Income, Income Inequality, and Health: Evidence from China∗

Hongbin Li† Department of Economics The Chinese University of Hong Kong Shatin, N.T., Hong Kong P.R. China Yi Zhu Department of Economics The Chinese University of Hong Kong Shatin, N.T., Hong Kong P.R. China May 17, 2004

We would like to thank the Carolina Population Center for kindly supplying the data. We are very grateful to Loren Brandt, Julan Du, Kai Yuen Tsui and Junsen Zhang for very helpful comments. † Corresponding author. Tel.: 852-2609-8185; fax: 852-2603-5805; E-mail: lhongbin@cuhk.edu.hk

Income, Income Inequality, and Health: Evidence from China
Abstract This paper tests whether individual health is associated with income and communitylevel income inequality using survey data from China. Although poor health and high inequality are key features of many developing countries, most of the earlier literature has drawn on data from developed countries in studying the association between the two. We find that self-reported health status increases with per capita income, but at a decreasing rate. Controlling for per capita income, we find an “inverted-U” association between self-reported health status and income inequality, which suggests that high inequality in a community poses threats to health. We also find that high inequality increases the probability of health-compromising behaviors such as smoking and alcohol consumption. Most of our findings are robust to different measures of health status and income inequality.

JEL Classification: D63; I10; O15; O53

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Introduction
China has recorded impressive growth over the past 25 years since the introduction

of the market economy, and there has been a substantial increase in average living standards. However, in recent years there has been growing concern about the large increase in income inequality during the same period. For example, Bramall (2001) shows that the Gini Coefficient for rural China has increased by almost 50 percent from 1980 to 1999. The rising inequality has had and will have important impacts on various aspects of social life, resulting, for example, in frequent social conflicts (Alesina and Perotti, 1996), higher levels of violent crime (Hsieh and Pugh, 1993), and ultimately in a slowing down of economic growth (Aghion et al., 1999). While inequality may affect the society and its economic development in many ways, we focus in this paper on a particular aspect of the socioeconomic effects of inequality, i.e., its impact on health. The relationship among income, income inequality and health is an issue which has attracted the attention of a variety of social science disciplines such as economics, sociology and public health. From an early stage in the debate, it was argued that income has a positive effect on health (Grossman, 1972; Preston, 1975). This is called the absolute income hypothesis. However, some researchers assert that relative income or income inequality plays an equally important role in determining health. According to the relative income hypothesis (or the weak income inequality hypothesis ), people who feel more economically disadvantaged than their peers in a reference group are more likely to have poorer health (Marmot et al., 1991; Wilkinson, 1997). Low relative income may cause stress and depression leading to illness (Cohen et al., 1997) or weaken one’s power in the allocation of local health-related resources (Deaton, 2003). Some (Wilkinson, 1996) go even further and argue that income inequality may affect the health of both the poor and the well off in a society (referred to as the strong income inequality hypothesis ), possibly through disinvestment in public health and human capital, the erosion of social capital, or stressful social comparisons (Kawachi and Kennedy, 1999). The relative income or income inequality hypotheses has been empirically tested, but

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. At the aggregate level. we also find evidence supporting the strong version of the income inequality hypothesis but not the weak version. income inequality may be spuriously correlated with the aggregate measure of health if individual health is a concave function of income.. Kennedy et al. Kaplan et al. Blakely et al.e. 2002.g. some support the income inequality hypothesis (e. a number of studies have shown a robust association between income inequality and public health (e.. This is in contrast with Eibner and Evans (2001).g. recent studies employ individual data. Lynch et al. Meara.almost exclusively drawing on data from industrialized countries. 2 . Finally. Soobader and LeClere.1 The tests have been conducted at both the aggregate and individual levels. Blakely et al.. we also show that rising inequality can significantly increase one’s probability of engaging in health-compromising behaviors such as smoking and alcohol abuse. the detrimental effect of income inequality on health only appears in communities with high inequality. However. that income has a positive effect on self-reported health status. Among these studies.. We contribute to the literature studying the relationship between income inequality 1 For a systematic review of previous empirical work. The goal of this paper is to test the above hypotheses and investigate the relationship between income. the use of aggregate data may be unconvincing. However. 1999. To differentiate between the absolute income and income inequality effects.. i. 1997. see Deaton (2003) and Lynch et al. (2004). Consistent with findings by Daly et al. Mellor and Milyo. while others find no significant effects of inequality (e. unlike previous findings of a linear relationship.. It is therefore difficult to discriminate between the effects of income and income inequality using aggregate data. 1996. and the results have been mixed. Waldmann. income inequality and health in China. (1998).. our results show an “inverted-U” association between self-reported health status and inequality. As noted by Gravelle (1998). using the high quality individual data from the China Health and Nutrition Survey (CHNS). who find relative deprivation more important than rank in explaining individual health. We find evidence supporting the absolute income hypothesis. 1998. 2002). 2001). We also test the effect of relative deprivation and income rank on health and find that only income rank has a significant positive effect on health. Kawachi et al... 1999.g. 1998). 1992.

Eibner and Evans. In contrast. but also permits us to examine the potential impacts of inequality within a society by taking a set of people who are more closely related. respectively. Income Inequality and Health: Hypotheses and Previous Literature In our study we attempt to examine whether health outcomes and behaviors are cor- related with income and income inequality in China. Mellor and Milyo. Previous studies have tested either the relative income hypothesis (Deaton. Although poor health and high inequality are key features of many developing countries. China has both rising inequality and a large variation in inequality across localities (Gustafsson and Li. The structure of the paper is as follows. which focus on the state or county level. 3 Gerdtham and Johannesson (2004) test both hypotheses. 2 3 . and Gerdtham and Johannesson (2004) employ data from Japan. but their measure of relative income is a simple one. because these countries are typically more egalitarian and do not have sufficient variation in income inequality across regions. we extend the previous work by explicitly distinguishing between the relative income hypothesis and the income inequality hypothesis in the same study. as pointed out by Gerdtham and Johannesson (2004).. Denmark and Sweden. 2 Income. and other industrialized countries. Section 4 reports our estimation results. we measure the income inequality at the community-level. Using community-level inequality not only facilitates the empirical test by allowing us to work with a larger variation in inequality. 2001) or the income inequality hypothesis (eg. this paper is one of the first studies to use individual data from a developing country. 2002). 2002). industrial countries like Sweden may not be the best places for studying the effects of income inequality.2 Moreover. the earlier literature has studied their association drawing mainly on data from U. so that our focus is more locally defined than most previous studies. Second.and health in the following ways. Section 2 presents the hypotheses and literature review.S. First. Shibuya et al. Osler et al. (2002). We begin with a discussion of several For example. Section 5 concludes. Section 3 describes the data and some measurement issues. (2002). 2001.3 Finally.

