An Anthropology of ‘Cancer Villages’: villagers' perspectives and the politics of responsibility

Abstract

This paper examines how villagers in rural Sichuan understand the development of cancer, how they attempt to make sense of why it seems widespread and of why it affects particular individuals. Lay aetiologies of cancer such as negative emotions, smoking, consuming alcohol and preserved vegetables are addressed in order to contextualise environmentally related factors, and explain why they may or not be resorted to. With reference to ethnographic examples, I argue that awareness of pollution's effects on health can only gain strength when it is consonant with locals' experience and moral parameters and when it is perceived to be productive in attracting media attention and obtaining redress from various levels of state bureaucracy.

Notes

^1. F. Wu, C. Maurer, Y. Wang, S. Xue and D. Davis, ‘Water pollution and human health in China’, Environmental Health Perspectives 107(4), (1999), p. 252.

^2. World Bank, The Cost of Pollution in China (2007), available at: http://siteresources.worldbank.org/INTEAPREGTOPENVIRONMENT/Resources/China_Cost_of_Pollution.pdf (accessed 8 August 2007).

^3. Richard Spencer, ‘Villages doomed by China's cancer rivers’, Telegraph.co.uk, (31 May 2006), available at: http://www.telegraph.co.uk/news/main.jhtml?xml = /news/2006/05/31/wchina31.xml&sSheet = /news/2006/05/31/ixnews.html (accessed 10 December 2007).

^4. Equally infamous are the ‘cancer villages’ near the Dabao Mountain mine, in Guangdong, where the Hengshi river and underground water are polluted by heavy metals following the opening of the mine. On Shangba village see Chuanming Yang and Qianhua Fang, ‘A village of death and its hopes for the future’, Nanfang News Evening Edition, (18 November 2005), available at: www.southcn.com/news/dishi/shaoguan/ ttxw/200511180238.htm (accessed 10 March 2006). On Liangqiao village see: ‘Red river brings cancer, Chinese villagers say’, CNN, (25 October 2007), available at: http://edition.cnn.com/2007/WORLD/asiapcf/10/23/pip.china.pollution/ (accessed 11 March 2007).

^5. , Dushi Nanfang, (5 November 2007), available at: http://www.nddaily.com/A/html/2007-11/05/content_299441.htm (accessed 18 November 2007). On the ‘water crisis’ see , Nanfang Dushi, (2 November 2007), available at: http://www.nddaily.com/sszt/watercrisis/ (accessed 21 November 2007).

^*Anna Lora-Wainwright is University Lecturer in the Human Geography of China at Oxford University. She holds a B.A. in Social Anthropology and an M.A. in Chinese Studies from the School of Oriental and African Studies. In 2006, she obtained a Ph.D. in Social and Cultural Anthropology from Oxford University, where she also held a lectureship in Modern Chinese Studies. Her field research and papers have focused on lay attitudes to health in rural Sichuan (China), healthcare provision, rural development and social inequalities. She is currently completing a monograph on experiences of cancer in rural China and undertaking collaborative interdisciplinary research on citizens' perception of the effects of industrial pollution on their health. This research was supported by the Arts and Humanities Research Council, The Leverhulme Trust, the Universities' China Committee in London, and the Contemporary China Study Programme (Oxford University). An earlier version of this paper was presented at the Social Science Research Council International Workshop on Environment and Health in China held in Hong Kong in April 2008. The author is grateful to the organisers and to participants for their comments. In particular, she would like to thank Nancy Chen, John Flower, Adam Frank, Jennifer Holdaway, Elisabeth Hsu, James Keeley, Pam Leonard, Frank Pieke, Bryan Tilt, Benjamin Van Rooij, Leon Wainwright, Xiang Biao, and Ye Jingzhong. Her deepest gratitude goes to the friends and informants in China and especially to Qing tongzhi and Zeng tongzhi. In order to protect informants, personal names and place names (except for Langzhong) have been changed.

