[MUSIC] Hi, in this module we're going to be talking about education, health, and overall well being of the population. These are areas in which there has been dramatic improvement among recent decades in China and they're all subjects of a lot of social science research. We'll talk about education first. China's record with respect to increasing access to education since the middle of the 20th century has been remarkable. Soon after the founding of the People's Republic of China in 1949, elementary school education became widely accessible so that even by the 1960s, large numbers of students were going to elementary school. Opportunities to attend middle school and then eventually high school became more common later. So that especially in the cities now in China, almost all students at least achieve a high school education. And then very recently, in the last decade or two, access to college education, that is the share of the population obtaining at least some kind of a college education, has increased dramatically. Now of course, understanding the implications of this is an important topic. Improvements in education change the labor force, they affect the economy, but a big topic for social science research is understanding inequities in access to education, and understanding their causes and consequences. These inequalities in access to education in China come on several different dimensions. One is gender. There are big differences between boys and girls in terms of access to education depending on where in China they live. So in rural areas there are, even now and certainly in decades past, differences in the opportunities for boys and girls to achieve even fairly basic levels of education. Another big difference is between urban and rural. Educational opportunities are much richer in the urban areas in China. As I mentioned, in urban areas now a days almost all children can achieve at least a high school education. Obviously there are big differences in educational opportunities according to parental status. The children of wealthy high income parents, highly educated parents have many more opportunities than other children. Nowadays, especially in some of China's wealthiest cities, many of the wealthiest parents even send their children abroad to exclusive private schools not even available or considered difficult to access for residents in those countries. And finally, a key difference is according to migrant status of people living in the cities. So in the cities in China right now, we have people who have an official permission to live in those cities, that is they have a urban hukou. And then we have migrants, who are still on what's called a rural hukou, who do not have formal permission to be living in the city. The hukou determines access, among other things, to various kinds of services, including health, including education. And in urban areas the children of parents who still have a rural hukou who migrated from rural areas, have much more limited educational opportunities than the children in those same cities whose parents have an urban hukou. Just to dramatize and showcase some of the changes in education in China over the past half century or so, this figure shows some of the percentages enrolled at different levels of education. So as we can see from the blue line, China actually achieved fairly high levels of primary education very early after 1950. This is a remarkable achievement and it's indeed one of China's most amazing achievements in terms of being such a large country that was able to bring education to so many people across so many different regions in a relatively short amount of time. More recently, the numbers of people that can attain a middle school or eventually a high school education has increased very dramatically. So that now, almost all children achieve at least a middle school education. More interestingly, and perhaps more remarkably, has been in the green line, again, the recent increase in the share of children who actually go to college. And so this is likely to have important implications again for China's economic development in the coming decades. It's fundamentally altering the nature of the labor force in China. I talked about health as being another one of the big changes in China. One way of dramatizing the improvements in health is to look at life expectancy, the average numbers of years that people will live. At the time of the founding of People's Republic in 1949, life expectancy in China was quite low, maybe even in the high 30s or low 40s, there's some debate about that. But as a result of public health measures that were introduced in the 1950s and in the 1960s, life expectancy rose very rapidly. And then even to this day, it continues to improve. This reflects not only successful policies intervening in public health, but in more recent decades, increasing improvements in people's livelihoods, changes in diets and so forth. Another way of looking at and dramatizing the improvements in health in China is to look at child mortality. So since the middle of the 20th century, the proportions of children who die when they're young have fallen dramatically. So again, at the time the People's Republic was founded in 1949, the child death rates were very high in China, as high as in many other very poor countries. But then again, as a result of various public health interventions in the 50s and 60s, and then sustained interventions and other changes that have taken place in recent decades, there's been continuing declines in child mortality that continue to this day. So people basically live longer than they did in the past and they generally live healthier. But, and this is a big topic for social science researchers, there are major challenges emerging. In particular, one that receives the most attention is pollution. China is widely noted, perhaps sometimes unfairly, for being a very polluted place, especially in certain cities that are characterized by heavy industry. Economists and others that have been studying the effects of pollution argue that it has cost the Chinese economy billions of dollars. It certainly contributed to people having shorter lives than they otherwise would. There have been changes in diet and exercise in recent decades. As China has become wealthier, people's diets have changed. They're not eating at home as often anymore, perhaps not eating as many freshly cooked vegetables, and so forth. They're eating out and they're eating a lot more than they used to. So now, in China we're beginning to see the emergence of diseases that we normally associate with the most developed countries including obesity, diabetes, and heart disease. And finally, partly as a result of these changes and partly as a result of the changes in policy, changes in the economy in recent decades, the healthcare system faces a very complex set of challenges in responding to these emerging issues when it comes to health. And there are also important challenges when it comes to equity in terms of access to healthcare. There are big differences between urban and rural in terms of access to quality healthcare, and then there are also differences within the cities. One of the challenges that we can show right here in terms of the challenges that the healthcare system is facing is the amount that's being spent on healthcare in China. It's rising very rapidly. So in the first few decades after the founding of the People's Republic in 1949, China was quite remarkable in terms of achieving very high life expectancy and very low levels of child mortality even though China remained a relatively poor country and did not actually spend that much money on health. In recent years, again, the amount of money being spent on health has exploded. This partly reflects the challenges that I just talked about, the rise of chronic diseases that are very expensive to treat, heart disease, diabetes, cancer and other diseases. And it also reflects issues related to the delivery of healthcare in China and the financing of the healthcare system and pharmaceuticals. So what's the future? Well, by almost any measure, there's a lot to be, in some sense proud of, in China. And a story to be told about how people are actually, in general, in many ways better off than they were just a few decades ago. However, in the last couple decades, inequalities have also increased. So even though on average everyone may be better off, there's big differences within China now in terms of a lot of measures of well being. Whether it comes to education, or health, or other measures. And indeed when we talk about inequality, inequality in China is now among the highest in the world. It's not the highest and there's some science that are maybe moderating but income inequality in the last 20 years has risen dramatically. And wealth inequality has also grown, though it's not as extreme as in some of other countries. And finally, and related to this rise in income and more recently wealth inequality, there are these inequities in well being associated with inequities and access to education and healthcare that have emerged. Just to help dramatize the rise in inequality in China in the last few decades we can look at the GINI coefficient, a standard measure of inequality within a country in China. As we can see in the recent decades it's risen very rapidly and it's now comparable to that of the United States, another country, that in spite of being prosperous, is also widely noted for it's very high levels of income inequality. And here we dramatize or showcase the increase in inequality in China. I mentioned earlier some of the differences between urban and rural areas and this figure helps dramatize those differences. This showcases the differences between Incomes in urban areas and rural areas in China. The differences are massive. This is a central challenge for China over the coming decades. And it's one of the topics, among many, related to education, health, and other aspects of well being that are going to be important topics for social science researchers studying China in the coming decades.
