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Introduction: Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China. Methods: We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach. Results: We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children’s risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development. Conclusion: There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement.
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BMJ Global Health
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Objective: Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China. Methods: We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality. Results: The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (β = 1.39, 95%CI 1.01–1.78) and tuberculosis (β = 0.89, 95%CI 0.69–1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002–0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005–0.021). Conclusions: The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care. Practice Implications: We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.
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Patient Education and Counseling
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Scott Rozelle
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Hongbin Li
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This article was first published in Vox China. Read the full article online.

In 2021, over 10.78 million Chinese high school students took the college entrance exam (Gaokao): a historical high. While the Gaokao is the most important talent selection channel in China, many questions about the Gaokao system remain unanswered. Does the exam measure ability? What type of ability? Does the exam score make a difference for a young person’s future career? Are higher-score individuals more likely to work in government, become entrepreneurs, or earn higher wages?

It is impossible to provide comprehensive answers to all of these questions in a single study, but here, we provide partial answers to some of these questions. Our results come from a recent study, motivated by a theoretical literature on talent allocation (e.g., Baumol 1990; Murphy, Shleifer and Vishny 1991; Acemoglu 1995). This literature has long noted that talent is general and can be used in both the entrepreneurial and non-entrepreneurial sectors, and that its allocation depends on the reward structure of a society. While this important theory of talent allocation has been developed for three decades, few empirical studies have directly tested it due to data challenges.

In Bai, Jia, Li and Wang (2021), we study whether talented Chinese are more or less likely to become entrepreneurs. Empirically, we link the universe of college admission records in 1999–2003 with the universe of Chinese firms and their owners, and then use a random sample of 20% of the linked data to examine who have become entrepreneurs and how successful their firms are. In total, this yields a sample of 1.8 million college graduates who created approximately 170,000 firms by 2015. We supplement this linked data with a large survey of Chinese college graduates that we conducted during 2010–2015 to study waged jobs. We use students’ Gaokao score as a proxy for talent and validate our measure with data.

Research design: within-college comparison

We focus on within-college analyses -- comparing individuals in their mid-30s with others in their cohort who graduated from the same college -- for conceptual and empirical reasons. Conceptually, the within-college comparison helps to control for the confounding factors of college reputation and network. Empirically, we find that most of the variation in firm creation comes from within colleges. For instance, although college fixed effects can explain up to 19% of the variation in wages of paid jobs (in our survey data), the effects can account for only 1.2% of the variation in firm creation. In addition, we find that the college fixed effects can explain only 46% of the variation in exam scores, leaving the majority of the variation to occur within colleges. The wide variation in scores within a college is driven by considerable uncertainty and political economy factors (particularly provincial quotas) in the college admission process. In addition, because Gaokao scores are comparable only for students from the same province and year, as well as the same academic track (social science vs. natural science), we isolate province-year-track fixed effects in our analyses.

We control for a set of individuals’ personal characteristics, which include gender, Hukou (rural vs. urban), high school quality, birth county’s GDP per capita, and age fixed effects. Although we do not have a specific measure of socioeconomic status (such as parental income), it is reasonable to assume that those from better high schools and wealthier counties have higher socioeconomic status. Within colleges, higher socioeconomic status is positively associated with exam scores.

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Hongbin Li's research finds that "In China, the college entrance exam score is predictive for both firm success and wage-job success in the future, yet higher-score individuals are less likely to create firms."

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SCCEI Affiliate Gretchen Daily is featured in The Washington Post discussing Natural Capital Project and her many research initiatives working to prioritize environmental conservation globally.

