lora-wainwright, anna. 2010. an anthropology of ‘cancer villages’- villagers’ perspectives and...

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An Anthropology of ‘Cancer Villages’:villagers' perspectives and the politicsof responsibilityAnna Lora-Wainwright

Available online: 27 Jan 2010

To cite this article: Anna Lora-Wainwright (2010): An Anthropology of ‘Cancer Villages’: villagers'perspectives and the politics of responsibility, Journal of Contemporary China, 19:63, 79-99

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An Anthropology of ‘Cancer Villages’:villagers’ perspectives and the politicsof responsibilityANNA LORA-WAINWRIGHT*

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.

These days, people here keep dying of cancer. Who knows why? There are many possible

reasons. But what you can say for sure is that once you get it you can only wait to die.

There is no cure. (Uncle Zeng, 53 years old, Baoma village, June 2005)

Already a decade ago, researchers stated that cancer deaths ‘have doubled since the1970s, and are now the leading causes of mortality in rural China’.1 More recently, aWorld Bank report assessing the cost of pollution in China again identified cancer asthe main cause of death, showing also that mortality rates for cancers associated with

* Anna Lora-Wainwright is University Lecturer in the Human Geography of China at Oxford University. Sheholds a B.A. in Social Anthropology and an M.A. in Chinese Studies from the School of Oriental and AfricanStudies. In 2006, she obtained a Ph.D. in Social and Cultural Anthropology from Oxford University, where shealso held a lectureship in Modern Chinese Studies. Her field research and papers have focused on lay attitudes tohealth in rural Sichuan (China), healthcare provision, rural development and social inequalities. She is currentlycompleting a monograph on experiences of cancer in rural China and undertaking collaborative interdisciplinaryresearch on citizens’ perception of the effects of industrial pollution on their health. This research was supportedby the Arts and Humanities Research Council, The Leverhulme Trust, the Universities’ China Committee inLondon, and the Contemporary China Study Programme (Oxford University). An earlier version of this paper waspresented at the Social Science Research Council International Workshop on Environment and Health in Chinaheld 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, andYe Jingzhong. Her deepest gratitude goes to the friends and informants in China and especially to Qing tongzhiand Zeng tongzhi. In order to protect informants, personal names and place names (except for Langzhong) havebeen changed.

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.

Journal of Contemporary China (2010), 19(63), January, 79–99

ISSN 1067-0564 print/ 1469-9400 online/10/630079–21 q 2010 Taylor & FrancisDOI: 10.1080/10670560903335785

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water pollution, such as liver and stomach cancer, are well above the world average.2

Reports about ‘cancer villages’ in China have appeared with increasing frequency inChinese and Western media. All these accounts outline a strong connection betweeneconomic growth, pollution and cancer. ‘Cancer villages’ are the result of economicprogress, leading to the proliferation of chemical factories, causing death in villagessuch as Xiditou and Liukuaizhuang, near Tianjin in northern China. Writing for TheTelegraph (UK), Richard Spencer3 states ‘As the effects of economic reformsrippled through the 1980s, local governments eagerly built new factories but hadlittle experience of environmental controls’.4 In most cases, the continuing misery isattributed to official corruption which poses an obstacle to implementingenvironmental regulations. For instance, a recent article examining three cancervillages (in Shandong, Jiangsu and Zhejiang) published in Nanfang Wang as part of areport on water pollution, documents how villagers’ attempts at seeking redressfailed due to insufficient evidence or through uncooperative officials bribed bypolluting industries.5 But how do people experience and understand cancer in areaswhere there is no agreement on its cause? Who or what do they blame?

Researching cancer was not my original intention. In May 2004 I formally enrolledas a visiting researcher at Sichuan University, hoping to carry out 15 months ofethnographic fieldwork in a rural part of the province. My Chinese supervisorselected the area of Langzhong (North-East Sichuan) as a location where, with thehelp of his connections, I would be allowed to reside in a village as I had requested.The following month (June 2004) I settled with a family of farmers and registered as aresident of Baoma village (a pseudonym), six kilometres from Langzhong city, whereI lived until September 2005. I planned to conduct an anthropological study of howfarmers understand health and illness, how they make decisions about treatmentwithin the family, and what home-based knowledge and practices are widespread forcommon illnesses. As my research unfolded however, cancer occupied an increasingamount of my time and attention. Doctors and local residents alike highlighted canceras a major local killer in the Langzhong area. Baoma’s former barefoot doctor turnedvillage doctor could list over 30 people who had died of cancer in the past 20 years.I counted 11 from 2004 to 2007 in Baoma, with a population of 500. In aneighbouring village unit (dui or zu) of 80 residents I call Meishan, nine people diedof cancer during the same time span.

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?xml¼ /news/2006/05/31/wchina31.xml&sSheet¼ /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 Hengshiriver and underground water are polluted by heavy metals following the opening of the mine. On Shangba village seeChuanming 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 10March 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 November2007).

ANNA LORA-WAINWRIGHT

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The aim of this paper is not to debate the existence of cancer villages, or to identifymy research location as one. In so far as Langzhong has been identified since the1980s as an area with a high rate of cancer, and that industry at that time (and stillnow) was minimal, local settlements are extremely unlikely to be ‘cancer villages’according to the conventional industrial pollution paradigm. Collecting anyquantitative data on cancer in the area proved extremely difficult. Although theBaoma village doctor, doctors in the municipal hospital and Public Health Bureaustaff were aware of research on cancer in Langzhong in the 1980s, they claimed tohave no records of such research. They further explained that even if they locatedsuch records, they would probably be classified as ‘internal’ (neibu) and thereforeinaccessible to me. All they could tell me was that such research had attributed highcancer rates to consumption of salt-preserved meat and vegetables, but was laterdismissed.6 I was confronted with a similar response when I requested access tohospital records on cancer patients. I was told that they were not comprehensive andthat providing me with this information would be very troublesome (hen mafan).At any rate, given that most cancer sufferers do not opt for hospitalisation and avoidsurgery, hospital records would have been severe underestimates.7

My attempts to gather a historical sense of numbers of cancer cases in Baoma werealso frustrated by the changing terms locals use to describe cancer. Stomach andoesophagus cancer, which are the most prevalent types of cancer in Langzhong, haveuntil recently (and in some cases still) been understood respectively as ‘vomitingillness’ (huishi bing) and ‘choking or spitting illness’ (gengshi bing). While mostvillagers regarded these illnesses to be equivalent to cancer, some distinguishedbetween them, stating ‘in the past we had many cases of vomiting and spitting illness,now we have few, but we have many cases of cancer’. Confusion between thesemedical and local labels makes quantifying cancer cases problematic. What we candeduce is that if there are local terms to describe these types of cancer, they haveprobably been widespread for some time.

