‘My health is my own business’: Radio,television and advice media in post-Mao China

Context

One of the key reform processes responsible for these profound social transformations is the privatization of the public sector, including public health, education, housing, and other goods and services. When the People’s Republic of China (PRC) was founded, a state-owned and -sponsored public health care system was put in place, in which citizens enjoyed open and relatively equal access to state-funded public health care. This was to change, however, in 1978, when the central government began an incremental process of shifting responsibility for medical services onto provincial and local authorities. A series of reforms in the 1980s, and particularly in the 1990s, introduced major changes to China’s health system, including a reduction of public funds, a higher degree of financial independence for public hospitals and health centres, and allowing the private ownership of health facilities and practices. Rather than outright privatization, these reforms have taken the form of institutional restructuring. These reforms led to a series of problems plaguing the urban hospital, including overcrowding, inflated drug prices, and medical negligence and corruption. (Cooper, 2016). This process has also led to decentralized and deregulated medical and pharmaceutical production and distribution, enabling individuals to seek their own medical products and treatments on the market on the one hand, while also encouraging dodgy practices on the part of private clinics and pharmaceutical companies, on the other. As Nancy Chen observes, health becomes a mirror of inequality in the new economy, and facing the fear of illness and exorbitant cost of health care, people, both rich and poor, turn to the consumption of pharmaceuticals and over-the-counter drugs as preventive measures (Chen, 2008). In 2000, the World Health Organization no longer advocated China’s health care system as the model for all developing countries. Instead, it ranked China 188 on its scale of ‘fairness in ‘nancial contribution’ (Wang, 2004: 18).

To address the inherent inequity in earlier reforms, over the past decade or so the Chinese government has introduced a number of health insurance schemes that feature an increase in government investment and that aim to maximize affordable coverage. However, although up to 95 percent of the Chinese population now participate in some kind of medical insurance scheme, the nation’s total health care budget in 2011 was still only 5 percent of total fiscal expenditure, which is less than 2 percent of GDP. Furthermore, despite the fact that 75 percent of listed medicines are now covered by rebates, medicine and medical services are still too costly. People in both urban and rural areas routinely experience difficulty in seeing a doctor (Xie, 2012).

The gradual withdrawal of state funding from public health care, along with other market-oriented reforms, has impacted on individuals in myriad ways. Government officials and state-owned enterprise (SOE) managers now feel less protected than before, even though their health care is still covered either partly or largely by workplace-based social insurance. In comparison, a number of social groups who comprise a large percentage of the Chinese population – workers laid off by SOEs, peasants living in rural areas, rural migrants working in flexible, informal jobs, and urban poor subsisting on minimum social welfare without social insurance – find themselves much worse off. Now subject to an unwritten principle of ‘no medical service without fee payment’ (Interview, 15 May 2013), ¹ ordinary people have to bear the financial burden of health care when they are diagnosed with an illness, including serious terminal and chronic diseases. It is therefore not surprising that many people are refused medical services because they cannot pay (Wang et al., 2009).

As far as the party-state and social policy makers are concerned, aged care, health care and education constitute China’s most serious challenges; indeed, they have been described as the ‘three new mountains’ facing the Chinese Communist Party (CCP) (Wu, 2009). The central government is acutely aware of the likely political ramifications of these challenges. A comprehensively inequitable system that denied the majority of the population adequate and affordable health care would be a most telling indictment of the government’s ability to build social harmony and improve people’s livelihood – the stuff of President Xi Jinping’s China Dream. After all, the maintenance of social stability, key to the political legitimacy of the CCP, hinges on minimizing discontent, insecurity and the general level of unhappiness in the population.

The privatization of health care has led to a range of privatized health-maintaining practices on the part of the Chinese people. One study points to an explosion of ‘self-health’ information in China in the 1990s (Farquhar, 2001). Another study finds that the high cost of health care, combined with people’s underlying fear of illness, motivates them to practise self-medication (Chen, 2008). Another recent study of the everyday health-keeping practices currently engaged in by urban Chinese residents argues that biological citizenship has indeed become a new and integral dimension of China’s citizenship project in the 21st century (W Sun, 2015). This body of evidence points to the fact that, just as in the global West, how to care for the body has indeed become a matter of choices and options (Giddens, 1991: 8). However, so far, little work has been done to interrogate the role of the media. Nor is there much consideration of how health communication presents itself as a new area in which to pursue issues of social justice, equity and access, and marginalization.

