Pathways to food insecurity: Migration, hukou and COVID-19 in Nanjing, China.

The COVID-19 pandemic has issued significant challenges to food systems and the food security of migrants in cities. In China, there have been no studies to date focusing on the food security of migrants during the pandemic. To fill this gap, an online questionnaire survey of food security in Nanjing City, China, was conducted in March 2020. This paper situates the research findings in the general literature on the general migrant experience during the pandemic under COVID and the specifics of the Chinese policy of hukou. Using multiple linear regression and ordered logistic regression, the paper examines the impact of migration status on food security during the pandemic. The paper finds that during the COVID-19 outbreak in 2020, households without local Nanjing hukou were more food insecure than those with Nanjing hukou. The differences related more to the absolute quantity of food intake, rather than reduction in food quality or in levels of anxiety over food access. Migrants in China and elsewhere during COVID-19 experienced three pathways to food insecurity-an income gap, an accessibility gap, and a benefits gap. This conceptual framework is used to structure the discussion and interpretation of survey findings and also has wider potential applicability.

Health worker migration from South Africa: causes, consequences and policy responses.

BACKGROUND: This paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries-Jamaica, India, the Philippines, and South Africa-have historically been "sources" of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa. METHODS: The study began with a scoping review of the literature on health worker migration from South Africa, followed by empirical data collected from skilled health workers and stakeholders. Surveys were conducted with physicians, nurses, pharmacists, and dentists. Interviews were conducted with key informants representing educators, regulators, national and local governments, private and public sector health facilities, recruitment agencies, and professional associations and councils. Survey data were analyzed using descriptive statistics and regression models. Interview data were analyzed thematically. RESULTS: There has been an overall decrease in out-migration of skilled health workers from South Africa since the early 2000s largely attributed to a reduced need for foreign-trained skilled health workers in destination countries, limitations on recruitment, and tighter migration rules. Low levels of worker satisfaction persist, although the Occupation Specific Dispensation (OSD) policy (2007), which increased wages for health workers, has been described as critical in retaining South African nurses. Return migration was reportedly a common occurrence. The consequences attributed to SHW migration are mixed, but shortages appear to have declined. Most promising initiatives are those designed to reinforce the South African health system and undertaken within South Africa itself. CONCLUSIONS: In the near past, South Africa's health worker shortages as a result of emigration were viewed as significant and harmful. Currently, domestic policies to improve health care and the health workforce including innovations such as new skilled health worker cadres and OSD policies appear to have served to decrease SHW shortages to some extent. Decreased global demand for health workers and indications that South African SHWs primarily use migratory routes for professional development suggest that health worker shortages as a result of permanent migration no longer pertains to South Africa.

'A foreigner is not a person in this country': xenophobia and the informal sector in South Africa's secondary cities.

South Africa's major cities are periodically wracked by large-scale xenophobic violence directed at migrants and refugees from other countries. Informal sector businesses and their migrant owners and employees are particularly vulnerable targets during these attacks. Migrant-owned businesses are also targeted on a regular basis in smaller-scale looting and destruction of property. There is now a large literature on the characteristics and causes of xenophobic violence and attitudes in South Africa, most of it based on quantitative and qualitative research in the country's major metropolitan areas. One of the consequences of big-city xenophobia has been a search for alternative markets and safer spaces by migrants, including relocating to the country's many smaller urban centres. The question addressed in this paper is whether they are welcomed in these cities and towns or subject to the same kinds of victimization as in large cities. This paper is the first to systematically examine this question by focusing on a group of towns in Limpopo Province and the experiences of migrants in the informal sector there. Through survey evidence and in-depth interviews and focus groups with migrant and South African vendors, the paper demonstrates that xenophobia is also pervasive in these smaller centres, in ways that both echo and differ from that in the large cities. The findings in this paper have broader significance for other countries attempting to deal with the rise of xenophobia.

Food Insecurity and Dietary Deprivation: Migrant Households in Nairobi, Kenya.

