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    Essays on health and nutrition in China
    (2015) Nie, Peng; Sousa-Poza, Alfonso
    This dissertation aims to investigate several major socio-economic determinants of health and nutrition in China. By using data from the China Health and Nutrition Survey (CHNS) spanning from 1991 to 2009, this enhances the understanding of the transition of health and nutrition with such unprecedented economic and social changes in China. This dissertation contains six chapters: more specifically, Chapter 1 gives a brief description of general background, research aim and also the outline. Then Chapter 2 examines the association between maternal employment and childhood obesity. Chapter 3 takes a comprehensive look at how income changes are related to calorie intake. Chapter 4 investigates the impacts of peers (one of most important aspects of social networks) on childhood and adolescent adiposity. Chapter 5 assesses the nexus between long work hours and health. Finally, Chapter 6 ends with some main conclusions and discussions. Chapter 2 analyses the alarming increase of overweight and obese children and considers the higher female employment participation in China. We analyze how maternal employment is correlated with childhood obesity in China. Our work makes a non-Western comparison in this field, which is useful as it is rather difficult to generalize the results (mostly significant positive association between maternal employment and childhood obesity) from related studies in the Western world. More importantly, we further explore how maternal employment is related to two key transmitters of obesity: diet and physical activities. We find no association of maternal employment and childhood adiposity. Moreover, maternal employment is also not associated with either diet or physical activity of children. However, our results are well consistent with some recent evidence in Europe (Greve, 2011; Gwozdz et al., 2013), supporting the evidence that maternal employment might not necessarily be detrimental to child adiposity. One tentative explanation is that, the major source of informal childcare in China is grandparents, who are more likely to provide childcare with a high quality. In Chapter 3, we provide an empirical analysis that looks at the association between income and calorie intake via a variety of parametric, nonparametric and semiparametric approaches. By means of panel data settings, we are capable of capturing time-invariant individual heterogeneity. It is worth noting that taking a close look at calorie-income elasticities is crucial and implicative of the effectiveness of income-mediated policies for food security in China. Our findings provide strong evidence that calorie-income elasticities are small, irrespective of using parametric, nonparametric, or semiparametric techniques. Furthermore, these elasticities remain small when taking nonlinearities into consideration, and also for sub-analysis for gender, individuals with differences in calorie intake or even impoverished households. Although calorie-income are small, our results are well in line with some prior studies (Bishop et al., 2010; Lu and Luhrmann, 2012; Shankar, 2010; Zhong et al., 2012), suggesting that households might be quite successful in maintaining calorie intake stable as income changes. Also note, despite the marked increase in income, the Chinese demand for better food quality, food diversity and food safety have amplified (Gale and Huang, 2007; Liu et al., 2013b), instead of an increased demand for calorie intakes. Chapter 4 takes a detailed look at how peer effects are associated with childhood and adolescent obesity in China. It expands the empirical work beyond the Western domain in light of different cultural backgrounds between individualistic and collective societies. Furthermore, it broadens the dominant front of adolescents and adults by analyzing children as well. Note that, understanding peer effects on childhood adiposity is of great significance primarily because, as emphasized by Dishion and Tipsord (2011), children’s consumption behaviors are influenced by their peers. More importantly, childhood adiposity could result in persistent adulthood overweight or obesity (Loh and Li, 2013). In addition, the use of self-perceived perceptions of body weight allows for an exploration of the relation between peer effects and individual perceptions of weight status, thereby providing insights into understanding pathways by which peer effects operate within a relatively broader environment. We provide further evidence that peer effects exist not only among adolescents, but also children, suggesting that the formation of health lifestyles associated with peers is important for young children. In addition, we find that the magnitudes of peer effects change greatly over the distribution of individual BMI and stronger effects are observable at the upper end than at the bottom or median. This finding implies that obese individuals are more vulnerable