WHAT TO KNOW
CULTURALLY
Chinese culture is one of the world's oldest cultures, tracing back thousands of years. Important characteristics of Chinese culture include family structure, traditions and holidays, architecture, martial arts, religion, history, communication, laws, and healthcare.
Family Structure:
(American Enterprise Institute, 2019)
Family is considered to be one of the most central institutions for people in China with the belief that the family has a collective identity and reputation. These beliefs are founded on Confucian values, however Confucian roles are not strictly adhered to anymore. Despite this, it is still expected that they will obey parents and honor the elders within the family in accordance with filial piety (Scroope & Evason, 2017). Loyalty to family is very important as the interest of the family should come before their individual interests.
Cultural Traditions:
Holidays
Chinese New Year, also known as Spring Festival, celebrates the upcoming year with hopes of luck and prosperity. Festivities include holding a family dinner, the exchange of red envelopes with money, fireworks, dancing, and elaborate decorations. Many will hang red items such as red lanterns and decorations around for luck (Peppas, 2012).
Hanging a red lantern in front of the door is believed to drive off bad luck (Peppas, 2012).
Feng Shui
The Baqua is an eight-sided symbol used as a map to show which corner and edge of a space represents a specific life energy to achieve a balanced feng shui (One World Nations Online, 2016)
An ancient Chinese practice or art using both the laws of heaven and earth to effect the flow of life energy, or Chi, which is made of yin and yang elements. "Feng" literally means "wind" and "shui" means "water" (Bruin, 2008). It is believed that by balancing yin and yang elements, people can improve the flow of positive chi in their lives and keep the negative chi away. This balance can be achieved by arranging buildings, objects, and space in an environment to achieve harmony.
A bird's eye view of Tekes County in west China's Xinjiang Uygur Region (China.org.cn, 2016).
Chinese Martial Arts
For centuries, Chinese martial arts has been an integral aspect of Chinese culture. It is believed to have been developed for self-defense, hunting techniques, and military training in ancient China. Current practice of chinese martial arts provides a unique combination of exercise, self-defense, self-discipline, and art. It focuses on achieving a balance between the internal Yin, referring to control of your breathing, your qi which is your life force, and your mind, and the external Yang, referring to muscle strength. Today, Chinese martial arts consists of a wide variety of types, each with its own distinctive techniques. Some of these types include Shaolin Kung Fu, Tai Chi, Xingyiquan, and Wing Chun (An & Hong, 2018).
Older individuals often practice Tai Chi to improve their balance and mental health.
Religious Beliefs:
Confucianism, developed in 5th century B.C.E, was generally adhered to for several centuries, but is not affiliated with China’s government. Confucianism addresses morals and ethics regarding one’s relationships and roles with other individuals and within a society. Traditions, rituals, values, and morals contribute to “social mores" or behavioral standards. Confucius discussed moral obligations based on a value of “co-humanity” or human interaction, especially within a family or society (Berling, n.d.). This laid a foundation for filial piety which is a widely accepted value across China.
The Chinese Constitution includes the right to Religious freedom, but religious practice is limited by the Chinese Communist Party (CCP). The CCP is officially atheist, and members of the CCP face sanctions for practicing religions. The CCP does recognize and monitor certain commonly practiced religions including Buddhism, Christianity, Doaism, and Islam (Albert & Maizland, 2020).
China has a high rate of religious persecution, especially against Muslims and Christians (Open Doors USA, 2021). The CCP attempts to limit the practice of religions by limiting access to social media, monitoring church activities, sanctioning certain religious activities, and even passing laws to limit religious practices. The banning of the Online Bible sales is an example of one of these laws. Muslims and Christians also face violence and detainment for unauthorized religious practices (Open Doors USA, 2021).
Communication:
Mandarin Chinese is the official language of China and is the most widely spoken Chinese dialect across the world (Bolotnikov, n.d.). Indirect communication is crucial and includes attentiveness to tone of voice, posture, and seeking clarification (Scroope & Evason, 2017).
In Mandarin Chinese, honorifics are often used when addressing elderly or speaking about them. This is a sign of respect to one’s elders. Traditional Chinese culture esteems the elderly.
Rather than addressing elderly men and women by their name, there are titles (honorifics) used to show politeness and respect towards one’s elders. There are many titles for one’s elders, and these titles depend on context and relationship.
(MDBG, 2021)
Laws:
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Filial Piety Law: The Protection of the Rights and Interests of Elderly People obligates children to regularly visit their parents, care for them, and avoid negligence acts towards them.
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One Child Policy: Limits each family to have only one child as an effort to stop the rapidly growing population. Intrauterine devices were mandated for women who had already birthed their first child. Women who already had multiple children were subject to sterilization. This policy lead to the 4:2:1 family structure concerns.
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Two Child Policy: Limits each family to have only two children.
(Dong, 2016)
(History.com Editors, 2019)
Healthcare:
In 2019, almost 75% of older people in China (aged 60 years and over) experienced chronic, noncommunicable illnesses such as hypertension, heart disease, stroke, chronic obstructive pulmonary disease, and type 2 diabetes. Behavioral risks including smoking, alcohol consumption, sedentary behavior and poor dietary intake contribute significantly to these conditions (Thomas et al., 2020).
Acupuncture points are believed to stimulate the body's natural healing abilities and promote physical and emotional well-being.
Historically, traditional Chinese medicine is based on the concept of feng shui and the idea that health is achieved from a balance of Chi in the body. This practice is thousands of years old and has changed little over centuries.
