The most recent period in the WVS data appears to

The most recent Atractyloside Dipotassium Salt in the WVS data, 2012, appears to show a SRH rebound. This rise could be interpreted in light of the junction of economic prosperity and state intervention. Starting in the mid-2000s, criticism of the problems instigated by market reform reached a climax (Whyte & Sun, 2010). During the 11th Five Plans (2006–10), the Chinese government emphasized balance between growth and equity to achieve a more harmonious society. Since the plan was initiated, economic inequality has decreased amidst sustained economic growth and coverage of the social protection system has expanded, including increased government health care funding (OECD, 2012). These efforts may be responsible for the recent growth in Chinese life satisfaction—a remarkable increase of 26 percentage point between 2007 and 2014 (Simons, Wike, & Oates, 2014). How self-rated health tracks with future change in Chinese economic growth and inequality is a topic for ongoing research. There is another important caveat to the general conclusion that health has improved in reform-era China. What was in 1990 a relatively egalitarian distribution of SRH has been replaced by an increasingly unequal distribution with respect to income and education. These findings generally align with the fundamental cause perspective, a theory which argues that social stratification maintains a persistent gap between status groups over time, even as overall conditions improve amidst modernization (Link & Phelan, 2002). The current results, however, reveal even more than a persistent disparity: they indicate a widening gap between those in the top and bottom quartiles of income and between those with and without a high school degree. Those in the more disadvantaged strata of Chinese society have seen very little net improvement from 1990 the present day. This is an especially interesting finding in light of increased social protections undertaken in recent years, initiatives which many may have expected to close gaps between low- and high-income groups. The study has several limitations. First, the cross-sectional nature of the data impedes causal inference. Although we speculate possible underlying causes of temporal trends in SRH, Age-Period-Cohort analyses of this type are descriptive and do not test specific mechanistic hypothesis. Another limitation is that changes in the response options for SRH differed in earlier and later versions of the WVS. This forced us to focus on differentiating good health from lower health ratings, instead of assessing an expanded set of SRH categories. Lastly, we acknowledge urban-rural dimensions of inequality in reform-era China (Chen et al., 2010; Schafer & Kwon, 2012) but are unable to empirically examine dynamics in our data. Unfortunately, WVS-China does not provide direct information about place of residence, a factor which deserves future consideration for understanding temporal trends in health inequality. To our knowledge, the present study is the first to simultaneously consider age, period, and cohort influences on the self-rated health of Chinese adults during the reform era. This study contributes strong evidence of period changes in self-rated health. By revealing non-monotonic temporal trends, this study illustrates the complex nature of health change in recent Chinese history and suggests that while economic conditions were key to health improvement in the early stages of reform, an “entire array of social, political, and economic policies” seem to gain explanatory prominence as the period unfolded (Link & Phelan, 2002: 732). The Chinese government has further extended social protection during its 2011–2015 12th Plan period (OECD, 2012). Based on the current findings, we might expect that such efforts will help sustain positive trends in subjective health. Yet other recent policy innovations have been ineffectual in reducing socioeconomic health disparities, so targeted interventions will be needed to narrow the education- and income-based health gaps that have widened in recent years.