Income productivity in China: on the role of health

Social causation, social selection, and economic selection in the health outcomes of Chinese older adults and their gender disparities

Background

The economic selection hypothesis, which argues that the initial economic situation determines both subsequent health and economic conditions, has been drawn into the debate on causation-selection issues. This study aims to construct a path model with self-rated health and depression score of older adults as health outcomes to measure and compare the social causation forces of wealth accumulation, social selection forces of adulthood health, and economic selection forces of childhood economics, and to examine their gender disparities.

Methods

Data was obtained from a sample of 19613 older adults aged 45 years or above from the 2014 life history survey and the 2015 routine follow-up survey of the China Health and Retirement Longitudinal Study. Structural equation modeling analysis was conducted employing the full information maximum likelihood estimation method.

Results

The presence of social causation, social selection, and economic selection were all statistically supported. In self-rated health, social selection forces held the dominant position, while social causation forces were comparable to economic selection forces. In depression score, social selection still exhibited stronger forces than economic selection, but social causation had forces close to social selection and greater than economic selection. The forces of the three hypotheses in self-rated health did not significantly change with gender, but social causation exerted mightier forces than economic selection within the male group, unlike the female group. The forces of economic selection in depression score were greater in females than males and no significant differences were observed among the forces of the three hypotheses in the female group.

Conclusions

Social causation, social selection, and economic selection operate simultaneously on the self-rated health and depression score of older adults. However, the force magnitudes of the three hypotheses and/or their rankings differ by health outcomes and gender.

Spatio-Temporal Differences in Economic Security of the Prefecture-Level Cities in Qinghai-Tibet Plateau Region of China: Based on a Triple-Dimension Analytical Framework of Economic Geography

The assessment of regional economic security (RES) is mainly based on the theoretical ideas of political economy and marginalism, and the research areas are mainly concentrated in European and American countries/regions, especially Eastern Europe. Taking the Qinghai-Tibet Plateau in China as an example, this paper constructs a triple-dimensional analytical framework, resources, and environmental-economic foundation-driving forces, based on the institutional approach of economic geography, with the purpose of making up for the deficiency of the extant literature, which pays little attention to regional characteristics and the dynamic mechanism concerning RES, and to provide a tool to identify key factors affecting RES. This paper obtained the main conclusions as follows. (1) The index of the economic security in the Qinghai-Tibet Plateau is on the rise, and the difference at the level of RES among cities is significant but tends to decrease. (2) There is a significant spatial autocorrelation among cities in the Qinghai-Tibet Plateau in terms of RES. The high-value areas are concentrated along the southeast edge, and the low-value areas are concentrated in the central areas of the west. (3) Despite lower weight values, the weakness of the economic foundation and the fragility of the ecological environment has increasingly hampered the improvement of the economic security in the Qinghai-Tibet Plateau. In terms of driving forces, it is the support of the central government and aid programs of other provinces that contributes to its economic development.

The inequality of health-income effect in employed workers in China: a longitudinal study from China Family Panel Studies

Background

The relationship between health and income is an essential part of human capital research. The majority of current analyses using classical regression models show that health has a significant impact on income after controlling for the endogeneity of health due to the measurement error and reverse causality. Currently, the Chinese government implements various policies including health related policies to fiercely fight for the domestic poverty issues, and thus only estimating the average effect of health on income could underestimate the impact for low income population and will make policy makers neglect or not pay enough attention to the significant role of health in poverty alleviation. To study the effect of health on income for workers at different income quantiles, we apply the quantile regression method to a panel data from a Chinese household survey. Furthermore, we test the heterogeneity of this health-income effect for different subgroups of workers characterized by sex, registered residence, and residential area. Lastly, we provide an explanation on the possible mechanism of the health-income effect.

Methods

This study uses data from four waves of the China Family Panel Studies (CPFS)- a biennial longitudinal study spanning from 2012 to 2018. The final data used in the regression analysis includes a balanced sample of 19,540 person-year observations aged between 18 to 70 years, with complete information of demographic and social economic status characteristics, job information, and health status of individuals. We use lagged self-reported health to control the potential endogeneity problem caused by reverse causality between health and income. Our identification on heterogenous treatment effects relies on panel quantile regressions, which generate more information than the commonly used mean regression method, and hopefully could reveal the effects of health on income for workers with income distributed at a wide range of quantiles. In addition, we compare the results derived from panel quantile regressions and mean regressions. Finally, we added interaction terms between health and other independent variables to recover the influence channel of health on income.

Results

The regression estimates show that the effects of health on income are more pronounced for workers distributed on the lower ends of income spectrum, and the health-income effect decreases monotonically with the increase of income. The treatment effect is robust to alternative measures of health and seems to be more pronounced for females than males, for rural workers than their urban counterparts. Finally, we find that health not only directly affects worker’s income but also has different effects on income for different occupation cohorts.

Conclusions

This study provides a different perspective on the impact of individual health status on income, uncovering the heterogeneous effects of health deterioration on income reduction for workers with different incomes by using panel data and rather advanced statistical techniques- panel quantile regressions. At present, the Chinese government is making every effort to solve the problem of poverty and our findings suggest public policies on health and income protections should emphasize different needs of workers with different incomes and special attention should be paid to low-income workers who are much more financially fragile to health deterioration than other income groups.

