Academic journal article Population

Mortality Changes during the Transition from Planned Socialism to State Capitalism: The Case of Shanghai

Academic journal article Population

Mortality Changes during the Transition from Planned Socialism to State Capitalism: The Case of Shanghai

Article excerpt

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While the complex mortality patterns associated with the reforms of China's socialist economy have not been adequately analysed, the mortality surge accompanying the transition to market economies in the former socialist economies of central and eastern Europe has been widely studied (Nolte et al., 2000a, 2000b; Stuckler et al., 2009). This European research constitutes the main body of knowledge on the link between mortality and the economic transition from long-standing socialism to one or other variant of capitalism. Studies of the Chinese experience will expand our knowledge of how mortality trends are affected by reforms and institutional changes (and the speed and depth of these changes), by compensatory factors (e.g. GDP growth, health and social welfare policies), by the political environment and levels of social cohesion.

Several pioneering studies have used available (but limited) national data to study economic reform and health effects in China (Liu et al., 1998; Banister and Zhang, 2005). However, the demographic and epidemiological characteristics of Chinese mortality patterns associated with economic reform are yet to be documented. This article addresses that knowledge gap by focusing analyses on Shanghai, China, a city with reliable death registration, a large population, and substantial economic activity.

Interpretation of mortality trends in China is not straightforward. However, it is generally agreed that, except during the famine period, mortality in China fell continuously during the second half of the twentieth century (Banister and Hill, 2004). Mortality decline continued during the economic reform period beginning in 1978, but was not always observed at regional or county levels (Banister and Zhang, 2005). The initial living conditions, the timing of the reforms and the pace of change were not geographically uniform (Jefferson and Singh, 1999). Interpreting mortality trends in China is even more difficult when cause-of-death statistics are incomplete or inaccurate (Rao et al., 2005). In addition, European experience suggests that the adverse effects of socioeconomic reform on mortality may be more pronounced in certain urban areas (Walberg et al., 1998).

For these reasons, analysis of the links between mortality trends and economic reforms should be restricted to Chinese sub-populations for which reliable information is available. This is the case for Shanghai, which has high-quality death statistics for a large share of its population. Major reforms of its socialist economic structure began in 1992 with large-scale privatization, along with the introduction of contract labour and the abolition of life-time job security.

We analyse the effects of the economic reforms on mortality patterns among permanent residents who are identified as having a Shanghai hukou (household registration) in order to exclude migrants who might introduce selection bias, given the huge increase in the floating population (i.e. without a Shanghai hukou) since the 1990s (Census Office of Shanghai, 2002). The experience in Shanghai is analysed with reference to eastern Germany (East Germany until October 1990), Poland, the Czech Republic (called the Czech Socialist Republic until March 1990), and Russia,(1) which show similarities and differences in the links between mortality patterns and economic reforms, and reveal diverse mortality patterns and policy approaches (e.g. in health and social welfare) during the economic reforms (Cornia and Paniccià, 2000).

This article begins by describing China's economic reforms from planned socialism to state capitalism, spanning the period from 1978 to 2007. We develop a theoretical perspective on reform and mortality, drawing on experiences in the former socialist economies of central and eastern Europe. The focus then moves to Shanghai, and cause-of-death patterns in the city are analysed for three economic periods: the early reform period from 1978 to 1991; an initial period of major reforms from 1992 to 1996; a further period of major reforms from 1997 to 2007. …

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