The Initial Exploration of Building a Rural Social Security System in New China (1949–1957)

The issue of social security for urban and rural residents has always been a practical subject of great concern to governments at all levels and academia. Systematically constructing a social security system is a necessary stage in the modernization of all countries. The imbalance in urban-rural dual social security has long existed, with significant disparities in the rights and interests of urban and rural residents in accessing social assistance, social welfare, and pension and medical insurance services. Since the 18th National Congress of the CPC, the Party Central Committee with Comrade Xi Jinping at its core has proposed the "New Three-Step Strategy," the first step of which is to complete the building of a moderately prosperous society in all respects by 2020. An inherent requirement of a moderately prosperous society in all respects is to realize a "moderately prosperous society common to both urban and rural areas," achieving "equalization of basic services" between urban and rural areas. At present, standing at a new historical starting point for socialist modernization, we must further promote substantial progress in common prosperity for all the people and further narrow the urban-rural gap.

城乡居民的社会保障问题一直是各级政府与学界十分关注的一项现实课题，系统构建社会保障制度是各国现代化的必经阶段。城乡二元社会保障不平衡问题长期存在，城乡居民在获得社会救助、社会福利以及养老与医疗保险服务等方面存在较大权益差异。自党的十八大以来，以习近平同志为核心的党中央提出了“新三步走战略”，第一步就是在2020年全面建成小康社会，而全面小康内在要求实现“城乡区域共同的小康”，使城乡的“基本服务均等化”。当下，我们站在社会主义现代化建设新的历史起点上，更需要推动全体人民的共同富裕取得实质性进展，进一步缩小城乡差距。

A series of governance experiences and policy explorations in the early period of New China provide important historical experience and unique reference value for developing countries in solving related problems. We should not mechanically measure the rural social security policies of the early New China period by the concepts and standards of modern or Western social security. Instead, we should include broader comprehensive measures, including basic guarantees for farmers' birth, aging, illness, and death. In this regard, the author attempts to examine the initial exploration by the Party and the state in building a rural social security system between 1949 and 1957, and to discuss the key historical process of China's transformation from informal, temporary social relief to a modern social security system, in order to provide some historical experience and institutional reference for building a unified urban-rural social security and welfare system.

新中国初期一系列治理经验与政策探索，为广大发展中国家解决相关问题提供了重要的历史经验与独特的参考价值。我们不能机械地以现代或西方国家社会保障的理念与标准来衡量新中国成立初期农村社会保障政策，而应将更广义范围的综合性措施，包括对农民生、老、病、死等基本保障纳入其中。对此，笔者尝试考察1949—1957年间党和国家对构建农村社会保障体系的初步探索，探讨我国从非正式、临时性安排的社会救济逐渐转变为现代社会保障制度的关键历史过程，以期为构建城乡统一的社会保障和福利制度提供一定历史经验与制度参考。

I. State Relief Becomes an Important Component of Rural Social Security

一、国家救济成为农村社会保障的重要组成部分

Before the founding of the People's Republic of China, the vast majority of farmers relied on self-sufficient small-scale peasant economies for their livelihood. Due to the lack of an institutionalized social welfare security system at the national level, when farmers encountered general natural disasters or difficulties in life, they could only bear the burden themselves or rely on mutual assistance and support from relatives, friends, and neighbors in rural society, as well as adjustments by social and economic organizations formed in civil society, such as community granaries, charity granaries, clans, and temples. Only when relatively large natural disasters occurred would the state carry out temporary relief or tax exemptions to help affected farmers tide over difficulties and maintain the stability of the agricultural economy. This state relief behavior reflected the contrast between the low efficiency of daily administration in bureaucratic institutions and the high efficiency of mobilizing manpower and resources during relief efforts. Overall, before the founding of the People's Republic of China, the vast rural areas mainly relied on farmers' families for self-protection, with community farmers connected by blood and geography using mutual aid and cooperation to try to overcome floods, droughts, famines, and other difficulties. From the late Qing Dynasty to the early years of the "Republic of China," Western powers often deeply intervened in local social affairs through churches establishing hospitals, schools, orphanages, welfare homes, and other welfare institutions in China. Objectively, this played a certain role in promoting China's early modernization, but its colonial character existed from beginning to end. Although the social relief system during the "Republic of China" period took on the form of a modern social system, it was not well implemented.

在中华人民共和国成立前，广大农民依靠自给自足的小农经济为生，由于国家缺乏制度化的社会福利保障体系，农民在遭遇一般自然灾害或生活出现困难时，只能由农民家庭自行承担或依托于乡村社会中的亲朋、邻里互助扶持，以及民间社会形成的社仓、义仓、宗族、寺院等社会经济组织进行调节。只有遭遇比较大的自然灾害，国家才会开展临时性救济或赋税蠲免来帮助受灾农民渡过难关，维持农业经济稳定。这种国家救济行为体现了官僚机构日常行政的低效率与救济时人力及资源动员的高效率之间的反差。总体而言，中华人民共和国成立前的广大农村主要以农民家庭的自我保障为主，由具有血缘和地缘的社区农民通过互助合作，以设法渡过洪涝、旱灾、饥荒等难关。晚清至“中华民国”初年，西方列强往往通过教会在中国设立医院、学校、育婴堂、福利院等福利机构，深度介入地方社会事务，客观上对中国早期近代化有一定促进作用，但其殖民色彩自始至终存在。“中华民国”时期的社会救济制度虽具备了现代社会制度的形态，但未能得到很好执行。

After the founding of the People's Republic of China, a state-level social security system began to be gradually established. In rural areas, the land reform [1]1 Land reform: The redistribution of land from landlords to poor and landless peasants carried out by the Chinese Communist Party in the early 1950s, which abolished feudal land ownership and established individual peasant ownership. freed farmers from heavy feudal exploitation. After the completion of land reform at the end of 1952, more than 400 million farmers across the country received land and means of production such as livestock and farm tools, and were exempted from the exorbitant land rent they had to pay to landlords each year, truly realizing a land system of "land to the tiller" based on individual farmer ownership. The vast majority of farmers acquired the most important means of production—land—which greatly increased their production enthusiasm. Agricultural production was quickly restored and developed in a short period, and farmers' income levels also increased significantly. As Liu Shaoqi pointed out in June 1950 at the Second Session of the First National Committee of the Chinese People's Political Consultative Conference, the land revolution was not only about relieving the poor but also about "liberating rural productive forces from the shackles of the feudal land ownership of the landlord class, so as to develop agricultural production and open up the path for the industrialization of New China." During the period of national economic recovery alone, farmers' incomes increased by 30%, and the problem of food and clothing was basically solved. From 1953 to 1957, China's rural areas also achieved a smooth transition from individual agriculture to collective agriculture. Agricultural production continued to maintain growth momentum, and farmers' net household income increased from 57 yuan in 1953 to 72.9 yuan in 1957.

中华人民共和国成立后，国家层面的社会保障体系才开始逐步建立。在农村，主要是土地改革使农民摆脱了沉重的封建剥削。1952年底土地改革完成后，全国4亿多农民分到了土地和农畜、耕具等生产资料，免除了每年要向地主交纳的苛重地租，真正实现了以农民个体所有制为基础的“耕者有其田”的土地制度。广大农民拥有了最重要的生产资料——土地，生产积极性有了极大提高，农业生产在短时间内迅速得到恢复和发展，农民收入水平也有了较大提升。正如1950年6月刘少奇在人民政协全国委员会第二次会议上所指出，土地革命不仅是救济穷人，也是为了“使农村生产力从地主阶级封建土地所有制的束缚下获得解放，以便发展农业生产，为新中国的工业化开辟道路”。仅在国民经济恢复时期，农民收入就增加了30%，温饱问题基本得到解决。1953年到1957年，中国农村还实现了由个体农业到集体农业的平稳过渡，农业生产继续保持增长势头，农民家庭纯收入也从1953年的57元增加到了1957年的72.9元。

The increase in farmers' income levels provided a certain economic foundation for farmers to achieve self-protection. However, due to the occurrence of natural disasters and their own relatively weak financial foundations, some farmers quickly fell back into poverty. Therefore, the relief measures of the Party and the state for rural areas were particularly important for maintaining agricultural production and the stability of farmers' lives. Some of the relevant relief policies were targeted at specific groups, such as care policies for the families of martyrs and the elderly without children. Due to space limitations, this article does not elaborate on these, but mainly discusses rural social relief and security policies with broader coverage.

农民收入水平的提高，为农民实现自我保障提供了一定的经济基础，然而，部分农民由于自然灾害的发生，加上本身家底较薄，很快又重新陷入贫困。因此，党和国家对农村的救济措施对于维持农业生产以及农民生活的稳定就显得尤为重要。相关救济政策中有一部分是针对特定群体的保障措施，如对烈士家属、孤寡老人等特定群体的照顾政策，因篇幅所限，本文对此不做展开，主要针对覆盖面更广的农村社会救济与保障政策进行探讨。

As early as December 1945, in the document "The Work Policy of the Liberated Areas for 1946" drafted by Mao Zedong for the Central Committee of the CPC, doing a good job of relief work was listed as one of the ten major tasks of the liberated areas. The policy proposed that, in addition to various relief measures established by the government, the main focus should be on encouraging the masses to help each other to solve difficulties. After the founding of New China, the Party and the state regarded "relief" as a social system and a basic right of citizens, and as an important component of urban and rural social security. In April 1950, the Chinese People's Relief Representatives Conference was held, discussing a series of issues such as establishing a relief system, defining relief work policies, and relief measures. Dong Biwu, then Vice Premier of the Government Administration Council, delivered a report titled "The Relief and Welfare Work of New China" at the conference, pointing out that relief and welfare work was "a component of a series of tasks in which the government and the people work together to heal the wounds of war and carry out peaceful construction." This essentially clarified the policy of government-led social relief work, giving new meaning and new content to the relief and welfare work of New China. Overall, the relief work during this period focused on disaster relief and social relief.

