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Building care amid navigating liability risks: The possibility of policy-driven care in China's drug-control arena

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  • Zhang, Chaoxiong

Abstract

For Chinese policymakers, shouldering responsibility is often associated with high liability risk, thus resulting in low-level care for risky and stigmatized populations such as drug users. Therefore, it is crucial to explore ways to improve care access in such an uneasy policy environment. Based on long-term ethnographic fieldwork conducted in Yunnan province in southwestern China from 2013 to 2021, this paper traces the policy-making process of the Yunnan Province Methadone Oral Solution Take-Home Treatment Work Proposal. All stakeholders involved considered this policy attempt “impossible” at first, as the highly addictive methadone becomes an illegal drug once it is taken outside a clinical setting. By analyzing how a group of local government officials, together with medical practitioners and drug users, strive to legitimize and ultimately implement the policy, I argue that people's concern over liability risks strengthens the boundary between methadone as a “drug” and methadone as a “medicine,” between methadone solution drinkers as “drug users” and as “patients,” and between “inside the clinic” and “outside the clinic.” By utilizing a culturalist approach to explore the possibility of care in such a context, this paper reveals that a “heqing heli hefa worthy-of-being-cared-for” discourse is crucial in that it acts as symbolic capital to dissolve the above boundaries embedded in the dominant political culture. Moreover, it is the key cultural logic of the “building” of care. The findings also illustrate how local policymakers negotiate and balance responsibility and liability to create a potential policy space for enabling care practices. Additionally, this study sheds light on the inclusion of care for the most stigmatized and marginalized populations, and has broad implications for policy-making in other contexts.

Suggested Citation

  • Zhang, Chaoxiong, 2022. "Building care amid navigating liability risks: The possibility of policy-driven care in China's drug-control arena," Social Science & Medicine, Elsevier, vol. 314(C).
  • Handle: RePEc:eee:socmed:v:314:y:2022:i:c:s0277953622007894
    DOI: 10.1016/j.socscimed.2022.115483
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    References listed on IDEAS

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    1. McNeil, Ryan & Kerr, Thomas & Anderson, Solanna & Maher, Lisa & Keewatin, Chereece & Milloy, M.J. & Wood, Evan & Small, Will, 2015. "Negotiating structural vulnerability following regulatory changes to a provincial methadone program in vancouver, canada: A qualitative study," Social Science & Medicine, Elsevier, vol. 133(C), pages 168-176.
    2. Faulkner-Gurstein, Rachel, 2017. "The social logic of naloxone: Peer administration, harm reduction, and the transformation of social policy," Social Science & Medicine, Elsevier, vol. 180(C), pages 20-27.
    3. Harris, Magdalena, 2020. "Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care," Social Science & Medicine, Elsevier, vol. 260(C).
    4. Frank, Vibeke Asmussen & Bjerge, Bagga, 2011. "Empowerment in drug treatment: Dilemmas in implementing policy in welfare institutions," Social Science & Medicine, Elsevier, vol. 73(2), pages 201-208, July.
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