Export trade has significantly benefited China's economic growth since it joined the World Trade Organization (WTO). However, the literature predominantly emphasizes the economic benefits of trade, with comparatively less attention devoted to its broader social welfare implications. Amidst global health crises, trade stagnation, and diminishing demographic dividends, this paper examines the health consequences of trade, especially the impact of export trade on the health of Chinese residents. Utilizing microlevel data from the China Family Panel Studies (CFPS), integrated with regional macro-data, this paper finds that (1) the growth of export trade can significantly improve the overall health of regional residents, including both subjective and objective health. (2) An analysis of the mechanisms reveals that export trade can improve the health of residents by providing employment opportunities and increasing income levels. Contrary to expectations derived from the pollution haven hypothesis, this study finds that regional export activities are associated with improved local environmental quality through reduced pollutant emissions, which, in turn, improves the health of residents. (3) An exploration of heterogeneity suggests that exports have a greater impact on the health of rural residents, women, and the middle-aged and elderly. This paper contributes to the literature on health economics and trade liberalization, and provides insights that are relevant to the formulation of trade policy, public health, and health service policy in China.
Citation: Runmin Deng, Xinju He, Yani Zhang. The social welfare effects of exports: Environmental and health impacts in China[J]. National Accounting Review, 2025, 7(3): 340-366. doi: 10.3934/NAR.2025015
Export trade has significantly benefited China's economic growth since it joined the World Trade Organization (WTO). However, the literature predominantly emphasizes the economic benefits of trade, with comparatively less attention devoted to its broader social welfare implications. Amidst global health crises, trade stagnation, and diminishing demographic dividends, this paper examines the health consequences of trade, especially the impact of export trade on the health of Chinese residents. Utilizing microlevel data from the China Family Panel Studies (CFPS), integrated with regional macro-data, this paper finds that (1) the growth of export trade can significantly improve the overall health of regional residents, including both subjective and objective health. (2) An analysis of the mechanisms reveals that export trade can improve the health of residents by providing employment opportunities and increasing income levels. Contrary to expectations derived from the pollution haven hypothesis, this study finds that regional export activities are associated with improved local environmental quality through reduced pollutant emissions, which, in turn, improves the health of residents. (3) An exploration of heterogeneity suggests that exports have a greater impact on the health of rural residents, women, and the middle-aged and elderly. This paper contributes to the literature on health economics and trade liberalization, and provides insights that are relevant to the formulation of trade policy, public health, and health service policy in China.
| [1] |
Alam MS, Raza SA, Shahbaz M, et al. (2016) Accounting for Contribution of Trade Openness and Foreign Direct Investment in Life Expectancy: The Long-run and Short-run Analysis in Pakistan. Soc Indic Res 129: 1155–1170. http://doi.org/10.1007/s11205-015-1154-8 doi: 10.1007/s11205-015-1154-8
