The Origins Of Health Inequality Of Middle-aged And Elderly People In China

Good health not only constitutes a prerequisite to pursue and enjoy a better life,but also forms the foundation for the social and economic development.With the development of economy,education and health care,Chinese people's health has been improving continuously.In 2018,the average life expectancy of Chinese is 77.0 years,and main health indicators are generally better than the average level of middle and high-income countries.However,the health status of Chinese elderly is not optimistic.At present,the proportion of the elderly with one or more chronic diseases is as high as 75%,and the number of disabled and partially disabled elderly is more than 40 million.People begin to enter the stage of potential aging after the age of 45,and they will have pre-aging characteristics,such as the slowing down of metabolism,the organic deterioration,and the decreased resistance to diseases.It is worth noting that the middle-aged and old people are not only a special group with increasing health vulnerability and disease risk,but also faced with increasingly serious health inequality with different socio-economic status(SES)With the development of the life course theory,more and more scholars have introduced it into the analysis framework to explain health inequality in recent years,in order to explore the origin of the health inequality.The current health status reflects the cumulative effect of various experiences and influencing factors in the previous life stages,and in one' life course,the childhood has a special significance for later life health.This paper defines the childhood as the whole stage from birth to adulthood.The childhood socio-economic status reflects one's family economic situation and living environment in childhood,which has a long-term impact on the health status and disease risk at middle-age and old age.Therefore,starting from the early stage of the life course-childhood,this paper traces the origin of health inequality back to the upstream of life course,by exploring the impact of childhood socio-economic status on the health inequality of middle-aged and elderly people.It not only shifts the research focus of health inequality from the current socio-economic factors to the upstream of the life course,but also makes a dynamic analysis of the cumulative process of health inequality combined with the cohort effect.On this basis,this paper studies the determinants of middle-aged and old people's health and health inequality in depth,and puts forward relevant suggestions to improve the health status and promote health equality,which also conforms to the policy idea-"from the perspective of the whole life course,all factors affecting health should be comprehensively and systematically intervened from the early stage of life"-emphasized by the "The 13th Five-year Plan for Healthy Aging".It is of great practical significance for the realization of "healthy aging".The main contents of this paper are as follows:First of all,Chapter 1 introduces the background and significance also related concepts of this research,including the meaning and measurements of health,health inequality,childhood and socio-economic status,and introduces the main research contents and research methods,then summarizes the potential contributions.Chapter 2 provides a systematical overview of previous research,including sorting out the measurement methods of health inequality and the current situation of the health inequality of the middle-aged and old people,discussing the determinants of the health inequality of the middle-aged and old people from socio-demographic characteristics,socio-economic status,life style and medical and health services,and tracing the origins of the health inequality of the middle-aged and old people back in childhood SES,and then summarizes and comments on the existing research literature On this basis,the main ideas and research direction of this paper are established.Chapter 3 constructs the theoretical basis.The key is to introduce the life course theory into the analysis framework of health inequality.Combined with the health demand theory and the new human capital theory,this paper constructs a theoretical model linking childhood SES with health at the middle and old age,in order to understand the importance of early life experience and investment to health production from the perspective of the whole life cycle.Within this framework,it analyzes the long-term impact of childhood SES on health,the cohort effect,and the mechanism and mode of health inequality developing as growing older,providing theoretical basis and research hypotheses for the follow-up chapters which demonstrate the impact of childhood SES on the health inequality of middle-aged and elderly people.Secondly,in order to explore the upstream factors of the health inequality of middle-aged and old people from the life course perspective,this paper draws data from China Health and Retirement Longitudinal Study(CHARLS)in Chapter 4,and constructs a indicator defining healthy aging following WHO's viewpoint,incorporating both family and neighborhood SES during childhood to explore the long-term impact of the childhood SES on the elderly's health,with proposing a theoretical SEM model to assess how the effect is mediated by potential mediating variables.It is found that there is a significant causal link between the childhood SES childhood and the middle-aged and the elderly's health,after dealing with endogeneity issues.The middle-aged and the elderly with superior family and community SES in childhood are significantly healthier than those with poor SES in childhood.Neighborhood SES during childhood produces a direct effect on healthy aging,while the effect of family SES in childhood is contributed by the mediating effect of education and adult SES.Therefore,the origins of health inequality