The Health and Social Care of Aboriginal Adults in Taiwan:

A Study of the Paiwan Group

Guaei (Chun-Tsai Hsu)

MPhil/PhD

Health and Social Policy Research Centre

University of Brighton

Abstract

I am studying issues and problems about the health and social care of aboriginal adults in Taiwan and this presentation will introduce the study and then focus on methodological issues of research.

The life history of Aborigines can be traced back 5,000 years in Taiwan and they can be divided into twelve groups, namely Amis, Atayal, Paiwan, Bunon, Puyuma, Rukai, Tsou, Saisiyat, Yami, Truku, Thao and Kavalan groups. However, aborigines are not only losing their culture, but also facing some major social problems, such as there are only a few in a higher education, their life expectancy is shorter than non-aborigines, they have a higher rate of single parent families and unemployment and a low family income and participation in National Health Insurance. Reasons for these problems were caused during a time of colonisation of part or the whole of Taiwan by the Portuguese, the Dutch, the Japanese and the Chinese and aboriginal positions are now located within disadvantaged socioeconomic structures.

The research aims (a) to demonstrate the core issues in policies, laws and projects of health and social care for aboriginal adults; (b) to explore how formal and informal care works, gaps in urban and rural settings and unmet needs; and (c) to explore Paiwan adults’ attitude and behaviour towards health and social care in urban and rural settings. Qualitative research and an ethnographic approach are mainly employed in this research. Furthermore, this study uses purposive sampling and snowball sampling to select samples and employs relevant documents, focus groups, in-depth interviews and participant observation to collect data. Therefore, the researcher will face several aspects of confidentiality and other ethical issues in this study.

1Introduction

1.1Background of the study

1.1.1Profile of Aboriginal people in Taiwan

The establishment of the Republic of China in 1912 by Dr. Sun Yat-sen was based upon nationalism, democracy and the livelihood for the people. The Japanese invasion into China and the eruption of World War II caused heavy losses. Shortly, after World War II ended, the Chinese Communist advancement caused destruction, especially to most of the newly rebuilt educational facilities. The Central government was forced to relocate to Taiwan, in 1949. Over the years, Taiwan has encountered an accelerated economic growth rate and social changes. Political change has involved more democratic changes. Economic growth saw a shift in the industrial structure and an impact on the "value" of goods. The access to information via technology was another important shift for Taiwanese society.

Taiwan is located in Eastern Asia, islands bordering the East China Sea, Philippine Sea, South China Sea, and Taiwan Strait, north of the Philippines, off the South-Eastern coast of China. Taiwan is made up of 14 different islands. The main island of Taiwan is about 240 miles long and about 90 miles wide. A mountain range runs the entire length of the island. The highest mountain is Yu Shan at13,113 feet. Taiwan is one-third the size of Ohio. Two-thirds of Taiwan is mountainous. One-third is lowland. The capital of Taiwan is Taipei. This is also the largest city in Taiwan.

The life history of Aborigines can be traced back 5,000 years in Taiwan. Lin (date unknown) and Li (date unknown) have indicated that they belong to Austronesian peoples. The Council of Indigenous People (2005) has pointed out that there are 458,326 aborigines and the Council (date unknown) has claimed that aborigines can be divided into twelve groups, namely Amis, Atayal, Paiwan, Bunon, Puyuma, Rukai, Tsou, Saisiyat, Yami, Truku, Thao and Kavalan groups. Hung (2003) has indicated that these divisions depend on language, customs and tribal structure.

1.1.2Aboriginal Social Problems

Although the aborigines still retain their language and culture, they are gradually losing it now (Hung, 2003; M. z. Li, 1998). These people, for example, have used their language in their tribe before 1980’s, but most of them, particularly young people, more often speak Chinese in the tribe. In addition, traditional wedding processes have changed and they are now not normally being held.

In addition to aborigines losing their culture, they are also facing some major social problems. This has been highlighted by Li (1998) who has pointed out that aboriginal social problems include education, employment, economics, residence, social relationships in the family, drink, students’ adaptation at school, problems of teenagers, disabled and elderly people. Qiu (2000) has indicated that these problems include cultural, health issues and social welfare. These problems can be categorised, in relation to statistics with the table below showing that (a) the aboriginal population is small; (b) aboriginal students at primary and junior school have a high drop-out rate and there are only a few in a higher education; (c) their life expectancy is shorter than non-aborigines; (d) they have a higher rate of single parent families and unemployment; (e) Taiwan’s aborigines have a low family income and a low rate of participation in National Health Insurance.

