Berkeley Brings CBPR Model to China

In an initiative to improve the health and well-being of young migrant workers in China, researchers at UC Berkeley have brought a community-based participatory research pioneered at Berkeley to the factories of the Changzhou Xinbei Development Zone.

The researchers are working in partnership with the Chinese government and community organizations and international foundations, including Pathfinder International, the Asia Foundation, the Levi Strauss Foundation and Oxfam. Together, they have launched the China Worker Wellness Project—a participatory program that engages workers, factory owners, government officials, and health service providers in a collaborative process to identify and address the health and social needs of the workers.“I think we have a win-win model: The workers win and the factory-owners and managers get happier, healthier, more effective workers,” says Linda Neuhauser, a UC Berkeley School of Public Health clinical professor who is the Berkeley principal investigator for the project. “We have the potential to improve the lives of millions of workers and improve the Chinese economy at the same time.”China is currently experiencing one of the largest demographic shifts in recorded history, with 100-200 million rural residents migrating to urban areas for work—largely to new economic development zones. Most of these migrant workers are under 30, with low educational levels, low health literacy, and little experience with urban environments. Though they live on site in the factory zones for the majority of the year, they are not entitled to the benefits of local residency.“Migrant workers are one of the most vulnerable populations in China,” says Eve Lee, senior advisor for Pathfinder International’s China program. “They are isolated in their new adopted cities and often struggle to get access to local health, social and educational services because they are not residents”. As a group, migrant workers report a number of health concerns related to sexual and reproductive health, mental health, occupational safety, and other issues—a poor health profile that has resulted in high rates of absenteeism and workplace injuries within these factory zones, as well as a worker turnover rate as high as 50 percent a month.“These workers are leaving their parents, spouses, and kids to go many days’ travel away where they don’t speak the local dialect or know the area. They are uprooted in the deepest sense and you can feel their disorientation and isolation when you visit,” says Neuhauser. Chinese workers’ health first garnered international attention in 2010 when a string of 14 suicides at Taiwanese-owned Foxconn manufacturing sites exposed poor working conditions and prevalent depression and isolation among the Chinese factory workers. While “suicide netting” and other programs have since been implemented on some sites, many of the interventions have proved unsuccessful, spurring Chinese policymakers to seek a new approach. The China Wellness project will employ a sustainable, participatory approach to health that engages community, government, university, and business stakeholders, as well as the workers themselves, in a collaborative process. Developed over the past 20 years at Health Research for Action, a center at the UC Berkeley School of Public Health, the wellness model is an evidence-based approach that empowers community members to take more control over issues in their lives, such as work, personal relationships, access to health care, and educational opportunities.

A key outcome of this process has been the creation of a Wellness Guide that comprehensively addresses health and wellbeing, including areas such as family planning, emotional health, and worksite safety. Wellness Guides have now successfully reached more than 40 million people globally, with research showing high rates of satisfaction, significant knowledge gains, and positive behavior changes as a result.Since 2011, Lee and Neuhauser have been helping to familiarize key stakeholders in the Changzhou Xinbei Development Zone with the concept of wellness and its focus on the social determinants of health.“We have gotten a lot of positive feedback from our partners in China,” Neuhauser says. “They say the wellness model fits with the holistic focus of traditional Chinese medicine, which has in part been lost in Chinese health care with the importation of western medical models.”So far, the China Family Planning Association, the Nanjing College for Population Management Program, the China Population and Development Research Center, and local health and social service organizations have all begun working on the project. Because the government funds the vast majority of health and social programs in China, Lee says that winning governmental support is essential. This will require a balance between the top-down processes of government with the inherently bottom-up nature of participatory research methods.

Over the next two years, participants will conduct research, plan, and implement project activities, evaluate results, and develop strategies to scale up the project to other development zones. Pathfinder International and UC Berkeley have committed to providing technical assistance throughout the process.The participatory process has already spurred the development of two innovative strategies to help migrant workers: a worker-designed Wellness Guide, and the creation of “Wellness Houses” in each participating factory, where workers can come to socialize, solve problems, and access health, social, and educational services.If the program is a success, Neuhauser says the Chinese government is interested in scaling up rapidly, potentially covering millions of migrants.