There are several potential pathways through which income inequality might harm an individual’s health directly.4 We follow the literature and test whether per capita income has a positive effect on individual health. regardless of a person’s particular income level.5 However. Hypothesis 2: Income Inequality Hypothesis The income inequality hypothesis presumes that income inequality per se is a threat to the health of individuals within a society. A related concept is the poverty hypothesis. It focuses on the direct tie between health and income inequality. which emphasizes that ill health is a consequence of low income or extreme poverty. One of the most influential works in this area is by Preston (1975). high levels of inequality might produce instabilities 4 5 See the review in Feinstein (1993). and a more recent discussion in Smith (1999). Hypothesis 1: Absolute Income Hypothesis The absolute income hypothesis argues that people with higher incomes have better health outcomes. For example. there is a concave relationship between income and health. who finds that the impact of additional income on mortality is greater among the poor than the rich. sociology and epidemiology) demonstrate a robust association between income and health (no matter how income and health are measured) using individual data.hypotheses that link income and income distribution to health. In other words. since the protective effect of absolute income on health is relatively uncontested (compared with the effect of income inequality or relative income). and most of the evidence points to a nonlinear relationship. but income inequality or relative income has no direct effect on health. 4 . We also control for income squared to capture the nonlinear relationship between income and health. followed by a selected review of previous empirical work. A large number of empirical studies in a variety of disciplines (such as economics. The idea that health improves with income goes back a long way in the literature. even holding their incomes constant. we do not place very much emphasis on this test. We then specify the empirical test for each hypothesis.

1992. some studies find an association between income distribution across U. 1997) and firearm crimes (Kawachi et al. morbidity. and stressful social comparisons.7 If all that matters to individual health is income. Kennedy et al. then for two communities Kawachi and Kennedy (1999) summarize three plausible mechanisms linking income inequality to health: disinvestment in human capital. by. Early studies use aggregate data to test the correlation between income inequality and health.. counties and cities within nations (Kaplan et al. The strong version states that inequality affects all members in a society equivalently. both at a point in time and over time..6 This hypothesis has two versions (Mellor and Milyo. For example. they use aggregate data. 1996) present evidence of a relationship between income inequality and life expectancy across a number of industrialized countries.. 2002). 1996.in the social capital. Wennemo. 1996. Kawachi et al.. or declining social cohesion.g. A link between income inequality and health measures (mortality. 1998). states and state-level measures of smoking (Kaplan et al. 1993). 1992. Ben-Shlomo et al. irrespective of their income levels. 1997. Although these studies are informative. 7 Using a new data set.. Deaton (2003) shows a recent version of the Preston curve and suggests that 6 5 . 1997. etc. which in turn adversely influence an individual’s own health through psychosocial responses like violent crime or self-destructive behaviors. or that the harmful effect of inequality on health decreases with one’s income rank. In addition.) has been discerned repeatedly at the level of countries (Waldmann.. Kawachi and Kennedy. The aggregate association between income inequality and health may merely reflect the nonlinear relationship between income and health at the individual level. if a transfer of one dollar from the rich to the poor improves the health of the poor more than it diminishes the health of the rich. While Wilkinson reports correlation coefficients. Lynch et al.. The weak version suggests that income inequality may harm the health of only the least well off in a society. increasing mistrust and stress. and across states. 1996). 1996. for example. alcohol consumption (Marmot. the erosion of social capital. a growing body of literature tests this hypothesis using regression frameworks.S. this income-equalizing transfer will increase the average health of the whole society. 1998).. making it hard to differentiate between the hypotheses for absolute income and income inequality. Various works by Wilkinson over the past decade (e.

finding that. 1999. 1998. A number of studies using U. Soobader and LeClere (1999). and Blakely et al. 6 . Mellor and Milyo (2002) construct several inequality measures both at the level of states and metropolitan areas. Using county and tract-level inequality data. Shibuya et al. Kennedy et al. 2002.S. For instance. In contrast. Meara. some studies indicate no association between income inequality and individual health. Most of the existing literature focuses on the strong version of the income inequality hypothesis. Gerdtham and Johannesson. the community with a more equal income distribution tends to have better average health than the one with greater inequality. Daly et al. LeClere and Soobade (2000) find supporting evidence as well. and find supporting evidence for the income inequality hypothesis in a particular time period.. but only for some specific subgroups in high-inequality counties. Blakely et al. 2004). it is hard to distinguish this “statistical artefact” (Gravelle. in aggregate studies. (1998). Meara (1999) examines the relationship between state-level inequality and birth outcomes (such as infant mortality and low birth weight). (2001) all show a significant association between inequality (at state or county-level) and self-rated health status. income redistribution from rich to poor countries will in principle increase average health worldwide. and show that their effects on self-rated health status are eliminated once individual income and locality effects are controlled. 2002. (1998) examine the effects of several measures of state-level income inequality on individual mortality. 2002. A few studies using data outside the U. one should employ individual data. and finds no significant relation. In order to identify the true effect of inequality. 1998) from mechanisms in which income inequality has a direct effect on individual health.with identical average income.. after controlling for income. Fiscella and Franks (2000). Only a few studies (Daly et al. Fiscella and Franks (1997) find no effects of county-level inequality on mortality. (2002) draw a similar conclusion. Thus. Mellor and Milyo. there is little association between income inequality and individual health. provide further evidence against the income inequality hypothesis (Osler et al.S data find that income inequality does indeed have a negative effect on individual health. Using the same data as Mellor and Milyo (2002).. Measuring inequality by the proportion of income earned by the poorest 50 percent of the population.

