China: Sickness, Murder And A Doctor-Patient Crisis Of Trust

Beijing's  Xuanwu Hospital
Beijing's Xuanwu Hospital
Yan Yong

SHANGHAI — Recently, two Shanghai hospitals have held special training courses for their doctors. One invited a Taekwondo coach to teach the physicians self-defense skills, while the other featured a local police expert in crisis negotiation to brief them about violence prevention.

The Chinese public of course understands what this is all about. Just two weeks ago, a patient in the coastal city of Wenling killed a doctor and wounded two others. In the last few years, similar incidents have occurred far too frequently across China, prompting the National Health and Family Planning Commission and the Ministry of Public Security to order every hospital to dispatch full-time security agents, at the rate of one agent for every 20 hospital beds.

But whether it’s about self-defense or about putting in place security staff, this is a stopgap policy in the face of the increasingly acute doctor-patient conflict. When patients turn their feelings of powerlessness into violence, doctors are paying with their lives and the whole of society suffers in China’s very different manifestation of the country's healthcare crisis.

What this dramatic clash reflects is the contradiction between the demand for healthcare services and the inefficiency of medical resources, and shortness of supply of quality care.

According to the 2012 China Health Statistical Yearbook data, outpatient visits in 2011 increased 53.1% compared with 2005, while the number of hospitalizations increased 112.9%. Meanwhile the number of practicing physicians grew by only 24.9%.

What this means is that doctors are exhausted. A doctor in a major public hospital ends up seeing up to 60 patients in half a day. But the patients are not any better off, having to queue up a whole morning in a clogged space just to be given a consultation of less than five minutes.

Bedside skills

In 1997, China introduced a major medical care reform. Unfortunately, not only were the boundaries not made clear between the government and the market, it actually triggered the public hospitals’ impulse to pursue profits. Doctors bear directly the task of generating income and benefit from the hospitals’ economic success, while the patients’ medical expenses soar.

While the anger toward the system deepens, the conflict is shouldered by the doctors. In addition, Chinese medical schools today almost entirely lack any humanistic education and doctors often are unwilling or unable to communicate with patients.

It is urgent that China reform its medical system, and find ways to expand the supply of proper medical resources if the doctor-patient conflict is to be resolved. The reforms should include the liberalization of the medical market, promotion of multi-access medical care so that healthcare resources can be shared evenly. The public hospitals should not have the monopoly of the doctors’ resources and physicians should be allowed to practice freely so as to promote an environment of orderly competition and fix the long distorted healthcare pricing system.

But the medical reform not only must address the question of financial security but also the quality of the health care services. The former is about who pays — how the government, the commercial insurance and the patient are to share out the cost. The latter is about the medical treatment, i.e. the doctors. Obviously, this implies attracting and mobilizing more resources for healthcare facilities and personnel.

Doctors in China are unhappy. The Physicians’ Association conducted four surveys regarding practitioners in 2002, 2004, 2009 and 2011. The last survey showed that 48.51% respondents are not satisfied with their working environment, and the higher their rank, the deeper the dissatisfaction. Only 6.8% of interviewed doctors said they would want their children to become doctors.

The survey also showed that 55.7% of doctors believe that “the public have prejudice against doctors.” After the Wenling incident, Chinese doctors voiced their concern collectively for the first time. This has in turn aroused public concern and empathy. To rebuild China’s doctor-patient trust, the medical system needs major changes.

Doctors and patients are not natural enemies, and indeed share the same foe: illness. But only if there’s trust between the two can our healthcare system lower its financial and human costs.

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The Food Truck, A Sign That The White And Wealthy Are Moving In

In San Diego, California, a researcher tracked how in the city's low-income neighborhoods that have traditionally lacked dining options, when interesting eateries arrive the gentrification of white, affluent and college-educated people has begun.

Balboa Park Spring Fling Food Truck festival

San Diego Food Trucks via Facebook
Pascale Joassart-Marcelli

SAN DIEGO — Everybody, it seems, welcomes the arrival of new restaurants, cafés, food trucks and farmers markets.

What could be the downside of fresh veggies, homemade empanadas and a pop-up restaurant specializing in banh mis?

But when they appear in unexpected places – think inner-city areas populated by immigrants – they're often the first salvo in a broader effort to rebrand and remake the community. As a result, these neighborhoods can quickly become unaffordable and unrecognizable to longtime residents.

An appetite for gentrification

I live in San Diego, where I teach courses on urban and food geographies and conduct research on the relationship between food and ethnicity in urban contexts.

In recent years, I started to notice a pattern playing out in the city's low-income neighborhoods that have traditionally lacked food options. More ethnic restaurants, street vendors, community gardens and farmers markets were cropping up. These, in turn, spurred growing numbers of white, affluent and college-educated people to venture into areas they had long avoided.

This observation inspired me to write a book, titled The $16 Taco, about how food – including what's seen as "ethnic," "authentic" or "alternative" – often serves as a spearhead for gentrification.

Take City Heights, a large multi-ethnic San Diego neighborhood where successive waves of refugees from places as far away as Vietnam and Somalia have resettled. In 2016, a dusty vacant lot on the busiest boulevard was converted into an outdoor international marketplace called Fair@44. There, food vendors gather in semi-permanent stalls to sell pupusas, lechon (roasted pig), single-sourced cold-brewed coffee, cupcakes and tamarind raspado (crushed ice) to neighborhood residents, along with tourists and visitors from other parts of the city.

