Intended for healthcare professionals


China’s “new” silk road

BMJ 2018; 360 doi: (Published 22 February 2018) Cite this as: BMJ 2018;360:k816
  1. Lawrence O Gostin, O’Neill chair in global health law
  1. Georgetown University Law Center, Washington, DC, USA
  1. gostin{at}

Promise or peril for health, development, and human rights?

The “new” silk road—the belt and road initiative (BRI)—is China’s grand idea for the 21st century, promising to transform international development assistance for health. Named after the ancient network of terrestrial and maritime routes, the BRI represents a massive $1trn (£715bn; €810bn) investment in trade and cultural exchange, stretching through Eurasia and connecting to Africa, the Middle East, and Europe.1 Murphy’s feature in The BMJ ( reveals global tensions about the BRI’s impact—will China forge a new paradigm for global health, or is the BRI a modern form of colonialism? What are the BRI’s promises and perils, and how could China reform the BRI to genuinely advance the right to health?

A remarkable transformation

At the turn of the century, China was the world’s largest aid recipient,2 but by 2011 it had become a net provider of foreign assistance. The China model hews sharply away from traditional aid programmes in Europe and the United States. Western aid is heavily multilateral (through the World Health Organization, the Global Fund, and Gavi) and grant driven …

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