to peers. Furthermore, females are more susceptible compared to males, which mirrors some U.S studies among adolescents (see, for instance, Trogdon et al., 2008). More importantly, we find that community-level average peer BMI is associated with self-perceived bodyweight in adolescents, providing evidence that a higher average peer BMI is related to the probability of a self-assessed perception of overweigh, in particular, for adolescent girls. All in all, our results support the existence of peer effects on childhood and adolescent obesity, but the magnitudes fall within the broader range for the U.S. adolescent studies using similar specification to ours. Therefore, it implies that peer effects do not necessarily strengthen within a collectivistic society, like China, as in comparison to the counterparts of an individualistic society, like the U.S. In Chapter 5, we provide a comprehensive picture of how long work hours are related to health, using not only subjective but also objective measures. Also, it provides a valuable comparison with existing studies predominantly in the Western world. More importantly, it explores several potential mechanisms through which long work hours could impact upon one’s health. In particular, it investigates the relation between long work hours and specific lifestyles, such as sleep, diet (calorie and fat intakes, time spent food preparation and cooking), physical activities (sports participation and time spent on sedentary activities). Apart from a cross-sectional settings, it also adopts a panel analysis, which allows for controlling for unobserved individual heterogeneity. Because, to the best of our knowledge, the only three studies in China (Fritjers et al., 2009; Verité, 2004; Zhao, 2008) all investigate subjective measures of health via cross-sectional data. We reveal that working above 50 hours per week (31-40 hours per week as the comparison), increases the probability of suffering from high blood pressure, though the effects are relatively small. Also, self-evaluated health is poorer for individuals working long hours compared with those weekly working 31-40 hours, however the effect is not so strong. Eventually, long work hours have various impacts of different aspects of individual lifestyles. Specifically, we cannot find a positive correlation between long work hours and obesity. Nevertheless, long work hours seem to be related to a decreased fat intake and less time spent on sedentary activity like watching TV. But, long work hours decrease the probability of sports participation. In summary, we provide limited evidence that long work hours in China have deleterious influences on health or lifestyles. Therefore, further research needs to explore the potential impacts of long work hours on other health or lifestyle measures. References Bishop, J.A. Liu, H.Y. & Zheng, B.H. 2010. Rising incomes and nutritional inequality in China. . In: BISHOP, J. A. (ed.) Studies in Applied Welfare Analysis: Papers from the Third ECINEQ Meeting. Bingley: Emerald Group Publishing. Dishion, T.J. & Tipsord, J.M. 2011. Peer contagion in child and adolescent social and emotional development. Annual Review of Psychology, 62, 189-214. Fritjers, P. Johnston, D.W. & Meng, X. 2009. The mental health cost of long working hours: the case of rural Chinese migrants. Mimeo. Greve, J. 2011. New results on the effect of maternal work hours on childrens overweight status: does the quality of child care matter? Labour Economics, 18(5), 579-590. Gwozdz, W. Sousa-Poza, A. Reisch, L.A. Ahrens, W. Henauw, S.D. Eiben, G. Fernandéz-Alvira, J.M. Hadjigeorgiou, C. De Henauw, S. Kovács, E. Lauria, F. Veidebaum, T. Williams, G. & Bammann, K. 2013. Maternal employment and childhood obesity - a European perspective. Journal of Health Economics, 32(4), 728-742. Gale, F. & Huang, K.S. 2007. Demand for food quantity and quality in China, Economic Research Report. No.32. Washington D.C. : US Department of Agriculture. Lu, L. & Luhrmann, M. 2012. The impact of Chinese income growth on nutritional outcomes. Available from Liu, R.D. Pieniak, Z. & Verbeke, W. 2013b. Consumers attitude and behaviour towards safe food in China: a review. Food Control, 33(1), 93-104. Loh, C.P. & Li, Q. 2013. Peer effects in adolescent bodyweight: evidence from rural China. Social Science & Medicine, 86, 35-44. Shankar, B. 2010. Socio-economic drivers of overnutrition in China. Journal of Human Nutrition and Dietetics, 23(5), 471-479. Trogdon, J.G. Nonnemaker, J. & Pais, J. 2008. Peer effects in adolescent overweight. Journal of Health Economics, 27(5), 1388-99. Verité 2004. Excessive overtime in Chinese supplier factories: causes, impacts and recommendations for action. Verité Research Paper, Amherst, Massachusetts. Zhong, F.N. Xiang, J. & Zhu, J. 2012. Impact of demographic dynamics on food consumption: a case study of energy intake in China. China Economic Review, 23(4), 1011-1019. Zhao, Z. 2008. Health demand and health determinants in China. Journal of Chinese Economic and Business Studies, 6(1), 77-98.