Concerned with addressing these gaps, this article begins by raising several exploratory questions: What shape and form does health-related advice take on radio and television? What are the political and economic factors – both global and domestic – that account for its emergence and popularity? What is the role of these programs in creating ‘self-governing subjects who will enrich and strengthen Chinese authoritarian rule’ (Ong and Zhang, 2008: 10)? The significance of pursuing these questions is at once empirical and theoretical. As is true elsewhere, health is an object of both state governance and market consumption. An examination of how the media teach the public to engage in a health-maintaining regime is by implication an analysis of how disciplinary power (Foucault, 1977) works in post-Mao China. Our study will help uncover the distinct strategies and challenges facing the Chinese individual as a ‘risk subject’ (Beck, 1992). If economic reforms and modernization have led to more social inequality, how is risk distributed?

As is the case elsewhere, the internet and self-help books are often logical places for urban, educated Chinese to seek information and advice on a wide range of matters. However, in a country where access to information is more than ever stratified along the lines of class, gender and the rural–urban divide, free-to-air radio and television are still the most popular sources of advice due to their ubiquity and affordability, and the low demands they make on reading and technological literacy. That is why, in spite of a swathe of magazines, periodicals and around 6,000 other publications that can be found on the shelves of various bookstores across the country, it is the wide range of free-to-air health-related advice on radio and television that the majority of consumers turn to first and foremost (Guo, 2011).

Our discussion draws on interviews with radio and television practitioners and audience members, and integrates a political-economic account of knowledge production with a cultural analysis of media. Focusing on radio and television as two key sites of public health communication, we first trace the emergence and development of the main health-related advice genres on radio and television in the latter half of the reform period (that is, from around 1990 onwards) – the decades when economic reform started to gain momentum and China began to see dramatic socioeconomic transformation. This will be followed by a more detailed discussion of the content, form and themes of health information and advice, first on radio and then on television. We then conclude by considering the reasons for, and implications of, the key connections and differences we have identified between these two sites.

The emergence of infomercial radio and lifestyle television

Infomercial radio started to appear in China in the 1990s as a result of the convergence of a number of factors. First, as discussed earlier, was the commercialization of medicine and the health care system in post-Mao China. In 1984, the Standing Committee of the National People’s Congress adopted the Law of Regulating Medicines, allowing the establishment of pharmaceutical manufacturing enterprises and assigning responsibility for their regulation to the local administrative level (Standing Committee of the National People’s Congress of the PRC, 1984).

Local governments soon recognized that increasing the production of pharmaceutical supplies was a profitable industry capable of boosting local economies. One study reveals that, by 2006, the number of drug manufacturing firms in China had increased to more than 5,000 (Q Sun et al., 2008). Meanwhile, both individuals and organizations participated in this distribution process, resulting in a growing number of pharmaceutical sales-people, private and hospital-run pharmacies, and other alternative and even underground channels. Ordinary Chinese citizens described their approach to medical consumption as ‘go to hospital if it is serious; go to the pharmacy if it is a minor problem’ (dabing qu yiyuan; xiaobing jin yaodian) (Yuan, 1997: 17).

In parallel with this commercialization of the health domain, China’s media and communication sector has also undergone the transforming processes of globalization and marketization (Y Zhao, 1998, 2008). In the early 1980s, national, provincial and municipal radio stations all began exchanging programs with foreign countries and regions, in particular classical and popular music programs (Lynch, 1999: 123). With the arrival of television in post-Mao China, the viability of radio came under threat, prompting it to resort to selling a great deal of airtime to advertisers in order to survive. A technician who works for one local radio station in a county-level city in Shandong Province in east China recounts the efforts to attract advertising in the early 1990s:

I joined the local broadcasting station in late 1991. The station already had trouble paying our salaries. The head of the station asked all of us to look for sponsors and advertisers. As a result, almost anything could be advertised on air as long as we could make a buck. (Interview, 15 May 2013)

