The Chinese Hukou System & its Impacts on Healthcare for Rural-to-Urban Migrants A Case Study of Tuberculosis Treatment Access in Urban Centres by Samantha Veronica Samuels 5202611 A Masters Research Paper Submitted to the Faculty of Graduate and Postdoctoral Studies in Fulfilment of the Requirements for Obtaining a Master of Arts in Globalization and International Development School of International Development & Global Studies Faculty of Social Sciences April 2017 ©Samantha Samuels, Ottawa, 2017 Table of Contents Acknowledgements ................................................................................................................................. i Abstract .................................................................................................................................................iii Résumé .................................................................................................................................................. iv List of Figures ....................................................................................................................................... vi List of Tables ........................................................................................................................................ vii Chapter 1: Introduction .......................................................................................................................... 1 1.1 Context .......................................................................................................................................... 1 1.2 New Initiatives ............................................................................................................................. 4 1.3 Problem Statement ....................................................................................................................... 5 1.4 Limitations and Contributions ..................................................................................................... 7 1.5 Research Paper: Structure ............................................................................................................ 7 Chapter 2: Literature Review & Theoretical Applications ..................................................................... 9 2.1 The Hukou System ....................................................................................................................... 9 2.1.1 The Hukou System: A Brief History ...................................................................................... 9 2.1.2 The Hukou System: Function and Practice ......................................................................... 10 2.2 Chinese Urbanization ................................................................................................................ 13 2.2.1 Rural-to-Urban Migrant Integration: The Effects of Hukou on Equal Urbanization ......... 14 2.2.2 China’s New Urbanization Plan: 2016-2020 ...................................................................... 15 2.3 China’s Healthcare System: An Historical Overview ................................................................. 17 2.3.1 Healthcare Access ............................................................................................................... 19 2.3.2 Who Benefits from Healthcare? ......................................................................................... 22 2.4 Theoretical Applications ............................................................................................................ 24 2.4.1 Critical Urban Theory ......................................................................................................... 24 2.4.2 Understanding the Right to the City & Spatial Justice ....................................................... 25 2.4.3 Confucianism ..................................................................................................................... 27 Chapter 3: Research Framework & Methodology ................................................................................ 30 3.1 Research Framework..............................................................................................................30 3.1.1 Research Questions .............................................................................................................30 3.1.2 Conceptual Model ............................................................................................................... 32 3.1.3 Conceptual Model – Explanation ........................................................................................ 35 3.2 Research Methods ...................................................................................................................... 36 3.2.1 Site & Case Study Selection ................................................................................................. 36 3.2.2 Methods .............................................................................................................................. 37 Chapter 4: Data Collection, Results, and Discussion ........................................................................... 39 4.1 Data: Collection & Results .......................................................................................................... 39 4.1.1 Tuberculosis & Migration: Overview ................................................................................... 39 4.1.2 Characteristics of New TB Migrants ................................................................................... 42 4.1.3 Factor 1: Initial Health Seeking (IHS) Behaviour ............................................................... 44 4.1.4 Factor 2: Ability to Recognize TB Symptoms ...................................................................... 46 4.1.5 Factor 3: Cost as a Deterrent Factor for Seeking Treatment ............................................... 48 4.2 Discussion & Interpretation ....................................................................................................... 51 4.2.1 Problem 1: The Hukou System – Current Agenda? ............................................................ 52 4.2.2 Problem 2: Economic Decentralization & the Structure of the Healthcare System ........... 53 4.2.3 Problem 3: Equal Healthcare Access as Right to the city – Revisiting the Conceptual Framework ................................................................................................................................... 56 Chapter 5: Conclusion – Continued Reform for a Better Urban Future .............................................. 61 5.1 Summary of the Research Findings ............................................................................................ 61 5.2 Challenges for Consideration ..................................................................................................... 63 References ............................................................................................................................................ 66 Acknowledgements I could not imagine the completion of this master’s research paper without the utmost level of support that I received from my family, friends, and colleagues. I first and foremost extend the abundance of my gratitude to my supervisor, Dr. Huhua Cao, whose enthusiasm, humour, wisdom, and never-ending support were there to motivate me when my spirit was waning. He is the most dedicated professor I know, not just to his own work, but to his students. While the committee for a master’s research paper is small, I would like to thank my second reader, Dr. Melissa Marschke Redwood, who has always been dedicated and more than open and willing to answering any questions I may have had throughout the process, as well as for teaching me about the requirements of a major research paper in my first year in the master’s program. I also owe some of this accomplishment to my employer, Steve Geffin, whose understanding and support of the completion of this paper and my degree I am exceptionally grateful for; there are few employers who fit this description. For the more detailed parts of this paper, specifically the creation of the table of contents, as well as the lists and my conceptual model, I owe many thanks to my friend Brittany MacDonald- Alleyne, whose enthusiasm and eagerness to help made this process a lot less stressful than it would otherwise have been. I would once again like to thank Dr. Cao for making me part of his “team,” as he likes to call it, and for making me an integral part of the project management and preparation process for the 2015 International Conference on Chinese and African Sustainable Urbanization, held here on i our campus. It was a most rewarding experience, the basis of many new-founded friendships, and offered many revelations for this research topic. I extend many thanks to my colleagues, and to the admin at the School of International Development and Global Studies, especially Katherine Belley and Tiffany Carrière who have been especially helpful throughout the administrative process in completion of this program. I would like to thank my mother, whose unending faith in me and encouragement was the most powerful source of inspiration when I questioned my capabilities and underestimated myself. Last, but certainly not least, I would like to thank my guiding light, Patrick Salonius, for being the energy, support, and unconditional love that I required to get through this. I know you shall be there for me throughout all triumphs