The current study focuses on food consumption and dietary diversity among internal migrant households in Kenya using data from a city-wide household survey of Nairobi conducted in 2018. The paper examined whether migrant households are more likely to experience inferior diets, low dietary diversity, and increased dietary deprivation than their local counterparts. Second, it assesses whether some migrant households experience greater dietary deprivation than others. Third, it analyses whether rural-urban links play a role in boosting dietary diversity among migrant households. Length of stay in the city, the strength of rural-urban links, and food transfers do not show a significant relationship with greater dietary diversity. Better predictors of whether a household is able to escape dietary deprivation include education, employment, and household income. Food price increases also decrease dietary diversity as migrant households adjust their purchasing and consumption patterns. The analysis shows that food security and dietary diversity have a strong relationship with one another: food insecure households also experience the lowest levels of dietary diversity, and food secure households the highest.

Emergency food supplies and food security in Wuhan and Nanjing, China, during the COVID-19 pandemic: Evidence from a field survey.

Motivation: Detailed empirical work on the impact of the COVID-19 pandemic on food security is scant. Local management of food security has received little attention. Purpose: This article describes emergency food policies in Wuhan and Nanjing, China during lockdown in 2020 and their implications for household food security in the two cities. Methods and approach: Policy documents and background data describe the emergency measures. Online surveys of residents of two Chinese cities were used to gauge household food security. Findings: Despite the determined efforts of provincial and city governments to ensure that food reached people who were locked down in Wuhan, or subject to restrictions on movement in Nanjing, households experienced some decline in food security. Most households found they could not access their preferred foods. But a minority of households did not get enough to eat.Government had contingency plans for the pandemic that ensured that most people had sufficient, if not preferred, food. But not all households were fully covered. Policy implications: A more resilient system of food distribution is needed, including a relatively closed and independent home delivery system. Grassroots organizations such as residential community committees, property management organizations, and spontaneous volunteer groups need to be brought into the management of emergency food provision.

Preparing for COVID-19: Household food insecurity and vulnerability to shocks in Nairobi, Kenya.

An understanding of the types of shocks that disrupt and negatively impact urban household food security is of critical importance to develop relevant and targeted food security emergency preparedness policies and responses, a fact magnified by the current COVID-19 pandemic. This gap is addressed by the current study which draws from the Hungry Cities Partnership (HCP) city-wide household food insecurity survey of Nairobi city in Kenya. It uses both descriptive statistics and multilevel modelling using General Linear Mixed Models (GLMM) to examine the relationship between household food security and 16 different shocks experienced in the six months prior to the administration of the survey. The findings showed that only 29% of surveyed households were completely food secure. Of those experiencing some level of food insecurity, more experienced economic (55%) than sociopolitical (16%) and biophysical (10%) shocks. Economic shocks such as food price increases, loss of employment, and reduced income were all associated with increased food insecurity. Coupled with the lack of functioning social safety nets in Nairobi, households experiencing shocks and emergencies experience serious food insecurity and related health effects. In this context, the COVID-19 pandemic is likely to have a major negative economic impact on many vulnerable urban households. As such, there is need for new policies on urban food emergencies with a clear emergency preparedness plan for responding to major economic and other shocks that target the most vulnerable.

Factors determining household-level food insecurity during COVID-19 epidemic: a case of Wuhan, China.

BACKGROUND: In coping with the coronavirus disease 2019 (COVID-19) epidemic, cities adopted social isolation and lockdown measures; however, little is known about the impacts of these restrictions on household food security. OBJECTIVE: This study provides a timely assessment of household food insecurity (HFI) in the Chinese city of Wuhan during the COVID-19 epidemic period and also investigates its determinant factors. DESIGN: We collected valid data on food insecurity from 653 households in Wuhan via an online questionnaire in March 2020. The Household Food Insecurity Access Scale Score (HFIASS) was used to measure HFI, and a multiple linear regression model was used to determine the HFIASS. RESULTS: The mean HFIASS in Wuhan was 9.42 (standard deviation: 5.82), with more than 50% of the households had an HFIASS < 9. Compared with normal conditions, lockdown measures had a huge negative impact on household food security. The results revealed that socio-demographic characteristics remained the underlying determinants of HFIASS during the epidemic. Households in Wuhan with local Hukou (city household registration) and self-owned property had a lower risk of food insecurity. DISCUSSION AND CONCLUSION: After the restriction of conventional food access channels, intermediary food purchase methods such as group purchasing, shopping with the help of neighborhood committees, property management agents, and volunteers became the most important or the only channel for residents to access food. There were similarities in the use of these intermediary channels. Based on the probability that the epidemic will continue and the probability of similar public health-related outbreaks in the future, the study calls for a more resilient and responsive sustainable food supply system by harnessing the capacity of communities, e-commerce and rapid logistics.

