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Miranda Horan

Access to good quality health care is difficult for people who live on the margins of society. In China, where the state health care has been decentralized and is now a privatized commodity, access to health care is biased against those who cannot afford expensive Western medicine and/or live in distant rural communities. The available research shows that because of this bias people are turning to other methods of healing to combat disease and injury. Traditional Chinese medicine, meditation and other ethnic-based methodologies are used as medical alternatives to modern Western medicine. Furthermore, as China continues to develop its economy and society, infectious disease prevention is no longer the focus of the health care system as the biggest health threats come from the dangers of chronic disease such as cancer and cardiovascular disease. Marginalized communities have the greatest risk of developing and succumbing to these diseases because they lack a secure and organized health care system that will provide them with the resources that they need.

The most difficult aspect in researching this topic was finding an adequate amount of anthropological sources. A significant amount of information came from biological and economic sources but very few from the field of anthropology. It was also difficult to find information on distinct marginalized groups: most research focused on the rural poor only and some focused on women, children and the larger ethnic minority groups such as Tibetans and Mongolians. Publications on the urban poor, immigrants, refugees, the mentally ill and smaller ethnic minorities was not available.

Some of the most prolific research came from Arthur Kleinman, a medical anthropologist who works in China. Work also came from Iowa State University anthropologist Shu-Min Huang. Both have done research on the changing nature of the Chinese health care system, from collective to privatized, and from infectious diseases to chronic diseases. Kleinman has also done work on epidemic outbreaks (most notably SARS) and what effect a disease like that has not only biologically but socially as well which will become more important other epidemic diseases that originate in Asia, such as the avian influenza, spread around the world.

Understanding the health care system of China and how it functions in such a diverse society is important as the country continues to develop socially, politically and economically. Marginalized communities, such as the rural poor and ethnic minorities, are continually at risk of suffering from treatable diseases but cannot seek treatment because they are without secure access to a health care system. Since they are without such a system they have learned to cope with the lack of health resources available by focusing instead on more traditional methods of healing. As China continues towards change, the health care system and its concerns reflect the shifting nature of the state.

Annotated Bibliography

Adams, Vincanne, Suellen Miller, Sienna Craig, Nyima, Sonam, Droyoung, Lhakpen, and Michael Varner 2005

The Challenge of Cross-Cultural Clinical Trials Research: Case Report from the Tibetan Autonomous Region, People's Republic of China. Medical Anthropology Quarterly 19 (3): 267-289.

This article compares the research of Tibetan medicine with misoprostol for preventing postpartum hemorrhage in delivering women in an effort to determine how Western clinical research works in non-Western medical settings. As the health care system is largely decentralized in China, this large ethnic minority population utilizes what it does know about Western medicine in an effort to assert their independence. However, the ways in which Western methodologies are applied and the strategies of negotiation and translation across cultures are not easy to find.

Tibet

Postpartum hemorrhage



Misoprostol

Western medical methodology

Medical anthropology

Anderson, James G. 1992

Health Care in the People’s Republic of China: A Blend of Traditional and Modern. Central Issues in Anthropology 10 (1): 67-75.

Anderson gives an overview of the health care system in China and how they have reconciled their traditional methods with modern/Western ideas of medicine and treatment. This article discusses how Chairman Mao brought the responsibility of health care to the masses by moving health care training facilities from urban to rural areas, where 85 per cent of the population was located, and training local people to treat a variety of ailments and injuries. This system allows for greater access to health care for everyone despite location or socioeconomic status.

China, rural

Barefoot doctors

Traditional Chinese medicine

Cultural Revolution

Medical anthropology

Chen, Nancy 2003

Breathing Spaces: Qigong, Psychiatry and Healing in China. New York: Columbia University Press.

The practice of qigong, meditative breathing exercises, in China allows people to seek a stable form of healing while the formerly state-subsidized medical care switches to for-profit market medicine. It also serves as a socially organizing function allowing practitioners to form new informal networks of social support. As new psychological diseases are being discovered, the Chinese government has medicalized some forms of qigong while promoting other more scientific forms.

China

Qigong

Social change

Medicalization

Medical anthropology

Farquhar, Judith 1996

Market Magic: Getting Rich and Getting Personal in Medicine after Mao. American Ethnologist 23 (2): 239-257.

With the decentralization of the health care system by Chairman Mao, private medical practices have begun popping up across China. These private practices utilize popular healing methods and cultivate personal auras in efforts to attract patients. In addition to this, these private practices have also allowed the medical personnel of these places to use them as a means of getting rich - a move that essentially undermines the collectivism of the state.

China


Private medical practice

State collectivism

Cultural anthropology

Furth, Charlotte and Ch'en Shu-yueh 1992

Chinese Medicine and the Anthropology of Menstruation in Contemporary Taiwan. Medical Anthropology Quarterly 6 (1): 27-48.

