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Death in China: Market Reforms and Health

Has China's remarkable reduction in income poverty since 1980 been accompanied by comparable progress in health? The author's findings are fourfold. First, province-level rates of improvement in life expectancy (LE) were higher in the 1990s than in the 1970s and 1980s, and were lowest in the 1980s. Second, even in the 1990s, when the province-level rates of improvement in LE were highest, they were lower than for many countries with similar initial LE level (although higher than the average for all such countries). Third, China's LE improvement between 1980 and 2000 was achieved much more quickly by almost all other countries considered, and in particular by most lower-middle-income countries that had similar LE improvements; similar conclusions are drawn from an analysis of China's LE improvements relative to two other sets of comparator countries—selected presently rich countries and high-growth East Asian countries. Finally, even those Chinese provinces that performed best over the period experienced rates of improvement significantly lower than for comparator countries. China's experience of reducing health deprivations has been notably less impressive than its record of income poverty reduction. There is a need for China to invest in the redevelopment of its public health infrastructure, which has withered during the period of market-oriented reforms.