The impact of public health events on individual physical health: taking the SARS epidemic as an example

This paper examines whether a short-lived public health shock affects subsequent physical health. We combine China Health and Nutrition Survey panel data from 1991 to 2009 with province-level SARS surveillance records and exploit cross-provincial variation in exposure to the 2003 SARS outbreak. The empirical design is a difference-in-differences specification with individual and survey-wave fixed effects. The estimates show that individuals in provinces more exposed to SARS experienced a decline in physical health after the outbreak. This result is robust to propensity-score adjusted DID specifications, alternative exposure measures, a city-population-based exposure denominator, alternative outcome coding, adult-sample restrictions, province-clustered inference, and leave-one-province-out checks. Event-study estimates show no clear pre-outbreak differential trend. Heterogeneity analysis suggests that the adverse effect is present for both women and men and is mainly concentrated among individuals with lower educational attainment. Channel evidence indicates that SARS exposure was associated with changes in drinking behavior and other health-related responses. The findings suggest that the health costs of public health emergencies extend beyond infection itself and may persist through behavioral and access-related adjustments.

Competing interests

The authors declare no competing interests.

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Ethical approval was not required because the study did not involve human participants or animals.

Informed consent

Informed consent was not required because the study did not involve human participants or animals.