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Gu D, Feng Q, Sautter JM and Qiu L

One interesting finding is that those who were exposed to urban contexts in early-life
only tended to have higher mortality risk compared to those with lifelong no exposure.
Examining possible historical backgrounds, we speculate that many older adults with
early-life-only exposure moved to the countryside with family before the 1950s to
avoid social turmoil and wars, and some of them moved to rural areas at young ages
in response to political call of the government, which peaked during the late 1950s
and the Cultural Revolution, usually known as “sent-down to the countryside” or the
rustication movement (Seybolt, 1975). Although a majority of these youth finally
returned to their home cities, some settled in the villages and never returned. With
such a disrupted life course, this group tended to be even more disadvantaged than the
local peasants. This finding provides some evidence to support the penalty hypothesis
of downward mobility (moving from an urban to rural area could be considered
downward mobility in China) (Luo and Waite, 2005).
One unexpected result is that, compared to older adults with no exposure to urban
settings, those who experienced a full exposure to urban context with no migration had
a similar mortality risk when only demographics were controlled for, and had a higher
mortality risk when socioeconomic status, family/social support, health practice, and
baseline health were additionally controlled for. This finding seems counterintuitive
because urban life is usually advantaged, but not uninterpretable, due to the specific
Chinese context. Nearly a century ago, the socioeconomic condition, infrastructure,
and sanitation in urban China were only marginally better than in rural areas. As
China underwent political and social turmoil from the 1950s to the 1970s, urban
residents might have born relatively more health risks than the rural peers (Seybolt,
1975), which may affect their health at older ages. Moreover, the recent crowding and
polluted environments in urban China may also run against the health of city residents
(Zheng and Kahn, 2017). In addition, mortality selection as noted earlier may have
played a role in this process.
Overall, our findings provide some evidence in support of the urban advantages
in health as proposed by socio-ecological theory, the compensation of social upward
mobility for early life disadvantages and penalty of social downward mobility as
highlighted by the social mobility hypothesis and the healthy migrants theory. At
the same time, we acknowledge several limitations of this study. First, although our
classification of urban life exposure expanded upon those used in most previous
studies, classification still needs further improvements. We were not able to model the
changes in residence status before the very first interview and whether the rural-to-
urban migrants are permanent (obtained an urban hukou status) or temporary (living
in urban areas with rural hukou). For example, we did not have data on the number
of years of stay in the reported residential place before the survey, which prevented
us from measuring the timing of change in residential status. We were also not able
to distinguish suburban residents from residents living in city property. Studies in the
U.S. showed that health status of suburban residents was different from rural and urban
residents (Eberhardt and Pamuk, 2004). As the current Chinese older cohorts have
witnessed drastic social transformation, industrialization, and political movements in
their lifetime, more sophisticated classifications are needed in future research to better
reflect their complicated experiences of urban life. Furthermore, because of the lack
of data, we were also not able to adequately test the healthy migrant theory, although
we examined the association between migration and mortality within each type of
exposure. Because healthy migrant selection likely interacts with the better condition
in urban areas to affect the health of current older adults in China, it is difficult to
disentangle their independent roles without scientific designs and solid evidence. We
call for more studies to provide insights into this theme.
Second, as China has witnessed rapid urbanization, residential status of many rural
residents has changed even if they live in the same village/township of their birth or
nearby due to in situ urbanization (Zhu, 2015). Moreover, the Chinese government’s
official definition of urban areas and the administrative boundaries of some counties/
cities have been changing over time (NBSC, 2002; 2008) and different names were

International Journal of Population Studies 2017, Volume 3, Issue 1 15