R4D China

Tuberculosis patient expenditure on drugs and tests in subsidised, public services in China: a descriptive study

Wed, 17 Feb 2010 17:10:00 +0800

Miscellaneous Qin Liu, H. Smith, Yang Wang, Shenglan Tang, Qingliang Wang and P. Garner 2010 Tropical Medicine & International Health (2010) 15 (1) 26-32 [doi: 10.1111/j.1365-3156.2009.02427.x] China has a TB control programme that is subsidised, but this survey found that patients are still paying substantive amounts for additional drugs and tests irrespective of their income. This includes what the study describes as excessive tests and patients being prescribed liver protection drugs, for which there is no research or rationale for use. For patients below the government poverty line, drug and test expenditure was 1.85 times their average household monthly income - and averaged at 40 US dollars per visit. Average charges varied little between income categories. In terms of anti-TB drugs prescribed, almost a fifth of regimens were inadequate by international standards. Providers reported they prescribe liver protection drugs to avoid claims of medical negligence, and they believed the drugs were effective; and the government subsidy for providing TB treatment was simply not enough. The authors conclude that further surveys are needed to confirm these practices are widespread but this needs to be coupled with financing strategies to tackle it.

COMDIS Communication Strategy [2009]

Wed, 10 Feb 2010 18:44:00 +0800

Miscellaneous 2009 15 pp. This version of the communication strategy refers to updates to the national strategies, with 2 examples, the communications plans of Guangxi-COMDIS and Ghana: Kwame Nkrumah University of Science & Technology (KNUST) - COMDIS. For the earlier output, click here.

Risk factors for syphilis infection among pregnant women: results of a case-control study in Shenzhen, China.

Wed, 03 Feb 2010 18:48:00 +0800

Miscellaneous Zhou, H.; Chen, X.S.; Hong, F.C.; Pan, P.; Yang, F.; Cai, Y.M.; Yin, Y.P.; Peeling, R.W.; Mabey, D. 2007 Sexually Transmitted Infections (2007) 83 (6) 476-480 [doi:10.1136/sti.2007.026187] Background: China has been experiencing a rapidly growing syphilis epidemic since the early 1990s, with the reported incidence of congenital syphilis increasing from 0.01 cases per 100 000 live births in 1991 to 19.7 cases per 100 000 live births in 2005. Detailed studies of risk factors for syphilis in pregnant women are needed to inform new preventive interventions. Objective: To investigate factors associated with recent syphilis infection among pregnant women and recommend strategies for improved preventive interventions in the community. Methods: A casecontrol study was conducted among women attending antenatal clinics in Shenzhen City, South China. Cases were antenatal clinic women testing positive for early syphilis, based on laboratory results, with those testing negative being controls. All participants completed the same anonymous questionnaire covering demographics, lifestyle, sexual behaviour, and sexual partnerships. Results: 129 cases and 345 controls were recruited. Syphilis was significantly associated with unmarried status, less education, multiple sex partners, travel of sex partner in the past 12 months, a history of induced abortion, and previous sexually transmitted infections. Overall, there were no differences between syphilis-positive and negative women in household registration status (hukou), living district and duration in Shenzhen, monthly income, and age at first sex. Conclusions: Many demographic and behavioural risk factors are associated with syphilis among pregnant women. In the government congenital syphilis control programme, comprehensive preventive interventions should be provided in all clinical settings in addition to the current procedures for syphilis screening among antenatal women.

Urban Poverty and Property Rights Changes in China: Full Research Report and Non-Technical Summary.

Wed, 03 Feb 2010 00:01:00 +0800

Miscellaneous Fulong Wu and C. J. Webster 2009 ESRC End of Award Report, and Non-Technical Summary, RES-167-25-0005. Swindon: ESRC. 11 + 3 pp. Since the late 1990s Chinese cities have been swamped with low skilled rural migrants living in marginal conditions. This project examined the mechanisms of urban poverty generation in Chinese cities and the concentration of poor groups in poor neighbourhoods. It reviewed how the redistribution of property rights occurring through urbanisation have impacted the poor. The work examined three major types of poor neighbourhoods: workers villages developed in the centrally planned economy; pre-1949 old neighbourhoods; and urban villages. The work was carried out in 25 poor neighbourhoods in six Chinese cities (Xian, Guangzhou, Nanjing, Wuhan, Harbin, and Kunming).

The potential academic impact of the work lies in its scrutiny of poverty processes in the context of market transition. The study reveals how the legacy of socialist institutions and newly introduced market forces work together to create social vulnerability. The findings are consistent with the idea that policy should go beyond traditional approaches to demolishing slums and improving physical conditions. The study provides important evidence for formulating the policies of urban village redevelopment in China.

Urban Poverty and Property Rights in China: Plain English Summary

Tue, 02 Feb 2010 23:51:00 +0800

Miscellaneous Fulong Wu 2009 2 pp. Since the late 1990s, Chinese cities have seen a huge influx of low-skilled rural migrants. In addition, millions of workers have been laid-off by companies affected by industrial restructuring and enterprise reforms. In combination, these two events have resulted in dense urban districts that are particularly poor.

This 2-page report summarises in plain English the project work on the characteristics of specific poor neighbourhoods and how they are affected by the redistribution of property rights.

New urban poverty in China: Economic restructuring and transformation of welfare provision

Tue, 02 Feb 2010 23:44:00 +0800

Miscellaneous Fulong Wu and Ningying Huang 2007 Asia Pacific Viewpoint (2007) 48 (2) 168-185 [doi: 10.1111/j.1467-8373.2007.00343.x] This paper examines the new urban poverty in China since the deepening of market-oriented reform in the 1990s and argues that the institutional process goes beyond recent market-oriented reforms. Poverty generation is driven by broad economic restructuring and transformation of welfare provision. De-industrialisation and decline in state-owned enterprises have generated a significant number of laid-off workers, forming the new urban poor who are simultaneously confronted with the transformation of welfare provision. The loss of workplace-based entitlement is a direct cause of their poverty or exacerbates their underprivileged conditions. For at least a significant proportion of new urban poor without the hope of returning to the mainstream labour market, the minimum living standard support programme in fact captures them at the edge of survival.

