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Consequences
The failure of agricultural policies, the movement of farmers from agricultural to industrial work, and possibly weather conditions lead to severe famine. Many also died from mistreatment by government officials. The economy, which had improved since the end of the civil war, was devastated. In response to the severe conditions, there was resistance among the populace. The effects on the upper levels of government in response to the disaster were complex, with Mao purging the Minister of National Defense Peng Dehuai in 1959, the temporary promotion of Lin Biao, Liu Shaoqi, and Deng Xiaoping, and Mao losing some power and prestige following the Great Leap Forward, which lead him to launch the Cultural Revolution in 1966.

Famine
Despite the harmful agricultural innovations, the weather in 1958 was very favorable and the harvest promised to be good. Unfortunately, the amount of labour diverted to steel production and construction projects meant that much of the harvest was left to rot uncollected in some areas. This problem was exacerbated by a devastating locust swarm, which was caused when their natural predators were killed as part of the Great Sparrow Campaign. Although actual harvests were reduced, local officials, under tremendous pressure from central authorities to report record harvests in response to the new innovations, competed with each other to announce increasingly exaggerated results. These were used as a basis for determining the amount of grain to be taken by the State to supply the towns and cities, and to export. This left barely enough for the peasants, and in some areas, starvation set in. During 1958–1960 China continued to be a substantial net exporter of grain, despite the widespread famine experienced in the countryside, as Mao sought to maintain face and convince the outside world of the success of his plans. Foreign aid was refused. When the Japanese foreign minister told his Chinese counterpart Chen Yi of an offer of 100,000 tonnes of wheat to be shipped out of public view, he was rebuffed. John F Kennedy was also aware that the Chinese were exporting food to Africa and Cuba during the famine and said "we've had no indication from the Chinese Communists that they would welcome any offer of food."

In 1959 and 1960 the weather was less favorable, and the situation got considerably worse, with many of China's provinces experiencing severe famine. Droughts, floods, and general bad weather caught China completely by surprise. In July 1959, the Yellow River flooded in East China. According to the Disaster Center, it directly killed, either through starvation from crop failure or drowning, an estimated 2 million people.

In 1960, at least some degree of drought and other bad weather affected 55 percent of cultivated land, while an estimated 60 percent of northern agricultural land received no rain at all.

With dramatically reduced yields, even urban areas suffered much reduced rations; however, mass starvation was largely confined to the countryside, where, as a result of drastically inflated production statistics, very little grain was left for the peasants to eat. Food shortages were bad throughout the country; however, the provinces which had adopted Mao's reforms with the most vigor, such as Anhui, Gansu and Henan, tended to suffer disproportionately. Sichuan, one of China's most populous provinces, known in China as "Heaven's Granary" because of its fertility, is thought to have suffered the greatest absolute numbers of deaths from starvation due to the vigor with which provincial leader Li Jinquan undertook Mao's reforms. During the Great Leap Forward, cases of cannibalism also occurred in the parts of China that were severely affected by famine.

The agricultural policies of the Great Leap Forward and the associated famine would then continue until January 1961, where, at the Ninth Plenum of the Eighth Central Committee, the restoration of agricultural production through a reversal of the Great Leap policies was started. Grain exports were stopped, and imports from Canada and Australia helped to reduce the impact of the food shortages, at least in the coastal cities.

Famine Deaths
The exact number of famine deaths is difficult to determine, and estimates range from 16.5 million to 46 million people. Because of the uncertainties involved in estimating famine deaths caused by the Great Leap Forward or any famine, it is difficult to compare the severity of different famines. However if a mid estimate of 30 million deaths is accepted, the Great leap Forward was probably the deadliest famine in the history of China and in the history of the world. This was in part due to China’s large population;  in  the Great Irish Famine, approximately 1 million of a population of 8 million people died, or 12.5%, in the Great Chinese Famine approximately 30 million of a population of 600 million people died, or 5%.

Death toll estimates based on demographics are usually derived from the 1953 and 1964 censuses showing total population change. This is combined with estimated birth and baseline death rates over the period to arrive at an excess death rate for the years of the Great Leap Forward, which is then translated into the total number of famine deaths. Estimates by Yang also include information from provincial and central archives and interviews with survivors, and estimates by Dikötter also include data from minutes of emergency committees, secret police reports, and public security investigations.

Estimates based on national census data and birth rates are fraught with uncertainty. National census data was not accurate and even the total population of China at the time was not known to within 50 million to 100 million people. There were numerous flaws in the 1953 census on which famine death projections are made. In addition to being inaccurate, census figures may also be inadequate, and lead to undercounting of famine deaths. Estimates of birth rate also contain a great deal of uncertainty.

