Global literature has suggested a potential negative impact of social stigma on both physical and mental health among those who are being stigmatized. However, limited data are available regarding the form of stigma and stigmatization against rural-to-urban migrant workers in developing countries, including China. This study, employing qualitative data collected from focus group discussions and in-depth individual interviews with rural-to-urban migrants in Beijing, China, was designed to understand the forms and context of stigmatization against rural migrant workers. The data in the current study show that rural-to-urban migrant workers in China had experienced various forms of stigmatization including labelling, stereotyping, separation, status loss and discrimination. Stigmatization occurred through different contexts of migrant workers' lives in urban destinations, including employment seeking, workplace benefits, and access to health and other public services. The current study is a necessary first step to assess the potential impact of stigmatization on both the physical and psychological well-being of rural-to-urban migrant workers.

Introduction

The global literature has suggested an association between population migration and risk for poor health in general and mental illness in particular (Williams 1989; Williams and Berry 1991). There are many situational and psychosocial factors that could contribute to such negative association. One factor is the stigmatization of migrants in urban destinations because of their migratory status (Li et al. 2006b). Previous research suggests that the experience of stigmatization may result in negative psychological and physiological changes among stigmatized individuals and lead to greater risk for depressive distress and anxiety, and higher rates of some psychiatric disorders (Mays and Cochran 2001; Krieger 1999; Carr and Gramling 2004; Link et al. 1997; Pavalko et al. 2003).

In a recent meta-analysis of 49 empirical studies, Mak and colleagues (2007) suggested a negative correlation between stigma and mental health status, after adjusting for sampling error, unreliability of measurement and other artifacts across various stigmatized conditions and mental health indicators. Previous studies have found that a stigmatized individual is devalued in the eyes of others and he/she may have depression (Finch et al. 2000; Noh et al. 1999) and low self-esteem (Crocker 1999). In addition, previous research has found that stigma has an adverse effect on psychological well-being and life satisfaction (Markowitz 1998).

Although the adverse effect of stigma and stigmatization on health is a universal phenomenon, the forms and nature of stigma and stigmatization may be culture and population specific. Developing an effective intervention or public policy to reduce the stigma and to mitigate the negative impact of stigmatization among a specific migratory population or in a particular cultural setting requires a good understanding of the forms and context of the stigmatization in that particular population or culture. However, our understanding of these issues is impaired by limited research in the field. The past decades have seen massive internal migrations in many developing countries, including China (Li et al. 2006a). Internal migrations in developing countries provide an excellent opportunity to study the forms and context of the stigmatization and its negative health consequences. Therefore, as the necessary first step, the current study explores the forms of social stigma and stigmatization against rural-to-urban migrants in China. We hope that a better understanding of stigma and stigmatization will help in developing effective interventions and public policies to reduce stigmatization and mitigate its negative impact on health and psychological well-being among rural-to-urban migrants in China and other developing countries.

Conceptual Framework of Stigma and Stigmatization

Stigma is "the identification of a bad or negative characteristic in a person or group of persons and treating them as not deserving of respect or less worthy than others." (Gilmore and Somerville 1994: 1341) Goffman describes stigma as a quality that significantly discredits an individual in the eyes of others (Goffman 1963). Although there is great variation in conceptualizing stigma (Stafford and Scott 1986), stigma is the recognition of social differences in some groups of people from most other "normal" groups from which the stigmatized persons are separated (Dovidio 2000). This separation implies a process of devaluation and discrimination against the stigmatized group (Gilmore and Somerville 1994).

Link and Phelan (2001) have proposed a conceptual framework of stigma. In their model, stigma is a process during which five interrelated components converge. These five components include "Labelling" (people identify and label human differences), "Stereotyping" (link labelled individuals to undesirable characteristics or negative stereotypes), "Separation" (place labelled individuals in distinct categories, separating "us" from "them"), "Status loss" (labelled individuals experience devaluation that leads to unequal outcomes) and "Discrimination" (systematic disapproval, rejection and exclusion of labelled individuals).

