Urban-rural Health Inequality in China: The Between-Group Gap and the Within-Group Dispersion
Creators: name: Chen, Mengxue
Publisher: name: The Australian National University
Year: 2024

description: This thesis aims to measure and explain China's urban-rural health inequality in the recent decades. It consists of seven chapters, including four analytical chapters. Chapter 1 provides historical background on the urban-rural divide in China, and establishes the research questions and motivation. Chapter 2 reviews theories, concepts, indicators, and findings in the study of health inequality, with a focus on urban-rural health inequality in the context of China. Chapters 3, 4, 5, and 6 are the analytical chapters. Chapter 3 examines between- and within-group urban-rural health inequalities using data from the Chinese Disease Surveillance Points (DSP) system and the cause-deleted lifetable method. The findings reveal that urban advantage exists not only in life expectancy, but also in the level of lifespan dispersion. Due to faster decrease of rural than urban mortality, the urban-rural gaps in life expectancy and lifespan disparity were shrinking over time. Cause-specific contributions to changes in life expectancy and lifespan disparity are also quantified. Chapter 4 considers geographic differences in urban-rural health inequality by analysing the urban and rural populations in East, Central, and West China. Using DSP data from 2010 to 2020 and a decomposition method, the change in national life expectancy over time is decomposed into contributions made by regional mortality change (the mortality component) and regional population weight change (the compositional component). This analysis reveals that increase in China's national life expectancy is influenced not only by the mortality reduction discussed in Chapter 3, but also by changes in regional composition of population. All regional populations were found to have made a positive contribution to national life expectancy increase through the mortality component, but this effort was either enhanced or offset by the compositional component. Building on the findings from Chapter 3 and 4, Chapter 5 explores the rich meaning of urban-rural health inequality by taking not only the length of life but also the quality of life into account. Using the Sullivan's method and data from the 2005 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the length and variation of physical and cognitive healthy lifespan were measured. It was discovered that the urban and rural populations in China have experienced an expansion of physical morbidity and a compression of cognitive morbidity. Rural advantage was observed in the prevalence of physical impairment, but not in cognitive impairment. The urban populations seem to experience higher variation in healthy lifespan despite their advantage in the length of healthy life. Using a step-wise replacement decomposition method, it was revealed that the improvement in both urban and rural healthy life expectancies was predominantly fuelled by the reduction in mortality, while changes in morbidity were primarily responsible for changes in the dispersion of healthy lifespan. In the last analytical chapter (Chapter 6), the focus shifts from measuring to explaining urban-rural health inequality by identifying the underlying determinants of functional health. A logistic regression model was built using information from the most recent wave of the CLHLS data. Despite an observed economic gradient in functional health within the urban and rural populations, results of the statistical analysis indicate that monetary income does not have a statistically significant impact on functional health. Instead, education, subjective income (or the sense of relative deprivation), and access to external support such as medical care and insurance, are found to be the most important underlying determinants of functional health for both urban and rural populations. Finally, Chapter 7 summarizes the key findings of the study, discusses observed trends, and identifies contributions, limitations, and future research directions.