Since China started economic reforms in 1978, Chinese children have been growing taller, but in the past ten years, the gains by rural children have been only one-fifth that of urban children, according to a new study in the New England Journal of Medicine (Aug. 8, 1996).

These findings suggest that socioeconomic development up to 1992 was not equitable across the far reaches of China and there is still a long way to go before the whole population of China is adequately nourished, says Jean-Pierre Habicht, M.D., Ph.D., co-author of the new study and one of the world’s leaders in international nutrition surveillance.  Habicht is a Cornell University professor of nutritional epidemiology and the co-director of the Program in International Nutrition.

“Although China has done well in general in improving the health and nutrition of the total population, the improvement has not been evenly distributed,” said Habicht, the James Jamison Professor of Nutritional Epidemiology at Cornell, and the founder of nutrition surveillance at Cornell.  “Rural children in China have always grown less well than urban children.  What is particularly distressing is that, for the first time, we now see an increasing discrepancy between the growth of rural children compared to that of urban children, which we hadn’t seen before in China although it is common in other developing countries.”

With Tiefu Shen, M.D., Ph.D. and Ying Chang, M.D., both of the Institute of Nutrition and Food Hygiene at the Chinese Academy of Preventive Medicine in Beijing, Habicht examined the trends in height-for-age of children, ages 2 through 5, by urban and rural areas using five large anthropometric surveys that had total samples of more than 790,000 children and were conducted between 1975 and 1992.

They found that between 1975 and 1985, the average height of Chinese children increased by 1.3 cm. for urban children and 2 cm. for children outside of urban areas, thereby narrowing the gap between urban and rural children by 0.7 cm.

However, a different picture emerged during the next decade.  Although both urban and rural children continued to show progress, urban children increased an average 2.5 cm ., five times more than the 0.5 cm. gain in rural children.

“Thus, we saw an increase of 2 cm. in the rural-urban difference during this period and in most provinces, urban children improved in growth more than rural children did,” Habicht said.  “This divergence in rural and urban populations became so marked that the overlap between the mean height of some urban and rural areas in different provinces seen in 1987 data no longer existed in 1990.”

Shen, Habicht and Chang suspect that these trends may be explained by looking at the changes in economic policy during the 20-year period.  The first 10 years were on the heels of the “cultural revolution,” when rural household income jumped by 110 percent and urban income by 85 percent.  The rural-urban difference widened during the second period, however, as economic growth in urban areas continued to climb but became stagnant in rural areas.

“Perhaps the most pronounced change since the early 1980s, however, was in the rural health care system,” Shen points out.  “While economic reforms dismantled the rural cooperative medical systems, they also resulted in a sharp reduction in the amount of government health care money for preventive services and maternal and child health care in rural areas while urban health systems continued to be well subsidized.”

Child growth is considered a good indicator of overall socioeconomic development in developing countries.  The World Health Organization has set height-for-age standards for the physical growth of children and any differences from those standards are primarily due to a combination of inadequate dietary intake and frequent infectious disease. Both of these factors, says Habicht, are rooted in low socioeconomic status and poverty.

“Therefore, child growth can reveal whether socioeconomic development, as a whole, is effective and equitable across populations affected by this development.  These analyses show that one cannot depend only on the motor of the free market system to be sure that everybody is well nourished even in periods of rapid economic development,” said Habicht, who has a long history of working with WHO on nutrition and growth standards, program advice, epidemiology and disease prevention; the National Academy of Science’s international nutrition programs and Food and Nutrition Board; and the National Institutes of Health committees on nutrition and disease.  He chaired the WHO Expert Committee that has just published “Physical Status: The use and interpretation of anthropometry,” which makes the most up to date recommendations about growth standards.

Chang organized the Chinese Nutritional Surveillance System with Mme. Chunming Chen, founding president of the Chinese Academy of Preventive Medicine.  Chen points out, “Thanks to the linking of surveillance information to policy and action, China has already taken steps to reestablish more equitable economic rural development with special attention to nutrition and health to ensure that everybody is well nourished.”

Shen trained staff at the Bureau of Statistics in China to take the measurements, supervised the data collection and performed the analyses during graduate training at Cornell.

The research was supported by Chinese nutritional surveillance grants from UNICEF, Beijing and the WHO.  The WHO Collaborating Center for Nutrition Surveillance at Cornell, directed then by Professor of Nutritional Sciences Pier Pinstrup Andersen, played a major role in the project as well and will continue to do so.