Ian G. Cook

Changing health in China: re-evaluating the epidemiological transition model

Abstract This paper reviews the changing health situation in China, which has shown remarkable improvement in the 50 years since the founding of the People’s Republic of China (PRC) in 1949. At first sight this improving health situation follows the classical epidemiological transition model. Just three decades ago health in China was characterised by high rates of infectious disease and early mortality (diseases of poverty) in a mainly peasant society. More recently infectious disease rates have decreased, with corresponding and extended morbidity and mortality associated with an aging population in a rapidly urbanising society. This process has given rise to new health problems, including chronic and degenerative diseases (diseases of affluence). Nonetheless, while there is some validity in the application of the epidemiological transition concept, further analysis demonstrates that China faces a new epidemiological phase, characterised by increasing life expectancy and diseases of affluence coupled with the emergence and re-emergence of infectious diseases. We demonstrate that China’s state policy plays a major role in defining the parameters of health in a Chinese context. We conclude that, today, China is faced with a new set of health issues, including the impact of smoking, hypertension, the health effects of environmental pollution and the rise of HIV/AIDS; however, state policy remains vital to the health of China’s vast population. The challenge for policy is to maintain health reform whilst tackling the problems associated with rapid urbanisation, widening social and spatial inequalities and the emergence of HIV/AIDS and other infectious diseases.

Health in China and India: a cross-country comparison in a context of rapid globalisation.

China and India are similarly huge nations currently experiencing rapid economic growth, urbanisation and widening inequalities between rich and poor. They are dissimilar in terms of their political regimes, policies for population growth and ethnic composition and heterogeneity. This review compares health and health care in China and India within the framework of the epidemiological transition model and against the backdrop of globalisation. We identify similarities and differences in health situation. In general, for both countries, infectious diseases of the past sit alongside emerging infectious diseases and chronic illnesses associated with ageing societies, although the burden of infectious diseases is much higher in India. Whilst globalisation contributes to widening inequalities in health and health care in both countries--particularly with respect to increasing disparities between urban and rural areas and between rich and poor--there is evidence that local circumstances are important, especially with respect to the structure and financing of health care and the implementation of health policy. For example, India has huge problems providing even rudimentary health care to its large population of urban slum dwellers whilst China is struggling to re-establish universal rural health insurance. In terms of funding access to health care, the Chinese state has traditionally supported most costs, whereas private insurance has always played a major role in India, although recent changes in China have seen the burgeoning of private health care payments. China has, arguably, had more success than India in improving population health, although recent reforms have severely impacted upon the ability of the Chinese health care system to operate effectively. Both countries are experiencing a decline in the amount of government funding for health care and this is a major issue that must be addressed.

Women's Experiences and Perceptions of Age Discrimination in Employment: Implications for Research and Policy

This paper reports on pilot study research for an ESF funded project. It examines the experiences and perceptions of 12 women in relation to the concept of ageism in paid employment. The women were all aged 50 or over at the time. The results show that whilst most of the women had faced (to differing degrees) or observed gender and age based discrimination, the experiences and interpretations revealed were not static, nor isolated from the wider historical, cultural and social contexts in which these women had grown up and grown older. It is therefore argued that policy attempts to combat age discrimination will need to take account of the gender dimension of ageism as well as the different ways in which it impacts on older women. For this to occur, more research and debate are needed on the issues raised in this paper.

Global ageing in comparative perspective: a critical discussion

Purpose – The aims of this paper are to summarise the rapid expansion in the proportion of the elderly across the globe and to highlight the main factors causing this. Specific areas of the globe will be focused on in more detail before the authors discuss some of the key challenges and consequences of global ageing for global society.Design/methodology/approach – The paper is a literature review of major trends and implications of population ageing across the globe.Findings – As a consequence of the global demographics of ageing, societies are being confronted with profound issues relating to illness and health care, access to housing and economic resources including pension provision. We have witnessed an unprecedented stretching of the human life span. This ageing of the global population is without parallel in human history. If these demographic trends continue to escalate, by 2050 the number of older people globally will exceed the number of young for the first time since formal records began, raisin...

