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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (1 November 2018) | Viewed by 41282

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Prof. Dr. Sean Sylvia

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Guest Editor

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Interests: Development economics; Health economics; Poverty and inequality; China

Dr. Scott D. Rozelle

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Guest Editor

Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
Interests: health economics; nutrition; early childhood development
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Dear Colleagues,

Over the past decade, China has implemented wide-ranging health system reforms and invested heavily in population health. Per capita health expenditure has increased by nearly six times since 2000—largely due to increased government investment. Most of this investment has been aimed at expanding access to health care and improving public health programs.

Despite progress in expanding access, there are signs that substaintial challenges remain in terms of increasing the quality and equity of health services. There are persisting concerns of low-quality medical care, particularly in rural areas and urban migrant communities. It is also unclear whether current public health services are sufficient to address evolving disease burdens affecting vulnerable populations such as young children and the elderly.

Recent initiatives have begun to address these challenges, yet the high quality empirical research needed to guide policy design and implmentation is lacking. In this special issue, we invite researchers in public health, epidemiology, health economics and other social sciences to submit high quality empirical papers related to the issues in this important research area.

Prof. Dr. Sean Sylvia
Dr. Scott Rozelle

Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

Public Health
Poverty
Inequality
China
Access
Quality of Health Care
Early Childhood Development
Children
Elderly
Empirical

Published Papers (10 papers)

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Research

15 pages, 313 KiB

Open AccessArticle

Breastfeeding and the Risk of Illness among Young Children in Rural China

by Shanshan Li, Ai Yue, Cody Abbey, Alexis Medina and Yaojiang Shi

Int. J. Environ. Res. Public Health 2019, 16(1), 136; https://doi.org/10.3390/ijerph16010136 - 07 Jan 2019

Cited by 8 | Viewed by 3731

Abstract

Poor rural areas in China exhibit the country’s highest rates of child mortality, often stemming from preventable health conditions such as diarrhea and respiratory infection. In this study, we investigate the association between breastfeeding and disease among children aged 6–24 months in poor rural counties in China. To do this, we conducted a longitudinal, quantitative analysis of socioeconomic demographics, health outcomes, and breastfeeding practices for 1802 child–caregiver dyads across 11 nationally designated poverty counties in southern Shaanxi Province in 2013–2014. We found low rates of continued breastfeeding that decreased as children developed: from 58.2% at 6–12 months, to 21.6% at 12–18 months, and finally to 5.2% at 18–24 months. These suboptimal rates are lower than all but one other country in the Asia-Pacific region. We further found that only 18.3% of children 6–12 months old met the World Health Organization (WHO)-recommended threshold for minimum dietary diversity, defined as consuming four or more of seven specific food groups. Breastfeeding was strongly associated with lower rates of both diarrhea and cough in bivariate and multivariate analyses. As the first analysis to use longitudinal data to examine the relationship between continued breastfeeding and child illness in China, our study confirms the need for programmatic interventions that promote continued breastfeeding in order to improve toddler health in the region. Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

15 pages, 1760 KiB

Open AccessArticle

Prenatal Exposure to Environmental Tobacco Smoke and Early Development of Children in Rural Guizhou Province, China

by Yang He, Renfu Luo, Tianyi Wang, Jingjing Gao and Chengfang Liu

Int. J. Environ. Res. Public Health 2018, 15(12), 2866; https://doi.org/10.3390/ijerph15122866 - 14 Dec 2018

Cited by 13 | Viewed by 3364

Abstract

Background: There is a substantial body of evidence supporting the association between maternal active smoking during pregnancy and child development, but the association between prenatal exposure to environmental tobacco smoke (ETS) and early child development has not been well documented. This cross-sectional study examines the association between prenatal exposure to ETS and the development of children in their first two years of life. Methods: We interviewed the primary caregivers of 446 children under two years old in rural Guizhou Province, China. Based on self-reported assessments about whether the mother was exposed to ETS during pregnancy, we divided the children into the ETS-exposed group or the non-exposed group. Sociodemographic information was collected through a questionnaire. The cognitive, language, motor, and socioemotional abilities of children were assessed using the Bayley Scales of Infant Development III (BSID-III). A multivariate linear regression model adjusting for confounding variables was used to estimate the association of interest. Results: About 60% of mothers experienced ETS exposure during pregnancy. Cognitive and language scores were lower among children in the ETS-exposed group. When adjusting for characteristics of the child, the mother, the household, and village fixed effects, prenatal exposure to ETS was associated with lower cognition scores (−3.41; 95% confidence interval (CI): −6.39 to −0.42; p = 0.03) and language scores (−3.01; 95% CI: −5.39 to −0.09; p = 0.04). Frequency of prenatal exposure to ETS was also negatively associated with language development (−0.48; 95% CI: −0.87 to −0.09; p = 0.02) before children reached two years old. Conclusions: Prenatal exposure to ETS is negatively associated with the cognitive and language development of rural young children within their first two years of life. The government should take action to raise public awareness about the negative effects of tobacco use, with an emphasis on the protection of pregnant women and their children, in order to carry through comprehensive smoke-free laws in rural areas, while also increasing tobacco taxation. Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

