Erenlai - Social Changes and Challenges 變動中的華人社會
Social Changes and Challenges 變動中的華人社會

Social Changes and Challenges 變動中的華人社會

Here are materials that examine and assess the current issues that are influencing the Pacific-Asian culture and society.

經濟發展所產生的變動已經全面衝擊了人們的生活型態與觀念。

 

 

 

Monday, 18 August 2008

學習不該是障礙--彞族打工者的未來

撰文│燕妮

《人籟》五十一期中的「中國彞族打工者的汗與淚」特輯,試圖透過探訪少數民族為生活遠走他鄉,在大都市生活的實際情況,拼湊出這些打工者的足跡圖像。但為了讓讀者對彞族打工者的內在思想有更真切的認識,我們繼續與他們接觸,並且更貼近他們生活的狀況,希望藉以找出能改善他們生活的方法。

經過多次接觸,大致可歸納出他們在過去一年中,除工資外的收穫主要是眼界的開拓和由此做出的省思,反而不是個人技能上的提升。原因是他們做的大多數都是重複性極高的粗活。不過也因此刺激他們學習的慾望,只是這些「學習」通常需要花錢才參加,成了另一道門檻。

因此,我們將為這些打工者開設打字訓練課程,並要求來上課的人也必須把這項技能交給無法前來的同伴,除了增加他們工作上的能力以外,目的也是想製造一個機會讓他們嘗試知識技術上的交流,建立更緊密的聯繫。希望藉由這樣的聯絡可以讓他們的關係更加密切、互助成長。

附加的多媒體:
{rokbox}media/articles/yanni_china.jpg{/rokbox}

Monday, 11 August 2008

Movies and cultural diversity

Yesterday morning, as I was riding my bicycle on my way to the supermarket, a group of teenagers started screaming at me in English: “Hello, Mister!” “How are you, Mister?” I was first amused to see young people so eager to demonstrate their English proficiency, but this comic encounter left me later with a bitter aftertaste: one more time in Taiwan, I was mistaken for an American. Not that I have anything against my dear friends from the United States, but it is always somewhat frustrating to picture yourself through other people’s stereotypes.

Stereotypes are maybe one of the most widely shared features of human beings, and on this issue a Frenchie like me has nothing to pride himself about. As I was making fun of this Taiwanese equation that “White” equals “American”, I realised that I also had my share of misconceptions about foreigners. For instance, it took me quite a long time to realise that Asian people living in Paris were not all Chinese, and it is only after several years that I realized that the fried spring rolls that I had been eating with delight in Asian restaurants was not a Chinese dish but a Vietnamese one.

I felt somewhat ashamed at the discovery of my own ignorance about foreign habits and ways of life, and this convinced me to launch a crusade against the clichés and items of conventional wisdom that we often take for authentic knowledge about the other. Not an easy task, I must confess. Look at history programs in schools: obsessed with the heroic task of instilling notions of national identity and pride, they leave quite a sparse room for teachings on other cultures and civilisations. So apart from the happy few who can spend their free time travelling around the world, most of us are condemned to rely on media if they wish to learn about other cultures. And here is the bug that bothers me: media are often a distorting mirror of foreign cultures, which are typically reduced to a set of clichés, not always devoid of xenophobic accents.
Another problem is the difficult access to cultural diversity in the media. Take movies for instance. How many non-Hollywood movies have you seen last year? Well, if you live in Taiwan, probably not many. Except for a few institutions such as the Taipei Film House, or for a couple of international movie festivals, it is Hollywood on every menu. The last fifteen years have seen the share of Asian movies shrink in the local box office, and now American big studio productions have the lion’s share in the movie industry revenue: a trend that is not likely to change in the future, considering the lack of policies encouraging cultural diversity.

I had the chance to grow up in Paris, a city that, despite its quite unaffordable living expenses, has the advantage to be crowded with little independent cinemas, where you can see, and usually for a cheap price, movies from other times and places. You might object that my taste for Iranian and Kazakhstan movies is just another illustration of my highbrow cultural tastes, and that I am part of an ultra-minority of snobbish people like me who delight themselves in watching four-hour long Hungarian black and white movies. Well, maybe you are right: after all, why adopt cultural policies that encourage the distribution of movies that nobody is ever going to see? Lots of foreign movies are often quite hermetic to audiences, who do not necessarily share the values and cultural codes embedded in such films. Those who have had the experience of watching a Bollywood movie know what I am talking about.

However, a country does not need to adopt volunteer policies to encourage the display of movies from different cultural horizons: the capitalist logic might be quite a sufficient incentive for that. Take China with its fast developing market for entertainment products: why not produce some movies that display Chinese values and ways of life, and which might be profitable in the Asian market while educating at the same time other folks about an Eastern civilization that is widely unknown to them? Well, I am not the first one to bump into this million-dollar idea: there is a precedent, and it is called Mulan. Mulan: an exemplary story of a girl who enrols in the army to relieve her ageing father; a folk tale that every Chinese person has known from childhood. Mulan seemed to provide the perfect storyline for Disney to enter the Chinese market and sell millions of tickets; however, it performed rather poorly in the Chinese box-office. The reason? Despite all the good will of the filmmakers, despite the overall “oriental” aesthetics of the movie, reflected in its soundtrack or in the drawing style, the movie did not reflect accurately the original meaning of the story. The Chinese makeup did not fool the local audience, who rejected the transplant of Western values on the original script. Mulan, a daughter going to war by filial piety, had become something that spectators could not recognize: a feminist lost in an archaic world of hysterical matrons, a symbol of independence in a universe of male domination.

Cultural hybridity needs a sense of nuance and delicacy that was clearly missed by Mulan producers. More successful in this crossing of cultures are the movies of Ang Lee. Take a traditional Chinese kung-fu novel, and rewrite the script to add the romance elements that captivate Western spectators, and you have Crouching Tiger, Hidden Dragon. The success of this movie lies in the very nuanced and careful way in which the director Ang Lee tried to make the plot understandable for a Western audience without departing from the Chinese elements of the story. As a Taiwanese director that moved early to the United States, Ang Lee has built himself a double culture that enables him to build bridges and new understandings between different value systems. Other directors have taken the same path: think of the way that Emir Kusturica or Tony Gatlif have reconstructed our imaginary representation of gypsy people, traditionally depicted in Europe basically as thieves or social parasites.

Through their written or filmic testimonies, nomadic artists of the 21st century are our best guides to the distant, the foreign, the other. But there is still a lot to be done. In a world where people and cultures are more and more intertwined, we still have too little testimonies of these fascinating or dramatic experiences that can be immigration, exile and cultural hybridism. Immigrants are often the second-class citizens of our globalized world, and although they often live at our doorstep, the lack of representation of these people in our media and objects of popular culture only reinforces the impression that they live in a distant or separate world. I think that the movie industry has a particular responsibility in bringing to us distant cultures that we ignore everything about. After all, films have historically been used quite as a means for National propaganda. It is time that they assume another historical mission: that of introducing to us other cultures and fighting our stereotypes.