According to Link and Phelan's model, stigmatization is "entirely contingent on access to social, economic, and political power that allows the identification of differences, the construction of stereotypes, the separation of labelled persons into distinct categories, and the full execution of disapproval, rejection, exclusion, and discrimination." (Link and Phelan 2001: 367) Stigmatization is linked to power and cultural beliefs that dominate society and to the norms and values that govern much of everyday life. It creates, and in turn is reinforced by, social inequality. It causes labelled individuals to be devalued and shamed, and others to feel that they are superior. In addition, as a cyclical process, stigmatization against labelled individuals not only builds upon, but also reinforces earlier negative stereotyping.

Rural-to-Urban Migration in China

Since the late 1970s, economic reforms have trigged internal migration on a large scale within China (Chan and Zhang 1999). Migration has increased dramatically since 1978, with most migrants moving from rural to urban areas (Liang and White 1996). "Rural-to-urban migrants" refers to individuals who move from rural to urban areas for jobs and better lives, without obtaining permanent urban household registration (Li et al. 2006). These migrants are often referred to as the "floating population," regardless of the duration of their stay at their urban destination (Goodkind and West 2002).

The number of rural-to-urban migrants increased from 58.4 million in 1996 to 88 million in 2000 (Goodkind and West 2002). According to the recent China National Population 1% Sample Survey, there were approximately 147 million migrants in China in 2005, of whom two thirds were rural-to-urban migrants (National Bureau of Statistics of China 2006). A variety of reasons motivate rural residents to move to urban areas. The main "push" factors for migration include shortage of arable land and surplus labourers in rural areas, and the "pull" factors include the large rural-urban income disparity and demand for labourers in the urban construction and private business sectors (Li 1996; Liu 1991). Modernization and rapid development in agricultural technology mean that fewer labourers are needed in rural areas. In addition, demand for labourers has increased in urban areas following the development of a market economy (Li 1996).

Since 1955, the Chinese government has used the household registration system (hukou) to identify rural and urban residents (Liu 2005). Under this system, rural migrants are required to apply for a temporary residence permit at their destination site, along with an official permit for out-migration from their point of origin (Woon 1999). Since the beginning of economic reform in the late 1970s, control of population movement has been relaxed. Many local city governments have made efforts to reform the hukou system to accommodate rural-to-urban migrants in the cities, but the effect of this reform has been limited (Chang and Brada 2006; Zhu 2007). In 2003, the Chinese government proposed some major changes to the household registration system by easing travel restrictions and protecting migrants' rights. However, some large cities, including Beijing, still tightly regulate and manage the migration of rural-to-urban migrant workers into the cities (Li and Piachaud 2006). Rural-to-urban migrant workers are not able to obtain the same benefits (e.g., government subsidized housing, healthcare, employment and child education) as local residents (Goodkind and West 2002) because of their household registration (hukou) status. At the urban destinations, migrants can frequently only find jobs that are dirty, difficult and dangerous (e.g., "3-D jobs"), requiring minimal skills and with low pay (Yang and Guo 1996). Migrants' living conditions in cities are usually very poor, with about 12% living in underground storage spaces and 8% in work sheds/shelters (Li et al. 2006a).

In addition to the difficulties they encounter at the destination, rural-to-urban migrants often face stigmatization, which includes discrimination in their daily life as well as in the workplace (Li et al. 2006b). For example, they are often blamed for increased delays and overcrowding at train stations during the Chinese holidays. According to the findings of one study conducted in six cities in Jiangsu province, approximately 62% of urban local residents believed that migrant workers were responsible for unemployment, overcrowding, and security and hygiene problems in the city (Nielsen et al. 2006).

While it is believed that rural-to-urban migrants are strongly stigmatized in Chinese society (Li et al. 2006b), there is a paucity of research to examine the forms and contexts of stigma and stigmatization against rural-to-urban migrant workers in China. Therefore, this study was designed to explore stigmatization experienced by migrant workers in China, using the conceptual framework developed by Link and Phelan (2001). We anticipate that the findings of the current study will contribute to improving the life of rural-to-urban migrant workers in their urban destinations.

