Eyeglasses boosted the standardized test scores of rural Chinese schoolchildren as much as 18 percent in just six months, according to a large-scale, ongoing study led by Stanford researchers.

"The evidence is overwhelming," said Scott Rozelle, co-director of the Rural Education Action Program (REAP), a coalition of Chinese universities and Stanford's Freeman Spogli Institute for International Studies that works to improve education and health in rural China.

The initial test scores for nearsighted students hovered around 68 percent. After receiving glasses, average scores soared to 86 percent. "You do these simple interventions and a child's whole life changes," Rozelle said. "It's fantastic."

REAP scholars partnered with Chinese ophthalmologists and scores of graduate students to orchestrate the massive project, the first to examine vision problems in rural China.

In 2012 and 2013, the team screened the vision of approximately 20,000 fourth and fifth graders in rural Shaanxi and Gansu provinces and doled out more than 4,000 pairs of eyeglasses. They discovered that 25 percent of the students were nearsighted, but only one in seven of those nearsighted students had the glasses they needed.

"There's a huge amount of unmet need," said Matthew Boswell, a REAP project manager based at Stanford.

The results may seem intuitive. Yet, helping the millions of nearsighted children in rural China is anything but easy, the REAP team discovered. Few of these rural children (and adults) know they are nearsighted – the world, to them, is naturally blurry. In addition, eye doctors are concentrated in the populous coastal corridors or regional "county towns," often dozens of miles by bus from the homes of rural Chinese families, Boswell said.

Basic eyeglasses cost between 200 and 500 yuan ($30 to $80), a price out of reach for many, he said.

The researchers also struggled to counter pervasive superstitions about eyeglasses.

For example, many rural Chinese residents believe that glasses make children's' vision deteriorate, relying on the observation that vision generally worsens with age, Boswell said. In addition, many Chinese do "eye exercises" by rubbing their eyes, cheeks and temples each morning, a practice they believe improves vision, he said.

They also face political struggles: China's rural health care program doesn't pay for vision care. "We could tell health or education officials until we were blue in the face there was a high level of need for vision care in rural communities," Boswell said. "But if your findings are not attached to something they care about, it's hard to make them listen."

Hence the connection to the test scores, a highly valued measurement by Chinese policymakers. The REAP team taps its large network of Chinese academic collaborators to translate its research results into policy reform, a process that is often successful, Rozelle said.

REAP is currently analyzing alternative ways to boost the delivery and acceptance of eye care, Boswell said. The original study assigned nearsighted students into six groups.  Researchers gave one-third of the students glasses; one-third received a voucher to purchase glasses; and another third remained untreated. Then, half of the students in each group received training about the causes and treatments for vision problems.

The training failed to significantly affect whether students wore the glasses, Boswell said.  The students who had to invest time to acquire glasses using a voucher demonstrated similar usage rates as students who received free glasses, he said.

Among a variety of other initiatives currently underway, the REAP team is training Chinese teachers to conduct simple vision tests, Boswell said.

"It's an extreme feel–good example," Rozelle said. "You put the first pair of glasses on a kid … and then a huge smile lights up their face."

Becky Bach is a writer for the Stanford News Service.

"Getting children in developing countries into school is only half the battle. We must also ensure they learn once they are there."

Getting children in developing countries into school is only half the battle. The Guardian cites REAP's computer-assisted learning, school lunch, and multivitamin projects as examples of ways to help kids learn once they are there. For the full article, click here.

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China’s commitment to agricultural development over the last thirty years has dramatically transformed the country’s economy. Rural income per capita has risen an astounding 20 times after 30 prior years of stagnation. Its poverty rate (US$1.25/day) has dropped from 40 percent to less than five, and 350 million rural people between the ages of 18-65 are now working in the industrial or service sector, enjoying rising wages and new economic opportunities.

This rapid transformation is largely the result of three key agricultural policy decisions: putting land in the hands of farmers, market deregulation, and major public investment in the agricultural sector. Although China must now contend with extreme inequality, high levels of pollution, and an aging farming sector there are still lessons to draw from China’s experience that could hasten the transformation of other developing countries.

China expert and agricultural economist Scott Rozelle broke these lessons down at FSE’s fourteenth Global Food Policy and Food Security Symposium Series last week, opening with an underlying theme of the series.

“Growth and development starts with agriculture,” said Rozelle. “Agriculture provides the basis for sound, sustained economic growth needed to build housing, invest in education for kids, start self-employed enterprises, and finance moves off the farm.”

To prove this point he referenced China’s ‘lost decades’ (1950s-1970s) when 80 percent of the population lived in the rural sector and relied on communal, subsistence agriculture. Poor land rights, weak incentives, incomplete markets and inappropriate investments left the average rural farmer poorer at the end of 70s than they were in the 50s with almost no off-farm employment growth.