 

Wednesday, 02 July 2008

卓越、自覺與分享

卓越、自覺與分享──專訪文向教育基金會凌氤寶董事長

企業社會責任並不是做好事而已,而是企業內省力量的發揮。
從追求卓越、意識自覺到行動分享,展現自發的回饋精神,
回歸以人為本的宗旨,才是企業公民的意涵與真締。

李禮君 採訪

人籟:關於企業應善盡的社會責任,您的看法為何?

凌:我認為,企業沒有營利或非營利之分,只有追求卓越與否的差異。當今社會企業(social enterprise)潮流全球風行,為了以創新的手段來解決貧窮問題、打破弱勢循環,越來越多的企業組織加入公益行列,發揮志願服務的精神。在台灣,也有越來越多人加入非營利組織所舉辦的公益活動,在如此的趨勢下,台灣必可一步步打造出更多對社會有益的創新計劃。
企業的社會責任應從企業的內部產生力量,而不是為了滿足來自外界的要求。當然,文向教育基金會在類別上乃是屬於企業型基金會,但基金會本身仍是公益組織。我們在社會上看到了一些需求,並且參與社會公益事業,希望能滿足這些需求。

人籟:請略述文向教育基金會的宗旨與使命?

凌:文向教育基金會本著「以人為本,尊重生命」理念,倡導企業員工培養「志工企業家」的精神。一如我們的識別標誌:雙手互牽形成一顆愛心,傳遞互相支持、溫暖相依的概念。
在文向的宗旨與使命中,我們有所謂的五大板塊,即「我愛鄉里」、「提升教育」、「生命關懷」、「環保資源」以及「企業公民」五大項。其中每一項都須透過長時間的耕耘和教育讓所有人了解。我所說的「所有人」,現階段指的是所有的企業員工。我們有一個願景,希望文向教育基金會能夠成為全國企業志工的一個平台,把全國的志工通通集合在一起,分享彼此的資源、理念和關懷。
最近我讀了一本好書《2010大趨勢:自覺資本主義的興起》,作者派翠西亞‧奧伯汀(Patricia Aburdene)提出的「自覺」概念正與本會的理念相呼應。作者預測二○一○年以後的世界將有七大趨勢:精神的力量、「自覺資本主義」興起、中層管理階層領導、企業的精神、價值觀導向的消費者、意識解決的浪潮和社會責任型投資的興盛。
在這些趨勢的背後,作者最終強調的乃是「資本主義」與「精神的探索」之間的結合。就如一句耳熟能詳的廣告詞:「科技始終來自於人性」。因為意識來自人性,人性在於需求,滿足需求也就是滿足人性。
而在企業社會責任方面,作者亦提出「社會責任型投資」的重要性,這不單只是企業透過公益活動的執行去回饋社會,而是「社會企業」本身成為主體。有的基金會甚至是專責從事所謂的社會回饋投資,也就是所謂的公益基金,透過投資的觀念讓這個基金及公益事業不斷持續,進而無限延伸。

人籟:如何與企業同仁分享這樣的理念?

凌:文向教育基金會的英文名稱為「We Share」,強調的就是「分享」。所以我們一直是用分享的概念在看所有事情,也以分享的方式與所有同仁互動,用一句民間諺語來說,就是「一人一半,感情不散」。投入工作時,我們「施」,同時也在「受」,施與受的界線已經在「分享」當中消失。也就是說,我們不是高高在上、由上而下的施予,而是蹲下來和對方同等,因為分享強調平等,強調雙向的互動。
換個角度來說,企業社會責任並不是企業透過一個單位去「做好事」而已,而是企業的內省力量的發揮。換言之,對企業本身而言,不論是領導者、管理階層或員工都必須要有自我反省的能力,這包括企業如何塑造、發揮這樣的企業文化,以及員工對企業使命感、理念的認同。當它成為一種企業文化之時,不論是這個企業所製造出來的商品,或是員工所提供的服務,都能展現出由內而外、自發性的服務和回饋的精神,如此才是企業社會責任的真正意涵。
另值得一提的是,我們去年贊助製作的「擁抱~綻放在山崖邊的花朵」,這是國內第一部針對國中、國小設計的生命教育專書,報導十二位身心障礙朋友勇敢克服艱難的成長歷程,內容結合漫畫、故事、電視、DVD、網路等多元媒體,它已成為我們提倡企業文化、鼓勵分享的最佳素材。許多台壽企業的同仁都非常認同且支持。有些同仁會購買這套教材送給親友、孩子,讓他們閱讀欣賞這樣的教材。就如我先前所強調的「自覺」,他們認識了這套教材,進而分享給家人、朋友或客戶,如此不斷地傳播出去,從點到線、從線到面。在這樣的分享中,他們也得到一種回饋的喜樂。反過來說,客戶也可能會對我們的產品產生更大的信心和感情。

人籟:您認為台灣的企業社會責任制度是否完善?尚有何不足之處?

凌:我曾讀過一份市場調查,它指出美國的消費者在購物時,往往會將形象較佳、企業責任做得較好的廠商列為優先選擇。希望在台灣,企業和消費者也可以慢慢建立這樣的制度或習慣。
對我們來說,我們希望自己能成為一個具有指標性的示範。就如國外企業已經開始做的,他們會把企業社會責任的執行成果匯整為年度報告,它與企業的財務報告同樣重要。我們已經開始這樣做,相信不久之後,其他的企業也會跟進。
社會責任有很多面向,譬如對某些製造業而言,其環境責任是最受關注的。此外,也有針對投資人、股東、員工及社區等各方面社會責任的強調等等。台灣人壽的商品是保險,而保險又和人的家庭、生命息息相關。此外,我們的員工遍佈在全國各地,所以如果由全體企業員工開始,向外推廣、分享生命教育的理念,也是善盡社會責任的一種方式。
回歸到「人」的基本面來談,保險是人的事業,社會也是由人所組成,所以所有的想法、需求、理念、服務也好、分享也好,最終都要強調人的「自覺」。

人籟:對於未來,文向的願景為何?

凌:聯合國在二○○○年制定了「千禧年發展目標」,其中包括希望在二○一五年將生活在極端貧窮和饑餓的人數減半、普及小學教育等等。台灣現在也有越來越多的團體,尤其是學術團體致力研究如何打破貧窮的循環。IMF前主席米榭‧康德緒(註)也提到,當一個決策者在制定政策的時候,如果沒有納入那些最貧窮族群的意見,全民將無法因此獲益。
那篇文章帶給我相當大的震撼,也因此更加肯定了我們的想法:我們應該致力於使社會大眾真正了解弱勢群體的聲音,大眾才能了解,什麼樣的作為才能真正幫助他們。換言之,假設我們能夠真正了解這些族群的需求,發展出正確的策略來幫助他們,我們的社會也將因此而更加美好!

