Decades of breakneck economic growth have raised questions regarding China’s level of development. By some measures, China is still developing. In other ways, China compares favorably with developed nations. In terms of public health, however, China’s development is not yet complete.
In order for governments to effectively translate economic growth into improvements in the domestic level of development, political leaders must direct a country’s economic strength toward improving social conditions. While China’s economic transformation has generated considerable public resources, and China’s leaders have in recent decades dramatically improved domestic health conditions, China’s still faces challenges in terms of improving health outcomes.
Life expectancy is a key social development indicator that provides an important summary of mortality conditions within countries. Examining trends in China’s life expectancy and mortality rates for different age groups provides key insights into the strengths and weaknesses of China’s health care system. In this way, life expectancy trends shed light on one of China’s most important resources for cultivating power – its own people. This question assesses life expectancy in China and compares these trends with both developed and developing countries. As it is inadequate to simply examine China’s mortality trends at a national level, this question also examines the significant regional disparities in life expectancy that exist within the country.
Global Life Expectancy Since 1990
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Source: World Bank and Various Other Sources
Each bubble represents a country and the size of the bubble is determined by GDP in terms of Purchase Power Parity. The colors of each bubble correspond to the World Bank’s development classification, which uses GNI per capita (Atlas method) to calculate the levels of development. Orange represents high income OECD countries; yellow represents other high income economies; green represents upper-middle income economies; dark blue represents lower-middle income economies; and light blue represents low income economies.
What do the trends in China’s life expectancy say about its level of development?
China has made impressive gains in life expectancy given the scale of its territory and population, as well as its relatively low gross national income (GNI) per capita level. In the second half of the twentieth century, China increased its average life expectancy at birth from around 40 years to over 70 years, a feat that took many advanced economies nearly a century to achieve. The following analysis will first examine the reduction of child and adult mortality through health improvements and then describe the challenges that China still faces.
Arguably, improvements in the provision of public health services, particularly in infant and maternal health, have been the biggest factors in raising life expectancy. In Mainland China, the Millennium Development Goal to reduce child mortality by two-thirds was reached in 2008, seven years ahead of the target date. World Bank data indicates that between 1990 and 2015, China’s mortality rate for children under 5 fell from 53.8 to 10.7 per 1,000, a reduction of approximately 80 percent. Similarly, improvements in adult mortality rates have also raised China’s life expectancy levels. In 1990, the mortality rate for adults between age 15 and 60 stood at 151 per 1,000, and by 2015, it had been reduced to 85. According to recent World Health Organization reports, China has nearly eliminated diseases like malaria and measles, with a drop in the incidence of other communicable diseases. Recent research from The Lancet likewise reports a 60–90 percent decrease in death from infectious diseases broadly in this period. Both improvements in infant and adult mortality have led to significant increases in overall life expectancy, which stood at 69 years in 1990 and reached 76.1 years in 2015.
Although mortality rates have also fallen, economic changes have presented public health policymakers with a new set of challenges. The prioritization of economic growth has led to worsening environmental conditions, including air, soil, and water pollution that adversely affect public health conditions. In addition, widening income inequality has impeded access to health care in economically disadvantaged communities and regions. The World Health Organization has noted recent increases in the incidence of cancer, heart disease, and chronic illness. These emerging health concerns correspond with increased lifespans and improved levels of development (which can contribute to unhealthy lifestyle behavior). When considering the severity of major disease, the World Health Organization estimates Healthy life expectancy (HALE), which is the average number of years that a person can expect to live in “full health.” HALE takes into account the number of years lived in less than full health as a result of disease or injury. Accordingly, China’s HALE improved from 64 years in 2000 to 68 years in 2012.
Development is wonderful. Rising incomes and affluence allow people to escape poverty and fulfill hopes and dreams that they otherwise couldn’t hope to achieve, but it also brings along with it the plague of chronic diseases.
How much do life expectancy rates vary in China?
Life expectancy within China varies greatly by region, owing to overlapping disparities both between the residents of urban and rural areas as well as land-locked and coastal provinces. Broadly speaking, China’s interior has experienced much lower levels of development than wealthier coastal areas, the direct beneficiaries of China’s post-1978 economic reforms.
