Finally, decentralization and underfinancing of public health services have significantly undermined China's ability to mount an effective, coordinated response to potentially pandemic infectious illnesses. The Chinese government's slow response to the SARS epidemic almost certainly was a reflection of these developments, which raise concerns about whether China's public health infrastructure will be up to the task of detecting and responding to the emergence of an incipient avian influenza epidemic. The same concerns arise with respect to China's ability to contain its growing epidemic of human immunodeficiency virus (HIV) infection and associated outbreaks of multidrug-resistant tuberculosis, especially in rural areas.


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