註 請參見〈世界公民的金融倫理〉,米榭‧康德緒(Michel Camdessus),發表於《人籟》2006年11月號。
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【文向教育基金會】WeShare Education & Charity Fund
以「分享」為使命:分享資源、分享關懷、分享愛心、分享希望。為龍邦集團及台灣人壽集團社會服務的平台,前身為「財團法人彰化縣永靖鄉朱文向文教基金會」,2006年九月更名為「財團法人文向教育基金會」。
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附加的多媒體:
{rokbox}media/articles/linyenpao_socialreponsibilities.jpg{/rokbox}

Wednesday, 02 July 2008

開發西部的新眼光

I left the road and went into the wood. The path was large and smooth. I had been told that it would lead me to a circular wall of stones, the remains of a common house or a sacred ground built by one the people who had anonymously ventured into the island. Not much was left of the little colony that had settled there around four thousand years ago. A few weapons and fragments of pottery had been excavated, and were now exhibited elsewhere, in a little-known museum. Most of the findings had probably been kept by the locals. In the wood, there was no signpost - you just had to follow the path till you bumped into this circular wall made of heavy and reddish stones. Turning on the left, I found the opening, a very large stone adorning its top. Once inside, it seemed to be a shell carved in the heart of the forest: you could bend your back and venture into little rooms arranged all around the inner circle drawn by the rough wall. The upper ranges of stones had disappeared, but the design was reminiscent of a hut or, somehow, a big igloo. One could easily imagine a kind of rounded roof, a space left on the top for letting the smoke fly towards the sky, together with the songs, the laughs or the curses that were exchanged around the fire.

I sat outside the circle, against the wall. From there, one could not distinguish the valley, so heavy was the cover of the trees on the slopes. But the space around the remains was half cleared, and I could see the evening sky. It was still intensely blue, though, from place to place, it now seemed to mirror the shades of the stones and the trunks. The moon was already there, discreet and ill at ease like a guest who has made a mistake and arrives too early for dinner – in this second half of the month of June, the light would just not go away, and was bathing earth and sky as long as it could. It took hours before the night was night at last, ruled by the small moon crescent and by strong, vibrant stars, all of them glazing at the wall and surely also at myself, as I was now lying on my back, defiantly watching at whomever was watching me.

And then… after this long vigil, music was suddenly flowing, a rarefied music, music that gives itself from the shell of silence; from the shell of the ear, from the shell of the inner rooms this wall was encircling, from the birds and the beasts of the night, from the blind wind hesitantly touching trees, grass and stones, from the earth and its bones, from my breath and the stars, from what was dark and what was not. Maybe this ground had been chosen and erected for giving pulse and vibration to the music that flows by night, to music that searches who will capture it in its nest and will then offer it in return to what or whom music comes from. The ground had been the harp through which sounds and rhythms were finding their shape and their master, and were, night after night, spelling the sentence to utter and repeat in new and endless variations. The harp now was resonating faintly, but to the one who would apply his ear against the stones and the earth that assembled them the sentence was still audible, as clear as the stars in the cloudless night. And I finally closed my eyes, not looking anymore at who was watching over me, but listening to the silence running under my voice and to the voice hidden in the silence I was reaching.

Attached media :
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Tuesday, 01 July 2008

彝族打工者

I left the road and went into the wood. The path was large and smooth. I had been told that it would lead me to a circular wall of stones, the remains of a common house or a sacred ground built by one the people who had anonymously ventured into the island. Not much was left of the little colony that had settled there around four thousand years ago. A few weapons and fragments of pottery had been excavated, and were now exhibited elsewhere, in a little-known museum. Most of the findings had probably been kept by the locals. In the wood, there was no signpost - you just had to follow the path till you bumped into this circular wall made of heavy and reddish stones. Turning on the left, I found the opening, a very large stone adorning its top. Once inside, it seemed to be a shell carved in the heart of the forest: you could bend your back and venture into little rooms arranged all around the inner circle drawn by the rough wall. The upper ranges of stones had disappeared, but the design was reminiscent of a hut or, somehow, a big igloo. One could easily imagine a kind of rounded roof, a space left on the top for letting the smoke fly towards the sky, together with the songs, the laughs or the curses that were exchanged around the fire.

I sat outside the circle, against the wall. From there, one could not distinguish the valley, so heavy was the cover of the trees on the slopes. But the space around the remains was half cleared, and I could see the evening sky. It was still intensely blue, though, from place to place, it now seemed to mirror the shades of the stones and the trunks. The moon was already there, discreet and ill at ease like a guest who has made a mistake and arrives too early for dinner – in this second half of the month of June, the light would just not go away, and was bathing earth and sky as long as it could. It took hours before the night was night at last, ruled by the small moon crescent and by strong, vibrant stars, all of them glazing at the wall and surely also at myself, as I was now lying on my back, defiantly watching at whomever was watching me.

And then… after this long vigil, music was suddenly flowing, a rarefied music, music that gives itself from the shell of silence; from the shell of the ear, from the shell of the inner rooms this wall was encircling, from the birds and the beasts of the night, from the blind wind hesitantly touching trees, grass and stones, from the earth and its bones, from my breath and the stars, from what was dark and what was not. Maybe this ground had been chosen and erected for giving pulse and vibration to the music that flows by night, to music that searches who will capture it in its nest and will then offer it in return to what or whom music comes from. The ground had been the harp through which sounds and rhythms were finding their shape and their master, and were, night after night, spelling the sentence to utter and repeat in new and endless variations. The harp now was resonating faintly, but to the one who would apply his ear against the stones and the earth that assembled them the sentence was still audible, as clear as the stars in the cloudless night. And I finally closed my eyes, not looking anymore at who was watching over me, but listening to the silence running under my voice and to the voice hidden in the silence I was reaching.

Attached media :
{rokbox size=|544 384|thumb=|images/slideshow_en.jpg|}media/articles/Benoit_Corsica.swf{/rokbox}

Tuesday, 01 July 2008

彝族打工者

I left the road and went into the wood. The path was large and smooth. I had been told that it would lead me to a circular wall of stones, the remains of a common house or a sacred ground built by one the people who had anonymously ventured into the island. Not much was left of the little colony that had settled there around four thousand years ago. A few weapons and fragments of pottery had been excavated, and were now exhibited elsewhere, in a little-known museum. Most of the findings had probably been kept by the locals. In the wood, there was no signpost - you just had to follow the path till you bumped into this circular wall made of heavy and reddish stones. Turning on the left, I found the opening, a very large stone adorning its top. Once inside, it seemed to be a shell carved in the heart of the forest: you could bend your back and venture into little rooms arranged all around the inner circle drawn by the rough wall. The upper ranges of stones had disappeared, but the design was reminiscent of a hut or, somehow, a big igloo. One could easily imagine a kind of rounded roof, a space left on the top for letting the smoke fly towards the sky, together with the songs, the laughs or the curses that were exchanged around the fire.

