduces one’s quality of life. Since people naturally favor a system in which their quality of life is maximized, a system that relies on performance legitimacy and neglects moral and ideological legitimacy is not as stable as one that intertwines both forms of legitimacy. Performance legitimacy takes into account some aspects of quality of life: economic well-being, social stability, governing competence, and accountability. However, quality of life also intrinsically entails concomitant ideology, ethics, and morality. For example, Chinese citizens do not possess freedom of expression, and the government censors material that could subvert the Communist regime. When I was in China, many of my college friends openly criticized the CCP’s censorship of the Internet. Others were less vocal, but nonetheless shared a desire to be able to freely express themselves, both in person and online. Forbidding freedom of expression reduces one’s quality of life because by restricting expression, the government takes something of value from its citizens. Similar arguments could be extended to a just legal system, or an upright leadership. Thus, a regime that possesses performance legitimacy in addition to moral and ideological legitimacy is more stable than one that is solely reliant on consistent performance.

U.S. Economy Add-On

Independently, U.S. public health depends on public health engagement with China


Hickey '14 (Christopher Hickey, Ph.D. Countr Director for the People's Republic of China, "China's Healthcare Sector, Drug Safety, and the U.S.-China Trade in Medical Products", U.S. Food and Drug Administration, www.fda.gov/NewsEvents/Testimony/ucm391480.htm, CL)

This rapid globalization of commerce poses challenges. For example, drugs and medical device manufacturers have the responsibility for the safety and quality of the drugs and devices they produce. Some countries do not have strong regulatory system oversight to ensure industry is meeting the standards required for safety and quality of these products. Increased numbers of suppliers, more complex products, and intricate multinational supply chains can introduce risks to product safety and quality. Unfortunately, these factors also mean that consumers can more easily be exposed to risks, including those from intentional or unintentional adulteration, as well as those that come from exposure to contaminated products. Below, I will discuss FDA’s implementation of its comprehensive strategy to use strong global partnerships to enhance the safety of imported products. Many of the challenges associated with globalization manifest themselves in China; however, challenges we see in China mirror challenges we see in other countries with developing regulatory systems. In recent years, FDA has faced several public health threats related to imports from China. The members of this Commission will recall the threats to the safety of the country’s heparin supply in 2007 and 2008, which emerged when Chinese suppliers of heparin (a critical drug that helps to prevent blood clots) substituted a lower-cost, adulterated raw ingredient in their shipments to U.S. drug makers. This substitution caused numerous deaths, as well as severe allergic reactions. In 2007, FDA found shipments of toothpaste from China that contained poisonous levels of diethylene glycol, a product used in antifreeze. And in China’s dmestic supply chain in 2012, numerous companies used industrial-grade gelatin to make pharmaceutical-grade gelatin capsules for drugs and dietary foods. This industrial-grade gelatin contained more chromium than the edible gelatin that firms should have used. FDA’s success in protecting the American public depends increasingly on the Agency’s ability to reach beyond U.S. borders and engage with its regulatory counterparts in other countries. This collaboration encourages the implementation of science-based standards to ensure the quality and safety of FDA-regulated products manufactured overseas and imported into the United States. It is equally important for FDA to partner with industry, and with regional and international organizations to accomplish this goal. FDA works with numerous partners to enhance responsibility and oversight for safety and quality throughout the supply chain.

Healthcare improvements in China causes economic growth for both countries


Huang ’16 (Yanzhong Huang, Senior Fellow for Global Health, Council on Foreign Relations, and professor of Diplomacy and International Relations at Seton Hall University, “China’s Healthcare Sector and U.S.-China Health Cooperation”, April 16, Council on Foreign Relations, CL)