This paper unpacks how villagers in Langzhong understand the development ofcancer, and attempt to make sense of why it seems widespread and why it affectsparticular individuals.8 Through participant observation—which involved taking partin daily activities and household and farming tasks, and resorting to local healthcare

6. One Public Health Bureau official whom I interviewed in April 2007 referred to research to the north of theirmunicipality. This initially made me wonder whether he referred to ongoing research by Oxford’s Clinical TrialService 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 twofurther 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 systemand 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 andBeatriz 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 andSocial 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, ‘Socialand cultural understandings of oesophagus and stomach cancer in rural Sichuan’, Asian and African Studies XII,(2007).

AN ANTHROPOLOGY OF ‘CANCER VILLAGES’

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practitioners—I gained first-hand experience of how illnesses are experienced andtreated. I closely followed two cases of cancer (one in my host family) since theirinception and carried out daily open interviews throughout 2004–2005 with locals(including municipal doctors and officials). I also conducted semi-structuredinterviews with 30 families (July 2005) focusing on cancer aetiology and debatinglocal cases of cancer. Most of my data were collected in Baoma during 2004–2005and two follow-up trips of one month each in 2006 and 2007. I also gathered datafrom a number of other sites which I selected by following women on their visits totheir natal villages. The village unit of Meishan is one such case. Given that nopervasive agreement was reached by locals as to what causes cancer, this paper isconcerned to outline how they evaluated possible factors, and to understandenvironmentally-related elements within this broader framework.

‘Cancer villages’ and the power of perceptions

If media reports on cancer villages abound, academic articles on the topic are muchmore scarce.9 A comprehensive account of cancer villages by Liu Mengqin and FuChen explains their existence as a ‘trade-off between development and poverty’.10

Liu and Fu identify the main underlying causes of cancer villages in the growingrural–urban gap and continuing rural poverty, which entails the transfer of pollutingfactories to poor areas. Secondly, as is common, they attribute the problem to anemphasis on economic development without adequate attention to environmentalprotection, and thirdly to local protectionism. They suggest as a solution first the needto tackle rural poverty and achieve more equal growth in both rural and urban areas.Second, they highlight the need for better law enforcement and the establishment of acontrol system for environmental law enforcement. Third, they argue for anindependent evaluation structure to tackle the challenge of establishing evidence forthe connection between cancer and pollution, and to clarify issues of unclearresponsibility. Fourth, they highlight the need for basic welfare insurance to counterpoverty, which is often closely related to both health and environmental factors.11

Finally, they stress the need for public participation by strengthening communitygovernance and participation in environmental protection, providing relevant trainingto villagers and supporting NGOs.

Liu and Fu, as do many media reports, identify the biggest barrier for localadvocates and NGOs as demonstrating the connection between pollution and healthconsequence.12 In the case of cancer, collecting substantive evidence thatconvincingly and indisputably connects it to pollution is particularly challenging.

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

10. Mengqin Liu and Chen Fu, 2007 — [‘A trade-offbetween development and poverty—a theoretical rethinking of the cancer villages in China’], unpublished paperpresented at the Workshop on Environment, Health and Poverty in the Context of Building the New SocialistCountryside, 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).


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The effects of pollution may not be readily evident, they may develop over arelatively long period of time and people are often exposed to so many different kindsof chemical hazards (from consumer goods, smoking, household heating andcooking) that it is difficult to establish a clear causal relationship between ‘dose’ and‘response’. But a given community may only mobilise around environmental healthissues and act to change conditions after they have themselves become aware of theconnection between pollution and illness. An interdisciplinary study by WilliamAlford et al. of ‘the human dimensions of pollution policy implementation’, whichfocused on air quality in rural Anhui province, assessed how ‘policy measures havebeen communicated to, understood by, and acted upon by the citizenry’ and con-cluded that ‘the central government’s message has yet to be absorbed’.13 They stressthat campaigns for environmental awareness have little effect14 and that awareness israther the result of personal experience, wealth, education and media. In their study,chronic symptoms did not necessarily trigger better awareness of the risks of indoorair pollution caused by cooking fuels. Their research is commendable for pointing outthat successful law enforcement requires creating awareness, providing incentives foraction, and making national regulations feasible locally.15 Yet, focusing on a ‘lack ofknowledge’ as the obstacle to better environmental practices precludes a closerexamination of villagers’ existing environmental knowledge, the environmentalthreats to health of which they are already aware, and how such awareness hasdeveloped—questions that the study did not address. This article, by contrast, situatesenvironmental knowledge within the wider spectrum of perspectives on healthand examines how these may undermine locals’ focus on the effects of pollutionon health.

Jun Jing’s work on environmental causes of protest16 turns a keeneranthropological eye on the processes by which villagers realise the harmfulness ofpollution. Jing reviewed official records of 278 environmental disputes from the mid-1970s to the early-1990s. He focused on two protests that took place during his fieldresearch, enabling him to better grasp their development. In the case of Dachuanvillage, in Gansu, locals protested against a fertiliser factory which contaminatedtheir water. Jing argues that their awareness of water pollution built on many aspects(such as the threat to domestic animals and the threat to farm produce) but wasspurred especially by the rise in birth defects, because it undermined one of thecentral values of local society: the ability to produce healthy babies. He concludesthat awareness of the causal connection between pollution and illness and thedecision to take action can only take place when they resonate ‘with a society’s valuesystem and its symbolic manifestation’.17 In a similar fashion, I am concerned with

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

14. Ibid., 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: understandingcitizen 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. Ibid., p. 212.


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the ways in which people make sense of their illness and the extent to which theytrace it to environmental factors.

Faced with the tragedy of what is often a fatal ailment, families articulate disparateviews regarding the question of ‘why him/her?’ and assemble various and conflictingstrategies to deal with illness. The elements villagers typically identify as causes ofcancer are: repressed anger or enduring hardship in general, smoking, drinking,preserved vegetables, and farm chemicals. A biomedically-based account of cancerwould start with testing villagers’ knowledge that smoking and drinking are potentialcauses of cancer. By contrast, this article gives primacy to locals’ own explanationsof why cancer was common. For some, cancer is mostly to be blamed on thesufferer—either because of their bad temper or their predilection for strong alcoholand cigarettes. For others it is caused by factors beyond the sufferer’s control—rapidsocial change leading to tensions amongst family members or consumerism requiringthe use of farm chemicals. Adherence to one or other of these aetiologies embodies aparticular engagement with the sociopolitical past and present and provides diverseanswers to the question of who is accountable for illness and who is responsible forhealing. The fight against cancer is deeply bound to efforts not only to maintainhealth, but also to debate one’s position within the family and the local community,and to make claims to entitlement to care and to a cleaner environment.

