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Health disparities among the western, central and eastern rural regions of China after a decade of health promotion and disease prevention programming

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Summary

Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate (IMR), maternal mortality rate (MMR) and under 5 mortality rate (U5MR) had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR (65.05%); whereas, western rural China had the greatest reduction in MMR (72.99%) but smallest reduction in U5MR (57.36%). Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators (odds ratios): IMR (central: 2.13; western: 5.31), U5MR (central: 2.25; western: 5.69), MMR (central: 1.94; western: 3.31), and prevalence of infectious diseases (central: 1.62; western: 3.58). The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health disparities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

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References

  1. The National Bureau of statistics. Chinese statistical yearbook 2007 (Chinese). Ref. 3-1 Gross Domestic Product. Available at: http://www.stats.gov.cn/tjsj/ndsj/2007/html/C0301e.htm

    Google Scholar 

  2. Ding H, Zhang ML. An analysis on the national maternal surveillance. Zhonghua Fu Chan Ke Za Zhi (Chinese), 1999,34(11):645–648

    CAS  Google Scholar 

  3. Liang J, Li WM, Wang YP, et al. Analysis of maternal mortality in China from 1996 to 2000. Zhonghua Fu Chan Ke Za Zhi (Chinese), 2003,38(5):257–260

    Google Scholar 

  4. Wang ZJ. The trends of infectious disease epidemic from 1990 to 2000. Chin J Epidemiol (Chinese), 2002,23(4):312–313

    CAS  Google Scholar 

  5. Li HB, Gu JM, Yang DB, et al. The decreasing pattern of Chinese infant mortality rate. Chin J Child Health Care (Chinese), 2012,20(8):722–724

    Google Scholar 

  6. Wang YP, Miao L, Qian YQ, et al. Analysis of under 5 years old children mortality and the leading death cause in China from 1996 to 2000. Chin J Prev Med (Chinese), 2005,39(14):260–264

    Google Scholar 

  7. Statistical information center, NHFPC. China health statistics summary 2008. Life Expectancy (Year) (Chinese). Available at: http://wsb.moh.gov.cn/htmlfiles/zwgkzt/ptjty/digest2008/q66.htm

  8. National Bureau of Statistics of China. Communiqué of the National Bureau of Statistics of People’s Republic of China on Major Figures of the 2010 Population Census[1] (No. 2) (Chinese). Available at: http://www.stats.gov.cn/english/NewsEvents/201104/t20110429_26450.html

  9. Department of health policy and regulation, Ministry of Health. Analysis of the 2004 National Maternal and child health surveillance report. Health Affairs Bulletin (Chinese), 2005.

    Google Scholar 

  10. Ministry of Health. China Health Statistical Yearbook 2004 (Chinese). Beijing: Peking Union Medical College Press, 2004,306–309.

    Google Scholar 

  11. Donnay F. Maternal survival in developing countries: what has been done, what can be achieved in the next decade. Int J Gynaecol Obstet, 2000,70(1):89–97

    Article  CAS  PubMed  Google Scholar 

  12. Guo SF, Wang LH, Zhang WK. Several levels analysis on the influence factors of death of the children under 5 years old. Zhongguo Fu You Bao Jian Za Zhi (Chinese), 2001,16(7):429–431

    Google Scholar 

  13. Lei XC. The comparison, research and analysis of the disparity in farmer’s income in the west of China. J Central Univ Finance Econom (Chinese), 2003(6):58–62

    Google Scholar 

  14. Le H, Tang SC, Chen YC. Comparing health development of rural areas in different districts of China—About the using of health service and the supply condition of health. Zhongguo Wei Sheng Jing Ji (Chinese), 2006,25(3):40–42

    Google Scholar 

  15. Statistical information center, Ministry of Health. The analysis of the third national health services survey report (Chinese). Beijing: Peking Union Medical College Press, 2004,68–158

    Google Scholar 

  16. Gazette of the Standing Committee of the National People’s Congress of the People’s Republic of China. Bulletin of the Standing Committee of the National People’s Congress of the People’s Republic of China (Chinese). 2001(3):21–43

    Google Scholar 

  17. The Central People’s Government of the People’s Republic of China. Decision of the State Council on the establishment of the revitalization of Northeast China and other old industrial base of the leading group (Chinese). 2003: No. 28. Available at: http://www.gov.cn/zwg¬k/ 2005-08/13/content_22275.htm