Methods

Participants

The current study was conducted in Beijing in 2003-2004. Beijing, the capital city of China, has a population of 13.82 million, with more than 3 million rural-to-urban migrant workers (National Bureau of Statistics of China 2002). Qualitative data were collected using six focus group discussions among 30 migrants (16 men and 14 women) and 10 in-depth individual interviews (five men and five women). The mean age was 25.3 years (SD=1.50) for participants in the focus group discussions and 30.9 years (SD=2.65) for those interviewed individually. Participants for focus group discussions and in-depth interviews were recruited from workplaces or the community through network sampling. Local community leaders (both formal and informal) in migrant settlements and workplaces served as facilitators for the recruitment process. Researchers contacted community leaders or local business owners/managers for permission to conduct the interview in their premises and for information on potential eligible participants. Migrants were eligible to participate in the study if they were at least 18 years of age, came from rural areas and lived in Beijing without permanent Beijing household registration. Participants were informed of the study's purpose and design and were assured of the confidentiality of their responses.

Interview Procedure

Interview guides were developed for the focus group discussions and for the in-depth interviews; they included 20 open-ended questions related to reasons for migration, life experience at the destination, problems encountered at the destination and coping strategies, as well as their own perspectives on life. Themes developed were based on theory of stigma and mental health and findings from previous studies. Focus group discussions were conducted in community settings (e.g., meeting rooms at local resident associations or classrooms at local schools), which were relatively private and convenient for migrant participants. The in-depth individual interviews were conducted at the migrants' workplace or at their homes, based on convenience to the participants. Six focus group discussions and 10 in-depth individual interviews were conducted by trained interviewers. All group discussions and individual interviews were audiotaped and transcribed verbatim. Focus group discussions took approximately one and a half hours each, while individual interviews took approximately one hour each.

Coding and Data Analysis

Data analysis was guided by grounded theory (Bernard 2006) to explore the different forms and contents of stigma perceived or experienced by the migrant workers. The grounded-theory approach is based primarily on inductive coding and focuses on the discovery of hypotheses. Initial interview transcripts were read line by line. Analysis was performed by reading and re-reading the transcripts, identifying the themes and coding the texts. This process helped researchers understand the forms and content of stigma experienced by migrants. Coding themes were developed based on constructs from the conceptual frameworks of stigma, domains from the interview guide and on the text of transcripts. New themes were identified and added during the coding process. Transcripts were recoded if either a new code was developed or an existing code was revised. Following the coding steps described by Miles and Huberman (1994), five master codes were yielded (labelling, stereotyping, separation, status loss and discrimination) and 49 subcodes were used to code all transcripts.

Results

Labelling - "You come here to pick up gold in Beijing"

According to Link and Phelan (2001), the first step in the process of stigmatization is the labeling in which people identify and label human differences. Rural-to-urban migrants in China move to cities mainly for job opportunities and a better life (Zhao 1999). Therefore, most participants interviewed felt that the common image most urban residents hold of them is "poor." As one participant stated,

I heard from some Beijing residents. They said to me: "You moved to Beijing because you could not find a job in your hometown, or you could not make enough money at your hometown. You come here to pick up gold in Beijing." -Female, 26 years, domestic servant

The majority of migrants often experienced stigmatization because they were from rural areas, which are less developed than urban ones. In the words of one participant,

Not every Beijing resident treats migrants badly, but some are really not good. They look down upon people coming from other places…they feel that you come here to work because you are poor. -Female, 25 years, library worker

"We are treated differently because of our accent"

Migrants in the city were labelled not only by their appearance or by being poor; they were also often labelled because of where they came from and how they spoke. The Chinese language has a variety of dialects, and it varies from region to region. Regional identity is strong in spoken Chinese. One 19-year-old male interviewee mentioned that when migrants conduct business or go shopping, "they are treated badly because local people can identify them as migrants by their accents." Some migrants thought that this way of "identification" was used not only by ordinary residents in the city, but also used by officials:

Government officers treat people differently based on their accents…. Their way of treating you differs depending on whether you are a local resident or a migrant. If they know you are a migrant, they discount you. They will not deal with you in an easy manner. But if they know by your accent that you are a local resident, they will pay more attention to you. -Female, 20 years, waitress

One migrant shared a story involving the police and his fellow workers. He mentioned that Beijing police consider people from Henan and the northeastern provinces prone to committing crimes. Thus, they pay more attention to migrants from these provinces. They think that migrants from the northeastern provinces are more likely to fight and kill people, whereas Henan migrants are more likely to steal. Policemen treat migrants differently depending on where the migrants are from, as the following story shows:

Once, my co-workers (one from Henan and one from Jiangxi) went out playing. They were caught by the police. The guy from Henan was sent back to his hometown but the Jiangxi guy was sent back to our company. -Male, 19 years, printing house worker

Stereotyping - "They treat me as a discredited person"

Stigmatization occurs when people link labelled individuals to undesirable characteristics or negative stereotypes (Link and Phelan, 2001). The common images of rural-to-urban migrants created by the media are "dirty," "ignorant," "distrustful" and "violent." During our interviews, some migrants felt they were often distrusted by local people just because of their migratory status. One female migrant shared her experience in working with an urban family as a servant:

They have the vigilance [in their family]. They were always scared that I would steal something from them.... I felt that they treated me as a discredited person. They said that they did not feel this way, but I could feel it. -Female, 26 years, family maid

Further, some migrant workers felt that local people suspected them of being thieves:

Beijing residents always act as if we will steal something from them. They act as if migrants may hurt them; they always suspect that they will be robbed. That is how they feel [when they see migrants]. Some even call 110 [local police line]. -Male, 22 years, seller

One 27-year-old male migrant who worked as a barber in Beijing was still very angry when he talked about his experience of being suspected as a thief:

My boss lost 5000 Yuan. There were only three employees in the store on the night that happened: his nephew, his "nominal daughter," and me.... He suspected only me for stealing his money. I told him that I did not take his money.... But he did not believe me.... He called the police and I was arrested. I told the police that I did not steal the money, but I was questioned many times and kept in the police station for about 12 hours. Later on, it was found that the boss's nominal daughter had taken the money. I was so depressed by this experience.

This distrust even happened at the very early stage of employment:

When one finds a job, there is no security deposit for local people, but migrants need to pay a deposit of several hundred Yuan in order to ensure that we will not steal anything from them and run away with the stolen goods. But for local people, no deposit is needed. -Female, 26 years, nanny

Some participants mentioned that migrants were not only suspected of stealing, but also of other things that happened in the community:

In the place we live, whenever something bad happened, local people often said that the migrants had done it. It seemed that every bad thing in society was done by migrants. -Female, 36 years, barbershop worker

Separation - "Expression of eyes"

According to Link and Phelan (2001), "separation" is a process of placing labelled individuals in distinct categories and separating "us" from "them." Almost all migrants interviewed reported an experience of being distinct from local residents through many means. For example, many reported being "looked at" with a different "expression of eyes" by the local residents. As one male migrant said,

You can tell from the expression of their eyes [local people]. Being construction workers, wherever we go, people always look at us with that kind of expression in their eyes. You cannot avoid it. -Male, 38 years, construction worker

Another migrant echoed that view:

It does not matter which city you are going to; the expression of the eyes with which those people look at you is always different [from how they look at local people]. -Male, 37 years, construction worker

Some migrants even experienced this kind of "expression of eyes" among their relatives. One male migrant worker said,

My uncle introduced me to work in Beijing.... My aunt [my uncle's wife] grew up in Beijing.... I only visited their home once. My aunt looked at me with [a] different expression in her eyes. At that time, I had just started working and only earned 300 Yuan monthly. I brought a box of soft drinks with me when I visited them.... My aunt looked at me with that kind of expression in her eyes.... I could not bear it! After that, I did not go to see them for 4 years. During this period, I only called my uncle but did not go to his home. -Male, 24 years, factory worker

From the expression of eyes of Beijing residents, migrants can sense that they are being "looked down upon." One migrant worker related,

Some of them [local residents], look at us and talk to us as though they are really looking down on us. -Male, 40 years, repairman

A female migrant worker explained,

Sometimes, it seems that Beijing residents look down upon our rural people, because they believe that rural people may be of lower quality and that we don't have enough education. -Female, 30 years, nanny

"They speak to us in a different tone"

Some migrants interviewed also felt that local residents, including government officials, were speaking to them in an unfriendly and different way, as one migrant described during our in-depth interview:

They [government officers] speak to local people politely, but speak to us migrants impolitely, and do not give the same treatment [to migrants]. -Male, 38 years, delivery worker