Traditional Chinese medicine treatment seeks to restore balance between the internal body organs and the external elements of earth, fire, water, wood, and metal. It is commonly practiced in China through
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acupuncture
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moxibustion - the burning of herbal leaves on or near the body
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cupping - the use of warmed glass jars to create suction on certain points of the body
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massage
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herbal remedies
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movement and concentration exercises - such as tai chi
(Johns Hopkins Medicine, 2021).
Traditional vs Western Medicine
Today, there are traditional Chinese medicine hospitals that treat patients with traditional Chinese medicine doctors, services, and products to maintain public health. To protect traditional medicine as an important part of Chinese cultural heritage and provide affordable medical services, the central government initiated a traditional medicine hospital system in 1954 (Wang et al., 2017). Although there is much respect for the practice of traditional Chinese medicine, the dominant form of medicine in China today is Western medicine. In China, traditional medicine as well as Western medicine play important roles in healthcare and there is a growing trend to support an integrative approach, combining traditional and Western medicine (Wang & Zhang, 2017).
Medical Coverage
China provides universal coverage through publicly funded basic medical insurance, which covers primary, specialty, hospital, and mental health care, as well as prescription drugs and traditional Chinese medicine. Urban employees are required and rural residents are encouraged to enroll in Urban-Rural Resident Basic Medical Insurance and urban residents without formal jobs, including children, the elderly, and the self-employed have the option for voluntary Urban Resident Basic Medical Insurance. China’s central government has overall responsibility for national health legislation, policy, and administration and believes that every citizen is entitled to receive basic health care services. In China, there is private health insurance that is purchased primarily by higher-income individuals to cover deductibles, copayments, as well as coverage for expensive services not paid for by public insurance (Tikkanen et al., 2020).
China has recently made remarkable progress in recent mental health reform through the creation of the National Mental Health Working Plan (2015–2020). By 2020, the plan sought to deliver more coordinated mental health services, expand and strengthen the workforce, ensure that over 80% of patients with “severe” mental illnesses are supervised and over 80% of people with schizophrenia receive treatment (Hua & Zhao, 2015). However, more prevalent mental disorders such as depression largely goes untreated due to low insurance coverage for mental health services and societal stigma (Liang et al., 2018). There are also disparities for mental health coverage between rural and urban areas (Patel et al., 2016).
Mental Health
'Healthy China' Initiative
The State Council, China's cabinet, has issued a new guideline to implement the country's Healthy China initiative.
The plan gives suggestions on how individuals, families and society can improve overall health by focusing on disease prevention and health promotion, the guideline proposed comprehensive intervention on health-influencing factors, including health knowledge, rational diet, fitness programs, tobacco control, and healthy environment. New to this plan is a design to promote mental health, by ensuring enough sleep, giving full play to the role of mental healthcare institutions, and enhancing mental health education among new employees and students to reduce the stigma of seeking help (Cao et al., 2018).
The Healthy China 2030 initiative gives suggestions on how individuals, families and society can improve overall health (Healthy China 2030, 2021).
Social Determinants of Health:
According to the US Department of Health and Human Services (2021), social determinants of health are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Within the context of China, geographical and socioeconomic inequalities, along with the lack of a balanced national social support system, cause a high variance of health outcomes among the regions and the older people of China.
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Urbanization relocation in China involves moving the family as a unit, including elder family members who have to contend with the stress of adapting to a new social network and living environment (Wu et al., 2016). As China’s new urban older adults are forced to move, these sudden changes in living environment and lifestyle become major stressful life events, greatly challenging them both physically and psychologically. Older people can experience symptoms including anxiety, fear, depression, and insecurity, which are manifested in disturbances such as deep sadness, insomnia, and weight changes (He et al., 2020).
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One of the largest health disparities in China is the inequality between rural and urban healthcare. In particular, rural patients face barriers to equal resources to healthcare access. There are less than half as many medical institution beds and licensed physicians per 1,000 citizens in rural areas compared to urban areas. Village doctors who practice in rural clinics receive unstandardized training, thus the quality of care is substandard (Ruan, 2017).
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Low literacy is common in Hong Kong and China, especially among the females and the elderly, which are populations who tend to experience more chronic illnesses (Lam et al., 2004). Females were denied educational opportunities due to their oppressed social status, confining them to roles of wifehood and motherhood which did not warrant formal education. Low literacy may be an important barrier to receiving adequate health care, because patients must be able to understand appointment slips, medicine labels, directions for self-care, informed consent forms, and health education material.
There are less than half as many medical institution beds and licensed physicians per 1,000 citizens in rural areas compared to urban areas (Ruan, 2017)
Socioeconomic Considerations:
Similar to those in the United States, it is found that
individuals who live in more rural areas, or certain regions
of the country, have increased levels of poor health in the
elderly due to limited access to economic, medical and
educational resources (Fan et al., 2019).
Studies show that individuals of a higher socioeconomic
status (higher income and education) have better health
than individuals who have low-income.
“About 97.6% of China's elderly health inequalities are
not caused by inter-provincial differences, but by factors
such as age, gender, culture, marriage, social interaction
and frequency of exercise at the individual level... individual
economic state is the main determinant of elderly health
inequality,” (Fan et al., 2019, Introduction section).
Although geographical differences allot for 2.4% of China’s elderly health inequalities, provincial factors should be considered as the country continues to change socially and economically and keep rural, low-income areas in mind when creating future health policies.
(Fan et al., 2019)