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Malnutrition, over-nutrition, and a prosperous China

The other week I had a chance to discuss nutrition with the doctors at my hospital. As we looked at beverages and snacks, many of them were surprised to see that the healthy choices they thought they had been making, weren’t so great. For example, every single one of the 30 doctors was shocked to learn that a bowl of instant noodles had twice as much sodium and much more fat than a grilled chicken sandwich from KFC.

The general agreement was that if they were misinformed about nutrition, than the public would probably be even less informed. A large part of the problem was that nutritional information was either absent or not in a standard, easy to understand format.

China’s urban areas are now facing nutritional problems similar to those seen in developed countries. Hypertension is one of the biggest killers in China, which isn’t surprising given smoking rates, but is also greatly influenced by the Chinese diet. Recent studies have showed that sodium consumption in China is nearly 3x higher than the recommended maximum of the WHO, and 50% beyond what the average American consumes.

Diabetes has also become a major concern in urban areas, rates of those affected are now similar to what we are seeing in the US. Childhood type 2 diabetes, something that was “unimaginable” in the US 30 years ago, is now appearing in both countries. One local doctor told me that she was currently working with two women under the age of twenty who had been diagnosed with type 2 diabetes. They reported that they had switched to drinking only iced tea and soft drinks, completely unaware of the repercussions it may have on their health.

Data from a presentation on diabetes in China and from the American Diabetes association*

Meanwhile children of poorer families in China, who are largely in rural areas, suffer from a variety of problems related to malnutrition. China has the second largest number of underweight children world wide (this is due partially to China’s massive population, and the fact that ~125 million Chinese still live on about $1/day). Additionally, 20% of rural children are anemic. Malnutrition has been linked to a number of physical and mental development problems, and as the author of the China study points out, it could easily be treated for a few cents per child per day.

When I worked in the countryside, college students were rarely taller than me, even though I’m not tall myself (about 5’7″), and you could tell just by looking which students came from rural areas. In Nanjing however, middle school students are regularly taller than me. The same was true even just visiting the cities of Guangxi, where people were both taller and fatter than in the countryside.

I believe this physical difference is a combination of proper/over nutrition in urban areas, and the steady flow of growth hormones that comes with eating more meat in China (there have been several scandals in connection with illegal growth hormones being fed to animals in China. This had caused several foreign athletes to bring their own food to China out of fear that they would test positive for steroids if they ate locally).

This visible gap between these two groups of people is a reminder of just how big the economic gap is in China. As China continues to develop, it will struggle with these preventable diseases. In urban areas it will lead to increasing health costs, and premature deaths. In the countryside though, poor nutrition will shape children’s futures and limit their potential.

Photo essay on rural lunch programs in rural China

*China numbers did not fully account for those who have not been diagnosed due to lack of access to health care, but US numbers do estimate for such cases. This partially explains the rural/urban gap in diabetes rates. US numbers are based on pop. over 20 years old. Total US average is 8.3%

White Guy Needed – Foreigners in Advertisements

In China, white people get an inexplicably large amount of respect simply by being white (I didn’t use “foreigners” here because people with darker skin are typically excluded from these “perks” regardless of their country of origin). You get preferential treatment when it comes time to find a job (often making several times what your Chinese counterpart makes)and even in Chengdu, a city with a decent number of foreigners, Casey and I were offered positions as “marketing managers” for a wine company while we shopped at a supermarket.

A few months ago, I was offered a spot in an advertisement for a nearby restaurant. For reading a few lines in Chinese I would have received 2,000RMB (close to what a factory worker earns in a month), and a scrumptious banquet for my friends. The premise of the commercial was this: three Chinese men would spot me sitting in the restaurant’s lobby and say something about me being a foreigner, to which I would respond by explaining many of the simple pleasures that could be found in Chinese alcohol, art, and food. At the end we would part-ways and I would say something like, “I understand China.” Unfortunately the deal fell through due to scheduling problems.