Transformation in both countries’ healthcare sectors are generating extra business opportunities. In the JCCT healthcare event, Dr. Michael Lu of U.S. Department of Health and Human Services identified five changes in the U.S. healthcare system: improved access through the Affordable Care Act, payment reforms, delivery systems transformation, health information technologies, and quality improvement and innovation. Similar dynamics can be found in China. With the government targeting healthcare as a social and strategic priority, the healthcare market is rapidly expanding. China now trails the United States as the second largest market of health industry in the world. It is estimated that five years from now the size of China’s health service industry—which covers medical care, pharmaceutical products, healthcare products, medical devices, and health management—would reach $1.3 trillion, up from less than 1.7 trillion RMB in 2012. This would mean an annual growth rate of 21 percent between 2012 and 2020. But U.S.-China cooperation in healthcare is not just about market opportunities. It is also about how to improve health and well-being of the people in both countries. The two objectives are not necessarily mutually exclusive, but without proper regulation and balance of interests, single-minded pursuit of business opportunities may exacerbate the problem of affordability, thereby defeating the very purpose of the healthcare reform. Already, demographic and epidemiological transitions against the background of moving toward universal health coverage have raised concerns regarding financing and cost control in both countries. The growing cost of healthcare highlights the importance of cooperation in preventive care. Over the past years, both countries have been collaborating over tobacco control research and tobacco surveillance. But the areas of cooperation can be further expanded to include health management, environmental health, healthy life style promotion, and encouraging the private sector and social forces in health education and risk reduction. Meanwhile, in seeking cooperation with China we have to keep in mind the inherent dilemmas and contraditions in China’s health policy processes. While the 13th Five Year Plan suggests that China is willing to allow the market to play a more decive role, it continues to rely on heavy-handed industrial policy in pursuit of the growth of its healthcare and pharmaceutical industires. While the government welcomes the entry of foreign business and investment, it has increased information and ideological control while sustaining its devotion to bolstering domestic industrial competiveness. Against this background, the U.S. Congress is advised to work more deligently and closely with the executive branch to pressure Beijing to improve the operating environment of U.S. businesses in China.

U.S. health is important to the U.S. economy


Blanding '12 (Michael Blanding, Boston-based journalist and author, "Public health and the U.S. economy", Harvard School of Public Health, Fall 2012, https://www.hsph.harvard.edu/news/magazine/public-health-economy-election/, CL)

How the next U.S. president can stack the deck in favor of people’s health and wealth in 2013 With the November 2012 elections on the horizon, Americans surveyed in national polls consistently rank the economy as their number one concern. Public health professionals can have a big impact on this ballot-box issue. More than 17 percent of the U.S. Gross Domestic Product is spent on health care—in many cases, for conditions that could be prevented or better managed with public health interventions. Yet only 3 percent of the government’s health budget is spent on public health measures. A 2012 study in Health Affairs notes that since 1960, U.S. health care spending has grown five times faster than GDP. Why do these numbers matter? First, a healthier workforce is a more productive workforce. According to an April 2012 report from the Institute of Medicine (IOM), the indirect costs associated with preventable chronic diseases—costs related to worker productivity as well as the resulting fiscal drag on the nation’s economic output—may exceed $1 trillion per year. A 2007 study from the Milken Institute found that when unhealthy workers show up on the job, as many must to survive financially, the effects of their lower productivity on the nation’s economic health are immense: in dollar value, several times greater than the business losses accrued when employees take actual sick days. Avoidable illness also diverts the economic productivity of parents and other caregivers. Second, the costs of health care are built into the price of every American-built product and service. And the per capita cost of health care in the U.S. is higher than in any nation in the world. If the U.S. can reduce the costs of health care over the long term—by preventing diseases that require costly medical procedures to treat and by making our existing health systems more efficient—the costs of American products can become more competitive in a global marketplace. Today, U.S. per capita health expenditures are more than twice the average of other countries in the Organization of Economic Cooperation and Development. The IOM estimates that cutting the prevalence of adult obesity by 50 percent—roughly the same reduction across the population as was achieved through public health’s multipronged attack on smoking in the late 20th century—could cut annual U.S. medical care expenditures by $58 billion.



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