China’s three-year health reform program and equity in sanitation improvement: a panel analysis

BMC Public Health

Wenjing Chen¹  Yanqing Miao²  Xiaolong Li¹ 

[1] School of Economics and Management, Beijing University of Posts and Telecommunications, Beijing 100876, China;China National Health Development Research Center, NHFPC, Beijing 100083, China

关键词: Absolute concentration index;    Concentration index;    Concentration curve;    Central investment;    Three-year health reform program;    Improved sanitation;    Inequity;   

Others  :  1122829
DOI  :  10.1186/s12889-015-1364-7

 received in 2014-07-10, accepted in 2015-01-06,  发布年份 2015

【 摘 要 】

Background

Accessible improved sanitation is critical to child health, and inequities in improved sanitation can be interpreted as health inequities across socio-economic groups. From 2009 to 2011, the Chinese government invested 4.448 billion yuan for rural sanitation improvement through a 3-year health reform program. This study assesses the inequity of sanitation improvement in rural China from 2003 to 2011 and examines whether the 3-year health reform program promoted equity in sanitation improvement.

Methods

Data from the China Health Statistics Yearbooks of 2004 to 2012 and the National Bureau of Statistics of China were used to create the concentration curve (CC), concentration index (CI), and absolute concentration index (ACI) of improved sanitation. Data of central investment for sanitation improvement in each province of China for 2009, 2010, and 2011 was gained through correspondence and used to create the CC and CI for investment.

Results

Although the CIs of improved sanitation are lower than the CIs of the net income of rural residents, the latter have an obvious downtrend. The CIs of improved sanitation increased from 2003 until 2008 and started to drop in 2009. As a result, by 2011, the CIs of improved sanitation had reached their 2003 levels. The ACI of improved sanitation decreased slightly from 2003 to 2008, but declined sharply from 2009 to 2011. The CIs of central investment for 2009, 2010, and 2011 are negative and the CCs of central investment are above the line of absolute equality, indicating that investments had been concentrated more on poorer provinces and regions.

Conclusions

The equality of rural residents’ net income has been improving each year, whereas equity in sanitation improvement deteriorated from 2003 to 2008. However, equity in sanitation improvement has increased since 2009 due to central investment in sanitation improvement during the 3-year health reform program that benefits low-income areas more. It is clear that the 3-year health reform program played an important role in promoting the level and equity of sanitation improvement.

