FOODWAYS AND THE FLOATING POPULATION: DIET AND RURAL-TO- URBAN MIGRATION IN NANJING, CHINA A THESIS SUBMITTED TO THE FACULTY OF UNIVERSITY OF MINNESOTA BY ROBERT SKORO, BA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE PROFESSOR CHERY SMITH, PHD, MPH, RD, ADVISER OCTOBER 2013 © Robert Alden Skoro 2013 ACKNOWLEDGEMENTS I would like to thank my advisor, Dr. Chery Smith, for several things: first, for recognizing the opportunity at hand, the rare chance to conduct graduate research in an international setting; second, for her thorough methodological guidance before, during, and after our data collection; and third, for her insight and patience in helping me produce the best-written analyses possible. Thanks are also due to our collaborators at Nanjing Medical University, Dr. Qing Feng and her student Yixu Jin. Together, they provided an array of different resources to us during our fieldwork which were key to our data collection. Further insights for this thesis have come from other faculty and peers at the University of Minnesota: my thesis committee members, Dr. Ann Waltner and Dr. Joanne Slavin; Dr. Liping Wang, Dr. Jason McGrath, and Dr. Polly Szartrowski, all of whom provided education and guidance at different points in the process of preparing this thesis, furthering my understanding of Chinese language and culture. Thanks also to my classmate Amy (Tuo) Chen, whose interest in my project and ongoing discussion of translation issues helped me read between the (transcript) lines when it was appropriate, and avoid doing so when it was not. Last, and certainly not least, I would like to thank my wife, Ellen; our daughter, Ruby; and our families for their support during this process. They provided the indispensible support for travel, research, and writing needed to complete this project. I am forever grateful for their strength and sacrifice. i DEDICATION This thesis is dedicated to Sam Mitchell and Yuan Lu, for introducing me to China and so much more. ii TABLE OF CONTENTS Acknowledgements ................................................................................................... i Table of Contents ...................................................................................................... iii List of Tables ............................................................................................................ iv List of Figures ........................................................................................................... v Note Concerning Translation of Chinese Terms ...................................................... vii INTRODUCTION ................................................................................................... 1 CHAPTER ONE: LITERATURE REVIEW ....................................................... 6 Part 1: China’s Last One Hundred Years ..................................................... 7 Part 2: Socioeconomic Development and Diseases of Affluence in Contemporary China ...................................................................................... 11 Obesity in China ........................................................................................... 12 Type 2 Diabetes in China .............................................................................. 13 Income, Urbanicity, and BMI in China ........................................................ 14 Changes in Food Consumption Patterns ....................................................... 16 Changes in Consumer Demographics ........................................................... 18 Part 3: Internal Migration in China: Hukou and The Floating Population ................................................................................. 22 Demographic Characteristics of China’s Floating Population ...................... 25 Objectives, Goals, and Risks of Migration ................................................... 28 Health Care and Insurance for the Floating Population ................................ 32 Summary of Literature Review ..................................................................... 33 References ..................................................................................................... 36 CHAPTER TWO: OVERVIEW OF RESEARCH STUDY ............................... 50 Rationale for Research Study Based on Literature Review .......................... 51 Project Hypothesis and Research Questions ................................................. 53 Overview of Research Study Design and Methodology ............................... 55 CHAPTER THREE: FOODWAYS AND THE FLOATING POPULATION: DIET AND RURAL-TO-URBAN MIGRATION IN NANJING, CHINA ........ 57 Introduction ................................................................................................... 58 Methods ......................................................................................................... 61 Results ........................................................................................................... 64 Qualitative Themes ....................................................................................... 67 Discussion ..................................................................................................... 93 Conclusion .................................................................................................... 103 iii References ..................................................................................................... 106 Table 1: Sample Characteristics of Study Participants in Nanjing ....... 115 Figure 1: Correlation of BMI and Years Lived in Nanjing (With Income Quintiles) Among Migrant Workers ........................................... 116 CHAPTER FOUR: DISCOURSE IN THE DIET: FOODWAYS, THE FLOATING POPULATION, AND SUZHI IN NANJING ....................................................... 117 Introduction: The Floating Population in China’s Nutrition Transition ....... 118 Nanjing Sample ............................................................................................. 121 Migrants and Discourse ................................................................................ 124 Suzhi and Nutrition Knowledge .................................................................... 130 Conclusion .................................................................................................... 138 References ..................................................................................................... 140 CHAPTER FIVE: SUMMARY OF RESULTS, CONCLUSIONS, AND IMPLICATIONS .......................................................................................... 146 Results Summary to Address Research Hypothesis and Objectives ............ 147 Conclusions and Implications ....................................................................... 153 References ..................................................................................................... 157 COMPREHENSIVE BIBLIOGRAPHY .............................................................. 158 APPENDIX ........................................................................................................... 175 Statement of Informed Consent .................................................................... 176 Survey Instrument ......................................................................................... 179 Focus Group Questions and Prompts ............................................................ 183 iv v LIST OF TABLES Table 1: Sample Characteristics of Study Participants in Nanjing .............. 110 vi LIST OF FIGURES Figure 1: Correlation of BMI and Years Lived in Nanjing (With Income Quintiles) Among Migrant Workers ......................................................................................... 111 vii NOTE CONCERNING TRANSLATION OF CHINESE TERMS: All research was conducted in dialects of Mandarin Chinese, with written forms of communication using Simplified Chinese. Throughout this thesis, best efforts have been made to maintain consistency in the way in which Chinese terms or concepts are used. Italicized terms are the pinyin commonly used to alphabetize written and spoken Chinese for an English readership. Chapter four provides transcript excerpts, which are verbatim presentations of portions of conversations. These passages include both Simplified Chinese and English translations, leaving no cause for the inclusion of pinyin. viii INTRODUCTION: Since its founding in 1949, the history of the People’s Republic of China (PRC) has been one punctuated by eras of exceptional diversity with regards to their political, economic, and social features. In just over sixty years, the PRC has changed from one of the more austere and violent iterations of communism in the twentieth century, largely rural and closed to much of the outside world, to a global spectacle of perennial double- digit economic growth, teeming with skyscrapers and prolific consumption of domestic and international goods in what even the ruling Chinese Communist Party (CCP) has come to designate a “socialist market economy” (Gamer, 2008; Tong & Wong, 2008). Consumption is certainly the central theme in China’s most current epoch, and it calls forth the unparalleled significance of food–both material and symbolic–that serves as the connective thread through these highly divergent eras (Anderson, 1988; Farquhar, 2002; Kipnis, 1997; Yan, 2000; Yue, 1999). While the rapid growth in automobile, real estate, or consumer goods markets are often