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Village characteristics and health of rural Chinese older adults: Examining the CHARLS Pilot Study of a rich and poor province

Highlights
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Existence of sewage systems was associated with fewer physical limitations (PLs).
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Use of coal in the home was associated with more PLs.
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Higher per capita net village income was associated with fewer PLs.
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Higher education was associated with fewer PLs.
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China's New Cooperative Medical Scheme was associated with fewer PLs.

Community (or village) characteristics have received growing attention as researchers have sought factors affecting health.

This study examines the association between a variety of environmental, economic, and social village characteristics and health of Chinese older rural adults with health measured in terms of physical limitations.

The Chinese Health and Retirement Longitudinal Survey (CHARLS) Pilot Study data were used.

Older villagers from a low-income province (Gansu) and a relatively wealthy province (Zhejiang) were surveyed between July and September, 2008.

The sample included 1267 respondents in 73 villages age 45 and older. The relationship between a variety of village characteristics and physical limitations of older adults was examined using negative binomial regression (NBR) with standard errors adjusted to account for non-independence of respondents in a village.

A comparison of means/percentages shows that Gansu and Zhejiang were significantly different on the dependent and most independent variables.

The NBR models show that at the personal-level, decreased risk of physical limitations was associated with being male, less than 60 years old, married, higher in education, and higher in household expenditures (proxy for income).

At the village-level, decreased risk of limitations was associated with a continuous supply of electricity, not using coal in the household, the existence of a sewage system, low cost of electricity, and village wealth.

Decreased risk of physical limitations was also associated with various characteristics of China's New Cooperative Medical Scheme (NCMS), an insurance program for rural older adults.

Policy implications for improved health of rural older adults include: (1) continued use of China's NCMS, (2) establishment of village sewage systems, (3) ending the use of coal in the home, and (4) increased educational opportunities focused on health.

ntroduction
The characteristics of communities and villages have received a great deal of attention world-wide over the past 30 years. These include a focus on a variety of environmental, economic, and social characteristics that are believed to create and maintain good health. The purpose of this paper is to examine the general propositions that environmental, economic, and social characteristics of a village are associated with the health of rural Chinese older adults. Urban communities were excluded from the analyses in order to improve the interpretation of the data. Urban communities are very different from Chinese rural villages, such as by having more government financial supports, more developed community infrastructure, and more social supports (Zimmer, Kaneda, & Spess, 2007).

These many changes have been particularly difficult for the Chinese rural and urban elderly (Chow and Bai, 2011, Li and Dorsten, 2011 and Pei, 2008). In the past, the family was a multi-generational, extended one where the young deferred to and cared for their elders. Family wealth was passed down from generation to generation and filial piety was strictly practiced (Zavoretti, 2006). However, today, recent economic and social changes have greatly diminished these traditional and social practices (Chen and Meltzer, 2008 and Wang et al., 2011; Yao, 2002). The financial and social needs of the elderly are no longer being met by their children. Likewise, the central government no longer provides total support to the elderly. Subsequently, many of the Chinese elderly are left with fewer financial and social supports than in years past (Giles and Mu, 2007 and Pei and Xu, 2011).

These many changes have been particularly difficult for the Chinese rural and urban elderly (Chow and Bai, 2011, Li and Dorsten, 2011 and Pei, 2008). In the past, the family was a multi-generational, extended one where the young deferred to and cared for their elders. Family wealth was passed down from generation to generation and filial piety was strictly practiced (Zavoretti, 2006). However, today, recent economic and social changes have greatly diminished these traditional and social practices (Chen and Meltzer, 2008 and Wang et al., 2011; Yao, 2002). The financial and social needs of the elderly are no longer being met by their children. Likewise, the central government no longer provides total support to the elderly. Subsequently, many of the Chinese elderly are left with fewer financial and social supports than in years past (Giles and Mu, 2007 and Pei and Xu, 2011).

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