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12 pages, 435 KiB

Open AccessArticle

Impact of a Local Vision Care Center on Glasses Ownership and Wearing Behavior in Northwestern Rural China: A Cluster-Randomized Controlled Trial

by Yue Ma, Yujuan Gao, Yue Wang, Haoyang Li, Lina Ma, Jiangchao Jing, Yaojiang Shi, Hongyu Guan and Nathan Congdon

Int. J. Environ. Res. Public Health 2018, 15(12), 2783; https://doi.org/10.3390/ijerph15122783 - 08 Dec 2018

Cited by 3 | Viewed by 2908

Abstract

Visual impairment is common among rural Chinese children, but fewer than a quarter of children who need glasses actually own and use them. To study the effect of rural county hospital vision centers (VC) on self-reported glasses ownership and wearing behavior (primary outcome) among rural children in China, we conducted a cluster-randomized controlled trial at a VC in the government hospital of Qinan County, a nationally-designated poor county. All rural primary schools (n = 164) in the county were invited to participate. Schools were randomly assigned to either the treatment group to receive free vision care and eyeglasses, if needed, or control group, who received glasses only at the end of the study. Among 2806 eligible children with visiual impairment (visual acuity ≤ 6/12 in either eye), 93 (3.31%) were lost to follow-up, leaving 2713 students (45.0% boys). Among these, glasses ownership at the end of the school year was 68.6% among 1252 treatment group students (82 schools), and 26.4% (p < 0.01) among 1461 controls (82 schools). The rate of wearing glasses was 55.2% in the treatment group and 23.4% (p < 0.01) among the control group. In logistic regression models, treatment group membership was significantly associated with spectacle ownership (Odds Ratio [OR] = 11.9, p < 0.001) and wearing behavior (OR = 7.2, p < 0.001). County hospital-based vision centers appear effective in delivering childrens’ glasses in rural China. Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

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15 pages, 326 KiB

Open AccessArticle

The Effect of Providing Free Eyeglasses on Children’s Mental Health Outcomes in China: A Cluster-Randomized Controlled Trial

by Hongyu Guan, Huan Wang, Kang Du, Jin Zhao, Matthew Boswell, Yaojiang Shi and Yiwei Qian

Int. J. Environ. Res. Public Health 2018, 15(12), 2749; https://doi.org/10.3390/ijerph15122749 - 05 Dec 2018

Cited by 15 | Viewed by 3557

Abstract

If children with common vision problems receive and use eyeglasses, their educational performance rises. Without proper treatment, visually impaired children may not achieve educational gains and could suffer from poor mental health. We use a randomized controlled trial to study the impact of an eyeglasses promotion program in rural China on the mental health of myopic primary school students. Three measures of mental health are used: learning anxiety, physical anxiety, and scores on the Mental Health Test (MHT). Our empirical analysis showed that on average, the treatment has small and insignificant for learning anxiety and MHT, and a small but significant reduction in physical anxiety. However, subgroup analysis reveals that myopic students who study more intensively see their learning anxiety and physical anxiety reduced after being provided with eyeglasses. In contrast, students with the lower study intensity suffer a rise in learning anxiety after receiving eyeglasses. A potential mechanism for the differing impacts is the increase in teasing reported among low study-intensity students that does not occur for high study-intensity students. Care should be taken to maximize the benefits and minimize the costs of in-school vision programs. Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

15 pages, 1816 KiB

Open AccessArticle

The Health Consequences of Social Mobility in Contemporary China

by Fei Yan, Guangye He and Yunsong Chen

Int. J. Environ. Res. Public Health 2018, 15(12), 2644; https://doi.org/10.3390/ijerph15122644 - 26 Nov 2018