^6. One Public Health Bureau official whom I interviewed in April 2007 referred to research to the north of their municipality. This initially made me wonder whether he referred to ongoing research by Oxford's Clinical Trial Service Unit (CTSU) in Cangxi county; see Jushi Chen, Liu Boqi, Pan Wenharn, Colin Campbell and Richard Peto, Diet, Lifestyle and Mortality in China (Oxford: Oxford University Press, 1990). However, his later reference to two further localities not included in the CTSU's study convinced me the research projects must have been separate. CTSU's two other sites in Sichuan were Wenjiang county and Qu county.

^7. On the unequal access to healthcare in China see: Jing Fang and Gerald Bloom, ‘China's rural health system and environment-related health risks’, Journal of Contemporary China 19(63), (2010); and Anna Lora-Wainwright, ‘“If you can walk and eat, you don't go to hospital”—the quest for healthcare in rural Sichuan’, in Jane Duckett and Beatriz Carrillo, eds, China's Changing Welfare Mix: Local Patterns of State, Community and Private Provision (forthcoming).

^8. These are topics on which I am preparing a full length monograph, titled Fighting for Breath: Cancer and Social Change in a Sichuan Village. My D.Phil. tackled some of these issues; see Anna Lora-Wainwright, Perceptions of Health, Illness and Healing in a Sichuan Village, China, D.Phil. dissertation, Oxford University, 2006. For an overview of perceptions of cancer causality amongst Sichuanese farmers see Anna Lora-Wainwright, ‘Social and cultural understandings of oesophagus and stomach cancer in rural Sichuan’, Asian and African Studies XII, (2007).

^9. As Guobin Yang argues, however, reports on cancer villages and on rural pollution in general are limited compared to the coverage of more politically innocuous issues. See Guobin Yang, ‘Brokering environment and health in China: issue entrepreneurs of the public sphere’, Journal of Contemporary China 19(63), (2010).

^10. Mengqin Liu and Chen Fu, 2007 — [‘A trade-off between development and poverty—a theoretical rethinking of the cancer villages in China’], unpublished paper presented at the Workshop on Environment, Health and Poverty in the Context of Building the New Socialist Countryside, held in Lijiang, Yunnan, 20–25 June 2007.

^11. See Fang and Bloom, ‘China's rural health system’.

^12. ‘A diary of death’, Nanfang Dushi, (5 November 2007). See also Jennifer Holdaway, ‘Environment and health in China: an introduction to an emerging research field’, Journal of Contemporary China 19(63), (2010).

^13. William P. Alford, P. Weller, Leslyn Hall, Karen R. Polenske, Yuanyuan Shen and David Zweig, ‘The human dimensions of pollution policy implementation: air quality in rural China’, Journal of Contemporary China 11(32), (2002), p. 495.

^14. William P. Alford, P. Weller, Leslyn Hall, Karen R. Polenske, Yuanyuan Shen and David Zweig, ‘The human dimensions of pollution policy implementation: air quality in rural China’, Journal of Contemporary China, p. 504.

^15. See also B. van Rooij, Regulating Land and Pollution in China, Lawmaking, Compliance, and Enforcement: Theory and Cases (Leiden: Leiden University Press, 2006) and B. van Rooij, ‘The people vs. pollution: understanding citizen action against pollution in China’, Journal of Contemporary China 19(63), (2010).

^16. Jun Jing, ‘Environmental protests in rural China’, in E. Perry and M. Selden, eds, Chinese Society: Change, Conflict and Resistance (London: Routledge, 2003).

^17. Jun Jing, ‘Environmental protests in rural China’, in E. Perry and M. Selden, eds, Chinese Society: Change, Conflict and Resistance, p. 212.

^18. Alford et al., ‘The human dimensions of pollution policy implementation’.

