Socioeconomic Status and Health Differentials in China: Convergence Or Divergence at Older Ages?
01 Jan 2009-
About: The article was published on 2009-01-01 and is currently open access. It has received 34 citations till now. The article focuses on the topics: Divergence.
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01 Jan 2004
TL;DR: Differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, are examined, and the subsequent impact of differential adherence on health status is assessed.
Abstract: There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation - better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys - one cohort study and one randomized clinical trial - that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.
477 citations
01 Jan 2010
TL;DR: In this article, the authors provide a global assessment of the relationship between formal education and adult health, using sample data from 70 countries that participated in the World Health Survey and find that an increase in formal education is associated with lower levels of disability in both younger and older adults.
Abstract: Contemporary research primarily in the West offers a strong case for the relationship between formal education and adult health; more education, measured either by level completed or years of schooling, is associated, often in a stepwise fashion, with lower levels of mortality, morbidity and disability. In this study, we attempt to provide a global assessment of that relationship as it pertains to adult disability, using sample data from 70 countries that participated in the World Health Survey. In each of five regions and some of the largest countries outside the West we find that an increase in formal education is associated with lower levels of disability in both younger and older adults. Using the regional education-based differentials and several estimates of growth in education levels, we project levels of disability to 2050 to estimate the health and human capital benefits obtained from investments in education. We find that considering education in the population projection consistently shows lower prevalence of disability in the future, and that scenarios with better education attainment lead to lower prevalence. It is apparent that the educational dividend identified in our projection scenario should be an important policy goal, which, if anything, should be more speedily advanced in those countries and regions that have the greatest need.
64 citations
Cites background from "Socioeconomic Status and Health Dif..."
...…data from the 2005 Inter-Census Survey suggests adults with more education report higher levels of good health and that for both men and women and in both rural and urban areas, the disparity between the least educated and the rest of the population increases with age (Lowry and Xie 2009)....
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TL;DR: Primary education has a stronger effect on mortality for men than for women and the effect of education is stronger for the young old than for the oldest old, which underscores the importance of national and subpopulation contexts in understanding the relationship between education and mortality.
46 citations
Cites background from "Socioeconomic Status and Health Dif..."
...Second, in a collective society like China, health behaviors and health care decisions tend to be a family affair rather than a personal matter and as the result, individual education levels may play a smaller role in determining health behaviors and health care decisions (Lowry and Xie, 2009)....
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...…improves self-rated health, reduces mental distress, and reduces mortality among elderly Chinese (Beydoun and Popkin, 2005; Chen et al., 2010; Gu and Zeng, 2004; Liang et al., 2000; Lowry and Xie, 2009; Ross and Zhang, 2008; Zhu and Xie, 2007; Zimmer and Kwong, 2004; Zimmer et al., 2010)....
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...Lowry and Xie (2009) suggest that the SES and health linkage may be weaker in China for two reasons....
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...Other programs, such as the wide dissemination of health knowledge, the subsidized health care, and a government-sponsored medical insurance system, may have helped alleviate SES gradient in health (Lowry and Xie, 2009; World Bank, 1983)....
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...There is evidence that education, and SES in general, reduces physical impairment, delays the onset of physical disability, improves self-rated health, reduces mental distress, and reduces mortality among elderly Chinese (Beydoun and Popkin, 2005; Chen et al., 2010; Gu and Zeng, 2004; Liang et al., 2000; Lowry and Xie, 2009; Ross and Zhang, 2008; Zhu and Xie, 2007; Zimmer and Kwong, 2004; Zimmer et al., 2010)....
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TL;DR: The results show that older Chinese women, rural residents, those with an education level lower than high school, without individual income sources, who are ex-smokers, and those from poor economic status households are more likely to report disability and poor self-rated health.
39 citations
Cites background from "Socioeconomic Status and Health Dif..."
...Other research by Lowry and Xie (2009) has noted that although socioeconomic status is positively and strongly associated with health status for individuals at younger ages in China; such an association is weaker in the latter part of the life course....
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TL;DR: The authors performed a meta-analysis of 4866 estimates gleaned from 99 published studies that examine the health effects of education and found that the overall effect size is practically zero, indicating that education generates no discernible benefits to health.
Abstract: While numerous studies assess the relationship between education and health, no consensus has been reached on whether education really improves health. We perform a meta‐analysis of 4866 estimates gleaned from 99 published studies that examine the health effects of education. We find that the current literature suffers from moderate publication bias towards the positive effects of education on health. After correcting for publication bias with an array of sophisticated methods, we find that the overall effect size is practically zero, indicating that education generates no discernible benefits to health. The heterogeneity analysis by Bayesian Model Averaging (BMA) and Frequentist Model Averaging (FMA) reveals that the reported estimates can be largely explained by whether the econometric models control for endogeneity of education, the types of data and the differences in health measurements. Our results also suggest that education may not be an effective policy option for promoting population health.