Another migrant offered his experience in an encounter with a local child:

I moved here for one year and I found that local people are rich but not good. They always say something to scare you. Yesterday afternoon we were selling our watermelons. A boy about 13 years old asked whether the melon was sweet. I told him, "It is sweet; I can cut it for you. If it is sweet, you can buy it; if it is not, you can just leave it here." He replied, "No need to leave it here; if it is not sweet, I will smash your stall." His parents did not say anything when they heard these words. -Male, 22 years, street vendor

Some migrants had similar experiences at their workplaces:

Sometimes when the boss was unhappy or if we might have done something wrong, he shouted at us. It was too harsh for girls to accept; and [girls are] uncomfortable, and cry since they did not have anyone to help them. -Female, 30 years, nanny

When we work together, the local people speak [to us] with too much pride and arrogance; but we cannot do that. -Female, 19 years, waitress

"For everything, local people come first"

Almost all rural-to-urban migrant workers we interviewed felt that they were separated by local residents as the "outsiders." When migrants sought help or services, they felt that the treatment they received was totally different from the one for local people. For instance, in many job advertisements, it was often noted that only people with local hukou status could apply. One participant explained,

Some jobs, such as supermarket stockman, are only open to local people. Some governmental institutions have limitations for jobs that migrants can apply [for]. They have the hukou requirement. I feel unequal. -Male, 19 years, factory worker

Apart from differences in job requirements, local unemployed workers can receive free skills trainings for re-employment. However, migrant workers were not eligible for such services. One migrant stated during the interview:

There are many free job-training programs in the city for local laid-off workers. But for migrants, it is not free. We have to pay for these programs. Many local people come to us and tell us that they can enjoy the benefits of free job training, but outsiders cannot. -Male, 19 years, printing house worker

Most participants stated that migrants experienced unfair treatment even when they sought help in an emergency. One migrant worker offered his view:

If local people call [the] police, the police will come within 20 minutes; but for migrants, even if you are in an accident, they will not come right away…. For everything, local people come first. I have experienced this myself. For the same thing, they will take care of it for local people, not for us migrant workers. I felt so bad about this unequal treatment. -Male, 25 years, printing house worker

Moreover, migrants might receive differential treatment even in situations of medical care. A 22-year-old male stall owner shared his experience in a hospital:

If a doctor realizes that you are a person from outside of Beijing, a migrant worker, he will let you wait. I had a fever[of] about 40 degrees, I felt very ill and I was too weak even to speak. The doctor did not treat me until I waited there for about two hours.

"Nobody wants to be close to you"

Many migrants had the experience of being rejected by local residents because of their appearance, their clothes, and because of the public image of migrants being "dirty." One example of such rejection often occurs on buses:

The thing that made me most angry is that on the bus nobody wants to sit in the place where the migrants sit. Drivers will often say to the migrants, "You are dirty, don't push others." The beautiful girl standing nearby says, "Why do you push (others), you are dirty." -Female, 20 years, typist

When we migrant workers sit on the bus, nobody wants to sit close to us. -Male 37 years, construction worker

One of the reasons that local residents keep a distance from migrants might be the dirty working clothes that the migrants wear. However, sometimes the migrants felt that they were treated in this way for reasons other than just the dirty clothes:

When we go back home from the construction site, we need to take the bus. We may be a little bit dirty, but we are not all that dirty. But when people see us, they dodge as far away from us as possible. -Male, 26 years, construction worker

Status loss - "Migrant workers do not have a choice"

Rural-to-urban migrants moving to urban destinations face difficulties in many aspects of their lives (e.g., housing, transportation, employment, leisure time). They usually have limited options. Most participants in our focus group discussion said that one of the main problems they encountered in Beijing was finding a place to stay, especially newly arrived migrants. Years after migrants had moved to the new place, living conditions were still bad. As one migrant stated:

At present, our living condition has been improved. We have one bed for each person, and there are seven to eight people in one room. But before this, there were many workers sleeping in one room [in one huge bed]. -Male, 38 years, construction worker

To save money, some employers provide substandard housing for migrants. Even worse is the situation in which migrants of both genders have to share the same room. One 19-year-old male interviewee who worked in a factory told a story about a female migrant who was raped because of the crowded housing, with male and female migrants sleeping together in one room:

She worked in a hotel in Beijing as a waitress. She was raped by one of her co-workers. The owner of the hotel wanted to save money and had male and female employees sleep in the same room. Migrant workers did not have any other choice. If you were raped, you had to accept it [because they were sleeping in the same room]. She could not bear it. She left Beijing and went back to her hometown.