^19. For general literature on how public perceptions shape policy (and vice versa) see Alan Irwin, Citizen Science: A Study of People, Expertise and Sustainable Development (London: Routledge, 1995); Alan Irwin and Brian Wynne, eds, Misunderstanding Science? The Public Reconstruction of Science and Technology (Cambridge: Cambridge University Press, 2004); and Paul Slovic, ‘Public perception of risk’, Journal of Environmental Health 59(9), (1997), pp. 22–29. For analyses of these issues in China, see Yok-Shiu Lee, ‘Public environmental consciousness in China’, in Kristin Day, ed., China's Environment and the Challenge of Sustainable Development (New York: M.E. Sharpe, 2005); Bryan Tilt, ‘Perceptions of risk from industrial pollution in China: a comparison of occupational groups’, Human Organization 65(2), (2006), pp. 915–932; Bryan Tilt, ‘The political ecology of pollution enforcement in China: a case from Sichuan's rural industrial sector’, The China Quarterly 192, (2007), pp. 915–932.

^20. For a full length discussion of emotions as causes of cancer see Anna Lora-Wainwright, ‘Fighting for breath: cancer and social change in a Sichuan village’, full-length manuscript, no date.

^21. A study by Cannas Kwok and Gerard Sullivan, ‘Influence of traditional Chinese beliefs on cancer screening behaviour among Chinese-Australian women’, Journal of Advanced Nursing 54(6), (2006), pp. 691–699, highlights a similar perception of cancer as brought about by negative emotions, and worsened by thinking about the illness.

^22. Although the term is not widespread in the rest of China, the link between fiery qi and illness is common. Yanhua Zhang, Transforming Emotions with Chinese Medicine (New York: State University of New York Press, 2007), p. 95, for instance, presents a patient who describes her condition as huoqi da, literally ‘big qi fire’, which made her easily angry, and therefore sick.

^23. Although it would be wrong to equate villagers' understanding of the role of emotions in cancer causation with Chinese medical theories of cancer, it is significant that they are so similar. On emotions and illness in China see S. Davis, ‘The cosmobiological balance of the emotional and spiritual worlds: phenomenological structuralism in traditional Chinese medical thought’, Culture, Medicine and Psychiatry 20(1), (1996), pp. 83–123; A. Kleinman, Patients and Healers in the Context of Culture (London: University of California Press, 1980); A. Kleinman, Social Origins of Illness and Distress: Depression, Neurasthenia and Pain in Modern China (New Haven, CT: Yale University Press, 1986); T. Ots, ‘The angry liver, the anxious heart and the melancholy spleen: the phenomenology of perceptions in Chinese culture’, Culture, Medicine and Psychiatry 14(1), (1990), pp. 21–58; N. Sivin, ‘Emotional counter-therapy’, Medicine, Philosophy and Religion in Ancient China, (1995), pp. 1–19; F. Wu, ‘Gambling for qi: suicide and family politics in a rural North China county’, The China Journal 54, (2005), pp. 7–27. For a recent full-length monograph on emotion-related illnesses in China see Zhang, Transforming Emotions with Chinese Medicine. For a definition of qi see E. Hsu, The Transmission of Chinese Medicine (Cambridge: Cambridge University Press, 1999), pp. 67–87; M. Porkert, The Theoretical Foundations of Chinese Medicine: System of Correspondence (Cambridge, MA: MIT Press, 1974), p. 167; V. Scheid, Chinese Medicine in Contemporary China: Plurality and Synthesis (London: Duke University, 2002), pp. 48–49; N. Sivin, Traditional Medicine in Contemporary China (Centre for Chinese Studies Michigan University, 1987), p. 47; P. Unschuld, Medicine in China: a History of Ideas (London: University of California Press, 1985), p. 72.

^24. Ruth Salzberger ‘Cancer: assumptions and reality concerning delay, ignorance and fear’, in J. Loudon, ed., Social Anthropology and Medicine (London: Academic Press, 1976), pp. 154–155.

^25. Deborah Gordon, ‘Embodying illness, embodying cancer’, Culture, Medicine and Psychiatry 14(2), (1990), p. 289.

