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An Anthropology of Cancer Villages:

villagers' perspectives and the politics
of responsibility
Anna 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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Journal of Contemporary China (2010), 19(63), January, 7999
An Anthropology of Cancer Villages:

villagers perspectives and the politics
of responsibility
Downloaded by [King's College London] at 01:08 11 March 2012
ANNA 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 pollutions 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 the
1970s, and are now the leading causes of mortality in rural China.1 More recently, a
World Bank report assessing the cost of pollution in China again identified cancer as
the 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. She
holds a B.A. in Social Anthropology and an M.A. in Chinese Studies from the School of Oriental and African
Studies. In 2006, she obtained a Ph.D. in Social and Cultural Anthropology from Oxford University, where she
also held a lectureship in Modern Chinese Studies. Her field research and papers have focused on lay attitudes to
health in rural Sichuan (China), healthcare provision, rural development and social inequalities. She is currently
completing a monograph on experiences of cancer in rural China and undertaking collaborative interdisciplinary
research on citizens perception of the effects of industrial pollution on their health. This research was supported
by the Arts and Humanities Research Council, The Leverhulme Trust, the Universities China Committee in
London, and the Contemporary China Study Programme (Oxford University). An earlier version of this paper was
presented at the Social Science Research Council International Workshop on Environment and Health in China
held in Hong Kong in April 2008. The author is grateful to the organisers and to participants for their comments.
In particular, she would like to thank Nancy Chen, John Flower, Adam Frank, Jennifer Holdaway, Elisabeth Hsu,
James Keeley, Pam Leonard, Frank Pieke, Bryan Tilt, Benjamin Van Rooij, Leon Wainwright, Xiang Biao, and
Ye Jingzhong. Her deepest gratitude goes to the friends and informants in China and especially to Qing tongzhi
and Zeng tongzhi. In order to protect informants, personal names and place names (except for Langzhong) have
been changed.
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.
ISSN 1067-0564 print/ 1469-9400 online/10/63007921 q 2010 Taylor & Francis
DOI: 10.1080/10670560903335785
ANNA LORA-WAINWRIGHT
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 in
Chinese and Western media. All these accounts outline a strong connection between
economic growth, pollution and cancer. Cancer villages are the result of economic
progress, leading to the proliferation of chemical factories, causing death in villages
such as Xiditou and Liukuaizhuang, near Tianjin in northern China. Writing for The
Telegraph (UK), Richard Spencer3 states As the effects of economic reforms
rippled through the 1980s, local governments eagerly built new factories but had
little experience of environmental controls.4 In most cases, the continuing misery is
attributed to official corruption which poses an obstacle to implementing
environmental regulations. For instance, a recent article examining three cancer
villages (in Shandong, Jiangsu and Zhejiang) published in Nanfang Wang as part of a
report on water pollution, documents how villagers attempts at seeking redress
failed due to insufficient evidence or through uncooperative officials bribed by
polluting industries.5 But how do people experience and understand cancer in areas
where 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 enrolled
as a visiting researcher at Sichuan University, hoping to carry out 15 months of
ethnographic fieldwork in a rural part of the province. My Chinese supervisor
selected the area of Langzhong (North-East Sichuan) as a location where, with the
help 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 a
resident of Baoma village (a pseudonym), six kilometres from Langzhong city, where
I lived until September 2005. I planned to conduct an anthropological study of how
farmers understand health and illness, how they make decisions about treatment
within the family, and what home-based knowledge and practices are widespread for
common illnesses. As my research unfolded however, cancer occupied an increasing
amount of my time and attention. Doctors and local residents alike highlighted cancer
as a major local killer in the Langzhong area. Baomas former barefoot doctor turned
village 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 a
neighbouring village unit (dui or zu) of 80 residents I call Meishan, nine people died
of 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 Chinas cancer rivers, Telegraph.co.uk, (31 May 2006), available at:
http://www.telegraph.co.uk/news/main.jhtml?xml /news/2006/05/31/wchina31.xml&sSheet /news/2006/05/31/
ixnews.html (accessed 10 December 2007).
4. Equally infamous are the cancer villages near the Dabao Mountain mine, in Guangdong, where the Hengshi
river and underground water are polluted by heavy metals following the opening of the mine. On Shangba village see
Chuanming Yang and Qianhua Fang, A village of death and its hopes for the future, Nanfang News Evening Edition,
(18 November 2005), available at: www.southcn.com/news/dishi/shaoguan/ ttxw/200511180238.htm (accessed 10
March 2006). On Liangqiao village see: Red river brings cancer, Chinese villagers say, CNN, (25 October 2007),
available at: http://edition.cnn.com/2007/WORLD/asiapcf/10/23/pip.china.pollution/ (accessed 11 March 2007).
, Dushi Nanfang, (5 November 2007), available at: http://www.nddaily.com/A/html/
5.
,
2007-11/05/content_299441.htm (accessed 18 November 2007). On the water crisis see
Nanfang Dushi, (2 November 2007), available at: http://www.nddaily.com/sszt/watercrisis/ (accessed 21 November
2007).
80
AN ANTHROPOLOGY OF CANCER VILLAGES
The aim of this paper is not to debate the existence of cancer villages, or to identify
my research location as one. In so far as Langzhong has been identified since the
1980s as an area with a high rate of cancer, and that industry at that time (and still
now) was minimal, local settlements are extremely unlikely to be cancer villages
according to the conventional industrial pollution paradigm. Collecting any
quantitative data on cancer in the area proved extremely difficult. Although the
Baoma village doctor, doctors in the municipal hospital and Public Health Bureau
staff were aware of research on cancer in Langzhong in the 1980s, they claimed to
have no records of such research. They further explained that even if they located
such records, they would probably be classified as internal (neibu) and therefore
inaccessible to me. All they could tell me was that such research had attributed high
cancer rates to consumption of salt-preserved meat and vegetables, but was later
dismissed.6 I was confronted with a similar response when I requested access to
hospital records on cancer patients. I was told that they were not comprehensive and
that 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 avoid
surgery, hospital records would have been severe underestimates.7
My attempts to gather a historical sense of numbers of cancer cases in Baoma were
also frustrated by the changing terms locals use to describe cancer. Stomach and
oesophagus cancer, which are the most prevalent types of cancer in Langzhong, have
until recently (and in some cases still) been understood respectively as vomiting
illness (huishi bing) and choking or spitting illness (gengshi bing). While most
villagers regarded these illnesses to be equivalent to cancer, some distinguished
between 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 these
medical and local labels makes quantifying cancer cases problematic. What we can
deduce is that if there are local terms to describe these types of cancer, they have
probably been widespread for some time.
This paper unpacks how villagers in Langzhong understand the development of
cancer, and attempt to make sense of why it seems widespread and why it affects
particular individuals.8 Through participant observationwhich involved taking part
in 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 their
municipality. This initially made me wonder whether he referred to ongoing research by Oxfords Clinical Trial
Service Unit (CTSU) in Cangxi county; see Jushi Chen, Liu Boqi, Pan Wenharn, Colin Campbell and Richard Peto,
Diet, Lifestyle and Mortality in China (Oxford: Oxford University Press, 1990). However, his later reference to two
further localities not included in the CTSUs study convinced me the research projects must have been separate.
CTSUs 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, Chinas rural health system
and environment-related health risks, Journal of Contemporary China 19(63), (2010); and Anna Lora-Wainwright,
If you can walk and eat, you dont go to hospitalthe quest for healthcare in rural Sichuan, in Jane Duckett and
Beatriz Carrillo, eds, Chinas Changing Welfare Mix: Local Patterns of State, Community and Private Provision
(forthcoming).
8. These are topics on which I am preparing a full length monograph, titled Fighting for Breath: Cancer and
Social Change in a Sichuan Village. My D.Phil. tackled some of these issues; see Anna Lora-Wainwright,
Perceptions of Health, Illness and Healing in a Sichuan Village, China, D.Phil. dissertation, Oxford University, 2006.
For an overview of perceptions of cancer causality amongst Sichuanese farmers see Anna Lora-Wainwright, Social
and cultural understandings of oesophagus and stomach cancer in rural Sichuan, Asian and African Studies XII,
(2007).
81
practitionersI gained first-hand experience of how illnesses are experienced and