|
| [2] |
Alberini A, Cropper M, Fu TT, et al. (1997) Valuing Health Effects of Air Pollution in Developing Countries: The Case of Taiwan. J Environ Econ Manage 34: 107–126. http://doi.org/10.1006/jeem.1997.1007 doi: 10.1006/jeem.1997.1007
|
| [3] |
Atkin D (2013) Trade, Tastes, and Nutrition in India. Am Econ Rev 103: 1629–1663.http://doi.org/10.2139/ssrn.1596827 doi: 10.2139/ssrn.1596827
|
| [4] |
Amiti M, Davis DR (2012) Trade, firms, and wages: Theory and evidence. Rev Econ Stud 79: 1–36. http://doi.org/10.1093/restud/rdr016 doi: 10.1093/restud/rdr016
|
| [5] |
Autor DH, Dorn D, Hanson GH (2013) The China Syndrome: Local Labor Market Effects of Import Competition in the United States. Am Econ Rev 103: 2121–2168. http://doi.org/10.1257/aer.103.6.2121 doi: 10.1257/aer.103.6.2121
|
| [6] |
Bombardini M, Li B (2020) Trade, Pollution and Mortality in China. J Int Econ 125: 103321. http://doi.org/10.1016/j.jinteco.2020.103321 doi: 10.1016/j.jinteco.2020.103321
|
| [7] |
Bernard A, Jensen J, Lawrence RZ (1995) Exporters, jobs, and wages in U.S. manufacturing: 1976–1987. Brookings Pap Econ Act Microecon 12: 67–119. https://doi.org/10.2307/2534772 doi: 10.2307/2534772
|
| [8] |
Bond EW, Trask K, Wang P (2003) Factor Accumulation and Trade: Dynamic Comparative Advantage with Endogenous Physical and Human Capital. Int Econ Rev 44: 1041–1060. http://doi.org/10.1111/1468-2354.t01-1-00099 doi: 10.1111/1468-2354.t01-1-00099
|
| [9] |
Byaro M, Nkonoki J, Mayaya H (2021) The Contribution of Trade Openness to Health Outcomes in Sub-Saharan African Countries: A Dynamic Panel Analysis. Res Glob 3: 100067. http://doi.org/10.1016/j.resglo.2021.100067 doi: 10.1016/j.resglo.2021.100067
|
| [10] |
Baldwin JR, Brown WM (2004) Regional manufacturing employment volatility in Canada: the effects of specialization and trade. Pap Reg Sci 83: 519–541. http://doi.org/10.2139/ssrn.1403262 doi: 10.2139/ssrn.1403262
|
| [11] | Bartik TJ (1991) Who Benefits from State and Local Economic Development Policies. Kalamazoo, MI: W.E. Upjohn Institute for Employment Research, 1991. http://doi.org/10.2307/144206 |
| [12] |
Birdsall N, Wheeler D (1993) Trade policy and industrial pollution in Latin America: Where are the pollution havens? J Environ Dev 2: 137–149. http://doi.org/10.1177/107049659300200107 doi: 10.1177/107049659300200107
|
| [13] |
Cesur R, Tekin E, Ulker A (2013) Air Pollution and Infant Mortality: Evidence from the Expansion of Natural Gas Infrastructure. Econ J 127: 330–362. http://doi.org/10.1111/ecoj.12285 doi: 10.1111/ecoj.12285
|
| [14] |
Chay KY, Greenstone M (2003) The Impact of Air Pollution on Infant Mortality: Evidence from Geographic Variation in Pollution Shocks Induced by a Recession. Q J Econ 118: 1121–1167. http://doi.org/10.1162/00335530360698513 doi: 10.1162/00335530360698513
|
| [15] |
Chang S., Yang X. Zheng H., et al. (2020) Air quality and health co-benefits of China's national emission trading system. Appl Energy 261: 114226. http://doi.org/10.1016/j.apenergy.2019.114226 doi: 10.1016/j.apenergy.2019.114226
|
| [16] |
Chen M, Wang H (2024) Does import trade liberalization worsen residents' health? Evidence from China. Front Public Health 12: 1470338. http://doi.org/10.3389/fpubh.2024.1470338 doi: 10.3389/fpubh.2024.1470338
|
| [17] |