Because of the expense, renting a house is often not a feasible or affordable option for most migrants. Thus, most migrants and their families live in housing with bad sanitation. As one migrant described it,

We (my husband and I) have stayed in an underground space. There are many mice at the place we are living in now; mice run around all over the ground.... I am not satisfied with this place, but I cannot rent a house, it is too expensive. I cannot afford it. -Female, 30 years, nanny

Deception by employment agencies

Looking for a job at the destination is the biggest challenge for migrants, especially for those who have newly moved into cities. These challenges include lack of knowledge about the job market in cities, not being familiar with the geographic setting or local transportation, and lack of knowledge about employment requirements or hiring procedures. As reported by some migrants, some employment agencies or individuals take advantage of migrants by either deceiving them or providing them with poor quality of service. Many migrants interviewed had experienced being deceived by urban agents (or zhongjie in Chinese, meaning "the middle men" or "middle agency") or individuals who claimed to help people finding jobs. A girl from Shandong province told the interviewer what happened one month after her arrival in Beijing:

I bought a newspaper.... It said that a hotel is hiring a waitress.... I went there and paid 50 Yuan for the application fee along with my resume. After 2 hours of waiting outside, I was told that I needed to submit an additional 500 Yuan....Then, the agent wrote some notes on a piece of paper saying that this would work as a recommendation letter for me. Then he directed me to an address far away. I changed several buses and still could not find the hotel. I finally realized that I was cheated, but I could not get my money back. -Female, 26 years, nanny

A male migrant from Jiangsu province had a similar experience when he searched for a job in Beijing:

In Xuanwu district, there was a company claimed being affiliated with the "China Women's Federation." I thought that this must be a government organization and that it would not cheat people, even though I had heard about many cases of cheating by zhongjie. I was asked to submit 200 Yuan for the application fees before I was recommended for a job working for a cell phone repair place. When I went to the place, I was told that the job required a Beijing hukou, or a Beijing guarantor. I did not have a Beijing hukou and nor did I have Beijing guarantor. I was cheated by the agency. -Male, 19 years, factory worker

Discrimination - Unfair Treatment at Work

Almost all participants we interviewed reported that even when migrants were able to find work, the type of job, working condition and the salary paid was often below their expectations and needs. Many jobs that migrants are able to find are dangerous and dirty, and are generally jobs that local people are not willing to do. A female migrant who worked as a babysitter related,

…if you are migrants, you must do the hardest work, the most tiring work, and your payment is the lowest. Everyone believes this to be true. For this reason, I don't want to say anything. However, we can eat and live. This is better than nothing; you have to survive. -Female, 30 years, nanny

Some migrants perceived that they had limited freedom in the workplace and felt less empowered to argue with the employers. One participant told the interviewer,

I cannot come down or leave this building. From this area, I can not make a telephone call to my family. I felt the time passed slowly during the days.... At their home, they are the masters, I am the maid. It is difficult to communicate with them. -Female, 26 years, family maid

Some participants mentioned that they were given bad meals (not fresh or food that had been sitting around for a long time) by their employers. The most serious issues faced by migrants in the workplace were less pay, overwork without additional pay, or late salary payments, deduction of wages and sometimes even complete withholding of salaries.

