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。

 

 

 

週二, 01 七月 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}

週二, 01 七月 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}

週二, 01 七月 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}

週三, 25 六月 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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週三, 28 五 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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週三, 28 五 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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週二, 27 五 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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週一, 26 五 2008

Health situation and ecological tensions in China

Problems of health and anxieties related to the environment are part of the same equation. The WHO considers that 17% of deaths in the western region of the Pacific – a region where the Chinese population is huge - are linked to one or even more ecological health risks.

The link between social tensions and environmental problems was strikingly illustrated by the demonstrations which occurred in Xiamen in May-June 2007. The people came onto the streets to oppose the construction of a giant petrochemical complex intended to produce parayxlene, a substance used in the manufacture of polyesters and dangerous for the health of those exposed to it without protection. At the end of a mass campaign which saw about a million telephone messages exchanged (and after the closure of the internet sites which denounced this construction), the deputy mayor had declared that the project was suspended temporarily. But the inhabitants continued their pressure to try to ensure that the project would be abandoned for good.

In May-June, 2007, Wuxi, an industrial centre in the Yangtze delta, the urban area of which contains 6 million people, had a water shortage for several days because of the proliferation of algae in Lake Taihu. The heat, combined with continuous discharge of a large part of the town’s sewage into the lake and the pollution from the factories, had contributed to the development of this green slick, which was finally controlled after sixty thousand tonnes of algae had been cleared.(1) There had already been a spectacular illustration of this in the serious incidents of pollution of water courses which occurred in
November and December 2005 at Harbin and close to Canton.(2) And the history of these repeated catastrophes points to structural failure:(3) China’s ecological crisis could not be overestimated.

One can see how the health, environmental and social problems must be grasped as a whole. The “Report on the implementation of the project for national economic and social development” from 2006 and the “Sketch of the 2007 Plan for national economic and social development” describe quite well the overall situation, as perceived by the Party-State:
“The need to save energy and to reduce pollution is extremely urgent because pressures on resources and the environment are continuing to grow. (…) Public opinion is expressing serious concerns as to the lack of accessibility and the excessive cost of medical care and education. There are also serious problems on the subject of the safety of food and drugs, housing, distribution of incomes, public safety and production. Other problems which have a negative impact on people’s interests include restructuring of enterprises, demolition of homes and rehousing in urban sectors, acquisition of lands and expropriations and
protection of the environment”.(4) Amartya Sen, Nobel Prize-winner for Economics, often uses a comparison to indicate the nature of the Chinese problem: “Although Chinese economic growth has been much faster than in India since the economic reforms of 1979, life expectancy in India has increased about three times faster than in China. In 1979, life expectancy for a Chinese was 14 years longer than for an Indian. It is now only seven years longer. Some regions of the country,
like the province of Kerala, now have an advance of four years over China in terms of life expectancy. In 1979, China and Kerala had exactly the same rates of infant mortality – 37 per 1,000. In Kerala today the infant mortality rate has fallen from 37 to 10, while the figure in China has fallen from 37 to 30”.(5)

(1) Xinhua press agency, 15 June 2007.
(2) Note at the same time that the catastrophe which occurred at Harbin was to accelerate the completion of major improvement works carried out along the Songhua river, one of the most polluted rivers in the country.
(3) The case of the River Huai, which provides the entry on the subject in the book by Elizabeth Economy, is particularly striking. Cf. E. Economy, "The River Runs Black", Cornell U.P., 2004.
(4) http:www.chinadaily.com.cn/china/2007-03/19/content_830762.htm
(5) http://www/asiasource.org/news/special_reports/sen.cfm. The comparison between Kerala and China has often been repeated by A. Sen on the basis of his work, "Development as Freedom, and other essays on the concept of human development".

