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Exposure to urban life and mortality risk among older adults in China

1.1.3 Healthy Migrant Theory
The healthy migrant theory highlights the selection effect in the health of migrants,
arguing that migrants (except for forced migrants) tend to be healthier compared
to non-migrants in the origin and/or native born in the destination (Abraido-Lanza,
Dohrenwend, Ng-Mak, et al., 1999; Atella and Deb, 2013). Individuals who want
to move to another place or country have to be healthy enough to move, be willing
to undertake the hardships in the migration process, and be able to pass medical
screenings before they can enter another country. All these issues will discourage or
prevent individuals with health problems from initiating a geographic movement (Fu
and VanLandingham, 2012).
However, there is evidence showing that the migrant health advantage may decline
or diminish over time (Anson, 2004; Finch, Do, Frank, et al., 2009), possibly due to
hardship encountered in the new environment; these hardships can include physical
and psychosocial distress, loneliness, discrimination (Atella and Deb, 2013), adoption
of less healthy lifestyles (Kristiansen, Razum, Tezcan-Güntekin, et al., 2016), and
socioeconomic disadvantages (Wakabayashi, 2010). At the same time, some studies
revealed that unhealthy migrants may go back to their origin, i.e., the salmon-bias
effect (Abraido-Lanza, Dohrenwend, Ng-Mak, et al., 1999; Hu, Cook and Salazar,
2008; Palloni and Arias, 2004). Recently researchers started to study the linkage
between the timing of migration and health at later ages (e.g., Wakabayashi, 2010).
They documented that late-life migrants are disadvantaged compared to earlier-
life migrants in some health indicators, possibly due to cumulative disadvantage in
socioeconomics throughout the lifetime (Wakabayashi, 2010).

1.2 Urban Context in China

1.2.1 Urban-Rural Divide
China has implemented a dual-regime of governance in rural and urban areas since
the early 1950s, which is still in effect even after the market reform initiated in the
late 1970s (Liu and McGuire, 2015; Wu and Wang, 2014). This dual-regime restricts
rural residents from moving to urban areas through a national household registration
system (or hukou), dividing the nation’s population and policies into two sectors with
distinct contextual environments. Urban areas receive priority in financial investments,
infrastructure construction, welfare and healthcare benefits, education, housing,
food supply, and so forth (Liu and McGuire, 2015; Wu and Wang, 2014; Zimmer,
Kaneda, and Spess, 2007). As a result, Chinese urban residents have higher income,
more educational and job opportunities, improved housing and healthcare, improved
infrastructure and sanitation, and more welfare and healthcare benefits compared to
rural residents. Rural residents often face poor and unstable socioeconomic conditions;
lack of welfare, education, and health care resources; vulnerability to natural disasters
(floods/droughts); and loss of land due to urbanization (Gong, Liang, Carlton, et al.,
2012). Accordingly, a large rural-urban health disparity exists that disadvantages rural
residents (Fang, Chen, Rizzo, 2009).
This long-term rural-urban divide in China has recently undergone major
transformation. Starting with the economic reform in the late 1970s, Chinese rural
residents were allowed to migrate to urban areas, although their hukou status remained
rural. With the huge flow of rural-to-urban migration from the hinterland to the east
coast of China, the old household registration system was relaxed in some areas so
that some migrants may obtain an urban status. Additionally, the rapid urbanization
in China often changed previously rural lands to urban administration, so that rural
residents could automatically acquire urban identities without geographic relocation
(Zhu, 2015). However, the dual-regime system still creates barriers for rural-to-urban
migrants to receive urban social welfare and healthcare entitlements (Gu, Zhu and
Wen, 2015).

4 International Journal of Population Studies 2017, Volume 3, Issue 1