Knowledge for Better Health and Better Policies

The eBulletin interviewed Shufang Zhang, Project Coordinator at UNRISD, about her project on Migration and Health in China.

Let us begin with the current research project you’re working on at UNRISD.

The project on Migration and Health in China aims to examine the current literature on key aspects of migration and health, narrow knowledge gaps on the topic, and shed light on the kinds of policies that can improve the health of migrants as well as the general population in China.

An important outcome of this project will be a series of papers and commentaries—also to be published as an edited volume—that synthesize current knowledge on a range of themes relevant for migrant health, and identify future research and policy directions. Another outcome will be the research network that the project has been building up, which can enhance the research capacity and facilitate future research collaboration on migration and health issues in China.

The project, funded by the China Medical Board and led by UNRISD and Sun Yat-sen Center for Migrant Health Policy (CMHP), is a coordinated effort to bridge the knowledge gap to advance migrant and population health in China. It brings together more than 70 Chinese and international experts, representing more than 30 research institutes, government agencies and international organizations around the world. We hope that we can make a difference through our work.

Tell us about your background and research interests.

I am trained as a health economist and have researched a range of issues on health policy, health and labour productivity, as well as tobacco control. My research interests include health policy, the monitoring and evaluation of health policy interventions, and migration and health. From 2002 and 2004 I worked at the World Bank Institute in Washington, DC, managing training portfolios for senior Chinese government officials on poverty reduction and sustainable development. Since 2009, I have been providing technical advice and support for the China Medical Board for its effort in building the research capacity of China in the area of health policy and system research.

What brought you to UNRISD?

I was drawn to UNRISD by the opportunity to work with Director Sarah Cook, who is a renowned expert on China and leading scholar on social development. I look forward to advancing the frontiers of our knowledge on migration and health—a very complex, important and under-researched topic in China.

What are the key health challenges posed by the high level of internal migration in China during the last three decades?

Many health challenges have emerged in the domains of both infectious and chronic disease. Issues of mental health and occupational health have become particularly alarming, as have health concerns for certain demographic groups such as migrant children; the children and elderly who are left behind by migrant workers; and the younger generation of migrants. These present new challenges to public health policy management in China.

From a policy perspective, the continuous influx of migrants into urban areas calls for a much more coordinated and effective government response to prevent and address health challenges. These responses will not be possible without adequate infrastructure, human resources, financial support and sound institutions: in other words, a responsive and efficient health system that is well integrated with other social service provision and protection schemes. Different levels of government face constraints in responding in an effective and timely manner through policy reform, capacity building, or implementing interventions. These aspects are all critical in order to minimize the negative health impacts associated with migration and the inherent health disparities which surface in the process of massive population movement in China.

How do China's existing social security, health and legal systems affect migrants' access to social security services?

China’s social security system presents a clear rural-urban division: the rural population in general is excluded from the social security system or protected at a much lower level than its urban counterparts, particularly employees in formal employment. Inequality and the segregated nature of systems prevail across different social service and protection schemes: housing, education, employment, health and pensions. This situation has made it very hard for migrants, both men and women, to have equal access to social security systems regardless of where they move to and work. There is little or no portability of the social security benefits to which migrants are entitled, such as health insurance. This prevents migrants from accessing basic social security and healthcare services.

Who are the most vulnerable and affected?

One of the most vulnerable and affected groups are migrants who are from poor and less educated backgrounds who have neither financial means nor social support networks to settle down in urban areas. These are the people who are often pushed into taking the difficult, dirty and dangerous jobs without being well compensated or protected. It is often the case that migrant women are most disadvantaged in such situations, as they have less access than men to resources and power to protect their health.

The other most vulnerable and affected group are the left-behind family members of migrants: often children and elderly who are deprived of much-needed care.

You have suggested that the health challenges associated with mass internal migration have been largely neglected by researchers and have not been adequately addressed in public policy in China. Why do you think this is the case, and what work is being done to change this?

Given the daunting health challenges with which China is confronted, the wide knowledge gap that exits, and the much-needed policy action in the context of massive population movement, the issue of migration and health is certainly under-researched academically and insufficiently addressed politically. However, scholars and research institutes within and outside China, international organizations and government agencies have been paying more attention in recent years and making stronger efforts to address these challenges. The migration and health project being undertaken by UNRISD and Sun Yat-sen University contributes to these efforts.

What do you aim to achieve through this project?

The volume produced through the project will be the first comprehensive study on the topic, so we hope that it will be widely referred to by international and Chinese scholars as a starting point to support future research. We also hope that the empirical findings and policy messages conveyed in the volume will help support government policy making and the agenda setting of international organizations in order to improve the health and social well-being of migrants.

Another key aim is to strengthen the research capacity of our local partner, the CMHP, by twinning the centre’s researchers with external experts to collaborate on research papers. This, we hope, will facilitate the development of a strong research network connected to the centre which can be drawn upon by the centre to lead future research efforts and contribute to evidence-based policy making.