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Wealth Buys Health – Even In China

Studies in the United States have long shown that rich people tend to be healthier than poor people, and that this “health gap” between the haves and have-nots gets worse as people get older. But is that because the U.S. is a capitalist society? Apparently not. A new study from North Carolina State University shows that the same is true in China. However, there is one key difference. In China, the overall health gap across generations is getting narrower – and it’s getting wider in the U.S.

Researchers from NC State and the University of Chicago set out to address two key questions: How does the health gap between people with higher and lower socioeconomic status (SES) in China change when they age? And, is the process different for people who belong to different generations? To address these questions, the researchers analyzed data collected from more than 7,000 adults over the course of 13 years to track changes in the health of the study participants.

They found that the health gap between people of high and low SES increased significantly over their lifetime, taking generational differences into account. “This reflects the cumulative disadvantage of the lower socioeconomic classes, who have less access to medical care, nutrition and other health-related factors over time,” says Dr. Feinian Chen, associate professor of sociology at NC State and lead author of the new paper. “This finding is consistent with similar studies done recently on the U.S. population.”

But the researchers also found that the health gap between Chinese study participants with high SES and those with low SES has decreased in recent generations.

“Even accounting for the fact that more recent generations are younger, the health gap between the advantaged and the disadvantaged has shrunk with each successive generation,” Chen says. “This is the exact opposite of what has been found in studies of the U.S. population, where the health gap has been shown to widen with each generation.”

While it is not immediately clear what is causing this narrowing of the health gap across generations, Chen and her co-authors are planning future research to explore the issue. “We suspect this narrowing of the health gap in China is due to significant social and economic changes over the past 20 years, including changes in health behaviors and access to health care,” Chen says.

The research, “Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis,” was published in March by American Sociological Review and was funded by the National Institutes of Health. The study was co-authored by Chen, Dr. Yang Yang of the University of Chicago, and NC State Ph.D. student Guangya Liu.

NC State’s Department of Sociology and Anthropology is a joint department of the university’s College of Humanities and Social Sciences and College of Agriculture and Life Sciences.


Note to editors: The study abstract follows.

“Social Change and Socioeconomic Disparities in Health over the Life Course in China: A Cohort Analysis”

Authors: Feinian Chen, Guangya Liu, North Carolina State University; Yang Yang, University of Chicago

Published: March 2010, American Sociological Review

Abstract: This article examines social stratification in individual health trajectories for multiple cohorts in the context of China’s dramatically changing macro-social environment. Using data from the China Health and Nutrition Survey, we find significant socioeconomic status (SES) differences in the mean level of health and that these SES differentials generally diverge over the life course. We also find strong cohort variations in SES disparities on the mean levels of health and health trajectories. The effect of education on health slightly decreases across successive cohorts. By contrast, the income gap in health trajectories diverges for earlier cohorts but converges for most recent cohorts. Both effects are more pronounced in rural areas. Given that these cohort effects are opposite those reported in recent U.S. studies, we discuss China’s unique social, economic, and political settings. We highlight the association between SES and health behaviors, China’s stage of epidemiologic transition, and the changing power of the state government and its implications for health care.