The Potential Causal Effect of Hukou on Health Among Rural-to-Urban Migrants in China
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ORIGINAL PAPER
The Potential Causal Effect of Hukou on Health Among Rural‑to‑Urban Migrants in China Meiping Sun1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A number of economic studies have shown a strong positive correlation between urban household registration status (hukou) and better health outcomes in China. The question at the center is whether the correlation implies causation. Change in the hukou system, in 1964, is used to test the causality between hukou and health. The regression-discontinuity (RD) design estimates suggest that urban hukou citizens have a much better chance of being in good health. The deleterious effects of rural hukou on health possibly work through mechanisms of income disparity, variations in educational attainment, and availability of health insurance. Keywords Rural-to-urban migrants · Household registration system · Hukou system · Health status JEL Classification I1 · I3 · R1 · R5 Research on domestic rural-to-urban migration in China is growing quickly and already includes a number of studies investigating migrants’ mental and physical health status. The results suggest that the hukou system has deleterious effects on the health of rural-to-urban migrants (Chan and Zhang 1999; Grey 2008; Li et al. 2006). For instance, a qualitative study conducted on migrant workers’ mental health in Beijing reported that psychological symptoms such as hostility, social isolation, sleep disorder, and substance abuse were very common among young rural-to-urban migrants who were interviewed (Li et al. 2006). Another study reported that migrant workers had a poorer health status than their non-migrant counterparts and the general Chinese population (Shen and Huang 2003). Because most of the studies rely upon data from a particular province or a specific city, the results may not reflect the overall health status of the floating population in China. It has also been questioned whether the observed positive correlation between urban hukou and better health represents a causal relationship, and therefore, is a good guideline for the
* Meiping Sun [email protected] 1
Department of Economics, Fordham University, The Bronx, USA
revision of public policies. The heart of the problem lies in the interpretation of the observed hukou-health correlation. With a large, on-going national dataset from the China Health and Nutrition Survey (CHNS), a change in household registration system (hukou) in 1964 is used to identify the causal effect of hukou on health among rural-to-urban migrants. In 1964, the central government started to put tight control on domestic migration. Thereafter, movement from rural to urban areas became virtually impossible. Hukou was (and is) ascribed at birth based upon mother’s hukou status, and could not be altered easily. The change in the hukou system, which occurred in 1964, provided a particularly credible source of exogenous variation in hukou status. Figure 1a illustrates the remarkable effect that the legislation change had on lowerin
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