I’m done. I just finished my sixth and final written exam, thus ending year one of my Masters of Science in Public Health. I’m officially an expert — on eye strain and multitasking. But I discovered a wonderful thing along the way — I really like the subject matter. I’ve immersed myself in a new way of thinking about health, and of the root cause of illness. This whole concept of inequalities of health, and of a social gradient that underlines health issues with just as much statistical risk as “lifestyle” risks (such as exercise and smoking), is a very interesting and new concept to me.
Along the way, I’ve started to wonder: what about Beijing expats? Is there a social gradient among us that underlines health differences? Is there an invisible population living along the edges and just scraping by, at a higher risk of diseases? For example, do poorer expats living in lower income, older hutong complexes have more exposure to indoor air pollutants and building hazards and local street foods, causing more illness than someone living large in Palm Springs apartments? Does a commuter taking a bike or the subway have more lung and heart disease than someone chauffeured to work in a company car?
To find out answers to such questions, we would need to first find out if the underlying assumption is true: are there health differences among expats? In other words, are there different levels of acute and chronic disease among different socioeconomic levels among Beijing expats? Also, is there less access to health care at different levels? I think there is, and I think we don’t know a lot about this inequality, nor about these groups — and perhaps it’s time we did.
For example, I know that my expat clinic, as much as the others, provides solid service but can be extremely expensive for those who don’t have the luxury of insurance. So, what about all those expats without insurance, where do they go? I’m sure that many traveling students may not have insurance, but there are also plenty of English teachers here, or “local hires” at Chinese companies or NGOs, who don’t get insurance in their benefits. A trip to an expat clinic may be out of the question for them, so they may be navigating through local Chinese clinics — and their health outcomes may be very different. Not automatically worse, or better: in either case, I’d like to see some data.
I would love to find out everyone’s stories, and to find out just how big — if any — this difference really is.
How To Find Out?
The first step may be to simply start a discussion on websites like this, to see how all my readers feel about this. Then, we could maybe do focus groups, perhaps mediated by the Beijing Healthcare Forum.
I think a big step would be a questionnaire survey. Run via the internet and open to all Beijing expats, a survey can be a terrific snapshot of the health of our community — and may reveal some neglected inequalities that could be addressed.
Fortunately, I need to find a project for my MsPH thesis, and I may take on such a project. I would love to have some help on this, from colleagues, students and others, so let me know if you’re interested (leave a comment below, or email me at [email protected]).
Down The Line…
So let’s say that we did discover that 15% of the expats had no insurance and were skipping doctor visits or unable to cover their Western meds — what could we do about it? That could be a good debate among us. For example, maybe we expat clinics could be more creative with special insurance, or discounts, to such groups. Or, we could help local clinics and hospitals set up more satellite clinics for foreigners, especially on the west side of Beijing. But that still wouldn’t address the more fundamental factors, such as not having universal health insurance, or improved indoor and outdoor pollution, among many others.
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