34 citations
References
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TL;DR: The main findings are that access to food is primarily determined by income, and this is in turn closely related to physical resources available to access healthy food.
Abstract: This paper examines the issues of access to food and the influences people face when shopping for a healthy food basket. It uses data from the Health Edu cation Authority's 1993 Health and Lifestyles Survey to examine the barriers people face in accessing a healthy diet. The main findings are that access to food is primarily determined by income, and this is in turn closely related to physical resources available to access healthy food. There is an associated class bias over access to sources of healthy food. The poor have less access to a car, find it harder to get to out-of-town shopping centres and thus are less able to carry and transport food in bulk. The majority of people shop in supermarkets as they report that local shops do not provide the services people demand and that food choice and quality are limited. In tackling food poverty and pro moting healthy eating, health promotion practice needs to address these struc tural issues as opposed to relying on psycho-social models of education based on the provision of information and choice.
136 citations
TL;DR: In the late 1970s China launched its agricultural reforms which initiated a decade of continued economic growth and significant transformation of the Chinese society, but China is still struggling to find an equitable, efficient and sustainable way of financing and organizing its rural health services.
112 citations
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TL;DR: It is likely that nationwide data on registered deaths by age were never collected until recently, and, therefore, that the government had no more idea of China's pattern of mortality since 1949 than foreign analysts.
Abstract: these reported crude death rates have almost never been revealed, and the data could have been based on the total number of registered deaths compiled from localities throughout the whole country or only from selected areas of the country. Because of the possibility of serious underregistration of deaths or reliance on an unrepresentative sample of localities, analysts of China's population have been reluctant to take these reported death rates at face value. Infant mortality rates, as occasionally reported for cities or rural areas, are often implausibly low, so that serious underregistration of infant deaths in particular appears likely.2 Reported data on China's level of mortality have been scattered and of questionable validity, but data on the age pattern of mortality for the country as a whole have not been reported at all. It is likely that nationwide data on registered deaths by age were never collected until recently, and, therefore, that the government had no more idea of China's pattern of mortality since 1949 than foreign analysts.
92 citations
Book•
01 Jun 1984
TL;DR: This review of the health sector begins by noting Chinas achievements in population control health status and nutrition, and discusses the evolution of several influences on health from outside the sector--nutritional improvements greater access to clean water and sanitary waste disposal and fertility reduction.
Abstract: This report is based on the findings of a World Bank rural health and medical education mission that visited China for 4 weeks during September and October of 1982. This review of the health sector begins by noting Chinas achievements in population control health status and nutrition. A section specifically on health then examines policies sources of financing and resource use that have contributed to Chinas successes. The report then discusses the evolution of several influences on health from outside the sector--nutritional improvements greater access to clean water and sanitary waste disposal and fertility reduction. A discussion follows of the problems that remain as the 2 major challenges to the health sector through the rest of the century. Chinas census of June 1982 recorded a population of 1008 million. Life expectancy rose from less than 35 years in the immdiate post-1049 period to almost 70 years in the early 1980s; the estimated infant mortality rate declined from 250 in 1950 to less than 50 in 1981. Steady improvements in the nutritional status of school-age children in China is noticeable at least in urban areas. In urban areas malnutrition has been substantially reduced and is no longer considered an important problem. Many children in rural areas however continue to suffer from moderate-to-serious malnutrition. China has emphasized public preventive over curative health services without neglecting curative services. Improved nutrition provision of safe water supplies and sanitary and convenient means of waste disposal fertility reduction and widespread educational improvements have been major policy objectives. A rapid growth in availability of hospital facilities and health personnel is apparent. A high proportion of total expenditure is mediated through insurance schemes. This reflects the high degree of health insurance coverage a major achievement of the Chinese health system. Major disparities continue to exist among and within provinces and between rural and urban areas in availability of health services and in health status. Effective health care delivery has been consolidated in urban areas. The next priority is to consoldate health care delivery in rural areas. The burden of Chinas health problems has been transferred to the older age groups who are particularly vulnerable to chronic diseases.
90 citations
TL;DR: Results based on 20 years of longitudinal data suggest that education is related to both the individual and accumulated number of behavioral, social, and economic health-risks, which in turn, are related to increasing educational differences in rates of disease incidence and survival.
83 citations