treated. I closely followed two cases of cancer (one in my host family) since their
inception and carried out daily open interviews throughout 2004 2005 with locals
(including municipal doctors and officials). I also conducted semi-structured
interviews with 30 families (July 2005) focusing on cancer aetiology and debating
local cases of cancer. Most of my data were collected in Baoma during 2004 2005
and two follow-up trips of one month each in 2006 and 2007. I also gathered data
from a number of other sites which I selected by following women on their visits to
their natal villages. The village unit of Meishan is one such case. Given that no
pervasive agreement was reached by locals as to what causes cancer, this paper is
concerned to outline how they evaluated possible factors, and to understand
environmentally-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 much
more scarce.9 A comprehensive account of cancer villages by Liu Mengqin and Fu
Chen 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 growing
rural urban gap and continuing rural poverty, which entails the transfer of polluting
factories to poor areas. Secondly, as is common, they attribute the problem to an
emphasis on economic development without adequate attention to environmental
protection, and thirdly to local protectionism. They suggest as a solution first the need
to 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 a
control system for environmental law enforcement. Third, they argue for an
independent evaluation structure to tackle the challenge of establishing evidence for
the connection between cancer and pollution, and to clarify issues of unclear
responsibility. Fourth, they highlight the need for basic welfare insurance to counter
poverty, which is often closely related to both health and environmental factors.11
Finally, they stress the need for public participation by strengthening community
governance and participation in environmental protection, providing relevant training
to villagers and supporting NGOs.
Liu and Fu, as do many media reports, identify the biggest barrier for local
advocates and NGOs as demonstrating the connection between pollution and health
consequence.12 In the case of cancer, collecting substantive evidence that
convincingly 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 limited
compared to the coverage of more politically innocuous issues. See Guobin Yang, Brokering environment and health
in China: issue entrepreneurs of the public sphere, Journal of Contemporary China 19(63), (2010).
2007
[A trade-off
10. Mengqin Liu and Chen Fu,
between development and povertya theoretical rethinking of the cancer villages in China], unpublished paper
presented at the Workshop on Environment, Health and Poverty in the Context of Building the New Socialist
Countryside, held in Lijiang, Yunnan, 2025 June 2007.
11. See Fang and Bloom, Chinas 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).
82
The effects of pollution may not be readily evident, they may develop over a
relatively long period of time and people are often exposed to so many different kinds
of chemical hazards (from consumer goods, smoking, household heating and
cooking) that it is difficult to establish a clear causal relationship between dose and
response. But a given community may only mobilise around environmental health
issues and act to change conditions after they have themselves become aware of the
connection between pollution and illness. An interdisciplinary study by William
Alford et al. of the human dimensions of pollution policy implementation, which
focused on air quality in rural Anhui province, assessed how policy measures have
been communicated to, understood by, and acted upon by the citizenry and concluded that the central governments message has yet to be absorbed.13 They stress
that campaigns for environmental awareness have little effect14 and that awareness is
rather the result of personal experience, wealth, education and media. In their study,
chronic symptoms did not necessarily trigger better awareness of the risks of indoor
air pollution caused by cooking fuels. Their research is commendable for pointing out
that successful law enforcement requires creating awareness, providing incentives for
action, and making national regulations feasible locally.15 Yet, focusing on a lack of
knowledge as the obstacle to better environmental practices precludes a closer
examination of villagers existing environmental knowledge, the environmental
threats to health of which they are already aware, and how such awareness has
developedquestions that the study did not address. This article, by contrast, situates
environmental knowledge within the wider spectrum of perspectives on health
and examines how these may undermine locals focus on the effects of pollution
on health.
Jun Jings work on environmental causes of protest16 turns a keener
anthropological eye on the processes by which villagers realise the harmfulness of
pollution. Jing reviewed official records of 278 environmental disputes from the mid1970s to the early-1990s. He focused on two protests that took place during his field
research, enabling him to better grasp their development. In the case of Dachuan
village, in Gansu, locals protested against a fertiliser factory which contaminated
their 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 was
spurred especially by the rise in birth defects, because it undermined one of the
central values of local society: the ability to produce healthy babies. He concludes
that awareness of the causal connection between pollution and illness and the
decision to take action can only take place when they resonate with a societys value
system 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 human
dimensions 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: understanding
citizen action against pollution in China, Journal of Contemporary China 19(63), (2010).
16. Jun Jing, Environmental protests in rural China, in E. Perry and M. Selden, eds, Chinese Society: Change,
Conflict and Resistance (London: Routledge, 2003).
17. Ibid., p. 212.
83
the ways in which people make sense of their illness and the extent to which they
trace it to environmental factors.
Faced with the tragedy of what is often a fatal ailment, families articulate disparate
views regarding the question of why him/her? and assemble various and conflicting
strategies to deal with illness. The elements villagers typically identify as causes of
cancer are: repressed anger or enduring hardship in general, smoking, drinking,
preserved vegetables, and farm chemicals. A biomedically-based account of cancer
would start with testing villagers knowledge that smoking and drinking are potential
causes of cancer. By contrast, this article gives primacy to locals own explanations
of why cancer was common. For some, cancer is mostly to be blamed on the
sufferereither because of their bad temper or their predilection for strong alcohol
and cigarettes. For others it is caused by factors beyond the sufferers controlrapid
social change leading to tensions amongst family members or consumerism requiring
the use of farm chemicals. Adherence to one or other of these aetiologies embodies a
particular engagement with the sociopolitical past and present and provides diverse
answers to the question of who is accountable for illness and who is responsible for
healing. The fight against cancer is deeply bound to efforts not only to maintain
health, but also to debate ones 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 environmental
pollution due to farm chemicals, their perception of its extent and its nature, its health
impacts, how their perceptions have developed, and the ways in which they inform
their actions. Pollution competes with other cancer aetiologies. Unlike Alford et al.,18
my findings suggest that chronic symptoms do raise awareness, but that whether
cancer is traced to environmental pollution (or any other factor) depends on who will
be held responsible as a consequencethe sufferer, their family, or others who failed
to prevent pollution, and whether this may lead to any corrective action. The question
of how environmental awareness rises and how it forms the basis for gathering further
evidence is inseparable from the political and economic obstacles to reporting high
rates of cancer. But rather than considering objective constraints as such (for instance
lack of funding to dig a well, or to resort to hospital treatment), I am interested in the
constraints created by actors perceptions. For example, the extent to which villagers
regard themselves as responsible for pollution or feel entitled to financial
compensation or provision of better water sanitation exerts a powerful influence on
their chosen avenues for action. In turn, I will argue, local officials attempt to avoid
blame by highlighting the lack of resources necessary to fulfil locals demands.
Ultimately, locals are more likely to blame cancer on pollution when at least some
of the following circumstances apply: (1) it is consonant with their experience; (2) it
explains why particular individuals fall ill; (3) it reinforces perceptions of the
sufferers and their families as having acted in a moral fashion; and (4) it is perceived
to be productivethat is, helpful in attracting attention and investment by the local
state. The latter point in particular will be the focus of attention, in terms of how
pollution is understood and managed, how this relates to locals understanding of
local officials capacity, and how those officials respond to locals demands.
18. Alford et al., The human dimensions of pollution policy implementation.
84
Discrepant perceptions among different actors of who is responsible when pollution