[The employer] deducted my pay, he said he would pay me the next year when I return to this job. -Male, 40 years, construction worker

Although migrant workers often work overtime and are generally overworked, they do not obtain the same benefits as local workers. One female migrant provided a typical account of the situation during the in-depth interview:

During the New Year and other holidays, Beijing resident employees receive extra money, but we don't receive those. During the holidays, Beijing resident employees who work can receive triple pay, but we do not; we never receive this kind of treatment. -Female, 20 years, waitress

Some participants addressed the issue that migrants in the same work unit as local workers receive unequal treatment. Local employees receive some social benefits, but migrant workers do not. Because companies or businesses offer medical benefits/insurance based on hukou status, migrants who lack this registration are unable to receive those medical benefits. As one migrant reported,

We, outsiders, only have accident insurance, but Beijing local people have three insurances, including social security insurance, elderly social insurance and health insurance. In addition, the salary of local people is higher and stable. -Male, 19 years, factory worker

Unfair treatment by law enforcement officers

Migrants were often asked to show their temporary residence permit by the local police. Sometimes, the manner in which the policemen dealt with them appeared to be inappropriate and resulted in the perception of discrimination among the migrant workers. The majority of migrants we interviewed reported having been asked by policemen to show the "card." As one migrant worker described it,

Once, I was asked by the policeman, "Do you have the temporary residence permit card?".... I did not bring the card with me. He did not listen to my explanation. He arrested me.... I stayed there [in the police station] for half the night. [The policemen] were fierce. Had I said anything, they would have shouted at me. -Female, 24, hairdresser

Some migrants perceived that police harassed them for no apparent reason. As one explained,

I was working in Gong Zhu Fen [in Beijing]. When I went back to work taking bus no. 21, I was arrested at the last bus stop by the police [for no reason]. They pushed me into a car and took me to the police station. I was kept there until the middle night [before my boss came to pick me up]. -Male, 47 years, construction worker

During focus group discussions, one 37-year-old male migrant angrily expressed,

They [policemen] came to our construction site.... Construction workers don't dress well at the construction site, and [sometimes] we work extra hours until 11 pm or 12 pm. When the police see us, they arrest us. If you see the police and run, they beat you when they catch you. [Otherwise] you have to give money [bribe] to the police.

Migrants were afraid of being checked for the temporary residence permit card and were even afraid to see a police because of past experience or perceived consequences of an encounter with police. One woman related,

Often when I see a policeman, I feel that I am seeing a monster; it is so scary. -Female, 27 years, barbershop worker

Discussion and Conclusion

The qualitative data in the present study suggest migrant workers in China felt that they were strongly stigmatized. Stigmatization against rural-to-urban migrants is common at both the individual and societal levels. Rural-to-urban migrant workers experienced stigmatization in their daily life, including employment, at the workplace, and in healthcare and access to other public services. The most common components of stigma experienced by migrant workers were separation and discrimination. Stigmatization against migrants may be attributable to several social and cultural factors, including the household registration system, socio-economic inequality between local residents and migrants, lack of legislation to protect the rights of rural-to-urban migrant workers and lack of public recognition of the contributions that migrants make to urban development.

<TX2>The hukou system in China has created a clear social identity that labels rural migrants differently from local urban people. The Chinese government has employed the hukou system mainly to control population movement. Hukou registration provided "the principal basis for establishing identity, citizenship and proof of official status" (Cheng and Selden 1994:644) that creates a social hierarchy of urban over rural. The hukou system is the most important contributing factor to the inequality of rural-urban status, since it deprives the rural population's access to equal education and employment opportunities (Liu 2005). Rural residents are unable to obtain government-subsided social benefits, healthcare and other services to which city residents are entitled. When migrating to cities, rural migrants, because of their "rural identity," are not entitled to benefit from the social services and social benefits at their urban destinations, since these services and benefits are provided on the basis of hukou (Li et al. 2006b). The hukou system also engenders a feeling of superiority among urban residents, making them feel more powerful. It also leads to further distrust and separation between the two groups, allowing stigmatization against migrant workers to become even more extensive.

The other potential cause of stigmatization against rural-to-urban migrants is based on the socio-economic inequality between the local population and rural migrants at their urban destinations. There is a larger disparity in economic development between rural and urban areas in China and the main factors contributing to urban-rural disparities are income and education. The low income levels in the rural population compared with the urban population probably account for the inequality that exists between these two populations (Du et al. 2005; Li and Piachaud 2006; Lu and Son 2006: Raa and Pan 2005). Moreover, the average educational level of the rural population is 3 years less than that of the urban population (Li and Piachaud 2006). Therefore, during economic reform in China, the movement of migrants to the cities "has given rise to significant social stratification within cities" (Chan and Zhang 1999:843). Furthermore, due to the absence of empowerment programs for them, migrant workers usually lack the opportunities to advance their education and job skills at their destinations. This forces migrants to remain at a lower social hierarchy level, further adding to the list of undesirable characteristics that evoke stigmatization (Link and Phelan 2001). Therefore, the social power of migrants at their destination is weaker because of their hukou status and lower socioeconomic status (Curran 2002).

