解析中国城乡人群社会经济相关健康不平等的原因：一种新的分解方法。
Decomposing the causes of socioeconomic-related health inequality among urban and rural populations in China: a new decomposition approach.
机构信息
School of Economics, Wuhan University of Technology, 122 Luoshi Road, Wuhan, 430070, Hubei Province, People's Republic of China.
Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
出版信息
Int J Equity Health. 2017 Jul 18;16(1):128. doi: 10.1186/s12939-017-0624-9.
BACKGROUND
In recent decades, China has experienced tremendous economic growth and also witnessed growing socioeconomic-related health inequality. The study aims to explore the potential causes of socioeconomic-related health inequality in urban and rural areas of China over the past two decades.
METHODS
This study used six waves of the China Health and Nutrition Survey (CHNS) from 1991 to 2006. The recentered influence function (RIF) regression decomposition method was employed to decompose socioeconomic-related health inequality in China. Health status was derived from self-rated health (SRH) scores. The analyses were conducted on urban and rural samples separately.
RESULTS
We found that the average level of health status declined from 1989 to 2006 for both urban and rural populations. Average health scores were greater for the rural population compared with those for the urban population. We also found that there exists pro-rich health inequality in China. While income and secondary education were the main factors to reduce health inequality, older people, unhealthy lifestyles and a poor home environment increased inequality. Health insurance had the opposite effects on health inequality for urban and rural populations, resulting in lower inequality for urban populations and higher inequality for their rural counterparts.
CONCLUSION
These findings suggest that an effective way to reduce socioeconomic-related health inequality is not only to increase income and improve access to health care services, but also to focus on improvements in the lifestyles and the home environment. Specifically, for rural populations, it is particularly important to improve the design of health insurance and implement a more comprehensive insurance package that can effectively target the rural poor. Moreover, it is necessary to comprehensively promote the flush toilets and tap water in rural areas. For urban populations, in addition to promoting universal secondary education, healthy lifestyles should be promoted, including measures such as alcohol control.
背景
近几十年来，中国经历了巨大的经济增长，同时也见证了与社会经济相关的健康不平等现象的日益加剧。本研究旨在探讨过去二十年来中国城乡社会经济相关健康不平等的潜在原因。
方法
本研究使用了 1991 年至 2006 年期间的六次中国健康与营养调查（CHNS）数据。采用集中趋势影响函数（RIF）回归分解法分解中国社会经济相关健康不平等。健康状况由自我评估健康（SRH）评分得出。分析分别在城乡样本中进行。
结果
我们发现，城乡人口的健康状况平均水平从 1989 年到 2006 年都有所下降。农村人口的平均健康评分高于城市人口。我们还发现，中国存在有利于富人的健康不平等现象。虽然收入和中等教育是减少健康不平等的主要因素，但老年人、不健康的生活方式和恶劣的家庭环境会加剧不平等。医疗保险对城乡人口的健康不平等有相反的影响，导致城市人口的不平等程度降低，农村人口的不平等程度升高。
结论
这些发现表明，减少社会经济相关健康不平等的有效途径不仅在于增加收入和改善医疗服务的可及性，还在于关注生活方式和家庭环境的改善。特别是对于农村人口，改善医疗保险的设计并实施更全面的保险计划，以有效针对农村贫困人口，尤为重要。此外，有必要全面推进农村地区的冲水厕所和自来水供应。对于城市人口，除了促进普及中等教育外，还应倡导健康的生活方式，包括控制饮酒等措施。
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