China's Health Ministries (Pt. 1): the National Health Commission
An insider guide to China's core Ministry of Health: history, function, strengths and limitations.
🔬 This Real Diagnosis post is the first in a multi-part deep dive into China’s most powerful health bodies.
Earlier this week, I went to a talk in London by Sir Jeremy Hunt, the notorious former UK Health Secretary. He’s since served as Foreign Secretary, Chancellor, and twice run for Prime Minister. But he remains best known for being voted Britain’s “most disliked frontline politician” during his time in health. In his opening remarks, he rather sheepishly recalled that the last time he had been in this auditorium, protestors had stormed the halls.
Hunt spoke at length about his colourful career, and at one point, he tried to joke that in each senior role - health, diplomacy, treasury - he’d started with zero subject knowledge: “On my first day as Chancellor, I knew nothing about economics or markets.”
An audience member didn’t let that slide: “There isn’t a CEO who knows nothing about their company. So why does Britain still let people lead entire sectors they’ve never worked in?”
The applause that followed was telling. No wonder: In 2022, Britain cycled through three Prime Ministers and four Chancellors in just four months. Between 2021 and 2022, five Health Secretaries came and went - none with any background in health, and none with any formal health role since.
Hunt responded with a smooth, politician’s answer - something about trusting his team of civil servants to guide him. But it laid bare a very real governance question: what qualifies leadership?
This isn’t just a British problem. In the US, public health leadership has become increasingly politicised. The NIH was led for 12 consecutive years by a physician-geneticist, but today, under Trump, public health appointments are vulnerable to partisan churn. RFK Jr’s appointment to HHS is a clear example of this. Even the US CDC has seen leadership instability and political pressure, particularly since the pandemic.
That said, there are signs of shift. In the UK, the new government under Keir Starmer has made efforts to appoint more grounded leaders. The current Health Secretary, Wes Streeting, spent nearly a decade in the health shadow brief. But the wider system still struggles with structural weakness: rotating politicians through ministries to make decisions affecting millions, despite having no firsthand understanding of the systems they’re trying to fix.
I first experienced this disconnect in 2016, as a fresh resident doctor. Hunt, then unpopular UK Health Secretary, introduced the controversial “Junior Doctor Contract”, imposing terms that were unsafe for patients and unsustainable for health staff. It triggered the UK’s first national doctor’s strike in 40 years.
I was elected by the British Medical Association to represent several hundred doctors across the Oxford and Thames Valley region. Between night shifts and national council meetings, I lobbied alongside fellow union reps for better terms. It was my first taste of how healthcare can be distorted by politics, to become collateral in a wider game of power.
Those experiences motivated me to step beyond clinical practice and engage more directly with systems and policy. During the COVID-19 pandemic, I joined the UK Foreign Office to lead the health team at the British Embassy in Beijing. We represented the UK in direct negotiations with China’s health ministry counterparts on pandemic preparedness, supply chains and outbreak data. It was a high-stakes and sensitive time to engage on public health, and provided me with an extraordinary window into how two very different governments approached a major health crisis.
The contrast was stark.
Every Chinese counterpart we met had deep sector knowledge. These technocrats weren’t career politicians parachuted in for a two-year term. They were trained clinicians, public health officials and scientists who had risen through local health bureaus, city-level posts and provincial departments before reaching national leadership.
Every Chinese Health Minister over the past 30 years began as a practising clinician. The health minister at the time, Ma Xiongwei, had trained in medicine and epidemiology and spent decades in health governance. In comparison, the UK health secretaries we represented at that time, Matt Hancock and Sajid Javid, both had no health background, and were cycled through in succession.
After a decade working across both systems, I’ve seen how much this difference matters.
In the UK, leadership is often a fluid path to power.
In China, leadership is always built through domain expertise.
Neither system is perfect. But there are crucial consequences. Who gets to lead and what qualifies them to do so shapes everything from policy design to crisis response to public trust. It affects whether reforms survive political cycles, whether crises are improvised or planned, and whether institutions learn, or forget.
That’s why I’m writing this new deep dive series on China’s health institutions.
If we want to understand how China reforms its system, responses to emergencies and advances global health ambitions, we need to understand how its governance is structured, and who is in charge.
If you missed it, I recently published a foundational explainer on China’s health ministries and governance model (link below), including a comprehensive visual map of the key players.
This series builds on that foundation. I’ll be writing about regulators, insurers and others, but today, we begin at the centre of it all: the National Health Commission.
Function
Today, China’s National Health Commission is a cabinet-level executive department under the State Council. Unlike many health ministries globally, the NHC does not operate at arm’s length from political leadership. It is both policy architect and system convenor, with explicit political alignment to the Party’s strategic objectives, including health security, resilient economic workforce and national rejuvenation.