South-South cross-border patient travel to South Africa.

This paper explores intra-regional South-South cross-border patient travel within the context of Southern Africa. South Africa, in particular, has been widely touted as one of the emerging destinations of high-end patients from the Global North alongside other destinations such as Brazil, India, Costa Rica and Thailand. Using South Africa as a case study, the paper demonstrates that South-South cross-border patient travel is far more significant than North-South patient travel both in numerical and financial terms. Every year, thousands of patients from neighbouring countries travel to South Africa in search of medical treatment for procedures that are not offered in their own countries. Despite its size and importance, the South-South flow of patients in Southern Africa is not fully understood and requires further scholarly research.

The relative deprivation-gratification continuum and the attitudes of South Africans toward immigrants: a test of the V-curve hypothesis.

It has long been established that there is a linear and positive relationship between relative deprivation and prejudice. However, a recent experiment suggests that the converse of relative deprivation, relative gratification, may also be associated with prejudice (S. Guimond & M. Dambrun, 2002). Specifically, the evidence suggests that the usual test for a linear relationship between relative deprivation-gratification and prejudice might conceal the existence of a bilinear relationship. This function, labeled the V-curve hypothesis, predicts that both relative deprivation and relative gratification are associated with higher levels of prejudice. This hypothesis was tested with a representative sample of South Africans (N=1,600). Results provide strong support for the V-curve hypothesis. Furthermore, strength of ethnic identification emerged as a partial mediator for the effect of relative gratification on prejudice.

South-South medical tourism and the quest for health in Southern Africa.

Intra-regional South-South medical tourism is a vastly understudied subject despite its significance in many parts of the Global South. This paper takes issue with the conventional notion of South Africa purely as a high-end "surgeon and safari" destination for medical tourists from the Global North. It argues that South-South movement to South Africa for medical treatment is far more significant, numerically and financially, than North-South movement. The general lack of access to medical diagnosis and treatment in SADC countries has led to a growing temporary movement of people across borders to seek help at South African institutions in border towns and in the major cities. These movements are both formal (institutional) and informal (individual) in nature. In some cases, patients go to South Africa for procedures that are not offered in their own countries. In others, patients are referred by doctors and hospitals to South African facilities. But the majority of the movement is motivated by lack of access to basic healthcare at home. The high demand and large informal flow of patients from countries neighbouring South Africa has prompted the South African government to try and formalise arrangements for medical travel to its public hospitals and clinics through inter-country agreements in order to recover the cost of treating non-residents. The danger, for 'disenfranchised' medical tourists who fall outside these agreements, is that medical xenophobia in South Africa may lead to increasing exclusion and denial of treatment. Medical tourism in this region and South-South medical tourism in general are areas that require much additional research.

Social change in South Africa: a historical approach to relative deprivation.

Dramatic social change involves profound transformations that impact an entire group moving forward. Such is the reality for race relations in South Africa. Research has found that most people report a trajectory of group-based relative deprivation that appears to parallel actual historical events. However, a significant subset of respondents reported a trajectory in which the perceived status of their group remained stable despite dramatic social change. The first goal of our research was to assess whether both the historically 'assumed' and 'stable' group trajectories arise consistently among South Africans (N = 2,989). The second and more important goal was to identify the factors that might account for this dichotomy in perceived trajectory building on both traditional and recent advances in relative deprivation theory as well as on social identity theory. We hypothesized that higher levels of in-group identification would be associated with the historically assumed group trajectory. Results supported this hypothesis. The third goal was to link the different group trajectories with important psychological outcomes such as personal well-being, group self-esteem, and interracial attitudes.