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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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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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Edited by Beatriz Carrillo, Johanna Hood and Paul Kadetz

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Ye Liu

This chapter explores the changing role of the State in the provision of educational opportunities, with a specific focus on geographical differences since the market reform in China. Drawing on evidence from national data on enrolment, progression rates and educational spending, it highlights widening inequality in access and participation in education between the eastern, central and western areas during the first stage of the reform (1980s–1990s), as the consequence of the Party-State’s gradual development strategy. Furthermore, from the 2000s a new initiative to improve educational provision in rural and western areas was coincident with the Party-State’s strategy of promoting social cohesion. However, the State’s selective strategy towards educational provision by prioritising funding to realise universal access to compulsory education and to support elite universities has further divided regions in opportunity structures. The chapter argues that the State’s educational provision, while consistent with its overall development objectives, allowed eastern provinces to increase their advantage in educational spending and access to higher education. The same institutional structures punished students from poor western and central provinces, who were relatively disadvantaged in their opportunities to achieve upward social mobility through higher education.

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Sarah Cook and Xiao-yuan Dong

This chapter examines welfare changes in reform era China through the lens of care – that is, the daily and generational work of reproduction essential for the functioning of society and the economy. During the Mao era, care roles and responsibilities were largely socialized, enabling women to enter the labour force in vast numbers while also contributing to rapid improvements in a range of welfare indicators. The reform era has seen the work of care largely returned to the domestic sphere, with households providing care with unpaid (predominantly female) labour, or accessing care services through the market. These changes have significant implications for women’s choices around work, family and fertility, as well as for the welfare of care recipients. Market reforms and the commodification of care services affect the provision and quality of care services, the nature of care work and the status of its providers. The chapter sheds light on the gendered nature of welfare systems, and the wide-ranging implications of how care is delivered and financed: on the welfare and opportunities of women as carers; and on the wellbeing of those in need of care, as well as on broader economic, social and demographic outcomes.

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Elaine Jeffreys

This chapter looks at the growth of charitable foundations funded by newly rich private entrepreneurs and commercial entertainment and sports celebrities in the People’s Republic of China (PRC). Foundations provide the basis for elite philanthropy in developed countries such as the United States, but are a new phenomenon in the PRC. The chapter first outlines the recent history of elite philanthropy, and philanthropy more generally in the PRC. It then examines a sample group of non-public foundations established by some of the most ‘rich and famous’ people in China, focusing on the nature of their missions and their founders’ interactions with government, elite politics and the media. It finds that conventional western critiques of elite philanthropy lack explanatory power in the PRC. It is neither the case that government is simply outsourcing welfare provision to ‘unaccountable’ business–celebrity elites nor that elite-funded foundations simply work independently to fill gaps in the government’s provision of public services. Elite philanthropists in the PRC typically operate hand in glove with the government on core social welfare and humanitarian initiatives while mobilizing more limited financial resources and their elite political connections to pursue peripheral independent interests.

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Karen R. Fisher, Xiaoyuan Shang and Megan Blaxland

This chapter examines people’s experiences of welfare policy intended to address the rights of people with disabilities as citizens of China. It applies a conceptual framework of disability and welfare from human rights. In a rights framework, meeting people’s support needs is required to fulfil their rights as citizens. Nationally, China adopts a rights framework in disability law. It is a signatory to the UN Convention on the Rights of Persons with Disabilities 2008. Yet, like other countries, research on disability in China indicates gaps between government commitment, experience of policies and consequent support required to fulfil their rights. In light of increased international and Chinese concerns about disability policy, it is timely to investigate experiences of support to inform welfare reform. Seeking socially inclusive policy for people with disabilities is directly related to rights, an issue high on the international political agenda. The chapter draws on fieldwork and secondary data analysis about the experience of people with disabilities within the family context (children, young people and older people) or in State care if family members are unknown. The policy implications of the findings focus on the ways State policy can strengthen family networks rather than exclude families from the disability policy process. In this, it takes a broad approach to policy implementation by acknowledging the role of the State, non-government agencies, communities and citizens.

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Ole Bruun

After 30 years of unbridled economic growth China is now facing tremendous challenges from urban air pollution, toxic emissions from industry and power plants, pollution of waterways and compromised foodstuff safety. Those aspects of environmental degradation most directly impacting human welfare have seen the strongest outcry from the public, resulting in both organised civil society activity and endless spontaneous protests. Today, environmental and food safety may constitute the most important threats to political stability. This chapter will outline relevant data on welfare issues relating to climate and environment in the broadest sense, and discuss State and media responses, new legislation, public opinion and the role of civil society organising. The chapter argues that China has come to an important juncture in its striving towards sustainable development, and that real change in environmental practices is questionable without simultaneous political change and a greater space for non-State actors. However, State–society relations remain ambiguous, hampering those ‘social forces’ that may contribute efficiently to reaching an environmental turning point, as well as hampering general public mobilisation for substantial improvements in environmental welfare. Finally, the chapter frames China’s present environmental health issues in a broader historical perspective, contending that the country is currently in a transitional state between inherent and modern perspectives on the environment, and that we must look beyond the shifting politico-economic arrangements in the contemporary era to appreciate the long-term processes in State–society–environment relations.

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Emily Baum

State provision for the mentally ill is a relatively recent phenomenon in China. Prior to the early twentieth century, mentally ill individuals were typically kept within the home, and State agents did not intervene unless the individual was violent or criminal. It was not until 1908 that the first public asylum was erected in China for the exclusive care of the insane. From that point on, subsequent governing regimes experimented with a variety of approaches to treating mental illness and managing those who were affected by the disorder. This chapter will place Chinese psychiatric welfare in its historical context, and will argue that certain issues facing psychiatric welfare in China today can be traced back to longer historical processes. In particular, it will discuss three factors that continue to exert an influence on the current state of psychiatric welfare: first, the longstanding priority placed on domestic, rather than State, care of the mentally ill; second, uneven geographical access to psychiatric care, with urban areas being prioritized over rural ones; and, third, popular attitudes and beliefs about the nature and proper treatment of mental illness. By examining the contemporary state of Chinese psychiatric welfare in its historical context, this chapter will show how Western forms of welfare do not always function as expected when transplanted into a Chinese setting.

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Jennifer Y.J. Hsu and Reza Hasmath

This chapter explores the role of non-governmental organisations (NGOs) as welfare providers and the difficulties they face during the reform era. Since 1978, the move toward a market economy has led to the dismantling of the old support system distributed via the work unit (danwei) and communes. The liberalisation of the welfare system has left millions of Chinese citizens with no or an inadequate support system. Systemic social reforms did not take off until the turn of the 21st century. Reforms were informed by various local experiments, with local governments responsible for new and innovative solutions. As a result, various novel methods of delivering welfare assistance were developed by both State and non-State stakeholders to fulfil such responsibilities, with NGOs playing a growing role. The devolution of responsibility, since the late 1970s, from the Central level down to the lowest levels of government, created opportunities from the 1990s onward for NGOs to engage with broader segments of society. Nevertheless, we argue in this chapter that the institutional and internal organisational constraints that beset NGOs can provide us with a clearer picture and more realistic expectations of what NGOs can achieve as welfare providers. We contextualise and support our argument with a case study of welfare NGOs in the city of Nanjing, in order to demonstrate some of the obstacles that NGOs face in conducting their work in China in general.