^26. The belief that mood affects cancer is also highlighted by a study of Chinese people working and living in London: I. Papadopoulos, F. Guo, S. Lees and M. Ridge, ‘An exploration of the meanings and experiences of cancer of Chinese people living and working in London’, European Journal of Cancer Care 16, (2007), pp. 424–432. Informants were found reluctant to talk about cancer (p. 428) and believed that a happy and positive mood would prolong survival (p. 429). Accordingly, many argued that cancer sufferers would not be informed by the family, because this is thought to quicken its development (p. 428).

^27. See Mary-Jo del Vecchio Good, Byron J. Good, Cynthia Schaffer and Stuart E. Lind, ‘American oncology and the discourse on hope’, Culture, Medicine and Psychiatry 14(1), (1990), pp. 59–79; Gordon, ‘Embodying illness’.

^28. I refer to my landlady as ‘elder sister’ (dajie) and to her father as gandie, literally ‘dry’ father. The role of ‘dry’ parents is roughly correspondent to that of godparents in the Christian tradition, but without the religious connotations. I have retained the Chinese term to avoid confusion.

^29. Gordon, ‘Embodying illness’.

^30. Chen et al., Diet, Lifestyle and Mortality in China; see also J. Chen, Liu Boqi, Pan Wenharn, Colin Campbell and Richard Peto, Geographic Study of Mortality, Biochemistry, Diet and Lifestyle in Rural China, (26 January 2006), available at: http://www.ctsu.ox.ac.uk/∼china/monograph/ (accessed 23 June 2006).

^31. Pat Caplan, Feasts, Fasts and Famines: Food for Thought (Providence, RI: Berg, 1992), p. 27; Pat Caplan, ‘Approaches to the study of food, health and identity’, in Food, Health and Identity (London: Routledge, 1997). For a similar study, based on research in a working-class community in Philadelphia with high cancer incidence, see Martha Balshem, ‘Cancer, control and causality: talking about cancer in a working-class community’, American Ethnologist 18(1), (1991), pp. 152–172; Martha Balshem, Cancer in the Community (Washington, DC: Smithsonian Institution, 1993). Balshem suggests that locals resisted the biomedical ideology promulgated by cancer education projects by referring to ‘defiant ancestors’ who ‘smoked two packs of cigarettes a day, ate nothing but lard and bread, never went to the doctor, and lived to the age of 93’ (p. 162).

^32. A. Kipnis, Producing Guanxi: Sentiment, Self and Subculture in a North China Village (Durham, NC: Duke University Press, 1997); M. Yang, Gift, Favours, and Banquets: The Art of Social Relationships in China (New York: Cornell University Press, 1994). For a brilliant elaboration of how perceptions of masculinity and the role of smoking in facilitating social relations hinder any attempts to quit, despite people's awareness of the harmfulness of smoking see Matthew Kohrman, ‘Smoking among doctors: governmentality, embodiment, and the diversion of blame in contemporary China’, Medical Anthropology 27(1), (2008), pp. 9–42; Matthew Kohrman, ‘Depoliticizing tobacco's exceptionality: male sociality, death, and memory-making among Chinese cigarette smokers’, The China Journal 58, (2007), pp. 85–109.

^33. Balshem, Cancer in the Community.

^34. Chen et al., Diet, Lifestyle and Mortality in China; Chen et al., Geographic Study of Mortality.

^35. Anna Lora-Wainwright, ‘Do you eat meat every day? Food, distinction and social change in contemporary rural China’, BICC Working Paper, (2007), available at: http://www.bicc.ac.uk/Portals/12/ALW%20WP%20NO.6.pdf; Anna Lora-Wainwright, ‘Of farming chemicals and cancer deaths: the politics of health in contemporary rural China’, Social Anthropology 17(1), (2009), pp. 56–73.

