it impossible for them to seek their fortune elsewhere. Cooperation with fellow villagers and good relations with village leaders became even more important than they had been in the past. The suppression of rural markets, which accompanied the drive for self-sufficiency in grain production and other economic activities, had severe social as well as economic consequences. Most peasants had neither reason nor opportunity for regular trips to town, and their opportunities for exchange and cooperation with residents of other villages were diminished. Villages became work units, with all that that implied. Decollectivization in the early 1980s resulted in the revival of rural marketing, and a limited relaxation of controls on out-migration opened villages and diminished the social boundaries around them. The social world of peasants expanded, and the larger marketing community took on more significance as that of the village proper was diminished. Village membership, once the single most important determinant of an individual's circumstances, became only one of a number of significant factors, which also included occupation, personal connections, and managerial talent. Healthcare After 1949, the Chinese healthcare system, in rural areas the first tier was made up of "barefoot doctors" working out of village medical centers. They provided preventive and primary-care services, with an average of two doctors per 1,000 people. The barefoot doctors emerged in 1968 when China lacked qualified health workers in rural areas and in 1985, China stopped using the term of barefoot doctor. Most of them were transferred to village doctors as private practitioners, making a living out of drug sales based on user fees. At the next level were the township health centers, which functioned primarily as out-patient clinics for about 10,000 to 30,000 people each. These centers had about ten to thirty beds each, and the most qualified members of the staff were assistant doctors. The two lower-level tiers made up the "rural collective health system" that provided most of the country's medical care. Only the most seriously ill patients were referred to the third and final tier, the county hospitals, which served 200,000 to 600,000 people each and were staffed by senior doctors who held degrees from 5-year medical schools. In the late 20th and early 21st century, the availability and quality of health care varied widely from city to countryside. According to 1982 census data, in rural areas the crude death rate was 1.6 per 1,000 higher than in urban