causes 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 environmentallyrelated health risks are perceived and handled by particular communities, and to
highlight the importance of culture and local context in framing and addressing these
problems. Understanding how people, at various levels, discuss these issues is vital in
achieving more effective policy implementation, better welfare and sustainable
development. If we do not grasp the perceptions driving peoples actions (for
instance, what farmers consider harmful to their health), we may misconstrue their
knowledge as ignorance, and blame them for their own suffering, or offer advice
which 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 and
why emotions, smoking, drinking and preserved vegetables are perceived to cause
cancer, in order to contextualise perceptions of the link between farm chemicals and
cancer. These aetiologies, I argue, are adopted when they do not contradict peoples
sense of normal, caring and moral behaviour. Rather than serving as stable referents,
given explanations may be resorted to at certain times during illness, then abandoned
and adopted once again after death. This suggests that cancer aetiology is not
objective and unchangeable knowledge but rather a flexible process that entails
reconstituting elements of the sufferers biography to formulate an acceptable
explanation for illness.
Negative emotions, in particular anger, repressed anger and anxiety, are among the
most 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 are
individuals who have been prone to anger and anxiety, or who experienced particularly
unbearable 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: Cambridge
University Press, 2004); and Paul Slovic, Public perception of risk, Journal of Environmental Health 59(9), (1997),
pp. 22 29. For analyses of these issues in China, see Yok-Shiu Lee, Public environmental consciousness in China,
in Kristin Day, ed., Chinas Environment and the Challenge of Sustainable Development (New York: M.E. Sharpe,
2005); Bryan Tilt, Perceptions of risk from industrial pollution in China: a comparison of occupational groups,
Human Organization 65(2), (2006), pp. 915 932; Bryan Tilt, The political ecology of pollution enforcement in
China: a case from Sichuans rural industrial sector, The China Quarterly 192, (2007), pp. 915932.
20. For a full length discussion of emotions as causes of cancer see Anna Lora-Wainwright, Fighting for breath:
cancer and social change in a Sichuan village, full-length manuscript, no date.
21. A study by Cannas Kwok and Gerard Sullivan, Influence of traditional Chinese beliefs on cancer screening
behaviour among Chinese-Australian women, Journal of Advanced Nursing 54(6), (2006), pp. 691 699, highlights a
similar perception of cancer as brought about by negative emotions, and worsened by thinking about the illness.
85
which was linked to a propensity to get angry.22 Such aetiology is reinforced by

Chinese medical theories that attribute illness to the physical effects of emotional
imbalance. According to Chinese medicine, many illnesses may be traced to
imbalance or blockages in the flow of qi (air, or breath).23 The very terminology for
describing anger (sheng qi, literally generating air) and repressed anger (ouqi or
blocked qi) is an example of how strong the connection between qi, anger and physical
discomfort is. The perception that anger and anxiety may precipitate the development
of cancer is, however, not peculiar to China or Chinese people. Feelings of guilt,
anger and aggression featured alongside heredity and external influences in Ruth
Salzbergers study of British cancer patients.24 Deborah Gordons study of cancer in
Italy also showed that naming discomfort as cancer, or even thinking about it, are seen
to bring about its development.25
Aunt Liu died of stomach cancer at 56, in November 2007. As I watched the
funeral guests make their way to her house in Baoma, I remarked that she seemed to
be in fairly good health when I had last visited in April that year. Her neighbour
commented:
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 a
series of hardships. In 1975, she married one of the village schoolteachers and as a
consequence she had to carry out all of the farm work alone. Due to gynaecological
problems that are now curable, Aunt Liu had been unable to bear children, and had
to adopt a daughter. This, she explained, had made her father-in-law angry and
frustrated. 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, which
made her easily angry, and therefore sick.
23. Although it would be wrong to equate villagers understanding of the role of emotions in cancer causation
with Chinese medical theories of cancer, it is significant that they are so similar. On emotions and illness in China see
S. Davis, The cosmobiological balance of the emotional and spiritual worlds: phenomenological structuralism in
traditional Chinese medical thought, Culture, Medicine and Psychiatry 20(1), (1996), pp. 83 123; A. Kleinman,
Patients and Healers in the Context of Culture (London: University of California Press, 1980); A. Kleinman, Social
Origins of Illness and Distress: Depression, Neurasthenia and Pain in Modern China (New Haven, CT: Yale
University Press, 1986); T. Ots, The angry liver, the anxious heart and the melancholy spleen: the phenomenology of
perceptions in Chinese culture, Culture, Medicine and Psychiatry 14(1), (1990), pp. 21 58; N. Sivin, Emotional
counter-therapy, Medicine, Philosophy and Religion in Ancient China, (1995), pp. 1 19; F. Wu, Gambling for qi:
suicide and family politics in a rural North China county, The China Journal 54, (2005), pp. 727. For a recent fulllength 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. 6787; M. Porkert, The Theoretical Foundations of Chinese Medicine: System of Correspondence
(Cambridge, MA: MIT Press, 1974), p. 167; V. Scheid, Chinese Medicine in Contemporary China: Plurality and
Synthesis (London: Duke University, 2002), pp. 4849; 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.
86
propensity to become irritated and resentful (ouqi