^36. Heavy reliance on farm chemicals (nongyao) and their effects on health are a prevalent topic of debate amongst researchers, NGOs and consumer associations. See Y. Yang, ‘Pesticides and environmental health trends in China—a China environmental health project factsheet’, China Environment Forum, (2007), available at: http://www.wilsoncenter.org/topics/docs/pesticides_feb28.pdf (accessed 15 June 2007); see also Elizabeth Economy, The River Runs Black: The Environmental Challenge to China's Future (Cornell: Cornell University Press, 2004), p. 85; R. Sanders, ‘A market road to sustainable agriculture? Ecological agriculture, green food and organic agriculture in China’, in Peter Ho and Eduard Vermeer, eds, China's Limits to Growth: Greening State and Society (Oxford: Blackwell, 2006); V. Smil, China's Past, China's Future: Energy, Food, Environment (London: RoutledgeCurzon, 2004), p. 2. According to the Organic Consumers Association ‘As much as 40% of pesticides on the market in China are sold under false brand names, and in Yunnan province, a 2002 study for the Global Greengrants Fund revealed that at least half of pesticide distributors are not legally registered or licensed’. See Organic Consumers Association, High Pesticide Residues Threaten China's Food Exports, (17 January 2003), available at: http://www.organicconsumers.org/Toxic/012003_food _safety.cfm (accessed 3 June 2008). Fears that chemicals are ‘fake’ and therefore not reliable motivate farmers to over-apply them in the hope of greater yields. See, for example, Yang, ‘Pesticides and environmental health trends in China’. Partly through overuse, partly through failure to use protective equipment, pesticide poisoning rates are worryingly high: ‘The Chinese government estimates that each year 53,300 to 123,000 people are made ill from pesticides, and 300 to 500 farmers die from pesticide exposure. Localized studies have shown much higher poisoning rates’ (Organic Consumers Association, High Pesticide Residues Threaten China's Food Exports).

^37. On rural–urban migration and its effects on rural China see: R. Murphy, How Migrant Labour is Changing Rural China (Cambridge: Cambridge University Press, 2002).

^38. Elsewhere I suggest that it is the local tendency to attribute cancer to high chemical content in the food rather than in the water as the common practice of limiting farm chemicals on crops grown for home consumption explains, as it allows more agency to farmers. See Lora-Wainwright, ‘Of farming chemicals and cancer deaths’.

^39. This is the case with cancer villages near Tianjin, or villages in Zhejiang and Guangdong provinces, and in developed areas of Jiangsu and Henan.

^40. Elizabeth Economy, ‘The great leap backward?’, Foreign Affairs, (September 2007), available at: http://www.foreignaffairs.org/20070901faessay86503/elizabeth-c-economy/the-great-leap-backward.html (accessed 1 October 2007).

^41. Pallavi Aiyar, ‘Beijing dips its toes in troubled waters’, A Times, (8 August 2007), available at: http://www.atimes.com/atimes/China/IH08Ad03.html (accessed 20 August 2007).

^42. World Bank, The Cost of Pollution in China, p. 34.

^43. On the use of the media to counter pollution and its effects on health see Guobin Yang, ‘Brokering environment and health in China’.

^44. See Channel 4, China's Poisoned Waters, available at: http://www.channel4.com/more4/news/news-opinion-feature.jsp?id = 299 (accessed 8 August 2006).

^45. See Lora-Wainwright, ‘Of farming chemicals and cancer deaths’, on how locals explained higher incidence of cancer amongst men in terms of their hard work and sacrifice for the well-being of their families.

^46. Provision of water to households is sometimes obtained through pumping water out of wells 10–20 metres deep. In most cases, water is taken out of the well with plastic buckets and carried home on shoulder poles. Whether it is pumped or carried home manually, water is stored in a container with a capacity of roughly 100 litres. In newer houses this may be a cubical concrete tiled tub, while in older houses it is a large clay vase. When needed, water is taken out of the storage container with plastic ladles and used for drinking, cooking, or emptied into metal or plastic bowl for washing (except for clothes, which are washed in the irrigation pond). Surface water gathered in irrigation ponds, most of which were dug in the 1960s and 1970s, is used to irrigate the paddies and water vegetables and hillside crops.

