Presenter:

Hongmei Wang

Authors:

Hongmei Wang, Mark Schlesinger, Hong Wang, William Hsiao

Mon June 5, 2006 9:30-10:45 Room Alumni Lounge

Rationale: Health researchers have observed stagnant and sometimes declining health outcomes in rural China despite the fact that absolute income is increasing constantly. The elimination of inequality in health is seen as an urgent public health policy issue, but the determinants of these disparities are poorly understood once economic deprivation has been reduced. Few studies have focused on social capital and health in China. In the case of China, a relevant question to ask is whether social capital, measured as interpersonal trust, has changed due to economic reforms and whether the erosion of social capital is related to the worsening of the health status of rural residents.

Objectives: In the setting of rural China: (1) Is social capital measured as trust related to individual’s health? If yes, how does social capital impact on health? (2) How does social capital compare to other socio-economic factors, such as income and education, as predictors of physical and psychological well-being? (3) How does social capital differentially affect an individual’s health status in developing countries compared to advanced economies?

Data and Methods: This paper employed data from the household survey of the Rural Mutual Healthcare Project, jointly conducted by Harvard China Health Policy Center and China Health Economics Institute. The survey was conducted in two provinces in China in year 2002 using stratified clustered sample. The final sample for this paper consisted of 9608 participants. The outcome variables included a 5-point scale self-reported general health and a 3-point scale self-reported mental health measure. Social capital was measured by 10 questions measuring both trust and mistrust levels. A trust index and a mistrust index were constructed and both measures were also aggregated at village level for analysis. This paper adopted multivariate ordered logistic regression analyses, adjusting for survey design effects, for main analyses. A rich set of control variables including demographic, health risk measures, social economics status variables, and sanitary measures were controlled in the models.

Conclusions: (1) Social capital measured as interpersonal trust is significantly associated with an individual’s health in rural China. Social capital appears to impact on both mental health and physical health, but to different degrees. Both individual-level social capital and village-level social capital have a significant impact on health. Individual trust and mistrust have opposite impact on a person’s health as expected. However, results from stratified analyses suggest that mistrust operates on health separately from trust. (2) The overall magnitude of effects of social capital on health is substantial, comparable to social economic status factors such as education and health insurance. (3) Compared to that of advanced economies, the magnitude of influences of social capital on health appears to be bigger in rural China.

Disclosure information: The authors are either faculty members or student at Yale University or Harvard University and have no conflicted interest with regard to this project.

Part of the abstract has been presented in ASSA 2005 annual meeting.