Women in contemporary Taiwan are changing the way they view themselves in terms of social status and pollution beliefs within their culture. Outsiders view the traditional Chinese medicine and culture as constricting to women and as having created negative images of the female. However, the women feel that their traditional system provides them with a better alternative to Western-style medicine in terms of menstruation while the pollution beliefs are not negative but rather gives the women a sense of social decency and dignity. These women have found that their traditional health system gives them with what they need, medically, socially and culturally.

Taiwan

Traditional Chinese medicine



Biomedicine

Women’s culture

Pollution beliefs

Menstruation

Medical anthropology

Gu X.Y., Tang S.L., and Cao S.H. 1995

The Financing and Organization of Health Services in Poor Rural China: A Case Study in Donglan County. International Journal of Health Planning and Management 10 (4): 265-282.

With the socio-economic reforms of the late 1970s, health sector resources expanded quickly but not always in a positive way. In the county of Donglan in southern China, the decentralization of health care along with the financial responsibility system have resulted in weak financing and provision of rural health services in the poorer areas. Preventive programs and basic health care, especially for the poor, are in decline in this area as they have financial difficulty in obtaining access to services.

China, rural

Donglan county

Poverty

Financial responsibility system



Decentralization of health care

Health studies

Huang Shu-Min, Kimberly C. Falk and Su-Min Chen 1996

Nutritional Well-Being of Preschool Children in a North China Village. Modern China (22) 4: 355-381.

As social and cultural reforms are creating change in society and the growth of the economy continues, China’s public health concerns are in a transitional stage, shifting the focus from acute and infectious disease prevention to chronic disease control. As the gap between rural and urban populations grows, data on nutrition and health status become important measures of how the reforms are affecting the population. By examining the nutrition of children in the rural village of Fengjiacun in the Shandong province of northern China, information is provided on individual health and the social dynamics of the community in relation to the state and how it cares for the rural poor.

China, rural

Fengjiacun village

Nutrition

Public health care reform

Society-state relationship

Nutrition and health studies

Huang Shu-Min 1988

Transforming China’s Collective Health Care System: A Village Study. Social Science and Medicine (27) 9: 879-888.

The health care system of Lin Village, Fujian Province in southeast China was established under the collective commune organization in 1968 and was transformed in 1978 when the government dismantled rural communal organizations. The changes caused the residents to reorganize the finances, training and operation of the village-based medical facility. The paper also identifies both benefits and problems that could affect the villages as the system is turned into an individual profit-seeking venture.

China, rural

Lin Village

Commune

Individual



Collective medicine

Medical anthropology

Janes, Craig R. 1995

The Transformations of Tibetan Medicine. Medical Anthropology Quarterly 9 (1): 6-39.

This article explores how Tibetan medicine has become institutionally modernized through changes in theory, practice and methods. Despite Chinese rule, Tibet has not given in to state interests. Their medical practices have instead become a type of ethnic revitalization and resistance to the Chinese state, particularly the treatment of rlung, a class of sickness associated with rapid social, economic and political change.

Tibet


Tibetan medicine

Rlung

Cultural resistance

Medical pluralism

Medical anthropology

Cultural anthropology

Jianlin, Ji, Arthur Kleinman and Anne E. Becker 2001

Suicide in Contemporary China: A Review of China's Distinctive Suicide Demographics in Their Sociocultural Context. Harvard Review of Psychiatry 9 (1): 1-12.

Data on suicide in China have not been publicly reported prior to this article and the information presented by the authors shows that, while low in the past, suicide is on the rise in certain groups: in rural areas, and among women and the elderly. These rates are indicative of the marginalization of particular social groups in China and how they feel they must cope with their social status.

China

Suicide


Social marginalization

Women


Elderly

Cross-cultural psychiatry

Medical anthropology

Kaufman, Joan 2005

China’s Health Care Response. SARS in China: Prelude to Pandemic? Arthur Kleinman and James G. Watson, eds. pp. 53-68. Palo Alto: Stanford University Press.

In 2003, a SARS (Severe Acute Respiratory Syndrome) epidemic broke out in China. While it only lasted a few months, its impact is considered to be a warning of how society will be able to deal with a large-scale epidemic, short-term and long-term, economically, socially, politically and even morally. This chapter focuses on the health care system‘s response, such as early detection, isolating cases, quarantine, and disinfection, in order to bring the epidemic under control.

China

SARS


Pandemic

Globalization

Medical anthropology

Kleinman, Arthur 1995

Writing at the Margin: Discourse Between Anthropology and Medicine. Berkeley and Los Angeles: University of California Press.

The author of this book focuses on how issues of disease relate to larger social problems. The body, as such, connects the individual to the group experience where certain diseases, such as depression, are not isolated in the individual but are an experience in a broader social context. Social policy and health policy are therefore linked to the treatment of individuals who suffer from illnesses, such as epilepsy, in China where individuals are stigmatized by society.

China

Individual



Collective

Epilepsy


Health policy

Social policy

Medical anthropology

Kleinman, Arthur 1986

Social Origins of Distress and Disease: Depression, Neurasthenia and Pain in Modern China. New Haven: Yale University Press.

