Health inputs and cumulative health deficits among the older Chinese.

Using a health economics framework, we examined how both individual level investments at different life stages and current community-level environmental factors affect individual health stock and flows at old ages. We used a nationwide dataset from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey, which included more than 15,000 adults aged 65 and older from 22 provinces in mainland China. We measured health stock with a cumulative health deficit index, a measure developed in geriatrics and gerontology that reflects deficits, illnesses, and functional impairment in numerous domains of health. The cumulative health deficit index has not been used in health economics before, but is a significant contribution because it captures the health stock concept very well and overcomes the problems of inconsistency resulting from the use of different measures of health stock in research. Our results show that several proxy measures for individual health investments in both childhood (nutritional status and parental survival status) and adulthood (family financial condition and access to healthcare) yielded positive returns to health stock measured by the cumulative health deficit index. Investments in social connections and healthy behaviors (religious involvement, alcohol use, and exercise) also produced positive returns in health stock. Current community-level factors such as air quality and labor force participation rate were significantly associated with levels of health deficits in old age as well. Yet, most of these individual investment and community environment variables did not significantly affect short-term health flows (improvement or deterioration in health status over three years). Our findings have important implications for developing preventive health programs in the context of population aging by focusing on policy-relevant predictors and a comprehensive indicator of health status in later life.