China’s agricultural decollectivization raised productivity but weakened the collective institutions supporting rural primary care. Using newly digitized county-level data and staggered difference-in-differences, we find that mortality increased by about 1.6 percent after reform, equivalent to roughly 90,000 excess deaths annually. Effects are concentrated where village-doctor availability declined most. The results highlight that China’s early market-oriented reforms carried substantial and long-lasting health costs by weakening local primary-care capacity.
Shulei Zhang
PhD Candidate in Economics, Australian National University
Development Economics · Health Economics · Labour Economics · Public Economics
I am a Ph.D. candidate in Economics at the Research School of Economics, Australian National University. My research lies at the intersection of development, health, labour, and public economics. I study how institutional reforms and local policies affect public services and household behavior, with consequences for health, fertility, and labour-market outcomes.
I completed my M.A. and B.A. in Economics at Nanjing University.
Email: Shulei.Zhang@anu.edu.au
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We study how local governments translated China’s nationwide fertility-control objective into different combinations of rewards and penalties. Drawing on roughly 4,000 county gazetteers and more than 30,000 local family-planning policy records, we use large-language-model (LLM)-assisted analysis to construct new measures of the types and intensity of local policy instruments. We find that non-monetary penalties—primarily administrative sanctions—are most strongly associated with fertility decline, with a significantly larger relationship in urban than in rural areas.
Building on Almond et al. (2019), this paper revisits how two contemporaneous reforms—the Household Responsibility System and the One-Child Policy—affected sex-selection behavior in rural China. We expand the county-level policy data, refine the measurement of local reform timing, and apply recent robust staggered difference-in-differences methods. The paper reassesses the relative and combined roles of economic reform and fertility policy in household sex-selection decisions.