What China's experiment in community building can tell us about tackling health disparities: community building and mental health in mid-life and older life: evidence from China

Abstract

Disparities in physical and mental health between advantaged and disadvantaged communities are among the largest threats to population health worldwide. These disparities appear to be growing, probably in part because we do not understand how to address their underlying causes. Many believe the underlying causes are thought to arise directly or indirectly from the psychosocial problems underlying poverty, such as hunger, poor housing, drug use, or crime. One logical solution is therefore to provide more community services targeted at addressing these problems within the most disadvantaged communities. However, to date, data on the efficacy of this approach is lacking. China serves as a possible laboratory for studying the efficacy of community-based programs. This is because the extensive community-based programs present prior to economic reforms in 1978 were removed, and then later re-instated in a quasi-experimental manner. In this issue, Yuying Shen uses multi-level models to explore the impact of this experiment on community mental health in a multi-level associational study. She finds that the quantity (but not their length of time in the community) of such services is positively associated with mental health. This study opens the door to more rigorous analyses that might motivate formal social experiments at the community level worldwide. If successful, such experiments might not only transform what we currently know not just about improving health in disadvantaged communities, but also prove transformative for health policy as a discipline.

Keywords: Community health; Health disparities; Health policy.