Showing posts with label China. Show all posts
Showing posts with label China. Show all posts

Tuesday, 20 August 2013

A way for China to resolve its 'immigration' dilemma

Main Category: Public Health
Article Date: 20 Aug 2013 - 1:00 PDT Current ratings for:
A way for China to resolve its 'immigration' dilemma
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University of Washington geographer Kam Wing Chan is in China this week, explaining how that country can dismantle its 55-year-old system that limits rural laborers from moving to and settling in cities and qualifying for basic social benefits.

It's an idea that he says makes economic and moral sense.

China's "hukou" household registration system was established in 1958 as a way of maintaining cheap farm labor to grow food for urban dwellers. Ever since, rural residents wanting to move to urban areas must receive permission from the police - and with it, the right to benefits such as unemployment, retirement, even education in the city.

That hasn't stopped millions of peasants from moving to cities in the last two decades, but those migrant workers remain stuck in low-paying service or factory jobs with no benefits and little hope of advancement. The same is true for their children, since hukou (pronounced "who-koe") status is hereditary.

Chan was in Beijing as a featured speaker at the prestigious Chinese Academy of Social Sciences Forum on Economics. His presentation was called "A Roadmap for Reforming the Hukou System."

"China, of course, is the world's factory, because China can produce cheap stuff with its vast army of cheap labor. And that cheap labor is related to the hukou system," Chan said. "Without that system, there would be no China that we know today. That cheap labor helped catapult China into a leading giant of manufacturing."

But, Chan argues, the hukou system is also holding the country back economically in the longer term. That's because China has millions of people who want to move out of poverty and into the middle class so they can spend money on better housing and consumer goods, which in turn would help rebalance the economy. China has been trying to move toward a more sustainable consumer-based economy, away from excessive reliance on investment and exports.

"This is something I think is of great importance not only to China, but to the global economy," Chan said. "I'm promoting gradual, constructive reform, and I'm cautiously optimistic."

Chan was born in a village in China but as a baby left with his family for the city just before hukou effectively shut the door. He said the Chinese government wants to reform the hukou system but hasn't yet decided how to change the household registration status of an estimated 230 million rural migrants currently living in urban areas. Chan said it is likely that number will reach more than 300 million by 2030.

After writing news articles about the problem for several years, Chan now has what he believes is an achievable 15-year plan to change the residential status of 20 million people each year from 2015 to 2030. He recently laid out that plan in an article for Caixin, a major media conglomerate that covers Chinese financial and business news.

He believes China can first focus on young college graduates, who will pay more taxes into the social welfare system than they take out in the 15-year plan period. That will help pay for some of the costs of reform. Skilled workers would make up the second phase, and low-skilled workers would be the third phase. He suggests that the first two phases would take about five to six years, with the main focus on the third phase, covering about 10 years.

Chan says others have proposed more radical reform plans over a much shorter time frame, but he believes they are too fast and would overwhelm the system, both logistically and financially.

One major roadblock to hukou reform is the perceived cost. Many Chinese government officials think that rural peasants will overrun the social services system, taking money out, rather than paying into it. While that may be true of the small group of the poorest migrants, Chan believes the majority of migrant workers is young and productive and can "finance" their social security through taxes, and voluntary and involuntary contributions in the longer run. At the same time, this gradual reform program will help China produce more consumers to drive the economy.

Another issue is that the central government sets hukou reform policy, but local governments are left to enforce it and deal with the financial costs.

Chan sees some interesting parallels in the discussions on China's hukou reform and the United States' immigration reform. Quoting a handful of studies showing that allowing illegal immigrants a path to citizenship will bring in more taxes and boost the U.S. economy, he sees that similar arguments can be made for China's hukou reform.

While Chan makes a case for reform from an economic standpoint, "I'm also trying to point out that there is perhaps a moral argument out there; everybody should be treated the same," he said. "We need to move more toward social justice."

He had planned to write a book in English about China's urbanization and hukou when a Chinese publisher recently asked him to write a book in Chinese.

"I am trying to turn my research into something that may benefit people. I am helping Americans understand the hukou system and maybe coming up with ideas that the Chinese government hasn't thought about yet."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Monday, 29 July 2013

In China over 90 percent of dementia cases go undetected

Main Category: Alzheimer's / Dementia
Also Included In: Psychology / Psychiatry;  Mental Health
Article Date: 28 Jul 2013 - 0:00 PDT Current ratings for:
In China over 90 percent of dementia cases go undetected
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An international team of researchers has found that over 90 percent of dementia cases in China go undetected, with a high level of undiagnosed dementia in rural areas. The team of public health experts led by Dr Ruoling Chen at King's College London argues that more mental health education targeting high-risk populations is now needed to improve diagnosis rates, and increase support for sufferers and their families.

