Income Inequality, Unequal Health Care Access, and Mortality in China

China made great progress in reducing mortality between 1950 and 1980 when its life expectancy at birth increased from approximately 35 to more than 65 years. Although China has achieved further reductions in mortality under rapid economic growth since that period, the profound socioeconomic transformation has brought about some negative changes in health care services, such as the collapse of the Cooperative Medical System in rural areas, that have had adverse public health consequences. The growing inequality in income distribution has also impeded progress in mortality decline in poor areas and among disadvantaged social groups. This article analyzes health and mortality data collected through the 2003 National Health Services Survey by the Ministry of Health from about 100 districts and counties. It first compares mortality changes between developed and less developed areas. Then it examines the differences in health care among these regions and the relationship between mortality changes and a wide range of socioeconomic factors, especially recent changes in health care and services. Finally, it considers the implications of inequality in health care and income distribution for further improvement in mortality in China.