Is China’s ‘Health Code’ Here to Stay?

There has been much media coverage over health code apps released by tech giants Alibaba and Tencent to combat the spread of COVID-19 in China. The algorithm assigns different colors to users, based on their medical records and travel history, to indicate their risk level for contracting COVID-19.

In late May, a controversial proposal from Hangzhou health officials to normalize the usage of these apps permanently and create citizen health scores based on personal lifestyles raised concerns over privacy. The proposed version of the new health code would collect personal data such as daily alcohol consumption, tobacco use, steps, and sleep time. Combined with an already prevalent surveillance system, many worried that the amount of personal data this proposed system might collect would be staggering and could potentially turn dystopian TV shows and books into reality.

The majority of the discussion in China and overseas about adopting a permanent health code system has mostly concentrated on the government’s overt intrusion into people’s daily lives and further encroachment of the limited privacy Chinese citizens are left with. The fixation on the narrative of an authoritarian government maliciously using AI and surveillance to control people’s lives is certainly understandable. Yet, it is unrealistic to assume that any government can accurately collect digital information such as daily exercise and alcohol consumption of all citizens. Even if people are instructed to enter the data, there is no way to guarantee information integrity. When Hangzhou’s health commission released its impractical proposal to the public, the amount of criticism – not only from Chinese netizens, but also from the state-run Xinhua news agency and more – was overwhelming. Having observed such a wide range of skepticism, Hangzhou’s health authority took down the controversial proposal from its official website within a month, according to an internet archive.

Hangzhou health officials’ quick retreat on the permanent health app, nonetheless, did not dissuade the general trend of being more receptive to the use of health data for both public governance and private business. After experiencing the power of the health code app and its big data analytics system first-hand, major Chinese cities aim to accelerate moving their health and other service programs online. During the pandemic, Alibaba’s mobile payment platform Alipay quickly added remote medical appointment features to the health code app, allowing local citizens to use the health code app instead of their medical insurance card to have online video appointments with doctors. Another rising IT company, iFlytek, provided voice recognition programs to assist doctors recording prescriptions, heralding the further integration of technology and government work. The president of Tencent Cloud, who also serves as the vice president at Tencent Group, commented that the paperless, mobile, and traceable nature of the health code app can provide an innovative solution to future social governance. In conjunction with Alibaba’s pilot City Brain program, the health code app and its amassed personal data is expected to further contribute to the development of future smart cities.

There is no doubt that a permanent health code can create business opportunities such as online medical services for targeted populations or home-care choices with e-doctors. However, the promising business vision or other e-government features the system may provide still need to address some nuanced issues, from both a theoretical and a practical perspective. The former speaks to the legitimate footing and proper use of the health code, and the latter concerns the accuracy and scalability of the health code. Facing a rapidly transmissible disease like COVID-19, governments arguably should be given the prerogative to track the spread of the virus to ensure the safety of the population. But as the virus would hopefully disappear after the release of successful vaccine programs, continuing the health code app becomes less easy to defend. The government and the private sector need to renegotiate a social contract and gain people’s consent to continue to collect private information, including locations and lifestyles, not to mention pushing everything online. Health code and relevant apps need to go through the process of explicit deliberation among different interest groups in the society, considering both its merits and demerits. Even if the health code weathers this discussion and makes headway, it should give individuals the choice to opt out.

How to properly use the collected information is another core issue. What information will be collected? Who will have access to the database? Will the information be adversely used against its provider? These questions are difficult to answer. A symbolic move in China’s first civil code sheds some light on privacy protection in the country. The legislation, reviewed by the National People’s Congress during this year’s “two sessions” protects an individual’s right to privacy and personal information, highlights the responsibility of data collectors, and outlaws leaking certain private information without consent from the individual. Optimistic legal scholars in China believe the new law offers strong protection for individual data and can in theory limit the government’s ability to collect and share much personal information, though in contrast many independent sources worry that the effectiveness of these new laws remains to be seen.

The practical concerns are related to the accuracy and scalability of the health code apps and relevant e-governance. Provincial data in Fujian shows that just about half of its population had health code apps as of early July. What’s more concerning is that health code apps may ignore one of the most vulnerable socioeconomic groups: the elderly. The entire health code system is based on the popularity of smartphones, yet such devices have far less penetration among the older population. Data from WeChat, one of China’s most popular apps, shows that there are more than 61 million users in the 55-70 age group. This amount is remarkable considering many of them have just learned how to use it in the past year or two, but the number pales in comparison to the total 60-plus population of 250 million. China’s National Bureau of Statistics estimates that only 23 percent of seniors have access to the internet. For this group, which is most susceptible to health risks, the popularization and prioritization of health code apps may inadvertently exclude them. In the past months, there have been numerous reports of the elderly not being permitted to go to restaurants or supermarkets because they don’t have the health code app. If the government wants to promote a permanent health code, addressing the difficulties faced by senior citizens and people with no smartphones would be an imminent struggle. In the longer term, these issues will only be exacerbated if the government decides to move more services online. Before smart devices and internet access become completely universal, alternatives should exist for those who are not as tech savvy.

Beyond the heated discussion about individual privacy, the Chinese health code app, born during the pandemic, offers a promising future for more efficient health governance and health sector opportunities. To fully unleash its potential, however, the moral, legal, and technical aspects of permanent health code systems should be closed examined, and all subsequent questions addressed.