    Google Scholar 

  18. Shang LL. Chinese vice premier stresses rise of central China. Xinhua News (Chinese). Available at: http://new-s.xinhuanet.com/english/2006-09/26/content_5141481.htm

  19. Key points of 11th Five-Year Guidelines (Chinese). 2006. Available at: http://news.xinhuanet.com/english/2006-03/07/content_4269175.htm

  20. The State Council. Notification on the implementation of the western development policies and measures (Chinese). 2000(33). Available at: http://www.gov.cn/gongbao/content/2001/content_60854.htm

  21. Ma YX. The law of western development and its contents. NATL Law Rev, 2009,6:141–171

    Google Scholar 

  22. The Central People’s Government of the People’s Republic of China. The State Council: some opinions on promoting the further development of the western region (Chinese). 2004, No. 6. Available at: http://www.gov.cn/zw-gk/2005-08/12/content_21723.htm

    Google Scholar 

  23. Ministry of Health. China Rural Primary Health Care Development Program (2001–2010) (Chinese). Available at: http://www.nhfpc.gov.cn/zwgkzt/pzcqgh/200804/311-23.shtml (in Chinese)

  24. General office, Ministry of Health. Circular on issuing the targeted aid project management plan for the 2-tiered and above hospitals to the township hospitals in 2010 by Dept. Rural Health (Chinese). 2010(40). Available at: http://www.moh.gov.cn/zwgkzt/pncws1/201008/48554.shtml

    Google Scholar 

  25. Information Office, the State Council, People’s Republic of China. Medical and Health Services in China (Chinese). 2012. Available at: http://www.scio.gov.cn/ztk/dtzt/91/12/Document/1262955/1262955.htm

    Google Scholar 

  26. Sun L. Re-thinking on strengthening the financial management of Health 8th Project. Health ECON Res (Chinese). 2005,2–49

    Google Scholar 

  27. Li KQ. Deepening medical reform for the benefit of all (Chinese). 2012. Available at: http://www.china.org.cn/china/2012-01/18/content_24437012.htm

    Google Scholar 

  28. Yin H, Guo Y. A preliminary assessment of the impact of the Safe Motherhood Project on maternal mortality rate in China. Zhongguo Fu You BaoJian ZaZhi (Chinese), 2008,23(20):2778–2780

    Google Scholar 

  29. Xiao NL, Hong Y, Duo LW. The evaluation of “Safe Motherhood” program on maternal care utilization in rural western China: a difference in difference approach. BMC Public Health, 2010,10:566

    Article  Google Scholar 

  30. Elaine Wee-Ling Ooi. The World Bank’s Assistance to China’s Health Sector. Operations Evaluation Department. Knowledge and Evaluation Capacity Department (OEDKE). 2005. The World Bank. Washington D.C. Available at: http://www.worldbank.org/oed

    Google Scholar 

  31. National Bureau of Statistics of the People’s Republic of China. Communiqué on Major Figures of the 2000 Population Census (No. 1) (Chinese). 2001. Available at: http://www.stats.gov.cn/english/StatisticalCommuniqu/200204/t20020423_61432.html

    Google Scholar 

  32. Delbecq AL, Van de Ven AH. A group process model for problem identification and program planning. J Applied Behavioral Sci, 1971,7(49):466–492

    Article  Google Scholar 

  33. United Nations. Resolution adopted by the General Assembly on 16 September 2005 (Chinese). 2005. Available at: http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N05/487/60/PDF/N0548760.pdf?OpenElement

    Google Scholar 

  34. Wong ST, Browne AJ, Varcoe C, et al. Enhancing measurement of primary health care indicators using an equity lens: An ethnographic study. Int J Equity Health, 2011,10:38–50

    Article  PubMed Central  PubMed  Google Scholar 

  35. Ministry of Health. Center for Health Statistics and Information. Analysis Report of National Health Services Survey in China, 2008 (Summary) (Chinese). Available at: http://www.moh.gov.cn/cmsresources/mohwsbwstjxxzx/cmsrsdocument/doc9912.pdf

    Google Scholar 

  36. IOM. The Future of the Public’s Health in the 21st Century. Washington DC: National Academies Press, 2003.

    Google Scholar 

  37. Kotler P, Wingard DL. The effect of occupational, marital and parental roles on mortality: the Alameda County Study. Am J Public Health, 1989,79(5):607–612

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Lahelma E, Valkonen T. Health and social inequities in Finland and elsewhere. Soc Sci Med, 1990,31(3):257–265

