Wellbeing in England and China

James Banks, Xiaoyan Lei, Albert Park, Andrew Steptoe, Yafeng Wang, Winnie

Yip, Paola Zaninotto, Yaohui Zhao

Motivation

• Healthy aging is priority in aging societies• Understanding determinants of wellbeing and

health is key for public policy• Cross-country comparisons can be invaluable

for identifying which factors are universal and which depend on local contextualizing factors

• Two harmonized data sets (ELSA and CHARLS) enable a comparison between the UK and China

Background

• China has experienced rapid economic development• Today’s elderly have had very different economic

status in their life time– Tremendous wealth accumulation in recent decades, some

due to random factors, especially in the housing market– Uneven distribution of luck

• Legacies of the past events may have long-term impacts on wellbeing – Collectivization, the Great Famine, the Cultural Revolution,

and rapid economic development

CHARLS Baseline Survey

• Nationally representative sample of people aged 45 and older– About 18,000 individuals in 10,000 households

distributed across 450 communities, 150 counties in 28 provinces

– Fielded 2011-2012• Strict quality control in sampling and survey stages• Harmonized with the HRS-ELSA family of surveys

• Compare with ELSA wave 4

Measures of Well-being

• Poor self-reported health• One or more limitations with ADLs/IADLs• One or more mobility impairment• Memory (immediate word recall) • Elevated depression symptoms (3 or more)• High Life satisfaction

Harmonizing Well-being MeasuresExample: ADLs/IADLs and Mobility

ELSA No 0 

Yes 1 

CHARLS No, I don’t have any difficulty

 1 

I have difficulty but can still do it

 2

Yes, I have difficulty and need help

 3

I can not do it  4

Do have any difficulty…..

Outcome measures % by country

Depression High life satisfaction Poor self-rated health IADL/ADL MOBILITY0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

ELSA CHARLS

*

*

* *

*

SES Variables

• Non-pension wealth per capita quintiles• Educational attainment (4 groups)

• Controls:– Age groups (5-year cohorts)– Gender– Marital status

Methodology for Comparative Analysis

• For each country, regress each outcome on the full set of explanatory

• Report coefficients for each explanatory variable (controlling for other factors)

• Denote with “*” if the coefficients for the two countries are statistically different

Key Findings: Wealth

• For physical health measures (self-reported health, ADLs/IADLs, mobility), wealth has stronger relationship in England than in China, with the poorest especially disadvantaged

• But opposite is true for psychological health measures (life satisfaction, depression)

• Result on memory is mixe

richest 4th 3rd 2nd poorest1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

5.50

6.00

Poor self-rated health by wealth

ELSA

CHARLS

Odd

s Ra

tios *

*

richest 4th 3rd 2nd poorest1.00

1.50

2.00

2.50

3.00

3.50

4.00

One or more limitation with ADLs-IADLs by wealth

ELSA

CHARLS

Odd

s ra

tio

*

*

richest 4th 3rd 2nd poorest1.00

1.40

1.80

2.20

2.60

3.00

3.40

3.80

Mobility by wealth

ELSACHARLS

Odd

s ra

tios

*

richest 4th 3rd 2nd poorest1.0

1.5

2.0

2.5

3.0

3.5

4.0

Elevated depressive symptoms by wealth

ELSACHARLS

Odd

s ra

tios

*

*

*

*

richest 4th 3rd 2nd poorest0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40High life satisfaction by wealth

ELSA

CHARLS

Odd

s ra

tios

** *

*

richest 4th 3rd 2nd poorest-0.80

-0.40

0.00

0.40

Memory by wealth

ELSACHARLS

Coeffi

cien

t

*

Explaining Wealth Findings

• Wealth less correlated with physical health in China than in England– Current wealth less correlated with lifetime

wealth?• Wealth more correlated with psychological

wellbeing in China– People in China are more dependent on their

current wealth for their livelihood; social security is less important in China

Key Findings: Education

• Education gradients greater in China for some measures (ADLs/IADLs, life satisfaction, memory)

High Medium Low No qualification1.00

1.50

2.00

2.50

3.00One or more limitation with ADLs-IADLs by education

ELSACHARLS

Odd

s ra

tios

*

High Medium Low No qualification0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

High life satisfaction by education

ELSACHARLS

Odd

s ra

tios

* * *

High Medium Low No qualification-2.00

-1.60

-1.20

-0.80

-0.40

0.00

Memory by education

ELSACHARLS

Coeffi

cient

**

*

Explaining Education Gradients

• Education measures lifetime wealth better than current wealth

Conclusions• Health and wellbeing seem to be more related to

lifetime socioeconomic status (e.g. education) in China than in the UK

• Perhaps due to rapid development and random factors in reshuffling wealth distribution, association between current wealth and lifetime living standards is less in China than in UK

• Current wealth is associated with psychological wellbeing– Psychological wellbeing easier to alter than physical

health