(1) where i and j are subscripts for individual and community respectively. We hypothesize that health outcomes deteriorate with income inequality (β1 < 0). we test both the strong and weak versions of the inequality hypothesis. but none of their findings support the hypothesis. smoking.Gerdtham and Johannesson. The model is Hij = β0 + β1 Qj + β2 Q2 j + δRij + ηQj ·Rij + Iij Γ + Xij Θ + εij . objective body conditions. denoted by Rij . and improves when one is prosperous relative to others. Hij denotes a number of health outcomes and behaviors (self-reported health status. Qj stands for the community-level income inequality. 2004) implicitly or explicitly test the weak version. The strong version of the income inequality hypothesis is specified as follows. In this paper. household and community variables. to allow the effects of income inequality to vary by the relative income level. etc. Hij = β0 + β1 Qj + β2 Q2 j + Iij Γ + Xij Θ + εij . We also include the squared term of inequality to capture the potential nonlinear effect. Iij is the vector of per capita income and income squared.). A similar hypothesis is the relative position hypothesis. rather than an individual’s absolute income. To test the weak version. According to this hypothesis. but the relation might not be linear (β2 = 0). health declines when one is financially deprived relative to one’s peers.8 8 The rank extends the concept of relative income as it can be measured by socioeconomic factors other 7 . (2) We expect a positive coefficient on the interaction term (η > 0). which stresses that one’s relative rank in a group is related to health outcomes. alcohol use. we extend equation (1) by introducing the interaction between inequality and a person’s rank (in ascending order of income). or that the negative effect of inequality on health outcomes is smaller for people with higher income rankings. Hypothesis 3: Relative Income Hypothesis The relative income hypothesis states that health depends on an individual’s income relative to others in his or her group. and Xij is the vector of other individual.

9 Some research on monkeys and primates (e. since they measure the level of relative income more specifically by the differences between an individual’s income and the incomes of the richer members of the group. but the two are not totally equivalent... In this sense. 1991). but finds no evidence supporting the hypothesis (eg. thus diminishing their health directly through diseases or indirectly via health-compromising behaviors.” 8 . one of the most widely-known studies on relative income (position). Some recent research uses the mean (or median) income of a community as a proxy for relative income. If inequality increases. However. the strong version of the income inequality hypothesis goes further than the relative income hypothesis.g. Cohen et al. Shively et al. even rich people. Robert.Some psychosocial and material factors may play a role in the mechanisms connecting relative income to health. Marmot et al.. Using than income. 10 Deaton (2003) takes the case of local housing in a town: the richest people are able to get the hilltop plots with fine views while the poorest are left with the plots downward of the smokestacks. Thus the harmful effect of income inequality is greater among the least well off. Gerdtham and Johannesson. Perceptions of being relatively deprived compared to their peers may make people stressed and depressed.. such as occupation and education. However.. the strong version suggests that income inequality might directly influence health through channels independent of relative income. here determined by money.. 1997. According to the strong version. and the rich become relatively more prosperous. the Whitehall study in Britain (Marmot et al.9 Another possibility is that within a community. Thus. 2004). the poor are made even poorer in relative terms. 1984. but rank. 1998. the relative income theory parallels the weak version of the income inequality hypothesis. 1997) provides biological evidence of how relative status may affect health. Studies using different measures of relative income generate mixed results.10 The relative income hypothesis is consistent with an effect of income inequality. relative income (or rank) may be more important in determining an individual’s access to material goods or services that are correlated with health. finds higher rates of morbidity and mortality among civil servants in the lower administrative ranks. who are least deprived in terms of relative income. The contributions by Deaton (2001) and Eibner and Evans (2001) are more interesting. This is an example “where it is not money itself that is important. may still suffer the adverse impacts of high income inequality.

were then randomly The definition of relative deprivation is originally proposed by Runciman (1966). and shows the link between relative deprivation and income inequality. Shandong. Guangxi. Four neighborhoods in each city. and the Chinese Academy of Preventive Medicine in 1993.these measures.2 for details). who argues that one is deprived if others in the group possess something that one does not have. 11 9 . data.11 they both find a significant relative-income effect on individual mortality from U. The difference in subscripts between Qj and RDij means that income inequality is an aggregate measure for the whole community. and one county-town neighborhood and three villages in each county. Moreover. which were collected by the Carolina Population Center (CPC) at the University of North Carolina at Chapel Hill. Jiangsu. Hubei.12 The sample households were randomly drawn in eight provinces including Liaoning.cpc. Yitzhaki (1979) develops the definition by viewing income as personal possessions. Following Eibner and Evans (2001). which stands for relative deprivation indices that measure an individual’s relative income (see section 4. and increases the probability of participating in health-compromising behaviors. we test the relative income hypothesis using the following specification. which are called relative deprivation (RD).S. such as smoking and not wearing a seatbelt while driving. 3 Data In this paper. except that we replace Qj with RDij . 12 A detailed description of the data and quality control procedures can be obtained at http:// www. Hunan. we use the China Health and Nutrition Survey (CHNS) data. Hij = β0 + β1 RDij + Iij Γ + Xij Θ + εij . the Institute of Nutrition and Food Hygiene. while the relative income measures that we use are individual-specific. Henan.edu/projects/china/. and Guizhou. (3) Equation (3) is similar to equation (1). Eibner and Evans (2001) show that relative deprivation also influences the probability that an individual will engage in health-compromising behaviors.unc. We hypothesize that higher relative deprivation of income (or lower relative rank) reduces the probability of being healthy. Two cities and four counties were sampled in each province.

even when controlling for more objective health measures (Idler and Benyamini. and the other of blood pressure. In total. As with SRHS. Deaton and Paxson. etc. SRHS is a categorical variable coded on a scale of one (excellent) to four (poor). Self-reported health status (SRHS) is the main health measure we use. SRHS. We now discuss a variety of measurement issues that need to be clarified before we present our estimation results.selected. Although SRHS is a subjective measure of individual health. PF provides information on the status of various body functions associated with heart. 3. We define a neighborhood or village as a community unit. Table 1 summarizes the definitions of variables in our sample. we also exclude those with non-positive household income. We construct a binary variable. lungs and stomach condition.1 Health Indicators The CHNS data offer several potential health measures. 1997. education. As we need to construct income inequality and relative deprivation indices.” 14 In the survey. ADL In the survey the interviewees were asked the question “right now. family income. We use two common indicators as PF measures: one is of heart. 1998). we have 7. how would you describe your health compared to that of other people of your age. etc. which are recorded in the physical examination section of the survey. which equals one if excellent or good health is reported and equals zero if fair or poor is reported. Approximately 20 households were sampled per community. 13 10 . physical conditions and health behaviors. we define two binary variables that equal one if the function is normal and zero otherwise. eyesight. The CHNS data contain detailed information on household and individual characteristics as well as health-related information such as self-reported health status. arms.13 previous studies show that SRHS is highly correlated with subsequent mortality. hearing. marital status.).300 observations in the sample. We restrict our sample to men and women over the age of 20 for whom we have a complete set of data on health and demographic variables (age. legs.14 We also use several objective health measures such as physical functions (PF) and activities of daily living (ADL). as shown in the top panel of Table 1. sex.