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週二, 29 一月 2008

成都府南河上游安龍永續發展示範村

梁准 撰文

座落在四川省郫縣安德鎮的安龍村,位於錦江上游,是成都的「可持續發展生態示範村」。上游農村大量化肥及農藥的使用使錦江水質日益惡化,已經威脅到1000萬成都人的日常生活,並危及岷江中下游、長江中下游水環境質量。
成都城市河流研究會在2005年11月提出「成都府南河上游安龍可持續發展示範村專案」。該專案實施內容爲,在錦江上游安龍村建立「具有生態效益」可持續發展的生態農業。將農村生産和養殖業排放的種種污染彙集成面,减少化肥農藥的使用,有效控制污染,從上游開始治理淨化河水。
發展生態農業實施迴圈經濟,幫助河流戒毒,讓錦江水質得以改善。改變農戶的傳統觀念,培養村民的環保意識,從而改變農村的生産生活方式。
河流研究會組織農民到外地參觀考察,舉辦生態農業與環保培訓班,將生態農業與環保的種子播撒在農民心中。沼氣池在消納農村生産生活廢弃物的同時,産出清潔高效的農家肥及可持續能源。
發起支援生態農業保護城市河流活動。組織城市居民積極購買生態農業産品,開展訂單農業,激發了農民參與生態農業的積極性。生態農業使農民得到更多的實惠,也從根本上
保證了城市河流的水質。
城市河流研究會陸續提出並實施:河流保護帶、林盤保護、濕地修復、河流維護及道路整治等改善鄉村環境,淨化水質的舉措。通過媒體,舉辦各種活動號召市民重視及參與到保護母親河的行動中,越來越多環保志願者的加入使這個專案更具活力。
安龍村的經驗將被推廣到錦江沿綫農村,在河道兩岸構建縱深各500米的生態帶,從而將錦江保護起來。

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週一, 28 一月 2008

西部客家第一鎮

梁准 撰文

洛帶古鎮距成都17公里,三國蜀漢時建鎮,傳說因蜀漢後主劉禪的玉帶落入鎮旁的八角井中而得名。這是一座歷史悠久,文化底蘊深厚,民風純樸的小鎮。
洛帶鎮2.3萬多居民中,有90%以上的居民爲客家人,至今仍完整地保留了客家方言、民俗和生活方式。洛帶古鎮在傳承客家文化,發展可持續性旅遊中的獨到見解和經驗,值得借鑒和分享。
旅遊資源的根本價值在於對旅遊者的吸引力,洛帶古鎮的客家文化及保留下來的會館等建築遺迹是其核心吸引力所在。精心呵護祖輩留下的物質和非物質文化遺産,是洛帶人的明智之舉。規模宏大,建築精美而又獨具特色的廣東會館、湖廣會館、江西會館,川北會館保存完好。落帶古街保留著明清時代一街七巷的格局,古街兩邊是清一色的青磚灰瓦,木板鑲門。鏤花雕窗,雕梁刻檐,呈現了完美的明清建築風格。
一年一度的「水龍節」、「火龍節」更是幾百年來客家人傳承下來的特色民俗活動。九鬥碗,釀豆腐,鹽焗鶏、油燙鵝及傷心凉粉,天鵝蛋等名菜小吃滿街飄香,遠近聞名。古鎮是當地居民的休養生息之地,古鎮文化不是遊離於居民生活之外,而是與居民的生活息息相關,密不可分的。長期生活在古鎮中的居民,本身就是很重要的人文景觀,居民的日常生活和親和度對于旅遊者的旅遊體驗具有重要的影響。以古鎮居民的日常生活爲根本立足點,在此基礎上發展旅遊業。使當地居民既能保持自己獨特的生活習俗,又能參與幷推動當地旅遊業的發展。
通過龍泉國際桃花節,「水龍節」、「火龍節」等節慶活動將客家文化與農家休閑旅遊甚至農業觀光旅遊相結合。這種可持續性發展的旅遊模式,將歷史與現在,未來自然緊密地結合在一起,在保持、發揚和光大洛帶古鎮客家文化的同時,也爲子孫後代留下一個生存發展的空間。
洛帶古鎮以可持續性發展的旅遊模式將自己打造成「西部客家第一鎮」。

