Barefoot doctors and the medical pyramid.

China is still a predominantly agricultural country. Despite the growth of vast industrial cities like Shanghai, most of the population still lives and works on the land. The provision of medical care for agricultural workers is based on two concepts: a decentralized, pyramidal system of medical responsibilities, with at the bottom of the pyramid the barefoot doctor. This system has been fully developed only in the last few years; indeed a major criticism of medicine made during the cultural revolution in 1966 was that hospitals and medical personnel were being concentrated in cities at the expense of rural areas, and it needed powerful political pressures to reverse this trend.