I sat outside the circle, against the wall. From there, one could not distinguish the valley, so heavy was the cover of the trees on the slopes. But the space around the remains was half cleared, and I could see the evening sky. It was still intensely blue, though, from place to place, it now seemed to mirror the shades of the stones and the trunks. The moon was already there, discreet and ill at ease like a guest who has made a mistake and arrives too early for dinner – in this second half of the month of June, the light would just not go away, and was bathing earth and sky as long as it could. It took hours before the night was night at last, ruled by the small moon crescent and by strong, vibrant stars, all of them glazing at the wall and surely also at myself, as I was now lying on my back, defiantly watching at whomever was watching me.

And then… after this long vigil, music was suddenly flowing, a rarefied music, music that gives itself from the shell of silence; from the shell of the ear, from the shell of the inner rooms this wall was encircling, from the birds and the beasts of the night, from the blind wind hesitantly touching trees, grass and stones, from the earth and its bones, from my breath and the stars, from what was dark and what was not. Maybe this ground had been chosen and erected for giving pulse and vibration to the music that flows by night, to music that searches who will capture it in its nest and will then offer it in return to what or whom music comes from. The ground had been the harp through which sounds and rhythms were finding their shape and their master, and were, night after night, spelling the sentence to utter and repeat in new and endless variations. The harp now was resonating faintly, but to the one who would apply his ear against the stones and the earth that assembled them the sentence was still audible, as clear as the stars in the cloudless night. And I finally closed my eyes, not looking anymore at who was watching over me, but listening to the silence running under my voice and to the voice hidden in the silence I was reaching.

Attached media :
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Tuesday, 01 July 2008

Xinjiang Ecological Environment and Human Activities

I left the road and went into the wood. The path was large and smooth. I had been told that it would lead me to a circular wall of stones, the remains of a common house or a sacred ground built by one the people who had anonymously ventured into the island. Not much was left of the little colony that had settled there around four thousand years ago. A few weapons and fragments of pottery had been excavated, and were now exhibited elsewhere, in a little-known museum. Most of the findings had probably been kept by the locals. In the wood, there was no signpost - you just had to follow the path till you bumped into this circular wall made of heavy and reddish stones. Turning on the left, I found the opening, a very large stone adorning its top. Once inside, it seemed to be a shell carved in the heart of the forest: you could bend your back and venture into little rooms arranged all around the inner circle drawn by the rough wall. The upper ranges of stones had disappeared, but the design was reminiscent of a hut or, somehow, a big igloo. One could easily imagine a kind of rounded roof, a space left on the top for letting the smoke fly towards the sky, together with the songs, the laughs or the curses that were exchanged around the fire.

I sat outside the circle, against the wall. From there, one could not distinguish the valley, so heavy was the cover of the trees on the slopes. But the space around the remains was half cleared, and I could see the evening sky. It was still intensely blue, though, from place to place, it now seemed to mirror the shades of the stones and the trunks. The moon was already there, discreet and ill at ease like a guest who has made a mistake and arrives too early for dinner – in this second half of the month of June, the light would just not go away, and was bathing earth and sky as long as it could. It took hours before the night was night at last, ruled by the small moon crescent and by strong, vibrant stars, all of them glazing at the wall and surely also at myself, as I was now lying on my back, defiantly watching at whomever was watching me.

And then… after this long vigil, music was suddenly flowing, a rarefied music, music that gives itself from the shell of silence; from the shell of the ear, from the shell of the inner rooms this wall was encircling, from the birds and the beasts of the night, from the blind wind hesitantly touching trees, grass and stones, from the earth and its bones, from my breath and the stars, from what was dark and what was not. Maybe this ground had been chosen and erected for giving pulse and vibration to the music that flows by night, to music that searches who will capture it in its nest and will then offer it in return to what or whom music comes from. The ground had been the harp through which sounds and rhythms were finding their shape and their master, and were, night after night, spelling the sentence to utter and repeat in new and endless variations. The harp now was resonating faintly, but to the one who would apply his ear against the stones and the earth that assembled them the sentence was still audible, as clear as the stars in the cloudless night. And I finally closed my eyes, not looking anymore at who was watching over me, but listening to the silence running under my voice and to the voice hidden in the silence I was reaching.

Attached media :
{rokbox size=|544 384|thumb=|images/slideshow_en.jpg|}media/articles/Benoit_Corsica.swf{/rokbox}

Tuesday, 01 July 2008

Overcoming migration difficulties

I left the road and went into the wood. The path was large and smooth. I had been told that it would lead me to a circular wall of stones, the remains of a common house or a sacred ground built by one the people who had anonymously ventured into the island. Not much was left of the little colony that had settled there around four thousand years ago. A few weapons and fragments of pottery had been excavated, and were now exhibited elsewhere, in a little-known museum. Most of the findings had probably been kept by the locals. In the wood, there was no signpost - you just had to follow the path till you bumped into this circular wall made of heavy and reddish stones. Turning on the left, I found the opening, a very large stone adorning its top. Once inside, it seemed to be a shell carved in the heart of the forest: you could bend your back and venture into little rooms arranged all around the inner circle drawn by the rough wall. The upper ranges of stones had disappeared, but the design was reminiscent of a hut or, somehow, a big igloo. One could easily imagine a kind of rounded roof, a space left on the top for letting the smoke fly towards the sky, together with the songs, the laughs or the curses that were exchanged around the fire.

I sat outside the circle, against the wall. From there, one could not distinguish the valley, so heavy was the cover of the trees on the slopes. But the space around the remains was half cleared, and I could see the evening sky. It was still intensely blue, though, from place to place, it now seemed to mirror the shades of the stones and the trunks. The moon was already there, discreet and ill at ease like a guest who has made a mistake and arrives too early for dinner – in this second half of the month of June, the light would just not go away, and was bathing earth and sky as long as it could. It took hours before the night was night at last, ruled by the small moon crescent and by strong, vibrant stars, all of them glazing at the wall and surely also at myself, as I was now lying on my back, defiantly watching at whomever was watching me.

And then… after this long vigil, music was suddenly flowing, a rarefied music, music that gives itself from the shell of silence; from the shell of the ear, from the shell of the inner rooms this wall was encircling, from the birds and the beasts of the night, from the blind wind hesitantly touching trees, grass and stones, from the earth and its bones, from my breath and the stars, from what was dark and what was not. Maybe this ground had been chosen and erected for giving pulse and vibration to the music that flows by night, to music that searches who will capture it in its nest and will then offer it in return to what or whom music comes from. The ground had been the harp through which sounds and rhythms were finding their shape and their master, and were, night after night, spelling the sentence to utter and repeat in new and endless variations. The harp now was resonating faintly, but to the one who would apply his ear against the stones and the earth that assembled them the sentence was still audible, as clear as the stars in the cloudless night. And I finally closed my eyes, not looking anymore at who was watching over me, but listening to the silence running under my voice and to the voice hidden in the silence I was reaching.

