X. People's Health and
Demographic Growth

Old Tibet, under the feudal serf system, had only three officially operated, small traditional Tibetan medical establishments, having simple and rough medical equipment, and a few private clinics. There were close to 100 practitioners. Even adding folk doctors of Tibetan medicine, the number totalled only about 400, averaging less than 0.4 per 1,000 people. These medical establishments and medical workers chiefly served the nobility and officials. Absolutely no medical treatment was given to the broad masses of serfs and slaves when they fell ill. Deadly infectious diseases such as smallpox and the plague occurred frequently and even ran rampant. According to records, in the 150 years before the peaceful liberation of Tibet in 1951, smallpox raged four times, and the contagion in 1925 caused 7,000 deaths in the Lhasa area alone. Epidemic typhoid fever in 1934 and 1937 took more than 5,000 lives in Lhasa. When some infectious diseases spun out of control, the former Tibetan local government did not take measures to save the afflicted but, on the contrary, drove them into high mountains or deep valleys, whose exits were guarded by troops. This resulted in the death of the expelled sufferers. Historical records show that in old Tibet, the average life span was 36 years, and the growth of the Tibetan population stagnated for a long time.

The primary task facing Tibet in the development of public health care has been to gain control over the most deadly infectious diseases. The Chinese government conscientiously carries out the principle of "taking prevention as the main task," with the result that no case of smallpox has been reported in tibet since the early 1960s. The incidence of various infectious and endemic diseases has gone down by a substantial margin, and some serious diseases that threaten the lives of people have been wiped out or brought under basic control. In order to assure the healthy growth of Tibetan children, a planned immunization program has been widely implemented in tibet since 1986. Over 85 percent of children have been inoculated.

After the Democratic Reform in 1959, the autonomous region gradually established a medical and health network throughout Tibet. In 1991, the region boasted 1,197 medical establishments, 401 times as many as in 1951. There were no hospital beds in 1951 but 5,077 in 1991. Professional medical workers numbered 9,740, or 98 times higher than in 1951. Among them 7,749 were health technicians, with Tibetans accounting for 80 percent of the total. Now, 88 percent of Tibetans are living in rural and pastoral areas, where there were 850 health establishments containing a total of 2,300 beds and 3,700 medical workers in 1991. A further 3,500 local rural doctors and health workers directly serve the masses of farmers and herdsmen. In Tibet, on average, there are 2.3 beds and 2.1 doctors per 1,000 people, figures equal to and above the national average respectively, and also higher than that of middle-income countries.

Traditional Tibetan medical science, comprising Tibetan medicine and pharmacology, has been handed down and developed. The government invested 20 million yuan in building a new inpatient department of the region's Hospital of Traditional Tibetan Medicine, as well as five local hospitals of this kind. In 1991, there were 1,015 Tibetan medicine doctors and pharmacists in the whole region. In order to meet the needs for the development of Tibetan medicine, the autonomous region founded the Tibetan Medical College and the Tibetan Medicine Research Institute, and encouraged and supported famous veteran Tibetan medicine doctors to write scholarly books. A chronology of valuable medical expertise was compiled by a group of aged specialists. The Four-Volume Medical Code, a famous book on Tibetan medical knowledge, was published and distributed. Efforts have also been made in the compiling and publishing of A Complete Collection of Wall Charts of the Four-Volume Medical Code and Medical Science Encyclopedia: Tibetan Medicine, plus dozens of teaching materials and special books about Tibetan medicine, including Physiology, Pathology, Pharmacology, Dietetics, and Newly Compiled Tibetan Medicine. Pharmaceuticals production is developing quickly too. Now, there are three Tibetan medicine factories.

Scientific research institutes of Tibetan medicine have put more efforts into the study of plateau sickness and other diseases which endanger the lives of Tibetan people, and have achieved important research results. Tibetan medical workers are both domestic and international leaders in rescue and the treatment of plateau pneumochysis, mountain coma and chronic plateau sickness.

To train more health workers, the Tibet Institute for Nationalities has opened a medical department. In addition, the Health School for the Tibet Autonomous Region has been established and another two in Xigaze and Qamdo. These schools have trained more than 6,000 high- and middle-ranking health workers. Since 1980, more than 5,000 health workers in the region have received on-the-job training, which has helped raise their professional and administrative levels.

The government provides free medical care for all Tibetans. This, plus considerable improvements in medical and health conditions, has greatly raised the average life span and health level of the Tibetan people. Average life expectancy has risen from 36 years before liberation to 65 years at present. When compared with 1965, the average height and weight of young Tibetans in the Lhasa area increased by 8.8 cm and 5.2 kg respectively.