), had caused him to develop
oesophagus cancer, of which he died in the early 1990s. She remarked, of course he
was irritable and resentful, people like that get cancer (30 June 2005). In the mid1980s, Aunt Lius husband developed heart and lung problems, rendering him unfit
for work and requiring him to be hospitalised every year. He died in 1997, at 48, of
pulmonary heart disease. Her husbands and father-in-laws illnesses impoverished
the family, and also took their toll on Aunt Lius health. She was forced to bear the
agricultural burden alone and, after 2000, she also cared for her granddaughter
(whose parents lived and worked in Chongqing) and for her nephew, after her
brothers divorce.
Aunt Liu understood her father-in-laws cancer to be due to his tendency to anger,
precipitated by her inability to bear children. In turn, her neighbours clearly attributed
Aunt Lius cancer and her speedy deterioration to her propensity to be anxious,
exacerbated by the hardships she had lived through.26 In this context, nondisclosure is
a common strategy to avoid further suffering for the person affected and to avoid
hastening the development of the disease. The recognition, in Western medicine, that
anxiety and stress might make cancer develop faster, and the consequent practice of
nondisclosure, 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 Vecchio
Good et al. show that in the US, where effective treatment is more widely available,
disclosure has recently become central to physicians attempts to engage sufferers
actively in the therapy. In Langzhong the reverse seems to be the case. When my
landlady Dajies father, Gandie, was diagnosed with oesophagus cancer, the family
decided, as is often the case, not to tell him.28 On 19 October 2004, as we made our
way to Dajies natal village to celebrate Gandies birthday, she cautioned me:
Dont you tell him, he doesnt 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 hes ill because he gets angry
too often, its repressed anger (ouqi). If he just relaxes and controls his temper it will go
away. Thats what the doctor said.
Dajie argued so convincingly that her father would recover that I started to doubt he
had been diagnosed with cancer at all. Nondisclosure itself expressed an active
engagement by the sufferers family with the illness, in an attempt to secure their
health. As in Gordons Italian case study,29 it served to keep the sufferer in their
social world, and to maintain hope alive. Nondisclosure and attributing illness to a
propensity to get angry, as Gandies 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 in
London: I. Papadopoulos, F. Guo, S. Lees and M. Ridge, An exploration of the meanings and experiences of cancer
of Chinese people living and working in London, European Journal of Cancer Care 16, (2007), pp. 424 432.
Informants were found reluctant to talk about cancer (p. 428) and believed that a happy and positive mood would
prolong survival (p. 429). Accordingly, many argued that cancer sufferers would not be informed by the family,
because this is thought to quicken its development (p. 428).
27. See Mary-Jo del Vecchio Good, Byron J. Good, Cynthia Schaffer and Stuart E. Lind, American oncology and
the discourse on hope, Culture, Medicine and Psychiatry 14(1), (1990), pp. 5979; Gordon, Embodying illness.
28. I refer to my landlady as elder sister (dajie) and to her father as gandie, literally dry father. The role of dry
parents is roughly correspondent to that of godparents in the Christian tradition, but without the religious
connotations. I have retained the Chinese term to avoid confusion.
29. Gordon, Embodying illness.
87
intelligible as part of a much broader set of emotion-related illnesses, and to

momentarily maintain hope that if he was able to control his temper cancer might not
develop further. Given that most villagers had little access to medical care, informing
them of their condition was also not necessary in order for them to make choices
about treatment options, as it would be in the United States or Europe.
In some cases, aetiologies that attribute the onset of cancer to personality or
hardship are used as a way to express grievances and therefore serve as powerful tools
for social reproduction. Local women such as Aunt Liu who had been unable to bear
children or young couples who had divorced, often identified their actions, and were
identified by others, as having caused irreparable suffering to their parents. If their
parents or in-laws developed cancer these actions would be held up as precipitating
factors. 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 an
individuals character, allowing those who would otherwise be blamed for causing
that anger to deny such responsibility. By pointing out that her father-in-law was
prone to anxiety and to losing his temper easily Aunt Liu rejected the suggestion that
his cancer had been caused by her failure to produce offspring, thereby avoiding full
responsibility for his poor health. This indicates a certain degree of ambiguity over
whether anger and anxiety are due to a persons temperament or whether they are
interpersonal in the sense that they are caused by others and therefore others are to
blame. It is through this very flexibility over who can be blamed that negative
emotions such as anger and anxiety gain efficacy as aetiologies of cancer.
Ambiguity, albeit of a different kind, also pervades lay perceptions of smoking and
drinking as causes of cancer. A study initiated by Oxford Universitys Clinical Trial
Service Unit (CTSU) on diet, lifestyle and mortality in China30 highlights smoking,
drinking, diet and pollution as possible causes of cancer. Although aware of these
epidemiological tenets, the majority of villagers often dismissed the possibility of
smoking and drinking as causes of cancer, and perceived their relationship to cancer
to be ambivalent. Locals admitted that excessive drinking (500 g of rice liquor baijiu
per day, every day, in one case; 250 g per day in some others) and smoking (two
packets per day) was harmful. Yet, they also claimed that ability to drink and smoke
was 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 dont feel that it
harms my health. I have smoked and drank this much since I was in my teens. I would
get sick if I stopped, I am used to it (10 November 2004). Locals referred to him in
order 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 Campbell
and Richard Peto, Geographic Study of Mortality, Biochemistry, Diet and Lifestyle in Rural China, (26 January 2006),
available at: http://www.ctsu.ox.ac.uk/,china/monograph/ (accessed 23 June 2006).
31. Pat Caplan, Feasts, Fasts and Famines: Food for Thought (Providence, RI: Berg, 1992), p. 27; Pat Caplan,
Approaches to the study of food, health and identity, in Food, Health and Identity (London: Routledge, 1997). For a
similar study, based on research in a working-class community in Philadelphia with high cancer incidence, see
Martha Balshem, Cancer, control and causality: talking about cancer in a working-class community, American
Ethnologist 18(1), (1991), pp. 152 172; Martha Balshem, Cancer in the Community (Washington, DC: Smithsonian
Institution, 1993). Balshem suggests that locals resisted the biomedical ideology promulgated by cancer education
projects by referring to defiant ancestors who smoked two packs of cigarettes a day, ate nothing but lard and bread,
never went to the doctor, and lived to the age of 93 (p. 162).
88
Paradoxically, although villagers accepted that drinking and smoking excessively