Attached media :
{rokbox size=|544 384|thumb=|images/slideshow_en.jpg|}media/articles/Benoit_Corsica.swf{/rokbox}

Wednesday, 25 June 2008

去年夏天,我曾到过汶川

五月十二日下午两点半左右,四川发生大地震,霎时,在成都楼层室内感觉摇摇欲坠,酒瓶落地摔得粉碎,书橱应声倒塌,厨房乒乒作响,小区内人心惶惶,处处传来凄厉叫声,聚集相互询问,个个惊慌失措,一脸狼狈。校园里、街道上群众奔驰,集聚走避,马路上交通几乎瘫痪,而通讯又一时中断,尤增诡异恐惧气氛。
到了晚上,通讯传递,才知道震央位置在距离成都市北区近一百公里处的汶川县发生八级强烈地震,天崩地裂,楼层倒塌,或震为平地,瓦砾残骸,一片哀号,瞬间数千名无辜老百姓伤亡;随著时间推移,死亡与失踪人数节节上升,令人不忍卒睹!

去年夏天,我校学院与香港城市大学师生曾经组织捐书活动到汶川草坡中心小学。记得那一天学校刚结束期末考试不久,我们共同坐了两部大型巴士由校园出发。一早七点多集合完毕,约八点钟开车。当经过都江堰后,巴士开始爬坡往汶川方向行进,进入藏区阿坝州,则沿途崇山峻岭,林木森森,顺著羊肠小径蜿蜒曲折而行,到处可见峡谷断崖,司机小心翼翼放慢车速,不敢加速超车,因为有任何的闪失,都可能坠落翻覆,魂断命丧。
山坡路很狭窄,曲折多弯,在最逼仄处,仅能容一车身行驶,因此,遇有前方来车相错而过,还必得缓缓调整挪移,才能顺畅通行。
我们几位师生在车座后排聊天唱歌,真是愉快。一路上又谈到抵达藏区小学要怎麽样鼓励那些小朋友等等,心情无限的好!
不久,车子突然停住不走了。原来前方不远处有巨石坍方,路面正在抢修中。不确定何时才能够恢复畅通,于是大家纷纷下车伸伸懒腰,透透空气。折腾了近两个小时左右,才又继续往目的地行进。
到了中午十二点钟过后,总算才到达草坡中心小学。这是一所人数只有一百多人的小学校,校长特别介绍启用不久的新教学大楼,还有一栋正在建筑中,预计几个月后也能使用了。
车子开到校门,把一捆又一捆的新书搬下车,运往校园升旗台上,早已有小朋友激动地列队欢迎我们。他们手舞足蹈,开心极了,个个眼神灵活,看著这批批打包完好的新书。我特别注意到他们的眼睛紧紧盯住很久,流露出喜悦、羡慕的目光。当我们要把书籍搬进办公室时,有几个小朋友还争先恐后自动说要帮忙。但他们的个子太小了,根本不可能帮上忙,而为了他们有参与感,还是让他们一起来吧。
后来,校长与多位老师说,这些小朋友有的在早上七、八点就来学校等候了。到了九点多、十点左右,还不停地问怎么还没有来呢。可见,这些小孩多么喜欢我们去看他们!
一直到午后一点多,把整个赠书仪式完成,大家才想到该吃午餐了。
起先这些学生有点腆腆,要他们来拍照合影,还互让半推一番,窃窃私语。
有个三年级的小女孩长得很漂亮,我会注意到她,是因为她的装扮比较特别:留著一头乌黑亮发,头上别著二朵小花,两耳挂著一对银白色耳环,在七月艳阳照耀下,尤显得夺目亮丽!我当时还半开玩笑说,所有同学都没有戴耳环,为什么你这么爱漂亮戴耳环。她反应很快,立刻说她是少数民族,全村的女孩从小就人人戴耳环,如果不戴才奇怪呢。我打从心里暗暗称许,她的回答真好,得体又合乎实情。与他们合照了几张相,带著依依不舍的心情告别。

没想到,这竟是一次永远的诀别!

一位参加那次捐书活动的同仁给我回复短信:“我在哭不能再跟我讲香港的同学也在问”,没有任何标点符号,我能够感受其心情。一位参与的大三学生说:“只知道那所小学已经不在了”,另一位学生说:“那个据辛老师说草坡中心小学已经坍塌了……确实如此…… 不过天地不仁……这也是没办法的事情……”,没说完,掩面而哭。

摩挲著相片,天真无邪的笑容挂在脸上,尤增悲怆,使人不忍多看。生命如纸薄,何其脆弱也!

九年前台湾九二一半夜大地震,我幸运地逃过一次劫难:在玻璃橱柜倒塌前,我被地震摇醒,本能反射用手臂去挡,玻璃碎片划破前臂,左手血流如注,急送医院缝了二十一针,留下一道长长的弧形伤疤,迄今回忆,犹有馀悸!

今年在成都经历大地震,往后几天,馀震连连,天天在半夜惊醒,果是真实状况。这样的日子还要持续多久,谁也不知道。

昨天下午上课,在黑板上写上李白〈剑阁赋〉:“咸阳之南,直望五千里,见云峰之崔嵬。前有剑阁横断,倚青天而中开。上则松风萧飒瑟蔚,有巴猿兮相哀。旁则飞湍走豁,洒石喷阁,汹涌而惊雷。送佳人兮此去,复何时兮归来。望夫君兮安极,我沉吟兮叹息。……”,也抄上〈蜀道难〉部分文字:“迩来四万八千岁,不与秦塞通人烟。西当太白有鸟道,可以横绝峨眉颠,地崩山摧壮士死,然后天梯石栈相勾连”,“蜀道之难,难于上青天,使人听此凋朱颜。连峰去天不盈尺,枯松倒挂倚绝壁,飞湍瀑流争喧虺,砰崖转石万豁雷,其险也若此,嗟尔远道之人胡为乎来哉!剑阁峥嵘而崔嵬,一夫当关,万夫莫开”,我跟学生讲这两首诗的意思,并以今日汶川的地形为例,说明为何地震无法立即有效抢救,必须要动用直升机空投与伞兵跳伞救援的原因。去年我到过汶川,李白这种描述是毫不夸张的。

我看到学生边抄写边听课,眼眶红红的,我不忍讲太久……。

我只恨,我只恨,我只恨,我太愚钝了,要牺牲这么多人的生命,才能完全读懂李白的诗歌,而这个代价,未免太大了!


