Written by Jane Pei-Chen Chang and Kyle Kai-Yuan Cheng.
What is the status of Taiwan in global health? What is its role in the World Health Organization (WHO)? What efforts have been made by Taiwan to help prevent global disease outbreaks and improve the health care status of global citizens?
From a global perspective, Taiwan boasts respectable medical achievements and an accomplished health system. It was the second country in Asia to provide universal health coverage and the University of Washington recently ranked it 34th out of 195 countries for access and quality of healthcare. Presumably, a country with such expertise in health should be coveted by the global health community and assume an active role. However, Taiwan’s “irregular statehood” has proven to be pernicious in that regards. This is perhaps best illustrated by Taiwan’s participation in the WHO, an organization deeply embedded in statehood-oriented global politics.
Taiwan’s health care system
Despite not being recognized by the WHO as one of the gatekeepers for global health, Taiwan has managed to provide health insurance to 99.9% of its population. The current healthcare system, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan that centralizes healthcare funds for redistribution. One of the highlights of NHI is that it promises equal access to healthcare for all citizens, regardless of social status, race, gender and age. NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. Moreover, Taiwan has better healthcare coverage than most of the countries in the WHO—where the lottery of one’s postcode does not impede access to healthcare—and has set a healthcare model for other countries to follow. Although NHI is not perfect and has flaws that need fixing, the implementation of universal healthcare coverage over the past two decades has helped Taiwan to improve its life expectancy and decreased infant mortality. As of 2018, life expectancy is about 80 years of age and the infant mortality rate is around 4.3 deaths per 1,000 lives.
Taiwan and the WHO
Taiwan was an active member of the WHO until 1972. This was when the Republic of China (ROC) departed the organization, bringing Taiwanese’s representation to a halt. Notable participants include Dr. I. C. Fang, who served as the inaugural director for the Western Pacific Regional Office (WPRO) between 1951 and 1966, and Dr T. Y. Lin, the WHO’s director of mental health between 1964 and 1969. The contributions of such individuals were accompanied by Taiwan’s wider participation in WHO programmes, with the International Pilot Study of Schizophrenia (IPSS) an important example.
Taiwan’s absence from the WHO has greatly limited its contact with the global health community. In 1997, it began its campaign to return to the most important institution for global health governance with a bid to take part in the World Health Assembly (WHA) as an invited observer. From 2009 to 2016, Taiwan received one-off invitations from the WHO’s Director-General to participate in the WHA as an observer. After this practice abruptly ended in 2017, Taiwanese health officials once again have had to resort to unofficial routes to make their voices heard and to exert influence (for instance, organising side events at self-found venues in Geneva at the time of the Assembly).
Taiwan has also been endeavouring to take part in other WHO affairs, including multiple other meetings and programmes. Under a special arrangement, Taiwan’s health administration has been involved in the International Health Regulation (IHR), a mechanism for disease outbreak surveillance and reaction. Unfortunately, these attempts have also been hindered. This February, Taiwan was prevented from taking part in a WHO technical meeting on flu vaccines held in Beijing.
As it should be, Taiwan’s participation in the WHO system has never been confined to governmental projects, nor is Taiwan’s interest in global health limited to the WHO. Recognising its difficult diplomatic position, Taiwan knows that it has to seize every opportunity for global health participation. In 2016, Taiwan hosted the general assembly of the World Medical Association (WMA), an influential NGO and close partner of the WHO. Furthermore, and despite all the hardship, Taiwan is not without allies. Governments including those of the United States and the European Union continue to voice support for Taiwan’s participation in the WHO. If there is a single strongest conviction behind Taiwan’s tireless fight for its representation in global health, it is that Taiwan takes it as a responsibility to work together for the advancement of human health as a whole.
Safeguarding global health should be the responsibility of every citizen on this planet. Health should always come before politics: Taiwan should be recognized for its efforts in global health and have an active role in the WHO to help promote the health and well-being of all people.
Jane Pei-Chen Chang is a PhD student in Institute of Psychiatry, Psychology & Neuroscience, King’s College London. She was also a fellow of Child and Adolescent Psychiatry in National Taiwan University Hospital. Kyle Kai-Yuan Cheng is a PhD student in Psychiatry at University College London. He is also a columnist for Crossing and a visiting scholar at Institute of Sociology, Academia Sinica, Taiwan. Photo Credit: CC Flickr: United Nations Photo.