Cole MA, Rayner AJ, Bates JM (1998) Trade Liberalisation and the Environment: The case of the Uruguay Round. World Econ 21: 337–347. http://doi.org/10.1111/1467-9701.00133 doi: 10.1111/1467-9701.00133
|
| [18] |
Copeland BR, Scott TM (1994) North-South Trade and the Environment. Q J Econ 3: 755–787. http://doi.org/10.2307/2118421 doi: 10.2307/2118421
|
| [19] |
Cropper ML (1981) Measuring the Benefits from Reduced Morbidity. Am Econ Rev 71: 235–240. http://doi.org/10.1016/0309-586X(81)90042-X doi: 10.1016/0309-586X(81)90042-X
|
| [20] |
Davis DR, Harrigan J (2007) Good Jobs, Bad Jobs, and Trade Liberalization. Int Econ 84: 26–36. http://doi.org/10.1016/j.jinteco.2011.03.005 doi: 10.1016/j.jinteco.2011.03.005
|
| [21] |
Dean JM, Lovely ME, Wang H (2009) Are Foreign Investors Attracted to Weak Environmental Regulations? Evaluating the Evidence from China. J Dev Econ 90: 1–13. http://doi.org/10.1016/j.jdeveco.2008.11.007 doi: 10.1016/j.jdeveco.2008.11.007
|
| [22] |
Deb P, Gallo WT, Ayyagari P, et al. (2011) The effect of job loss on overweight and drinking. J Health Econ 30: 317–327. http://doi.org/10.1016/j.jhealeco.2010.12.009 doi: 10.1016/j.jhealeco.2010.12.009
|
| [23] |
Ebenstein A (2012) The Consequences of Industrialization: Evidence from Water Pollution and Digestive Cancers in China. Rev Econ Stat 94: 186–201. https://doi.org/10.1162/REST_a_00150 doi: 10.1162/REST_a_00150
|
| [24] |
Eliason M, Storrie D (2006) Lasting or Latent Scars? Swedish Evidence on the Long-Term Effects of Job Displacement. J Labor Econ 24: 831–856. http://doi.org/10.1086/506487 doi: 10.1086/506487
|
| [25] |
Ettner SL (1996) New evidence on the relationship between income and health. J Health Econ 15: 67–85. http://doi.org/10.1016/0167-6296(95)00032-1 doi: 10.1016/0167-6296(95)00032-1
|
| [26] |
Fan H, Lin F, Lin S (2020) The Hidden Cost of Trade Liberalization: Input Tariff Shocks and Worker Health in China. J Int Econ 126: 103349. http://doi.org/10.1016/j.jinteco.2020.103349 doi: 10.1016/j.jinteco.2020.103349
|
| [27] | Feenstra R, Hong C (2010) China's Exports and Employment, In: Feenstra, R.C., Wei, S.J., eds., China's Growing Role in World Trade, NBER and University of Chicago Press, 167–199. http://doi.org/10.7208/9780226239729-007 |
| [28] |
Feng J, Xie Q, Zhang X (2021) Trade Liberalization and the Health of Working-age Adults: Evidence from China. World Dev 139: 105344. https://doi.org/10.1016/j.worlddev.2020.105344 doi: 10.1016/j.worlddev.2020.105344
|
| [29] |
Franzini L, Ribble J, Spears W (2001) The Effects of Income Inequality and Income Level on Mortality Vary by Population Size in Texas Counties. J Health Soc Behav 42: 373–387. http://doi.org/10.2307/3090185 doi: 10.2307/3090185
|
| [30] | Gerking S, Stanley LR (1986) An Economic Analysis of Air Pollution and Health: The Case of St. Louis. Rev Econ Stat 68: 115–121. |
| [31] |
Ghojagh HM, Agheli L, Faraji Dizaji S, et al. (2021) Economic development and health status in Iran: A panel data analysis. Environ Sustain Indic 17: 100221. http://doi.org/10.1016/j.indic.2022.100221 doi: 10.1016/j.indic.2022.100221
|
| [32] |
Grossman M (1972) On the Concept of Health Capital and the Demand for Health. J Polit Econ 80: 223–255. http://doi.org/10.1086/259880 doi: 10.1086/259880
|
| [33] |
Gruszczynski L (2020) The COVID-19 pandemic and international trade: Temporary turbulence or paradigm shift? Eur J Risk Regul 11: 337–342. http://doi.org/10.1017/err.2020.29 doi: 10.1017/err.2020.29
|
| [34] |
Guerrico SF (2021) The Effects of Trade-induced Worker Displacement on Health and Mortality in Mexico. J Health Econ 80: 102538. https://doi.org/10.1016/j.jhealeco.2021.102538 doi: 10.1016/j.jhealeco.2021.102538