The media played a significant role in the commercial success of a range of health product brands in the early 1990s (Han, 2005). Health products advertised on radio included, and continue to include, medicine, non-drug medical treatments, medical devices and private medical service providers. In particular, since the 1990s, as sexuality has grown into a key site for cultivating desire and (re)constructing individual subjectivity (E Zhang, 2007), medicinal products treating male sexual dysfunctions proliferated on air. Some medicinal product manufacturers and sales representatives became very wealthy very quickly from selling medicinal products treating sexual problems (E Zhang, 2007).

The scale of medical advertising and the range of medical products treating a variety of diseases have increased in subsequent years. An article published in 2005 indicates that if health-related programs were to be taken off air, from 20 to 60 percent of airtime on many radio stations would be vacant (Lü and Li, 2005). A 2012 report reveals that six out of nine Beijing radio stations aired health-related programs during the survey period, occupying 17 percent of total daily airtime of the nine Beijing channels considered (Xu et al., 2012). This figure goes up to more than 30 percent on some provincial radio stations. Each of over half of the 28 provincial radio stations surveyed has three or more channels that air health-related programs (Xu et al., 2012). Echoing this trend, a 2008 report reveals that the health industry had been among the top five industries to invest in media advertising in the period since 2002 (Lan et al., 2008). In the media sector, the advertising revenue from the health industry ranks first, with an 18.54 percent share of total national advertising revenue in 2009. In radio alone, medical call-in programs accounted for between 50 and 90 percent of total revenue across a number of radio stations; in one extreme case, 96.7 percent of the advertising revenue of a local radio station came from medical advertising (He, 2004).

As advertising on radio proved to be highly lucrative both to pharmaceutical companies and the radio sector, egregious practices such as false advertising and fraudulent, counterfeit or sub-standard products inundated radio infomercials. In response to growing public complaints about medical advertising over-promising and under-delivering, the government announced a series of measures aiming to regulate the market. Despite these initiatives, however, punishment for false and fraudulent advertising is lenient considering the size of the lucrative business of medical advertising. One interviewee, who used to be a pharmaceutical sales representative in the provincial city of Jinan in Shandong Province in the 2000s, recalls that the profit margin was up to 500 percent: the production cost of the medicine he represented was 22 RMB and the sales price was 138 RMB (Interview, 11 April 2014).

Public complaints about unethical practices in medical advertising on radio are perennial, calling for a more systematic mechanism of scrutiny and control. In response to such concerns, the key institutions in charge of medical advertising in the central authority have strengthened the existing medicine administration law and regulations, and improved the standards for the examination and publication of medical advertisements. Also, the pre-advertising approval and post-advertising supervision system is updated frequently whenever it is necessary to deal with emerging problems in medical advertising practice. The regulations also call for the establishment of an accountability mechanism and self-regulation in the media and communication industries. National and local radio stations in developed regions have been told to reduce health infomercial broadcasting on a large scale, whereas implementation has been less stringent for local radio stations in less developed regions. Since 2006, The Voice of China, China National Radio’s flagship channel, has banned medical advertising during morning prime time, from 6:00 am to 9:30 am (D Zhao, 2006). However, health-related infomercials continue to be a significant source of revenue for quite a number of local and provincial radio stations.

Given that a radio set or transistor radio had been a standard feature of Chinese households for a long time before the arrival of television, it is unsurprising that the earliest form of health-related advice appeared on radio. By contrast, television did not penetrate the Chinese household until the late 1980s (Lull, 1991), and real competition in television did not start until the end of the 1990s. Prior to 1998, viewers could only access television content produced by their own provincial television stations, but since then, thanks to satellite technology, all provinces have started to transmit their main television channels to a national audience. Not only did this transform Chinese television into an extremely competitive, diverse and dynamic sector, but it also effectively ended the monopoly of national television (Y Zhao, 2008; Zhu and Berry, 2009).