^47. This is in contrast to research on water pollution in Langzhong carried out by Italian NGO ASIA-ONLUS in 2004. ASIA-ONLUS found that in some villages, the nitrite-content introduced in the water cycle by the proximity of nitrogen-fertilised paddy fields to the well was ten times higher than acceptable values, according to WHO standards as well as Chinese Drinking Water Guidelines (personal communication, ASIA-ONLUS staff). When nitrite enters the bloodstream, it reacts with the haemoglobin and forms a compound called methaemoglobin. This compound reduces the blood's capacity to carry oxygen. The oxygen level decreases and babies show signs of a disease called methaemoglobinemia also known as ‘blue baby disease’.

^48. Although nitrite has not been conclusively shown to cause cancer new research in China proposes that nitrite nourishes cancer cells and a reduction of it slows cancer growth: see Kenneth Hsu, Ye Wenhua, Kong Yunhua, Li Dong and Hu Feng, Use of Hydrotransistor and De-nitrification Pond to Produce Purified Water (2007), available at: http://home.btconnect.com/KennethHsu/webdocs/Nitrite%20PNAS-19Feb2007.pdf (accessed 3 June 2008).

^49. On the toxicity of manganese and its effects on health see Agency for Toxic Substances and Disease Registry, TOxFAQs for Manganese (2001), available at: http://www.atsdr.cdc.gov/tfacts151.html#bookmark02 (accessed 3 June 2008), which states: ‘There are no human cancer data available for manganese. Exposure to high levels of manganese in food resulted in a slightly increased incidence of pancreatic tumors in male rats and thyroid tumors in male and female mice’. On excessive iron and cancer see R. Stevens Graubard, Marc S. Micozzi, Kazuo Neriishi and Baruch S. Blumberg, ‘Moderate elevation of body iron level and increased risk of cancer occurrence and death’, International Journal of Cancer 56(3), (1994), pp. 364–369.

^50. On the implementation gap in environmental governance and its effects on public health in Guangzhou see Yok-shiu F. Lee, Carlos Wing-hung Lo and Anna Ka-yin Lee, ‘Strategy misguided: the weak links between urban emission control measures, vehicular emissions, and public health in Guangzhou’, Journal of Contemporary China 19(63), (2010). On the Chinese state's role in environmental risk management see Lei Zhang and Lijin Zhong, ‘Integrating and prioritizing environmental risks in China's risk management discourse’, Journal of Contemporary China 19(63), (2010).

^51. The Ministry of Environmental Protection (MEP) has promoted public participation to deal with the limitations of top-down regulatory mechanisms, achieve more efficient implementation and expose local noncompliance. In an article published on China dialogue (a website devoted to environmental issues, especially in China), Pan Yue, a vice minister of MEP, states: ‘First of all, we must understand clearly that public participation is the right and interest of the people endowed by law. […] Involving public participation in environmental protection should be an aspect by which to evaluate political performance’. Yue Pan, ‘The environment needs public participation’, China Dialogue, (5 December 2006), available at: http://www.chinadialogue.net/article/show/single/en/604-The-environment-needs-public-participation (accessed 6 December 2006).

^52. In Kevin O'Brien and Lianjiang Li, Rightful Resistance in Rural China (Cambridge: Cambridge University Press, 2006), the authors defined ‘rightful resistance’ as people's appropriation of the central state's regulations and rhetoric to complain about failed implementation, which in turn gives them the right to protest. This strategy assumes a benevolent centre producing enforceable policies and local officials who work purely in their own personal interests, and care little about the welfare of the people. In turn, it still assumes (and hopes to exploit) a sort of revolutionary righteousness and fervour amongst the masses. It ultimately ensures that state policies themselves remain beyond scrutiny, therefore reinforcing the state's legitimacy.

^53. This argument is developed further, with reference to the same case studies, in Lora-Wainwright, ‘Of farming chemicals and cancer deaths’.