Regarding drinking behavior. such as taking a bath. Table 2 provides descriptive statistics concerning these health measures.. as illustrated in Table 1. Regarding smoking behavior. the CHNS data contain information on some healthcompromising behaviors such as smoking and alcohol consumption.measures whether or not the individual is physically restricted or unable to perform daily activities.172 observations. we generate a sub-sample of 3. Among all individuals. 11 . we find that men are more healthy than women. The proportion declines with age. and the frequency of drinking. we have knowledge of whether or not an individual smoked at the time of the survey. The proportion of people with no limitations in daily activities is close to that for SRHS. or putting on clothes. by limiting our sample to men who have non-missing behavior variables. 65 percent of men were smoking at the time of the survey.e. i. and equal to zero if respondents report any difficulty in these activities. and the number of cigarettes smoked per day. As most of the smokers and drinkers are men in our sample. Finally. By contrast.998 observations of the elderly. ADL measures are unavailable for individuals under fifty. In total. but ADL and health behavior variables are only available for smaller samples. cigarettes per day. current drinker and drinking frequency. both exceeding 90 percent for the whole sample. and 63 percent reported that they drank during the year prior to the survey. Examining the data in two sex groups. as only 56 percent of those over fifty report themselves to be in good health. We create two binary variables that are equal to one if respondents are able to perform the walking and lifting activities respectively. SRHS and PF measures are available for the whole sample. higher normal rates are reported for the two measures of physical functions. although it should be remembered that the sample is much smaller. Besides these direct measures. we know whether or not an individual had drunk any alcoholic beverage in the year prior to the survey. thus we can only use this measure for a sample of 1. with 76 percent of men but only 70 percent of women reporting themselves in good health. 73 percent reported being in good health. eating and drinking alone. current smoker. we have four variables to measure health behaviors. However.

While larger values in RDA. relative deprivation of log income (RDL).32 (Table 2). Based on the theory developed by Yitzhaki (1979). to test the robustness of our results. relative deprivation reflects a person’s position or rank relative to the incomes of others within a reference group. (4) It measures the relative deprivation of person i with income yi in a reference group of N people by the normalized total incomes of other group members who earn more than i does. As the Gini Coefficient depicts the overall income distribution of a society. and the choice of inequality indicators does not change the relationship between income inequality and mortality.2 Income Inequality and Relative Income Measures In this paper we mainly use the Gini Coefficient to measure the community-level income inequality.e. relative deprivation of absolute income (RDA). In contrast to the first three measures. namely the ratio of RDA relative to person i’s own income. The summary statistics of our relative deprivation measures are reported in Table 2. we construct several relative deprivation indices as the proxy for relative income. Unlike the Gini. We also use another inequality index. i. 12 . the rank ignores the magnitude of the income difference between individuals.6. The Gini ranges from 0. Following Eibner and Evans (2001). The final index we use is the individual’s centile rank within the reference group (where income is sorted in ascending order). and individual rank. with the average value around 0. RDL is the same as RDA except that it uses log (y ) rather than y in (4). RDL and RDI indicate higher levels of relative deprivation. and find that using different measures of inequality does not change our results qualitatively. RDI equals RDAi /yi .1 to 0. we calculate the Gini based on household income weighted by the family size. namely the Theil index. higher centile rank means a lower level. RDA is defined as: RDAi = 1 N (yj − yi ) j ∀ yj > y i .. which 15 Kawachi and Kennedy (1997) show that the six inequality measures (including the Gini Coefficient and the Theil index) used in their study are highly correlated with each other. relative deprivation over individual income (RDI). In order to be consistent with the Gini Coefficient. we use households in the same community as the reference group to generate these RD measures.3.15 For every community. In total there are about 180 communities in our sample.

family size. Specifically.16 Household environment measures the degree of excreta contamination around the respondent’s dwelling place and is directly recorded through the interviewer’s own observation. in better environments. we find that on average healthy people have higher per capita income and education level. The t-ratios in column 3 show that most of the means are significantly different between the two sub-samples. In Table 3 we divide the sample into two sub-samples: good health and poor health (columns 1 and 2). the poor health group on average is slightly more deprived. Those in good health also live in larger families. 3. 16 13 . and closer to medical facilities. On the other hand. rural and provincial indicators. as the average Gini Coefficient and Theil index for the two groups are very close. RDL and RDI) are not limited in value and therefore have larger variations in the sample.is bounded between 0 and 1. relative deprivation measures (RDA. education. as indicated by its smaller mean of individual rank and larger mean of the other three indices. age and age squared. and are much younger than unhealthy ones. the distance from the community to nearby medical facilities. The distance to medical facilities is obtained from the CHNS community survey and measures the availability of public health services to the community.374 yuan. we control for variables including per capita income and income squared. We use the consumer price index included in the CHNS data to adjust per capita income to prices in urban areas in Liaoning province. and year. Individuals in our sample have an average income of 1.3 Other Explanatory Variables In the individual-level analysis. The role of income inequality is less explicit. indicators for sex and marital status. The differences in personal characteristics between the two sub-samples are what we would intuitively expect. We use the average distance if more than one facility is frequently used. household environment. except for some inequality and relative deprivation variables. We show the descriptive statistics for these variables in Table 2.

14 .” i. the coefficients on the Gini and Gini squared both become significant at the five percent level.17 Our specifications also allow us to test the absolute income hypothesis (Hypothesis 1). we repeat all the regressions using the Theil index and obtain very similar results. the correlation is still insignificant.1 Income. PF. We also make changes in the model specifications to test the robustness of our results. and personal and household characteristics.40 (75 percentile in the sample) and decreases with inequality for larger Gini. The positive coefficient on the Gini and negative coefficient on Gini squared mean that SRHS increases with inequality when Gini is less than 0. we have the Gini as the only independent variable. Income Inequality and Individual Health We first employ Probit and OLS models to test the income inequality hypothesis (Hy- pothesis 2). However. or the marginal change of probability of reporting excellent or good health when the independent variable increases. The coefficient on the Gini is positive but not significant. in column 3. The results 17 As a robustness check. The main purpose of our study is to examine the correlation between individual health and income inequality or relative income. 4.e. in both the strong and weak versions. even though it is not our focus. Self-Reported Health Status Table 4 presents the results of probit regressions using SRHS as the dependent variable..4 Estimation Results In this section we employ OLS and Probit models to systematically test various hy- potheses discussed in Section 2. When we add the squared term in the second column. after we include other control variables such as per capita income. a quadratic relationship between SRHS and income inequality. In the first column. The results exhibit an “inverted-U. ADL and health behaviors. We apply models (1) and (2) to various health measures such as SRHS. We use the Gini Coefficient as the inequality index in this subsection. We report dF/dx. using individual-level data.