早在1945年12月，毛泽东在为中共中央起草的《1946年解放区工作方针》一文中，就把做好救济工作作为解放区的十大任务之一，该方针提出在政府所设各项救济办法以外，应主要鼓励群众进行互助以解决困难。新中国成立后，党和国家将“救济”作为一项社会制度和公民的基本权利，视为城乡社会保障的一个重要组成部分。1950年4月，中国人民救济代表会议召开，讨论了建立救济制度、确立救济工作方针和救济措施等一系列问题。时任政务院副总理的董必武在大会上作了题为《新中国的救济福利事业》的报告，指出救济福利工作是“政府和人民同心协力医治战争创伤并进行和平建设一系列工作中的一个组成部分”，这实际上明确了政府主导社会救济事业的方针，新中国救济福利事业有了新的意义和新的内容。总体而言，这一时期救济工作着重于灾害救济和社会救济。

First, disaster relief. After the founding of New China, the Chinese people took hold of political power, creating favorable conditions for overcoming natural disasters. The Party and the state led the people of the whole country in actively preventing, resisting, and providing relief for disasters. The human, material, and financial resources mobilized were incomparable to those of the old China period, reducing disaster losses to a minimum. Around the time of the founding of New China, severe natural disasters occurred in many parts of China, with droughts, floods, and insect plagues spreading across rural areas in Central-South, East China, North China, and the Northeast. According to statistics, in 1949, farmland affected to varying degrees nationwide totaled 121.56 million mu [2]2 mu: A Chinese unit of land area, approximately 1/15 of a hectare or 1/6 of an acre., and disaster victims numbered 40 million. In December of that year, the Government Administration Council issued the "Directive on Production and Disaster Relief," stating that production and disaster relief "concerns the life-or-death issue of several million people," "is an issue concerning the consolidation of the existence of the New Democratic regime in disaster areas," and "is one of the key issues in launching the great production movement of the coming year and building New China," elevating production and disaster relief to a considerable height. In response to the rural disaster situation, the government quickly established the Central Production and Disaster Relief Committee in February 1950 as the highest command organ for disaster relief work, putting forward the general relief policy of "production self-help, frugality to tide over difficulties, mutual assistance among the masses, work-relief, supplemented by necessary relief." [3]3 work-relief: A policy where disaster victims are employed on public works projects (e.g., building roads, irrigation) and paid in grain or cash, rather than receiving direct handouts. Governments in various affected areas actively responded to the general relief policy and carried out relief measures centered on "production self-help." For example, in the Anqing region of Anhui Province, the masses were organized to gather firewood, fish, and engage in porterage transport. A total of 100,000 people in the region participated in the production self-help movement, solving the livelihood problems of over 500,000 people. In Zhejiang Province, which was relatively severely affected, "production to tide over the famine" was made the overriding central task. The Zhejiang Provincial agricultural department loaned nearly 1.17 billion yuan (old currency) [4]4 old currency: Refers to the first series of the renminbi issued in 1948–1949, which was subject to high inflation and later replaced at a rate of 10,000 old yuan to 1 new yuan in 1955. to improve silkworm eggs, improved rice seeds, cotton seeds, and hemp seeds, mobilizing the masses to engage in various forms of production self-help. At the same time, local governments actively organized disaster victims to participate in water conservancy and transportation construction, implementing work-relief. This series of measures achieved good results, and the disaster situation was brought to an end relatively quickly.

首先是灾害救济。新中国成立后，中国人民掌握了政权，为战胜自然灾害创造了优越条件。党和国家领导全国人民积极防灾、抗灾、救灾，所动员的人力、物力、财力是旧中国时期无法比拟的，将灾害损失降至最低程度。新中国成立前后，中国多地发生严重的自然灾害，旱灾、水灾、虫灾遍及中南、华东、华北、东北等农村地区，据统计，1949年全国受灾程度不等的农田有1亿2156万亩，灾民达4000万人。是年12月，政务院发出《关于生产救灾的指示》，指出：生产救灾“是关系到几百万人的生死问题”，“是新民主主义政权在灾区巩固存在的问题，是开展明年大生产运动，建设新中国的关键问题之一”，将生产救灾提至相当高度。针对农村受灾情况，政府迅速在1950年2月成立了中央生产救灾委员会作为最高救灾工作指挥机关，提出了“生产自救、节约渡荒、群众互助、以工代赈，并辅之以必要的救济”的救灾总方针。各受灾地政府积极响应救灾总方针，开展了以“生产自救”为中心的救灾措施。如安徽省安庆地区组织群众打柴、捕鱼、挑担运输，全区共有10万人投入生产自救运动，使50多万人的生活问题得到解决。受灾较为严重的浙江省，将“生产渡荒”作为当时压倒一切的中心任务，浙江省农业部门贷放了近117亿元（旧币）用以改良蚕种、水稻良种、棉种、麻种，发动群众进行各种生产自救，同时，各地政府还积极组织灾民参加水利、交通建设，实行以工代赈。这一系列措施取得了良好效果，灾情得以较快结束。

For a long period after the founding of New China, the government adhered to the disaster relief policy centered on production self-help, helping disaster victims actively restore production and emerge from difficulties. Starting in 1955, the work focus of the Ministry of Internal Affairs (later the Ministry of Civil Affairs) and civil affairs departments at all levels shifted to disaster relief, social relief, and special care for entitled groups. The Ministry of Internal Affairs adjusted its internal structure to strengthen disaster relief and social relief work. That year, the nationwide area affected by disasters was 110 million mu, the disaster-affected population was over 36 million, grain production decreased by more than 12 billion jin [5]5 jin: A Chinese unit of weight, equal to 0.5 kilograms or approximately 1.1 pounds., and the state issued 168 million yuan in relief funds. In 1956, rainstorms and windstorms in several provinces and municipalities led to a nationwide disaster-affected area of 334 million mu, with 229.9 million mu of crop failure, a disaster-affected population of over 74 million, a grain production decrease of more than 24 billion jin, and the state issued over 300 million yuan in disaster relief. In 1957, several provinces and municipalities across the country experienced major famines. The nationwide area of crop failure was 22.58 million mu, the disaster-affected population was over 60 million, leading to a grain production decrease of 22.8 billion jin. The state issued 240 million yuan in disaster relief funds.

新中国成立后的很长一段时期里，政府都坚持以生产自救为主的救灾方针，帮助灾民积极恢复生产，走出困境。自1955年起，内务部（即后来的民政部）和各级民政部门的工作重点转移到救灾、救济与优抚等工作上。内务部对内部机构进行了调整，以加强救灾与社会救济工作。是年，全国成灾面积1.1亿亩，成灾人口3600余万人，减产粮食120多亿斤，国家发放救济款1.68亿元。1956年，多个省市的雨灾、风灾导致全国受灾面积3.34亿亩，成灾2.299亿亩，受灾人口7400余万人，减产粮食240余亿斤，国家发放救灾3亿多元。1957年，全国多个省市遭遇了重大灾荒，全国成灾面积2258万亩，成灾人口6000余万人，导致粮食减产228亿斤。国家发放救灾款达2.4亿元。

Alongside organizing disaster relief, the government implemented agricultural tax reduction and exemption policies for affected farmers. In August 1950, the Central-South Financial and Economic Committee issued the "Directive on Reducing Burdens Due to Disaster Situations in Various Provinces" (Document No. 83, Cai Mi Gong Zi), requiring provinces within the region to implement agricultural tax reduction measures for disaster victims. In affected areas, village governments, together with local peasant associations, were to inspect and determine the percentage of reduction. Those with a harvest of less than 30% were exempted, while others were correspondingly reduced according to the degree of crop failure. In early September 1950, the Central People's Committee passed the "Interim Regulations on Agricultural Tax in Newly Liberated Areas." Article 24 required the people's governments (military and political committees) of each major administrative region to formulate their own reduction and exemption methods based on local disaster situations and report them to the central government for record. Subsequently, major regions such as the Northwest and Northeast successively issued relevant methods, basically forming the tax reduction and exemption principle of "light reduction for light disasters, heavy reduction for heavy disasters, and full exemption for exceptionally severe disasters," which was finally confirmed in the "Measures for Agricultural Tax Reduction and Exemption for Disaster-Affected Farm Households" promulgated by the Government Administration Council of the Central People's Government in August 1952. The reduction and exemption of agricultural tax, as part of disaster relief work, closely coordinated with relief measures such as distributing relief grain and funds and organizing production self-help, achieving the effect of concerted efforts. Taking Zhejiang Province as an example, during the period 1950–1957, the province reduced and exempted a total of 111.856 million kilograms of rice (unhusked) in agricultural tax due to natural disasters, significantly lightening the burden on disaster victims.

