Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-28T03:07:35.031Z Has data issue: false hasContentIssue false
  • English
  • Français

The Educational Gradient in Health in China

Published online by Cambridge University Press:  15 May 2017

Qiulin Chen ,
Karen Eggleston ,
Wei Zhang ,
Jiaying Zhao  and
Sen Zhou
Qiulin Chen
Affiliation:
China Academy of Social Sciences, Beijing.
Karen Eggleston*
Affiliation:
Stanford University Shorenstein Asia-Pacific Research Center, and National Bureau of Economic Research.
Wei Zhang
Affiliation:
Tsinghua University School of Marxism, Beijing.
Jiaying Zhao
Affiliation:
The Australian National University, and Shanghai University.
Sen Zhou
Affiliation:
Stanford University Graduate School of Education.
*
Email: [email protected] (corresponding author).
Get access Rights & Permissions [Opens in a new window]

Abstract

It has been well established that better educated individuals enjoy better health and longevity. In theory, the educational gradients in health could be flattening if diminishing returns to improved average education levels and the influence of earlier population health interventions outweigh the gradient-steepening effects of new medical and health technologies. This paper documents how the gradients are evolving in China, a rapidly developing country, about which little is known on this topic. Based on recent mortality data and nationally representative health surveys, we find large and, in some cases, steepening educational gradients. We also find that the gradients vary by cohort, gender and region. Further, we find that the gradients can only partially be accounted for by economic factors. These patterns highlight the double disadvantage of those with low education, and suggest the importance of policy interventions that foster both aspects of human capital for them.

摘要

大 量证据表明存在着健康的教育梯度: 教育程度高的人群往往享有更好的健康和更长的寿命。从理论上讲, 平均教育水平的升高、以及对人群实施早期健康干预会减弱 健康的教育梯度; 而另一方面, 医疗技术的进步会加强健康的教育梯度。本文研究健康的教育梯度是如何在中国这个高速发展的国家演变的。目前的文献对此研究不 多。基于近年上海的死亡数据和全国人口健康抽样调查数据, 我们发现, 中国健康的教育梯度在很多情况下有所增强。我们还发现, 健康的教育梯度在不同出生世 代、性别和地区之间存在差异。进一步的研究显示, 经济因素只能部分解释这些梯度的存在。这些研究结果突出了低教育程度人群在教育与健康上所面临的双重劣 势。从上述两方面人力资本进行政策干预显得十分重要。

