How did China's life expectancy increase?

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I was all ready to write a very different blog post than this one.

I recently learned that in the early 50s, the people of China and India had similar health outcomes, but now China is much much healthier. For example, China’s life expectancy is 78, compared to 70 in India. On the basis of this, I was ready to write a post saying “do you see how important economic development is? It’s not just about having nicer clothes and cares - it’s about saving lives!”

But it turns out that the evidence from the China-India case actually goes largely against that narrative. Because China’s biggest improvements in health outcomes came between 1950-1979 - before its economic growth, not as a result of it.

As Jean Drèze and Amartya Sen say in book I’m getting most of this information from:

“The Chinese level of average opulence judged in terms of GNP per head, or total consumption per capita, or food consumption per person, did not radically increase during the period in which China managed to take a gigantic step forward in matters of life and death, moving from a life expectancy at birth in the low 40s (like the poorest countries today) to one in the high 60s (getting within hitting distance of Europe and North America).”

So what did China do to make its people so much more healthy compared to India? To the best of my understanding from an hour of Googling, it was largely a result of:

  • Improved education: Apparently experts don’t know exactly how a population being better educated leads to being healthier, but it is accepted as a general trend. In 1949, Chinese primary school enrolment was 20%. It was up to 80% in 1958 and then 97% in 1975.

  • Relatively egalitarian distribution of food: This was possible because rural people had land and urban people had jobs. The work communes also seemed to help ensure the poorest people had access to food (1).

This is a corrective my general assumption that to drive the most important outcomes for a poor society (health, security, happiness), it’s best to just focus on economic growth. Turns out those commies did a great job improving health by focusing on health, education, and food.

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1. This access to food in China has the notable exception of the famine of 1958-61 where 17-30 Million people died. But for perspective, Drèze and Sen claim that that many people die in India every 8 or so years from malnutrition.

Democracy in India may have protected it from famine, but it does not protect it from chronic malnutrition:

“as India's experience shows, open journalism and adversarial politics provide much less protection against endemic undernutrition than they do against a dramatic famine. Starvation deaths and extreme deprivation are newsworthy in a way the quite persistence of regular hunger and non‐extreme deprivation are not.”