在组织赈灾的同时，政府对受灾农民实行农业税减免政策。1950年8月，中南财委会下达了《关于各省因灾情减免负担的指示》（财秘工字第83号），要求区内各省对灾民实行减免农业税措施，遭灾地区由乡村政府会同当地农会查看并拟定减免成数，收获不足三成者免征，其余按歉收程度相应减征。1950年9月初中央人民委员会通过了《新解放区农业税暂行条例》，第24条规定要求各大行政区人民政府（军政委员会）针对本地灾情自行制定减免办法，并报请中央备案。此后，西北、东北等大区先后出台相关办法，基本形成了“轻灾少减，重灾多减，特重全免”的税收减免原则，并最终在1952年8月中央人民政府政务院颁布的《受灾农户农业税减免办法》中确定下来。减免农业税作为救灾工作的一部分，与发放救济粮款，组织生产自救等救灾措施密切配合，收到了通力合作之效。以浙江省为例，1950—1957年期间，全省因自然灾害共减免了稻谷11185.6万公斤的农业税，较大减轻了灾民的负担。

Second, social relief. The Party and the state attached great importance to rural social relief work and regarded social relief as an important measure to solve the livelihood difficulties of poor peasants. The Chinese nation has a fine tradition of respecting and caring for the elderly and supporting the widowed, orphaned, and childless. For example, in rural society, there were practices of using clan property and charitable estates within lineages to relieve the poor of the lineage, but a social relief system supported by state finances had never been established. Therefore, poor peasants were everywhere in the vast rural areas. In the early days of New China, the poverty problem inherited from the old society could not be changed in the short term. At the same time, there were still some widowers, widows, orphans, and the childless who lacked or had lost their labor capacity, as well as households with many people but few laborers, all of whom needed the government's care and attention. In November 1949, the Ministry of Internal Affairs was established, and local governments at all levels also successively set up civil affairs systems, responsible for the support and relief work for the rural poor.

其次是社会救济。党和国家十分重视农村社会救济工作，并将社会救济作为解决贫困农民生活困难的一项重要措施。中华民族素有敬老养老、扶助鳏寡孤独的优良传统，如乡村社会中往往有以宗族内部的族产、义庄等方式接济本宗贫困者的做法，但未曾建立一套有国家财政作为支撑的社会救济制度，所以广大农村地区贫困农民比比皆是。新中国成立初期，旧社会遗留下来的贫困问题不是短期内可以改变的，同时社会上还有一些缺乏或丧失劳动能力的鳏寡孤独与人多劳力少的困难户，都需要政府的关怀和照顾。1949年11月内务部成立，各级地方政府也相继组建了民政系统，负责对农村贫困人口的扶持救助工作。

Around the time of the founding of New China, natural disasters occurred relatively frequently. Many peasant families with poor economic conditions fell back into poverty due to natural disasters. Therefore, the government's social relief measures during this period were usually coordinated with disaster relief. Under the overall planning of the Party and the state, local governments not only helped disaster victims raise production funds, actively develop agricultural and sideline industries, and carry out production self-help, but also provided necessary livelihood relief for poor households to ensure their basic living. For example, in 1950, the Dacheng County government in Hebei Province, to help poor peasants overcome various difficulties in life and production, mainly adopted the following three measures: First, for 17,712 households with many people but few laborers, totaling 67,077 people, who had livelihood difficulties and no ability to repay, the state provided 669,753 jin of relief grain; Second, for households with greater difficulties but repayment ability, the state provided loans of grain and funds, solving the difficulties of 4,505 households and 15,228 people. Of the relief and loan grain distributed, 175,200 jin was used for agricultural seeds and 578,390 jin for livelihood; Third, the masses were organized to donate clothing and bedding, solving the problem of 518 cotton-padded coats for 474 households lacking them. The social relief work implemented by the central and local governments greatly alleviated the livelihood difficulties of peasants in the early days of New China and also better promoted production development.

新中国成立前后自然灾害发生较为频繁，很多经济情况较差的农民家庭因自然灾害而重新陷入贫困，因此，这一时期政府的社会救济措施通常是配合灾害救济的。在党和国家的统筹下，地方政府不仅帮助灾民筹措生产资金，积极发展农副业，进行生产自救，还为贫困户提供必要的生活救济，保障他们的基本生活。如1950年河北省大城县政府为帮助贫困农民克服生活与生产上的各种困难，主要采取了以下三项措施：一是针对生活困难又无还款能力的人多劳弱家庭共17712户，67077人，给予国家赈粮669753斤；二是对困难较大但有还款能力的家庭，国家提供贷款贷粮帮助，解决了4505户、15228人的困难。在发放的赈贷粮中，用于农业籽种的有175200斤，用于生活的有578390斤；三是组织群众募捐衣被，为缺少衣被的474户解决了518件棉衣。中央和各地政府所实施的社会救济工作较大缓解了新中国成立初期农民的生活困难，也能更好地促进生产发展。

After experiencing the period of national economic recovery, the rural economy initially improved. After 1953, rural social relief basically became a regular task of the central and local governments. The targets of relief were mainly the elderly, weak, disabled, orphans, and young children without support, as well as poor households with many people but few laborers. The relief items mainly involved helping relief targets solve difficulties in food, clothing, housing, and medical care. In 1953, the "Measures for the Distribution and Use of Rural Famine Relief Grain and Funds" formulated by the Ministry of Internal Affairs classified the elderly, weak, disabled, orphans, and young children without labor capacity and without support as first-class relief households, stipulating that they could receive full relief based on the length of time they lacked grain. For poor rural households, the government adopted a method of temporary relief, mainly during the spring plowing, summer weeding, and winter seasons, providing them with relief in necessities such as food rations and clothing and bedding in conjunction with production. The relief period did not exceed four and a half months at most, and the relief food ration per person per month did not exceed 17.5 kilograms of unhusked grain.

经历了国民经济恢复时期，农村经济初步好转，1953年以后，农村的社会救济基本上转为中央与地方政府经常性工作。救济对象主要是无依无靠的老弱残孤幼以及人口多而劳动力少的贫困户，救济项目主要是帮助救济对象解决吃穿住医等方面的困难。1953年，内务部制定的《农村灾荒救济粮款发放使用办法》将无劳动能力、无依无靠的孤老残幼定为一等救济户，规定他们可按缺粮日期长短全部救济。而政府对农村贫困户采取的是临时救济的方式，主要是在春耕、夏锄和冬季时节，结合生产给予他们口粮与衣被等必需品救济，救济时间最长不超过4个半月，救济口粮每人每月不超过17.5公斤原粮。

It is noteworthy that during this stage, the government initiated efforts to guide mutual aid and mutual assistance among peasants. In the early years of the founding of New China, the national relief work policy emphasized the people’s self-reliance and mutual labor assistance. For example, in 1951, the Ministry of Internal Affairs promoted nationwide the method used in Tanghe County, Henan Province, for settling the elderly, orphaned, disabled, and infirm: based on the principles of mutual voluntariness, prioritizing those nearby over those far away, and prioritizing relatives over neighbors, the settled person would bring their house, land, and property to the settler’s home, while the settler would be responsible for their care in life and burial in death, and would inherit the settled person’s property after their death. This experience gradually spread nationwide. According to incomplete statistics, by 1953, over 500,000 elderly, orphaned, disabled, and infirm people had been settled using this method. Such forms of mutual assistance among peasants effectively arranged for the livelihood and elderly care of the elderly, orphaned, disabled, and infirm, thereby assuming part of the social security function in rural areas.

值得注意的是，政府在这一阶段展开了对农民间互助互济的引导工作。新中国成立初期，国家救济工作方针重在强调人民群众自力更生、劳动互助。如内务部曾在1951年向全国推广河南省唐河县安置孤老残弱的方法：本着双方自愿、先近后远，先亲后邻的原则，被安置者将房屋、土地和财产带到安置者家，而其生养死葬由安置者负责，其死后财产由安置者继承。这一经验逐渐在全国推广，据不完全统计，到1953年以该办法安置了50多万孤老残弱。类似这种农民间的互帮互助方式，较好地安排了孤老残弱的生活与养老问题，承担了农村地区一部分社会保障功能。

II. The Collective Economy Was an Important Force Relied Upon by the Rural Security System

二、集体经济是农村保障体系依靠的重要力量

Whether it was disaster relief or poverty relief during this period, these were emergency security measures implemented by the state for sudden incidents and special groups in rural areas. The majority of peasants at that time did not enjoy normalized social security provided by the state, such as “having a reliable livelihood, medical care when ill, and support in old age.” In 1953, the general line for the transition period proposed the gradual realization of the socialist transformation of agriculture, handicrafts, and capitalist industry and commerce. Rural areas began to implement agricultural collectivization, and cooperative production forms such as mutual aid teams and cooperatives were promoted in both urban and rural areas. To adapt to the new situation, after 1954, the state revised the general policy for social relief work to “rely on the collective, mutual assistance among the masses, production self-help, supplemented by necessary state relief.” This policy became the long-term guiding principle for China’s social assistance work. The collective economy began to play a greater role in rural social security, with its main innovations being the system of public reserve funds and public welfare funds in rural cooperatives, cooperative medical care, and the system of supporting households with five guarantees for the rural population without support.