Cited by 10 | Viewed by 3784

Abstract

Although numerous studies have shown the importance of an individual’s socioeconomic status on his or her self-rated health status, less well-known is whether self-perceived class mobility, a measure highly correlated with an individual’s de facto social class and past mobility experiences, affects self-rated health. In this paper, we attempt to fill the gap by examining how perception of class mobility is associated with self-rated health. Using eight waves of Chinese General Social Survey data spanning the years 2005 to 2015, we conducted an analysis at the micro (individual) level and the macro (provincial) level. Analyses at both levels yielded consistent results. At the individual level, we employed ordered logistic regression and found that the perception of experiencing downward mobility was associated with significantly lower self-rated health in both rural and urban areas compared with those who consider themselves to be upwardly mobile or immobile. At the provincial level, the findings from static panel analysis further revealed that there is a positive relationship between the self-perceived class mobility and self-rated health level. Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

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15 pages, 1438 KiB

Open AccessArticle

The Quality of Tuberculosis Care in Urban Migrant Clinics in China

by Hao Xue, Jennifer Hager, Qi An, Kai Liu, Jing Zhang, Emma Auden, Bingyan Yang, Jie Yang, Hongyan Liu, Jingchun Nie, Aiqin Wang, Chengchao Zhou, Yaojiang Shi and Sean Sylvia

Int. J. Environ. Res. Public Health 2018, 15(9), 2037; https://doi.org/10.3390/ijerph15092037 - 18 Sep 2018

Cited by 7 | Viewed by 4124

Abstract

Large and increasing numbers of rural-to-urban migrants provided new challenges for tuberculosis control in large cities in China and increased the need for high quality tuberculosis care delivered by clinics in urban migrant communities. Based on a household survey in migrant communities, we selected and separated clinics into those that mainly serve migrants and those that mainly serve local residents. Using standardized patients, this study provided an objective comparison of the quality of tuberculosis care delivered by both types of clinics and examined factors related to quality care. Only 27% (95% confidence interval (CI) 14–46) of cases were correctly managed in migrant clinics, which is significantly worse than it in local clinics (50%, 95% CI 28–72). Clinicians with a base salary were 41 percentage points more likely to demonstrate better case management. Furthermore, clinicians with upper secondary or higher education level charged 20 RMB lower out of pocket fees than less-educated clinicians. In conclusion, the quality of tuberculosis care accessed by migrants was very poor and policies to improve the quality should be prioritized in current health reforms. Providing a base salary was a possible way to improve quality of care and increasing the education attainment of urban community clinicians might reduce the heavy barrier of medical expenses for migrants Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

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9 pages, 273 KiB

Open AccessArticle

Determinants of Health Care-Seeking Delay among Tuberculosis Patients in Rural Area of Central China

by Yeqing Tong, Xuhua Guan, Shuangyi Hou, Li Cai, Yadong Huang, Lei Wang, Faxian Zhan, Yuqin Shi and Jiafa Liu

Int. J. Environ. Res. Public Health 2018, 15(9), 1998; https://doi.org/10.3390/ijerph15091998 - 13 Sep 2018

Cited by 20 | Viewed by 4881

Abstract

Background The prevalence of tuberculosis (TB) in low and middle-income countries is a significant public health and social concern. TB is a common infectious disease caused by the Mycobacterium tuberculosis infection, which has a widespread infection rate. Health care-seeking delay maybe one of the most important neglected risk factors for the spread of TB. Objectives The aim of this study was to understand the situation of health care-seeking delay among rural tuberculosis patients in Hubei Province, and explore its risk factors. Methods A total of 1408 rural tuberculosis patients were surveyed using a standard structured questionnaire in three cities of Hubei Province during the past two years. Results For the 1408cases of pulmonary tuberculosis, 39.70% of them were health care-seeking delayed. Logistic regressions indicate that the Han nationality, farming careers, the over 45 min walk to the township’s hospital, and awareness of the national TB free treatment policy, were significantly associated with higher odds of a delay in care seeking. Conclusions The prevalence of health care-seeking delay among tuberculosis patients was high in rural areas. It is essential to take comprehensive targeted interventions to reduce care-seeking delay. Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

