Ethnic Minority Regions Research Articles

Spatial accessibility of primary health care in China: A case study in Sichuan Province

Access to primary health care is considered a fundamental right and an important facilitator of overall population health. Township health centers (THCs) and Community health centers (CHCs) serve as central hubs of China's primary health care system and have been emphasized during recent health care reforms. Accessibility of these hubs is poorly understood and a better understanding of the current situation is essential for proper decision making. This study assesses spatial access to health care provided by primary health care institutions (THCs/CHCs) in Sichuan Province as a microcosm in China. The Nearest-Neighbor method, Enhanced Two-Step Floating Catchment Area (E2SFCA) method, and Gini Coefficient are utilized to represent travel impedance, spatial accessibility, and disparity of primary health care resources (hospital beds, doctors, and health professionals). Accessibilities and Gini Coefficients are correlated with social development indexes (GDP, ethnicity, etc.) to identify influencing factors. Spatial access to primary health care is better in southeastern Sichuan compared to northwestern Sichuan in terms of shorter travel time, higher spatial accessibility, and lower inequity. Social development indexes all showed significant correlation with county averaged spatial accessibilities/Gini Coefficients, with population density ranking top. The disparity of access to primary health care is also apparent between ethnic minority and non-minority regions. To improve spatial access to primary health care and narrow the inequity, more township health centers staffed by qualified health professionals are recommended for northwestern Sichuan. Improved road networks will also help. Among areas with insufficient primary health care, the specific counties where demographics are dominated by older people and children due to widespread rural-urban migration of the workforce, and by ethnic minorities, should be especially emphasized in future planning.

Theory and practice of bilingual education in China: lessons from Liangshan Yi autonomous prefecture

ABSTRACT Bilingual education in China’s ethnic minority regions can serve as a test case of the ability of governments to maintain linguistic pluralism in the face of rapid social change and the spread of standard national languages. In pursuit of its policy of multilingualism, since the late 1970s China has conducted ambitious programs of bilingual education for many of its 55 officially recognized shaoshu minzu, or ‘minority nationalities,’ including the Nuosu, a subgroup of the Yi minzu or ‘nationality.’ Interviews, questionnaires, and class observations in 17 elementary and secondary schools in the Liangshan Yi Autonomous Prefecture in southwestern Sichuan assessed the success or failure of bilingual education in the Standard Chinese (‘Mandarin’) and Nuosu languages. While there was still widespread support for the concept of bilingual education, results did not match expectations: few students in bilingual programs left school with functional literacy in the Nuosu language. We attribute this problem to two kinds of factors: structurally, bilingual education has failed to adapt to changing linguistic landscapes in Liangshan; and practically, programs have suffered from inadequate teacher training, outdated textbooks, and omission of Nuosu language from entrance examinations. We propose reforms that would bring bilingual education up to date for contemporary society.

Factors associated with adoption of coping strategies among Chinese patients with heart failure in ethnic minority regions.

To examine the coping strategies in patients with heart failure (HF) in the ethnic minority regions of China and to explore the factors affecting the adoption of coping strategies. Effective coping with illness is an important element that influences the adaptation and increases the patient quality of life. Although different factors have been proposed to be determinants of coping strategy, findings are inconclusive, especially when it comes to the cultural background. A cross-sectional study was performed. A total of 360 HF patients in four districts of Xinjiang were enrolled. All participants completed the Medical Coping Modes Questionnaire, the Minnesota Living with HF Questionnaire and self-management Questionnaire. Heart failure patients had lower scores in confrontation and higher scores in avoidance and acceptance resignation than patients in the Chinese norm. The multiple regression analysis revealed several factors that indicate confrontation coping including symptom management, employment status and psychological and social management, whereas religion (R2), disease duration, employment status and payment system (P2) were identified as indicators of avoidance coping. In addition, ethnicity (E1), disease duration and employment status were indicators of acceptance resignation coping. Our findings from this study suggest that HF patients in the ethnic minority regions may use less confrontation coping and more avoidance and acceptance resignation coping than patients in the Chinese norm. Moreover, the cultural background, duration of disease, quality of life and self-management play important roles in the selection of HF coping strategy. The disparities of racial/ethnic exist in coping strategy. Healthcare providers are required to better understand the role of religion in the coping process and how it contributes to the selection of coping strategies.