If the marketization of medicine and health care was mostly responsible for the proliferation of medical advertising on Chinese radio in the 1990s, the emergence of health-related programs on television since the late 2000s can be explained in terms of the media’s transformation of this everyday, grassroots and individuated cultural tradition into a commodified, consumption practice. Yangsheng, meaning ‘life nurturance’, ‘health cultivation’ or ‘wellness promotion’, is an age-old cultural practice which reflects the philosophy of self-cultivation in the earliest Daoist and Confucian works (Farquhar and Zhang, 2012). Known for its objective of treating the ‘not yet ill’ (Zhan, 2009), yangsheng has existed outside the health care system, yet is always considered fundamentally compatible with the knowledge of Chinese traditional medicine (Zhang and Qu, 2005). Yangsheng, in its various forms and shapes such as tai chi and qigong, has been practised by Chinese people for a long time, even before the reforms in the medical system.

For media and cultural industries, yangsheng is not only an age-old tradition, the promotion of yangsheng-related knowledge is also big business. Facing stiff competition, television, like radio, also has to identify cost-effective ways of making programs. In other words, the production of yangsheng-related programs also makes perfect economic sense. As a producer from Hunan Satellite Television indicated, yangsheng programs cost little to make, and, unlike some entertainment programs, usually require a fairly basic studio set-up. The labour of the ordinary – mostly elderly – people who are willing to ‘star’ in these programs is free. Furthermore, such programs rate very well and so are highly lucrative in terms of advertising dollars; and payments to the medical experts who appear on the program are fairly moderate and are considered money well spent. So the decision to produce health-related advice programs, in the words of one Hunan Television producer, is a ‘win-win situation’ (Lin, 2010). Currently, there are more than 1,300 television programs on Chinese local, regional and national television that claim to specialize in the cultivation of health (Guo, 2011). Though these shows do not rate as highly as entertainment programs, they generate considerable revenue through product placement, product-sponsorship and advertising.

Radio infomercial, risk and the promise of a cure

We need to distinguish between health-related infomercials and the advertising of medicine. While the latter is relatively straightforward in terms of form and content, the former warrants careful consideration. The predominant form of health infomercial radio is a genre of radio programs that have titles such as Health Dictionary, Nutrition Dictionary and Expert Clinic to legitimate their claim to knowledge. Each episode normally lasts for one to one and a half hours, depending on the arrangement between radio station and advertiser, and consists of three segments. The first segment is a recorded piece containing a number of claims about the efficacy of the advertised products. In the second segment the in-studio expert delivers a short lecture about how the body works and an explanation of the causes of diseases. These lectures typically mix knowledge and interpretations drawn from western biology, medical science and traditional Chinese medicine. Finally, listeners are invited to call the expert with questions and comments.

The overriding message in these infomercials is the promise of a cure. We have identified a number of key strategies health infomercial radio employs in its production of this promise: the construction of expertise, the scientific nature of knowledge, the establishment of an appreciative doctor–patient relationship and the idea of the customer getting their money’s worth. For illustration, we turn to a particular health infomercial program that aired on Shanxi Provincial Radio’s ‘Voice of Health’ channel on 8 April 2014. The medicinal product that is the focus of this particular show is a capsule that the manufacturer claims improves the health of human cells. ‘Teacher Yu’, a female in-studio guest, is introduced as a veteran medical professor who has mastered both western and Chinese medicine. Professor Yu explains the fundamental significance of cells to the body, providing factual knowledge that also justifies the mechanism of the promoted capsule:

When cells are sick, the body is sick. Cells renew themselves every 100 to 120 days. They have a capacity for self-recovery. (‘Voice of Health’ radio channel, 8 April 2014)

Professor Yu backs up her statement with reference to cell theory, introduced as a fundamental theory in medical science. Based on this theory, disease is arguably the consequence of damage to cells, the basic units of the human body. The advertised product is claimed to have the capacity to improve human cells and facilitate the cell renewal process.