谨以此文敬悼五月十二日大地震丧生的同胞
二零零八年五月二十日晚于成都

附加的多媒体:
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Wednesday, 28 May 2008

The "New Rural Health Cooperatives" (NRHC) in China

a) Operation, recent development and government of the NRHC.
Aware of the failure of the health reform and the disastrous position of access to health in rural areas, the Chinese government tried to remedy it from 2003 on by launching the new rural health cooperatives (NRHC). The aim was to offer health insurance to the peasants who wanted it so that they could have better access to care and treatments.

These NRHC were originally financed as follows:
- rural households were to contribute at the rate of 10 RMB (1 euro) per person, on a voluntary basis;
- the local governments were to contribute an additional 10 RMB per person;
- the central government also allocated 10 RMB per person.

Thanks to this insurance system which was based on a sum of 30 RMB per villager who was willing to pay, the peasant who joined a NRHC could obtain reimbursement of his medical expenses if he were admitted to hospital. However, the rate of reimbursement varied with the reasons for hospital admission and the government declared that it could reimburse only a maximum of 65% of the medical costs of rural residents.

Since 2003, supported by well orchestrated government propaganda, NRHC have been set up in an increasing number of counties and have then covered an increasingly large number of peasants.

In 2003, this NRHC project was running in more than 300 Chinese counties.

In 2004, according to a study carried out jointly by the University of Beijing, the CASS and the Ministries of Agriculture and Health in 2006, of 70,769 peasants, in 257 pilot counties in 29 provinces, the NRHC helped to reduce the proportion represented by medical expenditure in relation to annual average income of farmers from 89% in 2003 to 65% in
2004.

In 2005, NRHC had been set up in 671 counties, and this enabled 177 million peasants to get cover. At that time, a study carried out of 10,000 families in 32 counties from 17 provinces showed that 57% of rural families who had registered for the NRHC programme had applied for reimbursement and had been reimbursed 25.7% of their total medical
expenditure, 731 RMB (73 euros) on average.

Since Wen Jiabao’s speech in March 2006, on the occasion of the 4th session of the 10th National People’s Congress, the government has doubled its financial contribution to the NRHC. Thus, under the new system, a peasant who intends to join the NRHC pays 10 RMB a year, while the central, provincial, municipal and county governments jointly
provided 40 RMB for this rural resident. The NRHC therefore now has 50 RMB per peasant. As to the maximum rate of reimbursement, it is still set at 65% of medical expenses.

At the end of 2006, according to the Ministry of Health, 46.7% of the total rural population (396 million people) had joined a NRHC and the latter were up and running in 1399 Chinese counties. As to the amount granted to the NRHC by the government, it rose to 4.23 billion RMB (423 million euros).

At the 5th session of the 10th National People’s Congress, in March 2007, Wen Jiabao confirmed the government’s commitment when he announced that by the end of 2007, the NRHC would be available in 80% of Chinese counties, that the central budget allocated to the NRHC would be 10.1 billion RMB (1.01 billion euros) in 2008 and that, finally, in the next four years, the government would spend 20 billion RMB (2 billion euros) on improving the infrastructures and equipment of rural clinics and hospitals.

According to the Chinese central authorities, the NRHC should cover 100% of the rural population by 2010.

Compared to the traditional cooperatives which operated in the villages and cantons (xiang) with a small base of contributors, the NRHC have more contributors and are often run by the county’s Health Office. Each county can set up three organisations: the Group responsible for the NRHC which concerns itself with coordination of the NRHC’s operations in the county and supervises the programme in the cantons, the Management Committee of the canton NRHC, and the Supervisory Committee of the canton NRHC. As for the management of the NRHC, it is often entrusted to the county health office and the canton health centre. A special NRHC account is opened by the committee in the local bank. Unlike rural pension funds, which can be invested to generate financial resources, the NRHC funds just stay in the bank, bringing in a small amount of interest. The NRHC Management Office under the responsibility of the NRHC Management Committee manages all the financial transactions. Because of a lack of resources, this office is often on the premises of the canton health centre or county health office. In most cases, the manager of the health centre is also the manager of the NRHC office, and the health centre accountant is also the person who manages the NRHC reimbursements. This traditional practice seems to have continued with the NRHC.

Although the principle of the NRHC remains an important and essential initiative, a number of questions emerge and several challenges will have to be taken up by the Chinese authorities, if the latter want the NRHC to improve the poorest peasants’ access to care and to health in general, in an efficient and sustainable manner.


b) Persisting questions and challenges concerning the NRHC
From international experience and from previous attempts to resuscitate the old rural health cooperatives in China, questions and challenges are emerging which the health authorities will have to resolve so that the NRHC are not just a waste of time.

Following this initiative, a first question which emerges concerns the sustainability of the NRHC, which depends above all on the viability of their three different sources of financing.
Doubts again arise as to the ability of each of the parties to contribute collectively since March 2006 at the rate of 40 RMB per villager registered. One may reasonably think that central government will be capable of pursuing its financial commitment particularly because of tax income, which is rising, and a genuine will to improve the condition of the poorest regions in China.

The current situation shows that the households’ contribution (10 RMB per person) is still feasible, at least for most of them, given that in 2005 this sum represented 0.3% of the average annual rural income (3254.9 RMB)(1). It has to be said that it will on the other hand be a much larger proportion for the poorest households who live below the poverty threshold. However, the government is considering the possibility of support for these most disadvantaged households through its Medical Assistance Programme administered by the Ministry of Civil Affairs. In all, financing problems appear today to come more from
local governments. Whether the local governments can spend 10 RMB or even more per person is even more unclear. As the local governments depend on their own income to finance their activities, they generally have health spending which varies considerably depending on how rich the provinces are and even more depending on the counties. For poor counties where population density is high, even 4 RMB per person may be a large proportion of their health spending per capita. Furthermore, the NRHC initiative comes at a bad time for local authorities: China has recently abandoned several agricultural taxes, which is tantamount to a large reduction in the income of the cantons and counties.

One may then wonder about how willing households will be to pay 10 RMB as a contribution to this NRHC programme. Although the peasants’ willingness to share in the financing of the NRHC depends on numerous factors, one of the main reasons is their perception of the level of reimbursement of medical expenses.
It is first of all important to bear in mind that even collecting 50 RMB per person can cover on average only between 25 and 35% of annual health expenditure in rural areas.

In other words, as observed in a study carried out by Professor Wu Ming, from Beijing University Department of Medicine in 2007, the rate of reimbursement of hospital costs is on average of the order of 27.5%, which means that financing of serious and terminal diseases in peasants is inadequate.(2) Thus, today, despite the NRHC, a lot of expenditure is still not covered.

This is important in the sense that the people responsible for this programme then have every interest in not promising too much if they do not want to see the rapid collapse of this initiative, while retaining the beneficial consequences of joining the NRHC in the eyes of the peasants.

