The “Difference Between Heaven and Earth”: Urban-rural Disparities in Health

and Well-being in China

Donald J. TreimanCalifornia Center for Population Research, UCLA

NUS Sociology Seminar27 January 2011

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The problem

• Massive economic growth in China over the past 60 years, especially the last 30 years (10% annual increase in GDP almost every year since 1978).

• But still a large urban-rural gap in socioeconomic inequality, well-being, and health.

• Has the gap been narrowing, increasing, or remaining unchanged?

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Two competing hypotheses

• Dramatic improvements in rural well-being, due to increase in job opportunities for migrants, mainly in export-oriented manufacturing, resulting in a narrowing of the gap.

• The urban sector has led economic growth, resulting in a widening of the gap.

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Urban-rural status• “Hukou” (registration) system, instituted in

1955, created a 2-class society, with access to welfare benefits differentially available to those with “non-agricultural” and “agric-ultural” (or “urban” and “rural”) registration:– Health, unemployment, and retirement insurance;

education; housing; jobs; and, in the days of rationing, food.

– Also, differential taxation, favoring the urban population: in-kind agricultural tax from 1958 until 2006, but no income tax until 1986.

• In sum, China built an urban welfare state on the backs of the peasants.

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Hukou conversion• It was, and is, very difficult to change

from rural to urban hukou, education being the key mechanism.

• It also was, and is, very difficult to acquire local hukou (required for most benefits), except when moving from a larger to a smaller place.

• Still, since the Economic Reform that began in 1978, many rural people have moved to cities and towns (see below).

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DataTwo national probability sample surveys of

mainland China carried out by me and colleagues:

• 1996 survey of people age 20-69 focused on inequality over the life course. N = 6,090.

• 2008 survey of people age 18-64 focused on internal migration. Includes an oversample of migrants—people born other than where they are currently living. N = 3,000.

The two data sets were merged, to produce a sample of 9,090 people born between 1927 and 1990.

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Urban-rural status typology

To focus on rural-urban differences, I created a 3-category typology based on residence and registration at age 14:

1. those with urban registration (before 1941, urban residence);

2. those with urban residence, but rural registration (born in 1941 or later, since hukou system not introduced until 1955);

3. those with rural residence and registration (before 1941, rural residence).

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More on the typology• Focusing on origins (measured at age 14)

avoids “sample selection bias,” since current status is an outcome, correlated with other aspects of inequality.

• No distinction by residence is made for those with urban hukou since only a small fraction live in rural areas.

• The 3-category typology permits two contrasts:– institutionalized discrimination.– urban vs. rural life experience.– Expectation: rural hukou, urban residence group

(hereafter “mixed”) will be intermediate.

• Here is the trend in residence type.

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Analytic Strategy• Pool the two data sets.

• Estimate trends for each of the 3 urban-rural status types by single-year birth cohorts: 1927-1990 (but 1941-1990 for the “mixed” category; 1927-1978 for age 30 analysis).

• Show gross trends (without controls) and, where appropriate, net trends, controlling for the usual suspects.

• Smooth data using Stata’s –lowess-.

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A rising tide lifts all boats• Overall conclusion: – The wellbeing of the Chinese population

has improved dramatically, especially over the past 30 years, with increased levels of education, a reduction of the agricultural workforce and increase in the non-manual workforce, and increases in income, material wellbeing, diet, and health.

– But, overall, there has been neither much increase or decrease in the rural-urban wellbeing gap.