This paper will focus in particular on how villagers experience environmentalpollution due to farm chemicals, their perception of its extent and its nature, its healthimpacts, how their perceptions have developed, and the ways in which they informtheir actions. Pollution competes with other cancer aetiologies. Unlike Alford et al.,18

my findings suggest that chronic symptoms do raise awareness, but that whethercancer is traced to environmental pollution (or any other factor) depends on who willbe held responsible as a consequence—the sufferer, their family, or others who failedto prevent pollution, and whether this may lead to any corrective action. The questionof how environmental awareness rises and how it forms the basis for gathering furtherevidence is inseparable from the political and economic obstacles to reporting highrates of cancer. But rather than considering objective constraints as such (for instancelack of funding to dig a well, or to resort to hospital treatment), I am interested in theconstraints created by actors’ perceptions. For example, the extent to which villagersregard themselves as responsible for pollution or feel entitled to financialcompensation or provision of better water sanitation exerts a powerful influence ontheir chosen avenues for action. In turn, I will argue, local officials attempt to avoidblame by highlighting the lack of resources necessary to fulfil locals’ demands.

Ultimately, locals are more likely to blame cancer on pollution when at least someof the following circumstances apply: (1) it is consonant with their experience; (2) itexplains why particular individuals fall ill; (3) it reinforces perceptions of thesufferers and their families as having acted in a moral fashion; and (4) it is perceivedto be productive—that is, helpful in attracting attention and investment by the localstate. The latter point in particular will be the focus of attention, in terms of howpollution is understood and managed, how this relates to locals’ understanding oflocal officials’ capacity, and how those officials respond to locals’ demands.

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


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Discrepant perceptions among different actors of who is responsible when pollutioncauses harm to health, and of what should be done, offer insights on the social,political and moral worlds which people inhabit.

Too often insights from anthropology are dismissed as mere anecdotes,commonplaces, stories about a particular location without any wider applicability.Yet, anthropology is especially positioned to understand how environmentally-related health risks are perceived and handled by particular communities, and tohighlight the importance of culture and local context in framing and addressing theseproblems. Understanding how people, at various levels, discuss these issues is vital inachieving more effective policy implementation, better welfare and sustainabledevelopment. If we do not grasp the perceptions driving people’s actions (forinstance, what farmers consider harmful to their health), we may misconstrue theirknowledge as ignorance, and blame them for their own suffering, or offer advicewhich locally makes little sense, and which is therefore unlikely to be followed.19

Competing lay aetiologies of cancer

Diverse factors are blamed for the development of cancer. I will examine how andwhy emotions, smoking, drinking and preserved vegetables are perceived to causecancer, in order to contextualise perceptions of the link between farm chemicals andcancer. These aetiologies, I argue, are adopted when they do not contradict people’ssense of normal, caring and moral behaviour. Rather than serving as stable referents,given explanations may be resorted to at certain times during illness, then abandonedand adopted once again after death. This suggests that cancer aetiology is notobjective and unchangeable knowledge but rather a flexible process that entailsreconstituting elements of the sufferer’s biography to formulate an acceptableexplanation for illness.

Negative emotions, in particular anger, repressed anger and anxiety, are among themost commonly cited causes of cancer, as well as of other ailments (such as headaches,poor digestion and chest pains).20 Villagers often commented that cancer sufferers areindividuals who have been prone to anger and anxiety, or who experienced particularlyunbearable conflicts and hardship, which precipitated anxiety, and in turn illness.21

They regarded cancer as more likely to occur in those suffering with qi huo bing( ) [literally ‘illness (due to) fiery vapour’], a discomfort in the chest or stomach

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: CambridgeUniversity 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 inChina: 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 screeningbehaviour among Chinese-Australian women’, Journal of Advanced Nursing 54(6), (2006), pp. 691–699, highlights asimilar perception of cancer as brought about by negative emotions, and worsened by thinking about the illness.


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which was linked to a propensity to get angry.22 Such aetiology is reinforced byChinese medical theories that attribute illness to the physical effects of emotionalimbalance. According to Chinese medicine, many illnesses may be traced toimbalance or blockages in the flow of qi (air, or breath).23 The very terminology fordescribing anger (sheng qi, literally generating air) and repressed anger (ouqi orblocked qi) is an example of how strong the connection between qi, anger and physicaldiscomfort is. The perception that anger and anxiety may precipitate the developmentof cancer is, however, not peculiar to China or Chinese people. Feelings of guilt,anger and aggression featured alongside heredity and external influences in RuthSalzberger’s study of British cancer patients.24 Deborah Gordon’s study of cancer inItaly also showed that naming discomfort as cancer, or even thinking about it, are seento bring about its development.25

Aunt Liu died of stomach cancer at 56, in November 2007. As I watched thefuneral guests make their way to her house in Baoma, I remarked that she seemed tobe in fairly good health when I had last visited in April that year. Her neighbourcommented:

yes, but she was a worrier that one. She had a hard time you know. She found out she had

cancer in the summer. She died really fast, she was terrified when she heard that word,

cancer, and if you are terrified of it, it gets you very fast.

During all of our meetings Aunt Liu stressed that her life had been characterised by aseries of hardships. In 1975, she married one of the village schoolteachers and as aconsequence she had to carry out all of the farm work alone. Due to gynaecologicalproblems that are now curable, Aunt Liu had been unable to bear children, and hadto adopt a daughter. This, she explained, had made her father-in-law angry andfrustrated. In turn, she felt that these negative emotions, as well as his general

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’, whichmade her easily angry, and therefore sick.

23. Although it would be wrong to equate villagers’ understanding of the role of emotions in cancer causationwith Chinese medical theories of cancer, it is significant that they are so similar. On emotions and illness in China seeS. Davis, ‘The cosmobiological balance of the emotional and spiritual worlds: phenomenological structuralism intraditional 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, SocialOrigins of Illness and Distress: Depression, Neurasthenia and Pain in Modern China (New Haven, CT: YaleUniversity Press, 1986); T. Ots, ‘The angry liver, the anxious heart and the melancholy spleen: the phenomenology ofperceptions in Chinese culture’, Culture, Medicine and Psychiatry 14(1), (1990), pp. 21–58; N. Sivin, ‘Emotionalcounter-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 andSynthesis (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.


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propensity to become irritated and resentful (ouqi ), had caused him to developoesophagus cancer, of which he died in the early 1990s. She remarked, ‘of course hewas irritable and resentful, people like that get cancer’ (30 June 2005). In the mid-1980s, Aunt Liu’s husband developed heart and lung problems, rendering him unfitfor work and requiring him to be hospitalised every year. He died in 1997, at 48, ofpulmonary heart disease. Her husband’s and father-in-law’s illnesses impoverishedthe family, and also took their toll on Aunt Liu’s health. She was forced to bear theagricultural burden alone and, after 2000, she also cared for her granddaughter(whose parents lived and worked in Chongqing) and for her nephew, after herbrother’s divorce.