不论是这一时期的灾害救济，还是贫困救济，都是国家针对农村中突发状况与特殊人群所实施的应急性保障措施，大多数农民在当时并未享受到国家提供的“生有所靠、病有所医、老有所养”等常态化社会保障。1953年过渡时期总路线提出要逐步实现对农业、手工业和资本主义工商业的社会主义改造，农村开始实行农业集体化，互助组和合作社等合作生产形式开始在城乡推行。为适应新形势，1954年以后，国家重新修订了社会救济工作的总方针，即“依靠集体，群众互助，生产自救，辅之以国家必要的救济”。这一方针成为我国长期执行的社会救助工作总的指导纲领。集体经济在农村社会保障上开始发挥更多作用，其主要创举是农村合作社公积金、公益金制度，合作医疗以及针对农村无依靠人群的五保户供养制度。

First, the system of public reserve funds and public welfare funds. The so-called public reserve fund refers to funds used for expanding production, increasing production investment, and other agricultural construction from the collective income of agricultural cooperatives. The public welfare fund refers to funds used for collective public welfare undertakings and necessary cultural, health, and relief undertakings within the collective. The system of public reserve funds and public welfare funds had already been proposed in some areas when mutual aid teams were promoted in the early 1950s. For example, in April 1951, the Shanxi Provincial Party Committee proposed to the North China Bureau that within mutual aid teams, methods of collecting public reserve funds and enhancing public accumulation should be adopted to gradually shake and weaken the foundation of private ownership. At that time, the North China Bureau did not agree with this proposal, arguing that mutual aid teams were collective labor organizations based on individual private ownership and the principle of voluntariness and mutual benefit, and that this practice was “fundamentally contrary to the principle of voluntariness and equal exchange based on private ownership.” However, with the further development of the agricultural cooperation movement, mutual aid teams and cooperatives established in various places gradually began to adopt this practice. For instance, in the spring of 1952, elementary cooperatives in Dongliao County, Jilin, set aside 5% of total income as a public reserve fund and 2% as a public welfare fund, to be used for expanding reproduction and supporting poor and needy households.

第一，公积金、公益金制度。所谓公积金，指的是在农业合作化集体收入中，用于扩大生产、增加生产投资等农业建设的资金。公益金，则是用于集体内公益福利事业与必要的文化、卫生、救济事业的资金。公积金、公益金制度，在20世纪50年代初期推行互助组的时候就已经有部分地区提出来，如1951年4月山西省委向华北局提出，要在互助组内采用征集公积金、增强公共积累的办法来逐步动摇、削弱私有基础。当时华北局并未同意这一主张，认为互助组是以个体私有经济为基础、自愿两利的集体劳动组织，这一做法是“根本违反在私有基础上自愿等价原则”的。不过，随着农业合作化运动进一步发展，各地建立的互助组与合作社开始逐渐采用这一做法。如1952年春，吉林东辽县的初级社按照5%公积金、2%公益金进行总收入提留，作为扩大再生产和扶持贫难户之需。

This innovative measure quickly received high attention from the Party Central Committee. On February 15, 1953, the Party Central Committee officially issued a document, suggesting that permanent mutual aid teams and agricultural production cooperatives in rural areas should accumulate public reserve funds and public welfare funds on their own as a material basis for expanding production and as a reserve for unforeseen natural and man-made disasters. This portion of the public reserve fund or public welfare fund could account for about 1% to 5% of collective income. On April 1, the North China Bureau, based on the Party Central Committee’s resolution, further refined the requirements and stipulated the uses of the cooperative’s public reserve fund and public welfare fund: first, public property such as the public reserve fund and public welfare fund should be accumulated gradually based on the principle of voluntariness, and could be accumulated in small amounts or not at all, with an appropriate proportion of 1% to 5% of the cooperative’s annual income; second, the public welfare fund was to be used for the cooperative’s public welfare undertakings, including culture, health, and relief for members, while the public reserve fund was to be used for expanding production; third, members withdrawing from the cooperative were allowed to take with them the public reserve fund and the means of production purchased with it, but the public welfare fund could not be taken away.

这一创新举措很快得到党中央的高度重视。1953年2月15日，党中央正式发文，建议农村里的常年互助组与农业生产合作社通过自行积累公积金和公益金的方式作为扩大生产的物质基础，以及防备天灾人祸的不时之需，这一部分公积金或公益金大概可以占集体收入的1%—5%。4月1日，华北局根据党中央决议进一步细化要求，对合作社公积金、公益金的用途作出规定，一是公积金、公益金等公共财产要根据自愿原则逐渐积累，可以少积或不积，占合作社岁入比在1%—5%为宜；二是公益金用于社内的公益福利事业，包括文化、卫生、救济社员等，公积金则用于扩大生产；三是社员退社允许带走公积金及公积金所购置的生产资料，而公益金则不能带走。

With the arrival of the climax of the agricultural cooperation movement, the public reserve fund and public welfare fund gradually became an important accumulated part of the cooperative’s collective income. In a report on July 31, 1955, at a meeting of secretaries of provincial, municipal, and district party committees, Mao Zedong pointed out that in line with the “increasingly high tide” of the rural cooperation movement, the proportion of the public reserve fund and public welfare fund should be further increased. For example, in the first few years, the public reserve fund was generally 5% of the total income from agriculture and sideline occupations, and could be further increased later; the public welfare fund was within 1%. In addition, when members withdrew from the cooperative, they could not take the public reserve fund with them, only the share fund they had contributed themselves, thus amending the provision in the February 1953 “Resolution on Mutual Aid and Cooperation in Agricultural Production” that members withdrawing from the cooperative “have complete freedom to take out the funds they have invested and the public reserve fund they have contributed.” On November 9, 1955, the “Model Charter for Agricultural Production Cooperatives (Draft)” passed at the 24th meeting of the Standing Committee of the National People’s Congress stipulated that the public reserve fund could be gradually increased from 5% to 10%, and for cooperatives growing cash crops, it could be slightly increased on this basis, while the public welfare fund could be gradually increased from 1% to 2% or 3%. Chapter 10 of the draft, “Political Work and Cultural Welfare Undertakings,” mentioned social security content, including paying attention to members’ labor safety; providing medical treatment and compensation for members injured or killed in the line of duty; carrying out public health work; and organizing busy-season nurseries. The expenditures for these social security measures all came from the collective’s public welfare fund income.

随着农业合作化高潮到来，公积金、公益金逐渐成为合作社集体收入的重要积累部分。1955年7月31日毛泽东在省市区委书记会议上的报告指出：随着农村合作化运动“日益高涨的形势”，公积金和公益金的比例应进一步提高。如公积金在开头几年一般为农副业总收入的5%，以后可进一步提高；公益金则在1%以内。此外，社员退社，公积金也不能带走，只能带走自己缴纳的股份基金，从而修正了1953年2月《关于农业生产互助合作的决议》中社员退社“有带出所投资金和所纳公积金的完全自由”。1955年11月9日，全国人大常委会第二十四次会议通过的《农业生产合作社示范章程草案》提出：公积金可以从5%逐步提高到10%，如果是经营技术作物的合作社，还可在此基础上略为增加，而公益金则可以从1%逐步提高到2%或3%。该草案第10章《政治工作和文化福利事业》所提到的社会保障内容，包括注意社员劳动安全；对因公负伤或牺牲的社员要救治、抚恤；开展公共卫生工作；组织农忙托儿所等几条。这些社会保障的经费开支，都来自集体的公益金收入。

However, because the income level in rural areas was generally low during this period, the problem of excessive deductions for the public reserve fund and public welfare fund leading to a general reduction in members’ income soon emerged, affecting members’ enthusiasm for production. On April 25, 1956, in “On the Ten Major Relationships,” Mao Zedong emphasized, “Our policy towards the peasants is not the Soviet policy, but a policy that takes into account both the interests of the state and the peasants,” such as relatively light agricultural taxes, narrowing the price scissors between industrial and agricultural products, and purchasing agricultural products under the unified procurement system at normal prices. At the same time, he pointed out that a reasonable proportion should be set for the public reserve fund and public welfare fund for control. Therefore, the “Model Charter for Advanced Agricultural Production Cooperatives” passed at the Third Session of the First National People’s Congress in June 1956 stipulated that the public reserve fund should not exceed 8%, and for cooperatives growing cash crops, it could be increased to 12%, while the public welfare fund should not exceed 2%. In addition, Chapter 9 was a special chapter on “Cultural Welfare Undertakings,” which included social security measures such as providing care for the elderly, weak, sick, and disabled in terms of labor burden; providing subsidies and compensation for members injured or killed in the line of duty; carrying out public health work; establishing nursery organizations; providing appropriate care for members without means of support, including ensuring their food, clothing, firewood supply, education for the young, and burial for the elderly (i.e., the “five guarantees” system); and gradually achieving a reserve of one to two years’ grain supply. Of course, because the proportions of the public reserve fund and public welfare fund were very small, welfare facilities, such as “busy-season nursery organizations,” were emphasized to be carried out according to the amount of the public welfare fund and within one’s means, and could only be gradually established as related funds increased. According to statistics from the All-China Women’s Federation, by the end of 1956, there were 634,640 busy-season nurseries, caring for over 61 million children.