Health inequity on access to services in the ethnic minority regions of Northeastern Myanmar: a cross-sectional study

ObjectivesTo evaluate health inequity on access to services in the ethnic regions of Northeastern Myanmar from three points of analysis: geographic barrier, gender-based disparity and financial burden of health services.SettingA...

Social inequity in health awareness and its association with health service utilization in ethnic conflict regions in northeastern Myanmar

Civil wars, political conflicts, ethnic issues, and stagnant social development have resulted in fragile health systems in northeastern Myanmar. Low health awareness is also one of the leading contributing factors to poor health status in these regions. The present study examines the socioeconomic differentials of health awareness and the association between health awareness and health-seeking behaviors in the ethnic minority regions of northeastern Myanmar. A multistage-stratified random cluster survey was conducted in the Shan State Special Region 2 (Wa region) and the Eastern Shan State Special Region 4 (SR4) of northeastern Myanmar in 2016. A total of 1572 participants were eventually recruited in the survey. Data were collected on demographics, household, health status, health care, health knowledge and behavior, and health service utilization. Linear and logistic regression models were applied to analyze the associations. Only 3% of women and 4.11% of men were found to have satisfactory levels of health awareness. The coefficients of higher levels of health awareness with higher income, educational attainment, and marital status were 0.05, 4.70, and 3.11 in women and 0.11, 4.24, and 2.85 in men, respectively, with significance. A higher level of health awareness was associated with increased health-seeking behaviors in men (OR: 2.86, 95% CI: 1.24–6.62) and women (OR: 1.22, 95%CI: 0.46–3.22) in these regions. The less educated, low household income earners, the unmarried and farming populations were all at risk for poor health awareness. Future promotion programs should target at the above populations to promote health knowledge dissemination and health service utilization along the China-Myanmar border.

Assessing equity in the distribution of high-technology medical equipment in Guangxi: evidence from an ethnic minority region in Southern China

BackgroundHigh-technology medical equipment (HTME) are important health resources. However, there is unequal distribution of these equipment in favor of metropolis and well equipped health facilities. This study sought to examine the equity gaps in the distribution of HTME in Guangxi. The results of this study could shed light on the future HTME allocation in Guangxi Zhuang Autonomous Region.MethodsData related to HTME was sourced from a general investigation of all the hospitals of Guangxi. Concentration index was used to assess the equity status of HTME in Guangxi.ResultsOver all, the total amount of HTME in Guangxi had been increasing from 2011 to 2015, and the per million population HTME of five kinds were all increased at the same time. Meanwhile, the concentration indices ranged between 0.1020 and 0.4617. The five medical equipment were all concentrated among the rich.ConclusionsThe possession of SPECT per million population in Guangxi is lower than the national average level while it is superior to the national average level for CT, MRI, DSA and LA. The equity status in the distribution of the five medical equipment has deteriorated since 2011. In 2015, the equity status of CT was the best, while the equity status of MRI was the worst. Meanwhile, 45.1% of HTME were concentrated in Nanning, Guilin, and Liuzhou.

Redefining China’s Xinjiang policy: Rhetoric or reality?

The Ürümqi riot (2009) in Xinjiang and frequent ethnic conflicts in other ethnic minority regions like Tibet has initiated a debate on reforming China’s ethnic management, calling for the adoption of a ‘second generation’ ethnic policy. The Chinese scholars and the minzu establishment (“ethnic” lobby) failed to reach a consensus on this much discussed and debated alternative. However, the Beijing and the Xinjiang authorities framed a new slogan of achieving ‘everlasting stability’ in Xinjiang proposing inclusive development and inter-ethnic unity as the ultimate objectives of the Chinese state in Xinjiang region. In this context, the paper explores the trajectory of China’s Xinjiang policy in the post-Ürümqi riot (2009) scenario. This paper discusses the scholarly debates on the direction of ethnic policy and examines the nature of its impact on China’s Xinjiang policy in the post-2009 period. It also explores the strategies of the Chinese state in the post-2009 Xinjiang to examine whether the regime subscribes to any radical shift in its approach towards Xinjiang, complying with the ethnic unity and stability slogans raised by the regime. The paper suggests that there is a comprehensive harmonization of Uyghurs in the post- Ürümqi Xinjiang that not only refutes any radical shift in Xinjiang policy but ensures continuity and change in China’s treatment of the region.