Aunt Liu understood her father-in-law’s cancer to be due to his tendency to anger,precipitated by her inability to bear children. In turn, her neighbours clearly attributedAunt Liu’s cancer and her speedy deterioration to her propensity to be anxious,exacerbated by the hardships she had lived through.26 In this context, nondisclosure isa common strategy to avoid further suffering for the person affected and to avoidhastening the development of the disease. The recognition, in Western medicine, thatanxiety and stress might make cancer develop faster, and the consequent practice ofnondisclosure, which is only recently beginning to decrease in the UK and the US,suggest that this aetiology is not as alien as it may at first seem.27 Mary-Jo del VecchioGood et al. show that in the US, where effective treatment is more widely available,disclosure has recently become central to physicians’ attempts to engage sufferersactively in the therapy. In Langzhong the reverse seems to be the case. When mylandlady Dajie’s father, Gandie, was diagnosed with oesophagus cancer, the familydecided, as is often the case, not to tell him.28 On 19 October 2004, as we made ourway to Dajie’s natal village to celebrate Gandie’s birthday, she cautioned me:

Don’t you tell him, he doesn’t know he has cancer. We asked the doctor to write that part

in English. So if dad asks you for a translation just tell him he’s ill because he gets angry

too often, it’s repressed anger (ouqi). If he just relaxes and controls his temper it will go

away. That’s what the doctor said.

Dajie argued so convincingly that her father would recover that I started to doubt hehad been diagnosed with cancer at all. Nondisclosure itself expressed an activeengagement by the sufferer’s family with the illness, in an attempt to secure theirhealth. As in Gordon’s Italian case study,29 it served to keep the sufferer in theirsocial world, and to maintain hope alive. Nondisclosure and attributing illness to apropensity to get angry, as Gandie’s relatives had done, served to make cancer

26. The belief that mood affects cancer is also highlighted by a study of Chinese people working and living inLondon: I. Papadopoulos, F. Guo, S. Lees and M. Ridge, ‘An exploration of the meanings and experiences of cancerof 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 wouldprolong 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 andthe 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 religiousconnotations. I have retained the Chinese term to avoid confusion.

29. Gordon, ‘Embodying illness’.


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intelligible as part of a much broader set of emotion-related illnesses, and tomomentarily maintain hope that if he was able to control his temper cancer might notdevelop further. Given that most villagers had little access to medical care, informingthem of their condition was also not necessary in order for them to make choicesabout treatment options, as it would be in the United States or Europe.

In some cases, aetiologies that attribute the onset of cancer to personality orhardship are used as a way to express grievances and therefore serve as powerful toolsfor social reproduction. Local women such as Aunt Liu who had been unable to bearchildren or young couples who had divorced, often identified their actions, and wereidentified by others, as having caused irreparable suffering to their parents. If theirparents or in-laws developed cancer these actions would be held up as precipitatingfactors. Yet, this did not entail a simple or unified sense of who or what was to blame.Anger and anxiety over the behaviour of family members might be attributed to anindividual’s character, allowing those who would otherwise be blamed for causingthat anger to deny such responsibility. By pointing out that her father-in-law wasprone to anxiety and to losing his temper easily Aunt Liu rejected the suggestion thathis cancer had been caused by her failure to produce offspring, thereby avoiding fullresponsibility for his poor health. This indicates a certain degree of ambiguity overwhether anger and anxiety are due to a person’s temperament or whether they areinterpersonal in the sense that they are caused by others and therefore others are toblame. It is through this very flexibility over who can be blamed that negativeemotions such as anger and anxiety gain efficacy as aetiologies of cancer.

Ambiguity, albeit of a different kind, also pervades lay perceptions of smoking anddrinking as causes of cancer. A study initiated by Oxford University’s Clinical TrialService Unit (CTSU) on ‘diet, lifestyle and mortality in China’30 highlights smoking,drinking, diet and pollution as possible causes of cancer. Although aware of theseepidemiological tenets, the majority of villagers often dismissed the possibility ofsmoking and drinking as causes of cancer, and perceived their relationship to cancerto be ambivalent. Locals admitted that excessive drinking (500 g of rice liquor baijiuper day, every day, in one case; 250 g per day in some others) and smoking (twopackets per day) was harmful. Yet, they also claimed that ability to drink and smokewas typical of healthy people. The 70-year-old Grandfather Liao, for instance,smoked two packets of cigarettes and drank an average of 250 g of baijiu every day.Asked whether this had a negative effect on his health, he replied ‘I don’t feel that itharms my health. I have smoked and drank this much since I was in my teens. I wouldget sick if I stopped, I am used to it’ (10 November 2004). Locals referred to him inorder to counter the suggestion that smoking and drinking cause cancer.31

30. Chen et al., Diet, Lifestyle and Mortality in China; see also J. Chen, Liu Boqi, Pan Wenharn, Colin Campbelland 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 asimilar study, based on research in a working-class community in Philadelphia with high cancer incidence, seeMartha Balshem, ‘Cancer, control and causality: talking about cancer in a working-class community’, AmericanEthnologist 18(1), (1991), pp. 152–172; Martha Balshem, Cancer in the Community (Washington, DC: SmithsonianInstitution, 1993). Balshem suggests that locals resisted the biomedical ideology promulgated by cancer educationprojects 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).


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Paradoxically, although villagers accepted that drinking and smoking excessivelycould cause illness, the ability to do so was perceived as a sign of strength and health.As the reasoning went, if one can engage in a harmful practice and still maintainhealth, it must mean that their bodies are ‘mighty’. Given that these activities areassociated with strong males (by contrast, they are regarded as undesirable forwomen), they are part of how masculinity is defined, and as a consequence they are ahabitual parameter of normality for men. Drinking and smoking also serve as keysocial lubricants32 that therefore could not be given up despite their harm to health.When given practices are experienced and perceived as commonplace, as is the casefor smoking and drinking, this serves to undermine their potential association withillness. Finally, attributing cancer to smoking and drinking would produce theundesirable result of blaming the sufferer for their illness. Accordingly, I found thatlocals would trace cancer to smoking and drinking only when no family member wascurrently affected by cancer. Although Gandie’s relatives had initially blamed hiscancer on anger, they ceased offering any explanations as soon as they realised hewould not recover. After his death, however, his daughter Dajie cautioned herneighbour Grandfather Liao: ‘you should be careful. My father drank and smoked alot, and he died of cancer’ (July 2005). During illness, relating the development ofcancer in a family member to specific events in his or her life would be immoral; itwould, as Balshem explains, imply they had brought cancer upon themselves.33

By contrast, after the sufferer’s death searching for an explanation becomesacceptable and desirable. These explanations may rely on epidemiologicalknowledge, such as in the case of smoking or drinking, or may search for morallyacceptable explanations by tracing cancer to traumatic events and the propensity toget angry.

