One of the defining features of China’s economy over the two decades between 1995 and 2015 was the persistent rise of wages for workers and professionals in nearly every segment of the economy—with wage rates for labor-intensive jobs in manufacturing, construction, and the informal service sector rising the fastest. Recently, however, the economic environment in China has begun to change, including changes in both employment and wages. We identify recent employment/wage trends throughout China’s economy and postulate the sources of these trends as well as possible future consequences if they continue. We use official, nationally aggregated data to examine employment and wages in multiple sectors and industries. Our findings indicate that China may have entered a new phase of economic development in the mid-2010s. According to the data, in recent years, wage growth has begun to polarize: Rising for professionals employed in formal skill-intensive industries; and falling for workers in the informal labor-intensive service sector. We attribute this increase in skill-intensive wages to an increase in demand for skill-intensive employment, due to the emergence of a large middle class in China, for whom the demand for high technology, finance, banking, health, and higher education industries is increasing while, at least in the recent short term, the supply of experienced, high-skilled professionals has not kept up. The employment/wage trend in the informal (low-wage) service sector, however, is following a different pattern. While there is a rising demand for services in China’s economy, the growth, due to a number of factors (e.g., large shares of GDP targeted by policymakers to investment; high rates of savings by consumers), is relatively slow. In contrast, due to a number of economic forces, including globalization and automation, the supply of labor into the service sector of the informal economy is being fueled by the flow of labor out of manufacturing and construction (two industries that that have experienced employment declines since 2013). These supply and demand trends, in turn, are leading to the fall in the growth rate of wages in the informal service sector. We conclude by discussing the possible longer-term consequences of these emerging polarization trends based on an examination of recent experience with wage polarization occurring in both middle- and high-income countries, as well as its consequences. We also present policy recommendations for greater investment in education and human capital, as well as for the development of a more comprehensive set of social safety nets for different segments of China’s population.

Background: 
The Baby-Friendly Hospital Initiative is generally considered an effective way to promote breastfeeding. Although China has the largest number of baby-friendly hospitals in the world, research on baby-friendly practices in China is limited, and the rate of exclusive breastfeeding (EBF) at 6 months, 20.7%, compared to the 2025 global goal of 50% is low. It is, therefore, important to determine the factors that remain significant barriers to EBF in China. To explore how the key baby-friendly practices affect EBF duration in China, we used a case-control study to compare the effects of baby-friendly-related practices on both EBF and non-breastfeeding (NBF) mothers at 3 months and to investigate the effects of both single and comprehensive baby-friendly practices in promoting EBF duration at 3 months, which is one step toward EBF at 6 months.

Methods: 
Participants were recruited from four maternal and child health hospitals in western (Chongqing), eastern (Qingdao), southern (Liuzhou), and central China (Maanshan). A total of 421 mothers (245 in the EBF group, 176 in the NBF group) of infants aged 3 months were surveyed through a self-reported questionnaire from April 2018 to March 2019. The experience of baby-friendly practices and breastfeeding during hospitalization were assessed with yes/no questions. Socio-demographic factors that influenced breastfeeding at 3 months were analyzed using bivariate and multivariate logistic regression analyses.

Results: 
Of mothers in the EBF group, 65.57% reported engaging in at least seven baby-friendly practices compared to 47.72% of mothers in the NBF group. Significantly more mothers in the EBF group engaged in baby-friendly practices than in the NBF group. These practices included “breastfeeding within one hour after birth” (74.29% vs. 59.09%), “breastfeeding on demand” (86.48% vs. 75.00%), and “never use a pacifier” (46.53% vs. 31.25%). After adjusting for confounding variables, we found that the mothers who engaged in fewer than seven baby-friendly practices were about 1.7 times less likely to breastfeed than were those who engaged in seven or more baby-friendly practices (odds ratio [OR] 1.720, 95% confidence interval [CI] 1.106, 2.667). Further, the mothers who did not breastfeed on demand were as likely to not breastfeed up to 3 months (OR 2.263, 95% CI 1.265, 4.049), as were mothers who did not breastfeed during hospitalization (OR 4.379, 95% CI 1.815, 10.563).

