Health China 2030 calls for health equity. The strict household registration system, known as Hukou, results in an uneven distribution of social resources between urban and rural China. Higher education can promote social mobility and narrow health inequality. Health literacy is a significant indicator to predict health status. Drawing on national representative data recently collected, this study examines the impact of higher education on health literacy in urban and rural China. Propensity score matching was used to address potential selection bias. Ordinary least squares regressions and Oaxaca–Blinder decomposition techniques were conducted to explore urban-rural disparities in health benefits from higher education. The findings indicate that there are existing gaps in health literacy, higher education attainment, household income, and healthcare coverage between urban and rural China. Higher education attainment can significantly promote health literacy both in urban and rural China, after controlling for a series of demographic, socio-economic, and individual characteristics. Moreover, this study highlights a negative heterogenous treatment effect pattern: those who are less likely to attend college can obtain more health benefits from higher education than those who are more likely to be admitted into college. Public education and health programs, policies, and goals should be further optimized to promote integrated development in urban and rural China.
IntroductionThe Healthy China Initiative emphasizes family health. Education is an upstream determinant of health, which can both achieve upward mobility and cause class solidification.MethodsUsing nationwide large-scale data collected in 2021, the present study explored the relationship between education and family health in the urban-rural dual society via Oaxaca-Blinder decomposition and propensity score matching.ResultsOur data revealed disparities in family health, educational attainment, household income, healthcare coverage, and job type between urban and rural China. An inverted U-shaped relationship existed between increasing years of education and family health. The upper limit was 17.1 years for urban residents and 13.7 years for rural residents, with limited health benefits from higher education obtained by rural residents. Mediated by work-family conflict, highly-educated people received gradually diminishing health returns. The results of the Oaxaca-Blinder decomposition showed that 25.8% of the urban-rural gap in family health could be explained by the disparity in education. Urban residents could translate cultural capital and economic capital into health capital to a greater extent. After propensity score matching, a robust, inverted U-shaped relationship was found between education and family health. The inverted U-shaped relationship was found to replace family health with self-rated health and quality of life.DiscussionFamily-centered public health and education programs, policies, and goals should be developed to break urban-rural dual structure barriers and advance social equity in China.
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