16 pages, 648 KiB

Open AccessArticle

Rural Versus Urban Patients: Benchmarking the Outcomes of Patients with Acute Myocardial Infarction in Shanxi, China from 2013 to 2017

by Miao Cai, Echu Liu and Wei Li

Int. J. Environ. Res. Public Health 2018, 15(9), 1930; https://doi.org/10.3390/ijerph15091930 - 05 Sep 2018

Cited by 15 | Viewed by 3503

Abstract

Rural-urban disparity in China attracts special international attention in view of the imbalance of economic development between rural and urban areas. However, few studies used patient level data to explore the disparity of health outcomes between rural and urban patients. This study aims to evaluate the trend of health outcomes between rural and urban patients hospitalized with acute myocardial infarction (AMI) in China. Using an electronic medical records (EMRs) database in Shanxi, China, we identified 87,219 AMI patients hospitalized between 2013 and 2017. We used multivariable binary logistic regressions and two-part models to estimate the association between region of origin (rural/urban) and two outcomes, in-hospital mortality and out-of-pocket (OOP) expenses. Rural patients were associated with lower in-hospital mortality and the adjusted Odds Ratios (ORs) were 0.173, 0.34, 0.605, 0.522, 0.556 (p-values < 0.001) from 2013 to 2017, respectively. For the OOP expenses, rural patients were experiencing increasing risk of having OOP expenses, with the ORs of 0.159, 0.573, 1.278, 1.281, 1.65. The coefficients for the log-linear models in the five years were 0.075 (p = 0.352), 0.61, 0.565, 0.439, 0.46 (p-values < 0.001). Policy makers in China should notice and narrow the gap of health outcomes between rural and urban patients. Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

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20 pages, 1533 KiB

Open AccessArticle

Reducing Food Poverty and Vulnerability among the Rural Elderly with Chronic Diseases: The Role of the New Rural Pension Scheme in China

by Zhaohua Zhang, Yuxi Luo and Derrick Robinson

Int. J. Environ. Res. Public Health 2018, 15(6), 1253; https://doi.org/10.3390/ijerph15061253 - 13 Jun 2018

Cited by 18 | Viewed by 6281

Abstract

Vulnerability to food poverty is the probability of an individual falling below the food poverty line in the near future, which provides a forward-looking welfare analysis. Applying a nationally representative survey dataset, this study investigates the role of the New Rural Pension Scheme (NRPS) in reducing food poverty and vulnerability among the rural elderly with chronic diseases. By designing province-specific food poverty lines to account for variations in the elderly’s needs, as well as the prices across provinces using a least-cost linear programming approach, the food poverty incidences among the elderly with chronic diseases are calculated. Applying a three-stage feasible generalized least squares (FGLS) procedure, the vulnerability to food poverty is estimated. Our results show that food poverty incidence and vulnerability of the elderly with chronic diseases in rural China is 41.9% and 35% respectively, which is 8% and 6% higher, respectively, than the elderly that are in good health. To address the potential endogeneity of pension payment, a fuzzy regression discontinuity (RD) regression is employed to investigate the effects of pension income on food poverty and vulnerability for different population groups. We found that pension income decreases the probability of being food poor and the vulnerability to food poverty among the elderly with chronic diseases by 12.9% and 16.8% respectively, while it has no significant effect on the elderly in good health. Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

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13 pages, 1746 KiB

Open AccessArticle

Parental Migration and Left-Behind Children’s Depressive Symptoms: Estimation Based on a Nationally-Representative Panel Dataset

by Mi Zhou, Xiaotong Sun, Li Huang, Guangsheng Zhang, Kaleigh Kenny, Hao Xue, Emma Auden and Scott Rozelle

Int. J. Environ. Res. Public Health 2018, 15(6), 1069; https://doi.org/10.3390/ijerph15061069 - 24 May 2018

Cited by 32 | Viewed by 4419

Abstract

China’s rapid urbanization in the past several decades have been accompanied by rural labor migration. An important question that has emerged is whether rural labor migration has a positive or negative impact on the depressive symptoms of children left behind in the countryside by their migrating parents. This paper uses a nationally representative panel dataset to investigate whether parental migration impacts the prevalence of depressive symptoms among left-behind children in China. Using DID and PSM-DID methods, our results show that parental migration significantly increases the depression scores of 10 and 11-year-old children by 2 points using the CES-D depression scale. Furthermore, we also find that the negative effect of decreased parental care is stronger than the positive effect of increased income in terms of determining the depressive symptoms status of children in rural China. Full article

(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)

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