中国居民健康不平等的经济社会影响因素研究
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摘要
改革以来，中国居民的总体健康水平显著提升，但与此同时，健康的社会经济不平等问题也日臻突出。中国城乡、地区以及阶层之间存在显著的健康差异，具体表现为城市、发达地区以及高收入阶层的健康状况明显优于农村、欠发达地区以及低收入阶层。当前，这种差异超越了社会的可接受范围，其根源于社会收入的不平等及其派生的其他社会不平等，已构成中国经济社会可持续发展的重大阻滞因素。因此，缓解和消除中国社会的收入不平等及其派生的居民健康不平等，对于维护中国社会和谐与稳定，对于经济全面、协调和可持续发展均具有重要的理论与现实意义。本文以健康的社会经济决定理论作为研究依据，综合运用微观调查和宏观统计数据，将理论分析与实证检验相结合，深入分析和探讨当前影响中国居民健康不平等的经济社会因素，以期对包括医疗、教育和养老在内的中国经济社会体制的全方位改革起到有益的借鉴和参考作用。
首先，论文在相关文献综述的基础上，进一步阐述了健康的社会经济决定理论，基于一个覆盖中国浙江和甘肃两省居民的健康微观数据集，来区分城乡实证检验居民健康与社会经济地位之间的关系。结果表明，不论城镇还是农村，健康与社会经济地位之间均表现出显著的相关关系，拥有不同收入或者教育程度的居民之间存在显著的健康梯度。此外，研究还揭示了性别、年龄以及省份因素对于居民健康的显著影响。
其次，基于具备全国代表性的CGSS微观数据集，论文先后区分城乡和省份来具体测算样本地区与收入相关的健康不平等，并运用分解方法进行健康不平等的影响因素分解。针对城乡的研究表明：中国城镇与农村居民的健康集中度分别为-0.125和-0.122，存在较为严重的偏富人的健康不平等；收入因素对健康不平等均起到最为重要的作用；除收入以外，就城镇样本而言，对健康不平等产生正向贡献的主要因素还包括就业状况、年龄以及教育等；而就农村样本而言，则主要是相隔集镇中心距离、地区变量、年龄因素中的60岁以上人口。针对省份的研究表明，各省在与收入相关的健康不平等方面存在显著差异，分区域来看，相比西部和东部，中部地区的省份有着更高程度的健康不平等；基于省份数据刻画的健康不平等库兹涅兹曲线呈波浪型特征；中部省份较高的健康不平等源于收入、城乡、年龄和教育因素的影响；不论单从平均健康水平，还是从综合了平均健康水平和健康分布的健康绩效指标来看，省份自西向东，表现出逐级递增的梯度特征。
第三，基于宏观年鉴数据，在中国经济体制改革与社会转型的背景下，研究还动态化地考察了中国居民在城乡、区域、性别之间的健康差异及其变动。结果表明，改革开放后相对于改革开放前，尽管居民总体健康水平仍在改进，但速度趋缓。与此同时，以城乡、区域和性别差异表征的健康公平问题仍持续存在，且局部指标呈恶化趋势。其中的重要原因在于：与持续拉大的城乡和地区差别相关的居民卫生提供和享有上存在的不平等，以及其他经济社会不平等的加剧。
最后，在前文实证检验的基础上，论文结合文献研究探讨了实现中国居民健康公平的基本路径与政策选择。指出促进和实现健康公平，并非是要实现社会个体或群体之间健康状况的完全平等，而关键在于通过政府的责任和对社会公平正义的干预，以及社会的努力，从根本上改变中国城乡、地区经济二元结构，改善收入分配关系，并在此基础上，公平地提供教育、医疗卫生、以及就业和养老等基础设施和社会保障，以实现包括医疗服务利用、教育资源享有公平在内的社会经济关系公平。
Since China adopted the policy of reform and opening-up, the China resident healthstatus has been improved remarkably. Meanwhile, socio-economic related healthinequality has been becoming more and more seriously. There is a remarkable healthdisparity between urban and rural areas, in different regions and income classes. Thehealth status of residents who are in the urban areas, developed regions and with highincome is obviously higher than the health status of residents in the rural areas, lessdeveloped regions and with low income. At present, this disparity has gone beyond theacceptable range. This problem results from the income inequality and its derived socialinequalities, which has become major blocking factors for china’s sustainabledevelopment. Thus, alleviating and eliminating the income inequality and its derivedhealth inequality have important theoretical and practical significance to the maintenanceof social harmony and stability, as well as to the comprehensive, coordinated andsustainable development of economy. Based on this background, the dissertation appliestheory of social determinants of health, comprehensively uses the micro and macro data,and combines the empirical test with theoretical analysis to discuss the Chineseinequalities in health and the influence factors. Hopefully, it will be helpful for the reformincluding health care, education, and pension system.
