to disease and illness. However unlike many 3rd world countries, China simply doesn't follow that trend.

Over my 20 years I've literally covered nearly every demographic across China except Tibet.

In 1997-2000 I lived and worked in a 3rd tier city (Shaoxing) and it's local county town Keqiao. Your observations aren't wrong. In my first plant, the fixtures in our restrooms were abhorrent, it wasn't until my little team arrived that we placed emphasis on making sure the comodes all worked, that they all flushed. These people had spitoons on the stairwells in the main office building, they hacked and spit on the floor. And yes, they all carried their own TP from their office when they used the toilet. And very little hand soap was available, not to mention ZERO hot water.

In my power plant when I changed jobs after 8 months, I literally had my HR ordering the custodians to keep rolls of TP in the stalls, and it was inspected daily. They even put little shelves on the main wall with 10-20 rolls. When I first ordered it, people stole it to use at home or in our dorms. So I did the same thing in the dorms. Eventually, they must have got their year supply, but the pilferage stopped. Every toilet had hand soap.

In the rest of life around us. No, people didn't and I don't dispute that a majority of places don't. But times change, and now most cities expect a hand sink near restrooms with a soap dispenser.

Now, if you are hanging out at universities, there is no doubt that facilities suffer across China in dorms, offices, and buildings that are publically funded. Don't know why that is a surprise.

But, to say as a culture they don't care. That's just not true. They do care, they use special utensils in their family eating style (like a common set of chopsticks for noodles to serve them so you don't use your personal chopsticks to get them). They use large spoons for many dishes, they serve individual serving of many dishes or first show them on the round table and then divvy them out.

They are meticulous about bathing at night, but in many settings a bath could be a 2-3 times a week experience. Most of my employees still shower at the plant. They are too cheap to have hot water or use it at home.

But to say they don't care about sanitation is counter-intuitive to how their population continues to grow and the level of health they enjoy.