|
| [35] |
Hawkes C (2006) Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases. Global Health 2: 1–18. http://doi.org/10.1186/1744-8603-2-4 doi: 10.1186/1744-8603-2-4
|
| [36] |
Helpman E, Itskhoki O, Redding S (2010) Inequality and Unemployment in a Global Economy. Econometrica 78: 1239–1283. http://doi.org/10.3982/ECTA8640 doi: 10.3982/ECTA8640
|
| [37] |
Herzer D (2017) The Long‐run relationship between trade and population health: Evidence from five decades. World Econ 40: 462–487. http://doi.org/10.1111/twec.12419 doi: 10.1111/twec.12419
|
| [38] |
Hiyoshi A, Honjo K, Platts LG, et al. (2023) Trends in health and health inequality during the Japanese economic stagnation: Implications for a healthy planet. SSM-Popul Health 22: 101356. http://doi.org/10.1016/j.ssmph.2023.101356 doi: 10.1016/j.ssmph.2023.101356
|
| [39] | Hummels D, Munch J, Xiang C (2016) No Pain, no Gain: The Effects of Exports on Effort, Injury, and Illness. Working Paper NBER, NO.3024. http://doi.org/10.2139/ssrn.2810427 |
| [40] |
Humphrey J, Mcculloch N, Ota M (2004) The impact of European market changes on employment in the Kenyan horticulture sector. J Int Dev 16: 63–80. http://doi.org/10.1002/jid.1063 doi: 10.1002/jid.1063
|
| [41] |
Jawadi F, El Gouddi S, Ftiti Z, et al. (2018) Assessing the effect of trade openness on health in the MENA region: A panel data analysis. Open Econ Rev 29: 469–479. http://doi.org/10.1007/s11079-017-9450-3 doi: 10.1007/s11079-017-9450-3
|
| [42] |
Jensen HT, Marcus R, Brown K, et al. (2019) International Trade, Dietary Change, and Cardiovascular Disease Health Outcomes: Import Tariff Reform Using an Integrated Macroeconomic, Environmental and Health Modelling Framework for Thailand. SSM-Popul Health 9: 100435. https://doi.org/10.1016/j.ssmph.2019.100435 doi: 10.1016/j.ssmph.2019.100435
|
| [43] |
Kiran S (2021) Occupational health could be the new normal challenge in the trade and health cycle: Keywords analysis between 1990 and 2020. Saf Health Work 12: 272–276. https://doi.org/10.1016/j.shaw.2020.11.003 doi: 10.1016/j.shaw.2020.11.003
|
| [44] |
Kovak BK (2013) Regional Effects of Trade Reform: What is the Correct Measure of Liberalization. Am Econ Rev 103: 1960–1976. http://doi.org/10.1257/aer.103.5.1960 doi: 10.1257/aer.103.5.1960
|
| [45] | Krueger AO, Lary HB, Monson T, et al. (1983) Trade and Employment in Developing Countries, Volume 3 Synthesis and Conclusions. University of Chicago Press. |
| [46] |
Kuhn A, Lalive R, Zweimüller J (2009) The Public Health Costs of Job Loss. J Health Econ 28: 1099–1115. http://doi.org/10.1016/j.jhealeco.2009.09.004 doi: 10.1016/j.jhealeco.2009.09.004
|
| [47] |
Lang M, McManus TC, Schaur G (2018) The Effects of Import Competition on Health in the Local Economy. J Health Econ 1: 1–13. http://doi.org/10.2139/ssrn.2668394 doi: 10.2139/ssrn.2668394
|
| [48] |
Levin A, Raut LK (1997) Complementarities Between Export and Human Capital in Economic Growth: Evidence from the Semi-industrialized Countries. Econ Dev Cult Change 46: 155–174. http://doi.org/10.1111/j.1467-9388.1994.tb00177.x doi: 10.1111/j.1467-9388.1994.tb00177.x
|
| [49] |
Levine DI, Rothman D (2006) Does Trade Affect Child Health. J Health Econ 25: 538–554. http://doi.org/10.1016/j.jhealeco.2005.10.001 doi: 10.1016/j.jhealeco.2005.10.001
|
| [50] |
