Chinese economic reform has accelerated the urbanization of the country at an unprecedented pace. The Chinese urban population ratio exceeded 50% for the first time in 2011 . During the 18th Congress of the Communist Party of China in 2012, terms such as “urbanization” and “urban and rural development” have been mentioned numerous times. The development process of urbanization in China has been closely observed. In the third Conference of the 18th Central Committee of the Communist Party of China in 2013, policy guidelines were proposed to improve the integration systems and mechanisms of urban and rural development and encourage farmers to participate in the modernization process and share the achievements of modern equality. The means of solving the difficulties encountered in urban development has become a primary social concern. Urbanization is the inevitable outcome of the economic development process, and a large proportion of the agricultural population has transferred to the non-agricultural sector and achieved urbanization. Modernizing in those developed countries is the universal law. More than 30 years after the policy of Reform and Opening-Up, the system arrangement of urbanization in China lifted the restriction on farmers and allowed their entry into the city. The system likewise encouraged and guided farmers to move to the city. This process has an important role in creating job opportunities, improving the industrial structure, and promoting economic growth. However, this process of rapid urbanization affects local Chinese farmers because they are forced to sell their lands to reduce the cost of urbanization. More than four million hectares of agricultural land has been bought off farmers for non-agricultural use over the past 20 years, with more than 50 million farmers losing their primary source of income. Moreover, the unreasonable land property rights system in China has significantly reduced the land use rights of these farmers .
These land acquisitions have shed light on the problems of landless farmers. The majority of studies focus on the four main aspects of such problems, namely, compensation and resettlement, social security, citizenship, and gender differences. First, although the landless farmers have been resettled by job resettlements and currency resettlements, they are unjustly compensated for their land. Areas with few or weak dynamic industries and lineage/kinship organizations are dominated by property rights that are often harmful to the livelihoods of landless farmers. The less-developed areas in inland China, especially in the Western region, are unfamiliar to non-Chinese specialists and have been given limited research attention. The imperfect compensation systems in these areas are inadequate for the dispossession of agricultural lands. Moreover, these farmers become vulnerable to poverty; they bear a significant portion of the transaction costs for urban expansion .
Second, the interests of landless farmers are not protected by an effective social security system. By the end of 2008, 1,201 counties in 27 Chinese provinces have implemented their respective social security policies for landless farmers. Although 13,240,000 landless farmers in the entire country are covered by the basic living or old-age security system , the beneficiaries only comprise approximately 1/4 of these farmers. Moreover, these farmers are given low compensation as they lose their lands for urban expansion. Therefore, the living conditions of approximately 60% of landless farmers have declined at varying degrees. Social tension and justice  as well as social insurance issues  have received considerable attention because of the long-term risks that they pose to the social stability and sustainable development of landless farmers.
Third, certain factors, such as estrangement from and fear of the city, have caused much confusion as regards the citizenship of landless farmers. Therefore, these farmers have been labeled as “landless peasants” in the retrogression of the urbanization process, and the social exclusion of these farmers is developing into a serious problem .
Fourth, although a 2008 study has observed no gender differences among the landless farmers, the population pressure and limited land resources continue to undermine the land ownership rights of women farmers .
By acquiring land, farmers are provided with (1) basic living security (i.e., farmers rely on their land for their basic living necessities); (2) job security (i.e., farmers rely on their land for employment) and agricultural production; (3) old-age security (i.e., farmers can sublet their lands to their children or to other individuals to support themselves during retirement); and (4) value-added security (i.e., farmers rely on their farming income to send their children to school, buy health insurance, or support their families). Losing their land will deprive these farmers of these benefits or necessities.
Therefore, certain social security policies have been implemented to support farmers after the requisitioning of their lands. The implementation of these policies allows the government to assist landless farmers with their social and economic needs, to protect their interests, to regulate their relationship, and to achieve social stability and fairness. Each province in China implements a unique social security policy, such as the Beijing—Chengdu model (comprising an urban social security system), the Qingdao model (comprising a rural social endowment insurance system), the Tianjin—Xi’an model(comprising a social insurance system), the Zhejiang—Jiangsu model (comprising a basic livelihood guarantee system), the Shanghai model (comprising a small town social security system), and the Chongqing model (comprising a commercial insurance system) . All of these models provide land compensation, medical insurance, pension insurance, job security, basic living security, and housing compensation for landless farmers.