could 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 maintain
health, it must mean that their bodies are mighty. Given that these activities are
associated with strong males (by contrast, they are regarded as undesirable for
women), they are part of how masculinity is defined, and as a consequence they are a
habitual parameter of normality for men. Drinking and smoking also serve as key
social 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 case
for smoking and drinking, this serves to undermine their potential association with
illness. Finally, attributing cancer to smoking and drinking would produce the
undesirable result of blaming the sufferer for their illness. Accordingly, I found that
locals would trace cancer to smoking and drinking only when no family member was
currently affected by cancer. Although Gandies relatives had initially blamed his
cancer on anger, they ceased offering any explanations as soon as they realised he
would not recover. After his death, however, his daughter Dajie cautioned her
neighbour Grandfather Liao: you should be careful. My father drank and smoked a
lot, and he died of cancer (July 2005). During illness, relating the development of
cancer in a family member to specific events in his or her life would be immoral; it
would, as Balshem explains, imply they had brought cancer upon themselves.33
By contrast, after the sufferers death searching for an explanation becomes
acceptable and desirable. These explanations may rely on epidemiological
knowledge, such as in the case of smoking or drinking, or may search for morally
acceptable explanations by tracing cancer to traumatic events and the propensity to
get angry.
A similar ambivalence pervades perceptions of preserved and mouldy vegetables
as causes of cancer. As with smoking and drinking, while the epidemiological
literature stresses that lack of dietary variation and consumption of preserved and
mouldy vegetables are possible causes of cancer,34 villagers dismiss this connection.
In principle, locals generally accepted that eating mouldy food might be harmful: its
mouldy, thats no good (frequent claim). In actual fact however, they were reluctant
to waste it and would still eat it. They explained: its not a big deal, you can still eat
it (frequent claim). Some also referred to the common saying bu gan bu jing bu
sheng bing
, literally (living in) dirty (conditions, one) does not fall
ill 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, and
supported 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: Duke
University Press, 1997); M. Yang, Gift, Favours, and Banquets: The Art of Social Relationships in China (New York:
Cornell University Press, 1994). For a brilliant elaboration of how perceptions of masculinity and the role of smoking
in facilitating social relations hinder any attempts to quit, despite peoples awareness of the harmfulness of smoking
see Matthew Kohrman, Smoking among doctors: governmentality, embodiment, and the diversion of blame in
contemporary China, Medical Anthropology 27(1), (2008), pp. 942; Matthew Kohrman, Depoliticizing tobaccos
exceptionality: male sociality, death, and memory-making among Chinese cigarette smokers, The China Journal 58,
(2007), pp. 85 109.
33. Balshem, Cancer in the Community.
34. Chen et al., Diet, Lifestyle and Mortality in China; Chen et al., Geographic Study of Mortality.
89
symptoms after eating it. Seeing the consumption of preserved and mouldy
vegetables simply as a form of poverty-related (self-)oppression thus masks the ways
in which locals understand it. Perceptions of what constitutes an adequate diet and of
what causes cancer depend very much on whose standards such assessments are based
on and on the moral economy of which they are part.35 Attitudes to preserved food are
closely tied to perceptions of whether cancer may be attributed to past shortage
(preserved food) or current development (farm chemicals). The common scepticism
about preserved vegetables role in the development of cancer is a means to defend
long-standing local habits against the widespread use of farm chemicals. Following
these 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 farm
chemicals. The most widely used fertilisers in Langzhong are nitrogen-based
compounds such as ammonium bicarbonate (tansuanqingan
NH4HCO3), urea
[niaosu
(HN2)2CO] and compounds with phosphorus and potassium such as
N P2O5 K2O. They are typically administered in powder form, mixed with
compressed rapeseed powder left over from the production of rapeseed oil and they
are spread without any protective equipment. Commonly used pesticides include
organophosphate and organochlorine compounds, and a great variety of herbicides,
fungicides and treatments for specific vegetables and specific diseases. These are
usually mixed with water, carried on farmers backs in a small plastic tank equipped
with a thin rigid hose roughly one metre in length, and sprayed without wearing
masks or protective gloves. Opinions on when exactly the use of farm chemicals
became widespread vary, but most agree that it was approximately in the early to
mid-1980s. It is likely therefore that their impact on health would only be becoming
fully felt in the present.36
Villagers had little doubt about the efficacy of farm chemicals, but they had
ambivalent 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 contemporary
rural China, BICC Working Paper, (2007), available at: http://www.bicc.ac.uk/Portals/12/ALW%20WP%20NO.
6.pdf; Anna Lora-Wainwright, Of farming chemicals and cancer deaths: the politics of health in contemporary rural
China, Social Anthropology 17(1), (2009), pp. 5673.
36. Heavy reliance on farm chemicals (nongyao) and their effects on health are a prevalent topic of debate
amongst researchers, NGOs and consumer associations. See Y. Yang, Pesticides and environmental health trends in
Chinaa China environmental health project factsheet, China Environment Forum, (2007), available at: http://
www.wilsoncenter.org/topics/docs/pesticides_feb28.pdf (accessed 15 June 2007); see also Elizabeth Economy, The
River Runs Black: The Environmental Challenge to Chinas Future (Cornell: Cornell University Press, 2004), p. 85;
R. Sanders, A market road to sustainable agriculture? Ecological agriculture, green food and organic agriculture in
China, in Peter Ho and Eduard Vermeer, eds, Chinas Limits to Growth: Greening State and Society (Oxford:
Blackwell, 2006); V. Smil, Chinas Past, Chinas Future: Energy, Food, Environment (London: RoutledgeCurzon,
2004), p. 2. According to the Organic Consumers Association As much as 40% of pesticides on the market in China
are sold under false brand names, and in Yunnan province, a 2002 study for the Global Greengrants Fund revealed
that at least half of pesticide distributors are not legally registered or licensed. See Organic Consumers Association,
High Pesticide Residues Threaten Chinas Food Exports, (17 January 2003), available at: http://www.
organicconsumers.org/Toxic/012003_food _safety.cfm (accessed 3 June 2008). Fears that chemicals are fake and
therefore not reliable motivate farmers to over-apply them in the hope of greater yields. See, for example, Yang,
Pesticides and environmental health trends in China. Partly through overuse, partly through failure to use protective
equipment, pesticide poisoning rates are worryingly high: The Chinese government estimates that each year 53,300
to 123,000 people are made ill from pesticides, and 300 to 500 farmers die from pesticide exposure. Localized studies
have shown much higher poisoning rates (Organic Consumers Association, High Pesticide Residues Threaten
Chinas Food Exports).
90
by the improved living conditions following market reforms, and as such they were a
powerful symbol of development. Farm chemicals are part and parcel of the transition
away from a past when the villagers diet was not even as good as a pigs diet now
and when you could barely grow anything. Farmers noted a stark improvement in
production since their introduction. They compared the tiny grains of maize of the
1960s and 1970s with those grown more recently and celebrated farm chemicals for
enabling better produce. Benefits to farming were clear: chemicals killed pests and
fertilised the soil; they made the workload lighter by reducing the heavy loads of
manure farmers had to carry on shoulder poles along narrow paths to their hillside
allotments; 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 produce
literally spotless food.
On the other hand, locals despised their dependence on chemicals for farming and
they complained that these substances were harmful and, in particular, that they
caused cancer. I have never encountered a single farmer who, when asked whether
farm chemicals are harmful to health, replied in the negative. Indeed, when men are at
home it is their job to apply chemicals, because they are generally perceived to be
physically stronger than women, and therefore to be better equipped to endure the
toxicity. Yet men are rarely available for the task as they engage in migrant labour to
supplement the familys income and to cover the rising costs of living, particularly
the cost of high school and healthcare. While women also join the migrant labour
force, men tend to return home at a later age than women, who usually return to care
for their children at critical stages of their upbringing (such as final exams for entry to
high school or middle school) and then to nurse their grandchildren.37 As a
consequence, women are mostly responsible for agricultural tasks, including
applying chemicals. In 2004 2005, my 36-year-old host Dajie shouldered most of
the farming work while her husband commuted to Langzhong city every day to work
as a carpenter. Yet when possible he would return before dark to spray pesticides on
the familys plot. Dajie explained that pesticides are harmful to health, that she
could tell this from their strong smell and from the efficiency with which they killed
pests, and that her husband should administer them because his health was better than
hers. This common perception that men should use chemicals because they are
stronger 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 harmful
effects of chemicals, they used the term nongyao and rarely mentioned feiliao.
If cross-questioned on whether feiliao too was harmful they provided mixed
responses. Uncle Wang reflected, as he spread fertiliser on his wheat field, well, to
be honest, it probably is harmful, it is a chemical after all. But is much more
convenient 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 were
not harmful, they are nutrition for the crops. Therefore, she explained, it was fine
37. On ruralurban migration and its effects on rural China see: R. Murphy, How Migrant Labour is Changing
Rural China (Cambridge: Cambridge University Press, 2002).
91
to spread them with her bare hands, as she was doing. As her husband stood by
watching 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 not
say so at first, they both felt that chemical fertilisers were potentially harmful, and
ought to be avoided by those whose health was poor. Like consumption of preserved
vegetables, such strategic choices over who should administer chemicals are
examples of locals active engagement with their understanding of farm chemicals
as harmful. Farmers efforts to reduce chemicals on crops intended for family
consumption provides yet more evidence that they are aware of the health hazard
posed by chemicals and they attempt to minimise it.38
The perceived harm of farm chemicals is expressed most clearly in their link with
cancer. When a man in his 40s died of cancer in 2005 his neighbour was quick to
conclude that it was obviously to do with his excessive use of chemicals. A young
woman, whose husband had left the village to become a migrant worker, reflected
that she often feels pain in her throat, which she linked to the widespread use of
chemicals. She explained that those who fall sick with oesophagus cancer usually
experience precisely this type of pain. She reasoned that cancer develops when a part
of the body is harmed repeatedly, that farm chemicals harmed the oesophagus and the
stomach in particular, and that these were the two most common types of cancer
locally. Understanding of the poisonous power of pesticides was further reinforced by
their use in suicide attempts. Three cases of suicide using pesticides have occurred in
the past five years in Baoma. The latest, in 2006, was a 70-year-old woman who was
diagnosed with stomach cancer. Having watched her in-laws and some of her
neighbours die slowly and painfully of the disease, she decided to kill herself.
Given the many competing aetiologies of cancer, no villager in Baoma attempted
to mobilise the local community around one in particular. By contrast, in the nearby
village unit of Meishan one man, Baohua, focused on water pollution as a cause
of cancer in the hope of obtaining provision of a better well. The case he made, as
I will show, is inspired by media coverage of cancer villages, yet without any claims
to industrial pollution. I will examine what the outcomes of his actions have been
and why.
Meishans case: politicising and delocalising water pollution
The cases of pollution which receive most journalistic and academic coverage are
usually to do with industrial pollution. As we have seen, most of the cases covered by
the media (and by Liu and Fus study) are concentrated in specific localities which
have recently undergone intense development (especially in industry). Cancer is
therefore understood to be precipitated by development, and in particular by factories
polluting water sources and contaminating food grown in the area.39 Reports on
environmental 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 rather
than in the water as the common practice of limiting farm chemicals on crops grown for home consumption explains,
as it allows more agency to farmers. See Lora-Wainwright, Of farming chemicals and cancer deaths.
39. This is the case with cancer villages near Tianjin, or villages in Zhejiang and Guangdong provinces, and in
developed areas of Jiangsu and Henan.
92
Chinas emphasis on economic development to the detriment of the environment,

