UCLA Faculty Research on China: Professor Virginia C. Li
"Going to China is for testing methodologies, not just for projects"
Published: Thursday, February 21, 2008
Virginia Li, Professor in the Department of Community Health Sciences, is a perfect example of how entrance through the gates of academia need not be via the conventional route. For a person who must follow an unconventional path -- even a woman with a family, at a time when society tended to relegate women to the role of housewife -- the gates can still be swung wide open . . . if that person is determined. After having three children, Li returned to graduate school and received her masters and doctoral degrees from the University of North Carolina School of Public Health.
Having been born in Guangzhou and subsequently moving to the United States as a teen, in her professional and personal life Professor Li has always been deeply connected to both China and the United States. However, it was not until 1974 that she returned to the China for the first time since she and her family fled from the Communist Revolution in 1949. It was around that time that she began research into public health in China. In addition to her appointment at UCLA, she has also held professorships at the University of Maryland and the Johns Hopkins University School of Hygiene and Public Health. She also holds honorary professorships at Guangdong Medical College, Nanjing College Nanjing College for Population Program Management, and Kunming Medical College.
One of Professor Li’s most salient research projects is her "Women’s Reproductive Health and Development Program" in the province of Yunnan, China. Sponsored by the Ford Foundation, it began with two guidelines: (1) it must employ a bottom-up method of implementation, and (2) it must ensure horizontal linkages among various agencies. Professor Li had the luxury to develop the other guidelines as she saw fit. Early on, Professor Li realized that although she was very familiar with China as a whole, she was not especially well acquainted with Yunnan Province specifically. Therefore, she contacted a consultant in Yunnan to build up her local capacity so to speak. She chose a professor from Beijing Medical University who had trained barefoot doctors during the Cultural Revolution to assist her in choosing and developing sites that are both easily accessible and that already enjoyed a certain amount of infrastructure and leadership.
After choosing a Chinese collaborator, Professor Li and her research group continued on to developing effective research methodologies. They rejected a purely clinical approach because women’s reproductive health in poor areas is complex, depending not so much on the idiosyncratic situation of the individual, as on income, literacy, transportation, and the like. Professor Li knew that there needed to be strong leadership from the Health Department, Family Bureau, and Women’s Federation in the province. Because her research project was strong and convincing -- also, one suspects, because of her negotiating skills and determination -- she successfully garnered their active support. She chose Kunming Medical College as the primary outside agency with which to work on the project.
Implementation of the project was based heavily on "needs assessments." Four to five agencies were involved in the project. Professor Li did not wish to identify any one lead agency, but rather wanted the agencies to work as partners. To accomplish this, she formed leadership groups with the heads of the agencies acting as the group heads. These groups' main purpose was to engage women at the township and county level in the project. The first year was spent entirely in needs assessment. Professor Li and her collaborators engaged fourth-year medical students from Kunming Medical School as interviewers for a 8,500 household survey. Most of these medical students were from urban areas and had never even been to a rural area. Thus in more ways than one the work they did contributed to their education and to broadening their horizon. During the interview stages, two med students, one acting as the interviewer and the other as the medical consultant, lived in a peasant home for six months. Kunming Medical College eased the way for the students by allowing the interview period to be counted as a practicum for medical school. The students were divided into two groups: while one group interviewed the villagers, the other set up a temporary clinic.
Most importantly, Li and her colleagues developed a new methodology called photo-voice (www.photovoice.com). This involved giving an Instamatic camera to the village women to take photographs of scenes that they deemed significant and important to their home environment. Subsequently, they organized a forum and invited county leadership in to be given a presentation and to discuss the meaning of the pictures. This allowed the local women to express their views while the medical students learned something about the social sciences. The images that accompany this article were taken by local women.
The next part of the project involved teaching the township and county cadres how to write proposals -- such as requests for nurseries, scientific pig raising, etc. -- based on the needs. Forty projects, which included health literacy, biogas tanks, silage pits, and innovation in turnip seed spreading machines, were planned for the eight-year period from 1991 to 1999.
Although the research portion of the project is over, Professor Li continues to work with the people of Yunnan, the Kunming Medical College, and the Institute for Health Programming to further reproductive health in rural China. From 1999 to 2000, the World Health Organization developed its own global health monitor indicator, which Li knew upon reading was not feasible or practical for China. She therefore developed two methodologies to measure reproductive health indicators. One involved a small-group method called the "nominal group process" in which over fifty individuals who had taken part in the Women’s Reproductive Health program participated. The second was a Delphi Questionnaire administered to a Chinese panel and an international panel with rural experience in developing countries. These methodologies, which asked Chinese and international experts to choose a set of health indicators for rural China, helped Li and her colleagues developed eight new indicators for global health. The WHO has since then held two meetings on global reproductive health indicators, one of which Li attended in March of 2006. In these meetings, the WHO used Li's indicators as the focal point.
Professor Virginia Li has also been active in creating and promoting a reproductive health website for rural doctors and teachers in Yunnan. The content of the website was developed with the help of volunteers and students from the Yunnan Reproductive Health Association and Kunming Medical College. The website focuses on five content areas: reproductive health, family planning, HIV/AIDS prevention, gender rights, and women’s health.
The website was connected to an experimental program in three counties that Li and her collaborators designed. The first county received training in computer technology, and was given a computer, printer, and emergency battery. A mobile team visited the county every six weeks to assess problem solving. The second county received all of this, excluding the training in computer technology. The third county, deemed the control county, received the printer and computer only. Professor Li and her team performed before and after assessments of each of the counties, questioning village doctors, teachers, and cadres on the usage and success of the system. They also undertook a sampling of the villagers themselves to see if the benefits were truly being felt.
"Going to China is for testing methodologies, not just for projects," Professor Li stated. A broad communication-based approach can truly influence social change and reproductive health. This test sought an answer to the question "What is the minimal requirement needed to make an impact in a rural environment?" Li and her team found that the impact in the classroom was the most evident and that experimental county #1 also experienced the greatest benefit due to the mobile teams and computer training. The second county had success with its website, but to a lesser degree and the impact on the villagers was minimal.
At the end of the study, Professor Li and her team concluded that the training in computer technology was essential to making the website effective. Also, a planning workshop on information diffusion was essential in disseminating the information from the township level agency and schools to the village-level clinic doctors and schoolteachers. The website remains up and running and open for use. The Office of Science and Technology in Kunming wished to take over the project, but Professor Li decided to hand it over to her colleagues at the Kunming Medical College.
Professor Li already has her sights on a future research project in China involving tobacco crop substitution in Yunnan. China is a cigarette-smoking country where the tobacco tax is the number one revenue source for the state. The Ministry of Health has taken some measures to promote smoking prevention and control, but this only addresses the demand side. Professor Li feels that it is crucial for China to conduct research that addresses the supply side. The main question of concern is "What could be planted that incurs the same costs and reaps the same benefits for farmers and the government?" Li traveled to Yunnan in October 2007 and discussed with government officials her interested in this subject. Surprisingly, they were receptive, and although she knows it is a very sensitive issue, she now has the green light. In fact, as this article is being written, Professor Li is in China, and reports that the authorities have approved her project. The next step is finding funding. Professor Li feels that until the supply side is resolved, China will always be a nation of smokers.
Read more on Professor Li, her current and upcoming research, and even her recently publish autobiography:
- A profile in the UCLA School of Public Health Magazine
- An article in UCLA Spotlight
- An article in UCLA Today
- A PowerPoint presentation: "Bridging the Urban-Rural Continuum to Improve Services in Rural China"
- Website on Virgina Li’s autobiography, From One Root, Many Flowers