Informal street vendors are casualties.

A public-private partnership called the City Heights Community Development Corporation, together with several nonprofits, launched the initiative to increase "access to healthy and culturally appropriate food" and serve as "a business incubator for local micro-entrepreneurs," including immigrants and refugees who live in the neighborhood.

On paper, this all sounds great.

But just a few blocks outside the gates, informal street vendors – who have long sold goods such as fruit, tamales and ice cream to residents who can't easily access supermarkets – now face heightened harassment. They've become causalities in a citywide crackdown on sidewalk vending spurred by complaints from business owners and residents in more affluent areas.

This isn't just happening in San Diego. The same tensions have been playing out in rapidly gentrifying areas like Los Angeles' Boyle Heights neighborhood, Chicago's Pilsen neighborhood, New York's Queens borough and East Austin, Texas.

In all of these places, because "ethnic," "authentic" and "exotic" foods are seen as cultural assets, they've become magnets for development.

Food vendor at outdoor international marketplace called Fair@44.

Fairat44 via Instagram

A call for food justice

Cities and neighborhoods have long sought to attract educated and affluent residents – people whom sociologist Richard Florida dubbed "the creative class." The thinking goes that these newcomers will spend their dollars and presumably contribute to economic growth and job creation.

Food, it seems, has become the perfect lure.

It's uncontroversial and has broad appeal. It taps into the American Dream and appeals to the multicultural values of many educated, wealthy foodies. Small food businesses, with their relatively low cost of entry, have been a cornerstone of ethnic entrepreneurship in American cities. And initiatives like farmers markets and street fairs don't require much in the way of public investment; instead, they rely on entrepreneurs and community-based organizations to do the heavy lifting.

In City Heights, the Community Development Corporation hosted its first annual City Heights Street Food Festival in 2019 to "get people together around table and food stalls to celebrate another year of community building." Other recent events have included African Restaurant Week, Dia de Los Muertos, New Year Lunar Festival, Soul Food Fest and Brazilian Carnival, all of which rely on food and drink to attract visitors and support local businesses.

Meanwhile, initiatives such as the New Roots Community Farm and the City Heights Farmers' Market have been launched by nonprofits with philanthropic support in the name of "food justice," with the goal of reducing racial disparities in access to healthy food and empowering residents – projects that are particularly appealing to highly educated people who value diversity and democracy.

Upending an existing foodscape

In media coverage of changing foodscapes in low-income neighborhoods like City Heights, you'll rarely find any complaints.

San Diego Magazine's neighborhood guide for City Heights, for example, emphasizes its "claim to authentic international eats, along with live music venues, craft beer, coffee, and outdoor fun." It recommends several ethnic restaurants and warns readers not to be fooled by appearances.

Longtime residents find themselves forced to compete against the "urban food machine"

But that doesn't mean objections don't exist.

Many longtime residents and small-business owners – mostly people of color and immigrants – have, for decades, lived, worked and struggled to feed their families in these neighborhoods. To do so, they've run convenience stores, opened ethnic restaurants, sold food in parks and alleys and created spaces to grow their own food.

All represent strategies to meet community needs in a place mostly ignored by mainstream retailers.

So what happens when new competitors come to town?

Food vendor at outdoor international marketplace called Fair@44.

Fairat44 via Instagram

Starting at a disadvantage

As I document in my book, these ethnic food businesses, because of a lack of financial and technical support, often struggle to compete with new enterprises that feature fresh façades, celebrity chefs, flashy marketing, bogus claims of authenticity and disproportionate media attention. Furthermore, following the arrival of more-affluent residents, existing ones find it increasingly difficult to stay.

My analysis of real estate ads for properties listed in City Heights and other gentrifying San Diego neighborhoods found that access to restaurants, cafés, farmers markets and outdoor dining is a common selling point. The listings I studied from 2019 often enticed potential buyers with lines like "shop at the local farmers' market," "join food truck festivals" and "participate in community food drives!"

San Diego Magazine's home buyer guide for the same year identified City Heights as an "up-and-coming neighborhood," attributing its appeal to its diverse population and eclectic "culinary landscape," including several restaurants and Fair@44.

When I see that City Heights' home prices rose 58% over the past three years, I'm not surprised.

Going up against the urban food machine

Longtime residents find themselves forced to compete against what I call the "urban food machine," a play on sociologist Harvey Molotch's "urban growth machine" – a term he coined more than 50 years ago to explain how cities were being shaped by a loose coalition of powerful elites who sought to profit off urban growth.

I argue that investors and developers use food as a tool for achieving the same ends.

When their work is done, what's left is a rather insipid and tasteless neighborhood, where foodscapes become more of a marketable mishmash of cultures than an ethnic enclave that's evolved organically to meet the needs of residents. The distinctions of time and place start to blur: An "ethnic food district" in San Diego looks no different than one in Chicago or Austin.

Meanwhile, the routines and rhythms of everyday life have changed so much that longtime residents no longer feel like they belong. Their stories and culture reduced to a selling point, they're forced to either recede to the shadows or leave altogether.

It's hard to see how that's a form of inclusion or empowerment.The Conversation


Pascale Joassart-Marcelli is a Professor of Geography and Director, Urban Studies and Food Studies Programs at San Diego State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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