Being offered a job simply because I’m white isn’t as flattering as it might sound. The company making the advertisement said they were looking for someone between 30 and 40 years old (I’m not), who was handsome (I’ll take it), and could read a few lines of Chinese off the script. Other companies are even more up front about it, simply asking for a “white guy.”

Unfortunately, few Chinese commercials promote foreigners in such a positive light.

In advertisements I’ve noticed that white people serve as a kind of shorthand for sophistication and wealth (especially prominent in real estate ads). In other cases we are symbols of modernity, or promote the idea of a company being “international” as if the company is saying, “See, even white people like our product.”

Are KFC's chef's really Chinese? Does KFC even have chefs? Do its customers dress up for their fast food? See the full ad on Youtube (thanks ChinaSmack)

When I discussed this with my Chinese co-workers they insisted that this was a symbol of how much Chinese people respected foreigners. After I mentioned the fact that in China white people can still build entire careers off of being able to speak Chinese (like Dashan), they do note that it is completely unfair. They asked “Why should foreigners get so many benefits just because they look different?”

To be honest it’s a pedestal that I wouldn’t mind stepping down from. These advertisements also reinforce many negative stereotypes about foreigners. Europeans are “cultured”, Americans are “cool”, and Africans are often portrayed as “primitive” (which has been brought up in more than one discussion with African friends here). In advertisements it’s hard at times to distinguish between powerful and colonial, idolized and ogled or between curious and completely daft. At other times these advertisements seem to have shifted slightly as China has become more assertive; the underlying message now being, “See, now the foreigners work for us.”

Hopefully a more confident China will eventually lose the trope altogether, but I’m not holding my breath.

So what’s it like over there in China?

As most of you know, I’m in the States for a few weeks visiting family. During my time here, I’ve realized just how much interest there is in China at the moment, and how little people know about China.

So today I’m going to share my answers to the three questions I’ve been asked the most.

1. Does China have rich people? China has some incredibly rich people, but the bar is lower to be considered rich. A few months ago China’s first yacht club opened up and the requirement for joining was a yearly salary of 200,000rmb (about $30,000). So by this measure a good chunk of Americans would be considered rich, but the top doctors at my hospital wouldn’t make the cut. The largest concentration of rich people live on the east coast.

China also has about 35 million people who make less than $125 a year (China does not use the dollar a day standard for measuring poverty). This gap between rich and poor is one of the gov’ts top concerns.

2. Why do you shop in the US, aren’t things cheaper there? Sure things are cheaper in China, but those items rarely hold up very well. I had a friend who told me that in the early 80’s they had “weekly shoes” because they fell apart that fast. So I try to avoid buying things in that price range.

Yet, when I went to the mall to buy a new coat, I couldn’t find one for less than $200. It was ridiculous. I looked at 15 stores or so before I was finally able to buy an acceptable looking coat at the supermarket, but the quality is questionable (it only needs to make it through 2 winters).

One of the major complaints I’ve heard from my Chinese coworkers is that there is nothing between luxury and economy. The example was that you could buy a $10 watch or a $1,000 watch, but if you bought one in between those two, there was no way of knowing if it would last more than a week.

3. Do you get tired of eating Chinese food every day? When I lived in the countryside, I got tired of eating Chinese food, but this was mostly due to the limited number of restaurants and flavors. In Nanjing we have Chinese food from every province (lots of different flavors), but we also have KFC, McD, Burger King, Subway, Pizza Hut, Papa John’s, and some small Italian, French, American, Mexican, Indian and even Turkish restaurants. A much better selection than most of the Midwest.

News Story of the Week

This week’s story has me scratching my head. Apparently a lot is going to change between now and 2030, when supposedly 2/3 of China is going to be overweight.

Now I’m not saying that Chinese people aren’t getting bigger, they are. When I arrived in 2007 people were complaining that McDonald’s and KFC were making the children fatter, but that’s only part of the story. Really, it’s the parents’ new found wealth that has changed the diet from mostly rice and vegetables with a few slivers of meat to something that more closely resembles American portions. There is even a noticeable difference in size between people from the countryside and those from the city (both in height and weight), which further shows that it is a wealth issue.