“A Tiger Behind, and Coming up Fast”: Governmentality and the Politics of Population Control in China

China has a growing “superaging” population, known colloquially as a “tiger behind.” This phenomenon has been traditionally analyzed by conventional social science methodology as a question of resource allocation to a burgeoning elderly population. However, population policies in China have emerged as key vehicles used to legitimize and position the identities that older people adopt. They contain specific yet continually changing technologies that function to mediate relations between older people and the Chinese state. They also represent an increase in state control that can be exerted on lifestyles in family form and older age and thus, the wider social meanings associated with that part of society and lifecourse. This article briefly summarizes the empirical detail and context of superaging in China, presenting an original theoretical analysis based on a reading of the work of Michel Foucault. The interrelationship between the Chinese government and older people is identified in terms of Foucaults (1978) and Rose and Millers (1992) concept of governmentality. The article highlights how and why older people are the subjects of the Chinese states gaze.

Theorising Chinese urbanisation: : A multi-layered perspective

Urbanisation in China and its rapid increase in recent decades as a result of industrialisation and globalisation are often conceived as a simplified process. Moreover, the speed of the present day process yields the impression that the traces of previous forms of urbanisation are erased for good. Both of these assumptions are challenged in this paper. The built environment resulting from this urbanisation process is to be conceived as a series of layers that reflect different modes of productions and related logics of production of space. Hence, we try to comprehend the spatial arrangement of the city, which can be thought of as a geological metaphor. The social groups that have to be sheltered in urban residential space also radically change in each of these periods. We proceed to analyse these layers and how they combine and interact over time with the concept of socio-spatial configuration, which denotes a precise type of residential environment related to a specific social group in the city. Chinese cities are made up of five types of urbanisation, reflected in five layers and their related socio-spatial configurations: the traditional, proto-globalisation, socialist, market-led and globalisation layers.

Longevity in the 21st century: a global environmental perspective

One of the great human success stories in the last few decades has been the marked increase in longevity in many, albeit not all, societies across the globe. Lifespans reaching into the 80s, 90s and 100s are becoming increasingly common, and forecasters predict even greater proportionate gains to come during the course of the 21st century. This article summarises the gains that have been, and continue to be, made then examines the extent to which these will continue in the face of climate change that will probably give rise to more frequent environmental disasters and threats in the future, as Malthusian and neo-Malthusian checks on longevity. Older people will themselves be among those groups most vulnerable to environmental disasters, and policies will be required to assist older people in many unstable environments around the globe in order to ensure their survival. Previous work on Asian longevity will be augmented by case studies of Hurricane Katrina and the recent Haiti earthquake in order to assess the validity of these generalisations.

Planning Beijing: socialist city, transitional city, and global city

Cities are centers of economic, social, and political change, and urban planning is a process responding to and guiding urban change and development. In the Maoist era and under the influence of socialist ideology, China limited urbanization while promoting industrialization, and urban planning served as an instrument for socialist construction. Since the reform of the late 1970s, Chinese cities have experienced unprecedented growth and restructuring. However, the gradualist, exploratory reform—exemplified by Deng Xiaoping’s slogan “crossing the river by feeling the stones”—makes Chinese cities constantly change without clear directions for future development. This paper uses Beijing as a case study to analyze changing institutional and global contexts underlying the transformation of Chinese cities, and planners’ responses and dilemmas in making plans and implementing them. We found that market reforms, rapid growth, and dramatic change make urban master plans quickly out of date, forcing Chinese planners to frequently revise these master plans. We also found that the content of urban master planning in China has broadened from physical planning, and Chinese planning has adapted to market reform through utilizing concepts of visioning, flexibility, and governance. Increasingly what we call a “hybrid” form of planning is arising in which global concepts and Chinese ideas interweave in order to direct the shape and form of the Chinese metropolis.

China's Urbanization in 1949-2015:Processes and Driving Forces

The pace and scale of China’s contemporary urbanization are stunning. This paper reviews process and the underlying driving forces of China’s urbanization between 1949–2015. Contemporary China’s urbanization has experienced four stages, and each has had different driving forces: 1) economic re-construction and industrialization-led urbanization (1949–1977); 2) economic reform and market-led urbanization (1978–1995); 3) economic globalization and the global-local urbanization (1996–2010); and 4) the land-economy-led urbanization (2010–). These urbanization processes and driving forces will undoubtedly provide scientific reference and have significant implications for developing countries, especially African countries, to formulate their urbanization public policies.

Aging in Comparative Perspective

Chapter 1: Introduction: An Aging World.- Chapter 2: Aging in the United States.- Chapter 3: Aging in the UK.- Chapter 4: Aging in Sweden.- Chapter 5: Aging in Japan.- Chapter 6: Aging in China.- Chapter 7: Aging in Nepal.- Chapter 8: Aging in South Africa.- Chapter 9: Lessons to be Learned.