Conclusions: 
These data from hospitals in China suggest that higher compliance with baby-friendly practices may have a positive impact on EBF at 3 months, particularly in terms of promoting the implementation of breastfeeding on demand and breastfeeding during hospitalization in China.

Purpose To describe changes in the prevalence of visual impairment and glasses ownership with age and as associated with income and population density for visual impairment among rural and urban migrant Chinese students.

Design Meta-analysis of 12 cross-sectional, school-based studies conducted between 2012 and 2017.

Setting Rural and urban migrant schools in seven Chinese provinces.

Participants A total of 83 273 rural and urban migrant Chinese students aged 6–17 years.

Results Prevalence of visual impairment (uncorrected visual acuity ≤6/12 in either eye) rose from 19.0% at age 6 to 66.9% at 17, with the overall age-adjusted prevalence higher for girls (35.8%) than for boys (30.1%, p<0.001). The rate of glasses ownership among students who needed them increased from 13.0% at age 6 to 63.9% (p<0.001) at 17 and was significantly higher for girls (37.0%) than boys (34.7%, p<0.001). The unmet need for glasses as a proportion of the student population peaked in junior high school (31.8%). A 1% increase in per capita gross domestic product was associated with a 4.45% rise in uncorrected visual acuity (R2=0.057, p=0.020). Population density was significantly associated with glasses ownership among children (R2=0.359, p=0.012). A 1% population density increase was associated with an increase in the glasses ownership rate of 6.83%.

Conclusion Efforts are needed to improve vision screening coverage in China’s schools, particularly junior high schools, as this is when many rural children leave school and glasses coverage is lowest.

Objective: To assess the effect of free eyeglasses provision on visual acuity among middle school students in northwestern rural China.

Methods and analysis: Among 31 middle schools randomly selected from 47 middle schools in northwestern rural China, students were randomly allocated by school to one of two interventions: free eyeglasses (intervention group), and eyeglasses prescriptions given only to the parents (control group). The main outcome of this study is uncorrected visual acuity after 9 months, adjusted for baseline visual acuity.

Results: Among 2095 students from 31 middle schools, 995 (47.5%) failed the visual acuity screening, 515 (51.8%, 15 schools) of which were randomly assigned to the intervention group, with the remaining 480 students (48.2%, 16 schools) assigned to the control group. Among these, a total of 910 students were followed up and analysed. Endline eyeglasses wear in the intervention group was 44%, and 36% in the control group. Endline visual acuity of students in the intervention group was significantly better than students in the control group, adjusting for other variables (0.045 LogMAR units, 95% CI 0.006 to 0.084, equivalent to 0.45 lines, p=0.027), and insignificantly better only for baseline visual acuity (difference of 0.008 LogMAR units, 95% CI −0.018 to 0.034, equivalent to 0.08 lines).

Conclusion: We found no evidence that receiving free eyeglasses worsened visual acuity among middle school students in northwestern rural China.

Book Synopsis:

As the glittering skyline in Shanghai seemingly attests, China has quickly transformed itself from a place of stark poverty into a modern, urban, technologically savvy economic powerhouse. But as Scott Rozelle and Natalie Hell show in Invisible China, the truth is much more complicated and might be a serious cause for concern.

China’s growth has relied heavily on unskilled labor. Most of the workers who have fueled the country’s rise come from rural villages and have never been to high school. While this national growth strategy has been effective for three decades, the unskilled wage rate is finally rising, inducing companies inside China to automate at an unprecedented rate and triggering an exodus of companies seeking cheaper labor in other countries. Ten years ago, almost every product for sale in an American Walmart was made in China. Today, that is no longer the case. With the changing demand for labor, China seems to have no good back-up plan. For all of its investment in physical infrastructure, for decades China failed to invest enough in its people. Recent progress may come too late. Drawing on extensive surveys on the ground in China, Rozelle and Hell reveal that while China may be the second-largest economy in the world, its labor force has one of the lowest levels of education of any comparable country. Over half of China’s population—as well as a vast majority of its children—are from rural areas. Their low levels of basic education may leave many unable to find work in the formal workplace as China’s economy changes and manufacturing jobs move elsewhere.

