Association for Public Policy Analysis & Management

In the past couple of decades, cities in China have experienced unprecedented levels of economic and social development. Research suggests that increases in chronic health conditions have increased commensurate with levels of development (Zhang et al. 2012). In particular, studies document the dramatic rise in childhood overweight and obesity among children in East Coast Chinese cities (Chen 2008; Zhang et al. 2012). During the last five years, equitable and affordable access to healthcare has been an explicit goal in China, though the focus on prevention services is still inconsistent and out-of-pocket costs are relatively high for families (WHO 2010; Cao et al. 2012). Research into childhood overweight and obesity in China has largely relied on large public health data that lacks detailed information on the social determinants of increased obesity in this rapidly changing country. Our study takes advantage of a new dataset focused on the wellbeing of children entering school in Shanghai that includes comprehensive contextual information on the parents, home life, and school settings of these children. Using this innovative new dataset, we examine the extent to which childhood overweight and obesity at school entry may be associated with family sociodemographic factors (e.g., income, education and rural vs. urban status) in Shanghai in 2014.

We use the 2014 Child Well-Being Study of Shanghai, China—a new study modeled on child cohort studies in the United States and several other countries. The sample of approximately 2,000 children are 7 years of age on average at the time of survey in 2014. We estimate odds ratios and adjusted proportions of overweight and obesity by income tercile, parental education, and hukou status (rural vs. urban). Results use the CDC overweight and obesity cutpoints for comparison to the United States, but we also conduct sensitivity analyses using other established international and Chinese overweight and obesity standards. All results are stratified by gender due to established gender differences in childhood obesity. We also include a number sociodemographic factors, health insurance status, and health behaviors in our models.

Preliminary results find a very high rate of childhood overweight and obesity (36% and 21%, respectively) in Shanghai, China. 42% of boys and 30% of girls in our sample are overweight or obese. Overall, childhood overweight and obesity is higher in Shanghai than it is in the United States (CDC, 2013). The analysis also indicates that like many developing countries, our sample has a reverse income and education gradient in childhood overweight and obesity—but only for girls. High income and high education are associated with higher rates of childhood overweight and obesity for girls, but no pattern by SES exists for boys. Girls from rural status families are also much less likely to be overweight or obese than girls from urban families. These results have important implications for social programs and health insurance reform in Shanghai, and how these new policies interact with gender differences and overall economic development in rapidly changing China.