不过，因为这一时期农村收入水平普遍较低，所以很快就出现了扣除公积金、公益金过多而导致社员收入普遍降低的问题，影响了社员生产的积极性。1956年4月25日，毛泽东在《论十大关系》中强调，“我们对农民的政策不是苏联的那种政策，而是兼顾国家和农民的利益”，如农业税比较轻、缩小工农业品的剪刀差、统购农产品按正常价格等，同时指出，公积金、公益金要提出一个合理的比例进行控制。因此，1956年6月召开的第一届全国人大第三次会议通过的《高级农业生产合作社示范章程》规定：公积金规定为不超过8%，如果是经营技术作物的合作社可以增加到12%，而公益金则为不超过2%。此外，第9章为“文化福利事业”专章，其中提到的社会保障措施，包括对老弱病残在劳动负担上的照顾；对因公负伤、死亡的社员的补助、抚恤；开展公共卫生工作；成立托儿组织；对生活没有依靠的社员的适当照顾，包括保证其吃、穿、柴火供应、年幼的教育及年老的安葬（即“五保”制度）；逐步做到储备1—2年粮食等措施。当然，因为公积金和公益金的比例很少，有关福利设施，如“农忙托儿组织”等，强调要根据公益金多少量力而行，只能随相关经费增加而逐渐举办。根据全国妇联的统计，1956年底，农忙托儿所有634640个，受托儿童达到6100余万人。

Second, the rural cooperative medical system. The rudiments of China’s rural cooperative medical system appeared in the anti-Japanese democratic base areas. The Shaanxi-Gansu-Ningxia Border Region once ran medical mutual-aid cooperative organizations funded by the masses through share-collecting. In 1944, when infectious diseases such as relapsing fever and typhoid were prevalent, at the request of the masses, the Border Region government entrusted the then commercial sales agency, the Mass Cooperative, to set up cooperative medical services. Funding came mainly from investment by the cooperative and the health-medicine cooperative, with some shares absorbed from groups and individuals, and the government also provided some free medicinal materials. Similar medical institutions run by the people with public support gradually developed under the support of the liberated area governments. By the 1950s, with the vigorous development of the rural mutual-aid and cooperative movement, a new type of medical service emerged in some areas, where funds were raised jointly by individual peasants and agricultural collectives, with each person contributing a few jiao or a few eggs per year as expenses, and part of the cost of medical treatment for members was reduced or exempted. This method was called “cooperative medical care” in some places, “collective health-care medical care” in others, and “pooled medical care” in still others. The earliest establishment of a collective health-care medical expense system was in Mishan Township, Gaoping County, Shanxi Province. In the spring of 1955, the local agricultural production cooperative, the peasant masses, and doctors jointly raised funds to set up a health station. The specific implementation plan was that each member raised 5 jiao per person per year for health-care fees, of which 3 jiao were paid from the agricultural cooperative’s public welfare fund and 2 jiao were paid by the individual member. When members sought medical treatment, they only paid for medicine and not for consultation fees. For poor members and those injured on duty, the medicine costs were paid directly from the public welfare fund. By combining work-point recording with cash payments, the doctors’ remuneration was reasonably settled. This medical system, jointly established by individual peasants and the collective, which “combined medical care and prevention but not medicine,” was conducive to developing rural health undertakings and protecting peasants’ health. It received approval from the Ministry of Health and was promoted in some parts of the country. Subsequently, medical security models such as “cooperative medical care” in Zhengyang, Henan, “semi-labor insurance medical care” in Wuxi, Jiangsu, and “medical expense contracting” in Qujiang, Guangdong, appeared one after another.

第二，农村合作医疗制度。我国农村合作医疗制度的雏形出现在抗日民主根据地。陕甘宁边区曾办过由群众集股的医疗互助合作组织。1944年回归热、伤寒等传染病流行，应群众要求，边区政府委托当时的商业销售机构：大众合作社办理起了合作医疗，资金主要由合作社与保健药社投资，并吸收一部分团体和私人股金，政府也会提供一些免费药材。类似这种民办公助的医疗机构在解放区政府的支持下逐渐发展起来。到20世纪50年代，随着农村互助合作运动蓬勃发展，一些地区出现了由农民个人和农业集体共同筹集资金，每个人每年出几角钱或几个鸡蛋作为经费，社员看病费用实行部分减免的新型医疗方式。这种方式有的地方叫作“合作医疗”，有的叫作“集体保健医疗”，也有的叫作“统筹医疗”。最早建立集体保健医疗费制度的是山西省高平县米山乡，1955年春，当地农业生产农业社、农民群众和医生共同集资成立了保健站。具体实施方案是社员每人每年按交5角钱筹集保健费，其中由农业社公益金支付3角钱，由社员个人支付2角钱。社员在看病时只收药费而不收诊费。其中贫困社员及因公受伤者的药费直接由公益金支付。通过记工分和支付现金相结合的方式，合理解决医生的报酬。这样一种农民个人和集体共同建立的“合医合防不合药”的医疗制度，有利于发展农村卫生事业与保护农民的健康，获得了卫生部肯定，并在全国部分地区推广。此后河南正阳“合作医疗”、江苏无锡“半劳保医疗”、广东曲江“医药费包干”等医疗保障模式相继出现。

Because the strength of the rural collective economy was still relatively weak at that time, the level of this cooperative medical care was actually very limited and cannot be compared with modern medical security systems. Nevertheless, it was after all a breakthrough from the traditional rural medical relief methods, a first attempt to establish a medical security model of mutual aid and cooperation between the collective and peasants in rural areas. Under limited material conditions, it played a positive role in popularizing medical treatment, medicine, and preventive health care across the vast countryside. Qian Xinzhong, former Minister of Health, in his preface to Zhang Zikuan’s selected works on rural health, believed that rural cooperative medical care was both “a system of a medical security nature” and “a new life science value concept,” and was a product of the rural land reform and the agricultural cooperation movement.

由于当时农村集体经济力量仍然比较薄弱，这种合作医疗的水平其实十分有限，不能与现代医疗保障制度相提并论。然而这毕竟是对传统农村医疗救助方式的突破，是在农村建立集体与农民互助合作的医疗保障方式的首度尝试，在有限的物质条件下，对普及广大农村的医药救治、预防保健发挥了积极作用。曾任卫生部长的钱信忠在给张自宽的农村卫生文选所写的序中认为，农村合作医疗既是“一种医疗保障性质的制度”，也是“一种新的生命科学的价值观”，是农村土地改革和农业合作化运动的产物。

Third, the rural “Five Guarantees” system. In traditional Chinese society, the family was responsible for the elderly care of parents by their children. The Marriage Law promulgated in 1950 stipulated: “Parents have the obligation to raise their children, and children have the obligation to support and assist their parents.” The family-based elderly care model was protected by law and became a legal responsibility of children. However, for those widowers, widows, orphans, childless elderly, and disabled persons in rural areas who lacked labor capacity, the government and the collective needed to provide them with basic living security. The 1954 Constitution clearly stipulated: “Working people in the People’s Republic of China have the right to material assistance when they are old, ill, or have lost the ability to work.” This elevated the state’s relief for widowers, widows, orphans, childless elderly, and disabled persons to the level of an institutional arrangement of social responsibility and livelihood rights, representing a significant step forward in the development of China’s social security system. As mentioned above, due to the financial pressure in the early years of New China, from 1949 to 1955, the rural elderly, orphans, childless elderly, and disabled persons who were without support, without labor capacity, or with only slight labor capacity were mainly organized by local civil affairs departments for mass mutual aid or given temporary relief.

第三，农村“五保”制度。传统中国社会的家庭是由子女负责父母的养老，1950年颁布的《婚姻法》规定：“父母对子女有抚养的义务，子女对父母有赡养扶助的义务。”家庭养老模式受到法律保护，成为子女的法定责任。然而，农村中那些没有劳动能力的鳏寡孤独及残疾人，则需要由政府和集体为他们提供基本生活保障，1954年《宪法》明确规定：“中华人民共和国劳动者在年老、疾病或者丧失劳动能力的时候，有获得物质帮助的权利。”这就将国家对鳏寡孤独残疾人的救助上升至社会责任与民生权利的制度安排层面，是中国社会保障制度发展的较大进步。如上文所言，迫于新中国初期的财政压力，1949—1955年，农村无依无靠、无劳动力或仅有轻微劳动力的孤老残幼，主要还是由当地民政部门组织群众互助或给予临时救济。

By 1956, the government established a support system for rural households enjoying the Five Guarantees, specifically targeting widowers, widows, orphans, childless elderly, and disabled persons in rural areas. This was mainly due to the development of agricultural cooperation. Agricultural production cooperatives became the most basic units of production and daily life in rural areas, and collective organizations could bear the responsibility of supporting the Five Guarantees households in the village. The “National Agricultural Development Outline (Draft)” (1956–1967) issued in January 1956 and the “Model Charter for Advanced Agricultural Production Cooperatives” issued in June were the earliest legal documents in New China to provide guarantees for rural Five Guarantees households. The former proposed that agricultural production cooperatives should make appropriate arrangements for the production and daily life of widowed, orphaned, childless, and disabled peasant households and disabled soldiers, ensuring “guaranteed food, guaranteed clothing, guaranteed fuel (for cooking), guaranteed education (for children and adolescents), and guaranteed burial,” so that their needs from birth to death were provided for. The latter made principled provisions on how to establish social insurance and welfare systems in rural areas. This provision also became the beginning of the Five Guarantees support system. Subsequently, local governments responded to the government’s call and established the Five Guarantees support system in rural areas one after another, which became a basic policy with Chinese guarantee characteristics implemented by the government in vast rural areas for a long time. For example, in Liaoning Province, in the autumn of 1956, pilot projects for scattered Five Guarantees households were first conducted in nine counties, including Tieling, and then rolled out across the province.

