Social perceptions, age stereotypes, and health behaviours: an economic and public health perspective from China

Population ageing is accelerating worldwide, making public attitudes towards older adults an increasingly important concern for public health. Using nationwide survey data from Chinese adults across multiple provinces, this study applies a multilevel analytical framework in which individual health behaviours are examined within provincial social climates, allowing both personal perceptions and contextual conditions to be considered simultaneously. The analysis focuses on two parallel pathways, namely the association between positive social cognition of ageing and health behaviour, and the association between age-related stereotypes and behavioural engagement, while also assessing how provincial discourse on ageing conditions these relationships. Results show that more favourable perceptions of ageing are strongly associated with higher levels of preventive care, physical activity, and social participation, with standardised coefficients ranging from approximately 0.46 to 0.55. About one quarter of this association is linked to an indirect pathway, whereby stronger social cognition corresponds to lower endorsement of negative stereotypes, which in turn is associated with healthier b