Education, Health and Cultural Change

A Country to be Re-educated

In 1949 around 80% of Chinese adults could not read. Most villages had no clinic; trained doctors clustered in the cities; life expectancy was c.36 years. Buddhism, Daoism, Christianity, Islam and ancestor worship shaped daily ritual. Mao’s regime set out to rebuild all three pillars of everyday life — education, health and culture — from above. The means were the propaganda machine, the work-unit (danwei) supervision system and, after 1966, the violence of the Red Guards. The results were genuinely transformative in some areas (literacy, rural healthcare) and devastating in others (the closure of universities, the destruction of religious sites).

Education before 1966

From 1949 the CCP launched literacy campaigns aimed at adults: village classes ran in winter when farm work was light, and worker classes ran in factories. The 1956 introduction of simplified characters reduced the strokes needed to write thousands of common words; Pinyin gave a Roman-letter system for teaching pronunciation and indexing dictionaries. Together they cut the time needed to reach functional literacy. Soviet aid helped build new universities and technical institutes during the First Five-Year Plan; gaokao, the national university entrance examination, ran competitively until 1966.

Education was framed as service to the revolution. Schoolchildren learned arithmetic alongside passages of Mao’s thought; agricultural and industrial work experience was built into the curriculum from primary school. By 1965, primary enrolment had reached around 80% of children of school age — a sharp gain on the pre-1949 figure of c.20%. Women’s and girls’ literacy rose particularly rapidly because the campaigns explicitly targeted them.

The Collapse of Education after 1966

The Cultural Revolution wrecked formal education. From May 1966, schools and universities across China closed. The gaokao was abolished and would not return until 1977. Teachers were denounced as ‘stinking ninth’ (the bottom of a hierarchy of class enemies); some were beaten to death by their own pupils. Universities reopened from 1970 with admission by class background and political reliability rather than examination, and the curriculum was reduced to revolutionary slogans plus practical work. From 1968 onwards, around 17 million urban ‘sent-down youth’ were dispatched to the countryside under the xiaxiang campaign, in theory to learn from peasants, in practice to disperse the Red Guards Mao no longer needed.

A common student misconception is that all education collapsed. Primary literacy classes in villages mostly continued, run by local cadres rather than universities; barefoot doctors’ basic training expanded; and propaganda materials reached far more peasants than Republican-era schoolbooks ever had. The collapse was concentrated at secondary and higher education, where a generation lost ten years of formal study. Strong answers separate the gains for primary literacy from the catastrophe for higher education.

Healthcare and the Barefoot Doctors

Pre-1949 China had perhaps 40,000 trained doctors for c.500 million people, mostly clustered in coastal cities. Mao attacked this as bourgeois medicine. The barefoot doctors programme, formalised in 1965, trained around one million paramedical workers in three to six months and dispatched them to communes. They carried a basic kit of medicines, taught hygiene, delivered vaccinations and ran family-planning clinics. By 1976 most communes had at least one barefoot doctor; rural infant mortality fell sharply; and life expectancy rose from c.36 in 1949 to c.66 by 1976.

Healthcare was not uniformly transformed. Trained doctors sent down to villages from 1965 often resented the move; cities lost specialist services; the worst famine years were not addressed by additional medical capacity but by the suppression of death reporting. Zhou Enlai privately pushed back against some of the most disruptive Cultural Revolution attacks on hospitals, but he could not prevent the chaos in major cities. Even so, by Western metrics the Mao era’s rural healthcare gains are widely acknowledged, including by sympathetic historians like Mobo Gao.

Attacks on Traditional Culture

From May 1966 the regime declared war on the ‘four olds’ — old customs, old culture, old habits, old ideas. Red Guards smashed Buddhist temples, Daoist shrines and Christian churches; Confucius’s tomb at Qufu was desecrated by Red Guards in November 1966 in a deliberate act of symbolic destruction. Mosques in the Hui Muslim regions and Tibetan Buddhist monasteries were attacked particularly violently. After the 1959 Tibetan uprising and the Dalai Lama’s flight to India, monasteries had already been closed in large numbers; the Cultural Revolution finished the job, with most of Tibet’s c.6,000 monasteries reportedly destroyed or damaged. Christianity, Islam and Buddhism were treated as foreign or feudal; clergy were paraded in struggle sessions, beaten and imprisoned; family ancestor altars were burned by their own owners under pressure from neighbourhood committees.

A misconception is that all religion was permanently extinguished. Folk and ancestor practices survived underground — in many villages the smashed altar was rebuilt as soon as the Red Guards left. After Mao’s death in 1976, enforcement relaxed; Deng Xiaoping’s reforms allowed limited reopening of temples and churches under state supervision. But the cultural damage of 1966–76 was irreversible: many ancient buildings, manuscripts, statues and artworks were destroyed.