his chapter aims to analyze the relationship between social change and the
population’s health by presenting a case study of that relationship from the
People’s Republic of China (China). With a territory of 9.6 million square
kilometers, it is ranked the third largest country in the world. It’s population
reached 1.25 billion in the year 2000, which ranks it the first in the world.1
China is considered one of few Socialist States in the world. Administratively,
China is divided into 23 provinces (including Taiwan), 5 autonomous regions, 2
special administration regions, and 4 municipalities.2
The government structure
from the top to the bottom includes the Central Government, Provincial
Government, Prefecture and City Government, District (in the urban area)/County
(in the rural area) Government, and Resident Street (in the urban area)/ Township
(in the rural area) Government. Although the Neighborhood Committee (in the
urban area)/ the Village Committee (in the rural area) also plays administration
roles at the bottom, below the resident street/ township government. It is
considered, as the extension, not the formal entity within the government structure.
Within the past 25 years, China has experienced transformation of its economic
system from a highly centralized planned economy toward a market oriented
economic system. This process has led to massive and rapid changes in all aspects of
society with profound effects on the population’s health in the large parts of the
country. Along with the material prosperity, the living conditions of Chinese
people, such as food, shelter, and sanitation status, have been improving steadily.
People have more capability to purchase health related merchandise as well as healthservices. Overall the health status of most Chinese has improved but there are
significant exceptions to this overall conclusion. These exceptions arise from
increasing inequity of income, increases in unemployment rates, the decline of
health insurance coverage, changes in demography, changes in social value, culture,
health related behaviors, and the changes of health care systems.
This chapter is organized into five sections. The introduction section provides
the background information including a brief summary of China’s geographic and
administration system and also the purpose of this case study. Section II, provides
an overview of China’s economic reform. Section III describes the major social
changes brought on by this economic reform that have potentially both positive and
negative influences on the population’s health status. Section IV describes the
current Chinese population health status, which reflect the mixed impacts by the
economic and social change process. Then finally the policy implications and
suggestions will be included in the last section V.