Lack of legislation to protect the rights of rural-to-urban migrant workers is another cause of stigmatization. Unequal pay is a very serious problem for migrants. However, there are no legal policies to protect them and ensure that they receive equal and timely pay. Even though some policies related to payment for migrants exist on paper, in practice most have not been successfully enforced, and in many instances, some migrants themselves were not aware of the existence of such policies (Goodkind and West 2002). Unfair treatment can be observed in many areas, such as in employment, job security, work compensation, overtime work, and bad working and housing conditions. Lack of appropriate legislative protection for migrants further creates an environment tolerating or permitting stigmatization against the workers.

Finally, lack of public recognition of contributions migrants make to urban development serves to increase resentment and further stigmatization against rural-to-urban migrants. Rural labour migrants not only contribute to urban development, but also contribute to rural development (Zhan 2005). However, some urban residents believe that migrants come to the city to compete with them for job opportunities and to share social welfare. They also believe that migrants impose an economic cost on cities for the possible need for additional public services, housing and infrastructure (Chang and Brada 2006). Appropriate public education among urban residents about the contribution that migrant workers have made toward urban development in past decades and the advantages of having rural-to-urban-migrants in cities would help to reduce stigmatization.

There is some potential limitation in the current study. Results are based on six of focus group sessions and 10 in-depth interviews conducted in Beijing. As such, these results may not be generalizable to migrants in other cities in China. Nevertheless, they shed light on understanding the stigmatization that experienced rural-to-urban migrant workers experience. As the first step in understanding the negative effects of stigma on health, the current study provides important information on the prevalence, forms and context of stigmatization against rural-to-urban migrants in China. Findings have some important public health and policy implications.

First, the findings suggest that the existing hukou system should be reformed, so that hukou registration serves merely as an indicator of residence rather than as a permanent status that is inherited from generation to generation. Furthermore, the reform should break the linkage between hukou status and eligibility for jobs, schooling, housing and other social services. Migrant workers and urban residents should have equal opportunities for employment, housing, healthcare, schooling for children, and other social services at urban destinations.

Second, the findings underscore the importance of public health education campaigns to reduce and eliminate the stigma against migrants. It is important to educate the public to recognize that stigmatization is detrimental to the migrants' life and social well-being, and to build social norms against stigmatization. It is necessary to establish social norms to respect migrant workers' rights. Stigmatization should be of concern not only to policy makers but also to society as a whole. Policies such as equal and affordable housing, adequate working conditions and equal pay are necessary to protect the rights of migrant workers.

Third, health promotion and prevention efforts among rural-to-urban migrant workers should consider the potential impact of stigma and stigmatization against migrants. Stigmatized migrants may suffer from health problems that are attributed to stigmatization (Markowitz 1998). However, data regarding potential mediators or moderators for the effect of stigma on health are limited (Li et al. 2006; Mak et al. 2007). Therefore, further research is needed to examine the association between stigma and health among rural-to-urban migrants and the potential factors that will mediate or moderate the association.

Fourth, well-designed comparative studies are needed to explore the different effects of migration-related stigmatization and other forms of social discrimination against temporary rural-to-urban migrants and other populations (e.g., the urban poor or permanent registered migrants). The migration-related stigmatization may be confounded by other forms of social discrimination against the poor or other economically marginalized social groups (such as unemployed urban residents). Likewise, future studies also need to examine the role of acculturation and various migratory experiences (e.g., length of migration, social capital at both rural origin and urban destinations) among rural migrants in their perceived or experienced stigmatization. Findings from these studies will be useful in understanding the roots and forms of migration-related stigma and stigmatization, formulating policies to improve migrants' access to healthcare at urban destinations and mitigating the potential negative effects of stigma on physical and psychological well-being among the migrant workers in China and other developing countries.

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