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Background: Attention deficit hyperactivity disorder (ADHD) is a widely recognized mental health problem in developed countries but remains under-investigated in developing settings. This study examines the prevalence, correlates, and consequences of ADHD symptoms among elementary school students in rural China. Methods: Cross-sectional data were collected from 6,719 students across 120 rural primary schools in China on ADHD symptoms, demographic characteristics, and academic performance in reading and math. ADHD symptoms were evaluated using the caregiver-reported ADHD Rating Scale-IV. Results: The prevalence of ADHD symptoms was 7.5% in our sample. Male students, students in lower grade levels, and students with lower cognitive ability showed a significantly higher prevalence of ADHD symptoms (ORs = 2.56, 2.06, and 1.84, respectively; p<0.05). Left-behind children showed a significantly lower prevalence of ADHD symptoms than did children who were living with their parents (OR = 0.74, p < 0.05). Adjusted regressions show that students with ADHD symptoms scored 0.12 standardized deviations lower in reading (p < 0.05) and 0.19 standardized deviations lower in math (p < 0.01). Limitations: The ADHD Rating Scale-IV is a screening scale rather than a diagnostic test. Caregiver self-report measures also may underestimate ADHD symptoms for our sample. Conclusions: ADHD is a common disorder among rural students in China and appears to be contributing to poor academic outcomes. The higher prevalence of ADHD among students with low cognitive ability also suggests that many rural children in China face multifactorial learning challenges. Taken together, the findings indicate a need for educators and policymakers in rural China to develop programs to reduce risk and support students with ADHD symptoms.

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Journal of Affective Disorders
Authors
Huan Wang
Matthew Boswell
Scott Rozelle
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Scott Rozelle, Yuqing Zheng, and Chengfang Liu were the guest editors of this special issue on agriculture, the rural economy and China's growth in the 21st century. Scott Rozelle also authored a publication in this issue.
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China Agricultural Economic Review
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Scott Rozelle
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2
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Purpose: This study aims to bridge the gaps in the existing literature by studying the links between children's development and the subjective well-being of the caregivers using first-hand data collected in rural China. Design/methodology/approach: Although the broad array of literature has examined the effects of child development on the subjective well-being of caregivers, the relationship between early childhood development and caregiver subjective well-being has not been well-studied using sample families with potential developmental delay in rural China. Also, existing research has relied on maternal reports to evaluate the developmental status of children. The study used data collected from 32 townships in seven nationally designated poverty counties in the Qinling mountainous area in 2016. The authors measure child development using the social-emotional module of the Ages & Stages Questionnaire and Bayley Scales of Infant and Toddler Development–Third Edition. Findings: The authors find that child development indicators are correlated with caregiver subjective well-being. In particular, social-emotional skills are positively associated with life evaluations and positive emotion. However, we do not find any significant correlation between child development and negative emotion or depression, anxiety and stress scores. Originality/value: The value of this study is to report the indicators of child development in rural China and examines the correlation between child development and caregivers' subjective well-being.
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China Agricultural Economic Review
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Scott Rozelle
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2
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"[Rozelle and Hell's] fresh book, Invisible China, focuses on an issue that has received little attention, China’s vast, isolated and long-neglected rural population. As the authors see it, the rural challenge has ‘remained invisible for too long, not only to the outside world but also to many Chinese’."

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This article was first published by The Guardian on July 1, 2021. It was later published by Taipei Times on July 7, 2021.

You can read the full article online at The Guardian or Taipei Times

"When Wang Zhenyu moved out of his small village in central Henan province to the coastal city of Dalian at 18, he was astonished. “It was like a culture shock for me, even though it was just a big city in my country, not a foreign land.” A few years later when he was enrolled in Peking University as a graduate student, he found much fewer students in the country’s top university coming from a similar background to his.

Growing up in a small village of 2,000 farmers, many of Wang’s childhood friends dropped out of school after finishing their nine years of compulsory education. Now with a decent academic job, Wang begins to experience “reverse culture shock” every time he goes back to his village for the annual lunar new year.

“When I get together with my childhood friends in my village, the number of attendees reduces every year. Some went out to be migrant workers in big cities then never came back; others have gotten used to the life as villagers. It’s the poverty that is dividing us. It’s a vicious circle.”

As China grows wealthier as a country, its gaps between rich and poor, urban and rural also increase. Although the country’s official Gini coefficient, a measurement of income inequality, has improved slightly in recent years, experts have also questioned its accuracy. Last May, Premier Li Keqiang revealed that 600 million citizens only earn about 1,000 yuan (£112) a month, indicating the extent of the problem. Many worry the Covid pandemic may have reversed the trend."

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Xi Jinping himself has warned China’s wealth gap is not only economic but political and could threaten party’s legitimacy. Scott Rozelle is quoted sharing just how rare it is for someone in China to move from living in poverty in rural China to the ranks of the educated middle class. This article authored by Vincent Ni is also featured in Taipei Times.

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