    Article  CAS  PubMed  Google Scholar 

  39. Duleep HO. Measuring socioeconomic mortality differentials over time. Demography, 1989,26(2):345–351

    Article  CAS  PubMed  Google Scholar 

  40. Pappas G, Queen S, Hadden W. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Eng J Med, 1993,329(2):103–109

    Article  CAS  Google Scholar 

  41. Duncan GJ, Daly MC, McDonough P. Optimal indicators of socioeconomic status for health research. Am J Public Health, 2002,92(7):1151–1157

    Article  PubMed Central  PubMed  Google Scholar 

  42. Gao J, Qian J, Tang S, et al. Health equity in transition from planned to market economy in China. Health Policy Plan, 2002,17(1):20–29

    Article  PubMed  Google Scholar 

  43. Gao J, Pei Y, Lei R, et al. Study on the equality of health-care among different income groups: evidence from Mei county of Shaanxi province. Chin Health Econ (Chinese), 2012,31(3):51–54

    Google Scholar 

  44. Yuan B, Qian X, Thomsen S. Disadvantaged populations in maternal health in China who and why? Global Health Action, 2013,6(10):19542

    PubMed  Google Scholar 

  45. Rural Survey Department of China National Bureau of Statistics, various versions? Poverty Monitoring Report of Rural China (Chinese). 2010, Beijing: China Statistics Press.

    Google Scholar 

  46. Anand S, Bärnighausen T. Human resources and health outcomes: cross-country econometric study. Lancet, 2004,364(9445):1603–1609

    Article  PubMed  Google Scholar 

  47. Filmer D, Pritchett L. The impact of public spending on health: does money matter? SocSci Med, 1999,49(10):1309–1323

    Article  CAS  Google Scholar 

  48. Zhou G, Zhou JL. Correlation analysis between socioeconomic indicators and incidence of infectious diseases. Chin Med Pharmacy (Chinese), 2013,3(8):173–174

    Google Scholar 

  49. Levy H, Meltzer D. “What Do We Really Know about Whether Health Insurance Affects Health?” In Health Policy and the Uninsured. McLaughlin C, eds. Washington DC: The Urban Institute Press, 2004,179–204.

    Google Scholar 

  50. Hadley J. Sicker and poorer-the consequences of being uninsured: a review of research on the relationship between health insurance, medical care use, health, work, and income. Medcare Res Rev, 2003,60(2):3–75

    Google Scholar 

  51. Lei X, Lin W. The new cooperative medical scheme in rural China: Does more coverage mean more service and better health? J Health Econ, 2009,18(2):25–46

    Article  Google Scholar 

  52. Chen Y, Jin GZ. Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China. J Health Econ, 2012,31(1):1–14

    Article  PubMed  Google Scholar 

  53. Ministry of Health. Chinese Health Statistics Yearbook 2010 (Chinese). Beijing: Chinese Peking Union Medical College Press, 2010,7:84.

    Google Scholar 

  54. Chen NS, Audibert M, Mathonnat J. Effect of society and economy development on infant mortality rate in China. Health Econ Res, 2003,20(2):9–12

    Google Scholar 

  55. Rosenfield A, Min CJ, Freedman LP. Making motherhood safe in developing countries. New Eng J Med, 2007,356(14):1395–1397

    Article  CAS  PubMed  Google Scholar 

  56. Gabrysch S, Campbell OM. Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy Childbirth, 2009,9:34

    Article  PubMed Central  PubMed  Google Scholar 

  57. Ma XZ, Cui XG, Ruan YS. Development of rural health service system in impoverished areas. Chin Rural Health Serv Administration (Chinese), 2008,28(8):563–565

    Google Scholar 

  58. Fu JH, Yu L. Problems of public health service in rural areas in China and their countermeasures. World Agriculture, 2006,9:1–4

    Google Scholar 

  59. Tang SC, Le H, Chen YC. Comparing health development of rural areas in different districts of China—About the health financing and countermeasures of health development in rural areas. Chin Health Econ (Chinese), 2006,25(4):33–35

    CAS  Google Scholar 

  60. Foreign Loan Office, Ministry of Health. Reference and enlightenment of the American medical and health service management system—the exchange summary of China-Tennessee exchange of the China Rural Health Development Project loaned by the World Bank and granted by the British government. Chin Health Econ (Chinese), 2008,127(11):75–80

    Google Scholar 

  61. The Ottawa Charter for Health Promotion. First International Conference on Health Promotion, Ottawa, 1986. Available at: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/. Accessed on December 10, 2013