Keywords

Chinahealtheducationsurvivaldisparities inequality中国健康教育存活差异不平等
Type
Articles
Information
The China Quarterly , Volume 230 , June 2017 , pp. 289 - 322
Check for updates
Copyright
Copyright © SOAS University of London 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmad, Omar, Boschi-Pinto, Cynthia, Lopez, Alan, Murray, Christopher, Lozano, Rafael and Inoue, Mie. 2001. “Age standardization of rates: a new WHO standard.” GPE Discussion Paper Series 31, http://www.who.int/healthinfo/paper31.pdf. Geneva: World Health Organization.Google Scholar
Auld, Christopher, and Sidhu, Nirmal. 2005. “Schooling, cognitive ability and health.” Health Economics 14(10), 1019–34.Google Scholar
Babiarz, Kimberly, Eggleston, Karen, Miller, Grant and Zhang, Qiong. 2014. “An exploration of China's mortality decline under Mao: a provincial analysis, 1950–1980.” Population Studies 69(1), 39–56.Google Scholar
Banister, Judith, and Zhang, Xiaobo. 2005. “China, economic development and mortality decline.” World Development 33(1), 21–41.CrossRefGoogle Scholar
Barker, David J.P., Bull, A.R. and Osmond, Clive. 1990. “Fetal and placental size and risk of hypertension in adult life.” BMJ: British Medical Journal 301(6746), 259–262.CrossRefGoogle ScholarPubMed
Barker, David J.P., Osmond, Clive, Winter, P.D. and Margetts, Barrie. 1989. “Weight in infancy and death from ischemic heart disease.” The Lancet 334(8663), 577–580.CrossRefGoogle Scholar
Baten, Joerg, Ma, Debin, Morgan, Stephen and Wang, Qing. 2010. “Evolution of living standards and human capital in China in the 18–20th centuries: evidence from real wages, age-heaping, and anthropometrics.” Explorations in Economic History 47(3), 347–359.Google Scholar
Bijwaard, Govert E., van Kippersluis, Hans and Veenman, Justus. 2015. “Education and health: the role of cognitive ability.” Journal of Health Economics 42, 29–43.Google Scholar
Cai, Yong. 2005. “National, provincial, prefectural and county life tables for China based on the 2000 census.” Center for Studies in Demography and Ecology (CSDE) Working Paper 05-03.Google Scholar
Cai, Yong. 2009. “Regional inequality in China: mortality and health.” In Davis, Deborah and Feng, Wang (ed.), Creating Wealth and Poverty in Post-socialist China. Stanford: Stanford University Press, 143–155.Google Scholar
Clark, Damon, and Royer, Health. 2013. “The effect of education on adult mortality and health: evidence from Britain.” American Economic Review 103(6), 2087–2120.Google Scholar
Conti, Gabriella, Heckman, James and Urzua, Sergio. 2010. “The education–health gradient.” American Economic Review 100(2), 234.CrossRefGoogle ScholarPubMed
Costa, Dora. 2013. “Health and the economy in the United States, from 1750 to the present.” Journal of Economic Literature 53(3), 503–570.Google Scholar
Crimmins, Eileen M., and Saito, Yasuhiko. 2001. “Trends in healthy life expectancy in the United States, 1970–1990: gender, racial, and educational differences.” Social Science & Medicine 52(11), 1629–41.CrossRefGoogle ScholarPubMed
Cutler, David, Deaton, Angus and Lleras-Muney, Adriana. 2006. “The determinants of mortality.” Journal of Economic Perspectives 20(3), 97–120.CrossRefGoogle Scholar
Cutler, David, and Lleras-Muney, Adriana. 2010. “Understanding differences in health behaviors by education.” Journal of Health Economics 29(1), 1–28.CrossRefGoogle ScholarPubMed
Cutler, David, and Miller, Grant. 2005. “The role of public health improvements in health advances: the 20th century United States.” Demography 42(1), 1–22.Google Scholar
Deaton, Angus. 2006. “The great escape: a review of Robert Fogel's The Escape from Hunger and Premature Death, 1700–2100 .” Journal of Economic Literature 44(1), 106–114.Google Scholar
Eide, Eric R., and Showalter, Mark H.. 2011. “Estimating the relation between health and education: what do we know and what do we need to know?” Economics of Education Review 30(5), 778–791.CrossRefGoogle Scholar
Fogel, Robert. 2004. The Escape from Hunger and Premature Death, 1700–2100: Europe, America, and the Third World. Cambridge: Cambridge University Press.Google Scholar
Fogel, Robert, and Costa, Dora. 1997. “A theory of technophysio evolution, with some implications for forecasting population, health care costs, and pension costs.” Demography 34(1), 49–66.Google Scholar
Fuchs, Victor. 1982. “Time preference and health: an exploratory study.” In Fuchs, Victor (ed.), Economic Aspects of Health. Chicago: University of Chicago Press, 93–120.Google Scholar
Goldman, Dana, and Smith, James. 2002. “Can patient self-management help explain the SES health gradient?” Proceedings of the National Academy of Sciences 99(16), 10929–934.Google Scholar
