An exploratory study of neighbourhood heterogeneity in health: evidence from China

ABSTRACT

A systematic understanding of the potential contribution of the neighbourhood in explaining health inequalities remains an under-researched area. To quantify the importance of the neighbourhood in explaining health, by conducting pooled cross-sectional investigations of 49,602 adult participants, this study has hierarchically examined the magnitude of neighbourhood heterogeneity in different health outcomes in five Chinese provinces from 2010 to 2016. We found significant neighbourhood heterogeneity in both self-reported health and mental health with neighbourhood explaining 2.37% to 22.7% of the total variance. The majority of neighbourhood heterogeneity remained significant, with a range between 2.66% to 19.16% after individual attributes were considered. The magnitudes of neighbourhood heterogeneity in health were different across provinces, with Guangdong being the highest, followed by Shanghai and Henan, followed by Gansu and ended by Liaoning. There was a slightly descending trend in neighbourhood heterogeneity in health from 2010 to 2016. There remained unexplained significant and increased spatiotemporal variations in neighbourhood heterogeneity in health, after neighbourhood socioeconomic and sociodemographic attributes were considered. Both the compositional and contextual factors of neighbourhood heterogeneity in health were conditional on broader contextual backgrounds. Our study is the first of its kind in systematically investigating neighbourhood heterogeneity in health using provincially representative data from China's national database. Our findings have strengthened the groundwork for studies linking the neighbourhood to health and provided the framework for future studies to assess neighbourhood heterogeneity in health in consideration to broader contexts.

KEYWORDS:

• Neighbourhood effect
• health
• heterogeneity
• multilevel modelling
• China

Disclosure statement

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

Notes

1 The Chinese people have become more mobile ever since the reform and opening-up policy began in the late 1970s. According to the household registration system introduced since the 1950s, only migrations with household registration being formally transferred are defined as permanent. However, due to the rigorous regulation in changing household registration, many of the intranational population movements do not involve a change in household registration and are referred to as the floating population. In a nutshell, the floating population is anyone whose household registration (i.e., Hukou) is in another jurisdiction in contrast to where they are living.

2 According to the characteristics of socioeconomic structure, such as location, people, landownership and administration, there are three types of neighborhood in China, i.e., urban residential community, urban village and rural village. Urban residential community, whose neighborhood affairs are administered by local government staff, is the lowest level in the administrative hierarchy of the city. The people in urban residential community are mainly urban residents and the land is state owned. In comparison, rural village, whose residents are mainly farmers, is a self-organized administration units situated in the rural areas with self-organized committee taking care of their neighborhood affairs. The land of rural village is collectively owned and its conversion to urban land can only be achieved through land expropriation by the government. Urban village is a unique form of neighborhood in China due to the rapid urbanization “enclose” movements in the past decades. The term “urban villages” in the Chinese context refers to those previously rural villages which have been granted urban administrative status during urbanization, but which have maintained their village collective economy organization. Because of the limited public services from city governments, there is a gap between urban villages and urban residential community in socioeconomic wellbeing. The mixed rural-urban culture and the landless villagers living in the urban village make it “not rural but not urban” (cun bu cun, ju bu ju in Chinese).

3 Dan wei provided employment and housing, meal provision and bathhouses, child care and early schooling, health care and welfare services, political study and party membership, marriage and divorce, policing and security.

Additional information

Funding

This work was supported by the Youth Program of National Natural Science Foundation of China [grant number 41901179]; the China Postdoctoral Science Foundation [grant number 2018M640171]; the Science and Technology Project of Beautiful China Ecological Civilization Construction [grant number XDA23100403].