Community Autonomy and Availability of Social Services for Older People In China

Background and Purpose: In response to the growing needs of the population, the social services delivery system has undergone significant change in China. The community, instead of the government, has increasingly become the main venue for the development and implementation of services. There is evidence that services are not equally available across communities. Using community services for older people as an example, this study examines the service infrastructure that communities have assembled and the role that community autonomy plays in developing program facilities. The following research questions are addressed: What types of services are initiated by the community locally as opposed to being driven externally? How has community autonomy affected the availability of services? How do communities differ in institutional resources and provision of services?

Methods: We used the 2008 China Health and Retirement Longitudinal Study (CHARLS) Community Survey, whose respondents included 2,685 individuals in 1,570 households from 96 communities in rural and urban areas of the Zhejiang and Gansu provinces. Community autonomy is a summation scale of the availability of 14 facilities/services and the extent to which these facilities are initiated by the community. The higher the score, the higher the level of autonomy the community possesses. We ran agglomerative hierarchical cluster analysis to classify 96 communities into three types of areas. Bivariate statistics were used to compare different community resources and contextual factors across clusters.

Results: Type I (n=18) communities have a high level of autonomy in general services such as cultural activities and mutual support. Primarily located in urban areas with high accessibility of public facilities and active business sectors, the proportion of individuals over 60 years of age is small whereas the education level of the community leadership is high in these communities. Type II (n=31) communities mainly provide services for older people such as exercising facilities, activity centers and nursing homes. One in four residents is over 60 years of age and the majority of these areas are located in rural areas with adequate accessibility of public service with somewhat active business sectors. Type III (n=47) communities have a low level of autonomy in most community facilities but they are highly motivated in initiating community health care clinics. Almost all are located in rural areas having the least accessibility of public services and few active business sectors.

Conclusions and Implications: In China, the geographic communities where older people live differed considerably in service availability. Community autonomy—community's capacity to develop facilities and provide activities to meet local older people's needs by increasing program accessibility—is not merely a function of the demographic for the older population per se. Although social, cultural, and recreational facilities are generally available in urban communities where a smaller proportion of older people reside, the isolated rural areas with a larger older population prioritize their resources on services such as health clinic and nursing homes. The education level of community leaders has appeared to play an important role in shaping the types of services communities pursued.