Diet in China during substantial economic growth: Quality, inequality, trends, and determinants

Abstract

This study investigates inequality in diets in China during its economic growth using data from the China Health and Nutrition Survey (1997–2011). Overall, diet quality was significantly improved over the 14 years, as indicated by the increasing mean of Chinese Healthy Eating Index (CHEI) scores from 40.76 in 1997 to 54.52 in 2011. Initially, dietary improvement favored affluent populations, leading to widening inequality, but it became more equitable in later years. Socioeconomic factors are critical determinants of inequality in diets, with urban-rural disparity being a significant barrier to equalizing diet quality. The results of the Oaxaca decomposition indicate that changes in inequality in diets are primarily driven by the extent to which nutritional choices respond to income fluctuations rather than the actual change in income itself. While women exhibited lower inequality in diets quality compared to men, they were more likely to be situated at a relatively lower level of diet quality. Furthermore, differences in health insurance coverage also play a significant role in the changes observed in inequality in diets. This study highlights the importance of considering income elasticity and its influence on dietary behaviors when examining the dynamics of income-based inequality in diets. Non-dietary factors, including basic health insurance and rural development initiatives, are essential in addressing the developing challenge of inequality in diets during economic growth phases.