For example: In Nanjing I’m “average” sized, but at that I’m stuck wearing XL clothing (and the shop assistant usually starts with XXL or worse). In Guangxi clothing wasn’t even made for people my size.

So it’s a very interesting thought, but I think for China to grow from 25% overweight (which I don’t believe to start with) to 66%, would require about 66% of the Chinese people to be wealthy.

The Problems They Didn’t Foresee

This is part three of a three part series. Part One. Part Two.

It’s not surprising that a plan that has supposedly prevented almost 400 million births (more than the entire population of the US), has also caused some side effects that have changed every stage of life.

One of the big side effects has been a drastic change in family relationships. As you have probably heard, Chinese families have one child and four grandparents. That tied with China’s growing wealth has led to unfathomable levels of spoiling (sadly not an official measure yet). In China, McDonalds and KFC are considered relatively expensive outside of the major cities, yet in even smaller, poorer areas, you see grandparents and parents shelling out the big bucks on their kids in packed restaurants while abstaining from the food themselves.

The other day as my wife and I walked through a store called “Children Kings,” I was starting to say that adoration for children here was completely different from what it is in the US, but my wife thought that was a bit too strong (America is very good at spoiling children too). Finally we agreed that China hasn’t created something new, but instead has brought it to a new level.

A single child not only inherits the wealth of the entire family, but also shoulders all of the hopes of the family. The amount of pressure on students to succeed is immeasurable in many cases. In the countryside there is currently no pension, so the children are their parent’s actual retirement plan.

This has led to another interesting shift: the growing value of daughters in the family. This isn’t a result of effective propaganda, but from the reality that sons are more likely to leave to work in the city, while daughters will stay behind and care for their parents. This is a far cry from the idea earlier this century that a girl was only a “small happiness,” now a girl is a sign of stability for her aging parents.

The third shift I want to bring up is the way the policy has changed marriage. For men who do not have the skills to find work in the cities, it is very hard for them to find a wife in the countryside. Women have little interest in farmers. In Longzhou my friend Terrence told me about a man in his village who had “bought” a wife from Vietnam. What exactly bought meant, I’m not sure, and Terrence lacked the human trafficking vocabulary to define it. When the woman arrived in his village she was miserable, and the man discovered it wasn’t easy to have a happy family when he couldn’t even talk with his wife. Terrence said that after a few weeks she ran away, and the whole village laughed at how foolish the man was.

From birth, to marriage, to retirement, the One Child Policy has changed everything.

Tomorrow expect something a bit cheerier.

Live from China its Christmas Eve

It’s Christmas Eve here in China, since we are 13 hours ahead of New York, and a full 17 hours ahead of Seattle.

My Chinese co-worker, Grace, is attending her daughter’s class Christmas party. Which includes a small gift exchange, performances and food ordered from KFC (at the parents’ expense of course). Grace and her daughter have prepared this cookie song (below), after which they will hand out knock off Oreos to all the other children. The rough idea of the song is about making cookies and then eating them. (“Little friends, isn’t it interesting to make cookies?!”)

One of my students/doctors, is going to be taking his family out for a nice dinner on Christmas eve (ironically in China they all eat western food on Christmas eve, and in the States the only thing that’s open is Chinese). After that he will take his son to the store to buy some presents and a Christmas tree. apparently I was not quick enough in my Christmas lesson to explain that he should have done that a month ago.

For the young Doctor, who isn’t married yet, he will be taking his fiance out to a fancy dinner and a movie. Their parents have no interest in Christmas.

Other doctors will simply do nothing, since their spouses will be on duty for Christmas.

My wife and I have a cozy day full of nothing to do, which will be nice. In the evening our British friend will come over for a small meal, and we’ll probably pray and play board games.

On Christmas we will call every part of our family and try not to think about how badly we wish we were with them. It’s especially tough this year with the niece and nephew having their first Christmas without us.

I hope all of you have an incredibly Merry Christmas with your families, and remember that you are truly blessed.