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Tom chats about rural China on

I had the chance last night to record a podcast with Mike from the new website We talked a bit about my last few posts on life in rural China, and I shared a few other thoughts and anecdotes. You can download it or listen online here.

Secondly, I’d just like to encourage you to check out Mike’s other episode and add China Blogcast to your podcast subscriptions (this is week 2, so it won’t take long to catch up). At the moment there is a real shortage of China related podcasts, and this is a very good addition to the others that already exist. Mike is planning on releasing a new ~30 minute episode every Thursday featuring chats with other China bloggers.

China’s tourism push – Does every city really need a new old town?

Yesterday we looked at a few of the pros and cons of rural life, today we’ll be looking at the development plan for this region.

“China is a large country with a large population,” seemed to be the catch-all excuse for much of the poverty we saw as we traveled through rural parts of a central Chinese province.* While I generally find it an unconvincing dodge, the remoteness of this region lead me to contemplate how it could ever be prosperous. Many of China’s remote regions were settled exactly because they were so difficult to reach, offering minority groups and small clans protection from outsiders. But now that trade and manufacturing are the base of China’s growth, these rural places have been left behind. One village we visited was located on what was essentially a cliff that could hold no more than a few dozen homes. They farmed in the narrow valley below, growing mostly rice and corn for their own consumption.

It’s difficult to imagine a way for such a remote place to prosper; in the US it would have been turned into a nature reserve long ago.

The local gov’t officials told me that their current plan was to try to grow tourism. Given that the “city” (that managed the tiny village) was located on a narrow two-lane road, it seemed like a more realistic vision than expanding heavy industry or manufacturing. Currently the region is mostly cash crop farming, with a few cement plants and a handful of mining operations. These industries though are quickly cannibalizing the mountains that the new plan relies on.

The same thing is happening to Guangxi’s famous mountains

It seems though that tourism has become the focus of every small town in China. While this region did have some spectacular views, the closest airport was two hours away and is already seated in an area that has world famous scenery and well developed infrastructure for tourists. The city I was visiting only offered scenic drives on rough dirt roads. Furthermore, every city between this small one and that tourist hub was focusing on tourism too.

It seems that 10 years ago, as domestic tourism was just starting to grow, the entry cost was much more attractive to farmers and villagers, and many decided to build small restaurants and guest houses. Now when you pass these places you see dozens of worn down, empty hotels standing in the shadows of big shiny new ones. Domestic tourists have much higher standards now and are uninterested in staying in what the villagers can afford to build (Jeremiah Jenne wrote a great post that explored a few other angles of tourism).

It’s also important to note that even though there are more and more domestic tourists, many of them have very little time and money for travel. When I talk with my Chinese friends about the vacations I have taken to the countryside, I’m often met with confused looks. Why would I ever visit a poor area when I could just as easily see a rich one? Why would I visit some county no one had heard of when a famous one was nearby? Chinese tourists seem to put a very high value on checking well-known sites off their lists as travel is very much a status symbol (Evan Osnos’s hilarious account of traveling with a Chinese tour company to Europe).

Additionally, this area lacked most of the key ingredients for becoming a tourist hot spot – It was not the site of an important ancient city or religious site, and had no preserved old town like Lijiang or Xi’an (but they were planning on building a new old town at the villagers expense, like many other cities in China); it did not have “famous” scenery, meaning that it was not a destination for poets or painters of the past; and it is still too rustic to attract those seeking something more luxurious like Shenzhen or Shanghai. I worry that the hundreds (thousands?) of villages seeking to develop tourism will fail at massive costs to their villagers.

Other tourist spots, like those in the quake effected parts of Sichuan, have seen a boom in the number of visitors, but have noted that few of them spend money while passing through. As a reporter from the Global Times stated,

“Each day, thousands of visitors come to see the ruined Xuankou Middle School and leave flowers, but they depart quickly.

As most of these spots lie outside the main residential areas, most visitors do not come into the center of town and see the newly reconstructed earthquake-resistant buildings. What’s worse, they do not participate in the economy.”

Perhaps it’s not a coincidence that the more prosperous villages I’ve visited aren’t focused on tourism, they are focused on cash crops and adding further value to the raw goods they are producing (like milling wheat and using the flour to make frozen mantou to sell throughout China, or growing kiwis and bottling the juice). It’s as if China has leapt from one rural development model to the next without much thought of how it would actually work.

Next week we’ll be looking at some of the projects I visited on this trip and discussing the state of the rural church.

*I’m being intentionally vague here.

Trading family for a washing machine – Are China’s poor really better off?

China’s rise has lifted hundreds of millions out of poverty, but has life really improved as much as that claim implies? As a recent study shows, life satisfaction in China has not increased over the past 20 years, which seems to suggest that increasing wealth has not brought about a correlating increase in happiness. Today we’ll be exploring why this might be the case in the countryside.

A few weeks ago I had the chance to visit several remote villages in central China. As the van bumped along rocky roads that wound over steep mountains for nearly 10 hours I started wondering how much life had really changed in many of these places over the past 60 years and whether or not these survivors would say that the countless campaigns of the past were worth it.

In the plus column– life expectancy has increased by 30 years, televisions occupy prominent places in many homes, some have washing machines, mobile phones are everywhere, famine is no longer a constant threat, and the children can read and write. This is no small accomplishment, and the Party is keen to remind us that these are all markers of a better life.