【 授权许可】

   
2015 Li et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Prüss-Üstün A, Bos R, Gore F, Bartram J: Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health. World Health Organization, Geneva; 2008.
• [2]Boschi-Pinto C, Velebit L, Shibuya K: Estimating child mortality due to diarrhoea in developing countries. Bull World Health Organ 2008, 86(9):710-7.
• [3]Bartram J, Cairncross S: Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med 2010, 7(11):e1000367.
• [4]Pardey PG, Alston JM, Piggott R: Agricultural R&D in the developing world: Too little, too late?. Intl Food Policy Res Inst, Washington, D.C; 2006.
• [5]Carlton EJ, Liang S, McDowell JZ, Li H, Luo W, Remais JV: Regional disparities in the burden of disease attributable to unsafe water and poor sanitation in China. Bull World Health Organ 2012, 90(8):578-87.
• [6]Zhang J, Mauzerall DL, Zhu T, Liang S, Ezzati M, Remais JV: Environmental health in China: progress towards clean air and safe water. Lancet 2010, 375(9720):1110-9.
• [7]Fang P, Dong S, Xiao J, Liu C, Feng X, Wang Y: Regional inequality in health and its determinants: evidence from China. Health Policy 2010, 94(1):14-25.
• [8]Zhang X, Xiong Y, Ye J, Deng Z, Zhang X: Analysis of government investment in primary healthcare institutions to promote equity during the three-year health reform program in China. BMC Heal Serv Res 2013, 13:114. BioMed Central Full Text
• [9]Implementation plan for the recent priorities of the health care system reform (2009–2011). Beijing: The State Council of China; 2009
• [10]Report on the implementation of central and local budgets for 2012. Beijing: Ministry of Finance; 2012
• [11]China Health Statistics Yearbook 2012. Peking Union Medical College Press. Beijing. 2012
• [12]Miao Y, Chen W, Gong Z, Lin Q: performance evaluation report of sanitation improvement in the rural areas. China National Health Development Research Center CNHDR, Beijing; 2013.
• [13]Laiyun S: China Statistical Yearbook 2012. China Statistics Press, Beijing; 2012.
• [14]Periago MR: Health in the Americas. Pan American Health Organization, Washington, D.C; 2007.
• [15]Cullis J, Koppen BC: Applying the Gini Coefficient to measure inequality of water use in the Olifants River water management area, South Africa. International Water Management Institute, Colombo, Sri Lanka; 2007.
• [16]Kirigia DG, Kirigia JM: Inequalities in selected health-related millennium development goals indicators in all WHO member states. Afr J Health Sci 2008, 14(3):171-86.
• [17]Wang X-j, Zhang J-y, Shahid S, ElMahdi A, He R-m, Wang X-g, et al.: Gini coefficient to assess equity in domestic water supply in the Yellow River. Mitig Adapt Strat Glob Chang 2012, 17(1):65-75.
• [18]Ásgeirsdóttir TL, Ragnarsdóttir DÓ: Determinants of relative and absolute concentration indices: evidence from 26 European countries. Int J Equity Health 2013, 12:53. BioMed Central Full Text
• [19]Hernández-Quevedo C, Jones AM, López-Nicolás A, Rice N: Socioeconomic inequalities in health: a comparative longitudinal analysis using the European community household panel. Soc Sci Med 2006, 63(5):1246-61.
• [20]Gunasekara FI, Carter K, McKenzie S: Income‐related health inequalities in working age men and women in Australia and New Zealand. Aust N Z J Public Health 2013, 37(3):211-7.
• [21]Clarke P, Smith L, Jenkinson C: Health inequalities: comparing health inequalities among men aged 18–65 years in Australia and England using the SF‐36. Aust N Z J Public Health 2002, 26(2):136-43.
• [22]Evans B, Colin C, Jones H, Robinson A: Sustainability and equity aspects of total sanitation programmes-A study of recent WaterAid-supported programmes in three countries: global synthesis report. WaterAid, London; 2009.
• [23]Whittington D, Lauria DT, Wright AM, Choe K, Hughes JA, Swarna V: Household demand for improved sanitation services in Kumasi, Ghana: a contingent valuation study. Water Resour Res 1993, 29(6):1539-60.
• [24]Chen J, Li Z, Gao X, Du H, Yu L, Ren H, et al.: Toilet retrofit in rural areas of China:impact factors and effect analysis. Chin Rural Health Serv Adm 2013, 002:181-3.
• [25]Hossain SI: Making an equitable and efficient education: the Chinese experience. Social Sector Expenditure Review, World Bank, China; 1996.
• [26]Kakwani N, Wagstaff A, Van Doorslaer E: Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econ 1997, 77(1):87-103.
• [27]Wagstaff A, Van Doorslaer E: Income inequality and health: what does the literature tell us? Annu Rev Public Health 2000, 21(1):543-67.
• [28]Wagstaff A, Van Doorslaer E, Watanabe N: On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econ 2003, 112(1):207-23.
• [29]O'Donnell OA, Wagstaff A: Analyzing health equity using household survey data: a guide to techniques and their implementation. World Bank Publications, Washington, D.C; 2008.
• [30]Braveman P, Starfield B, Geiger HJ: World health report 2000: how it removes equity from the agenda for public health monitoring and policy. Br Med J 2001, 323(7314):678.
• [31]Starfield B: Pathways of influence on equity in health. Soc Sci Med 2007, 64(7):1355-62.
• [32]Mooney G, Jan S, Wiseman V: Staking a claim for claims: a case study of resource allocation in Australian Aboriginal health care. Soc Sci Med 2002, 54(11):1657-67.
• [33]Yanqing M, Zhenbo Y, Heyu Z: Study on rural residents’ willingness to pay to sanitation and influencing factors in China: the improvement of rural sanitary toilets as example. Manage World 2012, 9:89-99.
• [34]Xiaolong L, Yazhou G, Yanqing M, Wenjing C: Understanding determinants of inequality in sanitation improvement in Rural China. Iran J Public Health 2014, 43(8):1148-9.
• [35]Kar K, Pasteur K: Subsidy or self-respect? Community led total sanitation. An update on recent developments. Institute of Development Studies, Brighton; 2005.