Zidovudine- versus Tenofovir-Based Antiretroviral Therapy for the Initial Treatment of HIV Infection in the Ethnic Minority Region of Liangshan Prefecture, Sichuan Province, China.

Tenofovir (TDF)-based highly active antiretroviral therapy (HAART), as recommended by the World Health Organization guidelines for HIV-naive patients, has been limited in resource-constrained settings. The aim of this study was to evaluate the effectiveness of zidovudine-(ZDV) versus TDF-based HAART in the Yi minority region of Sichuan Province, China at a single HIV treatment center. The primary end point was the attainment of an HIV viral load <50 copies/mL. Secondary end points included change in CD4 level, adverse reactions, mortality, and sustained virologic suppression. Of the 361 total participants, recipients of TDF-based HAART were more likely to achieve viral load <50 copies/mL (60% versus 46%, odds ratio [OR] = 1.7, P = .016) as well as sustained virologic suppression (61% versus 28%, OR = 3.4, P = .001). Tenofovir (adjusted odds ratio [ORadj] = 1.71, P = .025) and female sex (ORadj = 1.93, P = .003) were identified as independent predictors of achieving HIV viral load <50 copies/mL in the multivariate logistic regression analysis. Among Chinese Yi minority HIV-infected participants, TDF-based HAART was superior to ZDV-based HAART for initial treatment of HIV infection, suggesting TDF-based HAART should be the regimen of choice in China.

An Efficiency of Resource Allocation Research Based on DEA Within 30 Ethnic Minority Autonomous Prefectures

The 12th Five-Year is an important strategic opportunity period for the economic and social development in ethnic minority regions of China. The development strategy of ethnic minority areas should adhere to Scientific Outlook on Development as a guide, suit the measure to local condition, constantly optimize and improve the efficiency of resource allocation then further achieve economic and social scientific development with the national policy support for ethnic minorities. In this paper, the evaluation index system of input and output efficiency of resource allocation in Minority Autonomous Prefecture is established, and the DEA model is the main analysis tool for comparing China's resources allocation efficiency in 30 Ethnic Minority Autonomous Prefectures, and proposes some policy recommendations on optimization of resources allocation.

Mongolian Medicine Industrial Policy Based on Industrial Chain Extension

Over the past decade, the national pharmaceutical industry has kept its momentum of rapid development under the support of the party and the national policy. However, some of the existing pharmaceutical policies have not yet been close to the actual of minority areas, especially the development of Mongolian medicine, it is difficult to promote its industrialization relying solely on single industrial policy and the enterprises’ own financial resources. Furthermore, the integration and extension of Mongolian medicine industry chain lacks the support of policy system. Therefore, to construct a complete system of Mongolian medicine industry development policy system, to establish scientific policy-making mechanism, to regulate Mongolian medicine production standards and monitoring system can help effectively integrate and extend the Mongolian medicine and pharmacy industry chain, realizing the great-leap-forward development of economy in the ethnic minority regions

Lessons on malaria control in the ethnic minority regions in Northern Myanmar along the China border, 2007-2014.

BackgroundFor many countries where malaria is endemic, the burden of malaria is high in border regions. In ethnic minority areas along the Myanmar-China border, residents have poor access to medical care for diagnosis and treatment, and there have been many malaria outbreaks in such areas. Since 2007, with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), a malaria control project was introduced to reduce the malaria burden in several ethnic minority regions.MethodsA malaria control network was established during the period from 2007 to 2014. Multiple malaria interventions, including diagnosis, treatment, distribution of LLINs and health education, were conducted to improve the accessibility and quality of malaria control services for local residents. Annual cross-sectional surveys were conducted to evaluate intervention coverage and indicators of malaria transmission.ResultsIn ethnic minority regions where a malaria control network was established, both the annual malaria incidence (19.1 per thousand per year, in 2009; 8.7, in 2014) and malaria prevalence (13.6 % in 2008; 0.43 % in 2014) decreased dramatically during the past 5–6 years. A total of 851 393 febrile patients were detected, 202 598 malaria cases (including confirmed cases and suspected cases) were treated, and 759 574 LLINs were delivered to populations at risk. Of households in 2012, 73.9 % had at least one ITNs/LLINs (vs. 28.3 %, in 2008), and 50.7 % of children less than 5 years and 50.3 % of pregnant women slept under LLINs the night prior to their visit. Additionally, malaria knowledge was improved in 68.4 % of residents.ConclusionThere has been great success in improving malaria control in these regions from 2007 to 2014. Malaria burdens have decreased, especially in KOK and WA. The continued maintenance of sustainable malaria control networks in these regions may be a long-term process, due to regional conflicts and the lack of funds, technology, and health workers. Furthermore, information and scientific support from the international community should be offered to these ethnic minority regions to uphold recent achievements.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0191-0) contains supplementary material, which is available to authorized users.

