"Unworthy of Care and Treatment": Cultural Devaluation and Structural Constraints to Healthcare-Seeking for Older People in Rural China.

Ruth Fitzgerald,Xiang Zou,Jing-Bao Nie

doi:10.3390/ijerph17062132

Abstract

This paper examines the experiences of seeking healthcare for rural Chinese older people, a population who experiences the multiple threats of socio-economic deprivation, marginalization, and lack of access to medical care, yet have been relatively overlooked within the existing scholarly literature. Based on ethnographical data collected from six-month fieldwork conducted in a rural primary hospital in Southern China, this paper identifies a widespread discouraging, dispiriting attitude regarding healthcare-seeking for rural older members despite the ongoing efforts of institutional reforms with a particular focus on addressing access to health services amongst rural populations. Such an attitude was expressed by older people’s families as well as the public in their narratives by devaluing older members’ health care demands as “unworthy of care and treatment” (“buzhide zhi” in Chinese). It was also internalized by older people, based on which they deployed a family-oriented health-seeking model and strategically downgraded their expectation on receiving medical care. Moreover, underpinning this discouragement and devaluation, as well as making them culturally legitimate, is the social expectation of rural older people to be enduring and restrained with health-seeking. Simultaneously, this paper highlights the sourc2e of institutional and structural impediments, as they intersect with unfavorable socio-cultural values that normalize discouragement and devaluation.

Highlights

With a rapidly aging global population, there is an urgent need to address barriers older people face in accessing health care so as to promote proactive health-seeking behaviors amongst them [1].Such need is singularly pressing in Chinese rural regions, where older members, though over half of them are living with chronic symptoms and other co-morbidities, are deprived of access to necessary health and long-term care services, such as chronic care services and medical treatments, under a persistent rural–urban disparity [2,3,4]
A sense of “worthlessness” was internalized by many older patients, based on which they strategically normalized chronic symptoms and actively avoided utilizing hospital care, a few of them expressed a repressed emotion against discouragement and desire for medical care
Based on the narratives of older patients, their families, and other parties involved in seeking health care of older people, this paper adopts a relational account that focused on the interplay between the institutional structure and local cultural systems to examine issues of health-seeking of older people in a Chinese rural locality

Summary

Introduction

With a rapidly aging global population, there is an urgent need to address barriers older people face in accessing health care so as to promote proactive health-seeking behaviors amongst them [1]. Such need is singularly pressing in Chinese rural regions, where older members, though over half of them are living with chronic symptoms and other co-morbidities, are deprived of access to necessary health and long-term care services, such as chronic care services and medical treatments, under a persistent rural–urban disparity [2,3,4].

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Discussion

Conclusion