New home with a washing machine

The negative column though is much harder to quantify. The most striking thing you notice in the countryside is the almost complete lack of young people. In the dozen or so villages I visited, the only people between 10 and50 were a couple of pregnant women and a single doctor (she earned 1,000 rmb/month). These people in the middle made up a tiny fraction of those we saw. This has been true in every village I have visited since my first trip to China in 2006.

In China the family has always been the base unit, and despite Mao’s efforts to destroy the notion through collectivization, it seems that it has been China’s turn to capitalism that has most thoroughly dismantled it. One can’t help but wonder if the elderly wouldn’t be willing to trade in many of the new found conveniences in exchange for their children returning to the village.

Secondly, and I can’t emphasize this enough, work in the countryside is still incredibly difficult. Farm work is done almost exclusively by hand, the same way that it was done one hundred years ago (with the important difference that farmers now reap a much larger profit than they did under the feudal system). In the “wealthy” village we visited each farmer was entitled to roughly 1 mu of land (1/6 of an acre), which when planted with cash crops provided a decent income for many of the villagers (they could build a “modern” home within a decade and many had). In poorer villages though, many of the homes were mud and stick construction that had been improved with a concrete foundation. Despite the much touted fact that the Party has lifted hundreds of millions out of poverty, there are still clearly hundreds of millions living far from the “moderately prosperous” promises. Furthermore, it should be noted that it is the farmers who have lifted themselves out of poverty more than the Party, as few policies privilege this group.

Finally, as one of my Chinese friends from the countryside (who works in rural development) pointed out – even in these “wealthy” villages, no one is more than an accident or illness away from crushing poverty. If a single harvest is missed, or if a drought strikes the region, everything could be lost. She also told me that after visiting hundreds of these villages, and coming from one herself, that in these last few years life has become increasingly difficult for farmers. She blamed this largely on the hukou system that restricts rural residents from sharing in the social benefits that urban residents receive, and a quickly rising cost of living.

While every development metric tells us that the countryside is better off, it’s worth questioning whether or not the farmers were asked about their ideas of prosperity.

Over the next few days we’ll be exploring several other issues facing rural China and try to get a better understanding of rural life in modern China.

What does life in rural China look like?

We’re often presented with images of Beijing and Shanghai’s glittering skylines and are inundated with stories of economic success. We know that China has succeeded in bringing hundreds of millions of people out of poverty and that life in the countryside has never been better. But what does life actually look like in rural China for the nearly 700 million people that call it home? What kind of life does roughly $2.50 per day buy (this is the average rural income)?

Today I’ll be sharing some of the best photos from People’s Daily as well as from my own travels. These images would be familiar to most Chinese people.

In the countryside your school looks like this (more)

Your parents are most likely farmers (more)

Or work in some kind of small private business (more)

Visiting the clinic involves facing crowds like these (more)

You go shopping in a wet market

You watch traditional performances on holidays

Your friends don’t worry about the latest brands (yes, that is a pile of coal in the background)

And your way home looks something like this

The nearby town might look something like this

*Most of these photos are from Guangxi, and don’t represent the full diversity of the countryside, however the standard of living is fairly representative of “rural” life.

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%

How the hukou system creates AIDS villages

For the past few days we’ve been looking at migrant workers, and issues surrounding the hukou system, including left behind children, and forgotten grandparents and wives.

In China’s medical system there are a number of drugs that treat chronic conditions (like TB and AIDs), that are given out to sick patients at little or no cost. While this in itself should be applauded, this program is unfortunately tied to one’s hukou and therefore restricts the person’s movement. If the person leaves their village, it will be incredibly difficult for them to receive their much needed medications.

I believe that this policy was created with the intention of controlling the spread of diseases (which is a good intention), but that this has had some very troubling results. In the past this system was used to isolate sufferers of leprosy, today its effects can be seen in the AIDS villages of rural Henan.

If you have been following China-related news over the last decade, then this story is probably familiar, but it is one worth remembering.

In the mid-90’s local governments were desperate to increase their GDP’s, and many farmers were struggling to catch up with the urban areas that were leaving them behind. At this moment foreign drug companies hired Chinese companies to collect blood in rural areas for clinical testing. These Chinese companies (which should have been more closely monitored) reused the needles in order to save a few cents on each transaction, and spread AIDS through the countryside.

The local governments tried to cover up the epidemic, since they had been promoting blood sales as a means of getting ahead. They were also worried that businesses would not want to invest in a region afflicted with AIDS and that their agricultural sales would slump (they did). As the cover up continued, it seemed as if the gov’t’s plan was to simply wait for an entire generation to die.

Finally in the early 2000’s the story broke, and the National gov’t went to work providing medical care for villagers who tested positive for HIV. My church also applied pressure to the local gov’t to allow us to build new homes and replace their crumbling school. Despite great strides in reducing the stigma attached to AIDS, many villagers still refuse testing, since knowing that they are infected would limit any future job opportunities as well as crushing their family (AIDS orphans are often denied access to schools, even after tests show that they are not infected).

Because their hukou ties their medical treatment to this single village, their future is limited. The medical center consisted of little more than two cement rooms with a single locker of AIDS medications, and a couple of hardwood beds. Regulations required that doctors give the patient their dose daily, and it was not allowed for the doctors to give the patient a supply. Because these patients cannot survive without these pills, it is incredibly difficult for them to seek further treatment in a facility that would be better equipped.

This is an aspect of the hukou system that is not often discussed, and the way that China has in some ways institutionalized AIDS villages disgusts me. It was these people’s lack of mobility that caused them to suffer for so long unnoticed, and this system of tying treatment to locality makes it easier for these abuses to continue.

Tomorrow we’ll be looking at the rationale of the Hukou system.