Results on Health Inequalities from Chinese Aging Study

Health Outcomes and Socio-Economic Status among the Elderly in China: Evidence from the CHARLS Pilot

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Author Info

Strauss, John (strauss@usc.edu) (University of Southern California)
Lei, Xiaoyan (xylei@ccer.pku.edu.cn) (Peking University)
Park, Albert (albert.park@economics.ox.ac.uk) (University of Oxford)
Shen, Yan (yshen@ccer.pku.edu.cn) (Peking University)
Smith, James P. (smith@rand.org) (RAND)
Yang, Zhe (Peking University)
Zhao, Yaohui (yhzhao@ccer.pku.edu.cn) (Peking University)
Additional information is available for the following registered author(s):

• James P. Smith

Abstract

We are concerned in this paper with measuring health outcomes among the elderly in Zhejiang and Gansu provinces, China, and examining the relationships between different dimensions of health status and measures of socio-economic status (SES). We use the China Health and Retirement Longitudinal Study (CHARLS) pilot data to document health conditions among the elderly in Gansu and Zhejiang provinces, where the survey was fielded. We use a very rich set of health indicators that include both self-reported measures and biomarkers. We also examine correlations between these health outcomes and two important indicators of socioeconomic status (SES): education and log of per capita expenditure (log pce), our preferred measure of household resources. While there exists a very large literature that examines the relationships between SES and health measures, little has been done on Chinese data to see whether correlations reported in many other countries are replicated in China, particularly so for the aged. In general education tends to be positively correlated with better health outcomes, as it is in other countries. However, unmeasured community influences turn out to be highly important, much more so than one usually finds in other countries. While it is not yet clear which aspects of communities matter and why they matter, we set up an agenda for future research on this topic. We also find a large degree of under-diagnosis of hypertension, a major health problems that afflicts the aged. This implies that the current health system is not well prepared to address the rapid aging of the Chinese population, at least not in Gansu and Zhejiang.

Our Children are more than test scores, Part 3: What Bloomberg, Duncan and Klein should learn from the Chinese

Today, Mayor Bloomberg announced that he would order Joel Klein to tie all teacher tenure decisions to student test scores. Whether this violates state law and/or the union contract is a matter for others to determine.

What I can say is that his decision is the logical outgrowth of the rigid, unreliable and damaging accountability system that he and Klein have imposed on our schools, and that the Obama administration is now attempting to foist on the nation.

Check out Yong Zhao’s critique of the US Dept. of Education's “Race to the Top” program, and its attempt to force states to measure success and reward teachers on the basis of standardized test scores:

I have been reading through the 775-page final notice document to be published in the Federal Register on November 18, 2009. It includes the final versions of application guidelines, selection criteria and priorities for the $4.35 billion Race to the Top Fund (RTT), the largest education grant in U.S. history.

I can guess from news reports, op-ed pieces, and blog posts that many states are working hard to prepare their applications. From my reading of the criteria, I think the following are the winning strategies and actions to include in the application, although they may be inconsistent with research findings or common sense.

Suggestion #1: Stop paying teachers and principals a salary. Instead pay teachers and principals on a per standardized test point basis each day. At the end of each school day, students should be tested using a standardized test, what a teacher and principal is paid is calculated at the end of the day based on the growth of the student, i.e., how much has the student improved over the previous day. This is true accountability and will for sure keep teachers and principals on their toes! ….

Suggestion #2: Remove all “non-core” academic activities and courses and reduce all teaching to math and reading because what the Secretary wants is “increasing student achievement in (at a minimum) reading/language arts and mathematics, as reported by the NAEP and the assessments required under the ESEA” … Actually, no need to teach them these subjects, just teaching them how to pass the tests may be even more effective.

For his other (clearly ironic) suggestions, check out Over the Top: Winning Strategies for the Race to the Top Fund.

Zhao is a Distinguished Professor at Michigan State University, and his perspective is particularly interesting, as he was raised in China and once taught there. See what he says in another posting about what the Chinese government has learned from its top-down approach – and what America should learn from China's self-acknowledged mistakes:

China is determined to reform its education to cultivate a diversity of talents and creativity. China has recognized and suffered from the damaging effects of standardized testing and has been trying very hard to move away from standards. If America or any other nation wants to worry about China, it is its determination and focus on creativity and talents, not its test scores.

Once standardized test scores become an accepted way to judge the potential and value of a child, the performance of a teacher, and the quality of school, it is very difficult to change. We are already seeing signs of this in the U.S., thanks to all the education reformers who want to make Americans “globally competitive.”

Zhao is author of Catching Up or Leading the Way: American Education in the Age of Globalization, and was recently on the Brian Lehrer show, Comparing Education in China to the U.S. Here is an excerpt from his book:

Clearly, American education has been moving toward authoritarianism, letting the government dictate what and how students should learn and what schools should teach. This movement has been fueled mostly through fear—fear of threats from the Soviets, the Germans, the Japanese, the Koreans, the Chinese, and the Indians. The public, as any animal under threat would, has sought and accepted the action of a protector—the government.