A similar ambivalence pervades perceptions of preserved and mouldy vegetablesas causes of cancer. As with smoking and drinking, while the epidemiologicalliterature stresses that lack of dietary variation and consumption of preserved andmouldy vegetables are possible causes of cancer,34 villagers dismiss this connection.In principle, locals generally accepted that eating mouldy food might be harmful: ‘it’smouldy, that’s no good’ (frequent claim). In actual fact however, they were reluctantto waste it and would still eat it. They explained: ‘it’s not a big deal, you can still eatit’ (frequent claim). Some also referred to the common saying ‘bu gan bu jing busheng bing ’, literally ‘(living in) dirty (conditions, one) does not fallill’ to argue that eating dirty food may be a healthy practice (frequent claim). Dajie,for instance, defended her consumption of mouldy food as avoidance of waste, andsupported it by pointing to the fact that she experienced no adverse physical

32. A. Kipnis, Producing Guanxi: Sentiment, Self and Subculture in a North China Village (Durham, NC: DukeUniversity 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 smokingin facilitating social relations hinder any attempts to quit, despite people’s awareness of the harmfulness of smokingsee Matthew Kohrman, ‘Smoking among doctors: governmentality, embodiment, and the diversion of blame incontemporary China’, Medical Anthropology 27(1), (2008), pp. 9–42; Matthew Kohrman, ‘Depoliticizing tobacco’sexceptionality: 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.


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symptoms after eating it. Seeing the consumption of preserved and mouldyvegetables simply as a form of poverty-related (self-)oppression thus masks the waysin which locals understand it. Perceptions of what constitutes an adequate diet and ofwhat causes cancer depend very much on whose standards such assessments are basedon and on the moral economy of which they are part.35 Attitudes to preserved food areclosely tied to perceptions of whether cancer may be attributed to past shortage(preserved food) or current development (farm chemicals). The common scepticismabout preserved vegetables’ role in the development of cancer is a means to defendlong-standing local habits against the widespread use of farm chemicals. Followingthese principles, many villagers explained ‘I eat preserved and pickled vegetables,because they contain less chemicals’.

To explore these attitudes in more detail let me turn to the local use of farmchemicals. The most widely used fertilisers in Langzhong are nitrogen-basedcompounds such as ammonium bicarbonate (tansuanqing’an NH4HCO3), urea[niaosu (HN2)2CO] and compounds with phosphorus and potassium such asN þ P2O5 þ K2O. They are typically administered in powder form, mixed withcompressed rapeseed powder left over from the production of rapeseed oil and theyare spread without any protective equipment. Commonly used pesticides includeorganophosphate and organochlorine compounds, and a great variety of herbicides,fungicides and treatments for specific vegetables and specific diseases. These areusually mixed with water, carried on farmers’ backs in a small plastic tank equippedwith a thin rigid hose roughly one metre in length, and sprayed without wearingmasks or protective gloves. Opinions on when exactly the use of farm chemicalsbecame widespread vary, but most agree that it was approximately in the early tomid-1980s. It is likely therefore that their impact on health would only be becomingfully felt in the present.36

Villagers had little doubt about the efficacy of farm chemicals, but they hadambivalent feelings about using them. Their availability had been made possible

35. Anna Lora-Wainwright, ‘Do you eat meat every day? Food, distinction and social change in contemporaryrural 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 ruralChina’, 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 debateamongst researchers, NGOs and consumer associations. See Y. Yang, ‘Pesticides and environmental health trends inChina—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, TheRiver 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 inChina’, 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 Chinaare sold under false brand names, and in Yunnan province, a 2002 study for the Global Greengrants Fund revealedthat 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’ andtherefore 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 protectiveequipment, pesticide poisoning rates are worryingly high: ‘The Chinese government estimates that each year 53,300to 123,000 people are made ill from pesticides, and 300 to 500 farmers die from pesticide exposure. Localized studieshave shown much higher poisoning rates’ (Organic Consumers Association, High Pesticide Residues ThreatenChina’s Food Exports).


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by the improved living conditions following market reforms, and as such they were apowerful symbol of development. Farm chemicals are part and parcel of the transitionaway from a past when the villagers’ diet was ‘not even as good as a pig’s diet now’and when ‘you could barely grow anything’. Farmers noted a stark improvement inproduction since their introduction. They compared the tiny grains of maize of the1960s and 1970s with those grown more recently and celebrated farm chemicals forenabling better produce. Benefits to farming were clear: chemicals killed pests andfertilised the soil; they made the workload lighter by reducing the heavy loads ofmanure farmers had to carry on shoulder poles along narrow paths to their hillsideallotments; and they improved the appearance of foods, making them easier to sell.They are used out of necessity, in order to respond to market pressures to produceliterally spotless food.

On the other hand, locals despised their dependence on chemicals for farming andthey complained that these substances were harmful and, in particular, that theycaused cancer. I have never encountered a single farmer who, when asked whetherfarm chemicals are harmful to health, replied in the negative. Indeed, when men are athome it is their job to apply chemicals, because they are generally perceived to bephysically stronger than women, and therefore to be better equipped to endure thetoxicity. Yet men are rarely available for the task as they engage in migrant labour tosupplement the family’s income and to cover the rising costs of living, particularlythe cost of high school and healthcare. While women also join the migrant labourforce, men tend to return home at a later age than women, who usually return to carefor their children at critical stages of their upbringing (such as final exams for entry tohigh school or middle school) and then to nurse their grandchildren.37 As aconsequence, women are mostly responsible for agricultural tasks, includingapplying chemicals. In 2004–2005, my 36-year-old host Dajie shouldered most ofthe farming work while her husband commuted to Langzhong city every day to workas a carpenter. Yet when possible he would return before dark to spray pesticides onthe family’s plot. Dajie explained that pesticides are ‘harmful to health’, that shecould tell this from their strong smell and from the efficiency with which they killedpests, and that her husband should administer them because his health was better thanhers. This common perception that men should use chemicals because they arestronger implies that they are thought to be seriously harmful.