As with many countries, China exhibits a significant rural-urban developmental divide with a noticeable impact on health outcomes. In their examination of the China Health and Nutrition Survey, researchers Chen, Liu, and Yang discovered that rural residents with higher levels of education still demonstrated worse health outcomes than similarly educated urban counterparts. Before health care policy reforms expanded rural access in 2009, a 2003 survey indicated that only 20 percent of the rural population had access to health care coverage, in comparison to 60 percent of urban dwellers. In another comparison, the gap in average life expectancy between Shanghai and the poorest provinces in 2013 was 13 years, while a similar examination of the United States found that the gap between the highest (Hawaii) and lowest (District of Columbia) to be 7.5 years. Rural areas’ relative isolation, poverty, and lower levels of public infrastructure and expenditures thus have created evident health disparities.
A Conversation with Richard Jackson
0:09 - What are the linkages in China between development and life expectancy?
3:30 - What factors may positively or negatively impact Chinese life expectancy in the future?
8:30 - What is the role of rising life expectancy and population aging and what are the way to mitigate this impact?
In addition, the concentration of economic development in coastal cities has deepened the disparity between coastal and interior provinces. Particularly after Deng Xiaoping’s Southern Tour in 1992, China’s eastern provinces began to invest in infrastructure and industry, as well as developing areas to permit foreign trade and investment that received tax exemptions, electricity and utility subsidies, and other favorable policies. Resource-oriented western provinces received few gains from this development until national-level policies began to promote western and rural advancement in the Jiang Zemin and Hu Jintao administrations. Researchers Liu and Yu have demonstrated that interprovincial income inequality accounted for 11.2 percent of national inequality in 2004: that is to say, disparities between provinces has led to 11.2 percent of inequality, without regard to households’ education, income, or urban or rural designation. Recent research published in The Lancet shows how this context contributes to lower life expectancy levels and differences in causes of death: provinces and municipalities like Shanghai, Beijing, and Zhejiang have low mortality rates “even by the standards of high-income countries,” while provinces like Tibet, Guizhou, and Xinjiang have mortality rates “characteristic of low-income countries in Southeast Asia.” To add another layer of complexity, interprovincial inequality compounds on urban-rural disparities: western provinces exhibit more pronounced urban-rural income inequality levels by comparison to central or coastal provinces. Therefore questions of health access must also investigate interprovincial disparities as well as the urban-rural divide.
Declining family size, together with rising life expectancy greatly increases incentives to invest in human capital, in the quality of children, and hence of the future workforce, rather than in the quantity. So rising life expectancy is both a cause and a consequence of development.
Are life expectancy trends in Asia different than the rest of the world?
Given Asia’s diversity of economies and demographics, it is difficult to generalize life expectancy, which varies dramatically by country. As seen in the Worth Health Organization’s World Bank’s “Global Health Observatory,” in 1990, Japan already boasted a high life expectancy of nearly 80 years at birth, and that increased through 2015. Hong Kong and Korea did not start from an average life expectancy age as high as Japan, but both nations quickly caught up and currently also have averages higher than age 80. By contrast, Vietnam’s life expectancy remains more closely aligned with trends in China, with both currently standing at an average age of approximately 76 years. Countries like India and Indonesia had lower life expectancy levels at the beginning of 1990 (59 years in India and 63 years in Indonesia), and these averages have increased to about 68 years and 69 years respectively. As a result of this regional variation, Mainland China’s increase in life expectancy, from 69 years in 1990 to 75 years in 2015, mirrors the Western Pacific Region as a whole (which increased from 69 years to 76.6 years in the same period). Thus, general trends show gains in life expectancy across Asian countries, though some countries began with a lower average age.
Overall, life expectancy trends in Asia are in line with international trends. According to the World Health Organization, on average, life expectancy has increased by six years since 1990. Mainland China and the Western Pacific region both follow this trend almost exactly. While all regions saw increases in their life expectancy rates, not all regions observed the same gains. Generally, Southeast Asia and Africa as regions both began with lower life expectancy rates, and improvements in those regions outpaced the gains in life expectancy in other regions. In Southeast Asia, life expectancy rose from 59 years to 69 years, while Africa saw life expectancy improve from 50 years to 60 years. By contrast, smaller gains in Europe and the Americas (which both rose to nearly 77 years in 2015) allowed the Western Pacific region to reach the same average age.