credit recent central state policies with attempting to tackle problems and blame
unsuccessful implementation on local corruption and local protectionism. Some
scholars 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 ambitious
targets to protect the environment, local officials generally ignore them, preferring to
concentrate on further advancing economic growth.40
Yet,
according to Andres Liebenthal, head of the World Banks 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 main
pollutants are changing from heavy metals and toxic organic chemicals, which are
typically related to discharge of industrial wastewater, to pollutants from nonpoint
source. Runoff from agriculture, including pesticides and fertilisers, is the single
greatest contributor to nonpoint-source.42 In the case of industrial pollution
responsibility is fairly easily attributed to the nexus of offending industries, and
complicit local officials and citizens, but who is held responsible for avoiding harm to
health when no clear source of pollution is identified? The answer to this question is
central to the politics of maintaining state authority, and may only be understood with
reference to the broader range of causes blamed for cancer, and their social, cultural
and 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 a
cause of cancer and with what consequences. Baohua is in his early 40s, and lives in
Meishan, 15 km from Langzhong city along poorly built roads. I first met him in
January 2005, as I followed his two sisters (married in Baoma) on a visit to their natal
village. Assuming I was a reporter, Baohua told me many residents of Meishanhe
estimated at least four people in 2004 2005had died of cancer recently and that it
must 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 their
case 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 the
media, I was approached by a journalist in the spring of 2006, working on a report on
Chinas water pollution for the UKs 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 October
2007).
41. Pallavi Aiyar, Beijing dips its toes in troubled waters, A Times, (8 August 2007), available at: http://www.
atimes.com/atimes/China/IH08Ad03.html (accessed 20 August 2007).
42. World Bank, The Cost of Pollution in China, p. 34.
43. On the use of the media to counter pollution and its effects on health see Guobin Yang, Brokering
environment and health in China.
93
interview local people in Meishan, and the village and township officials, to ask them
what they thought caused the problem and what could be done.
Predictably, the journalist encountered opposition from local officials. The Public
Health Bureau refused to grant her access to any of their records or to carry out
water tests. She was told by a village official: we dont have any illness here, no
SARS and no AIDS.44 When I visited Meishan again in March 2007, Baohua
explained that the journalists visit had been unhelpful because she had bypassed
Langzhong officials and approached provincial officials directly, placing prefectural,
municipal and township officials in the spotlight. As a consequence, he felt, the
journalist had failed to gain the support from the local state which was necessary to
undertake a thorough investigation of the problem. This, no doubt, reflects what
village officials told villagers after the journalists visit, to discourage them from
seeking media attention again in the future. The outcome was that Baohua became
either too scared to resort to provincial officials, or genuinely convinced that nothing
could be gained from going beyond the municipal level. The possibility of resorting
to 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 lead
to any results. The widespread feeling was that a petition to local officials (which
I take to mean municipal and below) would have no effects, and that petitioning to
higher levels would be too risky. And yet, despite (or perhaps because of) the
journalists failure to identify the cause of local cancer rates, Baohua remained
convinced that the shallow well (less than five meters deep), often dry, and in close
proximity to the paddy fields (and therefore chemicals) was a definite cause of high
cancer rates.
Although the experience with the journalist persuaded Baohua that he should seek
help from lower levels of the state, he still felt that village and township officials
would be of no assistance. As I explored possible avenues for action with Baohua and
his 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 do
things, 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 taking
care but also controlling. The assertion that local officials do not control/care about
these 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 and
unwillingness or one of capacity also reveals who they think should fulfil these
responsibilities, 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 or
unwillingness) hindered village and township officials ability to intervene. As a
consequence, he argued that they would prefer villagers to approach municipal
officials directly rather than being confronted with the problem themselves. Water
pollution, Baohua explained, was too complex an issue to be solved by village or
township officials and therefore it was legitimate to seek assistance at the municipal
44. See Channel 4, Chinas Poisoned Waters, available at: http://www.channel4.com/more4/news/
news-opinion-feature.jsp?id299 (accessed 8 August 2006).
94
level. Municipal officials were perceived to be high enough to have sufficient