Infomercial health programs usually adopt a talkback format, enabling interaction between in-studio experts and their ‘patients’, the listeners. This two-way communication enables the production of an appreciative relationship between the doctor and patients. The in-studio speaker deploys her diagnostic skills to respond to callers’ questions and confusions, exhibiting her expertise as well as expressing care, concern and responsibility. Professor Yu offers a simple diagnosis based on callers’ individual descriptions of their physical condition and symptoms. For example, one female caller consults Professor Yu about her grandson, who is suffering from frequent coughing due to bronchitis. After learning that the child has been vulnerable to flu and has been taking anti-flu medicine for a prolonged period, Professor Yu analyses the case in a sympathetic voice:

The immune system has been ruined by the consumption of anti-flu medicine from an early age. His bronchitis is a man-made disease. (‘Voice of Health’ radio channel, 8 April 2014)

The positive on-air relationship between doctor and patients is produced through the callers’ passionate appreciation of the expert’s knowledge, and callers’ grateful testimonies about the efficacy of the products being promoted. One caller expresses his gratitude to Professor Yu:

Hi Professor Yu. Thanks for your efforts! I’ve been listening to your program for three days … [and] this product is really good for the body. (‘Voice of Health’ radio channel, 8 April 2014)

Health infomercial radio adopts the tactic of emphasizing the claimed scarcity of the product being advertised – that it is normally only available in specified pharmacies, and only for a limited period and in limited quantities. This hard-sell approach, combined with the offer of a discount, leads listeners to believe that they are getting good value, and it was a feature of all the health infomercial radio programs we listened to for the research. For example, listeners to a program called Health Hotline (Jiankang Rexian) learn that a particular medicine

treats multiple chronic diseases and problems, which both traditional Chinese medicine and western medicine have failed to cure.… The original price was 2970 RMB, but it’s now been reduced to 1470 RMB – a saving of 1500 RMB. (Jiankang Rexian radio program, 10 April 2014)

Apart from men concerned about their sexual performance, another significant segment of the population persistently targeted by these programs is the elderly, especially ‘empty-nesters’ (kongchao laoren). To address these intended listeners, in-studio speakers use terms such as ‘middle-aged and senior friends’, ‘old brother and old sister’ and ‘old comrades’. Callers normally highlight their age and their physical difficulties when introducing themselves. Due to the ageing process, the elderly are conventionally targeted as the group most likely to face life-threatening diseases – a strategy predicated not only on their concern about health but also on their media consumption patterns. The elderly represent a generation who developed an interest in listening to radio in Mao-era China, and they have maintained a regular habit of listening to radio in post-Mao China.

Other marginalized groups, in particular those with rural backgrounds – rural residents and rural-urban migrant workers – have also been the target of health infomercial radio. Since the 1990s medical advertising has continually targeted rural residents, following market research that points to their being more susceptible to infomercial-style marketing. These cohorts tend to have a low level of literacy, and because of this they tend to be less suspicious. Furthermore, they are less able to afford a high level of standard health care. The following account, from a medical advertising practitioner, is telling:

In Zhoukou, Anyang and Jiaozuo, in Henan Province, where an increasing number of people are leaving their hometowns for work, the population left behind consists mainly of women and the elderly. Since they face a wide range of illnesses including heart disease, brain and blood vessel problems, high blood pressure, diabetes, cataracts, liver disease and stomach disease, it is easy to promote medical products targeting these individuals. (Interview with Lanhai Zhida Team, 2010)

It is clear, then, that the promotion of medicinal products on radio targets socially and economically marginalized groups, but this strategy is driven by economic interest rather than an ethos of social responsibility. The irony here is indeed unfortunate: the emergence of this form of media ‘advice’ can be seen as an initiative to exploit a palpable sense of fear and anxiety that is associated with an awareness of being particularly at risk. And this business strategy makes infomercial radio itself a health risk through its promotion of often less-than-standard products and sometimes even outright fraudulent medicines.

Despite the potential health risks associated with sub-standard medical products advertised on health infomercial radio, some individuals naïvely cling to the socialist conception of the Chinese media as the mouth and tongue of the state, thus attributing a high level of public responsibility to the Chinese media. For instance, two interviewees in their fifties recalled that they chose to believe the claims of health infomercial radio in the 1990s because they were broadcast on state-owned media (Interview, 25 May 2013). And even in the 2000s, the credibility of the state-owned Chinese media’s advertising – if not its news propaganda – still held sway. When Fan Deng, a user of Sina Weibo (the Chinese counterpart of Twitter), warned his father that the health product he had bought after listening to health infomercial radio was likely to be ‘dodgy’, the father refused to listen. He did not want to believe that state-owned radio would air anything untrue (Fan, 2013).