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週三, 23 一月 2008

西部客家第一镇

梁准 撰文

洛带古镇距成都17公里,三国蜀汉时建镇,传说因蜀汉后主刘禅的玉带落入镇旁的八角井中而得名。是一座历史悠久,文化底蕴深厚,民风纯朴的小镇。
洛带镇2.3万多居民中,有90%以上的居民为客家人,至今仍完整地保留了客家方言、民俗和生活方式。洛带古镇在传承客家文化,发展可持续性旅游中的独到见解和经验,值得借鉴和分享。
旅游资源的根本价值在于对旅游者的吸引力,洛带古镇的客家文化及保留下来的会馆等建筑遗迹是其核心吸引力所在。精心呵护祖辈留下的物质和非物质文化遗产,是洛带人的明智之举。规模宏大,建筑精美而又独具特色的广东会馆、湖广会馆、江西会馆,川北会馆保存完好。落带古街保留着明清时代一街七巷的格局,古街两边是清一色的青砖灰瓦,木板镶门。镂花雕窗,雕梁刻檐,呈现了完美的明清建筑风格。
一年一度的“水龙节”、“火龙节”更是几百年来客家人传承下来的特色民俗活动。九斗碗,酿豆腐,盐焗鸡、油烫鹅及伤心凉粉,天鹅蛋等名菜小吃满街飘香,远近闻名。古镇是当地居民的休养生息之地,古镇文化不是游离于居民生活之外,而是与居民的生活息息相关,密不可分的。长期生活在古镇中的居民,本身就是很重要的人文景观,居民的日常生活和亲和度对于旅游者的旅游体验具有重要的影响。以古镇居民的日常生活为根本立足点,在此基础上发展旅游业。使当地居民既能保持自己独特的生活习俗,又能参与并推动当地旅游业的发展。
通过龙泉国际桃花节,“水龙节”、“火龙节”等节庆活动将客家文化与农家休闲旅游甚至农业观光旅游相结合。这种可持续性发展的旅游模式,将历史与现在,未来自然紧密地结合在一起,在保持、发扬和光大洛带古镇客家文化的同时,也为子孙后代留下一个生存发展的空间。
洛带古镇以可持续性发展的旅游模式将自己打造成“西部客家第一镇”。

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週五, 04 一月 2008

真實世界不是電腦遊戲

魏明德 撰文

前些日子,我帶著我的小表妹到中國大陸走一走。她是法國人,第一次到中國大陸旅行。有一次,我們經過一個大型工地,她對我說:「好奇怪喔,我覺得自己好像走在電腦遊戲的世界。」
我可以體會到她真正想要表達的想法。過不了多久,這個工地就會被直上雲霄的建築物所覆蓋;湖泊旁邊本來有人家種蔬菜、養水牛,現在整個都改種桃子,變成大型的觀光景點;工廠無故關閉,也沒有給員工遣散費;上山城的行道樹全被砍光,為的是開闢寬廣的新柏油路…
中國大陸的經濟成長令人嘆為觀止。然而,中國大陸的政經決策者似乎以為自己身在電腦螢光幕前:為了所謂的益處,在很短的時間內就必須做出決策,結果就是拆掉舊建築蓋上新工廠,或是拆掉舊工廠蓋上新房舍。取決的條件憑的往往是時興的選擇。當你置身在虛擬的世界時,若說有什麼抽象的概念或是不可變動的價值並不會影響你做決定。然而,我們必須面對的是真真實實、有血有肉的男女,以及唯一的自然環境,因為承載人類的只有一個地球。
當抽象認識只剩下實用價值,而熱愛電腦遊戲的思維又成為時尚時,難道不會主導我們對真實世界的看法嗎?如果只憑仗著數據與實用的概念,而沒有與人類的性情相依存,政治決策者將會製造出沒有人性的世界。
決策者所做出的決定,有好的一面,也有不好的一面。我們說有好的一面,因為他們的決定來自總體經濟學的考量,不管怎麼說都應該是正確無誤的;而不好的一面是說,這些決定往往遠離了人類的稟性,為了數字上的成長,犧牲了人文、林木、文化或是家庭。而這些成本需要賠上未來子孫的發展潛能,以及後代的寶貴資源作為代價。
決策者應該做的,就是當一個人,能夠欣賞夕陽的美、夏日的樹葉、迴響著腳踏車鈴聲的鄉間小路、田間的古墓、公園裡與鄰人下棋的閒情逸致…我們誠心希望每個決策所蘊含的智慧,也包括了品嚐生命的味道,而不是讓過度的理性主導而走向瘋狂。我們衷心希望每個決策者能夠像性情中人一樣去感受與述說,不要當沉迷於電腦遊戲的幻魂。決策者的政治責任一旦失去了人性的向度,就沒有真正繁榮的政治或經濟可言。

附加的多媒體:
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