Goldman, Dana, and Smith, James. 2015. “The increasing value of education to health.” Social Science & Medicine 72(10), 1728–37.Google Scholar
Grossman, Michael. 1972. “On the concept of health capital and the demand for health.” Journal of Political Economy 80(2), 223–255.CrossRefGoogle Scholar
Grossman, Michael, and Kaestner, Robert. 1997. “Effects of education on health.” In Behrman, Jere R. and Stacey, Nevzer (ed.), Social Benefits of Education. Ann Arbor, MI: University of Michigan Press, 69–123.Google Scholar
Heckman, James, Humphries, John, Veramendi, Gregory and Urzua, Sergio. 2014. “Education, health and wages.” IZA Discussion Paper No. 8027.Google Scholar
Hu, Anning, and Hibel, Jacob. 2013. “Educational attainment and self-rated health in contemporary China: a survey-based study in 2010.” The Social Science Journal 50(4), 674–680.Google Scholar
Huang, Wei. 2015. “Understanding the effects of education on health: evidence from China.” IZA Discussion Paper No. 9225.CrossRefGoogle Scholar
Hurt, Lisa, Ronsmans, Carine and Saha, Sajal. 2004. “Effects of education and other socioeconomic factors on middle age mortality in rural Bangladesh.” Journal of Epidemiology and Community Health 58(4), 315–320.CrossRefGoogle ScholarPubMed
Jayachandran, Seema, Lleras-Muney, Adriana and Smith, Kimberley. 2010. “Modern medicine and the 20th century decline in mortality: evidence on the impact of sulfa drugs.” American Economic Journal: Applied Economics 2(2), 118–146.Google Scholar
Khang, Young-Ho, Lynch, John and Kaplan, George. 2004. “Health inequalities in Korea: age- and sex-specific educational differences in the 10 leading causes of death.” International Journal of Epidemiology 33(2), 299–308.CrossRefGoogle ScholarPubMed
Lei, Xiaoyan, Sun, Xiaoting, Strauss, John, Zhang, Peng and Zhao, Yaohui. 2014. “Depressive symptoms and SES among the mid-aged and elderly in China: evidence from the China Health and Retirement Longitudinal Study national baseline.” Social Science & Medicine 120, 224–232.Google Scholar
Lei, Xiaoyan, Yin, Nina and Zhao, Yaohui. 2012. “Socioeconomic status and chronic diseases: the case of hypertension in China.” China Economic Review 23(1), 105–121.Google Scholar
Li, Shuzhuo, Sun, Fubin, Jiang, Quanbao, Zou, Xufeng and Guan, Renxian. 2004. Report of the Study on China's Mortality Changes in the 1990s Based on China's 2000 Population Census. Xi'an: Institute for Population and Economy Studies School of Management, Xi'an Jiaotong University.Google Scholar
Liang, Jersey, Mccarthy, John, Jain, Arvind, Krause, Neal, Bennett, Joan and Gu, Shengzu. 2000. “Socioeconomic gradient in old age mortality in Wuhan, China.” Journals of Gerontology: Social Sciences 55B(4), S222–S233.Google Scholar
Lin, Songbo, Song, Guixiang, Zhou, Feng and Zhang, Shennian. 2001. “Shanghaishi manxing feichuan ranxing jibing liuxingbingxue qushi yanjiu: 1951–1998 nian siwang ziliao fenxi” (Mortality study of major non-communicable diseases in Shanghai, 1951–1998). Zhonghua liuxing bingxue zazhi 22(4), 265–68.Google Scholar
Liu, Hong, Fang, Hai and Zhao, Zhong. 2013. “Urban–rural disparities of child health and nutritional status in China from 1989 to 2006.” Economics & Human Biology 11(3), 294–309.Google Scholar
Lleras-Muney, Adriana. 2005. “The relationship between education and adult mortality in the United States.” The Review of Economic Studies 72(1), 189–221.Google Scholar
Lochner, Lance. 2011. “Nonproduction benefits of education: crime, health, and good citizenship.” In Hanushek, Eric A., Machin, Stephen J. and Woessmann, Ludger (eds.), Handbook of the Economics of Education Vol. 4. Amsterdam: Elsevier Science, 183–282.Google Scholar
Marmot, Michael, Smith, George Davey, Stansfeld, Stephen, Patel, Chandra, North, Fiona, Head, Jenny, White, Ian, et al. 1991. “Health inequalities among British civil servants: the Whitehall II Study.” The Lancet 337(8754), 1387–93.Google Scholar
Marmot, Michael, Friel, Sharon, Bell, Ruth, Houweling, Tanja and Taylor, Sebastian. 2008. “Closing the gap in a generation: health equity through action on the social determinants of health.” The Lancet 372(9650), 1661–69.Google Scholar
Mazumder, Bhashkar. 2008. “Does education improve health? A re-examination of the evidence from compulsory schooling laws.” Economic Perspectives 33(2), 1–15.Google Scholar
Mazumder, Bhashkar. 2012. “The effects of education on health and mortality.” Nordic Economic Policy Review 12(1), 261–301.Google Scholar
Meara, Ellen, Richards, Seth and Cutler, David. 2008. “The gap gets bigger: changes in mortality and life expectancy, by education, 1981–2000.” Health Affairs 27(2), 350–360.Google Scholar
Miller, Grant. 2008. “Women's suffrage, political responsiveness, and child survival in American history.” The Quarterly Journal of Economics 123(3), 1287–1327.CrossRefGoogle ScholarPubMed
