Elsevier

Social Science & Medicine

Volume 98, December 2013, Pages 71-78
Social Science & Medicine

Village characteristics and health of rural Chinese older adults: Examining the CHARLS Pilot Study of a rich and poor province

https://doi.org/10.1016/j.socscimed.2013.08.041Get rights and content

Highlights

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    Existence of sewage systems was associated with fewer physical limitations (PLs).

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    Use of coal in the home was associated with more PLs.

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    Higher per capita net village income was associated with fewer PLs.

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    Higher education was associated with fewer PLs.

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    China's New Cooperative Medical Scheme was associated with fewer PLs.

Abstract

Community (or village) characteristics have received growing attention as researchers have sought factors affecting health. This study examines the association between a variety of environmental, economic, and social village characteristics and health of Chinese older rural adults with health measured in terms of physical limitations. The Chinese Health and Retirement Longitudinal Survey (CHARLS) Pilot Study data were used. Older villagers from a low-income province (Gansu) and a relatively wealthy province (Zhejiang) were surveyed between July and September, 2008. The sample included 1267 respondents in 73 villages age 45 and older. The relationship between a variety of village characteristics and physical limitations of older adults was examined using negative binomial regression (NBR) with standard errors adjusted to account for non-independence of respondents in a village. A comparison of means/percentages shows that Gansu and Zhejiang were significantly different on the dependent and most independent variables. The NBR models show that at the personal-level, decreased risk of physical limitations was associated with being male, less than 60 years old, married, higher in education, and higher in household expenditures (proxy for income). At the village-level, decreased risk of limitations was associated with a continuous supply of electricity, not using coal in the household, the existence of a sewage system, low cost of electricity, and village wealth. Decreased risk of physical limitations was also associated with various characteristics of China's New Cooperative Medical Scheme (NCMS), an insurance program for rural older adults. Policy implications for improved health of rural older adults include: (1) continued use of China's NCMS, (2) establishment of village sewage systems, (3) ending the use of coal in the home, and (4) increased educational opportunities focused on health.

Introduction

The characteristics of communities and villages have received a great deal of attention world-wide over the past 30 years. These include a focus on a variety of environmental, economic, and social characteristics that are believed to create and maintain good health. The purpose of this paper is to examine the general propositions that environmental, economic, and social characteristics of a village are associated with the health of rural Chinese older adults. Urban communities were excluded from the analyses in order to improve the interpretation of the data. Urban communities are very different from Chinese rural villages, such as by having more government financial supports, more developed community infrastructure, and more social supports (Zimmer, Kaneda, & Spess, 2007).

Section snippets

Change in rural and urban China

Chinese rural villages and urban communities have undergone tremendous change since 1949 when the Chinese communist party took control of the country. They experienced the “Great Leap Forward” initiated in 1958, the cultural revolution in the later half of the 1960's, and, in the 1980's they were introduced to a capitalist economic system that replaced many of the existing social programs such as national health care. In addition, they experienced the beginning of the “one-child” rule in the

Environmental, economic, and social conditions affecting health

We propose that the environmental, economic, and social conditions of rural Chinese older villagers are associated with their health. The literature largely supports these propositions and is reviewed below.

Data collection design and procedures

Data collected from the Chinese Health and Retirement Longitudinal Survey Pilot Study (CHARLS) were used to examine the relationship between the physical limitations of Chinese rural older adults and environmental, economic, and social conditions. The design and data collection procedures are described in detail in Zhao, Strauss, and Sun (2009) and Strauss et al. (2011). A team of researchers from Peking University, the University of Southern California, and Oxford University developed the

Results

Table 1 presents descriptive statistics for all variables in the study by province. The respondents from the wealthier Zhejiang province are significantly healthier, needing help with only an average of 1.4 of the 12 IADL/functional limitations measured compared to 3.4 among respondents from the much poorer Gansu province (p < 0.001; all p values are two-tailed test). Further, 47% of the Zhejiang respondents needed no help at all with any of the 12 physical limitations compared to 19% in Gansu.

Discussion

The purpose of this study was to examine the three general propositions that there is a relationship between the health of the Chinese village older adults and their (1) environmental (Brunekreef and Holgate, 2002, Pervin et al., 2008, Shaw et al., 2002), (2) economic (Li and Chi, 2011, Mazmanian and Kraft, 2009, Zeng et al., 2010), and (3) social characteristics (Gruenewald, Liao, & Seeman, 2012; Pynnonen et al., 2012). The CHARLS data support these propositions. Having a sewage system in

Implications for social policy

There are several findings that standout with regard to social policy in China. The data show encouraging results regarding the New Cooperative Medical Scheme—the NCMS appeared to be associated with fewer physical limitations. This suggests that the NCMS may be helping to improve health among the older Chinese villagers. The findings also show a clear association between the lack of a village sewage system and increases in physical limitations in Gansu. This suggests that villages, particularly

Acknowledgments

Collection of the data was supported by the U.S. National Institute on Aging, the China National Natural Science Foundation, and the World Bank, China.

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