Her condition is not disabling and does not warrant special intervention but the hospital deemed Liang unfit for the job because she did not meet required health standards for public servants.

“It was really shocking and I couldn’t understand why it was a barrier,” Liang said. “As a doctor who has spent nearly 10 years in undergraduate and graduate studies, I found out that I was rejected from the medical profession due to a disease that does not affect my work and daily life. This is a devastating blow. I feel that I am being deprived of my right to survive and make a living.”

01:12

Record 2.1 million Chinese sit civil service exam as economy slows, youth jobless rate climbs

Record 2.1 million Chinese sit civil service exam as economy slows, youth jobless rate climbs

Liang is far from alone. Amid a bleak outlook and intense competition in China’s job market, many jobseekers have been turned down, not because of ability or performance, but after physical exams exposed chronic conditions – such as HT, polycystic kidney disease and high blood pressure, according to numerous posts shared on multiple social media platforms, and court documents obtained by the South China Morning Post.

These health checks are part of standards set for public servants established in 2004 and revised in 2016 to ensure a capable workforce by excluding workers with certain medical conditions. They have also been adopted by many other industries – from education to finance – effectively broadening employment discrimination, which legal and medical experts say needs urgent review to ensure a non-discriminatory working environment.

The standards say HT is an autoimmune disease often accompanied by other autoimmune diseases, and that is “more common in middle-aged and elderly people, rare in young individuals”. But the prevalence has risen in recent years, affecting about 1 per cent of the population.

A Beijing-based thyroid doctor said that while HT was prevalent it did not significantly affect lifestyle, and most people could manage it with routine medication. A Guangzhou-based thyroid specialist added that early-stage HT was often mild and asymptomatic, and it would be a “pity” for job applicants if they were disqualified on the basis of the condition.

As a top medical student and person with HT, Liang learned a lot about the disease and her condition through multiple health checks and her training, which included a seven-year integrated bachelor’s and master’s programme followed by two years of residency training at a top-tier hospital in Guangzhou.

But when she negotiated with the human resources department at Xiamen Hospital of TCM she was told, “they were aware of the nature of the disease, which won’t affect normal life and work, but they had to follow the policy. They only executed according to the policy and couldn’t go beyond it.”

A 27-year-old master’s graduate surnamed Wang came up against a similar wall of discrimination. He said that after he was turned down for a teaching position because of polycystic kidney disease, a genetic disorder that affects the kidneys, he lost the passion for his career.

“Graduation means unemployment, and I felt like I was being sentenced to prison at an age when I should be shining and radiant. All I want to say is, is it really the disease that’s affecting me, or is it the rule?”

Chinese authorities have recognised the problems with such rules before.

In 2007, China passed a law prohibiting employment discrimination against carriers of contagious diseases and in 2010 it officially banned testing for hepatitis B virus (HBV), previously a source of discrimination for people with the disease. Since then, all local governments have removed civil service requirements that discriminate against HBV-positive individuals.

Li Zhongxia, a law professor from the China University of Political Science and Law (CUPL), sees the removal of HBV testing as “a huge step forwards in the rule of law, and in the protection of basic constitutional rights”.

Li was among the participants at a forum in April organised by the university to discuss the legitimacy of physical exams in the recruitment of public servants, with many experts calling for the standards to be brought up to date with progress in medicine and technology.

From a constitutional law perspective, the existing regulations might be too broad and restrictively interpretive, he said, and a more nuanced approach was needed to balance individual rights with the public interest. For example, conditions such as high blood pressure, insomnia and being HIV-positive are on the disqualification list but might not necessarily mean someone cannot become a public servant, Li said.

Xu Guogang, from the People’s Liberation Army General Hospital, suggested at the forum that the standards must be updated regularly to keep pace with advances in medicine and technology.

“[The standards should] focus on the actual impact of a disease on work ability rather than just its existence,” Xu said, adding that some infectious diseases might require strict control, while it should be considered that others could be managed by treatment.

