A new report by the World Bank that calls on China’s urban planners increase the density of its cities instead expanding its existing urban centers, or constructing entirely new ones. Many of the thought leaders in medical tourism camps and global health camps argue that the two are not related, one having to do with tourism attraction and the other having to do with public health. But I would argue that they intersect at a point that both may have overlooked: urban and regional planning.
China is in the middle of moving about 100 million rural Chinese to cities as part of an urbanization drive intended to help the economy. By 2020, a total of about 1 billion Chinese people, or 60% of the population will be urbanized, the government projects. But observers say it’s been difficult to direct the flow of rural migrants, who have traditionally moved to the larger coastal cities where urban sprawl, traffic and pollution are getting worse.
According to the World Bank, one answer is denser urban development, which reduces commuting times as well as congestion and pollution. Denser cities could save China about $1.4 trillion in infrastructure spending, or the equivalent of 15% of last year’s GDP, the report says. And denser urban planning should help conserve the shrinking amount of land that China has to feed its population, which has lowered the country’s self sufficiency.
There is an almost perverse reason why Chinese cities have not embraced greater density: Money. Local governments are highly dependent on selling undeveloped land to developers. Redeveloping existing cities to make them more dense wouldn’t result in any local government revenue. The World Bank noted that “denser urban planning would curb local governments’ reliance on land-based financing and limit the risk of unregulated borrowing,” which would surely be a good thing for China’s economy in the long run. But that very reliance is also the biggest impediment to the smarter, denser, urban development that the country needs.
Another place where Chinese self-sufficiency is threatened is in its privatized health delivery. Without private health options that afford Chinese rural residents an opportunity to buy private western-medicine health access and services locally, China’s rural population opts to leave the country to buy what they want elsewhere because the developers that are buying up the land for those projects are not developing privatized hospitals and clinics in the rural areas.