Table 1 The differences between aborigines and non-aborigines

Item / Non-Aborigines / Aborigines
Population (2004) / 98% / 2%
Education (2003) / Elementary school and below / 24.7% / 36.0%
College and above / 26.0% / 6.2%
Life Expectancy / 75.58 y/o / 67.24 y/o
Over 65 y/o / 9.0% / 5.8%
Rate of single parent family / 3.9% (1995) / 12.85%(1997)
Rate of Unemployment / 5.02% / 8.37%
Average family income/month / £1565.627 / £655.339
Rate of participation in National Health Insurance / 97% / 92.02%

Data is organised from The Council of Indigenous (2003).

The reasons for these problems are many and varied. Shih (2002), for instance, has noted that these might have been caused during a time of colonisation of part or the whole of Taiwan by the Portuguese, the Dutch, the Japanese and the Chinese. In addition, Hwang and Chan (2000) have attributed these problems to aboriginal positions located within disadvantaged socioeconomic structures. Therefore, it is clear that the mainstream influences these indigenous peoples situation in Taiwan.

As aboriginal social problems have been gradually increasing in recent years, the public and government have become concerned about aboriginal issues. Therefore, some tribal and political leaders promoted a movement, called ‘Aborigines Rename Movement’ (from 1984~1994). Their appellation has changed from ‘mountain people’ to ‘aborigines/indigenous’ (Lipay, date unknown). More recently, aboriginal intellectuals have continued lobbying government to establish an administration of aboriginal affairs, and the Council of Indigenous Peoples was set up in 1996 (The Council of Indigenous People, date unknown). The Council has started to improve aboriginal lives to reduce the difference between non-aborigines and aborigines and to promote certain laws with solutions for these problems, such as ‘Status Act for Indigenous People’ in 2001, ‘Indigenous People Employment Rights Protection Act’ in 2001, ‘Provisional Regulation for Indigenous Senior Citizens’ Welfare Living Allowances’ in 2002 and ‘Education Act for Indigenous People’ in 1998.

Developing health and social care for indigenous peoples in Taiwan could lead to changes in the aboriginal tribe support network, with formal care replacing informal care by the aboriginal family. Health and social care provided for aboriginal adults by government are at an early stage of development and research in this field is very limited still. So the Council is encouraging scholars to work in this field.

I myself am an aborigine and belong to the Paiwan group and I lived in our tribe until I graduated from senior high school. I began to pay attention to aboriginal issues and attended aboriginal activities while at university. After this, I worked not only in aboriginal social services when I was a postgraduate student in Chi Nan University, but also assisted with some research on this. In my experience and opinion, aboriginal social welfare is still an under-represented area of research. Because of this, and because I am concerned the problems aboriginal face, I am committed to this research.

1.2Reasons for the Research

  1. Health and social care for aboriginal adults are still under-represented areas of research. The government has begun to engage in provision of health and social care for aboriginal peoples, and offered funding to encourage scholars doing research in aboriginal issues in recent years. As it is clear that health and social care for aboriginal adults are at an early stage of development and research, I will focus on aboriginal adults’ issues.
  1. Aboriginal social problems have been taken more seriously in recent years, but more investigation and consideration of these issues is needed. These have shown that the aboriginal issues are of more and more concern to the public and government. From the ‘Aborigines Rename Movement’ have come laws and policies for aboriginal peoples, and aboriginal issues have captured public and government attention.
  1. This is a personal reason. Because I belong to the Paiwan people and grew up in the tribe, I have life experiences and I know what kinds problems we are facing now. Therefore, I have decided to investigate aboriginal health and social care issues.

1.3Purpose of the study

  1. The first aim of the study is to demonstrate the core issues in policies, laws and projects of health and social care for aboriginal adults. This is because, since the Council of Indigenous Peoples was set up, the Council has promoted some policies, laws and health and social care for aboriginal adults and asserted that these are concerned with aboriginal culture. Therefore, this study will use a Paiwan group case study to demonstrate and examine the relationship between health and social care and general aboriginal culture and then find out the core issues of policies, laws and health and social care for aborigines. It will employ documents, in-depth interview, and focus groups.
  1. The second aim of the study is to explore how formal and informal care works and gaps in urban and rural settings and identify unmet needs. This will involve the families of Paiwan adults who live in two different settings and will define gaps and tensions between formal and informal care. Aboriginal tribes have a closed social structure, and they have a strong support network. But since the government began the provision of health and social care for aboriginal families, this provision may have affected the informal care system. In addition, more and more Paiwan people are moving to the city, and this might also affect their original support network system. Therefore, this part is going to employ in-depth interviews using semi-structured questionnaires in order to achieve this aim.
  1. The third aim of the study is to explore the attitude of Paiwan adults and behaviour towards health and social care in urban and rural settings. In recent years, more and more Paiwanese people have moved from mountain areas to the city, and they believe that the different settings have different resources, and these are more accessible and available in the city rather than mountain areas. Therefore, this part will collect relevant documents to analyse and employ in-depth interviews using a semi-structured questionnaire and focus groups in order to achieve this aim.

