CIRCUITO COORDINADOR

The issues for adolescent health research in China include all of the general points referred to in Chapter 1, but there also are a number of specific considerations. As in many

countries adolescence in China has entered the classic measurement trap, whereby lack of data leads to situations in which the importance of a problem is not recognised and

therefore little attention is given either to the problem or to its measurement. (Figure 2.2) This idea was originally developed in relation to the health needs of women.

There are a number of specific reasons why young people’s health in China has entered this cycle of entrapment:

• As elsewhere, young people are regarded as healthy, because of their low mortality and morbidity and therefore low priority.

• There is a failure to recognise that adolescents have their own needs, which may be different from those of children or adults.

• Many of the more obvious health concerns of adolescents such as incipient substance abuse, and stress, fall outside the sphere of the health sector with its biomedical models of investigation, and social science research is in its infancy in China.

• Issues of risk behaviour, sexual activity and mental disorders are taboo in many areas of Chinese society and therefore research or intervention programmes in these areas meet considerable barriers, especially amongst Chinese officialdom.

• The concept of participatory research is very new in China. In a society where children are not encouraged to think for themselves, but rather to absorb political and cultural doctrine the idea of eliciting individual views in general, let alone the views of young people, is very threatening to authority.

F igure 2.3

T he m easurem ent tra p in adolescence in C hina a d ap ted fro m G ra h a m and C am pbell P o o r s c o p e and q u a lity o f in fo rm a tio n Ig n oran ce o f im p ortan ce o f a d o le sc e n t h ealth

L ittle rou tin e data O v e re m p h a sis on m o rtality in d ica to rs Common adolescent problems: still taboo Very limited body of research Participatory approaches threatening to authority Failure to see adolescents as separate from adults or children A d o le s c e n t h ealth c o n c e r n s not p u rely m e d ic a l, and so c ia l s c ie n c e research is n e w in C h in a M isc o n c e p tio n that y o u n g

p e o p le are all h ea lth y and th erefore lo w priority for

in terv en tio n s

2.7 IN TR O D U C TIO N T O Z H E JIA N G PR O V IN C E (see map, Fig 2.5) Zhejiang Province is a coastal province in eastern China located just south of the

municipality of Shanghai. Its population of 45 million is mainly concentrated in the coastal plain regions. From early times Zhejiang has been one of the most prosperous of China’s thirty-three provinces, owing to its fertile farmland and long coastline which has facilitated good trading links. It is in the vanguard of change in China in areas as diverse as

economics, health, family planning, education and tourism. Zhejiang’s economy grew rapidly following the instigation of market reforms in the late 1970s. This has resulted in large increases in per capita income. Figure 2.3 shows this steady increase in income since

1978, and it also illustrates how the benefits of the boom have been unevenly distributed with a widening gap between urban and rural incomes.

Figure 2.4

U rban and ru ral annual per capita income for Zhejiang Province: 1978-1998

9000 8000 7000 6000 m I 5000 c 5 4000 CL 3000 2000 1000 78 80 82 84 86 88 90 92 94 96 98 Year

Source; C om prehensive statistical data and materials on 5 0 years o f N ew China. N ational Bureau o f Statistics. China Statistics Press. B eijin g 1999

Com parison with Figure 2.2 shows that the inhabitants of Zhejiang are considerably wealthier than the national average. In 1996 the national average for urban per capita income(PCI) was 4300 RM B com pared with Z hejiang’s 7000 RMB.^^ For rural PCI the differences are more stark with the average for Zhejiang almost three tim es that of the national average: 3300 RM B com pared with 1150 RM B . (U S $ I = 8 R M B ) But these absolute figures conceal the differential in prices of basic com m odities in different areas. In Zhejiang these increases have been especially steep, disproportionately affecting the poor, and reinforcing the argument made by some com m entators that poor households in richer areas are the most disadvantaged of all.’^^ Expenditure on food in Zhejiang has increased lO-fold in urban areas since 1980 rising from 264 R M B per capita per annum to 2644 R M B in 1998, while in rural areas the increase has been 12-fold from 109 to 1362 RMB.^° Thus expenditure on food averages around one third of total incom e in urban areas and one half in rural areas. Since 1980 living space per person in Zhejiang has increased from 6m^ to 12m^ per person in urban areas and from 16m^ to 38m^ in rural areas.^^ M oreover great im provem ent in access to goods and com m odities, improved infrastructure and reliable pow er supplies have transform ed life for m an y over the past two decades. For example, ow nership o f air conditioners in H angzhou has increased from less than 1% to 59% of households betw een 1986 and 1998.'^^