First of all, having reviewed the literature, this dissertation explains the theory ofsocial determinants of health. Based on the micro datasets covering residents of twoprovinces, the samples of urban and rural areas are differentiated to test the relationshipbetween the health of residents and their socio-economic status. The results show thatthere is a remarkable correlation between health and socio-economic status, whether it isin urban or rural areas. There is a remarkable health gradient among the residents withdifferent income or education level. The study also shows that gender, age, and provincehave a great impact on the resident health.
Secondly, this dissertation adopts CGSS dataset to test the income-related healthinequalities of urban-rural areas and different provinces, and uses the method ofdecomposition to differentiate the influence factors of health inequalities. The results ofthe study about urban and rural areas show that heath concentration in urban and rural areas are-0.125and-0.122, respectively; there is a serious pro-rich health inequality;income plays the most important role in causing health inequalities; besides income, inurban areas, the main factors that have a positive contribution to the health inequalityinclude employment, age, and education; in rural areas, are the distance to the center of thetown, regional variables, people over60years old. The results of the study aboutprovinces show that there is a remarkable disparity in the income-related health inequalityin each province; compared with the western and eastern, the health inequality in centralprovinces is more seriously; the Kuznets curve is in the shape of wave; the more serioushealth inequality in central provinces results from the factor contribution of income,urban-rural areas, age and education; from west to east, whether the average health status,or the health achievement combined the average status with health distribution, isincreasing gradually.
Thirdly, in the background of China economic reform and transformation, thedissertation dynamically examines the health disparities between urban and rural areas, thehealth disparities in regions and genders, as well as their variations. The results show thatcompared with before reform, the overall health status is improving, but not obvious;meanwhile, the health inequality characterized by the disparities in urban and rural areas,regions, genders still exists and some indicators tend to be worse. The major reasons lie inthe health care inequity and some other social inequalities.
Lastly, on the basis of the previous empirical test, combined with the literature review,this dissertation explores the way to achieve the health equity and the policy options. Weargue that promoting and realizing the health equity do not mean to realize the absoluteequalities among individuals or groups, but to fundamentally change China's dualeconomic structure in urban and rural areas and some regions, to improve the distributionof incomes，through the intervention of the government's responsibility and social justice,as well as the community's efforts. And on this basis, social security and the infrastructureof education, health care, employment, pension and others should be provided equally torealize the social-economy equity including the medical services, educational resources,etc.
首先，论文在相关文献综述的基础上，进一步阐述了健康的社会经济决定理论，基于一个覆盖中国浙江和甘肃两省居民的健康微观数据集，来区分城乡实证检验居民健康与社会经济地位之间的关系。结果表明，不论城镇还是农村，健康与社会经济地位之间均表现出显著的相关关系，拥有不同收入或者教育程度的居民之间存在显著的健康梯度。此外，研究还揭示了性别、年龄以及省份因素对于居民健康的显著影响。
其次，基于具备全国代表性的CGSS微观数据集，论文先后区分城乡和省份来具体测算样本地区与收入相关的健康不平等，并运用分解方法进行健康不平等的影响因素分解。针对城乡的研究表明：中国城镇与农村居民的健康集中度分别为-0.125和-0.122，存在较为严重的偏富人的健康不平等；收入因素对健康不平等均起到最为重要的作用；除收入以外，就城镇样本而言，对健康不平等产生正向贡献的主要因素还包括就业状况、年龄以及教育等；而就农村样本而言，则主要是相隔集镇中心距离、地区变量、年龄因素中的60岁以上人口。针对省份的研究表明，各省在与收入相关的健康不平等方面存在显著差异，分区域来看，相比西部和东部，中部地区的省份有着更高程度的健康不平等；基于省份数据刻画的健康不平等库兹涅兹曲线呈波浪型特征；中部省份较高的健康不平等源于收入、城乡、年龄和教育因素的影响；不论单从平均健康水平，还是从综合了平均健康水平和健康分布的健康绩效指标来看，省份自西向东，表现出逐级递增的梯度特征。
第三，基于宏观年鉴数据，在中国经济体制改革与社会转型的背景下，研究还动态化地考察了中国居民在城乡、区域、性别之间的健康差异及其变动。结果表明，改革开放后相对于改革开放前，尽管居民总体健康水平仍在改进，但速度趋缓。与此同时，以城乡、区域和性别差异表征的健康公平问题仍持续存在，且局部指标呈恶化趋势。其中的重要原因在于：与持续拉大的城乡和地区差别相关的居民卫生提供和享有上存在的不平等，以及其他经济社会不平等的加剧。
最后，在前文实证检验的基础上，论文结合文献研究探讨了实现中国居民健康公平的基本路径与政策选择。指出促进和实现健康公平，并非是要实现社会个体或群体之间健康状况的完全平等，而关键在于通过政府的责任和对社会公平正义的干预，以及社会的努力，从根本上改变中国城乡、地区经济二元结构，改善收入分配关系，并在此基础上，公平地提供教育、医疗卫生、以及就业和养老等基础设施和社会保障，以实现包括医疗服务利用、教育资源享有公平在内的社会经济关系公平。