Different degrees of harm however are attributed to different chemicals.‘Nongyao ’ literally means farm chemicals, but also pesticides more specifically,while feiliao refers to ‘fertilisers’. When villagers complained of the harmfuleffects of chemicals, they used the term nongyao and rarely mentioned feiliao.If cross-questioned on whether feiliao too was harmful they provided mixedresponses. Uncle Wang reflected, as he spread fertiliser on his wheat field, ‘well, tobe honest, it probably is harmful, it is a chemical after all. But is much moreconvenient than manure, and it is not as harmful as pesticides’ (November 2007).The 60-year-old Aunt Xu, working in the nearby field, claimed that fertilisers werenot harmful, ‘they are nutrition for the crops’. Therefore, she explained, it was fine

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


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to spread them with her bare hands, as she was doing. As her husband stood bywatching her, I asked why did he not help. She replied: ‘because he has been sick,you can see he lost his hair, he is not healthy enough’. Clearly, although they did notsay so at first, they both felt that chemical fertilisers were potentially harmful, andought to be avoided by those whose health was poor. Like consumption of preservedvegetables, such strategic choices over who should administer chemicals areexamples of locals’ active engagement with their understanding of farm chemicalsas harmful. Farmers’ efforts to reduce chemicals on crops intended for familyconsumption provides yet more evidence that they are aware of the health hazardposed by chemicals and they attempt to minimise it.38

The perceived harm of farm chemicals is expressed most clearly in their link withcancer. When a man in his 40s died of cancer in 2005 his neighbour was quick toconclude that it was obviously to do with his excessive use of chemicals. A youngwoman, whose husband had left the village to become a migrant worker, reflectedthat she often feels pain in her throat, which she linked to the widespread use ofchemicals. She explained that those who fall sick with oesophagus cancer usuallyexperience precisely this type of pain. She reasoned that cancer develops when a partof the body is harmed repeatedly, that farm chemicals harmed the oesophagus and thestomach in particular, and that these were the two most common types of cancerlocally. Understanding of the poisonous power of pesticides was further reinforced bytheir use in suicide attempts. Three cases of suicide using pesticides have occurred inthe past five years in Baoma. The latest, in 2006, was a 70-year-old woman who wasdiagnosed with stomach cancer. Having watched her in-laws and some of herneighbours die slowly and painfully of the disease, she decided to kill herself.

Given the many competing aetiologies of cancer, no villager in Baoma attemptedto mobilise the local community around one in particular. By contrast, in the nearbyvillage unit of Meishan one man, Baohua, focused on water pollution as a causeof cancer in the hope of obtaining provision of a better well. The case he made, asI will show, is inspired by media coverage of cancer villages, yet without any claimsto industrial pollution. I will examine what the outcomes of his actions have beenand why.

Meishan’s case: politicising and delocalising water pollution

The cases of pollution which receive most journalistic and academic coverage areusually to do with industrial pollution. As we have seen, most of the cases covered bythe media (and by Liu and Fu’s study) are concentrated in specific localities whichhave recently undergone intense development (especially in industry). Cancer istherefore understood to be precipitated by development, and in particular by factoriespolluting water sources and contaminating food grown in the area.39 Reports onenvironmental degradation in China by Chinese and foreign journalists often stress

38. Elsewhere I suggest that it is the local tendency to attribute cancer to high chemical content in the food ratherthan 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 indeveloped areas of Jiangsu and Henan.


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China’s emphasis on economic development to the detriment of the environment,credit recent central state policies with attempting to tackle problems and blameunsuccessful implementation on local corruption and local protectionism. Somescholars also follow this line of argument. For example, in her latest piece,E. Economy, one of the leading scholars on the environment in China, explains that‘the situation continues to deteriorate because even when Beijing sets ambitioustargets to protect the environment, local officials generally ignore them, preferring toconcentrate on further advancing economic growth’.40

Yet,

according to Andres Liebenthal, head of the World Bank’s environment and social

division in Beijing, industrial pollution only accounts for one-third of total water

pollution in China. Another third is the result of municipal waste, with the final third

consisting of the runoff from fields contaminated by pesticide and fertilizer.41

The World Bank report on the cost of pollution in China states that ‘the mainpollutants are changing from heavy metals and toxic organic chemicals, which aretypically related to discharge of industrial wastewater, to pollutants from nonpointsource. Runoff from agriculture, including pesticides and fertilisers, is the singlegreatest contributor to nonpoint-source’.42 In the case of industrial pollutionresponsibility is fairly easily attributed to the nexus of offending industries, andcomplicit local officials and citizens, but who is held responsible for avoiding harm tohealth when no clear source of pollution is identified? The answer to this question iscentral to the politics of maintaining state authority, and may only be understood withreference to the broader range of causes blamed for cancer, and their social, culturaland political economic contexts.

The case of Meishan, a village unit (dui) with a population of roughly 80 residents,may illustrate some of the dynamics through which polluted water is implicated as acause of cancer and with what consequences. Baohua is in his early 40s, and lives inMeishan, 15 km from Langzhong city along poorly built roads. I first met him inJanuary 2005, as I followed his two sisters (married in Baoma) on a visit to their natalvillage. Assuming I was a reporter, Baohua told me many residents of Meishan—heestimated at least four people in 2004–2005—had died of cancer recently and that itmust be related to the local water, specifically to one well which serves Meishan.After realising I was not a reporter, Baohua asked me to find one to investigate theircase and attract attention, in the hope of obtaining provision of clean water.43

As accounts of cancer villages started becoming more and more common in themedia, I was approached by a journalist in the spring of 2006, working on a report onChina’s water pollution for the UK’s Channel 4 Television. I suggested she should

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 October2007).

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’.


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interview local people in Meishan, and the village and township officials, to ask themwhat they thought caused the problem and what could be done.

Predictably, the journalist encountered opposition from local officials. The PublicHealth Bureau refused to grant her access to any of their records or to carry outwater tests. She was told by a village official: ‘we don’t have any illness here, noSARS and no AIDS’.44 When I visited Meishan again in March 2007, Baohuaexplained that the journalist’s visit had been unhelpful because she had bypassedLangzhong officials and approached provincial officials directly, placing prefectural,municipal and township officials in the spotlight. As a consequence, he felt, thejournalist had failed to gain the support from the local state which was necessary toundertake a thorough investigation of the problem. This, no doubt, reflects whatvillage officials told villagers after the journalists’ visit, to discourage them fromseeking media attention again in the future. The outcome was that Baohua becameeither too scared to resort to provincial officials, or genuinely convinced that nothingcould be gained from going beyond the municipal level. The possibility of resortingto the legal system was regarded in a similar light. None of those I consulted,officials and farmers alike, thought that a petition compiled by villagers would leadto any results. The widespread feeling was that a petition to local officials (whichI take to mean municipal and below) would have no effects, and that petitioning tohigher levels would be too risky. And yet, despite (or perhaps because of) thejournalist’s failure to identify the cause of local cancer rates, Baohua remainedconvinced that the shallow well (less than five meters deep), often dry, and in closeproximity to the paddy fields (and therefore chemicals) was a definite cause of highcancer rates.