到1956年，政府在农村建立起了专门针对农村鳏寡孤独以及残疾人的五保户供养制度。这主要是得益于农业合作化的发展，农业生产合作社成为农村最基本的生产、生活单位，集体组织能承担起供养村内五保户的责任。1956年1月出台的《1956—1967年全国农业发展纲要》（草案）及6月出台的《高级农业生产合作社示范章程》，是新中国成立后最早对农村五保户提供保障的法律性文件。前者提出了农业生产合作社应对鳏寡孤独的农户和残废军人在生产和生活上给予适当安排，做到“保吃、保穿、保烧（燃料）、保教（儿童和少年）、保葬”，使他们生养死葬都有依靠；后者则对如何在农村建立社会保险和生活福利制度做出了原则规定。这一规定也成为五保供养制度的开端，此后，各地政府响应政府号召，纷纷在农村建立起五保供养制度，并成为政府在广大农村地区长期执行，具有中国保障特色的一项基本政策。如辽宁省在1956年秋先在铁岭等9个县农村进行散居五保户试点，之后在全省铺开。

The “National Agricultural Development Outline (Revised Draft)” published in October 1957 further clarified the implementation of the “Five Guarantees,” requiring agricultural cooperatives to make unified plans and provide appropriate care for members who had no means of support within the cooperative. The measures adopted by agricultural production cooperatives to place Five Guarantees households generally fell into the following four categories: First, for Five Guarantees recipients with some labor capacity, they were arranged to engage in work within their ability. Second, for Five Guarantees recipients who had lost their labor capacity, they were subsidized according to the average number of labor days per person per year for the entire cooperative, allowing them to participate in the cooperative’s distribution like other members. Third, subsidies in cash and kind were provided: based on the standards for guaranteed food, clothing, fuel, and education stipulated in the Five Guarantees, the required amount of cash and goods was calculated and distributed directly to Five Guarantees households from the public welfare fund in cash and in kind. Fourth, for those who were elderly, weak, ill, or disabled and unable to take care of themselves, special personnel were arranged to look after their daily lives. Taking the implementation of the Five Guarantees support system in the suburbs of Wuhan, Hubei Province, as an example, in August 1956, in the three suburban districts of Qingshan, Hongshan, and Hanqiao, Five Guarantees recipients were assessed during the autumn harvest distribution. Nominations were made by production teams, and discussions and approvals were conducted at general meetings of cooperative members. The living supply standard was calculated based on the annual living materials needed by each individual (grain, oil, salt, firewood, clothing, miscellaneous items), amounting to about 70 yuan. Expenses were covered by the public welfare fund of the cooperative or production team or from total production income. There were two specific implementation methods: first, the annual living expense standard was offset against the labor work points earned by the recipient, and any shortfall was made up; second, supply was provided according to the approved standard, while the subsidized work points for those who participated in labor remained unchanged—more labor did not reduce the subsidy, and less labor did not increase it. In 1957, there were 1,681 Five Guarantees households, totaling 2,123 people, in the suburbs. They participated in the summer pre-distribution and autumn harvest distribution like other members, and equally received holiday allowances and goods such as meat and fish. As a welfare policy long implemented by the Party and the state in rural areas, the Five Guarantees support system played a very positive role in rural social relief and security work.

1957年10月公布的《全国农业发展纲要（修正草案）》进一步明确实行“五保”，要求农业合作社对社内生活没有依靠的社员应统一筹划，给予适当照顾。农业生产合作社安置五保户所采取的措施一般分为以下四种情况：一是对有一定劳动能力的五保对象，安排他们从事力所能及的劳动；二是对丧失劳动能力的五保对象，按照全社每人一年的平均劳动日数，补助给五保户，与其他社员一样参与全社的分配；三是补助款物，按五保规定的吃、穿、烧、教等标准，计算出需要的款物数，从公益金中直接分给五保户现款和实物。四是对年老体弱病残且生活无法自理的人员，安排专人照顾他们的日常生活。以湖北武汉郊区所实施的五保供养制度为例，1956年8月青山、洪山、汉桥3个郊区各乡在秋收分配时评定五保对象，由生产队酝酿提名，社员大会讨论通过。生活供给标准根据个人全年所需生活物资（粮、油、盐、柴、衣、杂用）折算约70元左右，费用从社队公益金或者生产总收入中开支。具体执行方式有两种：一是按年生活费标准和自做劳动工分相抵，不足部分予以补足；二是按核定标准供给，参加劳动的补助工分不变，多劳不少补，少劳不多发。1957年，郊区“五保户”共1681户2123人，与社员同样参加夏季预分和秋收分配，同样领取过节费和鱼肉等实物。五保供养制度作为党和国家在农村长期实行的福利政策，在农村社会救济与保障工作中起到了非常积极的作用。

After the completion of the socialist transformation of agriculture, the collective economy grew rapidly and gradually replaced the family as the basic unit of production and operation in rural areas. The rural social security system also transformed into a pattern combining the state, the collective, and the individual, bringing new changes to the cause of farmers’ social security. The collective economy played a significant role in this process, strengthening the forces of rural social relief and security, broadening the avenues for rural social relief, and becoming an important pillar of the rural security system during this period. As Zhou Enlai pointed out in his *Government Work Report* on June 26, 1957, compared with the pre-liberation life of the vast majority of farmers who could not get enough to eat, after the land reform and the cooperative movement, 20%–30% of farmers’ lives had “a little surplus,” about 60% had “enough to eat and wear,” and 10%–15% still lived a life of “insufficient food and clothing.” Moreover, although the income gap between workers and peasants was wide, living conditions in urban and rural areas differed, and the cost of maintaining a life with adequate food and clothing in the countryside was much lower than in the cities. However, it must be pointed out that the rural collective security of this period was characterized primarily by “egalitarianism” under the cloak of “distribution according to work.” At that time, the development of productive forces was still relatively low, so under “egalitarianism,” farmers could only be guaranteed “not to worry about scarcity but about inequality” [11]11 A classical allusion to the Analects of Confucius (《论语·季氏》): “不患寡而患不均，不患贫而患不安” (One is not concerned about scarcity but about inequality; one is not concerned about poverty but about instability). Here it is used to describe the egalitarian distribution logic of the early collective economy., achieving basic psychological and material satisfaction, reducing the wealth gap among farming families, and avoiding the risk of general famine. Yet this also greatly dampened the initiative of the agricultural labor force.

农业社会主义改造完成后，集体经济快速成长，逐渐取代家庭成为农村地区基本的生产经营单位，农村社会保障体系也转变为国家、集体与个人相结合的格局，农民社会保障事业出现了新变化。集体经济在其中发挥了较大作用，壮大了农村社会救济与保障的力量，拓宽了农村社会救济的道路，成为这一时期农村保障体系依靠的重要力量。正如1957年6月26日，周恩来在《政府工作报告》中指出，与解放前广大农民食不饱腹的生活相比，经过土地改革和合作化运动，20%—30%的农民的生活已“略有积余”，60%左右“有吃有穿”，10%—15%还过着“少吃少穿”的生活。而且，虽然工农收入差距悬殊，但城乡生活条件不同，在农村维持有吃有穿生活水平的开支要比城市低很多。不过，需要指出的是，这一时期的农村集体保障，是以“按劳分配”外衣下的“平均主义”为主要特征，当时生产力发展仍然较为低下，因而“平均主义”下只能保障农民“不患寡而患不均”，能在心理和生活上实现基本满足，减少农民家庭间的贫富差距和避免一般情况的饥荒风险，但这也极大限制了农业劳动力的积极性。

III. Improving Rural Medical and Health Conditions as an Important Component of Rural Social Security

三、提高农村医疗卫生条件是农村社会保障的重要内容

In the exploratory practice of building a rural social security system in the early years of New China, another very important element was improving rural medical and health conditions. Marked by the “Patriotic Health Campaign” [12]12 A mass health campaign launched in 1952, originally to counter the threat of biological warfare during the Korean War, later institutionalized as a nationwide movement to improve sanitation, eliminate disease vectors, and promote public health., rural health, epidemic prevention, and the control of endemic diseases were also important components of the rural social security system at that time. The achievements in rural medical care and disease prevention during this period were mainly reflected in the establishment of the rural medical and health system, the prevention and treatment of endemic and infectious diseases, the promotion of health care knowledge, and the guarantee of drug supply.

在新中国初期构建农村社会保障体系的探索实践中，还有一项非常重要的内容，就是提高农村医疗卫生条件。以“爱国卫生运动”为标志，农村卫生、防疫、地方病防治等工作也是当时农村社会保障体系的重要组成部分。这一时期的农村医疗卫生与疾病防治的成就，主要体现在农村医疗卫生体系的建立、地方病与传染病的预防治疗、卫生保健知识的推广与药品供应保障等方面。

Regarding the establishment of the rural medical and health system since the founding of New China, exploration and experimentation first began in the Northeast. According to 1949 statistics, before the founding of New China, there were approximately 505,000 medical personnel (Chinese and Western medicine) nationwide, 2,600 hospitals, and 80,000 hospital beds, mostly concentrated in large and medium-sized cities and coastal areas. Rural medical and health institutions were particularly scarce, with only 20,000 hospital beds, and most Western medicines and medical equipment relied on imports. Zhang Zikuan, who served for a long time in the health system, mentioned that from early 1950 to the end of 1952, he participated in the experience of building rural health experimental counties in the Northeast. The Northeast was the first large region in the country to carry out rural health experimental work, targeting three main types: first, ordinary agricultural counties; second, counties with endemic and infectious disease epidemics; and third, ethnic minority areas. The main tasks of these experiments were to establish health care organizations, train health workers, and set up health care organizations from the county and district levels down to the central villages, so as to change the pre-liberation situation of rampant disease as quickly as possible. According to Zhang Zikuan’s statistics, by 1952, 40 health experimental counties had established a total of 146 district health centers, each equipped with at least two doctors, and actively carried out health surveys, publicity, and disease prevention and treatment for farmers. At the village level, medical personnel were mobilized to set up private cooperative central village health centers and health stations, equipped with briefly trained, non-full-time midwives and health workers. After training, the previously high incidence of neonatal tetanus, which had reached 30%, dropped significantly.