resources, 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 the
municipal hospital, Baohua told us 14 people had died since 2004, nine of them of
cancer, especially of the oesophagus, stomach and liver. They were all adult men, the
oldest 70, the youngest 40, who had lived in Meishan all their lives.45 Following this
visit, 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 from
the CDC who made the trip to Meishan with me to collect water samples commented
promptly this well isnt good, it is too shallow, and it is right by the pigsty, a drainage
ditch and the paddy fields. By law, wells need to be at least 50 metres from the nearest
toilet (5 April 2007). There were no factories in the vicinity of the well or of the
village of which Meishan is part, and CDC staff guessed that the well would be
contaminated 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 refuse
collects beneath them, ready to be used as fertiliser. With the increase in use of
chemical fertilisers, however, manure is used less and, as a consequence, it is more
likely that stagnant manure will contaminate the water than if it were distributed over
a wider area of soil. CDC staff explained that this condition was very common in the
Langzhong countryside, where drinking water is almost exclusively extracted from
shallow wells, which are very rarely further than a few metres from peoples homes
and toilets.46
The water test in Meishan did not show high levels of cadmium or arsenic (known
carcinogens); 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/l
according to the CDC and PHB) which both CDC staff and I had expected given the
wells shallowness and proximity to farm chemicals and sewage.47 The low level of
nitrate did not support the hypothesis of contamination by these pollutants, and even
if they had there is little evidence to date of a link between cancer, and nitrate and
nitrite in water.48 The test did show iron and manganese content (possibly linked to
pesticide 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 of
cancer amongst men in terms of their hard work and sacrifice for the well-being of their families.
46. Provision of water to households is sometimes obtained through pumping water out of wells 1020 metres
deep. In most cases, water is taken out of the well with plastic buckets and carried home on shoulder poles. Whether it
is pumped or carried home manually, water is stored in a container with a capacity of roughly 100 litres. In newer
houses this may be a cubical concrete tiled tub, while in older houses it is a large clay vase. When needed, water is
taken out of the storage container with plastic ladles and used for drinking, cooking, or emptied into metal or plastic
bowl for washing (except for clothes, which are washed in the irrigation pond). Surface water gathered in irrigation
ponds, most of which were dug in the 1960s and 1970s, is used to irrigate the paddies and water vegetables and
hillside crops.
47. This is in contrast to research on water pollution in Langzhong carried out by Italian NGO ASIA-ONLUS in
2004. ASIA-ONLUS found that in some villages, the nitrite-content introduced in the water cycle by the proximity of
nitrogen-fertilised paddy fields to the well was ten times higher than acceptable values, according to WHO standards
as well as Chinese Drinking Water Guidelines (personal communication, ASIA-ONLUS staff). When nitrite enters
the bloodstream, it reacts with the haemoglobin and forms a compound called methaemoglobin. This compound
reduces the bloods capacity to carry oxygen. The oxygen level decreases and babies show signs of a disease called
methaemoglobinemia also known as blue baby disease.
48. Although nitrite has not been conclusively shown to cause cancer new research in China proposes that nitrite
nourishes cancer cells and a reduction of it slows cancer growth: see Kenneth Hsu, Ye Wenhua, Kong Yunhua,
95
acceptable values according to Chinese Drinking Water Guidelines, but neither of

these elements have been conclusively categorised as carcinogens.49
Although the test proved that the water is, according to the CDC, not safe for
drinking, this did not automatically ensure the provision of a more adequate well.
Well-digging is the responsibility of the Water and Electricity Bureau, which
according to current budgets (2007) only has enough funds to dig one well per
township per year. Each township of an average size may have at least 300 wells,
many of them in violation of the CDCs 50 metre rule. The Water Bureau had already
spent its resources for 2007, and was more concerned with mountainous villages
where water is even scarcer. My contacts at the CDC suggested I use my connections
with the citys former Deputy Mayor to urge the Water Bureau to collaborate, but his
contacts in that bureau had since moved on. This, I was told, is part of a government
effort to combat corruption, which entails frequently transferring officials to different
posts so they cannot easily rely on connections.
Although the water test did not provide evidence of high levels of known
carcinogens, it did prove the need for cleaner water. Baohua had focused on water
pollution to explain cancer at the community rather than individual level, in the hope
of attracting attention. Through his experience with local officials and with the
journalist, Baohua had identified municipal officials as the level of bureaucracy with
the necessary expertise and resources for corrective action; and yet no action was
taken. How did municipal officials maintain legitimacy despite their failure to
provide for a better well? Officials at the Centre for Disease Control readily agreed
with Baohua that the water was not good (they did not have the expertise to suggest
whether it caused cancer). Recognising that the water was polluted suited the CDC
officials: 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 of
a nationwide problem, one that the central state, and not localities alone, are
responsible for on a structural level.50
At first, Meishans case may seem to fully comply with the states encouragement
of 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), available
at: http://home.btconnect.com/KennethHsu/webdocs/Nitrite%20PNAS-19Feb2007.pdf (accessed 3 June 2008).
49. On the toxicity of manganese and its effects on health see Agency for Toxic Substances and Disease Registry,
TOxFAQs for Manganese (2001), available at: http://www.atsdr.cdc.gov/tfacts151.html#bookmark02 (accessed
3 June 2008), which states: There are no human cancer data available for manganese. Exposure to high levels of
manganese in food resulted in a slightly increased incidence of pancreatic tumors in male rats and thyroid tumors in
male and female mice. On excessive iron and cancer see R. Stevens Graubard, Marc S. Micozzi, Kazuo Neriishi and
Baruch S. Blumberg, Moderate elevation of body iron level and increased risk of cancer occurrence and death,
International Journal of Cancer 56(3), (1994), pp. 364 369.
50. On the implementation gap in environmental governance and its effects on public health in Guangzhou see
Yok-shiu F. Lee, Carlos Wing-hung Lo and Anna Ka-yin Lee, Strategy misguided: the weak links between urban
emission control measures, vehicular emissions, and public health in Guangzhou, Journal of Contemporary China
19(63), (2010). On the Chinese states role in environmental risk management see Lei Zhang and Lijin Zhong,
Integrating and prioritizing environmental risks in Chinas risk management discourse, Journal of Contemporary
China 19(63), (2010).
51. The Ministry of Environmental Protection (MEP) has promoted public participation to deal with the
limitations of top-down regulatory mechanisms, achieve more efficient implementation and expose local
noncompliance. In an article published on China dialogue (a website devoted to environmental issues, especially
96
public participation to be aimed at exposing corruption, Meishans version exposes