Although the experience with the journalist persuaded Baohua that he should seekhelp from lower levels of the state, he still felt that village and township officialswould be of no assistance. As I explored possible avenues for action with Baohua andhis sister, they both stressed that ‘local officials cannot control/care (guan) much’.His sister explained: ‘low officials have no way, it is easy for the high ones to dothings, low officials do not have that ability, if they had they would take care of it’(24 March 2007). The verb guan has a very telling web of meaning: it entails takingcare but also controlling. The assertion that local officials do not control/care aboutthese things, could therefore refer to a lack of willingness, or to a lack of capacity.Whether villagers identify the root of the problem as one of corruption andunwillingness or one of capacity also reveals who they think should fulfil theseresponsibilities, and whether it is strategic to resort to municipal and higher levels.In this case, Baohua felt that lack of capacity and expertise (rather than corruption orunwillingness) hindered village and township officials’ ability to intervene. As aconsequence, he argued that they would prefer villagers to approach municipalofficials directly rather than being confronted with the problem themselves. Waterpollution, Baohua explained, was too complex an issue to be solved by village ortownship officials and therefore it was legitimate to seek assistance at the municipal

44. See Channel 4, China’s Poisoned Waters, available at: http://www.channel4.com/more4/news/news-opinion-feature.jsp?id¼299 (accessed 8 August 2006).


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level. Municipal officials were perceived to be high enough to have sufficientresources, but low enough not to threaten or scapegoat village and township officials.

When I returned to Meishan in March 2007 with a member of staff from themunicipal hospital, Baohua told us 14 people had died since 2004, nine of them ofcancer, especially of the oesophagus, stomach and liver. They were all adult men, theoldest 70, the youngest 40, who had lived in Meishan all their lives.45 Following thisvisit, I contacted the Centre for Disease Control (CDC) and the Public Health Bureau(PHB) in Langzhong, who agreed to carry out water tests. Two members of staff fromthe CDC who made the trip to Meishan with me to collect water samples commentedpromptly ‘this well isn’t good, it is too shallow, and it is right by the pigsty, a drainageditch and the paddy fields. By law, wells need to be at least 50 metres from the nearesttoilet’ (5 April 2007). There were no factories in the vicinity of the well or of thevillage of which Meishan is part, and CDC staff guessed that the well would becontaminated by nitrogen from the paddy fields and organic pollutants from manure.As is typical in rural China, the pigsty and the toilet are in the same room, and refusecollects beneath them, ready to be used as fertiliser. With the increase in use ofchemical fertilisers, however, manure is used less and, as a consequence, it is morelikely that stagnant manure will contaminate the water than if it were distributed overa wider area of soil. CDC staff explained that this condition was very common in theLangzhong countryside, where drinking water is almost exclusively extracted fromshallow wells, which are very rarely further than a few metres from people’s homesand toilets.46

The water test in Meishan did not show high levels of cadmium or arsenic (knowncarcinogens); nor did it show any significant contamination by ammonia or nitrate(which at 4.12 mg/l was well below the maximum acceptable value of 20 mg/laccording to the CDC and PHB) which both CDC staff and I had expected given thewell’s shallowness and proximity to farm chemicals and sewage.47 The low level ofnitrate did not support the hypothesis of contamination by these pollutants, and evenif they had there is little evidence to date of a link between cancer, and nitrate andnitrite in water.48 The test did show iron and manganese content (possibly linked topesticide use) to be 2.43 and 0.47 mg/l, respectively eight and five times higher than

45. See Lora-Wainwright, ‘Of farming chemicals and cancer deaths’, on how locals explained higher incidence ofcancer 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 metresdeep. In most cases, water is taken out of the well with plastic buckets and carried home on shoulder poles. Whether itis pumped or carried home manually, water is stored in a container with a capacity of roughly 100 litres. In newerhouses this may be a cubical concrete tiled tub, while in older houses it is a large clay vase. When needed, water istaken out of the storage container with plastic ladles and used for drinking, cooking, or emptied into metal or plasticbowl for washing (except for clothes, which are washed in the irrigation pond). Surface water gathered in irrigationponds, most of which were dug in the 1960s and 1970s, is used to irrigate the paddies and water vegetables andhillside crops.

47. This is in contrast to research on water pollution in Langzhong carried out by Italian NGO ASIA-ONLUS in2004. ASIA-ONLUS found that in some villages, the nitrite-content introduced in the water cycle by the proximity ofnitrogen-fertilised paddy fields to the well was ten times higher than acceptable values, according to WHO standardsas well as Chinese Drinking Water Guidelines (personal communication, ASIA-ONLUS staff). When nitrite entersthe bloodstream, it reacts with the haemoglobin and forms a compound called methaemoglobin. This compoundreduces the blood’s capacity to carry oxygen. The oxygen level decreases and babies show signs of a disease calledmethaemoglobinemia also known as ‘blue baby disease’.

48. Although nitrite has not been conclusively shown to cause cancer new research in China proposes that nitritenourishes cancer cells and a reduction of it slows cancer growth: see Kenneth Hsu, Ye Wenhua, Kong Yunhua,


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acceptable values according to Chinese Drinking Water Guidelines, but neither ofthese elements have been conclusively categorised as carcinogens.49

Although the test proved that the water is, according to the CDC, ‘not safe fordrinking’, this did not automatically ensure the provision of a more adequate well.Well-digging is the responsibility of the Water and Electricity Bureau, whichaccording to current budgets (2007) only has enough funds to dig one well pertownship per year. Each township of an average size may have at least 300 wells,many of them in violation of the CDC’s 50 metre rule. The Water Bureau had alreadyspent its resources for 2007, and was more concerned with mountainous villageswhere water is even scarcer. My contacts at the CDC suggested I use my connectionswith the city’s former Deputy Mayor to urge the Water Bureau to collaborate, but hiscontacts in that bureau had since moved on. This, I was told, is part of a governmenteffort to combat corruption, which entails frequently transferring officials to differentposts so they cannot easily rely on connections.

Although the water test did not provide evidence of high levels of knowncarcinogens, it did prove the need for cleaner water. Baohua had focused on waterpollution to explain cancer at the community rather than individual level, in the hopeof attracting attention. Through his experience with local officials and with thejournalist, Baohua had identified municipal officials as the level of bureaucracy withthe necessary expertise and resources for corrective action; and yet no action wastaken. How did municipal officials maintain legitimacy despite their failure toprovide for a better well? Officials at the Centre for Disease Control readily agreedwith Baohua that the water was ‘not good’ (they did not have the expertise to suggestwhether it caused cancer). Recognising that the water was polluted suited the CDCofficials: it served to at once define the problem as a very simple one (shallow well),with a simple solution (dig deeper) and an equally simple obstacle (lack of funds).Acknowledging water pollution functioned to delocalise the issue and make it part ofa nationwide problem, one that the central state, and not localities alone, areresponsible for on a structural level.50

At first, Meishan’s case may seem to fully comply with the state’s encouragementof public participation;51 yet, where the Ministry of Environmental Protection intends

Footnote 48 continued

Li Dong and Hu Feng, Use of Hydrotransistor and De-nitrification Pond to Produce Purified Water (2007), availableat: 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 (accessed3 June 2008), which states: ‘There are no human cancer data available for manganese. Exposure to high levels ofmanganese in food resulted in a slightly increased incidence of pancreatic tumors in male rats and thyroid tumors inmale and female mice’. On excessive iron and cancer see R. Stevens Graubard, Marc S. Micozzi, Kazuo Neriishi andBaruch 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 seeYok-shiu F. Lee, Carlos Wing-hung Lo and Anna Ka-yin Lee, ‘Strategy misguided: the weak links between urbanemission control measures, vehicular emissions, and public health in Guangzhou’, Journal of Contemporary China19(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 ContemporaryChina 19(63), (2010).