This effect decreases with inequality and becomes negative at high levels of inequality. As in the previous regression. but at a decreasing rate.833 yuan. at the mean level of the Gini (0. the Gini has a quadratic effect on health. the distance to medical facilities has a negative sign but it is statistically insignificant.8 percentage points higher probability of reporting good health. which suggests that the partial effect of the Gini depends on both the rank and the Gini itself. i. Men have a 3.e. and married people have a 4.50) = 0.2 percentage points higher probability than single people.051 + (−1.378 × 0.6) raises the probability by 1.3 percentage points. The critical point of the health-income quadratic curve is about 6. Moreover.10) will lead to a 1. But the negative interaction suggests that. Next in column 4.9 percentage points higher probability of being in good health than women. One more year of schooling increases the probability of being in good health by 0. Finally. the interaction between the Gini and the individual rank is negative and significant. the total partial effect of income inequality on health is 1.suggest that the strong version of the income inequality hypothesis (Hypothesis 2) is only supported for communities with large inequality.1 percentage points per year. we test the weak version of the income inequality hypothesis. A one-standard-deviation increase in family size (1.9 percentage points. The positive coefficient on income and negative coefficient on income squared are both significant at the one percent level. The protective effect of good household environment is sizable. increasing the probability of reporting good health by 13 percentage points. but 99 percent of the values for income in our sample are below this figure. This means that for most of our sample health increases with absolute income..32) and the individual rank (0.180.32) + (−0. This means that an increase in the Gini by one standard deviation (0.50). For example. The probability of being in good health decreases with age at a rate of 1. Other control variables also have the expected signs in column 3. Column 3 shows that there is a concave relationship between individual health and per capita income.18 We also find evidence supporting the absolute income hypothesis (Hypothesis 1). whether the effects of inequality differ by relative income.065 × 2 × 0. 15 . for people with higher 18 This is consistent with the findings of LeClere and Soobade (2000) who use US data.

but this positive effect becomes weaker in a more unequal community. the results in Table 4 show that the community-level income inequality influences the individual health status in a nonlinear way. and even turns negative when inequality is very high (the Gini above 0. in column 3). The enhancing effect of personal rank on health becomes smaller with more inequality.148 + (−0. The coefficient on the rank is significantly positive. and the proportion reporting normal blood pressure is 95 percent. In short. At the mean level of the Gini (0. The higher individual rank is beneficial to one’s health. the detrimental effect of income inequality on health is greater.rankings. The effects are not altered by one’s relative income position. According to the estimated coefficients. the total partial effect of an increase in the rank on health is 0.378 × 0. Physical Functions Table 5 reports estimations using two PF variables as dependent variables: the condition of heart. lungs and stomach.40. but no correlation between the Gini and blood pressure (columns 4 and 5). but the effect decreases with the Gini. as the coefficients on the interaction term are insignificant (columns 3 and 6). The proportion of people reporting normal heart condition amounts to 93 percent. that income inequality harms the health of the poor more than the rich. the result is more interesting if we examine the partial effects of the individual rank.32) = 0. This result seems to contradict what is predicted by the weak version of the income inequality hypothesis. We find a nonlinear relationship between the Gini and heart function (columns 1-3).39). 19 16 . However.32). income inequality tends to have a detrimental impact on health when a community has large inequality (the Gini above 0.19 Activities of Daily Living One concern about the above results is that PF measures may lack variation in our sample. and the condition of blood pressure. Only a few of the control variables are significant.027. Thus we can interpret the negative interaction as implying that living in a more unequal community would dilute the positive effect of the rank on health.

ADL measures may not be directly determined by general characteristics. We follow the estimation specifications that were previously applied to PF indicators. The community Gini has a negative effect on both walking and lifting abilities (columns 1 and 4). Moreover. we estimate the influence of income inequality on ADL measures in a restricted sub-sample of elderly people. 17 . the Gini has a strong positive effect.As another check. since the interaction of Gini and rank is not significant in columns 3 and 6. i.6 percentage points.10) will increase the probability of smoking by 2. The impacts of income inequality on ADL limitations are independent of the individual rank. We now explore one of the potential mechanisms of their correlation by examining whether an increase in income inequality increases the probability that an individual engages in health-compromising behaviors. The probit and OLS regression results using different dependent variables are reported in Table 7. Like PF variables. In the first column we have the current smoker indicator as the dependent variable. The two dependent variables we use are indicators of whether one is able to walk for one kilometer and lift a five-kilogram bag without difficulty. As with the estimation on current smoker. It predicts that a one standard deviation increase in community Gini (0. The coefficient on the Gini is positive and significant at the five percent level. Health Behaviors Previous results show that income inequality is strongly correlated to health outcomes. Table 7 (columns 1 and 2) shows a strong correlation between inequality and smoking habits.29 (about 38 percentile in the sub-sample).e. inequality has a nonlinear effect on the lifting ability (columns 5 and 6). We then use the OLS model to estimate the effects on cigarettes consumed per day in the second column. smoking and alcohol consumption. The estimation implies that the probability of being able to lift the bag decreases with income inequality when the Gini is greater than 0.. The regression results in Table 6 further confirm our finding that income inequality has an impact on individual health. because few of the control variables are significant in Table 6.

RDL and RDI). none of the coefficients on RDA. their effects are estimated separately. The effect of income inequality on the probability of being a current drinker is positive and significant at the five percent level. RDL and RDI is statistically significant. On the other hand. the coefficients on the Gini suggest that a rise in the Gini by one standard deviation (0.20 Holding an individual’s income constant. The estimation results with SRHS as the dependent variable (Table 8) show that the relative income hypothesis is only supported when relative deprivation is measured by one’s income rank. the individual rank has a significantly positive effect on SRHS. Their results are imprecise in many cases when they measure relative deprivation using rank. Specifically.01). we are not allowed 20 18 . RDL. but do not find any significant correlations with the relative deprivation indices. our results may be sensitive to the reference group we define. The model to be estimated is equation (3). including the individual rank (hence the results are not reported). who find that the relative deprivation has a stronger impact on health when it reflects income differences between individuals (measured in RDA. The pattern is similar for drinking frequency. even after we control for absolute income (column 4).2 percent higher probability of drinking alcohol.21 This effect is already shown when we test the weak version of the income inequality hypothesis (Table 4. 4. RDI and individual rank.2 Relative Income and Individual Health We now test the relative income theory (Hypothesis 3) by replacing the independent variables of inequality with relative deprivation measures: RDA. and an increase in drinking frequency by approximately half of its standard deviation (2. We conduct the same estimations taking PF/ADL and health behavior measures as dependent variables. increases in other people’ income (thus lowering the individual’s own rank) can be harmful to the individual’s health. column 4). 21 Due to the relatively small sample (about 40 individuals per community on average). Because these measures are highly correlated with each other.Table 7 (columns 3 and 4) also exhibits a strong association between inequality and drinking behavior. Our results differ from those of Eibner and Evans (2001). However. In columns 1 to 3.10) causes a 2.