In Invisible China, Rozelle and Hell speak not only to an urgent humanitarian concern but also a potential economic crisis that could upend economies and foreign relations around the globe. If too many are left structurally unemployable, the implications both inside and outside of China could be serious. Understanding the situation in China today is essential if we are to avoid a potential crisis of international proportions. This book is an urgent and timely call to action that should be read by economists, policymakers, the business community, and general readers alike.

Meet the Authors:

Scott Rozelle: Scott is the Helen F. Farnsworth Senior Fellow and the co-director of the Rural Education Action Program in the Freeman Spogli Institute for International Studies at Stanford University. His research focuses almost exclusively on China and is concerned with: agricultural policy, including the supply, demand, and trade in agricultural projects; the emergence and evolution of markets and other economic institutions in the transition process and their implications for equity and efficiency; and the economics of poverty and inequality, with an emphasis on rural education, health and nutrition. He has been published in top academic journals and has authored over 500 articles, chapters, and books. 

 

Natalie Hell: Natalie is a writer based in the San Francisco Bay Area. As part of Stanford University’s Rural Education Action Program, she has worked on Chinese education and health issues for seven years. This work has included managing numerous large-scale field studies and conducting extensive qualitative interviews across rural China. She holds a bachelor’s degree in Chinese language and political science from Williams College, and is a fluent Mandarin speaker.

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A growing body of literature has documented that community-based early childhood development (ECD) interventions can improve child developmental outcomes in vulnerable communities. One critical element of effective community-based programs is consistent program participation. However, little is known about participation in community-based ECD interventions or factors that may affect participation. This paper examines factors linked to program participation within a community-based ECD program serving 819 infants and their caregivers in 50 rural villages in northwestern China. The results find that more than half of families did not regularly attend the ECD program. Both village-level social ties within the program and proximity to the program significantly predict program participation. Increased distance from the program site is linked with decreased individual program participation, while the number of social ties is positively correlated with participation. The average program participation rates among a family’s social ties is also positively correlated with individual participation, indicating strong peer effects. Taken together, our findings suggest that attention should be given to promoting social interactions and reducing geographic barriers among households in order to raise participation in community-based ECD programs.

Background:
Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.

Methods:
We designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).

Results:
Overall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.

Conclusions:
The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.

In response to the COVID-19 epidemic, many education systems have relied on distance learning and educational technologies to an unprecedented degree. However, rigorous empirical research on the impacts on learning under these conditions is still scarce. We present the first large-scale, quantitative evidence detailing how school closures affected education in China. The data set includes households and teachers of 4,360 rural and urban primary school students. We find that although the majority of students engaged in distance education, many households encountered difficulties including barriers to learning (such as access to appropriate digital devices and study spaces), curricular delays, and costs to parents equivalent to about two months of income. We also find significant disparities across rural and urban households.

Objective: To estimate the effect of providing free spectacles on uncorrected visual acuity (VA) among urban migrant Chinese school children. Design Exploratory analysis from a parallel cluster-randomised clinical trial.

Methods: After baseline survey and VA screening, eligible children were randomised by school to receive one of the two interventions: free glasses and a teacher incentive (tablet computer if ≥80% of children given glasses were wearing them on un-announced examination) (treatment group) or glasses prescription and letter to parents (control group). The primary outcome was uncorrected logarithm of the minimal angle of resolution (LogMAR) VA at study closeout, adjusted for baseline uncorrected VA.

Results: Among 4376 randomly selected children, 728 (16.6%, mean age 10.9 years, 51.0% boys) at 94 schools failed VA screening and met eligibility criteria. Of these, 358 children (49.2%) at 47 schools were randomised to treatment and 370 children (50.8%) at 47 schools to control. Among these, 679 children (93.3%) completed follow-up and underwent analysis. Spectacle wear in the treatment and control groups was 68.3% and 29.3%(p<0.001), respectively. Uncorrected final VA for eyes of treatment children was significantly better than control children, adjusting only for baseline VA (difference of 0.039 LogMAR units, 95% CI: 0.008, 0.070, equivalent to 0.39 lines, p=0.014) or baseline VA and other baseline factors (0.040 LogMAR units, 95% CI 0.007 to 0.074, equivalent to 0.40 lines, p=0.020).

Conclusion: We found no evidence that spectacles wear worsens children’s uncorrected VA among urban migrant Chinese school children.