Property rights redistribution, entitlement failure and the impoverishment of landless farmers in China.

Tue, 02 Feb 2010 23:11:00 +0800

Miscellaneous S. He, Y. Liu, C. Webster and F. Wu 2009 Urban Studies (2009) 46 (9) 1925-1949 [doi: 10.1177/0042098009106015] Within the process of urban expansion through land requisition in China, farmers' de facto rights to collective land, including farmland and housing plots (zhaijidi), are forcibly acquired by the state and thereafter redistributed to private developers, to facilitate urban-based economic growth. Deprived of a secure livelihood, some landless farmers become trapped in poverty. Others find that the property rights restructuring in urbanised villages gives them an opportunity to earn rental income. However, the opportunities are not equally distributed and the processes are, in general, stacked against the interests of villagers. This paper analyses the impoverishment of farmers caught up in China's relentless urban expansion programme, using the perspectives of property rights and entitlements. It presents case studies of two villages in Xi'an to illustrate how farmers' entitlement sets and vulnerability to poverty have changed as a result of changes in land rights.

China's Emerging Neoliberal Urbanism: Perspectives from Urban Redevelopment

Tue, 02 Feb 2010 23:03:00 +0800

Miscellaneous Shenjing He and Fulong Wu 2009 Antipode (2009) 41 (2) 282-304 [10.1111/j.1467-8330.2009.00673.x] China's urbanization is undergoing profound neoliberal shifts, within which urban redevelopment has emerged in the forefront of neoliberalization. This study aims to understand China's emerging neoliberal urbanism by examining the association between urban redevelopment and neoliberalism. Rather than a deliberate design, neoliberalization in China is a response to multiple difficulties/crises and the desire for rapid development. The neoliberalization process is full of controversies and inconsistencies, which involve conflicts between neoliberal practices and social resistance, and tensions between central and local states. Nevertheless, China's neoliberal urbanism has a responsive and resilient system to cope with the contradictions and imbalances inherent in neoliberalism. Meanwhile, neoliberal urbanism is more tangible at the sub-national scale, since the local state can most effectively assist neoliberal experiments and manage crises. This study not only contributes to the understanding of China's neoliberal urbanism, but also has multiple implications for neoliberalism studies in general. First, in examining the interrelationship between the state and market, it is the actual effect of legitimizing and facilitating market operation rather than the presence (or absence) of the state that matters. Second, a new nexus of governance has formed in the neoliberalization process. Not only the nation state but also the local state is of great significance in assisting and managing neoliberal projects. Third, this study further validates the importance and necessity of scrutinizing neoliberal practices, in particular the controversies and inconsistencies within the neoliberalization process.

The State and Marginality: Reflections on Urban Outcasts from China's Urban Transition

Tue, 02 Feb 2010 22:53:00 +0800

Miscellaneous Fulong Wu 2009 International Journal of Urban and Regional Research (2009) 33 (3) 841-847 [doi: 10.1111/j.1468-2427.2009.00921.x] This essay reflects on four structural logics of poverty generation, developed in Urban Outcasts. These are the logics of macro-social, economic, political and spatial dynamics. Considering the Chinese context, the essay suggests that, rather than being isolated from mainstream production, the Chinese urban poor are engaged in global commodity production. While no obvious ghettos have been so far identified in Chinese cities, there are spatial concentrations of the poor in particular neighbourhoods. This spatial concentration is related to state institutions before and after economic reform. Throughout the process of poverty generation, the role of the state is prominent, as highlighted in Wacquant's research on American and French cities. I argue that the role of the state is complex, not just penal. One significant contribution of Wacquant's book is that it reveals important differences between French banlieues and American ghettoes, thus highlighting the need to examine place-specific regimes of marginality. As for 'advanced' marginality, Wacquant emphasizes its structural causes, which are particularly relevant to China's urban transition. In China, we can also identify the 'advanced' stage of suppressing the poor in the process of urban change.

Poverty, parental ill health and childrens access to schooling in rural Gansu, China.

Tue, 02 Feb 2010 22:30:00 +0800

Miscellaneous E. Hannum, T. Sargent, and Shengchao Yu 2009 Provincial China (2009) 1 (2) 24-60 As reforms to China's health care system have raised costs to users in recent decades, studies suggest that ill health has become intimately tied to social stratification as both a precipitant and a consequence of poverty. The problem may be particularly pronounced in Chinas poorest rural populations. Focusing on Gansu Province, one of Chinas poorest, this paper investigates the possibility that the ill health of adults also carries cross-generational consequences, through interfering with the education of children.

Analyzing a survey of children in 100 rural villages, we find that parental illness is experienced disproportionately by the most economically vulnerable children. Moreover, parental illness can be linked to childrens educational access and experience in several ways. Children with an ill father are less likely to be enrolled than others; prior parental ill health is associated with lower household educational spending; and ill parents are more likely to report borrowing for their childrens education. Children with ill mothers are more likely to be absent and to work longer in the household. Children with ill mothers perform more poorly in math, and those with ill mothers and ill fathers are more likely to work for wages, on average, but these effects are accounted for by the deeper impoverishment of households with ill parents, compared to other households.

Results suggest that ill health may have a spillover effect on the long-term educational (and thus economic) prospects of the next generation. A change in this situation depends heavily on the success of new government initiatives to reduce health care and education cost burdens on the poor.