In various media interviews, she has argued that more than 50 types of disease are listed as disqualifying for employment. Even though many of them do not affect normal life and work, they prevent potential students and professionals from pursuing chosen careers.

According to Chinese media reports, in 2019 a 30-year-old man with high blood pressure was rejected by the Guangzhou municipal public works bureau because it was determined his health issues might affect his ability to work long hours. In 2020, a 28-year-old woman with epilepsy was rejected by the Henan provincial Health Commission because she had a history of seizures.

Lawyer Zhang Xiaoli, representing a client with HT who lost a social worker job offer last year, said the hope was for change soon.

“The unreasonable standards should be adjusted. Specifically, chronic diseases that do not affect normal job performance, such as HT and polycystic kidney disease, should be removed from the unqualified category,” Zhang said.

In China, being a civil servant has traditionally been considered a prestigious and secure career path. Civil service jobs come with numerous benefits, such as job security, social welfare, housing subsidies, holidays, and medical insurance – benefits that are not common in the private sector.

Amid the economic downturn, even more people are pursuing civil service careers. According to state news agency Xinhua, more than 1.7 million people applied for the 2024 civil service exam, a 22,000 increase from last year. However, only around 39,600 will be selected.

In China, public servants are those working in government branches at different levels, while other public sector employees, such as teachers and researchers, are not categorised as public servants. Due to a lack of specific regulation for other sectors, however, it has become a common practice for various industries to refer to the public servant physical examination standards.

A university graduate in Chongqing wrote on Xiaohongshu that her job offer at a tech giant was revoked after she reported her HT diagnosis to the human resources department. She wondered on her post why the standard would affect a private enterprise.

“The standard seems to have become a template for all industries and occupations,” another university graduate said in a court submission after being rejected twice in both public and private education sectors. “As for us who have unintentionally contracted chronic diseases that do not affect our work, who have spent decades studying only to find no opportunities to shine, our job prospects are severely restricted.”

Zhang said a client surnamed Zhou lost a social worker job offer in Jiangsu province after failing the physical exam due to her HT diagnosis and sued the bureau for applying public servant standards to a non-public servant job. The client lost.

The court ruled that by registering for the examination, the applicant was deemed to have accepted the recruitment requirements and agreed to have a physical exam according to the standards for public servants as listed in the recruitment ad, Zhang said.

04:32

What is the gaokao? A look at China’s daunting university entrance exams

What is the gaokao? A look at China’s daunting university entrance exams

The status of the job was key for TCM doctor Liang who argued that the position she applied for did not count as “public servant” in China, and that her medical condition was stable without affecting her job performance. She sued the hospital for job discrimination but lost the appeal in March.

“I think it’s still very unreasonable. They only fulfilled their obligation to inform [in the ads], but they didn’t realise that their actual behaviour has already infringed upon our employment rights,” Liang said.

This pattern and rationale are not uncommon in other similar verdicts, according to Chen Bi, an associate professor of criminal law at CUPL, who told the university’s forum in April that all cases were administrative review and litigation cases, with none finding fault in the process.

However, CUPL law professor Cheng Xiezhong pointed out that the physical exam standards were not compulsory national standards but regulatory documents with limited binding force. He suggested that in administrative review and litigation, the reviewing agency or court should review how lawful the examination standards were and their relevance to job requirements.

“In most cases, there is no strong correlation between a civil servant’s physical condition and their ability to perform their job’s duties. Except for certain positions that require special physical abilities, it is not justified to use a person’s health status as a criterion for recruitment,” Cheng told the forum.

Lawyer Zhang hopes that physical examination standards for public servants will no longer be used for non-public servant positions to ensure there are more job opportunities for people with chronic diseases.

“Otherwise, a large group of people with chronic diseases will not only be excluded from public service positions but also from job opportunities in other public institutions and large [private] enterprises,” Zhang said.

Liang finally found another position in a private hospital in Xiamen which, while also using public service health standards as a reference, assessed candidates based on actual job requirements rather than strictly adhering to the guidelines – a result she said was lucky but rare because “so many other patients are still affected by the rules”.