<p>We use novel datasets to examine the allocation patterns of healthcare resources during the Great Chinese Famine and investigate the heterogeneous roles of officials with different backgrounds within the bureaucratic hierarchy. Our findings reveal that severely affected areas experienced significantly greater growth in healthcare resources, closely tied to the actions of county party secretaries. Those serving in their hometown provinces or having experienced severe famine in previous terms significantly increased local healthcare investment. In contrast, such background characteristics at the provincial level did not have comparable effects on the allocation of healthcare resources. This paper deepens our understanding of relief efforts during the Great Chinese Famine and reveals how bureaucratic structures and officials’ backgrounds shaped state responses to social crises.</p>