F ig u re 2.5 Location M ap: Zhejiang Province Jiangsu S C A L E 50 km Shanghai A nhui H A N G Z H O U X IA O S H A N C H U N A N East C hina S ea Z H E JIA N G PR O V IN C E Location o f Zhejiang in China Jiangxi o Beijin:

^

Zhejiang presents a post-epidemiological transition mortality and morbidity picture with non-communicable diseases dominating: cardiovascular disease, respiratory disease, cancers and injury. The official infant mortality rate is 15/1000, among the lowest in China. The average life expectancy is 72.1 years, 70.5 for men and 73.8 for women, higher than the national a v e r a g e . H o w e v e r , Zhejiang has also seen a marked resurgence of some types of infectious disease in the past decade, especially tuberculosis and sexually transmitted disease, including syphilis. Preventing the spread of these diseases, together with the demands of an ageing population, are regarded as major challenges for the health service.

There are three major types of socio-economic development recognised in Zhejiang and throughout eastern China: urban, rich rural and poor rural. The three areas selected for the study represent these three types and are described here, though further details about the selection process are explained in Chapter 3.

• Urban: Hangzhou

This is the capital of Zhejiang province, a city of great importance in Chinese history and culture. In the Twelfth Century it became the capital for rulers of the Southern Song Dynasty. It’s favourable location on West Lake has made it a major tourist attraction and a favourite haunt of Chinese leaders. A massive re-building programme with the destruction of whole sectors of the old city, has created a construction boom which has attracted large numbers of migrant workers. The Gross Domestic Product has increased 6-fold since 1990.^^"^ But the closure of many loss-making State Owned Enterprises has resulted in unemployment levels of around 3%.

• Rich rural: Xiaoshan

This county is adjacent to Hangzhou. Although classified as rural it has become wealthy as a result of the successful development of rural enterprises. It is now a designated development zone, creating a favourable investment climate, and attracting many Taiwanese-owned enterprises. Its GDP growth was 13% in 1998-9. It is typical of the new rural manufacturing economy which has underpinned China’s rapid

development and which fosters an entrepreneurial culture. Now in farming families it is the norm for one member to continue to work the land, while others work in

• Poor rural: Chunan

This is a poor farming area in a mountainous region about 200 km south west of Hangzhou. Chunan is the site of one of the biggest man-made lakes in China,

Thousand Island Lake. This was developed in the mid-1960s with the forced migration of 50,000 people, and the loss of low-lying agricultural land. Although one of the poorest counties in Zhejiang Province, it is classified as medium-income rural by national standards. A growing number of farmers have become migrant workers: an estimated 30% of the 18-25 age group in Chunan are working or studying outside the county. Seven percent of the county’s GDP is derived from this source.

Table 2.2 Key Indicators for Hangzhou, Xiaoshan and Chunan

Hangzhou Xiaoshan Chunan

Population 1.7 m 1.3m 0.6m

Population age (10-19) 290,000 230,000 130,000

Annual PCI in RMB (1998) 8,200 6500 3100

Infant Mortality Rate 15 18 31

M iddle school enrolment 99.5% 9&5% 96%

Source: Zhejiang Bureau o f Public Health 1998

2.8 ADOLESCENTS IN ZHEJIANG