Does ’class count’? The evolution of health inequalities by social class in early 21st century China (2002–2013)

ABSTRACT

Does social class matter in understanding health inequalities in early 21^st century China, when the country experienced unprecedented social stratification? Using nationally representative data from the latest waves of China Household Income Project surveys, we examine to what extent an individual’s health is structured by social class and how that structure evolved. We draw on a neo-Marxist measure of social class to tap into the hidden mechanism that engenders and sustains inequalities. Four classes are defined based primarily on their relationships to productive resources: owners/managers, professionals/skilled workers, less-skilled workers, and farmers. Such a measure has not been considered in the health gradient literature in the Chinese context. Our results show that, despite remedial policies that helped mitigate economic inequalities, inequalities in health have mostly widened during the early years of the current century between the ‘haves’, who own productive assets and/or managerial authority, and the ‘have-nots’. In 2002, self-rated health (SRH) was not clearly associated with class rank; in 2007, when China’s economic inequality reached a historical zenith, a gradational pattern between SRH and class emerged, and the largest health gap was found between the class of owners/managers and farmers; in 2013, when China’s income inequality reached a plateau, the health gap between owners/managers and less-skilled workers grew larger. Further, we identify job security as a mediator that links class and health among the lower social strata. In addition to improving the health of the disadvantaged, policies designed to narrow health inequalities should be orientated towards addressing social stratification.

KEYWORDS:

• Health inequality
• China
• social class
• neo-Marxism

Acknowledgements

We acknowledge the contribution of Lisong Zhou for assistance on data analysis.

Data availability

The data that support the results of this study were drawn from the 2003, 2007, and 2013 waves of Chinese Household Income Project (CHIP), an international research collaboration assisted by the National Bureau of Statistics of China. Data and related information are publicly accessible at http://www.ciidbnu.org/chip/index.asp?lang=EN.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Social Science Foundation of China under Grant [20BKS076].