Dancing a pas de deux between fear and anxiety on the one hand, and hope and faith on the other, infomercials simultaneously generate, and then address, the feeling of being ‘at risk’. As a result, individuals from these groups are not only more at risk of suffering from illness and disease, but they are also more at risk of falling victim to hoaxes and scams. For this reason, radio infomercials present themselves as good examples of how socioeconomic inequality leads to and manifests in the uneven distribution of risk.

Lifestyle television, health advice and the ideology of self-responsibility

Health infomercials also appear with great frequency on Chinese television, especially on local and provincial stations. As with radio, medical advertising is also a significant part of television advertising in general, but because of a more stringent scrutiny and censorship system (Niedenführ, 2013), direct-to-consumer medical advertising is much less prominent on television than on radio, and the incidence of hoaxes and false advertising is noticeably lower. Instead, yangsheng and health-related programs constitute the staple diet of television viewing, especially for elderly viewers. Like infomercial radio, yangsheng and health-related programs appear on local, metropolitan, provincial and national television networks, but they command an audience that is much more heterogeneous in terms of age, socioeconomic status and locality.

Our research has found that yangsheng-related television is not only stratified in terms of knowledge structure and style of advice, but that it also accommodates a wide variety of content and formats. The content ranges from the straightforward communication of medical knowledge to more nuanced and sophisticated discussions of healthy lifestyle choices. The mode of address also varies, with fairly didactic teaching at one end of the spectrum, and a more democratic exchange of ideas and sharing of wisdom about healthy living at the other. What accounts for these differences between programs is primarily the scale of the place in which they are produced. As we will show below, small, municipal-level and terrestrially relayed television stations like Bengbu Television (BBTV) have a modest production budget and mainly target local rural and township viewers, where the standard of living and consumption levels are low across the board. BBTV’s flagship health program, Zero Distance to Health (Jiankang ling juli), is produced with these local imperatives firmly in mind. The producer of the program told us that most of the program’s viewers are not as well educated as middle-class urbanites in big cities, which means that they want information that is very basic by the standard of big-city viewers. Consequently, the program has to ensure that the information it presents is clear, simple and straightforward.

Zero Distance to Health is accessible in both format and schedule. Just 15 minutes long, it is scheduled at 6:40 pm every day and is repeated the next morning. It provides health-related information in simplified language that is easier for elderly viewers to understand. Not all the information shared is scrupulously checked or attributed to a verifiable source, and it is often delivered in a repetitive and didactic manner. But the viewers we interviewed did not seem to mind. As one elderly woman in Bengbu told us:

Some information takes time to remember – for instance, that old people with heart disease should be careful not to get angry, chilled or tired, and they shouldn’t eat greasy, heavy meals. You hear this kind of advice again and again till finally you can remember it. (Interview, November 2013)

It is also noteworthy that a great proportion of the Zero Distance to Health content takes the form of consumer advice on how to mitigate the risks posed by living in modern, industrialized and increasingly urbanized settings. This advice is often presented as health tips, which, although packaged as scientific information, are nevertheless not too concerned with scientific rigor. For instance, in one episode viewers are warned that a great proportion of children’s toys pose health risks due to the unacceptably high level of toxic chemicals used in their manufacture, and the lack of child-proof mechanisms in their design, etc. Consumers are advised to look for clues for unsafe toys based on a number of factors, including colour, smell, design and labelling (Zero Distance to Health, 30 May 2011).