Let's hope that Americans reject this reflexive, damaging vision of education, and take a closer look at the potential consequences before we let our government turn our public schools into those like China's.

See also this Huffington Post column about how like China, South Korea is trying to move away from a system based solely on standardized test scores.

Nick Kristof Strikes Again, and Gets It Wrong Again

I can think of few journalistic practices more damaging and wrongheaded than the reporter who helicopters into a complex problem for a few days, sniffs around a bit without really understanding the context in which he or she is observing, and then drops an "expert opinion" editorial on the matter. No one in my recent memory appears more prone to this, and more badly misled, than the NY Times's periodic editorial contributor, Nick Kristof, particularly with regard to education.

Back in 2002, Mr. Kristof dropped himself in on some schools in Shanghai and then wrote a ridiculous column on China's "super kids" whose schooling and intelligence were apparently going to bury the U.S. competitively in the future. He could not have gotten the Chinese education system more wrong in 750 words than he did at that time; reading his 2002 column today is still an embarrassment for anyone who really understands what's going on in the Chinese education system.

Now, Mr. Kristof has inserted himself into education once again, and just as foolishly, with his latest contribution to the NY Times. In an October 15th piece oddly entitled "Democrats and Education" , Mr. Kristof elects to beat on that favorite old dead horse of education critics, that the problem with US education is bad teachers and their unions who simply won't let schools get rid of them.

In his article, he talks about NYC's system where "failed teachers" are sent at full pay to "rubber rooms," clearly not understanding that the purpose of such centers is to hold teachers against whom potentially serious allegations of misconduct (such as, for example, sexual misconduct or verbal or physical abuse of students) have been made while their cases are being investigated. Whatever one may think of rubber rooms, they are not holding pens for teachers who have merely been judged incompetent.

Of course, Mr. Kristof trots out a couple horror stories about bad teachers to "prove" his point, and there's certainly no argument here that abusive teachers who degrade their students or show up drunk do not belong in classrooms. As his column progresses, he slyly manages to conflate the clearly unacceptable behavior of his "horror stories" with the term "ineffective teachers," as though the U.S. education system is suffering from an epidemic of school-based child abuse. Ineffective and drunk (or telling a failed suicide that next time the student should cut his wrists more deeply) are not equal.

Anyway, these horror stories are old news, and Mr. Kristof writes as though he just discovered this issue. Beyond making it easier to remove such "ineffective" teachers, what are his solutions? Two of them are more charter schools and "objective measurement to see who is effective." Of course, while calling for better teachers with better compensation, he conveniently ignores the fact that under NCLB, teachers of all stripes and levels of ability are being hamstrung by precisely those types of measurement systems, all of which begin with state-defined standardized exams which place enormous pressure on school administrators and teachers to show ever-improving results.

The damage these exams are doing to real education is incalculable, since they distort both teaching and curricula by narrowing content, detracting from coverage of other subject areas, and focusing on test-taking rather than education as an exploration and learning experience.

In his closing, Mr. Kristof writes, "I’m hoping the unions will come round and cooperate with evidence-based reforms, using their political clout to push to raise teachers’ salaries rather than to protect ineffective teachers," as if this is the essential either/or choice. It's merely another false dichotomy -- the two items have nothing to do with one another.

More charter schools, more "objective" measurement of teachers' value added based on standardized exams, less intrusion from the teachers' unions -- this is what Mr. Kristof wants the Democrats to be doing. Sadly, President Obama (through his Secretary of Education, Arne Duncan) appears to be working from Mr. Kristof's playbook, acting more like a conservative Republican than the Democratic reformer for whom we thought we had voted. --Steve Koss

See also the letters to the editor in today's Times, in response to Kristof's column here.

A Crushing View of Reality

I've been spending a lot of time thinking about what money can buy -- $3,500 more specifically. In our project testing the effects of need-based financial aid on college students, that's how much the students attending 4-year colleges are being randomly assigned to receive. So I often ponder whether that amount is meaningful, in what ways, and why more might be needed.

This afternoon I was dealt a harsh dose of reality, bringing me down from "college-going land" to the real world. No sooner had my two-year old gone down for his nap and I'd picked up the New York Times to enjoy over a lovely and very necessary cappuccino, did my eyes fall on this front page story: "Chinese Hunger for Sons Fuel Boys' Abductions".

Know what $3,500 can buy in China? A five-year-old boy. That's right.

In a story full of weeping parents who've lost their kids--those who've had babies stolen from them, and those who unknowingly adopted stolen children--reality hits hard. It's not often that the Education Optimists write about anything outside the U.S. (and admittedly, shame on us for that). Thanks to this story, my mind is far, far from higher education on this very gray afternoon.