The Quiet Suffering of the Rural Migrants in the Urban Health Systems

13 May

In 2010, the percentage of the Chinese population which is considered urban rose above 50% for the first time, more than doubling since 1985 (PDDESA, 2013). Since then, poverty rates have plummeted (Figure 1) and the quality of life is generally considered to have improved greatly across the entire nation.

Despite general economic prosperity, a number of socio-cultural externalities have emerged out of this great transition which are creating a range of frictions across most major cities, with a particular brunt being felt in the longer-standing cities such as Beijing and Shanghai. As migrants move away from agriculture and in to urban areas, they are taking up relatively low paid jobs on the outskirts. Essentially, this is not the issue, as comparative wages actually see many migrants with better wages and a more reliable source of employment. The problems lie within the social status which partners their labour participation, and this stretches out across the entire family.

This issue has become most serious when addressing the subject of health inequalities. Although over recent years China’s health system has come on leaps and bounds, and seem on track to achieve many of their Millennium Development Goals, the general prosperity is hardly felt by the migrant population. Shaokang et al. (2002) find that migrants generally feel alienated from the health system in China and this is reflected in their study by claims that that 90% of all migrants chose not to take out health insurance. This means that the only way they access any type of healthcare would be through out-of-pocket expenditures, which resembles the state of many health systems in developing countries.

Zhao et al. (2009) writes, however, that this is merely the tip of the iceberg with regards to arguably the most critical form of healthcare following the one-child policy – maternal health. This financial contrast only really affects the uptake of regular necessary health services, such as antenatal care for pregnant women. At first glance this may seem to be a minor issue; China’s maternal mortality rate is relatively low, standing at only 37 per 100,000 live births. However, what this does resemble is an entire information culture which is absent among the migrant population. In segregating themselves from the rest of the urban population, they become excluded from popular medical advice, for example family planning advice, and this has led to a much poorer level of maternal health (Zhao et al., 2009).

Urban health centres are becoming overcrowded, and this has left “low-end” clinics deserted. These low-end clinics are generally found on the outskirts of cities, and are reportedly in much poorer condition than the main health centres and hospitals. Since migrants are often found in the surrounding areas they are left with the choice of long journeys for healthcare or no care at all (RAND, 2008) – this is but another factor discouraging the uptake of health insurance. Many migrants also feel that the staff in these facilities “look down” on them, and feel ashamed to seek care in such demeaning conditions (Zhao et al., 2009).

DFID (2008) argue that there is still a “lack of information culture” across urban areas. The Government still dictates a large proportion of the information which reaches citizens, for example over between the years 1998-2005 the number of women delivering in health facilities rose from 20-70% following Government policies which discouraged home deliveries (DFID, 2008). A potential intervention should therefore be a Government led campaign to encourage usage of antenatal services, targeting migrant mothers specifically, aiming for greater social integration in the long term.
Overcrowded central hospitals has stretched resources, and it is therefore detrimental to the healthcare of both long-term urban dwellers as well as migrants. Improving the secondary health care facilities could encourage urban mothers further away from the main hospitals to seek both emergency and non-emergency maternal care in their nearest facility. This would improve the allocation of resources and RAND (2008) believe that this can be achieved through improved management of existing facilities. These facilities should also be equipped to deal financially with out-of-pocket payments, rather than finance through insurance, as this is a more popular method of payment across the migrant population.

Overall, policies should aim in the short term to increase participation of the migrants’ population, but also in the long term to try and achieve full integration in to the Chinese health system. As many younger cities continues to emerge in China, this is guaranteed to become be a recurring issue, and it is important that it is addressed and implemented sooner rather than later or social and cultural inequalities could begin to rise even higher.

Figure 1:
Poverty Indicators

Sources:
DFID (2008) Improving maternal health – lessons from the basic health services project in China. http://r4d.dfid.gov.uk/PDF/Outputs/FutureHealth_RPC/ChinaMaternalHealthPolicyBrief.pdf (Accessed 30/04/2013)

PDDESA (2013) World Population Prospects: The 2010 Revision and World Urbanization Prospects: The 2011 Revision. http://esa.un.org/unup/unup/p2k0data.asp (Date Accessed 07/05/13)

RAND (2008) A Comparison of the Health Systems in India and China. http://www.rand.org/content/dam/rand/pubs/occasional_papers/2008/RAND_OP212.pdf (Date Accessed 29/04/2013)

Shaokang et al. (2002) Economic transition and maternal health care for internal migrants in Shanghai, China. Health Policy and Planning, 17(1): 47-55.

Zhao et al. (2009) Knowledge and attitude on maternal health care among rural-to-urban migrant women in Shanghai, China. BMC Women’s Health, 9(5): 1-8.

World Bank (2013) Data: Countries and Economies. http://data.worldbank.org/country (Date Accessed 09/05/2013)

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