The severity of the famine varied from region to region. Fuyang, a region with a population of 8 million in 1958, had a death rate that rivaled Democratic Kampuchea's Killing Fields; more than 2.4 million people perished there over the next three years. In Gao Village in Jiangxi Province there was a famine, but no one actually died of starvation.

Prior to the Great Leap Forward, famines were not uncommon in China. Additionally, prior to 1949, the chaos following the collapse of the Qing Dynasty, the Chinese Civil War, the Japanese invasion, and Japanese, Communist, and Nationalist democide all contributed to a high death rate. Minqi Li, a former Chinese dissident and political prisoner and now a Marxist Professor of Economics at the University of Utah, has produced data showing that even the peak death rates during the Great Leap Forward were in fact quite typical in pre-Communist China. Li argues that based on the average death rate over the three years of the Great Leap Forward, there were several million fewer lives lost during this period than would have been the case under normal mortality conditions before 1949.

Causes of the famine and responsibility
The policies of the Great Leap Forward were mostly, if not completely responsible for the famine. There is disagreement over how much, if at all, weather conditions contributed to the famine and how much, if at all, the famine was intentional or due to willful negligence.

Yang Jisheng, a long-time communist party member and a reporter for the official Chinese news agency Xinhua, puts the blame squarely on Maoist policies, such as diverting agricultural workers to steel production instead of growing crops, and exporting grain at the same time. During the course of his research, Yang uncovered that some 22 million tons of grain was held in public granaries at the height of the famine, reports of the starvation went up the bureaucracy only to be ignored by top officials, and the authorities ordered that statistics be destroyed in regions where population decline became evident. Economist Steven Rosefielde argues that Yang's account "shows that Mao's slaughter was caused in considerable part by terror-starvation; that is, voluntary manslaughter (and perhaps murder) rather than innocuous famine." Yang notes that local party officials were indifferent to the large number of people dying around them, as their primary concern was the delivery of grain, which Mao wanted to use to pay back debts to the USSR totaling 1.973 billion yuan. In Xinyang, people died of starvation at the doors of grain warehouses. Mao refused to open the state granaries as he dismissed reports of food shortages and accused the peasants of hiding grain. From his research into records and talks with experts at the meteorological bureau, Yang concludes that the weather during the Great leap forward was not unusual compared to other periods and was not a factor. Yang also believes that the Sino-Soviet split was not a factor because it did not happen until 1960, when the famine was well under way.

Chang and Halliday argue that "Mao had actually allowed for many more deaths. Although slaughter was not his purpose with the Leap, he was more than ready for myriad deaths to result, and had hinted to his top echelon that they should not be too shocked if they happened." Democide historian R.J. Rummel had originally classified the famine deaths as unintentional. In light of evidence provided in Chang and Halliday’s book, he now believes that the mass dyings associated with Great Leap Forward constitute democide (murder) and revised his democide total for the People's Republic of China from 35 million to 77 million.

According to Frank Dikötter, Mao and the Communist Party knew that some of their policies were contributing to the starvation. Foreign minister [[Chen Yi (communist)|Chen Yi] said of some of the early human losses in November 1958:

"'Casualties have indeed appeared among workers, but it is not enough to stop us in our tracks. This is the price we have to pay, it's nothing to be afraid of. Who knows how many people have been sacrificed on the battlefields and in the prisons [for the revolutionary cause]? Now we have a few cases of illness and death: it's nothing!'"

During a secret meeting in Shanghai in 1959, Mao demanded the state procurement of one-third of all grain to feed the cities and satisfy foreign clients, and noted that "If you don't go above a third, people won't rebel." He also stated at the same meeting:

"'When there is not enough to eat people starve to death. It is better to let half of the people die so that the other half can eat their fill.'"

Benjamin Valentino writes that like in the USSR during the famine of 1932-33, peasants were confined to their starving villages by a system of household registration, and the worst effects of the famine were directed against enemies of the regime. Those labeled as "black elements" (religious leaders, rightists, rich peasants, etc.) in any previous campaign were given the lowest priority in the allocation of food, and therefore died in the greatest numbers. According to genocide scholar Adam Jones, "no group suffered more than the Tibetans," with perhaps one in five dying from 1959 to 1962.

Mobo Gao suggested that the Great Leap Forward’s terrible effects came not from malign intent on the part of the Chinese leadership at the time, but instead relate to the structural nature of its rule, and the vastness of China as a country. Gao says "..the terrible lesson learnt is that China is so huge and when it is uniformly ruled, follies or wrong policies will have grave implications of tremendous magnitude".

The PRC government’s official web portal places the responsibility for the “serious losses” to “country and people” of 1959-1961 (without mentioning famine) mainly on the Great Leap Forward and the anti-rightist struggle, and lists weather and cancelation of contracts by the Soviet Union as contributing factors.