Lower Education and Household Income Contribute to Advanced Disease, Less Treatment Received and Poorer Prognosis in Patients with Hepatocellular Carcinoma

Understanding the ways in which socioeconomic status affects prognosis of hepatocellular carcinoma (HCC) is important for building up strategies eliminating the inequalities in cancer diagnosis and treatments among different groups, which, remains undetermined. In the present study, 1485 newly diagnosed HCC patients with complete demographic and clinical data were included. Socioeconomic data, including education, annual household income and residency was also reported by patients or families. In the present study, less educated patients were older, more female involved, poorly paid, more living in rural places, had more advanced tumor burden, received less curative and loco-regional therapies, and thus showed poorer short-term and long-term outcomes (in total or after surgical resection) than the highly educated. Patients with lower income were less educated, less treated, and more likely to live in rural places, had more advanced stages of HCC and thus poorer long-term survival (in total or after surgical resection) than higher income groups. In Cox regression analysis, lower household income was independently associated with poorer outcome (HR=1.2, 95% CI: 1.0-1.4, p=0.036). These results indicate that education and income are critically associated with early diagnosis, treatments and prognosis of HCC. Much more efforts should be taken to support the patients with less education and lower income to improve the outcomes of HCC.

Rising inequalities in income and health in China: who is left behind?

In recent decades, China has experienced double-digit economic growth rates and rising inequality. This paper implements a new decomposition approach using the China Health and Nutrition Survey (1991-2006) to examine the extent to which changes in level and distribution of incomes and in income mobility are related to health disparities between rich and poor. We find that health disparities in China relate to rising income inequality and in particular to the adverse health and income experience of older (wo)men, but not to the growth rate of average incomes over the last decades. These findings suggest that replacement incomes and pensions at older ages may be one of the most important policy levers for reducing health disparities between rich and poor Chinese.

The role of international remittances in health outcomes in Ecuador: prevention and response to shocks

This article evaluates the impact of remittances on health outcomes in Ecuador using an instrumental-variables approach. Although we do not find significant impacts on long-term child health variables, we find that remittances do have an impact on health expenditures, and on some preventive issues such as de-worming and vaccination. In addition, we find significant effects of remittances on medicine expenditures when illness occurs. In this regard, remittances are used for both preventive and emergency situations. Interestingly, we also find a significant and positive effect of remittances on health knowledge.

Is there a health penalty of China's rapid urbanization?

While highly pertinent to the human welfare consequences of development, the impact of rapid urbanization on population health is not obvious. This paper uses community and individual-level longitudinal data from the China Health and Nutrition Survey to estimate the net health impact of China's unprecedented urbanization. We construct an index of urbanicity from a broad set of community characteristics and define urbanization in terms of movements across the distribution of this index. We use difference-in-differences estimators to identify the treatment effect of urbanization on the self-assessed health of individuals. We find that urbanization raises the probability of reporting of poor health and that a greater degree of urbanization has a larger effect. The effect may, in part, be attributable to changed health expectations, but it also appears to operate through health behaviour. Populations experiencing urbanization tend to consume more fat and smoke more.

Determinants of Thailand household healthcare expenditure: the relevance of permanent resources and other correlates

Several papers in the leading health economics journals modeled the determinants of healthcare expenditure using household survey or family budgets data of developed countries. Past work largely used self-reported current income as the core determinant, whereas the theoretically correct concept of household resource constraint is permanent or long-run income (á lá Milton Friedman). This paper strives to rectify the theoretical oversight of using current income by augmenting the model with household asset. Using longitudinal data, we constructed 'wealth index' as a distinct covariate to capture the households' tendency to liquidate assets when defraying necessary healthcare liabilities after exhausting cash incomes. (Current income and assets together capture the household expanded resource base). Using 98 632 household observations from Thailand Socio-Economic Surveys (1994-2000 biennial data cycles) we found, using a double-hurdle model with dependent errors, that out-of-pocket healthcare spending behaves as a technical necessity across income quintiles and household sizes. Pre-1997 economic shock income elasticities are smaller than the post-shock estimates across income quintiles for large and small households. Proximity to death, median age, and assets are also among other significant determinants. Our novel findings extend the theoretical consistency of a multi-level decision model in household healthcare expenditure in the developing Asian country context.

Evaluating community health centers in the City of Dalian, China: how satisfied are patients with the medical services provided and their health professionals?

Around 58 community health centers (CHCs) were investigated to evaluate their performance, and 372 residents were surveyed randomly about their satisfaction towards these centers. State-owned CHCs gained the least benefits and received most patient visits. Residents' opinions about health professionals working in these centers showed marked distrust due to their insufficient work experience and low education level; however, affordability, availability and access to services and drugs among CHCs generated comparatively high satisfaction. Therefore, enhancing CHCs' service delivery is a necessity to improve the quality of community doctors and nurses, increase enrolment and training programs, and augmenting hospitals' support to CHCs.

Urbanization and the spread of diseases of affluence in China

We quantify, track and explain the distribution of overweight and of hypertension across Chinese provinces differentiated by their degree of urbanicity over the period 1991-2004. We construct an index of urbanicity from longitudinal data on community characteristics from the China Health and Nutrition Survey and compute, for the first time, a rank-based measure of inequality in disease risk factors by degree of urbanicity. Prevalence rates of overweight and hypertension almost doubled between 1991 and 2004 and these disease risk factors became less concentrated in more urbanized areas. Decomposition analysis reveals that one-half of the urbanicity-related inequality in overweight is directly attributable to community level characteristics, while for hypertension the contribution of such characteristics increased from 20% in 1991 to 62% in 2004. At the individual level, lower engagement in physical activity and farming explain more than half of the urban concentration of overweight and a rising share (28%) of the greater prevalence of hypertension in more urbanized areas. Higher incomes explain around one-tenth of the urban concentration of both overweight and hypertension, while the education advantage of urban populations has a similar sized offsetting effect.