ArticleFrontiers in public health2026
Policy integration fluctuations in China's rural toilet revolution: typology and strategies for public health governance.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
China's Rural Toilet Revolution, despite strong central support, reveals persistent challenges in sustaining policy integration within a complex, multi-level governance system. This study, based on process-tracing and fieldwork in Shaoguan, emphasizes the strategic agency of local governments in managing integration and develops a typology of integration fluctuations along two dimensions: vertical cross-level versus horizontal cross-departmental integration, and political authority versus social network drivers. Four patterns emerge-Bureaucratic Pressure-Driven, Differential Penetration-Driven, Institutional Regulation-Driven, and Network-Embedded Integration-demonstrating that fluctuations are not policy failures but adaptive responses to institutional tensions. Local governments actively reshape policy frames to align objectives, coordinate subsystems, and mitigate accountability risks. These frames serve a dual function: as tools for consensus-building and as sources of institutional legitimacy that shield actors from blame in cross-jurisdictional collaboration. The study advances policy theory by revealing how subnational actors navigate governance complexity and offers practical insights for designing resilient policy architectures in hierarchical systems where integration must be continuously renegotiated.
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