    Google Scholar 

  62. Armstrong R, Doyle J, Lamb C, et al. Multi-sectoral health promotion and public health: the role of evidence. J Public Health, 2006,28(2):168–172

    Article  Google Scholar 

  63. Johnson Z, Howell F, Molly B. Community mothers’ program: randomised controlled trial of nonprofessional intervention parenting. Brit Med J, 1993,306(6890):1449–1452

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  64. Kumpusalo E, Neittaanmaki L, Halonen P, et al. Finnish healthy village study: impact and outcomes of a low-cost local health promotion program. Health Promotion Int, 1996,11(2):105–115

    Article  Google Scholar 

  65. Kenzer M. Healthy Cities: A guide to the literature. Environ Urbanization, 1999,11(1):201–220

    Article  Google Scholar 

  66. Harpham T, Burton S, Blue I. Healthy city projects in developing countries: The first evaluation. Health Promotion Int, 2001,16(2):111–125

    Article  CAS  Google Scholar 

  67. Khosh-Chashm K. Healthy cities and healthy villages: how to tackle health and environmental problems in urban and rural areas. Eastern Mediterranean Health J, 1995,1(2):103–111

    Google Scholar 

  68. Howard G, Bogh C, Prüss A, et al. Healthy villages: A guide for communities and community health workers. World Health Organization, Geneva, 2002. ISBN 9241545534 (NLM Classification: WA 390).

    Google Scholar 

  69. World Health Organization. Evaluation of the healthy village program in the Syrian Arab Republi. Cairo: WHO. 2007,111.

    Google Scholar 

  70. Sadegh-Allahyari1 M, Alipour H, Ghahremani-Chbok R. Healthy village cooperative: An approach towards rural development. Sci Res Essays, 2010,5(19):2867–2874

    Google Scholar 

  71. Kiyu A, Steinkuehler AA, Hashim J, et al. Evaluation of the Healthy Village Program in Kapit District, Sarawak, Malaysia. Health Promotion Int, 2006,21(1):13–18

    Article  Google Scholar 

  72. Epp J. Achieving health for all. A framework for health promotion. Health Promote, 1986,1(4):419–428

    Article  CAS  Google Scholar 

  73. Olaf VDK, Verde PE, Dragano N. Education and health in 22 European countries. Soc Sci Med, 2006,63(5):1344–1351

    Article  Google Scholar 

  74. Goldman DP, Smith JP. Can patient self-management help explain the SES health gradient? Proc Natl Acad Sci USA, 2002,99(16):10929–10934

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  75. John M, Ross CE. Education and self-rated health: Cumulative advantage and its rising importance. Res Aging, 2008,30(1):93–122

    Article  Google Scholar 

  76. Zhang L, Wilson DP. Trends in notifiable infectious diseases in China: Implications for surveillance and population health policy. PLoS One, 2012,7(2):31076

    Article  Google Scholar 

  77. Yang G, Kong L, Zhao W, et al. Emergence of chronic non-communicable diseases in China. Lancet, 2008,372(9650):1697–1705

    Article  PubMed  Google Scholar 

  78. The World Bank. FEATURE STORY. Toward a healthy and harmonious life in China: stemming the rising tide of non-communicable diseases. 2011. Available at: http://www.worldbank.org/en/news/feature/2011/07/26/toward-health-harmonious-life-china-stemming-rising-tide-of-noncommunicable-diseasess

    Google Scholar 

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Authors and Affiliations

  1. School of Medicine and Health Management, Tongji Medical College, Huazhong University of Scientific and Technology, Wuhan, 430030, China

    Xi-fan Zhang  (张西凡) & Zhan-chun Feng  (冯占春)

  2. Chinese Center for Health Education, Beijing, 100011, China

    Xiang-yang Tian  (田向阳) & Yu-lan Cheng  (程玉兰)

  3. Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA

    Liang Wang  (王亮)

  4. Department of Community & Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, USA

    Jodi Southerland

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  1. Xi-fan Zhang  (张西凡)
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  2. Xiang-yang Tian  (田向阳)
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  3. Yu-lan Cheng  (程玉兰)
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  4. Zhan-chun Feng  (冯占春)
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Correspondence to Zhan-chun Feng  (冯占春).

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Zhang, Xf., Tian, Xy., Cheng, Yl. et al. Health disparities among the western, central and eastern rural regions of China after a decade of health promotion and disease prevention programming. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 35, 606–614 (2015). https://doi.org/10.1007/s11596-015-1478-2

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