Although certain studies have examined the health conditions of landless farmers as well as their influencing factors, these studies failed to adopt a professional health measurement scale. The concept of health-related quality of life (HRQOL) and its determinants have evolved since the 1980s to encompass those aspects of overall quality of life that can be clearly shown to affect health, either physical or mental. HRQOL is related to both self-reported chronic diseases (diabetes, breast cancer, arthritis, and hypertension) and their risk factors (body mass index, physical inactivity, and smoking status). Measuring HRQOL can help determine the burden of preventable diseases, injuries, and disabilities. HRQOL can likewise provide valuable new insights into the relationships between HRQOL and risk factors, and assist in monitoring the progress to achieve the health objectives of a nation . The interpretation and publication of these data can garner support for health policies and legislation, help allocate resources based on unmet needs, guide the development of strategic plans, and monitor the effectiveness of broad community interventions .
Studies in HRQOL and related factors of populations in mainland China have flourished in recent years. Chan et al. conducted a cross-sectional study on the HRQOL of depressed Chinese older people in Shanghai . Liu and Guo measured loneliness and HRQOL for the empty nest elderly in the rural area of a mountainous county in China . Wang et al. measured HRQOL of populations in Shanghai using the 36-item Short Form (SF-36) . Lam et al. studied HRQOL of Southern Chinese with chronic hepatitis B infection . Wang et al. attempted to find the effect of hypertension on HRQOL of population in Shanghai . Liang and Wang developed a new perspective to study the HRQOL of survivors of Sichuan earthquakes in China, and studied the effect of post-earthquake policies on the HRQOL of survivors .
The five-dimensional European quality of health scale (EQ-5D) is a handy, easy-to-use tool for measuring health outcomes that has been increasingly used in health services, economic analyses, pharmacies, and population health surveys. This scale can be used to calculate for quality-adjusted life-years , which in turn can be used to assess and test the quality and effectiveness of health services. Taiwanese version of the EQ-5D appears to be moderately valid and reliable too for measuring the health status of the general population in Taiwan . Besides, data provide promising evidence for the measurement equivalence of English and Chinese EQ-5D versions in Singapore . This tool has also been adopted by several studies on mainland China [21–23], such as the National Health Services Survey in 2008. By adopting the EQ-5D scales, Sun S. et al. examined the health status of people in the mainland by age, sex, and socio-economic status  as well as the regional differences in terms of health status , Sun X. et al. studied the relationship between the living conditions and the HRQOL of urban seniors , and He et al. studied the HRQOL of nurses and doctors .
Numerous studies have also examined the influencing factors on health of Chinese farmers. Wang HM et al. investigated the influences of trust and distrust (cognitive dimension of social capital) on health in rural China , Wang H. et al. examined the influence of rural mutual health service on health , and Mou et al. examined the health conditions and depressive symptoms of migrant factory workers in Shenzhen . Many studies have also adoptedEQ-5D to measure the HRQOL of different groups that suffer from certain affliction, such as rheumatic diseases , chronic prostatitis/chronic pelvic pain syndrome , Kashin–Beck disease . Another study also investigated individuals who are and are not suffering from chronic diseases . An additional study using EQ-5D evaluation indicates that the method could be enhanced when compared against utility measurements certain diseases .
The majorities of studies have only focused on the health conditions of Chinese rural-to-urban migrants [36–40], and have rarely adopted the EQ-5D scale to measure such conditions. The health conditions and HRQOL of Chinese landless farmers have not been investigated by standardized scales. Therefore, this paper addresses a new research area. This paper also investigates this topic from a new perspective by adopting the EQ-5D scale to measure the HRQOL of landless farmers and by examining the influence of social security policies on their HRQOL. Landless farmers suffer the most during the urbanization of the country, particularly in terms of their quality of life, employment, and pension. This issue has become a major problem in the development of the Chinese economy and society. Many domestic studies have suggested social security policies and proper measures for the placement of landless farmers. Helping these farmers maintain their livelihoods can positively affect the long-term development, stability, and prosperity of society. Therefore, the social security policies for landless farmers in China must be improved as soon as possible.
This paper studies the effects of social security policy for Chinese landless farmers on HRQOL from a new perspective. It offers a two-fold contribution. First, this paper comprehensively measures the satisfaction of landless farmers on the social security policies that are being offered to them by the Chinese government. These policies cover the land compensation, medical insurance, pension, job security, basic livelihood security, and housing compensation of landless farmers. Second, this study adopts the EQ-5D scale for the quantitative analysis of the health conditions and HRQOL.
Farmers lose much more during the requisitioning of their lands. They lose their rights and interests; they dissociate themselves from certain identities, such as “peasants”, “citizen”, “urban”, and “rural”. However, these farmers cannot enjoy the same social security policies that urban residents are being provided, which increases their vulnerability to poverty and oppression. This paper aims to (1) assess the HRQOL of landless farmers as well as their satisfaction with present social security policies, (2) to examine if the Chinese social security policies for landless farmers can help improve the HRQOL of their intended recipients, and (3) to provide certain suggestions for the improvement of these policies.