Dementia affects 10 million in China and up to 50 million worldwide, of which around 35 million sufferers are undiagnosed. Dementia causes deterioration in memory, thinking, behaviour and the ability to perform everyday activities. Although the condition mainly affects older people, it is not a normal part of ageing. Dementia is one of the major causes of disability and dependency among older people worldwide. Early diagnosis is crucial to alleviating the significant physical, psychological, social and economical impact the condition has on caregivers, families and society.

The new study, led by Dr Chen, a research leader in global health in the School of Medicine at King's, found that in China 93 percent of dementia cases in people aged 60 and over went undetected. The level of undetected dementia is much higher than has been seen in studies undertaken in high income countries, where about 60 percent of older adults with dementia are not diagnosed.

Published in the British Journal of Psychiatry and funded by Alzheimer's Research UK and the BUPA Foundation, the large population based study is a collaboration between scientists at King's College London and other universities in the UK, and Anhui Medical University and five other medical universities in China. The study is the first to examine factors influencing the poor diagnosis of dementia in older people in low-income countries, where there are more dementia sufferers than in high-income countries.

Dr Chen and his team interviewed a random sample of 7,072 older adults in six provinces across China, with one rural and one urban community in each province. They identified 359 older adults with dementia and 328 with depression. There were only 26 participants who had doctor-diagnosed dementia reported and 26 who had doctor-diagnosed depression. Overall, 93 percent of dementia cases and 93 percent of depression was not detected.

The team found that, in China, undetected dementia among older adults is strongly associated with low socioeconomic status such as a low educational and occupational class, and living in a rural area.

In rural China, the average annual income is two to five times lower than in urban areas and about 90 percent of older people are illiterate. Medical coverage and health services are often insufficient in rural areas, with primary care clinics mainly staffed by health-workers with limited training. In high-income countries most studies have not shown a strong association between low socioeconomic status and undetected dementia, which could be due to better access to healthcare.

The research team also identified that Chinese cultural factors may play a role in poor detection rates of dementia. Unlike in high-income countries, most of older Chinese people live with their families. A surprising, important finding was that undetected dementia is related to strong social support. Such 'help available when needed' may mask the disease and hinder detection. In addition, Chinese may interpret dementia symptoms in older people as being an acceptable part of the ageing process rather than as an illness.

Dr Ruoling Chen said: 'Dementia is increasingly a major global health challenge given that the world's population is ageing. China has the most dementia sufferers of any country in the world, but at the same time it is a poorly recognised condition.

Mental health services need to be prioritised as economic development extends throughout China. Mental health campaigns will ensure that health workers and the general population are able to recognise the condition, so that sufferers receive the support they need.

Our hope is that by looking at the rate of undetected dementia in China we can offer globally applicable insights into the common risk factors, aid earlier diagnosis, ultimately improve prognosis for sufferers and maintain caregivers' health and wellbeing .'

Professor Martin Prince, global mental health expert from the Institute of Psychiatry at King's College London, who was not involved in the research, commented: 'This is an important study, highlighting the very low detection rate by Chinese health services of dementia among older people.

Large treatment gaps for mental and neurological disorders have been observed in low income countries, but this is the first study to focus on older adults, among whom dementia is a major concern.

Detection is the first step in accessing evidence-based treatment and care. Limited knowledge, skills and confidence among health care workers, and a lack of understanding of the benefits that may stem from diagnosis and intervention are all likely to contribute.'

In a related recent commentary in the Lancet, Professor Prince argued: '... the Chinese Government faces a daunting task in addressing future needs for long-term care. Previously, these needs have been met by families, consistent with traditional values and enforced through the Elderly Rights and Protection Law of 1996. However, central government policy is shifting towards new social care initiatives and increased investment in social protection, as outlined in a radically amended version of the 1996 law which will take force from July, 2013.'

Dr Simon Ridley, Head of Research at Alzheimer's Research UK, said: 'We know that dementia is a global problem and it is important to understand more about the risk factors and barriers to diagnosis across different countries. Investigating the social, economic and cultural factors influencing attitudes and access to dementia diagnosis can help shape strategies that could benefit multiple countries across the world.

We must ensure long-term investment for dementia research if we are to improve the lives of millions living with this condition worldwide.'

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alzheimer's / dementia section for the latest news on this subject.

'Determinants for undetected dementia and late-life depression' is published in the British Journal of Psychiatry doi: 10.1192/bjp/bp.112.119354

'Dementia in China: east-west collaboration bears fruit' is published in the Lancet doi:10.1016/S0140-6736(13)60770-9

King's College London

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29 Jul. 2013. APA

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'In China over 90 percent of dementia cases go undetected'

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All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

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Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.



View the original article here