Explaining health policy change in China between 2003 and 2009: actors, contexts and institutionalisation

The health policy change in China between 2003 and 2009 was profound. In 2003, the Chinese government changed its response to the Severe Acute Respiratory Syndrome (SARS) outbreak from initial passivity to proactivity. Following the SARS outbreak, in 2005 the Chinese government started major healthcare reforms. During this process, the health policy direction then changed from marketisation towards being more government-led. Previous research has explained health policy change mainly from bureaucratic perspectives that considered the government playing the main role. This thesis explains how and why health policy changed by focusing on three actors outside the political system. I argue that, after the SARS outbreak, experts, the media, and international organisations influenced the health policies as a ‘Policy Entrepreneurial Coalition’ (PEC), the result of which was a combination of normal and paradigmatic policy changes between 2003 and 2009. This is a qualitative study. I conducted fieldwork in China involving semi-structured interviews of policy insiders and outsiders. The policy insiders are government officials in the Ministry of Health. The policy outsiders are: domestic Chinese experts in social science, health economics, and health; external (foreign) experts who were involved in China’s health policymaking; journalists in national media and other commercialised traditional media; and representatives of international organisations in China. I also did content analysis of both policy documents and media reports. I identified three cases: the health policy change during the SARS outbreak, the initiation of the healthcare reform, and the health policy change during the healthcare reform policymaking. This thesis makes three major contributions. First, it documents the health policy change between 2003 and 2009. Second, previous studies focused on bureaucratic bargaining during policymaking in China, but I examine roles of policy outsiders, who have conventionally been neglected in China’s policy process. Third, to explain the influence of the outsiders, I examine the policymaking process within the central government and how the policy outsiders interacted with the policy insiders. In doing so, this thesis contributes to the understanding of China’s politics and policy processes

Asymmetrical Power Between Internet Giants and Users in China

We find that the asymmetry of power between the Internet giants and the users, prevalent in the digital era, is deeply problematic in China in that the two key players of big data—the Internet giants and the government—are interested in exploiting the potential of big data, but the regulation of the use and application of user data is an obstacle to their goal. The Internet giants do not value the provision of transparent privacy policies and the enforcement of the policies, while the government, being an investor in and consumer of big data services, is neither interested in nor technologically capable of regulating big data technology. Moreover, there is no unified Internet governance system to solicit cooperation within the government to regulate Internet privacy. These contextual characteristics facilitate the building of the social credit system that pays limited attention to user privacy. The findings suggest that in the discussion about the political consequences of ICT development in China, we should focus on the Internet giants and their unchecked technological power instead of only the governmen

Research, Ethics and Risk in the Authoritarian Field

research ethics; authoritarian countries; research methodology; research in the authoritarian field; risk and field research; ethics and field research; authoritarianism; advice for field research; research transparency; research methods; mental impact of field research; planning for field research; dangers of field researc

Centralization vs Decentralization in Covid-19 Responses: Lessons From China

Researchers have begun to examine whether centralized or decentralized (or federal) political systems have better handled the Covid-19 pandemic. In this paper, we probe beneath the surface of China’s political system to examine the balance between centralized and decentralized authority in China ’s handling of the pandemic. We show that after the SARS epidemic of 2003 , China adjusted the central–local balance of authority over systems to handle both the detection and early response phases of health emergencies. In an attempt to overcome problems revealed by SARS, it sought both to centralize early infectious disease reporting and to decentralize authority to respond to local health emergencies. But these adjustments in the central–local balance of authority after SARS did not change “normal times” authority relations and incentive structures in the political system. As a result, local leaders had both the authority and the incentive to prioritize tasks that determine their political advancement at the cost of containing the spread of Covid-19. China’s efforts to balance central and local authority shows just how difficult it is to get it right, especially in the early phase of a pandemic

Development and design of ultra-high ductile magnesium phosphate cement-based composite using fly ash and silica fume

Magnesium phosphate cement (MPC) is one of the most promising binders to partially replace Portland cement to reduce carbon emissions. This study attempted to develop and design an ultra-high ductile MPC-based composite (UHDMC) using fly ash (FA) and silica fume (SF). Firstly, the macro-mechanical analysis of the UHDMC indicated that both the ultimate tensile stress and the ultimate tensile strain improved greatly when the additions of FA and SF replacing MPC were 30% and 20%, respectively. Compared to the addition of SF, the addition of FA resulted in a lower ultimate tensile stress but a higher ultimate tensile strain of UHDMC. Secondly, the micro-mechanical properties of the UHDMC were examined, and the stress-based and energy-based pseudo strain hardening indices (PSHσ and PSHJ, respectively) were calculated. It was found that both PSHσ and PSHJ of the UHDMC increased as the addition of SF or FA contents replacing MPC increased. Compared to the addition of SF, the addition of FA resulted in a similar PSHσ but a higher PSHJ. A quantitative relationship between pseudo strain hardening indices and ultimate tensile strain was established to guide the design of UHDMC with a desired ultimate tensile strain. It was found that PSHσ and PSHJ should reach above 2.2 and 26.7 concurrently for the UHDMC with ultimate tensile strains up to and above 3%. Lastly, the microanalysis was conducted to reveal the influence mechanism of FA and SF on the UHDMC. This study provides some technical guidance on the development and optimal design of UHDMC

Research, Ethics and Risk in the Authoritarian Field

research ethics; authoritarian countries; research methodology; research in the authoritarian field; risk and field research; ethics and field research; authoritarianism; advice for field research; research transparency; research methods; mental impact of field research; planning for field research; dangers of field researc

Research, Ethics and Risk in the Authoritarian Field

This open access book offers a synthetic reflection on the authors’ fieldwork experiences in seven countries within the framework of ‘Authoritarianism in a Global Age’, a major comparative research project. It responds to the demand for increased attention to methodological rigor and transparency in qualitative research, and seeks to advance and practically support field research in authoritarian contexts. Without reducing the conundrums of authoritarian field research to a simple how-to guide, the book systematically reflects and reports on the authors’ combined experiences in (i) getting access to the field, (ii) assessing risk, (iii) navigating ‘red lines’, (iv) building relations with local collaborators and respondents, (v) handling the psychological pressures on field researchers, and (vi) balancing transparency and prudence in publishing research. It offers unique insights into this particularly challenging area of field research, makes explicit how the authors handled methodological challenges and ethical dilemmas, and offers recommendations where appropriate