2Methodology

2.1Qualitative and ethnography approach

Social research methodology includes both quantitative and qualitative research (Berg, 2001; Bryman, 2004). Bryman (2004) has indicated that quantitative research is usually associated with a deductive approach, and qualitative research is usually associated with an inductive approach. Holloway (1997) has pointed out that deduction means researchers move from the general to the specific, and they then search for empirical evidence by testing a hypothesis through collecting data from observation and analysing it. In contrast, Holloway (1997:91) has asserted that ‘induction is starting with the observation or study of a number of individual cases or incidents and establishing generalities that link them to each other. Researchers collect data, analyse the data and generate theories.’ The research aims of this study are not to test a hypothesis but to understand Paiwan adults’ life experience in their settings. Therefore, this study will employ qualitative rather than quantitative research.

Berg (2001) has pointed out that qualitative research tries to answer questions about various social settings and the individuals who inhabit these settings. Thereby, researchers using qualitative research will try to understand people’s behaviour and their settings. In addition, Bryman (2004) has indicated that qualitative research is concerned with ‘words’ rather than numbers, and the ‘words’ including researcher’s participant observation and conversation (Fulcher & Scott, 2003). Qualitative research employs methods of participant observation, in-depth interviews, group interviews, and relevant documents to collect research data and then analyse them (Maykut & Morehouse, 1994).

In addition to qualitative research, this study will also employ an ethnographic approach. Brewer (2000) has indicated that the ethnographic approach has been employed in qualitative research in recent years, and Giddens (2001:647) has asserted that ‘ethnography is often referred to as a type of qualitative research, because it is more concerned with subjective understanding than numerical data.’ Basically, the ethnographic approach focuses on a research subject’s culture and people’s life experiences. Because the research aims of this study are associated with aboriginal culture, an ethnographic approach is appropriate.

This study will focus on one aboriginal group in Taiwan and on their culture, life experience, feelings and attitudes. Ethnography belongs to anthropology, and involves fieldwork in research settings for a period of time. It also employs participant observation and conversation in order to understand people’s life experiences (Brewer, 2000; Fulcher & Scott, 2003; Giddens, 2001; Holloway, 1997; Tedlock, 2000). Bryman (2004) has pointed out that the most difficult step in ethnography is gaining access to a social setting. However, the researcher is Paiwanese and has excellent access to the research settings. I recognise myself as an ‘insider’ and will take this into account in the methodology.

2.2Research procedure

According to the research aims, approach and methodology, the research procedure can be divided into three stages:

The first stage (May 2004 to July 2005): This stage has mainly focused on literature reviews; settings and population and qualitative questionnaire design. In respect to the literature review, I am focusing on collecting documents of health and social care history, policies and laws. These include social services, social care and health care. I will collect and organize information on race issues and health and social care for aboriginal adults in other countries. Secondly, I will describe the settings and population before I return to Taiwan to do fieldwork. Thirdly, I will consider designing qualitative semi-structured interview questionnaires. These will be employed in in-depth interviews and focus groups. Finally, I will arrange my fieldwork schedule before I return to Taiwan, including selection of interviewees and focus groups for interview, and dates of interviews.

The second stage (August 2005 to February 2006): This stage will carry out data collection, transcription, data analysis and begin writing the research results. Data collection is involved in doing qualitative in-depth interviews, focus groups and relevant documents; meanwhile, I will transcribe and begin data analysis. I will begin to write research results at this stage.

The third stage (March 2006 to November 2007): This is the final stage. This will be concerned with linking up the literature review with the research data and conclusion. It will link theories of racism and health and social care distribution to my findings and will reflect on my own personal development through this process.

2.3Methods

Purposive sampling and snowball sampling are employed in this study. Both Berg (2001) and Bryman (2004) have indicated that qualitative research usually uses a non-probability sample and there are four most common types: convenience samples, purposive sampling, snowball sampling and quota samples. Berg (2001:33) has asserted that ‘when developing a purposive sample, researchers use their special knowledge or expertise about some group to select subjects who represent this population’ while ‘the basic strategy of snowballing involves first identifying several people with relevant characteristics and interviewing them or having them answer a questionnaire. These subjects are then asked for the names of other people who possess the same attributes as they do.’ This study will need informants to provide information on the culture of Paiwan, the history of health and social care for aboriginal adults, and Paiwan adults’ life experience of informal and formal care and their attitude and behaviour toward health and social care. Therefore, this study will employ both purposive sampling and snowball sampling to achieve its aims.