Bhugra (2004) suggested that immigrants carry their cultural knowledge and expressions of distress with them when they immigrate. This study focuses on the experiences of first generation Chinese immigrants; therefore, a social-economic overview of China is provided here.
China, officially known as the People’s Republic of China (PRC), is the world’s most
populous country with a population of over 1.37 billion (Chinese National Census, 2014). Comprised of over 9.6 million square kilometres, China has enormous diversity both in its landscape and population. There are 55 nationally recognised ethnic minority groups in the PRC, with Han Chinese comprising the majority of the population at 91.51% (Chinese National Census, 2014).
In recent years, China’s economic growth has taken the world by storm. In 2015, China became the world’s largest economy in terms of purchasing power, a title that was
previously held by the USA for over a hundred years (IMF, 2015). It was only after the 1978 economic reforms that China began to re-enter the world stage and become an economic powerhouse. In less than four decades the country went through major economic transformations at an extremely rapid pace. This extraordinary economic
performance has impacted China’s social structures, family relationships, traditional
values and beliefs. As a result of the market-oriented economic reforms since the late 1970s, China has achieved an impressive annual gross domestic product (GDP), with growth averaging nearly 10% in 2014 (Morrison, 2015).
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This growth was achieved mostly by rapid urbanisation (World Bank, 2011). Due to the varied geographic composition of China, the economy of the inland western part of the country has predominantly been focused on agriculture, whilst the eastern costal area has been more trade and business driven. The higher financial returns to labour in non- agricultural sectors have motivated many farmers to migrate out of agricultural areas to cities around China (Cook, 2000). It was suggested by a World Bank Report that over half a billion people have moved from rural agricultural areas to seek work in manufacturing and services in cities such as Shanghai, Guangzhou and many other special economic zones and export-oriented industries over the last 30 years (World
Bank, 2011). Economists have predicted that by 2035 almost 70% of China’s
population will live in urban areas (Seto, Güneralp, & Hutyra, 2012). This urban transformation has been vital in the reduction of poverty, given that 679 million people in China were raised out of extreme poverty between 1981 to 2010 (World Bank, 2011). However, this vast migration and continual urbanisation has exerted great pressure on
China’s social structure and welfare system, including health care. These reforms and
urbanisation have contributed to disparities in social structures, due to economic policy liberation and lack of provision in social equity (WHO, 2011). The increasingly wide gap in the inequalities of health outcomes between cities and rural areas, and between the rich and poor, (Chao-lin & Kesteloot, 1997; Pei, 2006; Wang, 2004) poses a major challenge for the Chinese government. An example given by the WHO (2005) highlights the difference between the maternal mortality rate of 9.6 in Shanghai (the financial capital of China) compared to Tibet (northeast of the Himalayas), which is 339. This alarming difference shows the vast scale of the task at hand to minimise regional disparities in China. Furthermore, fast paced urbanisation could create high levels of mental stress that adversely impact psychological wellbeing (Li et al., 2006).
Another major challenge relating to health care in China’s current social-economic
environment is that it is an aging nation: China’s elderly population is growing rapidly.
As a result of China’s strict “one-child” policy imposed in 1979 and low mortality rates, China’s elderly population is predicted to be well over 300 million by 2050 (UN Dept.
of Economic and Social Affairs, 2010). Traditionally the Chinese elderly were cared for at home by family members, as according to the Confucian principle of filial piety, the younger generation of adult children is expected to care for their elderly parents (Gu, Dupre, & Liu 2007). This could create increasingly tiresome and stressful family relations between the generations. Lack of institutional care for the elderly also adds to
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the problem. A study conducted by Gu and colleagues (2007) found that only 2% of the elderly population are cared for outside of their homes. In comparison, in the UK the percentage is 4.6% for people who are 65 and over and 18.6% for people who are 85 and over (ONS, 2014). However, the increase in urbanisation, industrialisation and migration have all threatened traditional family support networks (Jackson, 2010), which decrease the availability of family care. As the elderly population continues to grow, more elderly people will seek care in professional institutions (Gu, Dupre, & Liu 2007). Lack of support for both the elderly and their carers places enormous strains on the current health care and social service infrastructures, which creates potentially adverse effects for mental health issues.
A brief overview of the Chinese mental health care system also reveals serious problems. Underutilisation of mental care services in China is a major concern and seeking help from mental health professionals is more likely to be seen as a last resort by Chinese citizens (Zhang et al., 2013). In 2012 a study stated that while there are currently over 170 million people suffering from a diagnosable psychiatric disorder in China, only 15 million people have ever received treatment (Xiang, Yu, Sartorius, Ungvari, & Chiu, 2012). The study also pointed out that there are only 4,000 adequately trained and qualified psychiatrists in China serving over 1.37 billion people (Xiang et al., 2012). A severe lack of workforce and resources in mental health care will pose a major challenge to the government.
2.3.1 The changing Chinese cultural context – generational subcultures As previously mentioned, the concept of culture is broad and dynamic. As Tung (1996) suggested, “Culture is an evolving set of shared beliefs, values, attitudes and logical processes which provide cognitive maps for people within a given societal group to
perceive, think, reason, act, react and interact” (p. 491). Culture therefore evolves over
time and is not static. Consequently, a study built around the concept of culture needs to also acknowledge the changing Chinese cultural context, in particular generational subcultures.
According to Mannheim (1952), each generation has its unique characteristics and subculture, which are largely due to the major socio-political events that the members of the generation encountered during their formative years. Further studies have suggested
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that significant macro-level social, political, and economic events that occurred during a generation’s impressionable pre-adult years result in a generational identity comprising a distinctive set of values, beliefs, expectations, and behaviours that remain relatively
stable throughout a generation’s lifetime (Inglehart, 1997; Strauss & Howe, 1991). This
concept is particularly relevant to the study of Chinese culture, as in a little over six decades, the Chinese have been exposed to startling political and social changes. Major political movements like the Communist Revolution in 1949, the Cultural Revolution in 1966 and the market reforms in 1981 have all undoubtedly influenced the mental framework of a Chinese-born person born between the 1960s and 1990s. Since China opened to the world nearly four decades ago, market competition, economic restructuring, the uneven distribution of wealth and western cultures have become embedded in the everyday life of Chinese people, and undoubtedly caused changes to traditional Chinese cultural values systems. And the subculture of different generations has also reflected the country’s particular historical period with changed values and priorities.
In relation to management style, Ralston and colleagues (1999) noticed there is a growing spirit of individualism and more Western ways of thinking are being adopted by young Chinese people when doing business. According to a study on generational differenced conducted by Shuai, Mi & Zou (2015) on people born in the 1970s, 1980s and 1990s, it was found that an increasing degree of individualism was correlated with generational difference. The group born in the 1990s showed more individualistic thinking and those born in the 1970s displayed more collective consideration. The concept of individualism and collectivism in relation to Chinese culture will be further explored in the conceptual framework section of the literature review (Chapter 2.7). As suggested earlier, the change in cultural context is an ongoing evolutionary process that involves changes in the priorities of values at both individual and societal levels, all of which need to be explored when studying first generation immigrants (Levkoff, Macarthur, & Bucknall, 1995) including the differences in generational subculture.