Assessing the disparity in spatial access to hospital care in ethnic minority region in Sichuan Province, China.

BackgroundThere is a great disparity in spatial accessibility to hospital care between ethnic minority and non-minority regions in China. Being one of the basic social demands, spatial access to hospital care in minority regions draws increasing attention in China in recent years. We performed this study to have a better understanding of spatial access to hospital care in ethnic minority region in China, and to guide the allocation of government investment in the future.MethodsSichuan Province, southwest of China was selected as a sample to examine the difference in hospital access between ethnic minority and non-minority region in China. We applied the shortest path analysis and the enhanced two-step floating catchment area (E2SFCA) method under ArcGIS 9.3 environment.ResultsIn Sichuan, healthcare access in ethnic minority region is worse than in non-minority region in terms of time to hospital and the value of spatial accessibility. There is relatively greater inequality in access to doctors and health professionals than in access to hospital beds. In ethnic minority region, the balance between primary, secondary, and tertiary hospitals, as well as between public and private hospitals, is less even, compared with the non-minority region. The disparity within ethnic minority region is larger than in non-minority region.ConclusionsThe combination of shortest path analysis and E2SFCA method is superior to the traditional county ratio method in assessing spatial access to healthcare. Compared to the non-minority region, ethnic minority region rely more heavily on government investment to provide healthcare. In ethnic minority region, the current distribution of primary, secondary and tertiary hospitals is inappropriate, and there is an urgent shortage of healthcare personnel. We therefore recommend that the government use preferential policies to encourage more social capital investment in ethnic minority region, use government investment as a supplement to build a more equitable healthcare market, encourage doctors to work in such regions, and push forward road construction in rural area.

Prevalence of diabetes and determinants: evidence from a minority region in People's Republic of China.

BackgroundThis study aimed to examine the prevalence of diabetes mellitus and other categories of glucose intolerance (impaired glucose tolerance and impaired fasting glucose) and explore the risk factors in an ethnic minority region, Guangxi Zhuang Autonomous Region, People’s Republic of China.MethodsA population-based study enrolled 53,270 residents older than 5 years in Guangxi, People’s Republic of China. The prevalence of diabetes was calculated using the 1999 World Health Organization (WHO) oral glucose tolerance test diagnostic criteria.ResultsAmong 53,270 individuals, the prevalence of diabetes, impaired glucose tolerance, and impaired fasting glucose was 5.96%, 7.36%, and 2.62%, respectively. Of the 3,173 individuals with diabetes mellitus, 696 (21.94%) were found to have a history of diabetes and 2,477 (78.06%) were newly diagnosed. A lower prevalence was found in Zhuang ethnic minority people compared with the majority of Han people. The prevalence was significantly associated with age, body mass index, waist-to-hip ratio, dyslipidemia, medical history of hypertension, and family history of diabetes.ConclusionGuangxi shows a rapidly rising prevalence of diabetes. Weight control and blood lipid control are important to decrease the rapidly increasing prevalence of diabetes in Guangxi, an ethnic minority region.

Perceptions and experiences of perinatal mental disorders in rural, predominantly ethnic minority communities in northern Vietnam.