where we can see the people interacting with each other more to define narrower reference groups by age or education within the community. studies. Another limitation is that we only focus on one dimension of inequality.or provincial-level.S. the relationship we find appears as an “inverted-U” shape. and to harm health when inequality is above a certain level. rather. it is among the first to provide evidence from a developing country on the negative association between inequality and health.5 Conclusion In this paper. we employ micro data from China to test several hypotheses linking income and income inequality to individual health status. We find some evidence supporting these hypotheses. In fact. as Eibner and Evans (2001) are able to do. Second. While this study has its own limitations. Finally. our results show a concave relationship between self-reported health status and per capita income (the absolute income hypothesis).. Although the sample size is relatively small compared with the data in many U. and is probably the best Chinese data set. We do not claim that community-level inequality is necessarily more important than inequality at county. both of which are important issues for students of development. Additional income brings about greater improvement in the health of the poor than of the rich. community-level inequality. but its protective effect decreases with inequality and turns negative under extremely high inequality. the centile rank of income has a strong positive effect on self-reported health status (the relative income hypothesis). the set of CHNS data we have used is so far one of the best data sets used in studying inequality and health in the context of developing economies. We also find evidence that income inequality may influence health via increasing the likelihood and frequency of health-compromising behaviors such as smoking and alcohol consumption. i. 19 . That is to say.e. rising inequality tends to improve health when inequality is low. we find a significant association between self-reported health status and community-level income inequality (the income inequality hypothesis). First. our purpose is to examine the socioeconomic impacts of inequality in a local setting.

The government has recently been shifting its focus from the more developed coastal areas to the poor inland areas. lower tax rates and cheaper loans. 1997). It plans to remove all agricultural taxes in the next two to three years. 20 .” in agriculture (Lin. The Chinese government has apparently taken note of the serious issue of inequality. “eating from the same kitchen system. strictly speaking. Finally. Wen Jiabao. The reforms have improved incentives in most workplaces. the causality is more likely to go from inequality to health because it would be difficult to argue that individual health affects the community-level inequality. income redistribution will improve the health of the population. intuitively. our paper shows a particular one. has repeatedly told the public that the goal of this government is to achieve equitable growth.closely. While it remains to be seen how well these policies are implemented and how effective they are. the government is moving in the right direction in fighting inequality. As suggested by our results. our empirical tests are tests of correlations between community-level inequality and individual health. 1992). However. in industry (Li. especially in regions where large inequality prevails. the new premier. the ever-increasing inequality that accompanies growth will ultimately slow it down. The causal link may not be established until more evidence becomes available regarding the intermediate mechanisms through which inequality affects health. While there are many channels through which inequality could affect growth. Focusing on the community level can also facilitate the empirical tests by allowing a larger variation of inequality in the sample. China began its economic reform by abandoning the principle of absolute equality. which in turn has led to historic levels of growth in the past 25 years. A recent study by Benjamin et al. However. such as a wider range of fiscal subsidies. The government is also shifting its focus from the fast developing industries to the sluggish agricultural sector which employs most of China’s poor. introducing a series of preferential policies in favor of the latter. 1997) and even in government (Qian and Weingast. poor health. which is itself a direct indicator of underdevelopment. (2004) finds that village-level inequality is negatively associated with village economic growth in the long run.

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0 if not Average number of cigarettes smoked per day 1 if drink alcoholic beverage in the year prior to the survey. 5 if daily or almost everyday Inequality and Relative Deprivation Community Gini Community Theil Individual Rank RDA RDL RDI Other Variables Income Education Age Male Indicator Married Indicator Family Size Household Environment Distance to Medical Facility Rural Indicator Per capita household income Years of formal schooling (Restricting our sample to adults over the age of 20) 1 if male 1 if married. 3 if once or twice a week. lungs and stomach. for all yj > yi . 0 if some or much Average distance of the community to most frequently used facilities 1 if the community is a village unit Gini Coefficient of income within the community Theil index of income within the community Centile rank (in ascending order of income) within the community Yitzhaki’s relative deprivation index: RDAi=∑(yj-yi)/N. 4 if 3-4 times a week. 0 if with limitation 1 if able to lift a 5-kilogram bag. i. including adults and children 1 if little or no excreta around dwelling place. 0 if not 0 if not drink.. 0 if never married or divorced or widowed Number of household members. 0 if with high blood pressure Definition 1 if health is excellent or good. 0 if otherwise 1 if normal in blood pressure. where yi is income of person i and N is the size of the community Substituting log(y) for y in RDA RDA/y. 1 if no more than once a month. 0 if with limitation 1 if normal in condition of heart. 0 if fair or poor 25 .e.Table 1: Definitions of Variables Variables Self-Reported Health Status (SRHS) Physical Functions (PF) Heart Function Blood Pressure Activities of Daily Living (ADL) Walking Lifting Health Behaviors Current Smoker Cigarettes Per Day Current Drinker Drinking Frequency (0~5) 1 if smoke at the survey time. 2 if once or twice a month. dividing RDA by one’s own income 1 if able to walk for a kilometer.

374 6.050 43.549 18 93 1 1 13 1 22 1 0.307 0.323 0.099 0.677 1.381 14.259 0.247 4.0001 0 20 0 0 1 0 0 0 13.446 0 0 1 1 0.Table 2: Descriptive Statistics of Health.726 0.429 0. Inequality and Other Variables in China Standard Variables Self-Reported Health Status (N=7.556 0.468 0.764 0.137 0.596 0.300) Whole Sample All Men All Women Age above 50 Physical Functions (N=7.444 0.498 0.300) Heart Function Blood Pressure Activities of Daily Living (N=1.415 0.05 0.804 1.494 0.379 1.124 0.198 106.172) Current Smoker Cigarettes Per Day Current Drinker Drinking Frequency Inequality and Relative Deprivation (N=7.004 9.010 0 0 0 0 1 60 1 5 0.066 0.534 0.397 2.300) Community Gini Community Theil Individual Rank RDA (/1000) RDL RDI Other Variables (N=7.457 0.513 5.500 0.928 0.497 0 0 0 0 1 1 1 1 Mean Deviation Min Max 26 .203 0.863 0.409 0.634 2.671 0.224 0.429 0.226 0.762 1 3.482 2.833 4.730 0.300) Income (1000 yuan) Education Age Male Indicator Married Indicator Family Size Household Environment Distance to Medical Facility (km) Rural Indicator 1.373 1.998) Walking Lifting Health Behaviors (N=3.498 0.470 0.025 0 0 0 0 0.947 0.224 0 0 1 1 0.650 10.703 0.303 0.057 0.590 0.758 0.477 10.

