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National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation.

This paper attempts to explain why education fails to facilitate upward mobility for migrant children in China. By comparing a public school and a private migrant school in Shanghai, two mechanisms are found to underpin the reproduction of the class system: the ceiling effect, which is at work in public schools, and the counter-school culture, which prevails in private migrant schools. Both mechanisms might be understood as adaptations to the external circumstances of – and institutional discrimination against – migrants rather than as resistance to the prevailing institutional systems. Thus, the functioning of these mechanisms further strengthens the inequality embodied in the system. 本文试图解释为什么中国的教育无法为农民工子女提供向上流动的机会。通过比较上海的一所公办学校和农民工子弟学校, 作者发现了两种不同的阶级再生产机制: 一是存在于公办学校的天花板效应, 二是盛行于农民工子弟学校的反学校文化。这两种机制与其说是农民工子女对主流制度体系的反抗, 不如说是对外部环境和制度性歧视的适应。这些机制的存在进一步强化了嵌入在制度体系中不平等。

This article examines the parent–child relations within rural-to-urban migrant households to explore the continuations and changes in the patrilineal family system under the forces of migration and urbanization in late-socialist China. Based on ethnographic data collected between 2008 and 2015 in Shanghai, it takes a processual approach to understand son preference as a contextualized family practice and examines four aspects of parent–child relations in migrant households: reproductive strategy, childrearing practices, educational investment, and parental expectation of adult children. Through exploring intimate negotiations between migrant parents and their children over material and emotional resources at different life stages, this article demonstrates how the gendered parent–child relations in migrant households in Shanghai have been shifting away from the traditional focus on sons and gradually giving way to pragmatic adjustments and emotional redefinition under the forces of socialist institutions and capitalist markets. 本文着眼于城乡移民家庭中的亲子关系, 以此探讨中国社会主义晚期父系家庭体制在城乡移民大潮、城镇化影响下的延续及变迁。作者根据2008–2015 年间在上海田野调查所得的定性数据, 描绘了移民家庭亲子关系中的四个侧面: 生育策略、育儿实践、教育投资以及父母对成年子女的期望, 从而以动态的视角将重男轻女这一性别歧视阐释为情境化的家庭实践。通过研究第一代城乡移民和他们孩子之间在不同生活阶段就物质及情感资源分配上的亲密互动和协商, 本文指出城乡移民家庭中父母与子女的关系由于受到资本主义市场和社会主义户口制度及其框架下教育、医保、求职等壁垒的多重影响, 正在从传统的优待男生转化为更为实际的调整和情感上的再定义。

This article explores the considerations internal migrant youths in Shanghai make as they orient themselves towards the future. Unlike their parents, these youths come of age with dreams and desires that mirror those of their local middle-class peers, yet they are funnelled into the vocational educational system since they do not have local household registrations. Cast as non-aspiring and failed students that break with doxic middle-class aspirations, I contend these youths still find ways to aspire and strategize to achieve a better life. As such, I argue for a more nuanced understanding of the grounds on which vocational education is chosen. Rather than a negative choice, I argue that migrant youths who attend vocational education may do so as a compromise between potential material gains, prestige, feelings of belonging, filial piety and closeness to family and friends. Therefore, educational aspirations cannot be untied from broader desires for the future.

As spaces in public schools are limited, a substantial number of migrant children living in Chinese cities but without local hukou are enrolled in private migrant schools. This paper studies the quality of migrant schools using data collected in Shanghai in 2010 and 2012. Although students in migrant schools perform considerably worse than their counterparts in public schools, the test score difference in mathematics has almost been halved between 2010 and 2012, due to increased financial subsidy from the government. We rule out alternative explanations for the convergence in test scores. We also conduct a falsification test and find no relative changes in the performance of migrant school students based on a follow-up survey of a new cohort of students in 2015 and 2016, a period with no changes in financial subsidies to migrant schools.

This study aimed to analyze the changes in the 10 major categories of women’s healthcare services (WHSs) in Shanghai (SH) and New York City (NYC) from 1978 to 2017, and examine the relationship between these changes and maternal mortality ratio (MMR). Content analysis of available public policy documents concerning women’s health was conducted. Two indicators were designed to represent the delivery of WHSs: The essential women’s healthcare service coverage rate (ESCR) and the assessable essential healthcare service coverage rate (AESCR). Spearman correlation was used to analyze the relationship between the two indicators and MMR. In SH, the ESCR increased from 10% to 90%, AESCR increased from 0% to 90%, and MMR decreased from 24.0/100,000 to 1.01/100,000. In NYC, the ESCR increased from 0% to 80%, the AESCR increased from 0% to 60%, and the MMR decreased from 24.7/100,000 to 21.4/100,000. The MMR significantly decreased as both indicators increased (p < 0.01). Major advances have been made in women’s healthcare in both cities, with SH having a better improvement effect. A common shortcoming for both was the lack of menopausal health service provision. The promotion of women’s health still needs to receive continuous attention from governments of SH and NYC. The experiences of the two cities showed that placing WHSs among policy priorities is effective in improving service status.

In the past few decades, China has witnessed the emergence of a psychological discourse of childhood. This new discourse portrays children as persons with unique emotional needs and seeks to redefine childhood as a time of play and relaxation rather than study or toil. Drawing on the results of ethnographic fieldwork in Shanghai's schools and homes in 2004–2005, the present article describes the complex ways Shanghai's teachers and parents engage with this normalizing, developmental discourse. It argues that the rise of a psychological discourse of childhood signals a shift in Chinese modes of governing school and family life, and in current conceptualizations of the child-as-citizen and the child-as-subject in postsocialist, urban China.

The aims of this paper were to quantify the heavy metal concentrations in street dust of small towns in Shanghai suburban area compared with those in urban area, and examine their seasonal and spatial variations, and to assess their risks to water environment and local populations. Street dust samples were collected from three small towns and urban area in Shanghai in different seasons. Levels of heavy metals were determined by atomic adsorption spectrophotometer analyzer. The method of potential ecological risk index and the health risk assessment model were used to evaluate the potential risks to water bodies and local residents, respectively. The mean metal concentrations in street dust of small towns were far above soil background values but still lower than those in the urban area. No significant seasonal change was observed except for Cr, Ni, and Zn concentrations. Higher metal concentrations tended to be located in central area of towns and township roads. The integrated metal contamination was high and posed a strong potential ecological risk. Children had greater health risk than adults. The carcinogenic risk probabilities were under the acceptable level. The hazard index values to children were close to the safe level. Street dust from the studied area has been contaminated by heavy metals. The contamination of these elements is related more to the pollution source than seasonal change. The combination of the six metals may threaten the water environment and has non-cancer health risk to children, but not to adults.

China's one-child policy is a major example of social engineering and the subject of human rights concerns. Given the significance of the policy, it is important to ascertain the attitudes of Chinese citizens. We conducted interviews in 2003 with residents of Shanghai who were of childbearing age either at the policy's inception or at the time of the interview. Our respondents, who were generally well educated, did not perceive the policy as extraordinary when it was introduced; resignation to one more intrusive government regulation was mixed with understanding and even approval of the policy. People talked about the political and social context, demographic concerns, family economic strategy, and the results of government-engineered gender equality. Among the young interviewees, the context has changed from a population striving to get by under tight government control to a much richer population that is upwardly mobile and perceives their local government to be basically beneficial. The one-child family is considered normal; few are still concerned with the policy per se, while others see it as unnecessary. The one-child policy seems to reflect Shanghainese current preferences; its status as a legal requirement may be largely irrelevant.