Health disparities under market transition: Evidence from nine provinces in China, 1991–2004

Existing research on socioeconomic inequality in health has documented significant associations between health and socioeconomic status (SES). Typically, income, education, and occupation are employed to measure the three major dimensions of stratification, including property, prestige, and power. Yet, it remains unclear how state power influences health status. Despite the large body of literature on the developed world, the developing countries have only recently come to the attention of researchers. As such, it has become increasingly interesting and important to explore the socioeconomic inequalities in health in developing countries, especially in countries where state policy has important influences on social stratification. This dissertation investigates social and economic inequalities in health in contemporary China, with a focus on the health implications of traditional SES components, as well as state policies. My findings indicate significant associations between health and the three major SES components. Income acts as a robust promoter of health, as well as an important mediator for associations between health and marriage, education, and political capital. Education impacts health in multiple ways. When other sociodemographic factors are considered, direct educational returns to health are only observed in rural areas. Meanwhile, in both rural and urban areas, the well educated are more likely to be hired and keep their jobs, to have higher income and more health knowledge, and to enter into and be promoted in the Chinese bureaucratic system. Through these pathways, education influences health indirectly. Being out of the labor force shows a negative influence on health. A dramatic increase in the unemployment rate in cities partially accounts for an emerging urban disadvantage in self-reported health between 1991 and 2004. Findings regarding self-reported health suggest a decline in health in both urban and rural areas between 1991 and 2004, as a consequence of continuous industrialization and social transition. During this period, urban residents are more likely to be exposed to physical, socioeconomic and psychological health risks, which accounts for an emerging urban-rural difference in self-reported health, in favor of rural residents. An increasing level of health expectation and awareness of disease among urban residents further inflates this urban health disadvantage. Political capital has significant and robust influences on health as well. Membership in the Communist Party shows considerable direct rewards for health. Being a cadre is associated with better monetary and non-monetary rewards, both of which are important health-promoting resources