500) 0.50*** 5.445) 1. 5.649 (3.374) 1.542) 0.37*** 9.464) Note: *.015) 0.90*** 1.531 (15.89*** 2.477) 4.392) 0.91*** 2.968 SRHS=1 5.443 (0.398) 4.300) Mean and Standard Deviation (1) Variables Observations Inequality and Relative Deprivation Community Gini Community Theil Individual Rank RDA (/1000) RDL RDI 0.362) 4.471 (0.301) 0.322 (0.423 (0.220) 40.506) 1.Table 3: Descriptive Statistics of Variables for Healthy versus Unhealthy People in China (N=7.281 (1.332 0.203 (0. and *** represent significance levels of 10.729 (0.21*** 4.177 (4.832 (0.098) 0.202 (0.701) 0.136) 0.368 (0.802 (0.37 4.139) 0.437 (2.277 (1.707) 0.448 (0.178) 4.410 (1.04*** 15.58*** 1.845 (0.185) 0.78* 2.740 (4.29*** 4. 27 T-Statistics (3) (2) SRHS=0 1.508 (0.951 (13.270) 6.78*** 25.464 (1.650 (0.353 (6. and 1 percent.533 (4.540) 50.57 0.515) 1.323 (0.497) 0.590) 0.32 1.666) Other Variables Income (1000 yuan) Education Age Male Indicator Married Indicator Family Size Household Environment Distance to Medical Facility (km) Rural Indicator 1.686 (0. **.407 (0.415) 0.619) 0.100) 0.304) 0.516 (0.91*** .

41) Gini * Rank -0.Table 4: Probit Regressions Measuring the Effects of Income Inequality on Self-Reported Health Status Dependent Variable: Self-Reported Health Status (1=excellent or good.33) Male Indicator 0.039*** (3.87) -1.58) 0.309 (1.98) Individual Rank (3) 0.033*** (2.10) Control Variables Income (/1000) 0.54) Family Size 0.003** (1.042** (2.011*** (-4.57) .70) Education 0.32) 0.043*** (2.52) 0.012*** (3.039*** (3.030 (0.57) Gini Squared (2) 0.003** (2.148** (2.00) Age -0.003*** (-2.47) (4) 1.032 (1.378** (-2.032 (1.87) 0.66) -0.012*** (3.98) -0.15) -1.041*** (4.065** (-2.414 (-0.002* (-1.48) 28 0.40) Income Squared -0.926*** (2.07) -0.131** (-2.34) 0.51) Age Squared (/1000) 0.011*** (-4.53) Married Indicator 0.051*** (3.51) 0. 0=fair or poor) (1) Community Gini 0.

Household Environment 0.19) Provincial Indicators Observation Pseudo R-squared No 7300 0.92) -0.00 Yes 7300 0.130*** (8. and 1 percent. 5.10 Note: Numbers in parentheses are t-statistics.61) Rural Indicator 0.10 Distance to Medical Facility -0.027** (2. *. **.05) Yes 7300 0.129*** (8.001 (-0.00 No 7300 0. 29 .029** (2.69) 0.001 (-0.89) 0. and *** represent significance levels of 10.

0003 (1.80) Family Size 0.007* (-1.0004 (-1.18) -0.12) 0.036 (1.13) 0.0004 (-1.0002 (0.006*** (-2.007*** (-4.90) 0.012** (2.003 (0.12) -0.37) -0.005 (1.006*** (-6.84) 0.18) .013** (2.88) 0.01) -0.23) 0.36) Control Variables Income (/1000) 0.0002 (0.007 (0.007*** (-5.06) -0.003 (1.041*** (3.01) -0.008* (-1.08) (6) -0.Table 5: Probit Regressions Measuring the Effects of Income Inequality on Physical Functions Dependent Variable: Heart Function (1=Normal in heart. lungs and stomach.15) Age -0.08) Gini Squared (2) 0.92) 1.19) -0.03) 30 Dependent Variable: Blood Pressure (1=Normal blood pressure.007* (-1.005 (-0.79) 0.71) 0. 0=High blood pressure) (4) 0.20) -0.076 (-0.14) -0.04) -0.61) 0.133 (1.033 (-0.036*** (4.10) 0.93) 0.007 (0.0001 (0.005 (0.0004 (-0.88) 0.90) 0.55) 0.99) Income Squared -0.95) 0.128 (1.93) 0.00002 (0.73) 0.61) 0.08) Gini * Rank -0.0004 (-0.01) Age Squared (/1000) 0.27) -0.012 (0.0004 (-0.533** (-2.68) -0.0002 (0.11) Married Indicator 0.006*** (-6.97) -0.0001 (0.03) 0.10) -0.06) -0.036*** (4.042*** (3.008 (1.402** (2.82) 0.91) 0.0001 (0.05) -0.73) 0.04) 0.007 (0.068 (-0.0003 (1.13) 0.005 (-1.006*** (-2.0003 (0.003 (1.19) Male Indicator 0.0002 (0.007*** (-4.02) -0.20) Individual Rank (3) 0.430** (2.31) -0.73) (5) -0.041*** (3.542** (-2.012** (2.95) 0.0002 (0.70) Education 0.83) 0.006*** (-6.036*** (4.43) -0.003 (1. 0=Otherwise) (1) Community Gini 0.001 (-0.16) -0.003 (-0.

31 .015* (1.016*** (4.08 0.59) Yes 6359 0.006 (1.08 0.08 Note: Numbers in parentheses are t-statistics.26) Yes 6048 0.20) 0.80) -0.56) 0.002** (-2.02) 0. 5.012* (1.Household Environment Distance to Medical Facility Rural Indicator 0. **.17) Yes 6048 0.0003 (0.006 (1.015** (2.21 Provincial Indicators Observation Pseudo R-squared Yes 6359 0.012 (1. *.78) -0. and 1 percent.65) Yes 6359 0.006 (1.015* (1. and *** represent significance levels of 10.79) -0.0003 (0.30) 0.21 0.39) 0.016*** (4.21 0.48) 0.015*** (4.30) Yes 6048 0.002** (-2.39) 0.0004 (0.015* (1.34) 0.58) 0.24) 0.002** (-2.