Kleinman discusses how expressions of depression, neurasthenia and pain in modern China are idioms of psychological distress. Psychological distress most likely comes in the form of somatization and how those physical symptoms become a factor in gaining access to scarce resources and perceived powerlessness and helplessness of individuals. He further discusses how the body’s relationship to society interpreted by society and how that interpretation informs social understanding of the interaction between culture and the self.

China

Depression



Neurasthenia

Somatization

Medical anthropology

Li, Victor H. 1975

Politics and Health Care in China: The Barefoot Doctors. Stanford Law Review 27 (3): 827-840.

This article discusses China’s reaction to the breakdown of their health services just prior to the establishment of the Republic and the use of “barefoot doctors” in rural areas in order to provide health care to such a large population. Barefoot doctors were locally trained for a period of 3-6 months to diagnose and treat a variety of ailments, promote sanitation and pest control and even conduct minor surgical procedures. By using the barefoot doctors, the government was able to bypass its lack of trained professional doctors and physicians and still provide adequate care for the people while at the same time preventing professional elitism that is associated with persons of a certain education.

China, rural

Barefoot doctors

Preventive health care

Grassroots health care

Medical anthropology

Longde Wang, Lingzhi Kong, Fan Wu, Yamin Bai and Robert Burton. 2005

Chronic Diseases 4: Preventing Chronic Diseases in China. The Lancet 366 (9499): 1821-1824.

Eighty percent of deaths that occur in China are due to chronic diseases such as cancer, hypertension, cardiovascular disease and obesity. With such high health risks being so prevalent, the government is stepping in and implementing prevention and control programs. These programs are aimed at reducing the frequency of chronic disease but resources and sustainability are difficult to maintain.

China

Chronic diseases



Health prevention and disease control programs

Medical anthropology

Stoner, Bradley P. 1986

Understanding Medical Systems: Traditional, Modern, and Syncretic Health Care Alternatives in Medically Pluralistic Societies. Medical Anthropology Quarterly 17(2): 44-48.

This article is a discussion of how various populations blend traditional and modern/Western medical practices. Although modern medicine may provide better results for a patient, members of certain social or ethnic groups may prefer to use the traditional medical practices in addition to the available modern procedures as a way to maintain a connection with their culture. Maintaining traditional medicine is evident in many Asian countries, such as China, Japan and India.

China, general

Health care alternatives

Traditional medicine

Medical syncretism

Medical anthropology

Wang, Ruotao 2000

Critical Health Literacy: A Case Study from China in Schistosomiasis Control. Health Promotion International 15 (3): 269-274.

In China, a social and political movement that began in the 1950’s aimed at increasing health education and literacy in the population at large in an effort to reduce infectious diseases. It was effective for some diseases but others, such as schistosomiasis still remain a major threat. The author argues that in order to fully combat infectious diseases, China must continue to develop in the field of health policy so that the state can better respond to social and cultural changes of disease. Using schistosomiasis as a case study, this article focuses on how higher rates of health literacy lead to positive outcomes in disease control and prevention.

China


health education

health literacy

schistosomiasis

public health

White, S.D. 1999

Deciphering "Integrated Chinese and Western Medicine" in the Rural Lijiang Basin: State Policy and Local Practice(s) in Socialist China. Social Science and Medicine 49 (10): 1333-47.

This article explores the practice of integrated medicine (Chinese and Western) in the rural southwest area of China known as the Lijiang Basin. Examined at both the state policy level and in the everyday practice by villagers, integrated medicine can be viewed as operating “syncretism from above” by state officials and “syncretism from below” by the lay people. The practice of integrated medicine in the rural basin shows how state policy and local operation work together to provide care to isolated communities.
China, rural

Lijiang Basin

Integrated medicine

Syncretism

Cultural anthropology

Williams, Dee Mack 1997

Grazing the Body: Violations of Land and Limb in Inner Mongolia. American Ethnologist 24 (4): 763-785.

Some Mongol communities of Inner Mongolia are at risk for exposure to chronic cold stress and accidental injury and death from hypothermia. The global political economy and privatization of rangeland has led to the degradation of land with soil erosion and the body with limb deficiencies, amputation and death. The male herders of the Mongol communities are at the largest risk of death from the lack of available health care as China has decollectivized the region which has led to destabilization and left the Mongol communities out of the protection and support of the Chinese state.

Inner Mongolia

Decollectivization

Health risks

Lack of health services

Hypothermia

Globalization

Land degradation

Medical anthropology

Xiang Biao 2005

Migration and Health in China: Problems, Obstacles and Solutions. National University of Singapore: Asian MetaCentre Research Paper Series, No. 17.

Eighty-five million rural-urban migrants in mainland China face great health risks but are not recognized as being in need of or offered any protection and support from a medical care system. The author argues that this is due mainly to institutional arrangements around security from health risks and service provision, particularly for migrant workers who live in rural villages but work in cities. Because of their high mobility and indefinable status as either rural or urban, migrants are often unable to secure access to health care either privately or from the state.

China


Rural-urban migrants

Health care provision

Access to health care

Health policy studies







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