The Public Health Embedding of Community-based Rehabilitation in China from a Historical Institutionalist Perspective: Institutional Change, Path Dependence, and Historical Continuity with the “Healthy China” Strategy
Abstract
Within the context of the “Healthy China” strategy, this paper employs historical institutionalism to analyze the integration of community-based rehabilitation (CBR) into China’s public health system. It delineates the three-stage development of CBR: grassroots pilots prior to 2000, formal policy integration from 2000 to 2015, and strategic alignment with national health governance post-2016. Institutional changes are propelled by critical junctures such as public health emergencies, shifts in top-level policy, and demographic transitions, while being constrained by path dependencies stemming from hierarchical governance structures, primary care infrastructure, and local community care traditions. The study reveals that CBR embodies a combination of historical continuity and incremental reform. Government-led resource allocation and community mobilization sustain its operations, whereas iterative policy evolution expands its functions from disability rehabilitation to integrated services encompassing chronic disease management, elderly care, and preventive health. Despite inherent synergies with the Healthy China strategy’s goals of equitable service access and whole-cycle health management, CBR faces challenges including fragmented intersectoral coordination and uneven regional resource distribution. Targeted optimization proposals are presented to bolster grassroots health governance and support the high-quality implementation of the “Healthy China” strategy.
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