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The long-term effects of early life exposure to primary healthcare expansion: Evidence from the Barefoot Doctor Program

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  • Huang, Feng
  • Li, Ya
  • Zhu, Yuke

Abstract

This paper examines the long-term effects of China's Barefoot Doctors Program (BDP), a large-scale expansion of primary healthcare implemented between 1965 and 1978. Combining newly digitized county-level data with a cohort-based difference-in-differences design, we identify the impact of early-childhood exposure to the program (ages 0–5) on adult outcomes. We find that exposure to the BDP leads to economically meaningful improvements in adult health and educational attainment, with effects concentrated among females. Exploring potential mechanisms, we present evidence consistent with the hypothesis that improvements in nutritional knowledge and dietary practices are key channels. Overall, the results document substantial long-term returns to a low-cost, workforce-based primary healthcare intervention.

Suggested Citation

  • Huang, Feng & Li, Ya & Zhu, Yuke, 2026. "The long-term effects of early life exposure to primary healthcare expansion: Evidence from the Barefoot Doctor Program," Social Science & Medicine, Elsevier, vol. 399(C).
    • Handle: RePEc:eee:socmed:v:399:y:2026:i:c:s0277953626003205
    DOI: 10.1016/j.socscimed.2026.119244
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    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I21 - Health, Education, and Welfare - - Education - - - Analysis of Education
    • H40 - Public Economics - - Publicly Provided Goods - - - General

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