Another message in most yangsheng and health-related programs is that many of our everyday habits are not ‘scientifically based’ and are therefore in need of correction. This advice may take myriad forms, including pointing out incorrect ways of carrying your grocery bags (thereby injuring the shoulder), of cooking food (thereby destroying nutritional balance), and other less-than-scientific habits such as spending too much time in front of computer screens). Again, the viewers we interviewed seemed appreciative of these tips, even though they were not necessarily willing to believe in everything being taught, as one middle-aged female viewer in Shanghai told us:

You don’t have to believe everything they teach you, but it’s always good to become more knowledgeable. For instance, I didn’t know that by cooking bean curd and spinach together I’ll destroy the nutritional value of both due to their chemical interaction.… Yes, we have many wrong and unhealthy habits we aren’t aware of. (Interview, October 2011)

Like Zero Distance to Health, Yangsheng House (Yangsheng Tang) also targets China’s ageing population. Started in 2009 on Beijing Television’s (BTV’s) Science and Education Channel, the show has now become the most popular yangsheng program on Chinese television (Wang, 2012). Broadcast daily and lasting 50 minutes, this is a lively and interactive program with a live studio audience that aims to strike a balance between authoritativeness and accessibility. It claims to draw on the expertise of the most respected specialists in Beijing, and this respect for science and well qualified experts is regularly emphasized in order to set Yangsheng House apart from shows with less scientific rigor. As its producer says, ‘All the information and knowledge in our show must withstand the test of science and evidence. Unlike some television channels, we do not chase ratings at all costs, nor do we invite experts with spurious credentials. Our viewers will not be hoodwinked’ (Wang, 2012).

Though not aiming to compete with BTV in terms of ratings, China Central Television’s flagship health program, Chinese Medicine (Zhonghua Yiyao) has, since its inception in 1998, prided itself on being the best-researched, most authoritative health program in China. This weekly, 50-minute show is worth noting not only because it sets a benchmark for health and well-being programs on Chinese television (Liu, 2011), but also because it is the show that most consistently promotes the ethic of self-responsibility. In fact, one segment of Chinese Medicine is simply called ‘Taking Control of Your Own Health’, and it features individuals who embody this ethos. On 4 January 2008, Chinese Medicine focuses on the experiences of a number of individuals (from the ancient poet Lu You to contemporary ‘longevity stars’), and promises to reveal the secret of a healthy, long life. The episode starts with a preamble from the host:

Hello dear viewers, welcome to Chinese Medicine. Good health and longevity is something we all aspire to, but how can we achieve it? An old man over the age of 90 once said this: ‘Health maintenance relies on science, longevity requires no miracles. If one wants health and longevity, it’s 90% down to the self.’ What does it mean when he said it’s ‘down to the self?’ He meant a good attitude and good habits.

After this preamble, the episode goes on to detail the health-keeping practices of these ‘longevity stars’, with a consistent message that these people’s good health and longevity is a credit to their good habits. The host then ends the episode by reminding viewers that:

to do something once or twice does not constitute habit; habits are a matter of cultivation and accumulation. It’s a test of one’s strength and determination. We decide what habits to have, and whether we will be healthy or not. The power of decision lies with us. So we are back to that good old saying: take control of your own health.

However, while this is an example of a most explicit attempt to promote the message of self-care and self-responsibility, in our interviews with many senior citizens about their viewing habits and health-keeping regimes, we came to realize that the ideology of self-responsibility works both at subliminal and conscious levels, and that it steers a middle course between top-down teaching and individual choice. It is indeed true that many seniors rationalize their myriad practices by repeating the declared motto of the show: ‘I take control of my own health; my health and longevity depend on me.’ At the same time, most of our interviewees seemed to demonstrate a tendency to seek out or resonate with messages and advice that speak to their experience in the first place.

Despite variability in the standards of production, the level of scientific rigor in the information imparted and the credibility of the expertise on offer, yangsheng and other health-related television programs share a number of things. First, mostly sponsored by brand names and featuring specialists with impressive credentials, these shows encourage viewers to see pharmaceutical companies and experts as more authoritative sources of knowledge than doctors in the hospital. Second, they actively promote the illusion that as long as you are prepared to adopt a different mind-set, change your behaviour and cultivate a different lifestyle, these problems can be overcome. Third, these programs make a significant contribution to improving the health literacy of the Chinese population by promoting the public understanding of science and giving citizens the information they need to cope with the risks of modern society – not to mention the additional ‘deficiency risk’ facing rapidly modernizing societies such as China. However, these programs do not call for the provision of more adequate social welfare. Nor do they suggest an equitable redistribution of economic resources and risks. Instead, citizens are told to take control of their own lives, and to be willing to take responsibility for their actions. Finally, a number of reasons, including the ageing population, the privatization of health care, and the ensuing climate of anxiety, all conspire to the ‘reinvention’ of the yangsheng tradition (Farquhar and Zhang 2012: 28) and its new and officially legitimated status. Consequently, yangsheng has become an intensely mediatized social practice, with its distinct media forms and discourses, and more than ever, it also mediates between the state and the market, and between the expert and lay knowledge.