Li M, Du W, Wang Z, et al. (2023) Export globalization and pollution localization: Multivariate heterogeneous data based on Chinese enterprises. Energy Rep 9: 472–483. http://doi.org/10.1016/j.egyr.2022.11.203 doi: 10.1016/j.egyr.2022.11.203
|
| [51] |
Li R, Luo Y, Zhu X, et al. (2025) Increasing health burdens driven by global trade induced air pollution. Earth's Future 13: 1–21. https://doi.org/10.1029/2024ef004814 doi: 10.1029/2024ef004814
|
| [52] |
Liang S, Katerina S, Stylianou JO, et al. (2017) Consumption-based Human Health Impacts of Primary PM2.5: The Hidden Burden of International Trade. J Clean Prod 167:133–139. https://doi.org/10.1016/j.jclepro.2017.08.139 doi: 10.1016/j.jclepro.2017.08.139
|
| [53] |
Lindahl M (2005) Estimating the Effect of Income on Health and Mortality Using Lottery Prizes as an Exogenous Source of Variation in Income. J Hum Resour 40: 144–168. http://doi.org/10.2307/4129568 doi: 10.2307/4129568
|
| [54] |
Mcmanus TC, Schaur G (2016) The Effects of Import Competition on Worker Health. International Economics 102: 160–172. https://doi.org/10.1016/j.jinteco.2016.06.003 doi: 10.1016/j.jinteco.2016.06.003
|
| [55] | Mcmichael AJ, Spirtas R, Kupper LL (1974) An Epidemiologic Study of Mortality within a Cohort of Rubber Workers, 1964-72. Occupational Medicine Official Publication of the Industrial Medical Association 16: 458–464. |
| [56] |
Melén E (2021) Air pollution and IgE sensitization in 4 European birth cohorts—the MeDALL project. Journal of Allergy and Clinical Immunology 147: 713–722. http://doi.org/10.1016/j.jaci.2020.08.030 doi: 10.1016/j.jaci.2020.08.030
|
| [57] |
Milner C, Wright P (1998) Modelling labour market adjustment to trade liberalization in an industrializing economy. Economic Journal 108: 509–528. http://doi.org/10.1111/1468-0297.00301 doi: 10.1111/1468-0297.00301
|
| [58] |
Morris J (1996) International Trade and the Environment. Econ Affa 16: 4–7. https://doi.org/10.1111/j.1468-0270.1996.tb00561.x doi: 10.1111/j.1468-0270.1996.tb00561.x
|
| [59] |
Nguyen V (2015) The Impact of Trade Facilitation on Poverty and Inequality: Evidence from Low-and Middle-income Countries. J Int Trade Econ Dev 24: 315–340. http://doi.org/10.1080/09638199.2014.898315 doi: 10.1080/09638199.2014.898315
|
| [60] |
Owen AL, Wu S (2007) Is Trade Good for Your Health. Rev Int Econ 15: 660–682. http://doi.org/10.1111/j.1467-9396.2007.00677.x doi: 10.1111/j.1467-9396.2007.00677.x
|
| [61] |
Ou J, Zheng Z, Zhang N (2023) A study of the effect of trade openness on population health: Empirical evidence from China. Sustainability 15: 12571. https://doi.org/10.3390/su151612571 doi: 10.3390/su151612571
|
| [62] |
Pangallo M, Aleta A, del Rio-Chanona RM, et al. (2024) The unequal effects of the health–economy trade-off during the COVID-19 pandemic. Nat Hum Behav 8: 264–275. https://doi.org/10.1038/s41562-023-01747-x doi: 10.1038/s41562-023-01747-x
|
| [63] |
Papageorgiou C, Perez-Sebastian F (2006) Dynamic in a Non-scale R&D Growth Model with Human Capital: Explaining the Japanese and South Korean Development Experiences. J Econ Dyn Control 30: 901–930. http://doi.org/10.1016/j.jedc.2005.03.005 doi: 10.1016/j.jedc.2005.03.005
|
| [64] |
Pierce JR, Schott PK (2016) The Surprisingly Swift Decline of US Manufacturing Employment. Am Econ Rev 106: 1632–1662. http://doi.org/10.1257/aer.20131578 doi: 10.1257/aer.20131578
|
| [65] |
Qadir N, Majeed MT (2018) The Impact of Trade Liberalization on Health: Evidence from Pakistan. Am Econ Rev 1: 71–108. http://doi.org/10.29145/eer/11/010104 doi: 10.29145/eer/11/010104
|
