Collaborative Grants, 2008-2013
2013
- Intensive Agriculture and the Environmental Health Needs of Agricultural Workers
WANG Yiyang, Kunming Medical University
China’s State Council No.1 document for 2013 emphasized the acceleration of the modernization of Chinese agriculture, focusing on the goals of securing supply, increasing yields and speeding up rural reform. It also emphasized the intensification, specialization and organization of agriculture in order to increase productivity. As part of this transformation of Chinese agricultural production, more and more farmers will cease to be smallholders who farm their own land and become agricultural workers. These new occupations will expose them to environmental health risks different than those stemming from traditional agriculture, including the possibility of more concentrated exposure to pesticides among workers in agriculture and to zoonoses among those working in animal husbandry.This project focuses on understanding the types of risks that agricultural workers face in different occupations, the way in which policy addresses these, and gaps in provisioning. It will assess the levels and frequency of use of farm chemicals, workers’ awareness of risks and protective measures taken. Information about incidences of pesticide poisoning and other health effects among workers in intensive agriculture will be gathered from workers and local health authorities. For those working in livestock-rearing, information will be gathered about the incidence of zoonoses and of illnesses relating to exposure to concentrated animal waste, as well as the use of antibiotics and antibiotic resistance.
The project hopes to increase awareness of this issue and to make suggestions for how health services can better meet the needs of this new occupational group.
The project is lead by WANG Yiyang and FANG Jing at Kunming Medical University. They are collaborating with experts from the Yunnan Agricultural University and the Southwest University of Finance, Politics and Law. The project sites will be Yuanmou County (intensive agriculture) and Luquan County (intensive animal husbandry) in Yunnan Province. The study builds on previous work supported by the EcoHealth Program of the International Development Research Centre in Yuanmou County.
2012
- Assessing the Response of the Rural Health System to Health Risks from Environmental Pollution in Yunnan Province
FANG Jing, Kunming Medical University
The National Action Plan for Environment and Health, introduced in 2007, committed the Chinese health system to addressing the environmental determinants of disease. This project assesses the implementation of that policy at the local level. It will explore the ways in which the rural health system in Yunnan Province is responding to environmental health risks, analyze the policy, fiscal, technical and other factors that shape responsive capacity, and make suggestions for how rural environmental health risks can be more effectively monitored and addressed.Yunnan Province is in the southwest of China. The province has rich mineral deposits and as a result, lead, cadmium and other heavy metal pollution from mining presents a serious threat to health in some rural areas. Non-point pollution from the intensification of agriculture and livestock-raising is also a problem that affects both the producers and consumers of food. This project will look at four counties, two of which have mining and industrial pollution (Huize and Qujing); one with intensive animal husbandry (Qiubei) and one with intensive horticulture (Yuanmou). The project team will interview local health system officials and workers to understand the way in which they view environmental health risks and the resources and management capacity they have available for monitoring and responding to them.
The team includes experts on public health management and medical sociology as well as public health.
- Water Source Protection, Livestock-Raising and Rural Livelihoods in Northern Fujian
SU Shipeng, Institute for Sustainable Development, Fujian Agriculture and Forestry University
This project has been examining the challenge of balancing environmental protection and health with rural livelihoods in a mountainous region of northern Fujian. The area provides a vital source of drinking water to downstream areas, but pollution from intensive livestock-rearing is increasingly contaminating water sources, threatening the ecosystem and human health. Addressing the problem is particularly difficult because it involves conflicts of interest between upstream and downstream areas.The team is led by SU Shipeng, Dean of the School of Public Policy at the Fujian Agriculture and Forestry University in Fuzhou. He is an expert in public management. Other members of the team are experts in ecology, animal husbandry, environmental engineering and regional economics.
Fujian province is a major producer of pork—more than 1.5 million tons in 2012. But many pigs are raised in mountainous areas, and in relatively small facilities with no pollution control. As a result, livestock-rearing presents a threat to the safety of drinking water for downstream populations, as well as to the viability of other agricultural occupations. However, pig-raising is an attractive option for farmers in poor areas, because it requires relatively little labor and is not a highly skilled occupation. And because the residents of mountain villages are able to drink spring water themselves, the pollution of rivers and other surface water does not affect their own drinking water safety. They are therefore not particularly motivated to invest in pollution control. Because small pig farms are scattered in mountain areas, they are difficult for government agencies to track down and monitor. For these reasons, although the Fujian Provincial Regulations on the Protection of Watershed Environments, which came into effect on February 1 2012, clearly stipulates that it is forbidden to build new livestock-rearing facilities in water source areas or to expand existing facilities, the implementation of the policy has been weak.
Over the last two years the project has examined various aspects of the interaction between development, environment and health in this rural area. In its first two years, the project examined the severity of pollution from solid household waste, waste water and livestock-rearing, and the implementation of the “Comprehensive Management of the Rural Environment” (nongcun huanjing lianpian zhengzhi) policy. It found that although significant investments had been made in waste water treatment facilities and solid waste disposal, these were not based on an accurate estimate of the resident population and, in light of significant out-migration, investment was out of proportion with actual needs. In contrast, investment in facilities to treat animal waste, which is a growing problem, was much lower and insufficient to address the problem. Furthermore, because government officials and residents in upstream and downstream areas had very different interests and understandings of the problem, collaboration was minimal.
In the current phase the project will focus on better understanding the role of livestock-rearing in rural livelihoods, exploring the ways in which policies can provide greater incentive for farmers to reduce pollution. It will do this through an analysis of both stakeholder and farmer social networks in order to develop an integrated, network-based model for managing livestock-rearing in an ecologically sustainable way.
- An Ethnography of Waste Pickers in Guiyang
YANG Lichao, Beijing Normal University
Rapid industrialization and urbanization have led to the rapid growth of the informal waste recycling sector in peri-urban China since the mid-1980s. Waste pickers are constantly exposed to a range of different types of pollution, have unhealthy living conditions and are prone to injuries and diseases, all of which decrease their overall life expectancy. In addition, the ill-health of waste pickers and the conditions around recycling areas are increasingly becoming a public health problem. This research aims to understand waste pickers’ experience and the role of government policy in managing the health problems associated with the informal waste recycling sector in peri-urban China.
Urbanization, population growth and rising living standards have made Chinese municipalities the world’s largest generators of solid waste. In 2004, the urban areas of China generated about 190 million tons of trash and by 2030 this could increase to 480 million tons (World Bank, 2005). According to a survey conducted in 2004, about 1.3 million people work in the formal urban waste collection system and another 2.5 million in the informal sector, paid mainly by the sale of collected materials (InterChina, 2004). Aside from the rapid increase in waste, the lack of city-wide recycling programs has contributed to the emergence of an informal sector of waste pickers, who are usually very low-income rural migrants who collect recyclable materials to sell to recycling facilities.
Waste pickers frequently sort through waste in residential areas, hazardous landfills and street containers, and also sort and burn waste at landfills in order to recover metals and other valuable substances. Open burning of wastes emits particulates, carbon monoxide and POPs like toxic dioxins. In addition to chemical burns and respiratory problems from particulate matter, other health problems include puncture wounds, back injuries and traffic accidents. Waste pickers generally live close to landfills in unhealthy conditions and generally have no health insurance.
In order to better understand the environmental health problems faced by waste pickers and the ways in which policy might more effectively address them, this project will conduct ethnographic research into one community of waste pickers in Guiyang. The project involves a collaboration between Beijing University School of Social Development and Public Policy, Guizhou Medical University and the Guiyang Centre for Disease Control and Protection. It includes experts on Anthropology and Public Health.
2010
- An Exploration of Five “Cancer Villages”
CHEN Ajiang, Hohai University
This project sought to understand the phenomenon of “cancer villages” in China. Through a detailed analysis of five sites it explored the complexity of assessing industrial pollution’s impacts on health and the economic and social factors influencing villagers’ responses to perceived health risks. The team conducted fieldwork in five villages with differing types of pollution, levels of economic development, and patterns of social organization and social capital in Guangdong, Henan, Jiangxi, Jiangsu and Zhejiang.The project collected information on the basic demographic and economic situation of the villages, the major industries, and, as much as possible, the health status of the population. In addition to short surveys to collect general information and semi-structured interviews, the team also reviewed available official documents and media reports, and conducted participant observation living and working with villagers.
Although each of the field sites has been identified as a “cancer village” by villagers or the media, the project demonstrates that in many cases it is not possible to prove or disprove a causal relationship between pollution and cancer. Scientific uncertainty, long latency periods, and the interaction between genetics, lifestyle and other environmental factors mean that there are there are very few cases in which the relationship between pollution and cancer can be decisively established. Most cases fall on a continuum somewhere between these two poles. The project groups cases into four broad categories: 1) cases in which a connection between pollution and cancer has already been clearly established; 2) cases where a relationship can reasonably be inferred on the basis of considerable evidence; 3) cases where there is not much evidence for the claimed connection; and 4) cases where there is no evidence base for the claim.
Despite this uncertainty, cancer villages have nonetheless become a “social fact,” heightening people’s awareness of the relationship between pollution and cancer, and generating responses from government and civil society. In the face of uncertainty, villagers act in an effort to protect themselves from perceived risks by seeking to have factories closed, moving away, and changing their sources of water and food. Both economic and social factors are important in shaping the nature of their responses and the way in which they interact both with factories and local government.
The findings of the project will soon be published by the Social Science Academies Press.
- Environment and Health Problems in an Urbanizing Countryside
LAI Lili, Beijing University
This project examined daily hygiene and environmental health problems that have accompanied the urbanization of the countryside, tracing the way in which environmental health problems have changed and the ways in which rural people respond to these changes. The project entailed a collaboration between LAI Lili, medical anthropologist from Beijing University, and the Henan Center for Disease Control (CDC). A field study was conducted in rural Henan. Main research methods were participant observation, as well as in-depth interviews with villagers, government officials and village doctors. The project also involved experimental use of inexpensive water testing devices.The project found that rising living standards in rural areas have gone hand in hand with an emerging "rural environmental crisis.” The county in which research was conducted has experienced rapid economic development, with many young people migrating to work in cities. This has increased family incomes and changed lifestyles rapidly. Changing living conditions have in turn produced new types of garbage associated with urban lifestyles, but rural areas lack the infrastructure and services for garbage disposal that are available in urban areas. Where formerly much food was home-grown and food waste was composted, the purchase of more food has increased food waste. Packaging is also more elaborate and often not biodegradable. But organized trash collection is rare.
Flush toilets in the absence of water treatment facilities have also led to a problem of household waste water. As water improvement projects have provided piped water, villagers no longer rely on surface and ground water for drinking, lessening concern with its quality. Testing showed that some water sources exceeded standards for arsenic and mercury but were below levels dangerous to health.
However, these issues were not yet priority concerns for local policy or for villager residents, who were more concerned with economic development and did not see garbage as causing an immediate threat to health. At the same time, villagers welcomed the team’s testing the water and had high expectations for the results, hoping that this would bring attention from the government and improve their living environment. The study found that women were generally more concerned about environmental degradation than men.
2009
- The Economic Impact and Policy Responses to the Environment-Related Health Problems of Migrants
CHEN Chuanbo, Institute for Advanced Study on Sustainable Development, Renmin University
Rural-urban migrants are exposed to a variety of environmental health risks as a result of their concentration in dangerous industries and their poor living conditions. However, assessing their health status is complicated by the fact that when migrants are sick or injured they often return to their rural homes. This study looked at the economic and other costs of occupational injury among migrants through a study of return migrants. The analysis drew on existing quantitative and qualitative data from the large-scale POVILL study of rural health, focusing on migrants within the sample.In particular, CHEN Chuanbo analyzed in detail a number of in-depth interviews with migrants with severe occupational injury who had returned to their home villages in order to understand the circumstances of the injury, the employer’s response and level of compensation, and the subsequent expenses for healthcare that the migrant incurred, as well as the impact on the family. He found that in nearly all cases the amount of compensation was far too little to cover the costs of treatment and long-term care, and that these were not covered by the rural healthcare policies. In addition to the cost of treatment, family members were often prevented from continuing their normal employment because of the need to care for injured children or siblings, resulting in a loss of income to the family. These findings have important indications for the services provided under the new rule healthcare policies, as well as for assessments of the real costs and benefits of migration to rural areas, and for the country as a whole. As many other environment-related diseases are also not covered, the significance goes beyond migrant workers to other rural residents.
- Environment and Health Issues facing Migrant Workers in Shenzhen
NIU Jianlin, Chinese Academy of Social Sciences
This project examined the environment and health issues associated with large scale rural-urban migration to Shenzhen. As China’s first special economic zone, the experiences of Shenzhen offer important insights for later-urbanizing areas. The project was a collaboration between the Institute of Population and Labor Economics of the Chinese Academy of Social Sciences and the Shenzhen Health, Population and Family Planning Commission.The project reviewed the history of migration to Shenzhen and the shift in policy responses from the 1980s to the present, tracing the change from a policy of control to one of migration management and the provision of public services. Through a survey in three districts of Shenzhen, the team collected data on socio-demographic status, physical/psychological health status, health knowledge and behaviors, health care access and needs and related barriers, neighborhood environment, living and working conditions, annual income, and occupation. Survey data was supplemented by focus groups with migrants and social service workers.
The team found that, as a self-selected and young population, labor migrants are relatively healthy. The most common chronic conditions they reported are anemia and gastrointestinal diseases, and other health problems included insomnia, neck/shoulder or back pain, eye pressure, dermatitis and memory impairment. Despite their relatively good physical health, migrants experienced some psychological problems or pressures, such as anxiety, loneliness, nervousness and depression. Only half or fewer of the respondents felt confident or capable to deal with personal matters and troubles.
As expected, environmental factors in migrants’ living and working conditions affected their health. Those living in non-standard storied buildings reported poorer health, as did migrants working in unfavorable/extreme working conditions. Working for extended hours regularly also had detrimental effects on migrants’ health. On the contrary, a good neighborhood environment with more amenities had a positive effect. Net of other effects, living with spouse or partner and having good social support both contribute positively to migrants’ health. Similarly, personal health behaviors and lifestyles showed significant effects on migrants’ health. For instance, regular physical exercise contributed significantly to good health. Healthy eating, such as having breakfast regularly and not eating expired food, also had significant impacts on migrants’ health.
In addition to the individuals’ health-related behaviors and social support, other important factors shape the environment-health relationship in Shenzhen. These include health care services, insurance and other welfare policies, and the overall social and economic developmental strategy in the host city. The study found that most of the labor migrants in Shenzhen work intensively (56 hours a week) on a regular basis, have limited medical insurance on average, and face great uncertainty regarding their life and employment. High medical costs effectively prevent them from using health care services when needed.
It is evident that at policy level, some of the regulations have not been executed properly. For instance, the labor law states that the weekly working hours should not exceed 40 or 44 hours in enterprises, and the overtime working hours should not exceed 36 hours monthly. But this is not implemented. In order to earn a decent income and keep their job, many migrants have to work every day and work overtime.
There are other deficiencies in existing policies and regulations regarding insurance and other welfare provisions. For instance, we found that the current regulations on pension plans require both migrants and their employers to pay into the system for 15 consecutive years. However, in the event of the enterprise breakup, employees lose their contribution even if they have paid for 13 or 14 years.
Nevertheless, as a Special Economic Zone, Shenzhen has been taking the lead in developing/reforming policies to improve the environment and welfare of workers (including labor migrants). For instance, Shenzhen published its detailed regulations on stand-down in extreme weathers as early as in 2005.
In addition, the geographic location is also relevant in the broad environment-health relationship. Located to the north of Hong Kong, Shenzhen supplies more than 90% of the fresh water used in Hong Kong. As a result, industry in Shenzhen is subject to strict pollution regulation. Domestic sewage disposal is also standardized even in the non-standard storied buildings and tap water is accessible in almost all buildings. This has contributed to the city’s overall environment, and is beneficial to migrants’ health.
2008
- Integrating Rural Access to Safe Drinking Water into Public Planning and Budgeting: A Case Study in Jiangxi Province
WANG Xiaolin, International Poverty Reduction Research Center of China
This project examined the problem of rural people’s access to safe drinking water through a case study in Jiangxi. It was conducted by the International Poverty Reduction Research Center of China in collaboration with Jiangxi Agricultural University. The team included experts in human development, agricultural economics, environmental economics and social protection. The project reviewed national-level policy on safe drinking water and the mechanisms for implementing it at the local level, including budgetary arrangements and mechanisms for the approval and implementation of projects. It examined environmental impacts on rural drinking water in the county and analyzed the implementation of the 11th Five Year Plan with a focus on procedures for planning and securing funds for water improvement projects.In 2007 only 49.5% of the population in Jiangxi Province had access to piped drinking water, ranking it number 24 out of 31 provinces nationwide, with more than 13 million people lacking access to safe water. The project found that although the supply of rural drinking in the country has improved, quality is still a big problem. A lot of water is now piped, but with the exception of a few towns and state-owned farms, most places did not have a clean or treated source of water and there was no regular inspection of rural water sources. Although water in the township was inspected yearly, water in rural areas was inspected only when villagers paid the cost themselves. Water was polluted mostly by fertilizer and pesticide run-off, waste from livestock-rearing and household wastewater. Many areas also face water shortages, especially in the dry season.
Improving water quality is not part of the local poverty alleviation strategy. Poor villages receive 100,000 yuan from the national and provincial governments each year for five years under the Poor Village Overall Improvement program (pinkun nongcun zhengti tuijin). But funds are allocated after public debate and in poor areas where there are many needs for infrastructure and economic development, water is not always a priority. Under the 11th Five Year Plan the county set goals of reducing the number of people without access to safe treating water by 1/3 by 2010, by half during the 12th Five Year Plan and completely by 2022. However, funds for improving drinking water come from the national government and the program directs subsidies towards the central and western provinces. Counties in the eastern part of the country generally have to provide matching funds, which is difficult for poor areas. Procedures for designing and implementing programs are also spread across multiple departments including the Development and Reform Commission, Water, and Health. The project found that management responsibilities are not clear and it is not evident which department is responsible for the quality of rural drinking water. Case studies of three villages unpack the particular issues involved and the difficulties in implementing water improvement projects.
- Nonpoint Pollution of the Jiulong River Basin
ZHANG Luoping, Xiamen University
This project explored the sources of nonpoint pollution affecting the Jiulong River Basin in Fujian province and their implications for health. The team identified major sources of pollution as waste from livestock-rearing, fertilizer use and household waste. The report reviews policies and techniques for nonpoint water pollution management used in the US, Canada and a number of European countries as well as the development of laws to control agricultural non-point pollution in China. A survey was also conducted to understand the attitudes of local people in the upstream areas to pollution and health issues. On the basis of the research, recommendations were made to the Xiamen municipal and Fujian provincial governments. - Rural Citizens’ Perceptions and Responses to Health Risks from Industrial Pollution
ZHANG Yiyun, Yunnan Health and Development Research Association
One of the characteristics of China’s development strategy has been rural industrialization. While rural industry has provided an important source of employment and revenue, it has also caused serious industrial pollution and long term health impacts. This project used ethnographic methods to look at the way in which rural residents in Yunnan perceived and responded to health risks from a fertilizer factor. It built on previous research in the area by Benjamin Van Rooij.The team found that although they are often assumed to be ignorant, villagers had quite complex understandings of the impact of pollution on health and had developed “lay epidemiologies” for identifying new and unusual patterns of disease. At the same time, they were also aware of the difficulty of establishing a causal relationship between pollution and health, and this undermined their confidence in holding the factory responsible for health impacts. Nor did awareness of the problem translate easily into action. Although villagers initially protested and called for health tests, in the face of opposition from the factory and a gradual habituation to living in polluted conditions, they later settled for—and became dependent on—compensation for damage to crops.
The project brought together researchers from the Yunnan Health and Development Association, Yunnan University, the Yunnan Academy of Social Sciences and Oxford University. The team included experts in Public Health, Medical Anthropology, Rural Development and Law.
This project has resulted in a number of publications.
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