51. The Ministry of Environmental Protection (MEP) has promoted public participation to deal with thelimitations of top-down regulatory mechanisms, achieve more efficient implementation and expose localnoncompliance. In an article published on China dialogue (a website devoted to environmental issues, especially


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public participation to be aimed at exposing corruption, Meishan’s version exposesinstead lack of capacity. The strategy employed by municipal officials successfullysubverts the central state’s invitation to denounce local causes of failedimplementation and diverts the ‘rightful resistance’ that might have been wagedagainst local officials towards deeper problems of capacity.52 In doing so, localofficials secured legitimacy at the expense of higher levels of the state. Unable toobtain corrective action by municipal officials, Baohua was also unable to convincethe local community that water had any explanatory power as a cause of cancer, andeven less potential as a mobilising force.

Villagers could, of course, raise funds to dig the well themselves. Any suchattempts however would be confronted with local conflicts of interest. For example,would contributions be required from migrant workers, who spend very little timeliving in the village? They might argue that they would not benefit from a new welland would rather save money to buy a flat in the township. These arguments were putforward surrounding contributions to a village road, and they would be likely to applyto well digging in similar ways. As part of efforts towards building the ‘new socialistcountryside’, since 2007, local families who do not already live by the roadsidehave been encouraged to build a new house close to it to facilitate transport links.The current dislocation also creates confusion over where water would be sourced,and although it presents a vital opportunity to provide cleaner water, families arelikely to be averse to contributing funds towards well digging when they are alreadyfinancially burdened by their investment in a new house.

In addition to practical considerations, disagreement over whether waterpollution is really the main cause of high cancer rates hindered Baohua’s attemptsto convince other locals of the need for a deeper well. Indeed, water tests did notprove that water pollution was responsible for increased cancer rates locally. Mostcrucially, water pollution competes with other cancer aetiologies, which may beregarded as more likely and more productive candidates to focus on than water.As some locals argued, all villagers drink the same water, and therefore water maynot explain why some fall ill and others do not. For a family facing the imminentdeath of a relative, aetiologies which account for why he or she in particular is ill—for instance tracing cancer to emotions, smoking or drinking—have a strongerexplanatory efficacy.53

Footnote 51 continued

in China), Pan Yue, a vice minister of MEP, states: ‘First of all, we must understand clearly that public participation isthe right and interest of the people endowed by law. [ . . . ] Involving public participation in environmental protectionshould be an aspect by which to evaluate political performance’. Yue Pan, ‘The environment needs publicparticipation’, 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 UniversityPress, 2006), the authors defined ‘rightful resistance’ as people’s appropriation of the central state’s regulations andrhetoric to complain about failed implementation, which in turn gives them the right to protest. This strategy assumesa 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 revolutionaryrighteousness and fervour amongst the masses. It ultimately ensures that state policies themselves remain beyondscrutiny, therefore reinforcing the state’s legitimacy.

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


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Conclusion

This article has examined the various ways in which farmers in southwest Chinaexperience and understand cancer. I have shown that negative emotions such as angerand anxiety are productive aetiologies in so far as they allow ambiguity regardingwho may be blamed for the onset of illness, variously configuring the sufferer as avictim of hardship or as individually predisposed to these emotional reactions. Localsfelt they had many examples—of which Aunt Liu and her father-in-law were justtwo—to support the claim that cancer affected those who were often angry and tense.As such, awareness can only gain strength when it is substantiated by personalexperience, and is undermined when this is not the case. For instance, despite beingaware of epidemiological evidence that smoking and consumption of alcohol,mouldy and preserved vegetables may be causes of cancer, locals dismiss theseaetiologies because they find little evidence in their own experience to support them.Smoking and drinking are sometimes called upon to explain cancer after a relative’sdeath, because relating cancer to particular elements in the sufferer’s biographyallows their families to make sense of what has happened. Preserved and mouldyvegetables, by contrast, are rejected as an explanation for cancer incidence becausethis is inconsistent with locals’ habits and experiences, and also because thisintersects with perceptions of farm chemicals as harmful. On this basis, farmersjustify their consumption of preserved vegetables (on which few chemicals are used)as an attempt to limit harm.

These findings highlight the fact that awareness of farm chemicals’ harm to healthis common and that these chemicals are seen as playing a role in causing cancer, butwhether these perceptions motivate locals to focus on water pollution as an issue thatneeds to be addressed also depends on whether tracing cancer to water is seen aslikely to lead to any positive results. Baohua’s case shows that his understanding ofthe structural challenges to solving the problem of water pollution also affected hischosen avenues of action. He initially resorted to the media, but learnt that seekingassistance from officials beyond the municipal level did not produce any results.He then justified resort to municipal officials on the grounds that lower level officialslacked the capacity to deal with the problem. Lack of capacity, however, was usedagainst him in much the same fashion by municipal officials, and this served tomaintain legitimacy locally and avoid blame. The nexus between cancer andpotential precipitating factors is therefore always subject to revision, according towhether it is reinforced or undermined by experience, and whether it is perceived toallow any agency on the part of the sufferer, the family and the local community.The importance of such potential for agency becomes clear in Meishan’s example,where Baohua focused on water because of its potential to lead to officialintervention, and failure to muster a successful intervention in turn undermined theappeal of water as an aetiology.

Meishan and Baoma may not be ‘cancer villages’ in the conventional sense ofareas affected by industrial pollution. They are nonetheless areas where the localpopulation is afflicted by cancer rates which are higher than average. This highlightsthe need to broaden attention to cancer beyond ‘cancer villages’ to encompass areaswhere the cause of cancer remains unclear. Understanding the wider spectrum


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of aetiologies to which cancer may be attributed, and the disagreements over whichof these may be held responsible for high cancer rates may explain why residents ofthese areas fail to mobilise and attract attention, as well as elucidate why residentsof conventional ‘cancer villages’ may not readily identify pollution as the culprit.This article does not provide an answer to why Langzhong is affected by high rates ofcancer, as Uncle Zeng asks in the opening quote, but understanding the factors localsidentify as potential causes provides a solid foundation for grasping how cancer isexperienced and how sufferers and their families handle its burden.


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lora-wainwright, anna. 2010. an anthropology of ‘cancer villages’- villagers’ perspectives and...

Documents

development of cancer

cancer deaths

lay aetiologies of cancer

rural china

villagers perspectives

social anthropology

human geography of china

university lecturer