Since China adopted the policy of reform and opening-up, the China resident healthstatus has been improved remarkably. Meanwhile, socio-economic related healthinequality has been becoming more and more seriously. There is a remarkable healthdisparity between urban and rural areas, in different regions and income classes. Thehealth status of residents who are in the urban areas, developed regions and with highincome is obviously higher than the health status of residents in the rural areas, lessdeveloped regions and with low income. At present, this disparity has gone beyond theacceptable range. This problem results from the income inequality and its derived socialinequalities, which has become major blocking factors for china’s sustainabledevelopment. Thus, alleviating and eliminating the income inequality and its derivedhealth inequality have important theoretical and practical significance to the maintenanceof social harmony and stability, as well as to the comprehensive, coordinated andsustainable development of economy. Based on this background, the dissertation appliestheory of social determinants of health, comprehensively uses the micro and macro data,and combines the empirical test with theoretical analysis to discuss the Chineseinequalities in health and the influence factors. Hopefully, it will be helpful for the reformincluding health care, education, and pension system.
First of all, having reviewed the literature, this dissertation explains the theory ofsocial determinants of health. Based on the micro datasets covering residents of twoprovinces, the samples of urban and rural areas are differentiated to test the relationshipbetween the health of residents and their socio-economic status. The results show thatthere is a remarkable correlation between health and socio-economic status, whether it isin urban or rural areas. There is a remarkable health gradient among the residents withdifferent income or education level. The study also shows that gender, age, and provincehave a great impact on the resident health.
Secondly, this dissertation adopts CGSS dataset to test the income-related healthinequalities of urban-rural areas and different provinces, and uses the method ofdecomposition to differentiate the influence factors of health inequalities. The results ofthe study about urban and rural areas show that heath concentration in urban and rural areas are-0.125and-0.122, respectively; there is a serious pro-rich health inequality;income plays the most important role in causing health inequalities; besides income, inurban areas, the main factors that have a positive contribution to the health inequalityinclude employment, age, and education; in rural areas, are the distance to the center of thetown, regional variables, people over60years old. The results of the study aboutprovinces show that there is a remarkable disparity in the income-related health inequalityin each province; compared with the western and eastern, the health inequality in centralprovinces is more seriously; the Kuznets curve is in the shape of wave; the more serioushealth inequality in central provinces results from the factor contribution of income,urban-rural areas, age and education; from west to east, whether the average health status,or the health achievement combined the average status with health distribution, isincreasing gradually.
Thirdly, in the background of China economic reform and transformation, thedissertation dynamically examines the health disparities between urban and rural areas, thehealth disparities in regions and genders, as well as their variations. The results show thatcompared with before reform, the overall health status is improving, but not obvious;meanwhile, the health inequality characterized by the disparities in urban and rural areas,regions, genders still exists and some indicators tend to be worse. The major reasons lie inthe health care inequity and some other social inequalities.
Lastly, on the basis of the previous empirical test, combined with the literature review,this dissertation explores the way to achieve the health equity and the policy options. Weargue that promoting and realizing the health equity do not mean to realize the absoluteequalities among individuals or groups, but to fundamentally change China's dualeconomic structure in urban and rural areas and some regions, to improve the distributionof incomes，through the intervention of the government's responsibility and social justice,as well as the community's efforts. And on this basis, social security and the infrastructureof education, health care, employment, pension and others should be provided equally torealize the social-economy equity including the medical services, educational resources,etc.
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