Conclusion

In our analysis, we have juxtaposed radio infomercials and lifestyle television programs as two distinct advice media formats. At the same time, we have also treated them as historically specific yet interrelated moments with the aim of uncovering some similarities and differences between them, thereby helping to illuminate China’s distinctive journey toward privatization. To this end, we can make a few observations. First, media regulators would usually categorize both radio infomercials and health-related lifestyle television programs as providing a consumer advice service, and therefore as being neither politically sensitive (like news) nor morally questionable (as is sometimes the case with entertainment). Our analysis suggests, to the contrary, that health communication in both these media formats is a key site where meanings of health and illness are (re)defined and contested, dominant power relations reinforced, and the socioeconomic status quo maintained. We now also have some evidence pointing to how the media use hope and fear to motivate individuals, especially those from disadvantaged groups, thereby translating possibility, anticipation and expectation into action (Rose and Novas, 2005: 452). In these respects, then, these two media formats appear to be very similar.

The second observation highlights a difference between them. Since the latter part of the economic reform period, the content and form of health-related knowledge has been both enabled and circumscribed by the logic of market. This being so, it is also clear that health communication on radio is more geared toward providing a promise of a cure for illness and disease, whereas health-related television programs put more emphasis on individuals’ need to correct and adjust their lifestyle and attitudes themselves. In other words, radio infomercials offer more of a reactive, ‘band-aid’-like approach to risk management in personal health, whereas health-related advice on television cultivates a more holistic risk-management strategy by equipping individuals with an appropriate ethical and philosophical subject position. Viewing the two modes of communication synchronically, we are able to see a socioeconomic stratification of health needs, health literacy and health-maintaining practices, and can identify the role of the media in simultaneously addressing and reinforcing this problem of stratification. In radio infomercials that promise a cure, individuals are concerned with questions of how to cope with new forms of risk and danger in modern life. Going beyond this relatively simple view of risk, health-related lifestyle television programs teach a life-political ethos and strategy, and individuals learn to acquire a ‘calculative attitude to the open possibilities of actions’, which can be both positive and negative (Giddens, 1991: 28).

Related to this difference is the fact that earlier health-related advice media were more concerned with selling medical products by exploiting people’s fear of ill health – a relatively straightforward technique of advertising on the part of pharmaceutical companies. In comparison, television programs in recent years actively promote the discourse of self-responsibility – a more subtle form of ideological interpellation that simultaneously speaks to the political logic of the state and the economic logic of the market. This explains why, while there are vociferous complaints from more discerning consumers about egregiously unethical practices such as false advertising in medical radio infomercials, there is a relatively higher level of willingness to accept the central message promulgated in yangsheng-related television programs – that is, the need to change the attitude and lifestyle of the self. If we view these differences as embodying two historically distinct moments, we are able to discern a progressively more clear articulation of neoliberal logic in post-Mao China.

Our discussion produces more evidence of a distinct process in which the selfhood of the individual is itself in the process of being privatized. In the several decades of economic reforms, people have become progressively more active in pursuing a wide range of self-governing and self-enterprising activities that shape and optimize their life chances. Our discussion reveals a few key moments in China’s reform period in which the advice media have assisted in the creation of ‘self-governing subjects’ (Ong and Zhang, 2008: 10) who also support Chinese authoritarian rule. The media, being subservient to both authoritarian rule and market logic, indeed play a pivotal role in these key moments, even though this role has evolved and diversified over time. Rather than reflecting or directly causing social change, we argue, these media and cultural forms and practices are crucially constitutive of China’s distinct journey to modernization.