25) -0.0004 (0.85) (5) 1.001 (0.185* (1.001 (-0. 0=Have limitation) (4) -0.37) -0.009 (-0.59) Gini * Rank -0.001 (-0.019 (0.71) 0.012* (1.55) -0.009 (-0.07) 0.438 (-1.93) Individual Rank (3) 0.17) 0.64) 0.21) Family Size 0.15) Income Squared 0.65) 0.246* (1.003 (1.143** (-2.991 (-0.40) -0.71) 0.124*** (4.89) -2.41) 0.78) .24) -0.062 (-0.320** (-2.313 (0.235 (1.549*** (-3.003 (0.81) -0.25) 0.010 (-0.192 (0.314** (-2.36) -0.004 (0.59) -0.58) -0.083 (-0.74) 0.025 (1.25) 0.028 (1.19) Age Squared (/1000) -0.11) 0.035 (1.011 (-0. 0=Have limitation) (1) Community Gini -0.06) Male Indicator 0.71) 0.002 (-0.152*** (6.65) -0.71) -0.24) 0.001 (0.007 (-0.03) Control Variables Income (/1000) 0.004 (0.024 (1.126*** (4.005 (0.026 (-0.72) 0.012* (1.125*** (4.78) 0.003 (0.002 (-0.81) 0.83) 0.003 (0.45) (6) 1.15) 0.65) Age 0.072 (-0.21) -0.43) 0.030* (1.153*** (6.034 (1.003 (0.42) Education 0.003 (-0.29) 0.204 (-0.88) -0.68) 32 Dependent Variable: Lifting (1= Able to lift a 5-kg bag.152*** (6.63) -0.034 (1.86) 0.025 (1.004 (0.311** (-2.88) -2.008 (-0.24) -1.101 (0.013* (1.44) Married Indicator -0.25) -0.333*** (-2.27) 0.081 (-0.76) 0.174** (-2.57) 0.88) 0.73) Gini Squared (2) 0.61) -0.70) 0.14) -0.Table 6: Probit Regressions Measuring the Effects of Income Inequality on Activities of Daily Living Dependent Variable: Walking (1=Able to walk for 1 km.60) -0.

002 (0. **.035 (1.031 (0.49) -0.58) Yes 1998 0.32) 0. 5.043 (1.70) 0.003 (-0.76) Yes 1479 0.13 Note: Numbers in parentheses are t-statistics.56) 0.047 (1. and 1 percent.99) Yes 1479 0.05) Yes 1998 0.16) 0.15) Yes 1998 0.90) 0.41) 0.041 (1.002 (0.040 (1.92) 0. 33 .19 0.13 0.43) -0.043 (1.004 (-0.46) 0.039 (1.19 Provincial Indicators Observation Pseudo R-squared Yes 1479 0.003 (-0.024 (0.029 (1.003 (0. *.23) 0.Household Environment Distance to Medical Facility Rural Indicator 0. and *** represent significance levels of 10.026 (1.045 (1.19 0.27) 0.39) -0.13 0.

56) -1.80) 0.811*** (4.53) Rural Indicator 0.128*** (4.32) -0. *.39) Age Squared (/1000) -0.49) Married Indicator 0.64) Age 0.182*** (-4.008 (0.06) -0.04) -0.03 0.007*** (-2.76) -5.03 0.030*** (3.25) Yes 3172 0. and *** represent significance levels of 10.261*** (-6.006** (2.27) Yes 3172 0.82) -0. **.87) Control Variables Income (1000 yuan) 0.83) 0.003 (0.005 (-0. 5.39) 0.15) 0.67) Education -0.34) 0.219** (2.662** (3.088*** (-6.022 (0.14) 0.70) Yes 3172 0.106*** (6.023*** (5.41) Family Size 0.140*** (-2.55) 0.72) Probit Current Drinker (4) 0. and 1 percent.68) Note: Numbers in parentheses are t-statistics.007 (0.303** (2.395*** (3.68) 2.141*** (4.694* (1.37) 0.003 (0.048 (0.498*** (-6.39) OLS Drinking Frequency (5) 0.06 0.66) 0.70) 0.74) 0.013*** (3.059** (2.013* (1.04 OLS Cigarettes Per Day (2) 6.39) Provincial Indicators Observation R-squared Yes 3172 0. 34 .970*** (2.002 (-0.Table 7: Probit and OLS Regressions Measuring the Effects of Income Inequality on Health Behaviors Probit Current Smoker (1) Community Gini 0.258*** (2.461*** (5.

040*** (3.69) Income Squared -0.56) 35 (2) (3) (4) 0.041*** (3.002** (-1.012*** (3.68) 0.004 (-0.046* (1.91) Control Variables Income (/1000) 0.48) 0.57) 0.73) -0.54) 0. 0=fair or poor) (1) RDA (/1000) 0.020* (1.14) 0.64) 0.002** (-2.041*** (3.70) -0.Table 8: Probit Regressions Measuring the Effects of Relative Deprivation on Self-Reported Health Status Dependent Variable: Self-Reported Health Status (1=excellent or good.013*** (3.033 (1.003* (1.003 (0.40) Male Indicator 0.011*** (-4.043*** (2.40) 0.012*** (3.032 (1.012*** (3.18) 0.0001 (-0.70) 0.70) Married Indicator 0.75) -0.59) Family Size 0.002** (-2.96) 0.61) 0.08) Individual Rank 0.30) RDI -0.033 (1.59) 0.043*** (2.002 (1.73) 0.035*** (3.043*** (2.001 (-1.34) 0.034*** (3.18) RDL -0.011*** (-4.61) 0.40) 0.59) 0.62) Age Squared (/1000) 0.61) .011*** (-4.041*** (3.10) -0.011*** (-4.041** (2.18) Education 0.033 (1.002 (1.59) -0.46) -0.033*** (3.002 (1.58) Age -0.

71) 0.94) 0.001 (-0.10 0.76) 0.126*** (8. **.63) 0.03) -0. 5.040*** (3.001 (-0. and *** represent significance levels of 10.16) Yes 7271 0.97) -0.130*** (8.041*** (3. 36 . *.036*** (2.001 (-0.19) Yes 7298 0. and 1 percent.19) Provincial Indicators Observation Pseudo R-squared Yes 7300 0.64) -0.60) Rural Indicator 0.132*** (9.041*** (3.10 Distance to Medical Facility -0.Household Environment 0.001 (-0.79) Yes 7300 0.130*** (8.10 Note: Numbers in parentheses are t-statistics.09 0.