A Natural Experiment about the Effects of Urbanization on Elders’ Mental Well-Being and Chronic Disease Management: Lessons from China’s Passive Urbanization

This dissertation examined how China’s passive urbanization (i.e., state-led urbanization) affected elders’ mental health and chronic disease management. China’s passive urbanization usually involved land requisition and village reconstruction, and it has transformed many rural villages into urban-style communities. But its social and health impacts have rarely been evaluated. This dissertation explored how passive urbanization affected depressive symptoms and hypertension management and whether intergenerational support from children mediated these effects, among elders who were originally rural. This dissertation used the 2011 national baseline data from the China Health and Retirement Longitudinal Study (CHARLS). Passive urbanization was found to be associated with an increase in elders’ receipt of financial support from children by 1449 yuan/year. Passive urbanization was associated with a 5% risk difference in having severe depressive symptoms. However, passive urbanization did not improve hypertension management among elders. G-estimation revealed that the mediation effects of intergenerational support were very small.These findings suggest that passive urbanization might have improved rural elders’ mental well-being through improved community-level physical and social environments as well as increased income. But healthcare services in rural China still need to be strengthened to combat the epidemic of non-communicable diseases