关于新中国成立以来农村医疗卫生体系的建立，最先是在东北展开探索与实验的。据1949年统计，新中国成立前，全国中西药卫生人员大约50.5万人，医院2600所，病床8万张，且多集中在大、中城市和沿海地区，其中农村的卫生医疗机构更是十分缺乏，病床仅有2万张，且大部分西药、医疗器械都依赖进口。据长期在卫生系统任职的张自宽提到，他在1950年初到1952年底参与了东北农村卫生实验县建设的经验。东北是全国最先开展农村卫生实验工作的大区，主要针对三种类型：一是普通农业县，二是地方病、传染病流行县，三是少数民族地区。该实验的主要任务是建立卫生保健组织、培训卫生工作人员，建立起由县、区到中心村的卫生保健组织，尽快改变解放前疾病流行的局面。据张自宽统计，至1952年，40个卫生实验县共建立了146所区卫生所，每个卫生所至少配备2名医生，并积极开展卫生调查、宣传和为农民防病治病工作。村一级也动员医务人员成立私人合作性质的中心村卫生所、卫生站，配备经过短期培训的不脱产的接生员、卫生员。经过培训，此前高达30%的新生儿破伤风发病率大幅下降。

This experience from the Northeast was quickly promoted nationwide. By 1952, 85% of counties nationwide had health hospitals. In 1951 alone, 378 county health hospitals and over 1,400 district health centers were added. The First and Second National Health Conferences were held in 1949 and 1952, and the Party Central Committee formulated the four major guidelines for health work: “serve the workers, peasants, and soldiers; put prevention first; unite Chinese and Western medicine; and combine health work with mass movements.” These guidelines pointed the way forward for New China’s medical and health work and proclaimed the political concept of “people’s health.” After several years of development, by 1956, medical and health institutions had been universally established in urban and rural areas and industrial and mining areas nationwide. Among them, there were 2,102 county health hospitals (county hospitals) and 61,000 rural joint clinics and health stations. By 1957, the number of hospital beds in county-level and above hospitals had grown to nearly 295,000.

东北这一经验迅速在全国推广，至1952年，全国85%的县有了卫生医院，其中仅1951年就增加了县卫生医院378所，区卫生所1400余所。1949年、1952年两次全国卫生会议召开，党中央形成了卫生工作四大方针，即“面向工农兵、预防为主、团结中西医、卫生工作与群众运动相结合”，为新中国医疗卫生工作指明了发展方向，昭示了“人民卫生”的政治理念。经过几年发展，至1956年，全国城乡、工矿都普遍建立了医疗卫生机构，其中县卫生院（县医院）达到2102所、农村联合诊所加保健站共6.1万所。至1957年，全国县以上医院的病床增长到将近29.5万张。

The prevention and treatment of endemic and infectious diseases was also an important part of the “Patriotic Health Campaign” and became a long-term basic policy of the state. As early as February 1950, the Ministry of Health and the Military Commission’s Ministry of Health jointly launched a spring epidemic prevention campaign for both the military and civilians, mobilizing health workers to conduct health publicity among the masses, promoting universal smallpox vaccination, and deploying measures for the prevention and treatment of acute infectious diseases such as plague, smallpox, and measles. In December 1952, the Second National Health Conference was held, emphasizing that rural areas should focus on preventing endemic diseases. In March 1954, the Ministry of Health issued the *Notice on Strengthening the Prevention and Treatment of Diphtheria*, requiring local authorities to organize forces to quickly curb the occurrence and spread of diphtheria. In November 1955, after hearing a report on the prevention and treatment of schistosomiasis, Mao Zedong immediately instructed the Party to establish a leading group for schistosomiasis prevention and treatment within the Party. The Ministry of Health was to regard the eradication of schistosomiasis as a political task, and all provinces were to take immediate action. Subsequently, the nation set a seven-year plan to eliminate schistosomiasis. In March 1956, the Ministry of Health held a national professional conference on plague prevention and control, passing a plan to basically eliminate plague within seven years. Article 28 of the *National Agricultural Development Program (1956–1967)* (draft) proposed “striving to eliminate the most serious diseases harmful to the people,” including schistosomiasis, smallpox, plague, malaria, and neonatal tetanus. In addition, diseases such as measles, typhoid, diphtheria, and tuberculosis were also to be actively prevented and treated. To this end, medical and health personnel, including practitioners of Chinese medicine, were to be actively trained. Through a series of top-down infectious disease prevention and control policies, the pre-liberation situation of rampant infectious diseases was brought under initial control. By early 1954, a cumulative total of 560 million smallpox vaccinations had been administered nationwide, completing universal vaccination against smallpox except in remote ethnic minority areas. By February 1957, the *Health News* reported on China’s achievements in eliminating the “four pests” [13]13 The “four pests” (四害) targeted in the Patriotic Health Campaign were originally rats, sparrows, flies, and mosquitoes; sparrows were later replaced by bedbugs. The campaign aimed to eliminate disease vectors and improve environmental hygiene. and diseases, noting that plague and smallpox had been basically eliminated, and the cure rate for kala-azar had reached 97%.

地方病与传染病的预防治疗，也是“爱国卫生运动”的重要组成部分，并成为国家长期坚持的一项基本政策。早在1950年2月，卫生部、军委卫生部联合开展军民春季防疫工作，动员卫生工作者对群众进行卫生宣传，推行普种牛痘，以及对鼠疫、天花、麻疹等急性传染病的防治进行部署。1952年12月第二届全国卫生会议召开，强调农村以预防地方病为重点。1954年3月，卫生部发出《关于加强白喉防治工作的通知》，要求各地组织力量迅速扑灭白喉的发生和流行。1955年11月，毛泽东在听取防治血吸虫病的汇报后，当即指示党内成立防治血吸虫病领导小组，卫生部要把消灭血吸虫病作为政治任务，各省立即行动，随后全国定下了7年消灭血吸虫病的计划。1956年3月，卫生部召开全国鼠疫防治专业会议，通过了7年内基本消灭鼠疫的规划。《1956年至1957年全国农业发展纲要》（草案）第28条提出“努力消灭危害人民最严重的的疾病”，包括血吸虫病、天花、鼠疫、疟疾、新生儿破伤风等。此外，如麻疹、伤寒、白喉、肺结核等疾病也要积极防治。为此，要积极培养包括中医在内的医务卫生人员。通过自上而下的一系列传染病防治政策，解放前传染病流行的局面得到了初步控制。1954年初，全国已累计种痘5.6亿人次，完成了除边远少数民族地区外预防天花的普种工作。至1957年2月，《健康报》报道了我国在消除四害和疾病上的成绩，其中鼠疫、天花已经基本消灭，黑热病的治愈率也达到97%。

Regarding the promotion of health care knowledge and drug supply. Taking the new method of childbirth as an example, according to the 1957 work report of the All-China Women’s Federation, through the implementation of the new method of childbirth, the incidence of puerperal fever in mothers and tetanus in infants dropped significantly. After agricultural cooperation, the training organizations for midwives, health workers, and child-care workers within the cooperatives also improved the quality of the new method of childbirth. By 1956, the proportion of rural births using the new method had reached 40%. In addition, regarding the guarantee of drug supply, on June 4, 1956, the Ministry of Commerce, the Ministry of Health, and the All-China Federation of Supply and Marketing Cooperatives jointly issued a notice, requiring that the supply of drugs (including veterinary drugs) in rural areas be effectively ensured, and that the task of “eliminating pests and eradicating diseases” proposed in the *National Agricultural Development Program* be implemented, so as to improve the health level of rural residents and ensure the development of agricultural production.