BackgroundPreliminary research has suggested that perinatal mental disorders (PMDs), including post-partum depression, are prevalent in Vietnam. However the extent to which these disorders are recognized at the community level remains largely undocumented in the literature. PMDs have also never been investigated within Vietnam’s significant ethnic minority populations, who are known to bear a greater burden of maternal and infant health challenges than the ethnic majority.ObjectiveTo investigate knowledge and perceptions of PMDs and their treatments at the community level in a rural, predominantly ethnic minority region of northern Vietnam.MethodsQualitative semi-structured interviews were conducted on the topic of common PMDs. Participant groups were primary health workers (PHWs) working at local community health centers, and pregnant or postpartum women enrolled in a program for maternal and infant health that was not mental health related. Interviews included vignette scenarios that asked respondents to interpret cases of women experiencing PMDs, as well as open-ended questions about mental disorders and their treatments.ResultsTwelve PHWs and 14 perinatal women completed the study. Major themes that emerged from the interviews included (1) Family relationships impact psychological well-being, (2) Nutrition contributes to perinatal mental health, (3) Both traditional and western medicine play roles in perinatal health, (4) There was a lack of personal experience with women experiencing PMDs, (5) Descriptions of mental health symptoms focused on behaviours, and (6) Community care is the primary mental health support.ConclusionsPHWs reported having almost never treated a woman with a PMD. However, anecdotal evidence from the women interviewed suggests that there are incidents of mental disorders during the perinatal period that go largely unaddressed. Willingness to present to primary care appears to be high, and presents an opportunity to address this need by training PHWs in effective screening, treatment, and referral. Such training should account for culturally specific presentations of mental disorders as well as the importance of the patient’s social context. To the best of the author’s knowledge, this research presents the first evidence of a PMD burden within Vietnam’s ethnic minority communities.

低碳经济背景下西南沿边民族地区城镇化模式反思

低碳经济是以低能耗、低排放、低污染为基础的经济模式，民族地区城镇化是实现民族地区经济发展的必由之路。在低碳经济成为未来主要发展方式的大背景下，西南沿边民族地区已有的城镇化模式所带来的负面影响越来越严重，低碳城镇化发展道路已经成为西南沿边民族地区的必然选择，面对边界“屏蔽效应”、缺乏产业支撑、建设资金匮乏等城镇发展困境，建议西南沿边民族地区政府引导增强低碳意识、引进低碳技术、发展低碳产业、拓宽融资渠道、加强国际合作。 The low-carbon economy is a kind of economic development model which is based on low energy consumption, low emissions and low pollution, and the urbanization is the only route which must be passed to realize the economic development in ethnic minority regions. For the low-carbon economy development model will become the main development method in the future, the negative effect brought by the existing urbanization pattern of southwest border ethnic areas becomes more and more serious, as a result, the low-carbon development path of urbanization has become the inevitable choice of the southwest border ethnic areas. In the face of some developing predicaments, such as the “shielding effect”, the lack of industry support and construction funds, we should guide the governments of the southwest border ethnic areas to increase the awareness of low carbon development, bring in the low carbon technology, develop the low carbon industry, broaden the financing channels, and strengthen the international cooperation.

Ecological Degradation and Endangered Ethnicities: China's Minority Environmental Discourses as Manifested in Popular Songs

Much has been written in recent years about the environmental degradation in China's ethnic minority regions and the impact that this degradation and the policies that have been implemented to combat it have had on minority populations. To date, however, the research has focused mainly on the livelihood and lifestyle of minority herders and farmers. This article shifts the focus to the more symbolic realm of discourse and identity and to the minority educated urban elite, for whom this environmental degradation is linked primarily to ethnic politics. Based on an analysis of popular songs by famous Mongolian, Uyghur, and Tibetan musicians, along with interviews with the musicians who created them and other minority intellectuals, this article proposes that China's minority intellectuals have appropriated the global discourse of environmentalism to construct minority environmental discourses that they use to assert their ethnic identities, express ethnic concerns and aspirations, and make ethno-nationalist claims.