So what changed? Incentives, market deregulation and strategic investments by the state were key.

Creating the right incentives

In 1978 the Chinese government broke the communes down into small “family farms” such that every rural resident was allocated a small parcel of land. A family of five farmed an area the size of a football field. While they did not own nor could sell the land, they had the right to choose what crops and inputs they used and the right to the income generated from their land.

“Incentives are important, and can be enough in the short run,” said Rozelle. “Hard work led to money in the pockets of farmers and China was off.”

“Every two and half years China added another California in term of agriculture,” said Rozelle.

Between 1979 and 1985 productivity for wheat, maize, and rice went up 50 percent using the same amount of labor, land and inputs. Agriculture across the spectrum has grown at an astounding rate of 5 percent since 1988 (about four times the population growth rate). Livestock and fisheries have grown even faster – accounting for most of the output of the agricultural sector by 2005.

Income growth from farming enabled family members to begin to seek work off the farm. Between 1980 and 2011, off-farm work increased 71 percent with more than 90 percent of households reporting that at least one family member worked off the farm.

Increasing efficiency through liberalization and investment

Another key policy decision was China’s commitment to market liberalization and investment in public goods.

“Markets can be an effective, pro-poor tool of development,” said Rozelle. “A remarkable partnership is formed when you let farmers do production and government do infrastructure…let markets guide decisions.”

The government dismantled state-owned grain trading companies and deregulated trading rules. Prices were set once a week the same day across China to better integrate markets, and eventually prices for major crops closely mirrored those of world prices. Villages began specializing in crops and livestock and incomes of the poor increased. By not providing government input subsidies (e.g, pesticides, fertilizers), traders were incentivized to participate in the market.

“Giving land to farmers and letting the private sector emerge is an easy thing for governments, even without a lot of money, to do,” said Rozelle.

The government provided more indirect market support by publicly investing in better roads, communications, and surface water irrigation. Groundwater was left to the private sector. There were no water or pumping fees nor subsidies for electricity, keeping it completely deregulated. As a result, 50 percent of cultivated land in China is irrigated, compared to 10 percent in the US and only four percent in sub-Saharan Africa.

Finally, China has invested heavily in agricultural research and development (R&D). One percent of China’s agricultural GDP is now invested in agricultural R&D while US investment has fallen over time. US$2 billion alone goes to investments in Chinese biotechnology.

Despite major investment, China only has one major success story to show for so far. The introduction of Bt cotton led to a significant drop in pesticide use (with important health benefits for farmers), and drop in labor and seed price; resulting in a huge 30 percent increase in net income.

“GM technology benefits exist but big policy decisions still need to be made in the face of much resistance both in China and elsewhere in the world on its application,” said Rozelle.

Status of China’s economy

China has largely solved the country’s macro-nutrient food security problem at the household level (>3000 Kcal/day/person) and millions have been lifted out of poverty. Practically all 16-25 years old are now working off the farm.

“This is a real transformation, and one that could not have happened without a major investment in agriculture,” said Rozelle.

While China’s agricultural accomplishments have been major, Rozelle recognizes the system is far from perfect. For starters, there are serious food safety concerns due to lack of traceability. An astounding 98 percent of Beijing consumers think their food is tainted, said Rozelle.

Water is being pumped like crazy and farmers are aging. The younger generation is neither willing nor interested in following in their parents’ farming footsteps. To make up for a labor deficit farmers are applying huge amounts of fertilizer on their land with serious environmental consequences. As a result of changing demographics and an increasing demand for meat, fish, fruits and vegetables, China is likely to be a net importer of food in the long run.

China also faces major urban and rural inequality issues. Even though wages have risen, inequality has not fallen, largely a result of China’s decision not to privatize rural land.

“Rural people have no assets on which to build wealth while urban people were given assets in the form of housing,” said Rozelle. “Housing prices in major cities in China now rival those in the Bay Area!”

The Chinese government fears losing control of the land, but this comes at a price of less individual incentive to invest and inability to build larger farmers. As agricultural growth slows, Rozelle worries high levels of inequality could lead to instability.

Adding fuel to the fire, investment in rural health, nutrition, and education remains far from sufficient. Only 40 percent of the rural poor go to high school resulting in 200 million people who can barely read or write.

“What’s going to happen in 20 years when low skill manufacturing jobs move to other countries?” asked Rozelle. “The rural, uneducated poor are going to become unemployable.”

China’s record leaves room for improvement, but presents a strong case for supporting smallholder agriculture. For those countries emerging out of their own lost decades, smallholder agriculture should remain a primary focus of investment and development.