关于卫生保健知识推广与药品供应。以新法接生为例，根据1957年全国妇联的工作报告，通过开展新法接生，产妇产褥热、婴儿破伤风的发病率大为下降。农业合作化后，社内的接生员、保健员、保育员的训练组织，也提高了新法接生的质量。至1956年，农村新法接生比例已达40%。此外，在药品供应保障上。1956年6月4日商业部、卫生部与合作总社联合发布通知，要求切实做好农村药品供应（包括牲畜用药），贯彻《全国农业发展纲要》提出的“除害灭病任务”，以提高农村居民健康水平，保证农业生产发展。

It was precisely under the guidance of the Party Central Committee’s concept of “people’s health” that, through the vigorous implementation of the above series of medical and health and disease prevention policies, the situation of widespread shortage of doctors and medicines in rural areas was rapidly changed, and the quality of life and life expectancy of peasants were greatly improved. In his government work report delivered at the Fourth Session of the First National People’s Congress on June 26, 1957, Zhou Enlai clearly stated that China had achieved considerable results in improving people’s health and in disease prevention and treatment, including the rapid expansion of the medical and health workforce, significant improvements in urban and rural environmental sanitation and personal hygiene, and the basic control of plague, cholera, smallpox, and other diseases. On the other hand, there were still problems such as mass health campaigns being sometimes intense and sometimes slack, and unreasonable and inconvenient aspects of the medical system. In addition, in his report to the Enlarged Third Session of the Eighth Central Committee of the Party on September 26, 1957, Zhou Enlai pointed out that there was a relatively obvious “imbalance” in medical and health work at that time. For example, according to 1957 statistics, the average annual number of outpatient visits per person for the group enjoying public medical care was about 15, while according to survey statistics, the average number of outpatient visits per person for urban residents was about 3–5, and for peasants only 2. Public medical care consumed a large amount of medical resources. To change this unreasonable situation, Zhou Enlai emphasized that the future direction of medical and health work was “to serve the 600 million people, balance urban and rural areas, expand outpatient services, and set up simple hospital beds.” At the same time, it was necessary to expand preventive work, lower drug prices, reform the medical system, and not be too hasty in implementing joint operations for private clinics. To implement Zhou Enlai’s instructions, the Ministry of Health held a National Hospital Work Conference in December 1957, which clarified the thinking of “running hospitals diligently and frugally, reforming hospital systems to facilitate patients’ access to medical care, improving medical quality, and establishing the idea of serving the people wholeheartedly,” and carried out reforms to the system to make it easier for the people to see a doctor. At the same time, medical personnel were organized to leave the hospitals and go deep into factories, mines, mountainous areas, and rural areas to prevent and treat diseases for the masses. However, the “Great Leap Forward” [14]14 The Great Leap Forward (1958–1961) was a nationwide economic and social campaign initiated by the CPC to rapidly industrialize the country and collectivize agriculture, which led to severe economic difficulties and a major famine. and “leftist” errors after 1958 also brought certain losses to the medical cause, such as the hasty conversion of rural joint clinics into commune health centers, which led to excessive concentration of grassroots health institutions, inconvenience for the masses in seeing a doctor, overly strict demands on medical personnel, restrictions on individual medical practitioners, and premature reduction or exemption of medical expenses leading to deficits and other problems.

正是在党中央“人民卫生”理念的指导下，通过以上一系列医疗卫生与疾病防治政策的大力推行，广大农村缺医少药的状况得到迅速改变，农民的生活质量与预期寿命得到大幅度提高。周恩来在1957年6月26日第一届全国人大第四次会议上所作政府工作报告中明确表示，我国在改善人民健康和防治上面取得了不少成绩，包括医药卫生队伍迅速扩大、城乡环境卫生和个人卫生改善显著，鼠疫、霍乱、天花等已基本控制。但另一方面，还存在群众性卫生运动时紧时松、医疗制度有不合理和不方便的地方等问题。此外，周恩来在1957年9月26日党的八届中央委员会第三次扩大会议报告中指出，当时医疗卫生上存在比较明显的“不平衡”现象。如1957年的统计中，享受公费医疗群体每年人均门诊次数约15次，而根据调查统计，市民的人均门诊次数约为3—5次，农民只有2次。公费医疗占用了大量的医疗资源。为改变这一不合理状况，周恩来强调，今后的医疗卫生工作方向是“为六亿人民服务，城乡兼顾，扩大门诊，举办简易病床”。同时要扩大预防工作、降低药品价格、改革医疗制度、私人诊所不宜过急实行联营等。为贯彻周恩来的指示，卫生部于1957年12月召开全国医院工作会议，明确了“勤俭办院，改革医院制度，便于患者就医，提高医疗质量，树立全心全意为人民服务”的思想，对制度进行改革，方便老百姓看病。同时组织医务人员走出医院，深入工矿、山区、农村为群众防病治病。不过，1958年以后的“大跃进”“左倾”错误也给医疗事业带来了一定损失，如急于把农村联合诊所改为公社卫生院，导致基层卫生机构过于集中，群众看病不方便，对医务人员要求过死，限制了个体医务人员，过早减免医疗费用导致入不敷出等问题。

Since the founding of New China, two different sets of social security models have been implemented in urban and rural areas. In terms of urban social security construction, from 1949 to 1957, the government gradually established a social security system covering urban workers nationwide through the implementation of regulations and policies such as the “Labor Insurance Regulations of the People’s Republic of China,” initially solving social security issues closely related to them, such as childbirth, medical care, unemployment, and retirement pensions. At the same time, to ensure industrial production, the state also implemented a policy of priority supply for urban workers in terms of employment, grain, education, housing, and other aspects. This directly linked social security to urban household registration, and cities gradually established a relatively complete social security system with distinct socialist characteristics. At that time, due to the relatively low level of rural productive forces and the limited financial capacity of the state, the government was unable to afford the investment needed to establish a labor insurance system and social security system in the vast rural areas similar to those in cities. Therefore, in terms of rural social security construction, the Party and the state first attempted to establish a social security system based primarily on production self-help, while strongly relying on the collective economy, promoting mutual aid among peasants, supplemented by state disaster relief and assistance, and improving rural medical and health and disease prevention conditions. What the government could provide in rural areas was more of an emergency temporary assistance nature, as well as providing the most basic survival security for the rural population with special living difficulties, resulting in problems such as low security levels and a small coverage scope.

新中国成立以来，城市与农村实施的是两套不同的社会保障模式。在城市的社会保障建设上，1949—1957年，政府通过实施《中华人民共和国劳动保险条例》等法规与政策，逐步在全国范围内建立起了一套覆盖城镇劳动者的社会保障制度，初步解决了与他们息息相关的生育、医疗、失业、退休养老等社会保障问题。同时，为保证工业生产，国家在就业、粮食、教育、住房等方面也对城镇劳动者实行优先供给的政策。这就使得社会保障与城镇户口直接挂钩，城市逐渐建立起一套具有鲜明社会主义色彩，较为完备的社会保障制度。当时农村生产力水平较低以及国家财力有限，政府无力负担在广大农村建立与城市同样的劳动保险制度、社会保障体系所需要的投入。因此，在农村的社会保障建设上，党和国家首先试图建立一个以生产自救为主，同时大力依靠集体经济，提倡农民互助，辅之以国家救灾与救济，改善农村医疗卫生与疾病防治条件的社会保障体系。政府在农村所能提供的更多是具有应急性质的临时援助，以及为特别生活困难的农村人口提供最基本的生存性保障，存在保障水平低、受众小等问题。

In the exploration and practice of building a rural social security system in the early period of New China, the collective economy became the most important breakthrough. Under the circumstances where the state was not yet capable of establishing a social security system covering both urban and rural areas, actively leveraging and mobilizing the collective security function of the rural areas themselves was consistent with the state’s policy of gradually realizing agricultural collectivization at that time. Therefore, the state encouraged collective economic organizations to play a greater role in the rural social security system, such as bold experiments in public reserve funds, public welfare funds, rural cooperative medical care, the Five-Guarantee Household System [15]15 The Five-Guarantee Household System (五保户制度) was a rural social security policy providing guaranteed food, clothing, medical care, housing, and burial expenses for elderly, infirm, or orphaned peasants without family support., and other aspects. This was a development and innovation of the rural tradition of social mutual aid. However, due to the limitations of actual national conditions, the rural social security system of this period still had shortcomings such as narrow coverage, unsystematic security items, relatively high project standards, and a single funding channel. It is worth noting that the Patriotic Health Campaign [16]16 The Patriotic Health Campaign (爱国卫生运动) was a mass movement launched in 1952 to improve public health and hygiene, initially focused on preventing disease during the Korean War and later extended to rural areas. promoted nationwide after the founding of New China, along with a series of rural medical and health and disease prevention policies, played a positive role in the development of rural medical and health undertakings and the basic living security of the lowest-level masses, providing a good start for China’s health care cause.

在新中国初期构建农村社会保障体系的探索与实践中，集体经济成为最为重要的突破口，在国家暂时还没有能力建立覆盖城市与农村社会保障体系的情况下，积极发挥与动员农村自身的集体保障功能，与当时国家逐步实现农业集体化的政策是一致的。因此，国家鼓励集体经济组织在农村社会保障体系中发挥更大作用，如在公积金、公益金、农村合作医疗、五保户制度等方面的大胆尝试，这是对农村社会互助传统的发展与创新。只是由于实际国情的限制，这一时期的农村社会保障体系还存在覆盖面窄、保障项目不系统、项目标准较高、资金渠道单一等不足。值得注意的是，新中国成立后在全国范围推行的爱国卫生运动及一系列农村医疗卫生和疾病防治政策，对农村的医疗卫生事业的发展与最底层群众的基本生活保障都发挥了积极作用，为我国卫生保健事业提供了良好开端。

Between 1949 and 1957, social security work in rural areas achieved initial results. The vast majority of peasants received land, realizing self-security based on land. At the same time, the Party and the state carried out a series of powerful disaster relief and assistance efforts in rural areas in response to various disasters. More notably, starting from 1953, the collective economy gradually began to assume an important function in peasant security, and rural medical and health conditions were also greatly improved. This was an unprecedented new change in the agricultural society of several thousand years.

1949—1957年间，农村地区的社会保障工作初见成效，广大农民分得了土地，实现了以土地为基础的自我保障。同时，党和国家在农村地区针对各种灾情开展了一系列强而有力的救灾与救济工作。更值得注意的是，从1953年起，集体经济逐渐开始承担农民保障的重要职能，农村医疗卫生条件也得到了巨大改善，这是数千年来农业社会前所未有的新变化。

(Author: Zhou Xiao, Lecturer, School of Marxism, Foshan University of Science and Technology)

（作者：周肖，佛山科学技术学院马克思主义学院讲师）

Online Editor: Tongxin

网络编辑：同心