Ministry of Health of China. 1999. Report of the Second Wave of National Health Services Survey in 1998. http://www.nhfpc.gov.cn/mohwsbwstjxxzx/s8211/201009/49160.shtml. Accessed 2 April 2016.Google Scholar
Ministry of Health of China. 2009. Report of the Fourth Wave of National Health Services Survey in 2008. http://www.nhfpc.gov.cn/mohwsbwstjxxzx/s8211/201009/49166.shtml. Accessed 2 April 2016.Google Scholar
Morgan, Stephen L. 2000. “Richer and taller: stature and living standards in China, 1979–1995.” The China Journal 44, 1–39.Google Scholar
Morgan, Stephen L. 2014. “Growing fat on reform: obesity and nutritional disparities among China's children, 1979–2005.” The China Quarterly 220, 1033–68.CrossRefGoogle Scholar
Popkin, Barry M., Du, Shufa, Zhai, Fengying and Zhang, Bing. 2009. “Cohort profile: the China Health and Nutrition Survey: monitoring and understanding socio-economic and health change in China, 1989–2011.” International Journal of Epidemiology 39, 1435–40.Google Scholar
Preston, Samuel. 1975. “The changing relation between mortality and level of economic development.” Population Studies 29(2), 231–248.Google Scholar
Preston, Samuel. 1980. “Causes and consequences of mortality declines in less developed countries during the twentieth century.” In Easterline, Richard A. (ed.), Population and Economic Change in Developing Countries. Chicago: University Of Chicago Press, 289–360.Google Scholar
Rao, Chalapati, Lopez, Alan D., Yang, Gonghuan, Begg, Stephen and Ma, Jiemin. 2005. “Evaluating national cause-of-death statistics: principles and application to the case of China.” Bulletin of the World Health Organization 83(8), 618–625.Google Scholar
Rosen, Leon. 1958. “Observations on the epidemiology of dengue in Panama.” American Journal of Epidemiology 68(1), 45–58.Google Scholar
Rosenzweig, Mark, and Schultz, Paul. 1982. “The behavior of mothers as inputs to child health: the determinants of birth weight, gestation, and rate of fetal growth.” In Fuchs, Victor (ed.), Economic Aspects of Health. Chicago: University Of Chicago Press, 53–92.Google Scholar
Salaff, Janet. 1973. “Mortality decline in the People's Republic of China and the United States.” Population Studies 27(3), 551–576.Google Scholar
Shanghai Municipal Statistical Bureau. 1983–2011. Shanghai Statistics Yearbook. Beijing: China Statistics Press.Google Scholar
Singh-Manoux, Archana, Ferrie, Jane E., Lynch, John W. and Marmot, Michael. 2005. “The role of cognitive ability (intelligence) in explaining the association between socio-economic position and health: evidence from the Whitehall II prospective cohort study.” American Journal of Epidemiology 161(9), 831–839.Google Scholar
Smith, James, Tian, Meng and Zhao, Yaohui. 2013. “Community effects on elderly health: evidence from CHARLS national baseline.” Journal of the Economics of Ageing 1, 50–59.Google Scholar
Smith, S.K., Tayman, J. and Swanson, D.A.. 2001. State and Local Population Projections: Methodology and Analysis. New York: Kluwer Academic/Plenum Publishers.Google Scholar
Stringhini, Silvia, Sabia, Severine, Shipley, Martin, Brunner, Eric, Nabi, Hermann, Kivimaki, Mika and Singh-Manoux, Archana. 2010. “Association of socio-economic position with health behaviors and mortality.” JAMA 303(12), 1159–66.Google Scholar
Xie, Yu, and Hu, Jingwei. 2014. “An introduction to the China Family Panel Studies (CFPS).” Chinese Sociological Review 47(1), 3–29.Google Scholar
Xie, Yu, and Lu, Ping. 2015. “The sampling design of the China Family Panel Studies (CFPS).” Chinese Journal of Sociology 1(4), 471–484.Google Scholar
Yang, Gonghuan, Hu, Jianping, Rao, Ke Quin, Ma, Jeimin, Rao, Chalapati and Lopez, Alan D.. 2005. “Mortality registration and surveillance in China: history, current situation and challenges.” Population Health Metrics 3(3). DOI:10.1186/1478-7954-3-3.Google Scholar
Yang, Wei, and Kanavos, Panos. 2012. “The less healthy urban population: income-related health inequality in China.” BMC Public Health 12, 804.Google Scholar
Zhao, Jiaying, Jow-Ching Tu, Edward, Song, Guixiang and Sleigh, Adrian. 2015. “Mortality changes during the transition from planned socialism to state capitalism: the case of Shanghai.” Population 70(4), 783–814.Google Scholar
Zhao, Yaohui, Hu, Yisong, Smith, James P., Strauss, John and Yang, Gonghuan. 2014. “Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS).” International Journal of Epidemiology 43, 61–68.Google Scholar
Zhou, Maigeng, Wang, Haidong, Zhu, Jun, Chen, Wanqing, Wang, Linhong, Liu, Shiwei, Li, Yichong, et al. . 2016. “Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013.” The Lancet 387(10015), 251–272.CrossRefGoogle Scholar