External pressure has also impacted on the development of China's public health. During the SARS outbreak, the WHO directly told the Chinese government in its mission report in April 2003 that`` [t] here was an urgent need to improve surveillance and infection control'' in the country [7] . Two years later, the Chinese government officially admitted its health care system was ailing in a joint report issued by State Council's Development Research Centre and the WHO [8] . The recent decision on a new rural cooperative medical system is one of its efforts to provide its rural residents by 2010 with more equitable and accessible health care [9±11] and improve its diseases surveillance system at the local level. In addition, both the``loss of face'' in the Summary Points N SARS not only exposed a fundamental shortcoming of China's public health surveillance system as well as its single-minded pursuit of economic growth since the late 1970s, but also forced China to realize that, in the era of globalization, public health is no longer a domestic, social issue that can be isolated from foreign-policy concern. N Its ailing health care system, its aspiration to be seen as a``responsible state,'' and international demands for health cooperation have compelled China to be more proactive in the global health domain.