of middle-aged and old people in China can be traced back to the socio-economic status of families and communities in childhoodIn order to analyze more pertinently how poor socioeconomic conditions in early life affect middle-aged and old people's health,and to investigate the social change and the trend of historical development by studying the differences of the health level of different birth cohorts,Chapter 5 takes the Great Famine in 1959-1961 as a natural experiment,making use of variations in effects of famine across cohorts and regions to construct a difference-in-differences estimator to investigate the long-term effects of famine in the early stage of life on the health status of the survivors.The estimates show that who experienced the famine at age of 10-17 are significantly less likely to achieve healthy aging than those who did not.Through the analysis of mechanism,this paper further finds that education is an important channel for the long-term impact of the famine on health.By reducing the number of years of education,the Great Famine has detrimental health effects to the middle-aged and elderly.This not only further explains the long-term adverse effects caused by the extremely bad social and economic conditions in childhood,but also illustrates the health status of different birth cohorts can reflect the specific social changes and cohort characteristics.Thirdly,in order to investigate the dynamic relationship between SES and health over the whole life course,analyze how the differences in health trajectories caused by childhood SES change as one grows old,thus leading to the health inequality in the middle and old age,Chapter 6 uses longitudinal data from CHARLS(2011-2015)and the growth curve model to examine long-term effects of childhood SES on health trajectories of the middle-aged and old people for multiple cohorts,which makes up for the lack of distinguishing age effect and cohort effect in previous relevant studies Findings from this study indicate that,in the process of aging,people from different childhood SES groups have different health trajectories over the life course Specifically,low childhood SES people tend to age faster than their high SES counterparts,which means socioeconomic disparities in health increased with age,supporting the cumulative advantage/disadvantage theory and cumulative inequality theory.Moreover,this divergence is found to strengthen in recent birth cohorts.Lastly,based on the conclusions of this paper,Chapter 7 puts forward some policy suggestions to improve the current situation of health inequality in China,summarizes the shortcomings of this paper,and puts forward the next research direction and research prospects.The contributions of this paper are as follows:Firstly,this paper extends previous research investigating associations between childhood SES and later life health.On the one hand,the existing related research mainly focuses on the elderly(especially the oldest old),but the research on the middle-aged and the young elderly is still insufficient;this paper no longer only studies the elderly,but expands the research object to the middle-aged and the elderly.On the other hand,when exploring the long-term impact of childhood SES on health,we should not neglect the important role of neighborhood SES in childhood on the elderly's health.Some foreign scholars have tried to combine life course theory with social ecology theory to explain health inequality(Johnson et al.,2012;Jivraj et al.,2019),emphasizing the influence of neighborhood SES in childhood on health outcomes and health inequality in later life;therefore,this paper not only focusing on the relationship between family SES in childhood and the middle-aged and old people's health,but also trying to explore the long-term impact of neighborhood SES in childhood on health,thus capturing more fully the influence of childhood SES on health in the views of the two dimensions,time and space.Secondly,this paper identifies the causal link between childhood SES and health outcomes at middle and old age.It is usually difficult to avoid the endogeneity issues for previous studies on this topic,so the results can only show the correlation between various factors and health outcomes.This paper considers and deals with the potential endogeneity issues of models,and finds that there is a significant causal link between the effect of childhood SES on the middle-aged and the elderly's health,rather than merely presents the correlation.In addition,this paper also uses the difference-in-differences method to identify the long-term causal effects of the 1959-1961 famine on the health outcomes of survivors,thus further explains the causal link between extremely poor socioeconomic conditions in early life and adverse health outcomes of the middle-aged and the elderlyThirdly,this paper investigates the cumulative effect of childhood SES on health inequality over the life course.Compared with western research,domestic research pay less attention to the dynamics of health inequality,especially the dynamics of the middle-aged and elderly.Only a small amount of literature deals with the trend of health returns of education and income as growing older,neglecting the childhood SES is also an important part of the process of inequality accumulation.Moreover,most related literatures use cross-sectional data,which is unable to distinguish age effects and cohort effects.By using longitudinal data and growth curve model,on the premise of distinguishing cohort effect and age effect,this paper examine the long-term effects of childhood SES on the health trajectories of the middle-aged and old people,investigates how socioeconomic disparities in health change with aging,and whether this relationship is identical across cohorts.Therefore,it promotes the understanding of the determinants and dynamic changes of health stratification over the whole life course.