instead lack of capacity. The strategy employed by municipal officials successfully
subverts the central states invitation to denounce local causes of failed
implementation and diverts the rightful resistance that might have been waged
against local officials towards deeper problems of capacity.52 In doing so, local
officials secured legitimacy at the expense of higher levels of the state. Unable to
obtain corrective action by municipal officials, Baohua was also unable to convince
the local community that water had any explanatory power as a cause of cancer, and
even less potential as a mobilising force.
Villagers could, of course, raise funds to dig the well themselves. Any such
attempts however would be confronted with local conflicts of interest. For example,
would contributions be required from migrant workers, who spend very little time
living in the village? They might argue that they would not benefit from a new well
and would rather save money to buy a flat in the township. These arguments were put
forward surrounding contributions to a village road, and they would be likely to apply
to well digging in similar ways. As part of efforts towards building the new socialist
countryside, since 2007, local families who do not already live by the roadside
have 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 are
likely to be averse to contributing funds towards well digging when they are already
financially burdened by their investment in a new house.
In addition to practical considerations, disagreement over whether water
pollution is really the main cause of high cancer rates hindered Baohuas attempts
to convince other locals of the need for a deeper well. Indeed, water tests did not
prove that water pollution was responsible for increased cancer rates locally. Most
crucially, water pollution competes with other cancer aetiologies, which may be
regarded 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 may
not explain why some fall ill and others do not. For a family facing the imminent
death of a relative, aetiologies which account for why he or she in particular is ill
for instance tracing cancer to emotions, smoking or drinkinghave a stronger
explanatory 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 is
the right and interest of the people endowed by law. [ . . . ] Involving public participation in environmental protection
should be an aspect by which to evaluate political performance. Yue Pan, The environment needs public
participation, China Dialogue, (5 December 2006), available at: http://www.chinadialogue.net/article/show/single/
en/604-The-environment-needs-public-participation (accessed 6 December 2006).
52. In Kevin OBrien and Lianjiang Li, Rightful Resistance in Rural China (Cambridge: Cambridge University
Press, 2006), the authors defined rightful resistance as peoples appropriation of the central states regulations and
rhetoric to complain about failed implementation, which in turn gives them the right to protest. This strategy assumes
a benevolent centre producing enforceable policies and local officials who work purely in their own personal interests,
and care little about the welfare of the people. In turn, it still assumes (and hopes to exploit) a sort of revolutionary
righteousness and fervour amongst the masses. It ultimately ensures that state policies themselves remain beyond
scrutiny, therefore reinforcing the states legitimacy.
53. This argument is developed further, with reference to the same case studies, in Lora-Wainwright, Of farming
chemicals and cancer deaths.
97
Conclusion
This article has examined the various ways in which farmers in southwest China
experience and understand cancer. I have shown that negative emotions such as anger
and anxiety are productive aetiologies in so far as they allow ambiguity regarding
who may be blamed for the onset of illness, variously configuring the sufferer as a
victim of hardship or as individually predisposed to these emotional reactions. Locals
felt they had many examplesof which Aunt Liu and her father-in-law were just
twoto 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 personal
experience, and is undermined when this is not the case. For instance, despite being
aware of epidemiological evidence that smoking and consumption of alcohol,
mouldy and preserved vegetables may be causes of cancer, locals dismiss these
aetiologies because they find little evidence in their own experience to support them.
Smoking and drinking are sometimes called upon to explain cancer after a relatives
death, because relating cancer to particular elements in the sufferers biography
allows their families to make sense of what has happened. Preserved and mouldy
vegetables, by contrast, are rejected as an explanation for cancer incidence because
this is inconsistent with locals habits and experiences, and also because this
intersects with perceptions of farm chemicals as harmful. On this basis, farmers
justify 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 health
is common and that these chemicals are seen as playing a role in causing cancer, but
whether these perceptions motivate locals to focus on water pollution as an issue that
needs to be addressed also depends on whether tracing cancer to water is seen as
likely to lead to any positive results. Baohuas case shows that his understanding of
the structural challenges to solving the problem of water pollution also affected his
chosen avenues of action. He initially resorted to the media, but learnt that seeking
assistance from officials beyond the municipal level did not produce any results.
He then justified resort to municipal officials on the grounds that lower level officials
lacked the capacity to deal with the problem. Lack of capacity, however, was used
against him in much the same fashion by municipal officials, and this served to
maintain legitimacy locally and avoid blame. The nexus between cancer and
potential precipitating factors is therefore always subject to revision, according to
whether it is reinforced or undermined by experience, and whether it is perceived to
allow any agency on the part of the sufferer, the family and the local community.
The importance of such potential for agency becomes clear in Meishans example,
where Baohua focused on water because of its potential to lead to official
intervention, and failure to muster a successful intervention in turn undermined the
appeal of water as an aetiology.
Meishan and Baoma may not be cancer villages in the conventional sense of
areas affected by industrial pollution. They are nonetheless areas where the local
population is afflicted by cancer rates which are higher than average. This highlights
the need to broaden attention to cancer beyond cancer villages to encompass areas
where the cause of cancer remains unclear. Understanding the wider spectrum
98
of aetiologies to which cancer may be attributed, and the disagreements over which
of these may be held responsible for high cancer rates may explain why residents of
these areas fail to mobilise and attract attention, as well as elucidate why residents
of 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 of
cancer, as Uncle Zeng asks in the opening quote, but understanding the factors locals
identify as potential causes provides a solid foundation for grasping how cancer is
experienced and how sufferers and their families handle its burden.
99

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Journal of Contemporary China

An Anthropology of Cancer Villages:

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Journal of Contemporary China (2010), 19(63), January, 7999

An Anthropology of Cancer Villages:

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AN ANTHROPOLOGY OF CANCER VILLAGES

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practitionersI gained first-hand experience of how illnesses are experienced and

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AN ANTHROPOLOGY OF CANCER VILLAGES

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Discrepant perceptions among different actors of who is responsible when pollution

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which was linked to a propensity to get angry.22 Such aetiology is reinforced by

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AN ANTHROPOLOGY OF CANCER VILLAGES

propensity to become irritated and resentful (ouqi

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intelligible as part of a much broader set of emotion-related illnesses, and to

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AN ANTHROPOLOGY OF CANCER VILLAGES

Paradoxically, although villagers accepted that drinking and smoking excessively

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AN ANTHROPOLOGY OF CANCER VILLAGES

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Chinas emphasis on economic development to the detriment of the environment,

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AN ANTHROPOLOGY OF CANCER VILLAGES

level. Municipal officials were perceived to be high enough to have sufficient

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acceptable values according to Chinese Drinking Water Guidelines, but neither of

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public participation to be aimed at exposing corruption, Meishans version exposes

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AN ANTHROPOLOGY OF CANCER VILLAGES

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