Some recent studies have shown that many households consider that, all in all, this programme gives them little with which to reduce their exposure to the risk of high medical costs. In this case, support for the NRHC could gradually fall. Indeed, according to a number of international experiments, it has been found that it is young people and people in good health who may well leave the NRHC first, and it will then start to make losses and will require other contributions. The latter will lead to an additional exodus of young people and people in good health, the spiral will begin and the programme will collapse. This situation is known in public health as adverse selection.(3)
The question of the impact of the NRHC on the reduction of poverty equally arises today.

In other words, given the current level of contribution, will the NRHC make it possible to reduce the poverty related to heath spending. In 2004, on the basis of the 2003 China National Health Services Survey, Chinese researchers made the following observations:
there are 25,764 rural households in the west and mid-west regions. Their average per capita income is 2062 RMB and their annual per capita health spending is 225 RMB. The per capita income of 14% of households is below the rural poverty line (865 RMB). In 21% of poor households, this is due to medical costs. They then concluded that the 30 RMB proposed by the NRHC will reduce by 27% the number of households which have become poor because of their health spending. They therefore considered that the level of financing was not capable of reducing significantly the increase in cases of people being reduced to abject poverty because of illness. They then calculated that, for the NRHC to make it possible to halve these situations of impoverishment, a total of 54 RMB per person was needed.(4) In 2007, per capita financing of the NRHC is still below that (50 RMB).

According to the estimates of Dr. Ge Yanfeng, from the RCD, for the Chinese health system to be available to all today, it would cost between 150 and 200 billion RMB (between 15 and 20 billion euros), which represents between 5 and 7 times the country’s national income or 1 to 1.5% of GNP in 2005.(5)

The question of confidence between peasants and NRHC managers should not be neglected. This is essential so that country people will join the NRHC, that is to say there can be no doubts about corruption. It is not inappropriate to mention here that numerous attempts at rural health cooperatives have failed in the past because of corruption.
Engaging the beneficiaries in the mechanism of supervision of the NRHC may help to reduce attempts at corruption. It is a solution which is as yet rarely adopted and which is nonetheless being developed at the moment by Harvard University in Kaiyang (Guizhou) and Zhenan (Shaanxi) counties, where villagers sit on the committee which runs the NRHC.
Finally, the question of the portability of this cooperative health system becomes extremely important when one considers the position of migrants.160 Migrants from rural regions moving into the towns (150 million in 2005) continue today to find themselves in no-man’s land where health insurance is concerned. Ineligible for the urban health insurance system because they have no official residence, they are in theory obliged to return to their villages for treatments reimbursed by the NRHC. In practice, if they stay in a town only a tiny part of their expenditure will be reimbursed. For the NRHC to become more portable in
order to improve the access to care of millions of Chinese migrants appears to be a major and urgent challenge for those in charge of health in China.


(1) National Bureau of Statistics of China, China Statistical Yearbook 2006, www.stats.gov.cn
(2) “Chinese government under pressure to make rural healthcare system work”, Xinhua, 21 April 2007.
(3) This is why health insurance in industrialised countries is nearly always compulsory. On this point see: Liu Y. L., “Development of the rural health insurance system in China”, Health Policy and Planning, 2004, 19 (3), 159-165.
(4) Y. Liu, Z. Mao, B. Nolan, “China’s Rural Health Insurance and Financing: A Critical Review”, September 2004, p. 8. Available on: http://web.worldbank.org/
(5) China’s Failing Health Care System Searching for Remedy, Xinhua News Agency, 6 October 2006.

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Wednesday, 28 May 2008

Combat HIV/AIDS in China

- The main challenges of the national policy -

Although it is undeniable that the Chinese central political authorities have now become aware of the gravity of the situation and the need to act rapidly and effectively against HIV/AIDS, what they have done so far should be considered only as a start. In fact, they are facing a number of important challenges today:

1/The level of knowledge about HIV/AIDS among the people remains relatively low.
Generally speaking, numerous studies concerning the level of knowledge among the different target populations say the level is relatively low. Thus:
A recent survey revealed that only a little more than 67% of Chinese college students had precise knowledge about HIV/AIDS.(1) Other studies show that there are enormous geographical disparities where the level of knowledge about HIV/AIDS is concerned. In fact, young Chinese but also adults living in the west of China appear to be less aware of
the modes of transmission of HIV and the means of protection than people in the eastern part of the country.(2) This disparity is also observed between residents of rural areas and townspeople in China.(3)
A survey carried out in 2005 of 3000 Chinese Communist Party officials with a university degree and who were under 50 years of age showed that more than 60% did not know that there was no vaccine against AIDS and 30% thought that seropositive patients should be isolated so that they could be treated.(4)
Finally, a study on the level of knowledge among waitresses working in bars, saunas and hotels in Shandong province discovered that 63.6% of the women questioned had answered incorrectly more than half of the 33 questions in the questionnaire.(5)
Now, this situation feeds discrimination against and stigmatisation of seropositive persons, on the one hand, and makes it easy to see the large number of at-risk activities which may occur every day in China just through lack of knowledge about HIV on the other hand.
Numerous Chinese public health professionals are therefore demanding that efforts at prevention and education should be redoubled at all levels of society and in all the provinces.

2/Most seropositive people are unaware of their status.
Two figures may explain this fact. On the one hand, in October 2006, the Ministry of Health acknowledged that 183,733 seropositive people had been detected by screening. According to the estimates, China has 650,000 cases. There could therefore be more than 460,000 people who are not aware of their serological status and who thus may well transmit the disease. Consequently, although screening has been increased, extended and regularised, its cover in terms of geography and population still seems to be too low, particularly because of the lack of trained staff. An effort concerning the identification of these seropositive people and the prevention of secondary transmission appears to be essential.

3/The application of national policy of “4 free things and one care” remains uneven.
The Chinese Ministry of Health acknowledged in January 2006 that, although implementation of this policy has been relatively good in places most affected by the virus, this could not be said of the less affected regions. This situation is preventing a large number of AIDS orphans, pregnant women who are victims of HIV/AIDS, and poor people
residing in urban and rural areas who are seropositive from benefiting from the support of the public authorities.

