Inequality in Beijing: A Spatial Multilevel Analysis of Perceived Environmental Hazard and Self-Rated Health

Environmental pollution is a major problem in China, subjecting people to significant health risk. However, surprisingly little is known about how these risks are distributed spatially or socially. Drawing upon a large-scale survey conducted in Beijing in 2013, we examine how environmental hazards and health, as perceived by residents, are distributed at fine (sub-district) scale in urban Beijing, and investigate association between hazards, health and geographical context. A Bayesian spatial multilevel logistic model is developed to account for spatial dependence in unobserved contextual influences (‘neighbourhood effects’) on health. Results reveal robust associations between exposure to environmental hazards and health. A unit decrease on a 5-point Likert scale in exposure is associated with increases of 15.2% (air pollution), 17.5% (noise) and 9.3% (landfills) in the odds of reporting good health, with marginal groups including migrant workers reporting greater exposure. Health inequality is also evident, and associated with age, income, educational attainment and housing characteristics. Geographical context (neighbourhood features like local amenity) also plays a role in shaping the social distribution of health inequality. Results are discussed in the context of developing environmental justice policy within a Chinese social market system that experiences tension between its egalitarian roots and its pragmatic approach to tackling grand public policy challenges.