The government has special policies on birth control in Tibet. Family planning is not practiced for the farmers and herds people who constitute 88 percent of the region's entire population. The government only conducts publicity campaigns to inform them about rational births and ways to have healthy babies. Tibet has a vast expanse of territory, but few land resources which can be developed. In 1991, the average amount of cultivated land per person was only 1.54 mu. As Tibet's population has been increasing at a fast rate, population control is necessary. Since 1984, the regional government has advocated and carried out the policy of two children per couple among Tibetan cadres, workers and the staff of enterprises and residents in cities and towns. However, among the Han cadres, workers and staff members in Tibet, the policy of one child per couple has been advocated and enforced. Only 12 percent of the people in Tibet are covered by the family planning policy. In the process of carrying out family planning, the government always persists in the principle of "mainly publicity, volunteering, and service," and prohibits any form of forced abortion.

Over the past 40 years, the population of Tibet has rapidly mounted. Between 1950 and 1990, there was a net increase of 1.196 million people in Tibet, with the number of Tibetans climbing to more than 2 million, more than double the figure of 1 million in 1950. In 1951, when Tibet was peacefully liberated, there were no accurate population statistics provided by Tibetan local government. When China conducted the first national census in 1953, the Tibetan local government headed by the Dalai Lama reported that there were 1 million people in Tibet. The second national census in 1964 showed that the population in Tibet was 1.251 million, of which 1.209 million were Tibetans, making up 96.63 percent of the total. The third national census in 1982 said there were 1.892 million people in Tibet, of whom 1.786 million were Tibetans, accounting for 94.4 percent. The fourth national census in 1990 showed that there were 2.196 million people in Tibet, of whom 2.096 million, or 95.46 percent, were Tibetans. People of the Han and other non-Tibetan nationalities have always made up around 5 percent of the total population in Tibet. Since 1970, the birth rate and natural population growth have both been above the average national level. Between 1982 and 1990, there was an increase of 309,800 ethnic Tibetans in Tibet, and the rate of natural population increase was 17.34 per thousand, 2.64 perthousand points higher than that of the national level in the same period. For Tibet, it is impossible to reach such relatively high levels in terms of birth rates and the natural growth rates of population in so short a period of time without the abolition of the feudal serf system, and economic growth plus the obvious improvement of people's living standards and medical and health conditions.

On the question of the size of the Tibetan population, the Dalai clique has spread many rumors. The most sensational was that more than 1.2 million people were killed after the peaceful liberation of Tibet. In 1953, the Tibetan local government under the Dalai Lama reported the population stood at 1 million people. If 1.2 million inhabitants had been massacred, it would have been a case of genocide and certainly the population in Tibet could not have increased to the present 2 million.

The Dalai Lama clique has also contended that geographically Tibet extends far beyond the boundaries of today, including areas inhabited by the Tibetans in Sichuan, Qinghai and other places, making a total population of 6 million. This so-called Tibet Major is merely a conspiracy hatched by imperialists in an attempt to carve up China. As a result of long historical changes, ethnic Tibetans have settled not only in Tibet but also in areas in Sichuan, Qinghai, Gansu and Yunnan provinces. But these areas were not under the jurisdiction of Tibet in the past, and the former Tibetan local government never administered any Tibetan-inhabited areas beyond Tibet. From the 13th century on, the central governments of the Yuan and Ming dynasties placed Tibet and other areas with Tibetan populations under separate administrations. The Qing Dynasty further defined administrative divisions in Tibetan-inhabited areas. During the period of the Republic of China, Tibetan-inhabited areas beyond Tibet remained under the jurisdiction of the provinces where they were located. These administrative divisions basically remained after the founding of the People's Republic of China. In the Tibetan-inhabited areas of the four provinces of Sichuan, Qinghai, Gansu and Yunnan, ten Tibetan autonomous prefectures and two Tibetan autonomous counties were set up. The Tibetan population, including Tibetans in Tibet and Tibetan-inhabited areas of other provinces, fell short of 6 million. When China conducted the first national census in 1953, the overall Tibetan population, including those residing in Tibet, totalled 2.77 million. The 1990 national census gave a count of 4.59 million people. As in Tibet, the numbers of Tibetans in other areas had grown considerably over the period between the two censuses.

Another lie is the claim that a large number of Hans have migrated to Tibet, turning the ethnic Tibetans into a minority. It is very easy to confuse and poison the minds of people who are not aware of the truth. In Tibet, the natural conditions are harsh, the air is oxygen-poor and the climate is bitterly cold. Most of the land consists of mountains, wilderness, and permafrost and snow zones. Customs there are so different from those in the heartland of the country that people from the interior can hardly adapt to them. Tibet is not like the western part of the United States, where large numbers of people moved in for development. The figures from various national censuses have thoroughly exploded the lie that the Han population in Tibet has already surpassed that of the Tibetans.