4/Efficient implementation of treatment and care programmes is still difficult.
- In 2006, 80% of recipients of the free treatment were on a three first-generation ARV (anti-retroviral) scheme (AZT/d4T+ddl+NVP) which is known to cause very serious adverse effects. Only 18% of the patients use the (AZT/d4T+3TC+NVP) combination which includes an ARV introduced into China in early 2005, 3TC, which is approved by all the international first-generation treatment programmes. Furthermore, some Chinese and foreign professionals and health officials are expressing concern as to the first signs of resistance to ARVs which could rapidly make the first-generation regimens inefficacious, while the second-generation ones are not yet on the Chinese market.(6)
- Most patients are people from the central provinces of China who formerly sold their blood. Today the people most affected by HIV are the IDU in the west and south-west of China. Although treatment centres for IDU have been established, for political and technical reasons it is sometimes difficult to speed up their introduction and operation.
- Few seropositive children, of whom there are estimated to be more than 9,000, are given treatment against the virus, because China has extremely limited access to paediatric ARV and also very little experience of HIV/AIDS in children.(7) The majority of the latter are
deprived of treatment or treated with adult regimens which have adverse effects which are very severe for them.
- There are numerous obstacles to the clinical management of the treatment: the refusal of certain hospitals to treat seropositive patients, lack of staff to carry out essential laboratory tests, irregular follow-up of patients or, again, the rarity of reports concerning the patients’ data.
- The nature of the rural health system on which 80% of seropositive people in China depend is a burden on the efficient implementation of the National ARV Treatment Programme. On the one hand there are the seropositive patients, mostly without health insurance, who have to pay with their own money for the medical care that they require. On the other hand, hospitals, from county level and below, where the money they get from all their patients is the only source of income that they have. These hospitals are therefore offering – not necessarily high-quality – care services at high charges to residents in rural areas who are seropositive. This situation greatly restricts access to the care which seropositive people frequently need and is consequently an obstacle to the proper progress of the treatment. In addition to this, there are other financial barriers: the cost of drugs for opportunistic disorders (sometimes sold at exorbitant prices by unscrupulous doctors), for routine laboratory tests, for hospital admissions, for transport to and from the places of treatment, etc. The success of the treatment is therefore intrinsically related to the nature and quality of the system of rural health and social protection for the most disadvantaged.
- Finally, implementation of the treatment is still difficult in seropositive migrants who have fled the misery in their villages to join a “floating population” of more than 120 million people in China today. Indeed, if a change in living conditions can influence the body’s
reaction to treatments, the difficulty arises in particular from the fact that, in order to benefit from free treatment, the patient must be a resident of the locality where the department which is going to provide him with the ARV is located. This situation directly affects the migrants’ access not only to treatments and to care but also to the information which they may need.

5/Some forms of cooperation remain sensitive.
The efficacy and sustainability of the programmes against HIV require evaluation and close monitoring of the situation, and these depend essentially on information collected in the field. However, many counties and local health offices see the collection of these data
as a burden and more for the benefit of central government in particular. Despite current searches for a simple system of sharing information, this problem of “down-up” cooperation has until now delayed numerous assessments, and this may have affected the efficiency of some projects.
Cooperation between the authorities from different levels and the voluntary associations is also difficult. Although the number of independent local associations is increasing and the central authorities would like them to join in the projects to combat HIV/AIDS,(8) the situation on the ground is not always straightforward: it is not in fact unusual for local people in charge, who are still mistrustful of the role played by these social organisations, to adopt a coercive attitude to their activities or to prohibit them from some activities. The famous activist, Wan Yanhai, was interrogated at the end of November 2006 by the police in Beijing in the offices of his association, Aixhi, and forced to cancel a symposium on HIV/AIDS, the main topics of which were to be the rights of seropositive people and the quality of blood products in China. What is more, he is thought to have disappeared since then.(9) Lastly, in February 2007, Dr. Gao Yaojie, a pioneer of the fight against AIDS in China, was placed under house arrest by the local government in Henan, which did not want her to travel to the United States to receive a prize from a foundation sponsored by Hillary Clinton.(10)
Finally, numerous activists also stress that the support provided by local governments to the NGOs (11) is often given to what they call “puppet NGOs”, also known as government NGOs (GONGOs).

(1) “Chinese college students have poor knowledge of AIDS: survey”, Xinhua, 23 March 2006.
(2) “Youth in the west lack understanding of AIDS”, Xinhua, 5 January 2007.
(3) “Wang Xin-lun et al. “Survey of knowledge of and attitude to AIDS among residents in rural areas and cities”, Chinese Journal of Health Education, vol. 22, no. 4, April 2006, 260-268.
(4) Rong Jiaojiao, “Educating the masses on HIV/AIDS”, China Daily, 13 February 2007.
(5) Liu-Xi-liang, “Survey of AIDS knowledge and sexual behaviour of female waitresses”, Chinese Journal of Health Education, vol. 22, no. 3, March 2006, 192-195.
(6) “Better drugs urgent for China to combat AIDS”, China Daily, 13 August 2006.
(7) At present, only 200 children are receiving adequate treatment, provided by the Clinton Foundation, and another 50 are being treated by MSF.
(8) “China encourages NGOs’ participation in fight against AIDS”, Xinhua, 22 March 2007.
(9) “Chinese AIDS activist ‘missing’”, BBC News, 25 November 2006.
(10) “[Gao Yaojie, Chinese anti-AIDS militant, is under house arrest]”, Le Monde, 13 February 2007.
(11) Since 2003, the authorities are thought to have allocated 2.5 million euros to 231 projects run by associations in 150 counties in Zhang Fneng, “More Power for anti-AIDS campaigners”, China Daily, 4 October 2006.

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Tuesday, 27 May 2008

Social protection in China: the third phase of evolution

If the modern State has two essential tasks, these are to ensure the education of the largest number and the proper functioning of public health. Two spheres on which the Chinese government laid great emphasis after 1949 and at first produced undeniable successes. The literacy campaigns relieved by the simplification of the ideogram system and the despatch of “barefoot doctors” into rural areas remain the two symbols of this effort carried out on a virtually continental scale. This undertaking was largely reduced to nothing by the turmoil of the Cultural Revolution and the regime’s economic failure until the beginning of the Deng Xiaoping era.

Since the mid-nineties, the situation has to some extent been reversed: even while China’s economic successes are impressing the whole world, while the country has taken so many of its citizens out of absolute poverty and allowed many access to modest comfort, the educational and health tasks of the State have been particularly badly performed.

The health system has undergone de facto privatisation. While before 1980, health expenditure was covered virtually one hundred per cent by the State, today only 16% is covered, the rest of the financing being essentially provided by the patients. Now, 90% of the rural population does not benefit from any health insurance system. Even in a country
as liberal as the United States, the proportion of state cover is 44%, and in most other industrialised countries it is approximately 70%. Privatisation has been accompanied by corruption and malpractice. It is well known that, in most hospitals, it is best to slip an envelope to the surgeon who is operating on you if you want to have his undivided attention. Or again, another fact of everyday life has recently been noted by one Chinese university: half of deliveries of infants are by Caesarean (70% in some hospitals) because a surgical procedure is much better paid, and this practice also allows the doctors to organise their time better. Another finding: as drugs are sold directly by the hospital, their sale accounts for more than half the income of some hospitals.

That being said, we are now entering the third phase of this evolution, where the Chinese government is trying to put together a general system of social protection. The priority is now the construction of an integrated system in the countryside. At the same time, the problem is shifting: if, in the next few years, the health risk will be less directly linked to the system of financing of care, it will be increasingly dependent on the rise of the ecological risk.

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