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Edited by Beatriz Carrillo, Johanna Hood and Paul Kadetz

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Edited by Beatriz Carrillo, Johanna Hood and Paul Kadetz

The Handbook is a timely compilation dedicated to exploring a rare diversity of perspectives and content on the development, successes, reforms and challenges within China’s contemporary welfare system. It showcases an extensive introduction and 20 original chapters by leading and emerging area specialists who explore a century of welfare provision from the Nationalist era, up to and concentrating on economic reform and marketisation (1978 to the present). Organised around five key concerns (social security and welfare; emerging issues and actors; gaps; future challenges) chapters draw on original case-based research from diverse disciplines and perspectives, engage existing literature and further key debates.
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Zhongwei Zhao, Hongbo Jia and Jiaying Zhao

Great disparities in health, morbidity and chances of survival exist widely across different populations. These disparities are closely related to and often caused by inequalities in levels of income, standards of living and accessibility to high-quality health services and care. Health disparities can also increase the gap in income and living conditions that already exist in a population. As important strategies, social medical insurance and financial assistance have been developed to address such health inequities and their negative externalities on vulnerable social groups. Through an analysis of health and demographic data collected and published by the Chinese government, national censuses and surveys, and a review of the existing literature and official documents, this chapter aims to provide a systematic introduction to the development of China’s health insurance and medical financial assistance programmes, and their contributions to the improvement of social welfare in its urban and rural areas.

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Bingqin Li

Housing continues to be one of the three most pressing concerns among all social policy areas, inciting strong public outcry. High housing prices are considered to be an important cause of the low life satisfaction among urban residents, in particular among new university graduates and migrant workers. The strong discontent over housing affordability, to a great extent, reflects the inability of the Chinese housing policy to address pressing urban housing needs. Using secondary sources and primary research carried out by the author, this chapter provides an historical review tracing the different stages of China’s housing reform. It argues that despite the radical changes in the housing market, the logic behind Chinese housing policies at different stages of the reform is in essence similar to that during the Central Planning period (1953–1977), even in the context of recent reforms, which claim to be people oriented. The seemingly improved inclusiveness of the new housing welfare system in China is a response to labour market changes rather than an effort to satisfy the housing needs of urban citizens.

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Yi Zeng and Therese Hesketh

In October 2015, China’s ‘one-child policy’ was replaced by a universal two-child policy. The impacts of the new policy are inevitably speculative, but predictions can be made based on recent trends. The population increase will be relatively small, peaking at 1.45 billion in 2029 (compared with a peak of 1.4 billion in 2023 if the one-child policy continued). The new policy will allow almost all Chinese people to have their preferred number of children. The benefits of the new policy include virtual elimination of abortions of unapproved pregnancies and problems of unregistered children and a lower sex ratio at birth – all of which should improve health outcomes. Impacts of the new policy on the shrinking workforce and rapid population ageing will not be evident for two decades. In the meantime more sound policy actions need to be taken to meet the social, health and care needs of the quickly growing elderly population. About 45 per cent of China’s population currently live in rural areas, where the potential is great for fertility increase to enrich the future workforce and cumulate pension premium funds from young farmers (who previously have not participated in old-age insurance programmes). China’s current low retirement age and cultural tradition of familial care for the elderly could provide useful potential opportunities to address ageing problems. In conclusion, we believe that if (and only if) the universal two-child policy is thoroughly and quickly implemented and other needed policy actions are taken, China should be able to face the serious challenges of population ageing.

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Beatriz Carrillo, Johanna Hood and Paul Kadetz

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Shao-hua Liu

This chapter examines China’s leprosy control during the collective era (1950s–1978) into the 1980s. In this health campaign, China adopted a universal type of welfare that is usually considered to foster stigma reduction. However, leprosy-related stigma seemed to be long-lasting, and even expanded as a counter-effect of the campaign, which requires a reconsideration of the role of stigma in welfare-programme design. This chapter shows how different kinds of stigma, which haunted both leprosy sufferers and the politically disadvantaged doctors who treated the disease – underpinned the design and efficacy of this welfare programme. This case provides a lesson how a stigmatised disease indeed needs support but that, unless the patients’ participation in all aspects of welfare is normalised, a future without the stigma of leprosy will remain an elusive goal.

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Paul Kadetz and Johanna Hood

Foreign aid directed toward the health sector, or health diplomacy, is a form of soft power that ultimately may assist with the fulfilment of the foreign policy goals of the donor country. China’s health aid to African States (which spans more than half a century) seeks to offer an alternative to normative western aid in its discourse of mutually sustainable self-development and historically in its more horizontal approach to health care. This research, based on a review of the literature and semi-structured interviews conducted at the Third International Roundtable for China–Africa Health Cooperation in Beijing, and with pertinent stakeholders in Antananarivo, Madagascar, aims to identify the actual sustainable self-development being fostered by Sino-African health diplomacy. Regardless of the horizontal structure of China’s health aid to African contexts, the foreign policy development discourse emanating from Beijing and the work of thousands of Chinese in African States since the mid-1960s, this research finds that Chinese health aid to Madagascar, as with western health aid, has resulted in a fragmented health care system – and, ultimately, an increased dependency on foreign aid – rather than in the growth of sustainable self-development.

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Tony Saich

Policy development is analyzed in light of two key factors: changing support for core groups, and how the leadership assesses and responds to perceived risk. This framework is used to understand the political economy of welfare reform in China, and how policy has been used to consolidate and perpetuate State, in reality Chinese Communist Party (CCP), power. In so doing the chapter raises the question of whether welfare policy is becoming more inclusive. We outline a four-period categorization of welfare policy since 1949. The reforms introduced after 1980, combined with policy neglect and a naïve faith in the market, led to a breakdown of the workplace-based system established after 1949. The initial response (1996–2002) centered on shoring up support within urban China, despite the dramatic impact policy had on those living in rural China. A more inclusive approach has been taken since 2002, both in terms of support for those in the countryside and for the rapidly expanding numbers of migrant workers. While China’s welfare system shares certain features with other Asian polities, there is no single system for public service delivery, and the outcomes are marked by greater inequalities of service provision. We conclude that while recent policy trends indicate moves towards a welfare system based on the notion of citizenship, a welfare policy based on this alone remains far off: migrants are still significantly disadvantaged, as are those who remain in the countryside. Urban bias remains strong, and government officials and party workers remain a privileged elite.

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Juan Chen

In light of the rapid urbanization process and the associated social and welfare reforms in China since the 21st century, this chapter examines rural-to urban migrants’ access to urban social services and integration into various aspects of urban life, based on analysis of the 2011 Migration and Quality of Life Survey data. Results present a mixed picture: in the areas of occupation, industry, health status and receipt of medical treatment, rural-to-urban migrants did not face more discrimination than urban residents; neither did they report higher levels of perceived institutional or interpersonal discrimination. However, they were still excluded from jobs in the State sector, and their identity was closely linked to their rural background. Nonetheless, rural-to-urban migrants did not show a lesser degree of involvement in urban community activities or a greater inclination to move out of their host city than urban residents or urbanized rural residents after socio-demographic characteristics, particularly homeownership, were controlled in the analysis. Given that rural-to-urban migrants represent a significant proportion of the urban population but have not enjoyed the same citizenship rights of urban dwellers, such an investigation provides essential insights for improving the efficacy of social and welfare reforms in China. Particularly, ongoing pro-urbanization policies must be accompanied by measures to grant rural-to-urban migrants equal access to jobs in the State sector; to urban health insurance and medical services; and to stable and affordable housing in the host cities.