The influence factors analysis of households' poverty vulnerability in southwest ethnic areas of China based on the hierarchical linear model: A case study of Liangshan Yi autonomous prefecture

Currently, vulnerable poverty has become the main factor that constrains ethnic minority area development and the improvement of rural household living standards in China. This study examines the Liangshan Yi Autonomous Prefecture with reference to the existing research framework and employs a complete two-layer linear model to identify critical factors that affect rural household poverty vulnerability levels. The model results show that critical variables affecting poverty vulnerability at the household level include Laborers scale, Laborers education, House scale, Value of a house, Disease costs and Disaster loss. Of these, House scale has a negative effect on the dependent variable, while the remaining variables have positive effects. At the village level, critical variables of poverty vulnerability include Poverty village, Poverty proiect, Yi village, Village road mileage and The distance from villages to the center of towns. In using this method, a simultaneous measure for households that employs both family and village level variables was achieved, enabling an investigation of impacts across these two layers. These results are critical to the future of poverty alleviation in China's ethnic minority regions. Accordingly, some policy suggestions were provided based on this results.

The Pulse in the Machine: Automating Tibetan Diagnostic Palpation in Postsocialist Russia

AbstractThis article analyzes efforts by Soviet and present-day scientists in Russia to “rationalize” and ultimately automate the diagnostic techniques of Tibetan medicine. It tracks the institutional and conceptual histories of designing a pulse diagnostic system, a project that began in the Soviet Union in the early 1980s. It has recently been re-enlivened in Buryatia, an ethnic minority region in Southeastern Siberia, in efforts to mobilize indigenous medical practices in response to local and national public health concerns. I focus on the translational ideologies that informed efforts to develop the pulsometer as a medical imaging technology, and analyze obstacles to these efforts found at the core of the device. Scientists working on the pulsometer have systematically tried to discern whether their measurements indicate sustained bodily pathologies, or instead reflect only technological white noise, and they still recruit and rely on the embodied expertise of practitioners of Tibetan medicine to validate their findings. In so doing they reaffirm claims that Tibetan medicine in Buryatia is inextricable from the forms of knowledge and practice that their projects work to standardize. I show how the apparent failures at perfect mechanization have made the pulsometer a surprisingly productive site for creating new kinds of expert communities and forms of knowledge making.

经济对新疆地区人口迁移影响定量分析

民族地区经济对少数民族人口的流动影响具有什么样的规律，长期以来，仅限于理论套用和粗线条的定性分析，缺少客观性数据分析和历史性态势描述。本文试图使用定量方法以新疆地区为例研究经济因素对人口迁移问题的影响。首先，分析了省际间人口迁移的空间格局和历史演变。其次，建立统计学模型研究我国人口迁移圈的影响因素。本文在经典人口迁移模型分析基础上，构建了适合民族地区人口迁移的理论模型。利用Matlab对模型假设的影响因子进行相关性分析，确定模型的合理性，通过SPSS 19.0主成分回归确定模型系数，得到民族地区人口迁移的实证模型。 What kind of rules that economy in the ethnic minority regions impacts on the flow of population of ethnic minorities is ambiguous. For a long time, the qualitative analysis, limited to the theory apply and thick lines, is the main method. And this method is described with lack of objective data analysis and historical trend. This paper tries to use quantitative method to study the problem of population migration. Firstly, we analyze the spatial construction and historical changes of migration among provinces. Secondly, influence factors of population migration among provinces in China are focused on. In this paper, the suitable theory model of population migration for ethnic areas is built based on the classical population migration model analysis. By analysis on the influencing factors, the model is proved reasonable. Proposing the hypothesis of the coefficient of the model through the principal component regression analysis by MATLABA, the model is proved reasonable, and the empirical model of population migration in ethnic minority areas is got at last by SPSS 19.0.

On General Issues of Bilingual Education for Minority Ethnic Groups

Minority language literacy is an important issue in national education policy for any multi-nationality country. China sticks to the policy of safeguarding the rights and interests of ethnic minority groups to use their own languages and writing systems. In education, considering communications among different nationalities and the development of minority ethnic groups, a bilingual education policy is being implemented by insisting on teaching students in their own ethnic languages; when the mastery of their own languages has been achieved, bilingual teaching will be employed. There are three types of bilingual teaching for minority ethnic groups: teaching in their own languages, with Mandarin Chinese added; teaching in Mandarin Chinese, with minority languages added; teaching both in Mandarin Chinese and in minority languages. The biggest problems to be solved in implementing bilingual education in ethnic minority regions are the editing of language textbooks and supporting materials for minority ethnic groups and the training of ethnic minority teachers.