Deaths by violence
Not all deaths during the Great Leap were from starvation. Benjamin Valentino notes that "communist officials sometimes tortured and killed those accused of failing to meet their grain quota." Frank Dikötter estimates that at least 2.5 million people were beaten or tortured to death and 1 to 3 million committed suicide. He provides some illustrative examples. In Xinyang, where over a million died in 1960, 6-7 percent (around 67,000) of these were beaten to death by the militias. In Daoxian county, 10 per cent of those who died had been "buried alive, clubbed to death or otherwise killed by party members and their militia." In Shimen county, around 13,500 died in 1960, of these 12 per cent were "beaten or driven to their deaths."

Beatings with sticks was the most common method used by local cadres (roughly half of all cadres regularly pummeled or caned people), but others devised harsher means to humiliate and torture those who failed to keep up. As mass starvation set in, ever greater violence had to be inflicted in order to coerce malnourished people to labor in the fields. Victims were buried alive, thrown bound into ponds, stripped naked and forced to labor in the middle of winter, doused in boiling water, forced to ingest excrement and urine, and subjected to mutilation (hair ripped out, noses and ears lopped off). In Guangdong, some cadres injected salt water into their victims with needles normally reserved for cattle.

Impact on economy
During the Great Leap, the Chinese economy initially grew. Iron production increased 45% in 1958 and a combined 30% over the next two years, but plummeted in 1961, and did not reach the previous 1958 level until 1964.

The Great Leap also led to the greatest destruction of real estate in human history, outstripping any of the bombing campaigns from World War II. Approximately 30 to 40 per cent of all houses were turned to rubble. Frank Dikötter states that "homes were pulled down to make fertilizer, to build canteens, to relocate villagers, to straighten roads, to make place for a better future beckoning ahead or simply to punish their owners.”

In agrarian policy, the failures of food supply during the Great Leap were met by a gradual de-collectivization in the 1960s that foreshadowed further de-collectivization under Deng Xiaoping. Political scientist Meredith Jung-En Woo argues: "Unquestionably the regime failed to respond in time to save the lives of millions of peasants, but when it did respond, it ultimately transformed the livelihoods of several hundred million peasants (modestly in the early 1960s, but permanently after Deng Xiaoping's reforms subsequent to 1978.)"

Despite the risks to their careers, some Communist Party members openly laid blame for the disaster at the feet of the Party leadership and took it as proof that China must rely more on education, acquiring technical expertise and applying bourgeois methods in developing the economy. Liu Shaoqi made a speech in 1962 at Seven Thousand Man's Assembly criticizing that "The economic disaster was 30% fault of nature, 70% human error."

Modes of resistance
According to over 20 years of research by Ralph Thaxton, professor of politics at Brandeis University, villagers turned against the CPC during and after the Great Leap, seeing it as autocratic, brutal, corrupt, and mean-spirited. The CPC's policies, which included plunder, forced labor, and starvation, according to Thaxton, led villagers "to think about their relationship with the Communist Party in ways that do not bode well for the continuity of socialist rule."

Often, villagers composed doggerel to show their defiance to the regime, and "perhaps, to remain sane." During the Great Leap, one jingle ran: "Flatter shamelessly—eat delicacies.... Don't flatter—starve to death for sure."

Impact on the government
Many local officials were tried and publicly executed for giving out misinformation.

Mao stepped down as State Chairman of the PRC in 1959, predicting he would take most of the blame for the failure of the Great Leap Forward, though he did retain his position as Chairman of the CPC. Liu Shaoqi (the new PRC Chairman) and reformist Deng Xiaoping (CPC General Secretary) were left in charge to change policy to bring about economic recovery. Mao's Great Leap Forward policy came under open criticism at the Lushan party conference. The attack was led by Minister of National Defense Peng Dehuai, who, initially troubled by the potentially adverse effect of the Great Leap Forward on the modernization of the armed forces, also admonished unnamed party members for trying to "jump into communism in one step." After the Lushan showdown, Mao defensively replaced Peng with Lin Biao.

However, in June 1962, the party held an enlarged Central Work Conference and rehabilitated the majority of the deposed comrades who had criticized Mao in the aftermath of the Great Leap Forward. The event was again discussed, with much self-criticism, with the contemporary government calling it a "serious [loss] to our country and people" and blaming the cult of personality of Mao. Following the 1962 conference, Mao became a "dead ancestor", as he labeled himself: a person who was respected but never consulted, occupying the political background of the Party. He launched a vain attempt for influence in 1966 with the Cultural Revolution, but died ten years later, leaving the forces within the party that opposed the Cultural Revolution and the Great Leap Forward in power.