Keeping the doctor away

"I cried a lot today," wrote 27-year-old new mother Zhai Chen, adopting the point of view of her infant daughter. "I've gained 750 grams of weight since last month. I prefer being fed with infant formula imported from the Netherlands - in comparison, my mother's breast milk seems quite dull."

Zhai has been keeping a diary like this ever since giving birth. Each entry is written from the perspective of her now 2-month-old daughter, and records every physical change in her brief life thus far.

Zhai has also been keeping a notebook with detailed records about changes in her own physical condition throughout her pregnancy.

"Every time I go to the hospital, I copy down the questions that the doctor asks me, and keep a record of the results," said Zhai. "The doctors told me I'm the most earnest pregnant woman they had ever seen."

These personal health records are part of a deliberate effort by Zhai to monitor and manage her own well-being. She is following in the footsteps of her sister, who was similarly diligent about recording her son's physical condition when she gave birth.

"One time, her son suddenly started vomiting. The doctor read through my sister's diary, and from what she had recorded, correctly diagnosed that her son had a gastrointestinal tract obstruction," said Zhai.

Zhai and her sister's conscientiousness about keeping records of their own health and that of their children's are part of a wider movement that is gaining popularity in China called jiankang guanli, which can be roughly translated as "health maintenance."

The idea behind health maintenance is to maintain general well-being at all times. One's physical condition is constantly monitored, so rather than having to resort to seeing a doctor after one comes down with an illness, small interventions, such as an adjustment in diet or an increase in exercise, can be taken in order to prevent illness in the first place.

To practice health maintenance, a large number of people have taken to self-monitoring, as there are currently few accredited professionals that are able to provide such services in the country. Furthermore, medical records kept by hospitals or clinics cannot be shared between health providers in China, which means that there is a practical incentive for people to keep records of their own.

An industry in the making

Earlier this month, the Ministry of Human Resources and Social Security announced that it would be introducing training courses for health maintenance at government-sponsored training centers known as CETTIC (China Employment Training Technical Instruction Center) to meet demand for official accreditation.

In an interview with Chinese newspaper the Life Times, Gao Lianfeng, the director of CETTIC, said that the role of health maintenance professionals was to make and keep medical records for individuals, to analyze and assess personal medical records, and to give consultation and guidance that would promote general well-being and prevent potential illness.

The introduction of health maintenance as a part of China's healthcare system can be compared to the "managed healthcare" system that was introduced in the US following the enactment of the Health Maintenance Organization Act of 1973. Under the act, health maintenance organizations developed a set of techniques designed to reduce unnecessary health costs and hospital care.

According to a report published in Hangzhou-based newspaper the Daily Business, 7 out of 10 Americans subscribe to some sort of health maintenance program, while in China, only 1 out of every 150,000 people use a similar service.

The role of health maintenance in China might also be compared to that of a general practitioner or a family health clinic in the UK. In Chinese cities, the idea of a family doctor who oversees an individual's general well-being is largely unknown, except in private clinics.