| [66] | Rogers RG, Hummer RA, Nam CB (2000) Living and Dying in the USA: Behavioral, Health and Social Differentials of Adult Mortality. https://doi.org/10.1016/B978-0-12-593130-4.X5000-1 |
| [67] |
Sakyi D, Villaverde J, Maza A (2015) Trade Openness, Income Levels, and Economic Growth: The Case of Developing Countries, 1970–2009. J Int Trade Econ Dev 24: 860–882. http://doi.org/10.1080/09638199.2014.971422 doi: 10.1080/09638199.2014.971422
|
| [68] |
Schank T, Schnabel C, Wagner J (2007) Do exporters really pay higher wages? First evidence from german linked employer-employee data. J Int Econ 72: 52–74. http://doi.org/10.1016/j.jinteco.2006.08.004 doi: 10.1016/j.jinteco.2006.08.004
|
| [69] |
Sly PD (2021) Adverse Environmental Exposure and Respiratory Health in Children. Pediatr Clin N Am 68: 277–291. https://doi.org/10.1016/j.pcl.2020.09.018 doi: 10.1016/j.pcl.2020.09.018
|
| [70] | Strutt A, Anderson K (1999) Estimating Environmental Effects of Trade Agreements with Global CGE Models: A GTAP Application to Indonesia. CIES Discussion Paper No. 99/26, Centre for International Economic Studies, University of Adelaide. http://doi.org/10.1787/9789264180659-EN |
| [71] |
Stevens P, Urbach J, Wills G (2013) Healthy trade: the relationship between open trade and health. Foreign Trade Rev 48: 125–135. http://doi.org/10.1177/001573251204800106 doi: 10.1177/001573251204800106
|
| [72] |
Sullivan D, Wachter TV (2009) Job Displacement and Mortality: an Analysis Using Administrative Data. Quarterly J Econ 124: 1265–1306. http://doi.org/10.1162/qjec.2009.124.3.1265 doi: 10.1162/qjec.2009.124.3.1265
|
| [73] |
Tanaka S (2015) Environmental Regulations on Air Pollution in China and Their Impact on Infant Mortality. J Health Econ 42: 90–103. http://doi.org/10.1016/j.jhealeco.2015.02.004 doi: 10.1016/j.jhealeco.2015.02.004
|
| [74] | Troesken W (2003) Lead Water Pipes and Infant Mortality in Turn-of-The-Century Massachusetts. http://doi.org/10.3386/w9549 |
| [75] |
Wang Z, Zhang B, Zeng H (2016) The Effect of Environmental Regulation on External Trade: Empirical Evidences from Chinese Economy. J Clean Prod 114: 55–61. https://doi.org/10.1016/j.jclepro.2015.07.148 doi: 10.1016/j.jclepro.2015.07.148
|
| [76] |
Were M (2015) Differential Effects of Trade on Economic Growth and Investment: A Cross-country Empirical Investigation. J Afr Trade 2: 71–85. http://doi.org/10.1016/j.joat.2015.08.002 doi: 10.1016/j.joat.2015.08.002
|
| [77] | Xu X (2000) International trade and environmental regulation: Time series evidence and cross section test. Environ Resour Econ 17: 233–257. |
| [78] |
Yang T, Zhou K, Ding T (2022) Air pollution impacts on public health: Evidence from 110 cities in Yangtze River Economic Belt of China. Sci Total Environ 851: 158125. http://doi.org/10.1016/j.scitotenv.2022.158125 doi: 10.1016/j.scitotenv.2022.158125
|
| [79] |
Yasmeen R, Li Y, Hafeez M (2019) Tracing the trade–pollution nexus in global value chains: evidence from air pollution indicators. Environ Sci Pollut Res 26: 5221–5233. http://doi.org/10.1007/s11356-018-3956-0 doi: 10.1007/s11356-018-3956-0
|
| [80] |
Zhao H, Wu R, Liu Y, et al. (2023) Air pollution health burden embodied in China's supply chains. Environ Sci Ecotechnol 16: 100264. https://doi.org/10.1016/j.ese.2023.100264 doi: 10.1016/j.ese.2023.100264
|
Runmin Deng, Xinju He, Yani Zhang. The social welfare effects of exports: Environmental and health impacts in China[J]. National Accounting Review, 2025, 7(3): 340-366. doi: 10.3934/NAR.2025015
DownLoad: